Prevalence of 25-hydroxyvitamin D deficiency in Korean adolescents: association with age, season and parental vitamin D status

AbstractObjectiveWe aimed to assess the prevalence and associated factors of vitamin D deficiency in healthy adolescents and to determine parent–adolescent association in vitamin D status.DesignA cross-sectional study.SettingData from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008–2009. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using 125I-labelled RIA kits. Vitamin D deficiency in adolescents was defined as 25(OH)D level <27·5 nmol/l, and 25(OH)D levels between 27·5 and <50 nmol/l were considered insufficient. For the parents, vitamin D deficiency was defined as 25(OH)D level <50 nmol/l.SubjectsThe study population consisted of 2062 adolescents (1095 boys, 967 girls; aged 10–18 years) and their parents (1005 fathers, 1341 mothers).ResultsOverall, 13·4 % of adolescents (boys 11·7 %, girls 15·4 %) were 25(OH)D deficient, 54·7 % were 25(OH)D insufficient. Prevalence of vitamin D deficiency increased with age (P < 0·0001). Parental vitamin D deficiency was more prevalent in vitamin D-deficient adolescents than in non-deficient adolescents (all P < 0·0001). In multivariate logistic regression analyses, predictors for vitamin D deficiency were senior high school students (OR = 3·45–4·33), winter/spring season (OR = 3·18–5·11/5·35–7·36) and parental vitamin D deficiency (OR = 1·78–4·88; all P < 0·05).ConclusionsVitamin D insufficiency is prevalent among healthy Korean adolescents and the parent–offspring association warrants vitamin D screening for family members of deficient individuals.

Download Full-text

Vitamin D status of children in Kerala, southern India

Public Health Nutrition ◽

10.1017/s1368980018003622 ◽

2019 ◽

Vol 23 (7) ◽

pp. 1179-1183 ◽

Cited By ~ 1

Author(s):

Madhava Vijayakumar ◽

Vijayalakshmi Bhatia ◽

Biju George

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Sun Exposure ◽

Southern India ◽

Fish Diet ◽

Vitamin D Status ◽

Cross Sectional ◽

Dietary Recall ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

AbstractObjectiveTo study plasma 25-hydroxyvitamin D (25(OH)D) status of children in Kerala, southern India, and its relationship with sociodemographic variables.DesignCross-sectional observational study.SettingTertiary government hospital.ParticipantsChildren (n 296) with trivial acute illness were enrolled. Sun exposure and Ca and vitamin D intakes (7 d dietary recall) were documented. Serum Ca, P, alkaline phosphatase, plasma 25(OH)D and parathyroid hormone (PTH) were measured.ResultsPrevalence of vitamin D deficiency (plasma 25(OH)D <30 nmol/l) was 11·1% (median, interquartile range (IQR): 52·6, 38·4–65·6 nmol/l). Children who ate fish daily had significantly higher plasma 25(OH)D than those who did not (median, IQR: 52·5, 40·8–68·9 v. 49·1, 36·2–60·7 nmol/l; P = 0·02). Those investigated in the months of March–May showed highest 25(OH)D v. those enrolled during other times (median, IQR: 58·7, 45·6–81·4 v. 45·5, 35·6–57·4 nmol/l; P <0·001). Plasma 25(OH)D correlated positively with serum P (r = 0·24, P <0·001) and Ca intake (r = 0·16, P 0·03), negatively with age (r = −0·13, P 0·03) and PTH (r = −0·22, P <0·001.). On linear regression, summer season (March–May), lower age, daily fish intake and higher Ca intake were independently associated with plasma 25(OH)D.ConclusionsPrevalence of vitamin D deficiency is low in Kerala. The natural fish diet of coastal Kerala and the latitude may be protective. Public health policy in India should take account of this geographical diversity.

