CC BY-NC-ND 4.0 · Sports Med Int Open 2018; 02(05): E148-E156
DOI: 10.1055/a-0669-0791
Training & Testing
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Predictive Factors for Vitamin D Concentrations in Swiss Athletes: A Cross-sectional Study

Simeon Joel Zürcher
1   Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
,
Andrea Quadri
2   Spital Bulach, Internal Medicine, Bulach, Switzerland
,
Andreas Huber
3   Kantonsspital Aarau, Labaratory Medicine, Aarau, Switzerland
,
Lothar Thomas
4   Klinikum der Johann-Wolfgang-Goethe Universität, Central laboratory for Clinical Chemistry and Hematology, Frankfurt am Main, Germany
,
Graeme Leonard Close
5   LJMU, Sports Science, Liverpool, United Kingdom of Great Britain and Northern Ireland
,
Saskia Brunner
3   Kantonsspital Aarau, Labaratory Medicine, Aarau, Switzerland
,
Patrik Noack
6   Medbase Abtwil, Swiss Olympic Medical Center, Abtwil, Switzerland
,
Boris Gojanovic
7   Hopital de la Tour, Swiss Olympic Medical Center, Meyrin, Switzerland
,
Susi Kriemler
1   Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

received 20 March 2018
revised  13 July 2018

accepted 18 July 2018

Publication Date:
25 September 2018 (online)

Abstract

Vitamin D concentrations corresponding to 75 nmol/L 25(OH)D have been associated with maintained muscle function, growth and regeneration, optimal bone health and immunology in athletes. The objective of this study was to investigate the prevalence and predictors of insufficient 25(OH)D concentrations in athletes. Six hundred three Swiss athletes were assessed. 25(OH)D was analysed by high-performance liquid chromatography (HPLC). A standardized questionnaire was used to gather information about potential predictors for 25(OH)D concentrations; 50.5% showed insufficient 25(OH)D concentrations. Differences in predicted probability of insufficient 25(OH)D were found for those vitamin D supplemented (42%) versus not supplemented (52%), in those performing indoor (58%) versus outdoor sports (43%), and during the sun-deprived seasons of fall (49%), winter (70%) and spring (57%) compared with summer (17%). Higher BMI z-scores and age were associated with higher 25(OH)D concentrations. In conclusion, insufficient 25(OH)D concentrations were common among athletes especially at a younger age, among those not supplemented, in athletes who trained indoors, and during the sun-deprived seasons. Because the prevalence of insufficient 25(OH)D concentrations in this study was high, regular supplementation in athletes may be indicated, except perhaps during the summer season. Further research is needed to determine which 25(OH)D concentrations lead to optimal health and performance in athletes.

