scholarly journals Very high prevalence of vitamin D deficiency in South Asian adults (n 6433) in the UK Biobank: urgent action required

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Andrea Darling ◽  
David Blackbourn ◽  
Kourosh Ahmadi ◽  
Susan Lanham-New
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
South Asian ◽  
South Asians ◽  
Uk Biobank ◽  
Baseline Serum ◽  
Asian Ethnicity ◽  
High Prevalence ◽  
South Asian Ethnicity ◽  
The Uk

AbstractPublished studies have suggested a high prevalence of 25-hydroxyvitamin D (25OHD) deficiency in western dwelling South Asians, particularly in women. However, sample sizes have been relatively small with few men. Moreover, South Asians are vastly under-represented in national dietary surveys and further research into 25(OH)D status is needed. The UK Biobank is a cohort of 500,000 individuals; n 6433 are of South Asian ethnicity and have baseline serum 25(OH)D data (2006–2010, aged 40–69 years). Blood draws were spread across the year. Of note, the 25(OH)D measurements were produced using the DiaSorin Liaison XL assay which underestimates 25(OH)D by 4% at 25nmol/L, but overestimates 25(OH)D by 5–10% at ≥ 40nmol/\L(1). We used the commonly used cut-points of < 25nmol/L (deficiency), < 50nmol/L (insufficiency). In women (n 2927), median (IQR) was 24.3 (20.5) nmol/L with 50.4% < 25nmol/L, and 88.6% < 50nmol/L. In men (n 3506), median (IQR) was 21.7 (16.2) with 58.4% < 25 nmol/L and 93.8% < 50 nmol/L. Of concern, 17.8% of women and 21.1% of men had 25(OH)D < 15nmol/L. A Mann Whitney test showed that gender differences were statistically significant (P < 0.0001). In terms of ethnic sub-groups, in the Bangladeshi group (n 207), median (IQR) was 26.1 (14.3) nmol/L with 43.5% < 25nmol/L and 91.3% < 50nmol/L. In the Indian group (n 4792), median (IQR) was 23.8 (19.3) with 52.0% < 25nmol/L and 90.4% < 50nmol/L. Finally, in the Pakistani group (n 1434) median (IQR) was 19.3(14.5) with 65.7% < 25nmol/L and 94.9% < 50nmol/L. A Kruskal Wallis test showed that ethnic subgroup differences were statistically significant (P < 0.0001). To the authors’ knowledge, this is the largest analysis to date of 25(OH)D status in European dwelling South Asians. Deficiency of 25(OH)D was almost universal, with 50% or more not even reaching 25nmol/L. Of great concern, 20% of participants had levels < 15nmol/L which, although not a widely used cut-off point, still represents severe deficiency and likely osteomalacia. Moreover, these results are most probably an underestimation of this societal challenge as the UK Biobank is likely to contain participants that are healthier and more educated than the general population. In conclusion, our analyses suggest the need for urgent public health interventions to prevent and treat vitamin D deficiency in UK South Asians. This research was conducted using the UK Biobank Resource under application number 15168.

scholarly journals Very high prevalence of 25-hydroxyvitamin D deficiency in 6433 UK South Asian adults: analysis of the UK Biobank Cohort

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Andrea L. Darling ◽  
David J. Blackbourn ◽  
Kourosh R. Ahmadi ◽  
Susan A. Lanham-New
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
South Asians ◽  
Large Sample Size ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Hydroxyvitamin D ◽  
Severe Deficiency ◽  
25 Hydroxyvitamin D ◽  
The Uk