Download Full-text

Prevalence and determinants of vitamin D deficiency and insufficiency among three immigrant groups in Finland: evidence from a population-based study using standardised 25-hydroxyvitamin D data

Public Health Nutrition ◽

10.1017/s1368980019004312 ◽

2020 ◽

Vol 23 (7) ◽

pp. 1254-1265

Author(s):

Folasade A Adebayo ◽

Suvi T Itkonen ◽

Eero Lilja ◽

Tuija Jääskeläinen ◽

Annamari Lundqvist ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Migrant Health ◽

Population Based ◽

Vitamin D Insufficiency ◽

Dietary Vitamin ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

Dairy Consumption ◽

25 Hydroxyvitamin D

AbstractObjective:We investigated the determinants of serum 25-hydroxyvitamin D [S-25(OH)D] and dietary vitamin D sources among three immigrant groups in Finland and compared their S-25(OH)D to the general Finnish population.Design:Cross-sectional population-based Migrant Health and Wellbeing Study and the nationally representative Finnish Health 2011 Survey. S-25(OH)D was standardised according to the Vitamin D Standardisation Program. Vitamin D sources were assessed by interview.Setting:Six different municipalities in Finland (60°–63°N).Participants:Immigrants aged 18–64 years (446 Russians, 346 Somalis, 500 Kurds), 798 Finns aged 30–64 years.Results:The mean of S-25(OH)D was 64 (95 % CI 62, 66), 44 (95 % CI 41, 46), 35 (95 % CI 34, 37) and 64 (95 % CI 62, 66) nmol/l for Russians, Somalis, Kurds and Finns, respectively. S-25(OH)D among Somalis and Kurds was lower compared with Finns (P < 0·001). The prevalence of vitamin D deficiency (S-25(OH)D <30 nmol/l) and insufficiency (S-25(OH)D <50 nmol/l) was higher among immigrants than Finns (P < 0·001). Vitamin D-rich foods differed between the groups; vitamin D-fortified fat spread consumption was higher among Somalis (91 %) than among Russians (73 %) and Kurds (60 %); fish was less consumed among Kurds (17 %) than among Russians (43 %) and Somalis (38 %); and 57 % Russians, 56 % Kurds and 36 % Somalis consumed vitamin D-fortified dairy daily (P < 0·001 for all). Daily smoking, alcohol consumption and winter blood sampling were determinants of vitamin D insufficiency (P ≤ 0·03). Older age, physical activity, fish and vitamin D-fortified dairy consumption were associated with lower odds of insufficiency (P ≤ 0·04).Conclusions:Vitamin D status differed among immigrant groups and the determinants are, to some degree, associated with learned or existing cultural behaviours.

Download Full-text

Vitamin D deficiency is associated with anaemia among African Americans in a US cohort

British Journal Of Nutrition ◽

10.1017/s0007114515000999 ◽

2015 ◽

Vol 113 (11) ◽

pp. 1732-1740 ◽

Cited By ~ 20

Author(s):

Ellen M. Smith ◽

Jessica A. Alvarez ◽

Greg S. Martin ◽

Susu M. Zughaier ◽

Thomas R. Ziegler ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Bivariate Analysis ◽

Vitamin D Status ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

The Us ◽

Inflammatory Processes ◽

25 Hydroxyvitamin D ◽

Sectional Analysis

Vitamin D deficiency is highly prevalent in the US population and is associated with numerous diseases, including those characterised by inflammatory processes. We aimed to investigate the link between vitamin D status and anaemia, hypothesising that lower vitamin D status would be associated with increased odds of anaemia, particularly anaemia with inflammation. A secondary aim was to examine the effects of race in the association between vitamin D status and anaemia. We conducted a cross-sectional analysis in a cohort of generally healthy adults in Atlanta, GA (n 638). Logistic regression was used to evaluate the association between vitamin D status and anaemia. Serum 25-hydroxyvitamin D (25(OH)D) < 50 nmol/l (compared to 25(OH)D ≥ 50 nmol/l) was associated with anaemia in bivariate analysis (OR 2·64, 95 % CI 1·43, 4·86). There was significant effect modification by race (P= 0·003), such that blacks with 25(OH)D < 50 nmol/l had increased odds of anaemia (OR 6·42, 95 % CI 1·88, 21·99), v. blacks with 25(OH)D ≥ 50 nmol/l, controlling for potential confounders; this association was not apparent in whites. When categorised by subtype of anaemia, blacks with 25(OH)D < 50 nmol/l had significantly increased odds of anaemia with inflammation than blacks with serum 25(OH)D ≥ 50 nmol/l (OR 8·42, 95 % CI 1·96, 36·23); there was no association with anaemia without inflammation. In conclusion, serum 25(OH)D < 50 nmol/l was significantly associated with anaemia, particularly anaemia with inflammation, among blacks in a generally healthy adult US cohort.