Supporting Information

 
  • References

  • 1 Abboud M, Puglisi DA, Davies BN, Rybchyn M, Whitehead NP, Brock KE, Cole L, Gordon-Thomson C, Fraser DR, Mason RS. Evidence for a specific uptake and retention mechanism for 25-hydroxyvitamin D (25OHD) in skeletal muscle cells. Endocrinology 2013; 154: 3022-3030
  • 2 Allison RJ, Close GL, Farooq A, Riding NR, Salah O, Hamilton B, Wilson MG. Severely vitamin D-deficient athletes present smaller hearts than sufficient athletes. Eur J Prev Cardiol 2015; 22: 535-542
  • 3 Bakken A, Targett S, Bere T, Adamuz MC, Tol JL, Whiteley R, Wilson MG, Witvrouw E, Khan KM, Bahr R. Health conditions detected in a comprehensive periodic health evaluation of 558 professional football players. Br J Sports Med 2016; 50: 1142-1150
  • 4 Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006; 84: 18-28
  • 5 Brown MT, Bussell JK. Medication adherence: WHO cares?. Mayo Clin Proc 2011; 86: 304-314
  • 6 Burnand B, Sloutskis D, Gianoli F, Cornuz J, Rickenbach M, Paccaud F, Burckhardt P. Serum 25-hydroxyvitamin D: Distribution and determinants in the Swiss population. Am J Clin Nutr 1992; 56: 537-542
  • 7 Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exerc 2009; 41: 1102-1110
  • 8 Chen TC, Chimeh F, Lu Z, Mathieu J, Person KS, Zhang A, Kohn N, Martinello S, Berkowitz R, Holick MF. Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys 2007; 460: 213-217
  • 9 Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1982; 1: 74-76
  • 10 Constantini NW, Arieli R, Chodick G, Dubnov-Raz G. High prevalence of vitamin D insufficiency in athletes and dancers. Clin J Sport Med 2010; 20: 368-371
  • 11 Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int 2005; 16: 713-716
  • 12 Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N. IOF position statement: Vitamin D recommendations for older adults. Osteoporos Int 2010; 21: 1151-1154
  • 13 Elizondo-Montemayor L, Castillo EC, Rodriguez-Lopez C, Villarreal-Calderon JR, Gomez-Carmona M, Tenorio-Martinez S, Nieblas B, Garcia-Rivas G. Seasonal variation in vitamin D in association with age, inflammatory cytokines, anthropometric parameters, and lifestyle factors in older adults. Mediators Inflamm 2017; 2017: 5719461
  • 14 Farrokhyar F, Tabasinejad R, Dao D, Peterson D, Ayeni OR, Hadioonzadeh R, Bhandari M. Prevalence of vitamin D inadequacy in athletes: A systematic review and meta-analysis. Sports Med 2015; 45: 365-378
  • 15 Fitzpatrick TB. Soleil et peau. J Med Esthet 1975; 2: 33-34
  • 16 Galan F, Ribas J, Sanchez-Martinez PM, Calero T, Sanchez AB, Munoz A. Serum 25-hydroxyvitamin D in early autumn to ensure vitamin D sufficiency in mid-winter in professional football players. Clin Nutr 2012; 31: 132-136
  • 17 Goolsby MA, Boniquit N. Bone health in athletes. Sports Health 2016; 9: 108-117
  • 18 Hamilton B, Grantham J, Racinais S, Chalabi H. Vitamin D deficiency is endemic in Middle Eastern sportsmen. Public Health Nutr 2010; 13: 1528-1534
  • 19 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 update. Int J Sports Med 2017; 38: 1126-1131
  • 20 He CS, Aw Yong XH, Walsh NP, Gleeson M. Is there an optimal vitamin D status for immunity in athletes and military personnel?. Exerc Immunol Rev 2016; 22: 42-64
  • 21 Heaney RP. The vitamin D requirement in health and disease. J Steroid Biochem Mol Biol 2005; 97: 13-19
  • 22 Heaney RP. Vitamin D: Criteria for safety and efficacy. Nutr Rev 2008; 66: S178-S181
  • 23 Heaney RP. Health is better at serum 25(OH)D above 30ng/mL. J Steroid Biochem Mol Biol 2013; 136: 224-228
  • 24 Heller JE, Thomas JJ, Hollis BW, Larson-Meyer DE. Relation between vitamin D status and body composition in collegiate athletes. Int J Sport Nutr Exerc Metab 2015; 25: 128-135
  • 25 Hill KM, Jonnalagadda SS, Albertson AM, Joshi NA, Weaver CM. Top food sources contributing to vitamin D intake and the association of ready-to-eat cereal and breakfast consumption habits to vitamin D intake in Canadians and United States Americans. J Food Sci 2012; 77: H170-H175
  • 26 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
  • 27 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911-1930
  • 28 Khalid AN, Ladha KS, Luong AU, Quraishi SA. Association of vitamin D status and acute rhinosinusitis: Results from the United States National Health and Nutrition Examination Survey 2001–2006. Medicine 2015; 94: e1447
  • 29 Koundourakis NE, Avgoustinaki PD, Malliaraki N, Margioris AN. Muscular effects of vitamin D in young athletes and non-athletes and in the elderly. Hormones (Athens) 2016; 15: 471-488
  • 30 Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics 2009; 124: e362-e370
  • 31 Levy MA, McKinnon T, Barker T, Dern A, Helland T, Robertson J, Cuomo J, Wood T, Dixon BM. Predictors of vitamin D status in subjects that consume a vitamin D supplement. Eur J Clin Nutr 2015; 69: 84-89
  • 32 Macdonald HM. Contributions of sunlight and diet to vitamin D status. Calcif Tissue Int 2013; 92: 163-176
  • 33 MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985; 76: 1536-1538