Abstract Little research has assessed serum 25-hydroxyvitamin D (25(OH)D) concentration and its predictors in Western-dwelling South Asians in a relatively large sample size. This observational, cross-sectional analysis assessed baseline prevalence of 25(OH)D deficiency in UK-dwelling South Asians (aged 40–69 years, 2006–2010) from the UK Biobank Cohort. Serum 25(OH)D measurements were undertaken using the DiaSorin Liaison XL assay. Of 6433 South Asians with a 25(OH)D measurement, using commonly used cut-off thresholds, 55 % (n 3538) had 25(OH)D < 25 nmol/l (severe deficiency) and 92 % (n 5918) had 25(OH)D < 50 nmol/l (insufficiency). Of the participants with a measurement, 20 % (n 1287) had 25(OH)D concentration <15 nmol/l (very severe deficiency). When 824 participants with undetectable (<10 nmol/l) 25(OH)D measurements were included (total n 7257), 29 % (n 2105) had 25(OH)D < 15 nmol/l, 60 % (n 4354) had 25(OH)D < 25 nmol/l and 93 % (n 6749) had 25(OH)D < 50 nmol/l. Logistic regression predictors of 25(OH)D < 25 nmol/l included the following characteristics: being male; Pakistani; higher BMI; 40–59 years old; never consuming oily fish; summer sun exposure <5 h/d, not using a vitamin D-containing supplement, measurement in winter or spring and vegetarianism. In terms of region, median 25(OH)D concentration was 19–20 nmol/l in Scotland, Northern England, the Midlands and Wales. Across Southern England and London, it was slightly higher at 24–25 nmol/l. Our analyses suggest the need for increased awareness of vitamin D deficiency in South Asians as well as urgent public health interventions to prevent and treat vitamin D deficiency in this group.

scholarly journals 925Ethnic differences and determinants of vitamin D deficiency in the UK Biobank

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Joshua Sutherland ◽  
Ang Zhou ◽  
Matthew Leach ◽  
Elina Hyppönen
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Asian Population ◽  
European Ancestry ◽  
Uk Biobank ◽  
Mixed Ancestry ◽  
Black African ◽  
Hydroxyvitamin D ◽  
The Uk ◽  
Summer Time

Abstract Background While controversy remains regarding optimal vitamin D status, the public health relevance of true vitamin D deficiency is undisputed. There are few contemporary cross-ethnic studies investigating the prevalence and determinants of very low 25-hydroxyvitamin D [25(OH)D] concentrations. Methods We used data from 440,581 UK Biobank participants, of which 415,903 identified as white European, 7,880 Asian, 7,602 black African, 1,383 Chinese, and 6,473 of mixed ancestry. 25(OH)D concentrations were measured by DiaSorin Liaison XL and deficiency defined as ≤ 25 nmol/L 25(OH)D. Results The prevalence of 25(OH)D deficiency was highest among participants of Asian ancestry (57.2% in winter/spring and 50.8% in summer/autumn; followed by black African [38.47%/30.78%], mixed ancestry [36.53%/22.48%], Chinese [33.12%/20.68%] and white European [17.45%/5.90%], P &lt; 1.0E-300). Participants with higher socioeconomic deprivation were more likely to have 25(OH)D deficiency compared to less deprived (P &lt; 1.0E-300 for all comparisons), with the pattern being more apparent among those of white European ancestry and in summer (Pinteraction&lt;6.4E-5 for both). In fully-adjusted analyses, regular consumption of oily fish was effective in mitigating ≤25 nmol/L 25(OH)D deficiency across all ethnicities, whilst outdoor-summer time was less effective for black Africans than white Europeans (OR: 0.89; 95% CI: 0.70, 1.12 and OR: 0.40; 95% CI: 0.38, 0.42, respectively). Conclusions Vitamin D deficiency remains an issue throughout the UK, particularly in lower socioeconomic areas and the UK Asian population, half of whom have vitamin D deficiency across seasons. Key messages The prevalence of 25(OH)D deficiency in the UK is alarming, with certain ethnic and socioeconomic groups considered particularly vulnerable.

Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom

Heart ◽  
2020 ◽  
Vol 106 (9) ◽  
pp. 671-676 ◽  
Author(s):  
Amar Mistry ◽  
Zakariyya Vali ◽  
Bharat Sidhu ◽  
Charley Budgeon ◽  
Matthew F Yuyun ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
South Asian ◽  
South Asians ◽  
Geographical Differences ◽  
Icd Implantation ◽  
Asian Ethnicity ◽  
Cardioverter Defibrillator ◽  
Tertiary Centre ◽  
Implantation Rates ◽  
The Uk

ObjectiveThere are large geographical differences in implantable cardioverter defibrillator (ICD) implantation rates for reasons not completely understood. In an increasingly multiethnic population, we sought out to investigate whether ethnicity influenced ICD implantation rates.MethodsThis was a retrospective, cohort study of new ICD implantation or upgrade to ICD from January 2006 to February 2019 in recipients of Caucasian or South Asian ethnicity at a single tertiary centre in the UK. Data were obtained from a routinely collected local registry. Crude rates of ICD implantation were calculated for the population of Leicestershire county and were age-standardised to the UK population using the UK National Census of 2011.ResultsThe Leicestershire population was 980 328 at the time of the Census, of which 761 403 (77.7%) were Caucasian and 155 500 (15.9%) were South Asian. Overall, 2650 ICD implantations were performed in Caucasian (91.9%) and South Asian (8.1%) patients. South Asians were less likely than Caucasians to receive an ICD (risk ratio (RR) 0.43, 95% CI 0.37 to 0.49, p<0.001) even when standardised for age (RR 0.75, 95% CI 0.74 to 0.75, p<0.001). This remained the case for primary prevention indication (age-standardised RR 0.91, 95% CI 0.90 to 0.91, p<0.001), while differences in secondary prevention ICD implants were even greater (age-standardised RR 0.49, 95% CI 0.48 to 0.50, p<0.001).ConclusionDespite a universal and free healthcare system, ICD implantation rates were significantly lower in the South Asian than the Caucasian population residing in the UK. Whether this is due to cultural acceptance or an unbalanced consideration is unclear.

High prevalence of Somali population in children presenting with vitamin D deficiency in the UK

2010 ◽  
Vol 95 (7) ◽  
pp. 568-569 ◽  
Author(s):  
G. Modgil ◽  
B. Williams ◽  
G. Oakley ◽  
C. P. Burren
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
High Prevalence ◽  
The Uk

scholarly journals Vitamin D Status of the British African-Caribbean Residents: Analysis of the UK Biobank Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4104
Author(s):  
Rebecca M. Vearing ◽  
Kathryn H. Hart ◽  
Karen Charlton ◽  
Yasmine Probst ◽  
David J. Blackbourn ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Societal Implications ◽  
Vitamin D Status ◽  
Uk Biobank ◽  
Blood Draw ◽  
Cross Sectional ◽  
Increased Risk ◽  
African Caribbean ◽  
The Uk

The vitamin D status of the United Kingdom (UK) African-Caribbean (AC) population remains under-researched, despite an increased risk of vitamin D deficiency due to darker skin phenotypes and living at a high latitude. This cross-sectional study explored the vitamin D status and intake of AC individuals (n = 4046 with a valid serum 25(OH)D measurement) from the UK Biobank Cohort, aged ≥40 years at baseline (2006–2010). Over one third of the population were deficient (<25 nmol/L), 41.1% were insufficient (25–50 nmol/L) and 15.9% were sufficient (>50 nmol/L). Median (IQR) 25(OH)D was 30.0 (20.9) nmol/L. Logistic regression showed that brown/black skin phenotype, winter blood draw, not consuming oily fish and not using vitamin D supplements predicted increased odds of vitamin D deficiency, whilst older age and a summer or autumn blood draw were significantly associated with reduced odds of vitamin D deficiency. Vitamin D deficiency and insufficiency were prevalent in this AC population and is of considerable concern given the individual and societal implications of increased morbidity. Public health messaging for this group should focus on year-round vitamin D supplementation and increasing intakes of culturally appropriate vitamin D-rich foods. These data also support the urgent requirement for a revised vitamin D RNI for ethnic groups.

scholarly journals ‘It’s possibly made us feel a little more alienated’: How people from ethnic minority communities conceptualise COVID-19 and its influence on engagement with testing