Download Full-text

Vitamin D status in Sudanese pregnant women: a cross-sectional study

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trz054 ◽

2019 ◽

Vol 113 (9) ◽

pp. 569-571 ◽

Cited By ~ 1

Author(s):

Ahmed A Gaffer ◽

Duria A Rayis ◽

Osama G Elhussein ◽

Ishag Adam

Keyword(s):

Vitamin D ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Cross Sectional Study ◽

Vitamin D Status ◽

Sectional Study ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

History Of ◽

25 Hydroxyvitamin D

Abstract Background Maternal vitamin D deficiency is associated with maternal and perinatal adverse effects. This study was conducted to assess the vitamin D status among pregnant Sudanese women. Methods A total of 180 pregnant women were enrolled in a cross-sectional study in Saad Abualila Hospital, Khartoum, Sudan. The medical history of each woman was collected and 25-hydroxyvitamin D [25(OH)D] was measured using an electrochemiluminescence immunoassay. Results The median age, gravidity and gestational age was 27.7 y, 1.0 and 10.7 weeks, respectively. Of the 180 woman, 169 (93.9%) had vitamin D deficiency (≤20 ng/ml). There was no correlation between the 25(OH)D level and body mass index (r=−0.135, p=0.071) or haemoglobin level (r= 0.001, p=0.999). Conclusions The current study showed a high prevalence of vitamin D deficiency. Further studies investigating the risk factors for vitamin D deficiency and the outcome of pregnancy are needed.

Download Full-text

Relationship Between Vitamin D Deficiency And Insulin Resistance In Obese Children

Global Journal of Health Science ◽

10.5539/gjhs.v13n1p82 ◽

2020 ◽

Vol 13 (1) ◽

pp. 82

Author(s):

Aidah Juliaty ◽

Putri Lestari Gabrilasari ◽

Dasril Daud ◽

Johan Setyawan Lisal

Keyword(s):

Insulin Resistance ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Cross Sectional Study ◽

Bivariate Analysis ◽

Obese Children ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Deficiency Group

INTRODUCTION: Obesity represents the major risk factor for development of insulin resistance during childhood and adolescents. In obesity, adipose tissue release free fatty acids, various hormones, and cytokines, resulting in insulin resistance. This study aimed to establish the correlation between vitamin D deficiency and the incidence of insulin resistance in obese children. DESIGN AND METHOD: This analytical cross-sectional study was arranged from December 2019 - February 2020 included 96 students aged 11 - 17 years old from junior and senior high school who met the criteria for obesity in Makassar. The study subjects were parted into two groups, obese children with vitamin D deficiency (levels of 25-hydroxyvitamin D ≤ 20 ng/ml) and obese children without vitamin D deficiency group (levels of 25-hydroxyvitamin D > 20 ng/ml). Data were analyzed using univariate and bivariate analysis. RESULTS: The frequency of insulin resistance in obese children with vitamin D deficiency was 28 (54.9%), while obese children without vitamin D deficiency was 10 (22.2%). Based on statistical analysis, the frequency of the occurrence of insulin resistance in vitamin D deficiency obese children was higher than in obese children without vitamin D deficiency with OR = 4.261 (95% CI 1.744 – 10.411), p = 0.001. CONCLUSION: The risk of insulin resistance in obese children with vitamin D deficiency is 4.261 times higher than obese children without vitamin D deficiency.