  • 34 Magee PJ, Pourshahidi LK, Wallace JM, Cleary J, Conway J, Harney E, Madigan SM. Vitamin D status and supplementation in elite Irish athletes. Int J Sport Nutr Exerc Metab 2013; 23: 441-448
  • 35 Maruyama-Nagao A, Sakuraba K, Suzuki Y. Seasonal variations in vitamin D status in indoor and outdoor female athletes. Biomed Rep 2016; 5: 113-117
  • 36 Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 1987; 64: 1165-1168
  • 37 Mitchell DM, Henao MP, Finkelstein JS, Burnett-Bowie SA. Prevalence and predictors of vitamin D deficiency in healthy adults. Endocr Pract 2012; 18: 914-923
  • 38 Moons KG, Donders RA, Stijnen T, Harrell Jr FE. Using the outcome for imputation of missing predictor values was preferred. J Clin Epidemiol 2006; 59: 1092-1101
  • 39 Moore C, Murphy MM, Keast DR, Holick MF. Vitamin D intake in the United States. J Am Diet Assoc 2004; 104: 980-983
  • 40 Narayanan DL, Saladi RN, Fox JL. Ultraviolet radiation and skin cancer. Int J Dermatol 2010; 49: 978-986
  • 41 Ogan D, Pritchett K. Vitamin D and the athlete: Risks, recommendations, and benefits. Nutrients 2013; 5: 1856-1868
  • 42 Owens DJ, Fraser WD, Close GL. Vitamin D and the athlete: Emerging insights. Eur J Sport Sci 2015; 15: 73-84
  • 43 Owens DJ, Sharples AP, Polydorou I, Alwan N, Donovan T, Tang J, Fraser WD, Cooper RG, Morton JP, Stewart C, Close GL. A systems-based investigation into vitamin D and skeletal muscle repair, regeneration, and hypertrophy. Am J Physiol 2015; 309: E1019-E1031
  • 44 Peeling P, Fulton SK, Binnie M, Goodman C. Training environment and vitamin D status in athletes. Int J Sports Med 2013; 34: 248-252
  • 45 Rhodes LE, Webb AR, Fraser HI, Kift R, Durkin MT, Allan D, O'Brien SJ, Vail A, Berry JL. Recommended summer sunlight exposure levels can produce sufficient (>or=20 ng ml(-1)) but not the proposed optimal (>or=32 ng ml(-1)) 25(OH)D levels at UK latitudes. J Invest Dermatol 2010; 130: 1411-1418
  • 46 Rosenstreich SJ, Rich C, Volwiler W. Deposition in and release of vitamin D3 from body fat: Evidence for a storage site in the rat. J Clin Invest 1971; 50: 679-687
  • 47 Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: What clinicians need to know. J Clin Endocrinol Metab 2011; 96: 53-58
  • 48 Shuler FD, Wingate MK, Moore GH, Giangarra C. Sports health benefits of vitamin D. Sports Health 2012; 4: 496-501
  • 49 Skaaby T, Husemoen LL, Thuesen BH, Pisinger C, Hannemann A, Jorgensen T, Linneberg A. Longitudinal associations between lifestyle and vitamin D: A general population study with repeated vitamin D measurements. Endocrine 2016; 51: 342-350
  • 50 Snellman G, Melhus H, Gedeborg R, Byberg L, Berglund L, Wernroth L, Michaelsson K. Determining vitamin D status: A comparison between commercially available assays. PLoS ONE 2010; 5: e11555
  • 51 STATA. StataCorp. Stata Multiple-Imputation Reference Manual. Release 13. College Station, TX: Stata Press; 2013
  • 52 Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR. Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls. BMF 2009; 338: b2393
  • 53 Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med 2004; 14: 25-32
  • 54 Swiss Olympic. Swiss Olympic Talent Cards Report 2014. In Swiss Olympic ed. Ittigen, Bern, Switzerland: Swiss Olympic; 2014
  • 55 Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: Umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 2014; 348: g2035
  • 56 Tomlinson PB, Joseph C, Angioi M. Effects of vitamin D supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis. J Sci Med Sport 2015; 18: 575-580
  • 57 Tsugawa N, Suhara Y, Kamao M, Okano T. Determination of 25-hydroxyvitamin D in human plasma using high-performance liquid chromatography--tandem mass spectrometry. Anal Chem 2005; 77: 3001-3007
  • 58 Vieth R, Kimball S, Hu A, Walfish PG. Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the well-being of patients. Nutr J 2004; 3: 8
  • 59 Webb AR. Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol. 2006: 92: 17–25
  • 60 Webb AR, Kift R, Berry JL, Rhodes LE. The vitamin D debate: Translating controlled experiments into reality for human sun exposure times. Photochem Photobiol 2011; 87: 741-745
  • 61 Weng FL, Shults J, Leonard MB, Stallings VA, Zemel BS. Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents. Am J Clin Nutr 2007; 86: 150-158
  • 62 White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med 2011; 30: 377-399
  • 63 Willis KS, Smith DT, Broughton KS, Larson-Meyer DE. Vitamin D status and biomarkers of inflammation in runners. Open Access J Sports Med 2012; 3: 35-42
  • 64 Wolman R, Wyon MA, Koutedakis Y, Nevill AM, Eastell R, Allen N. Vitamin D status in professional ballet dancers: Winter vs. summer. J Sci Med Sport 2013; 16: 388-391
  • 65 World Health Organisation. BMI-for-age (5–19 years). In: Organization WH, ed. World Health Organization. 2006; World Health Organisation Application tools accessed 2017
  • 66 Wroe AL. Intentional and unintentional nonadherence: A study of decision making. J Behav Med 2002; 25: 355-372