2022 ◽  
pp. 135581962110549
Author(s):  
Tushna Vandrevala ◽  
Lailah Alidu ◽  
Jane Hendy ◽  
Shuja Shafi ◽  
Aftab Ala
Keyword(s):  
Ethnic Minority ◽  
South Asian ◽  
Minority Groups ◽  
Cultural Beliefs ◽  
Ethnic Minority Groups ◽  
Structured Interviews ◽  
Asian Ethnicity ◽  
Black African ◽  
South Asian Ethnicity ◽  
The Uk

Objectives The cultural beliefs, practices and experiences of ethnic minority groups, alongside structural inequalities and the political economy play a critical, but overlooked role in health promotion. This study aimed to understand how ethnic minority groups in the United Kingdom conceptualised COVID-19 and how this influenced engagement in testing. Method Black (African and Caribbean) and South Asian (Indian, Pakistani and Bangladeshi) community members were purposefully recruited from across the UK. Fifty-seven semi-structured interviews were conducted and analysed using principles of grounded theory. Results We found that people of Black and South Asian ethnicity conceptualised COVID-19 as a disease that makes them visible to others outside their community and was seen as having more severe risk and suffering worse consequences, resulting in fear, stigmatisation and alienation. Views about COVID-19 were embedded in cultural beliefs, relating to culturally specific ideas around disease, such as ill-health being God’s will. Challenges brought about by the pandemic were conceptualised as one of many struggles, with the saliency of the virus contextualised against life experiences. These themes and others influenced engagement with COVID-19 testing. Testing was less about accessing timely and effective treatment for themselves and more about acting to protect the family and community. Testing symbolised a loss of income, anxiety and isolation, accentuated by issues of mistrust of the system and not being valued, or being treated unfairly. Conclusion Health communications should focus on counterbalancing the mistrust, alienation and stigmatisation that act as barriers to testing, with trust built using local credible sources.

scholarly journals Vitamin D supplement use and associated demographic, dietary and lifestyle factors in 8024 South Asians aged 40–69 years: analysis of the UK Biobank cohort

2018 ◽  
Vol 21 (14) ◽  
pp. 2678-2688 ◽  
Author(s):  
Andrea L Darling ◽  
David J Blackbourn ◽  
Kourosh R Ahmadi ◽  
Susan A Lanham-New
Keyword(s):  
Vitamin D ◽  
South Asians ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Hydroxyvitamin D ◽  
Supplement Use ◽  
Supplement Usage ◽  
Vitamin D Supplements ◽  
The Uk ◽  
Vitamin D Supplement

AbstractObjectiveVitamin D deficiency (serum 25-hydroxyvitamin D<25 nmol/l) is extremely common in Western-dwelling South Asians but evidence regarding vitamin D supplement usage in this group is very limited. This work identifies demographic, dietary and lifestyle predictors associated with vitamin D supplement use.DesignCross-sectional analysis of baseline vitamin D supplement use data.SettingUK Biobank cohort.SubjectsIn total, 8024 South Asians (Bangladeshi, Indian, Pakistani), aged 40–69 years.ResultsTwenty-three per cent of men and 39 % of women (P<0·001) (22 % of Bangladeshis, 32 % of Indians, 25 % of Pakistanis (P<0·001)) took a vitamin-D-containing supplement. Median vitamin D intakes from diet were low at 1·0–3·0 µg/d, being highest in Bangladeshis and lowest in Indians (P<0·001). Logistic regression modelling showed that females had a higher odds of vitamin D supplement use than males (OR=2·02; 95 % CI 1·79, 2·28). A lower supplement usage was seen in younger persons (40–60 years v. >60 years: OR=0·75; 95 % CI 0·65, 0·86) and in those living outside Greater London (OR=0·53 to 0·77), with borderline trends for a lower BMI, higher oily fish intake and higher household income associated with increased odds of vitamin D supplement use.ConclusionsVitamin D supplements were not used by most South Asians and intakes from diet alone are likely to be insufficient to maintain adequate vitamin D status. Public health strategies are now urgently required to promote the use of vitamin D supplements in these specific UK South Asian subgroups.