Download Full-text

Vitamin D Deficiency Is Common in Ghana despite Abundance of Sunlight: A Multicentre Comparative Cross-Sectional Study

Journal of Nutrition and Metabolism ◽

10.1155/2021/9987141 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Samuel Asamoah Sakyi ◽

Maxwell Hubert Antwi ◽

Linda Ahenkorah Fondjo ◽

Edwin Ferguson Laing ◽

Richard K. Dadzie Ephraim ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Geographical Area ◽

Daily Intake ◽

Cross Sectional Study ◽

The Body ◽

Sectional Study ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

Background. Vitamin D is a steroid hormone important for the normal functioning of the body. It is produced through skin exposure to sunlight and from the diet. Although Ghana is located in the tropics where sunlight is abundant, factors like culture, diet, skin pigmentation, variation in the ozone layer, and geographical area influence the optimization of vitamin D concentration. It is imperative to evaluate the interplay between sunshine exposure, proinflammatory cytokines, and mediators of vitamin D metabolism and their relationship to vitamin D status in three geographical sections among apparent healthy Ghanaians. Methods and Results. In a cross-sectional study, a total of five hundred (500) healthy blood donors from three geographical areas in Ghana were enrolled. Their age ranged from 17 to 55 years with a mean age of 27.97 ± 8.87 years. The overall prevalence rate of vitamin D deficiency was 43.6% (218/500), with 41.2% (91/221), 45.3% (63/139), and 45.7% (64/140) of vitamin D deficiency being recorded in participants from the Northern Sector (NS), Middle Belt (MB), and Southern Sector (SS), respectively. However, there were no significant differences in the proportions of vitamin D deficiency across various geographical sectors. The median 25-hydroxyvitamin D serum levels were compared among geographical areas (NS, MB, and SS) and there were no significant differences ( P = 0.275 ) after adjusting for confounding factors. 25-Hydroxyvitamin D correlated positively with corrected ionized calcium (rs = 0.622, P ≤ 0.001 ) and phosphorus (rs = 0.299, P ≤ 0.001 ) and negatively correlated with SBP (rs = −0.092, P = 0.039 ), vitamin D binding protein (VDBP) (rs = −0.421, P ≤ 0.001 ), intact parathyroid hormone (iPTH) (rs = −0.0568, rs ≤ 0.001), IFN-gamma (rs = −0.684, P ≤ 0.001 ), and TNF-alpha (rs = −0.600, P ≤ 0.001 ). After adjusting for possible confounders, not having knowledge about vitamin D foods, taking fewer vitamin D foods, and higher levels of IF-γ and IL-10 were associated with a higher risk of having vitamin D deficiency. Conclusion. The prevalence of 25-hydroxyvitamin D deficiency is high among the general adult population in Ghana despite the abundance of sunlight. Increasing knowledge on vitamin D diet coupled with a daily intake of vitamin D dietary supplements is likely to reduce the risk of developing 25-hydroxyvitamin D deficiency.

Download Full-text

Skeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions

Endocrine Reviews ◽

10.1210/er.2018-00126 ◽

2018 ◽

Vol 40 (4) ◽

pp. 1109-1151 ◽

Cited By ~ 110

Author(s):

Roger Bouillon ◽

Claudio Marcocci ◽

Geert Carmeliet ◽

Daniel Bikle ◽

John H White ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Human Subjects ◽

