Vitamin D insufficiency and factors associated: a study with older adults people from primary health care network

Rolizola, Patricia Moreira Donato; Freiria, Carolina Neves; Silva, Graziele Maria da; Brito, Tabatta Renata Pereira de; Borim, Flávia Silva Arbex; Corona, Ligiana Pires

doi:10.1590/1413-81232022272.37532020

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FREE THEMES • Ciênc. saúde coletiva 27 (02) • Feb 2022 • https://doi.org/10.1590/1413-81232022272.37532020 copy

Vitamin D insufficiency and factors associated: a study with older adults people from primary health care network

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Abstract

This article aims to analyze vitamin D insufficiency and factors associated among older adults using primary health care services. This is a cross-sectional study that evaluated 533 older adults individuals (≥ 60 years old) in three cities in the state of São Paulo, Brazil. Serum level of 25-hydroxyvitamin D (25-OHD) was evaluated by chemiluminescence. The factors evaluated were sociodemographic information (sex, age group, ethnicity, education, income, marital status), health conditions (reported diseases), body composition (BMI, waist circumference), lifestyle (physical activity and smoking), and sun exposure (purpose, duration, frequency, time of exposure, exposed body parts, use of sunscreen, skin type). The prevalence of vitamin D insufficiency was 64.5%, presenting association with female participants, non-white/unreported ethnicity, low weight, high waist circumference (risk for CVD - cardiovascular disease), and physical inactivity. Negative association was observed with habitual sun exposure of hands, arms and legs, during leisure activities, daily commuting and physical activity, and between 9 am and 3 pm. The findings show the relevance of factors such as sex, ethnicity, body composition, physical activity, and sun exposure habits in the high prevalence of inadequate levels of vitamin D among older adults.

Key words:
Elder people; Vitamin D; Sun exposure; Public health

Characteristic	Total		Vitamin D sufficiency		Vitamin D insufficiency		p-value
			(≥ 30 ng/mL)		(< 30 ng/mL)
	n = 533		n = 189 (35.5%)		n = 344 (64.5%)
	n	%	n	%	n	%
Sex							0.000
Female	353	66.2	99	52.4	254	73.8
Male	180	33.8	90	47.6	90	26.2
Age							0.218
60-74 years	419	78.6	143	75.7	276	80.2
75 years and older	114	21.4	46	24.3	68	19.8
Ethnicity							0.026
White	284	53.3	113	59.8	171	49.7
Other - black, brown, indigenous, yellow or unreported	249	46.7	76	40.2	173	50.3
Monthly income*							0.059
< 2 minimum wages	108	20.3	29	15.3	79	23.0
≥ 2 minimum wages	376	70.5	138	73.1	238	69.2
unreported	49	9.2	22	11.6	27	7.8
BMI							0.004
Low weight	44	8.3	9	4.8	35	10.2
Eutrophy	167	31.3	74	39.1	93	27.0
Overweight	322	60.4	106	56.1	216	62.8
Waist circumference							0.001
With risk	313	58.7	93	49.2	220	64.0
No risk	220	41.3	96	50.8	124	36.0
Physical activity							0.225
Active	230	43.2	91	48.1	139	40.4
Not active	303	56.8	98	51.8	205	59.6
Smoking							0.749
Yes	39	7.3	14	7.4	25	7.3
No	313	58.7	107	56.6	206	59.9
Former smoker	181	34.0	68	36.0	113	32.8

Characteristic	Crude OR	p value	adjusted OR⁺	p value
Sex
Male	1.00		1.00
Female	2.58	< 0.001	2.54	<0.001
Ethnicity
White	1.00		1.00
Other - black, brown, indigenous, yellow or unreported	1.48	0.031	1.46	0.043
Monthly income*
< 2 minimum wages	1.00		1.00
≥ 2 minimum wages	1.58	0.057	1.29	0.303
unreported	0.68	0.226	0.67	0.219
BMI
Eutrophy	1.00		1.00
Low weight	3.09	0.005	2.56	0.023
Overweigh	1.60	0.016	1.41	0.085
Waist circumference
No risk	1.00		1.00
With risk	1.83	0.001	1.57	0.018

Variável	Total		Vitamin D sufficiency		Vitamin D insufficiency		p- value
			(≥ 30 ng/mL)		(< 30 ng/mL)
	n = 533		n = 189 (35,5%)		n = 344 (64,5%)
	n	%	n	%	n	%
Sun exposure
During leisure activities	137	25.7	60	31.7	77	22.4	0.018
During daily commuting	408	76.5	153	81.0	255	74.1	0.075
During physical activities	190	35.6	81	42.9	109	31.7	0.010
For health purposes	83	15.6	35	18.5	48	14.0	0.164
Use of sunscreen							0.207
Yes	188	35.3	60	31.7	128	37.2
No	345	64.7	129	68.3	216	62.8
Time of exposure
Before 9 am	256	48.0	85	45.0	171	49.7	0.295
Between 9 am and 3 pm	274	51.4	109	57.7	165	48.0	0.032
After 3 pm	95	17.8	33	17.5	62	18.0	0.871
Exposed body parts
Face	418	78.4	149	78.8	269	78.2	0.864
Hands and arms	474	88.9	175	92.6	299	86.9	0.046
Legs	272	51.0	107	56.6	165	48.0	0.056
Average duration							0.115
< 15 minutes	435	81.6	161	85.2	274	79.7
≥ 15 minutes	98	18.4	28	14.8	70	20.3
Frequency of exposure							0.718
< 3 days a week	350	65.7	126	66.7	224	65.1
≥ 3 days a week	183	34.3	63	33.3	120	34.9
Skin type (Fitzpatrick scale)							0.542
Type 1	70	13.1	23	12.2	47	13.7
Type 2	142	26.6	52	27.5	90	26.2
Type 3	107	20.1	43	22.7	64	18.6
Type 4	144	27.0	48	25.4	96	27.9
Type 5	39	7.3	10	5.3	29	8.4
Type 6	20	3.8	7	3.7	13	3.8
Not reported	11	2.1	6	3.2	5	1.4

Characteristic	Crude OR	p value	Adjusted OR⁺	p value
Sun exposure
During leisure activities
No	1.0		1.0
Yes	0.62	0.018	0.63	0.030
During daily commuting
No	1.0		1.0
Yes	0.67	0.076	0.57	0.019
During physical activities
No	1.0		1.0
Yes	0.61	0.010	0.67	0.040
For health purposes
No	1.0		1.0
Yes	0.71	0.166	0.71	0.172
Time
Before 9 am
No	1.0		1.0
Yes	1.20	0.219	1.20	0.326
Between 9 am and 3 pm
No	1.0		1.0
Yes	0.67	0.032	0.68	0.042
After 3 pm
No	1.0		1.0
Yes	1.03	0.871	1.08	0.744
Exposed body parts
Face
No	1.0		1.0
Yes	0.96	0.864	0.83	0.442
Hands and arms
No	1.0		1.0
Yes	0.53	0.049	0.46	0.019
Legs
No	1.0		1.0
Yes	0.70	0.056	0.66	0.031

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[1] Collaborations

PMD Rolizola worked on data collection, data analysis and manuscript writing. CN Freiria contributed to data collection, database preparation, data analysis and manuscript review. GM Silva acted in data collection, database preparation and manuscript review. TRP Brito and FSA Borim worked on coordinating the research and reviewing the analysis and manuscript. LP Corona contributed to the study design, analysis plan, research coordination and manuscript review. All authors read and approved the final manuscript.