scholarly journals Vitamin D deficiency in western dwelling South Asian populations: an unrecognised epidemic

2020 ◽  
Vol 79 (3) ◽  
pp. 259-271 ◽  
Author(s):  
Andrea L. Darling
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
South Asian ◽  
South Asians ◽  
Sun Exposure ◽  
The United States ◽  
Bone Diseases ◽  
Public Health Action ◽  
Western Countries ◽  
Asian Populations

Vitamin D deficiency (25-hydroxyvitamin D; 25(OH)D) is at epidemic proportions in western dwelling South Asian populations, including severe deficiency (<12⋅5 nmol/l) in 27–60% of individuals, depending on season. The paper aimed to review the literature concerning vitamin D concentrations in this population group. Research from the UK and Europe suggests a high prevalence of South Asians with 25(OH)D concentration <25 nmol/l, with most having a 25(OH)D concentration of <50 nmol/l. In Canada, South Asians appear to have a slightly higher 25(OH)D concentration. There are few studies from the United States, South Africa and Australasia. Reasons for vitamin D deficiency include low vitamin D intake, relatively high adiposity, sun exposure avoidance and wearing of a covered dress style for cultural reasons. Possible health effects of deficiency include bone diseases such as rickets and hypocalcaemia in children and osteomalacia in adults. Vitamin D deficiency may also increase the risk of other chronic diseases. Increased fortification of food items relevant to South Asian groups (e.g. chapatti flour), as well as increased use of vitamin D supplements may help reduce this epidemic. Introducing culturally acceptable ways of increasing skin exposure to the sun in South Asian women may also be beneficial but further research is needed to assess the effectiveness of different approaches. There may be a need for a South Asian specific vitamin D dietary intake guideline in western countries. To conclude, vitamin D deficiency is epidemic in South Asians living in western countries and there is a clear need for urgent public health action.

scholarly journals Prospective associations between vitamin D and depression in middle-aged adults: findings from the UK Biobank cohort

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Amy Ronaldson ◽  
Jorge Arias de la Torre ◽  
Fiona Gaughran ◽  
Ioannis Bakolis ◽  
Stephani L. Hatch ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D Status ◽  
Uk Biobank ◽  
Middle Aged ◽  
Wide Range ◽  
The Uk ◽  
Middle Aged Adults ◽  
New Onset

Abstract Background A possible role of vitamin D in the pathophysiology of depression is currently speculative, with more rigorous research needed to assess this association in large adult populations. The current study assesses prospective associations between vitamin D status and depression in middle-aged adults enrolled in the UK Biobank. Methods We assessed prospective associations between vitamin D status at the baseline assessment (2006–2010) and depression measured at the follow-up assessment (2016) in 139 128 adults registered with the UK Biobank. Results Amongst participants with no depression at baseline (n = 127 244), logistic regression revealed that those with vitamin D insufficiency [adjusted odds ratio (aOR) = 1.14, 95% confidence interval (CI) = 1.07–1.22] and those with vitamin D deficiency (aOR = 1.24, 95% CI 1.13–1.36) were more likely to develop new-onset depression at follow-up compared with those with optimal vitamin D levels after adjustment for a wide range of relevant covariates. Similar prospective associations were reported for those with depression at baseline (n = 11 884) (insufficiency: aOR = 1.11, 95% CI 1.00–1.23; deficiency: aOR = 1.30, 95% CI 1.13–1.50). Conclusions The prospective associations found between vitamin D status and depression suggest that both vitamin D deficiency and insufficiency might be risk factors for the development of new-onset depression in middle-aged adults. Moreover, vitamin D deficiency (and to a lesser extent insufficiency) might be a predictor of sustained depressive symptoms in those who are already depressed. Vitamin D deficiency and insufficiency is very common, meaning that these findings have significant implications for public health.

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