Osteoporotic Fractures ◽

Vitamin D Supplementation ◽

Current Evidence ◽

Elderly Subjects ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

AbstractThe etiology of endemic rickets was discovered a century ago. Vitamin D is the precursor of 25-hydroxyvitamin D and other metabolites, including 1,25(OH)2D, the ligand for the vitamin D receptor (VDR). The effects of the vitamin D endocrine system on bone and its growth plate are primarily indirect and mediated by its effect on intestinal calcium transport and serum calcium and phosphate homeostasis. Rickets and osteomalacia can be prevented by daily supplements of 400 IU of vitamin D. Vitamin D deficiency (serum 25-hydroxyvitamin D <50 nmol/L) accelerates bone turnover, bone loss, and osteoporotic fractures. These risks can be reduced by 800 IU of vitamin D together with an appropriate calcium intake, given to institutionalized or vitamin D–deficient elderly subjects. VDR and vitamin D metabolic enzymes are widely expressed. Numerous genetic, molecular, cellular, and animal studies strongly suggest that vitamin D signaling has many extraskeletal effects. These include regulation of cell proliferation, immune and muscle function, skin differentiation, and reproduction, as well as vascular and metabolic properties. From observational studies in human subjects, poor vitamin D status is associated with nearly all diseases predicted by these extraskeletal actions. Results of randomized controlled trials and Mendelian randomization studies are supportive of vitamin D supplementation in reducing the incidence of some diseases, but, globally, conclusions are mixed. These findings point to a need for continued ongoing and future basic and clinical studies to better define whether vitamin D status can be optimized to improve many aspects of human health. Vitamin D deficiency enhances the risk of osteoporotic fractures and is associated with many diseases. We review what is established and what is plausible regarding the health effects of vitamin D.

Download Full-text

Recommended intakes of vitamin D to optimise health, associated circulating 25-hydroxyvitamin D concentrations, and dosing regimens to treat deficiency: workshop report and overview of current literature

Journal of Nutritional Science ◽

10.1017/jns.2015.10 ◽

2015 ◽

Vol 4 ◽

Cited By ~ 33

Author(s):

Michiel G. J. Balvers ◽

Elske M. Brouwer-Brolsma ◽

Silvia Endenburg ◽

Lisette C. P. G. M. de Groot ◽

Frans J. Kok ◽

...

Keyword(s):

Vitamin D ◽

The Netherlands ◽

Vitamin D Deficiency ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

Vitamin D Intake ◽

Skeletal Disease ◽

Health Council ◽

Dosing Regimens ◽

25 Hydroxyvitamin D

AbstractVitamin D is a fat-soluble hormone that traditionally has been linked to bone health. Recently, its involvement has been extended to other (extra-skeletal) disease areas, such as cancer, CVD, energy metabolism and autoimmune diseases. Vitamin D deficiency is a worldwide problem, and several recommendation-setting bodies have published guidelines for adequate vitamin D intake and status. However, recommendations from, for example, the Health Council of the Netherlands do not provide advice on how to treat vitamin D deficiency, a condition that is often encountered in the clinic. In addition, these recommendations provide guidelines for the maintenance of ‘minimum levels’, and do not advise on ‘optimum levels’ of vitamin D intake/status to further improve health. The NutriProfiel project, a collaboration between the Gelderse Vallei Hospital (Ede, the Netherlands) and the Division of Human Nutrition of Wageningen University (Wageningen, the Netherlands), was initiated to formulate a protocol for the treatment of vitamin deficiency and for the maintenance of optimal vitamin D status. To discuss the controversies around treatment of deficiency and optimal vitamin D status and intakes, a workshop meeting was organised with clinicians, scientists and dietitians. In addition, a literature review was conducted to collect recent information on optimal intake of vitamins, their optimal circulating concentrations, and effective dosing regimens to treat deficiency. This information has been translated into the NutriProfiel advice, which is outlined in this article.

Download Full-text

Very high rates of vitamin D insufficiency in women of child-bearing age living in Beijing and Hong Kong

British Journal Of Nutrition ◽

10.1017/s0007114507844382 ◽

2008 ◽

Vol 99 (6) ◽

pp. 1330-1334 ◽

Cited By ~ 43

Author(s):

Jean Woo ◽

Christopher W. K. Lam ◽

Jason Leung ◽

Winny Y. Lau ◽

Edith Lau ◽

...

Keyword(s):

Vitamin D ◽

Hong Kong ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Vitamin D Insufficiency ◽

Dietary Intakes ◽

Hydroxyvitamin D ◽

The North ◽

25 Hydroxyvitamin D ◽

The Relationship

We aimed to describe the vitamin D status of young women living in two Chinese cities in the spring – Beijing in the north (latitude 39° north) and Hong Kong (latitude 22° north) in the south. We also examined the relationship between serum 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations to determine a threshold for serum 25-hydroxyvitamin D above which there is no further suppression of PTH. Finally, we examined whether dietary Ca intake influences this relationship. Non-pregnant women aged 18–40 years (n 441) were recruited between February and June. Fasting blood was collected and dietary intakes were assessed using 5 d food records. Mean serum 25-hydroxyvitamin D concentration was lower in Beijing than Hong Kong women (29 v. 34 nmol/l; P < 0·001). Vitamin D deficiency ( ≤ 25 nmol/l) was indicated in 40 % of Beijing and 18 % of Hong Kong women, and over 90 % of women in both cities were insufficient ( ≤ 50 nmol/l). Mean Ca and vitamin D intakes were 478 mg/d and 2·0 μg/d, respectively. The relationship between 25-hydroxyvitamin D concentration and PTH was linear throughout the range with a slope of − 0·36 (different from 0; P < 0·001; R 0·26), with no apparent threshold. There was no influence of Ca intake on the relationship between 25-hydroxyvitamin D and PTH concentration. Vitamin D deficiency is common and insufficiency is very common in non-pregnant women in Hong Kong and Beijing during spring. Serum 25-hydroxyvitamin D was inversely associated with PTH with no apparent threshold. Strategies such as vitamin D fortification or supplementation may be required.

Download Full-text

Circulating 25-hydroxyvitamin D levels in relation to blood pressure parameters and hypertension in the Shanghai Women's and Men's Health Studies

British Journal Of Nutrition ◽

10.1017/s0007114511005745 ◽

2012 ◽

Vol 108 (3) ◽

pp. 449-458 ◽

Cited By ~ 21

Author(s):

Tsogzolmaa Dorjgochoo ◽

Xiao Ou Shu ◽

Yong-Bing Xiang ◽

Gong Yang ◽

Qiuyin Cai ◽

...

Keyword(s):

Blood Pressure ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Antihypertensive Drugs ◽

Urban China ◽

Inverse Association ◽

Cross Sectional ◽

Who Criteria ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

Little is known about the association of circulating 25-hydroxyvitamin D (25(OH)D) and blood pressure (BP) parameters, including systolic and diastolic BP, pulse pressure (PP), mean arterial pressure (MAP) and hypertension in non-Western populations that have not yet been exposed to foods fortified with vitamins and seldom use vitamin D supplements. A cross-sectional analysis of plasma 25(OH)D levels in association with BP measures was performed for 1460 participants (1055 women and 405 men, aged 40–74 years) of two large cohort studies in Shanghai. Multivariable linear and logistic regressions were conducted. Overall, the prevalence of vitamin D deficiency was 55·8 % using National Health and Nutrition Examination Survey, USA criteria and 29·9 % using WHO criteria. The median plasma 25(OH)D level in the population was 38·0 nmol/l for men and 33·6 nmol/l for women (P < 0·01) among participants who were not on antihypertensive drugs. Among men, BP parameters (systolic BP, diastolic BP and MAP) were significantly and inversely associated with higher quintiles of 25(OH)D compared with the lowest quintile (Ptrend < 0·05 for all). Vitamin D non-deficient status (WHO criteria) was inversely associated with hypertension (ORadjusted = 0·29; 95 % CI 0·10, 0·82). An inverse association was also found between hypertension and the highest quintile of 25(OH)D (ORadjusted = 0·16; 95 % CI 0·04, 0·65 for ≥ 50·6 nmol/l; Ptrend = 0·02). Among women, no significant associations were found for BP parameters and hypertension. The present study shows that vitamin D deficiency is common among adults in urban China. Circulating 25(OH)D levels were inversely related to the levels of individual BP parameters and hypertension among middle-aged and elderly men but not among women. More research is needed to investigate the potential sex differential associations.

Download Full-text