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Prevalence and Predictors of Low Serum 25-Hydroxyvitamin D among Female African-American Breast Cancer Survivors

Published:January 02, 2018DOI:https://doi.org/10.1016/j.jand.2017.10.009

      Abstract

      Background

      African-American breast cancer survivors commonly demonstrate low serum 25-hydroxyvitamin D (25(OH)D). Decreased cutaneous conversion, high levels of adiposity, and even breast cancer treatment may influence vitamin D status. Previous investigations have analyzed African-American women in aggregate with other breast cancer survivors and have not comprehensively addressed these influential factors.

      Objectives

      To determine the prevalence of low serum 25(OH)D in an exclusively African-American cohort of female breast cancer survivors with overweight/obesity and to evaluate the role of ultraviolet (UV) light exposure, body composition, and dietary sources of vitamin D on serum 25(OH)D levels.

      Design

      Cross-sectional.

      Participants

      Pre- and postmenopausal African-American breast cancer survivors (n=244) were recruited from various neighborhoods in the city of Chicago, IL, between September 2011 and September 2014 for a larger weight loss trial.

      Main outcome measures

      Demographic, clinical, anthropometric (body mass index [calculated as kg/m2], waist circumference, and hip circumference), blood specimen, dietary intake (food frequency questionnaire), and sun behavior data were collected by trained study personnel before trial participation. Dual-energy x-ray absorptiometry was used to quantify adiposity (total, percentage, regional, visceral) and lean mass. Serum 25(OH)D was used as the biomarker reflective of vitamin D status.

      Statistical analyses

      Mean (±standard deviation), frequencies, and multivariate linear regression modeling.

      Results

      The average participant was 57.4 years old (±10.0), 6.9 years (±5.2) from initial breast cancer diagnosis with a body mass index of 36.2 (±6.2). The majority of participants (60%) reported habitual oral vitamin D supplementation with mean intake of 327 IU (±169). Vitamin D deficiency was prevalent in 81% and 43%, when the cut points of the Endocrine Society (<30 ng/mL or <75 nmol/L) and the Institute of Medicine (<20 ng/mL or <50 nmol/L) were applied, respectively. A multivariate model adjusting for age, seasonality of blood draw, total energy intake, use of supplemental vitamin D, darker skin pigmentation, breast cancer stage, and waist-to-hip ratio was able to explain 28.8% of the observed variance in serum 25(OH)D concentrations. No significant associations were detected for body mass index or any dual-energy x-ray absorptiometry measures of body composition.

      Conclusions

      Considering the number of women who endorsed use of vitamin D supplementation, the prevalence of vitamin D deficiency among these African-American breast cancer survivors was high. Vitamin D supplementation, sun behavior, and waist-to-hip ratio may serve as future points of intervention to improve the vitamin D status of this minority survivor population.

      Keywords

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      Biography

      P. Sheean is an assistant professor, Loyola University Chicago, Marcella Niehoff School of Nursing, Maywood, IL.

      Biography

      C. Arroyo is a clinical research coordinator, Clinical Research Center, University of Illinois at Chicago; at the time of the study, she was a project coordinator, University of Illinois at Chicago.

      Biography

      J. Woo is a certified nurse midwife, a women's health nurse practitioner, and a clinical assistant professor, Baylor University, Dallas, TX; at the time of the study, she was a research assistant, Loyola University Chicago, Marcella Niehoff School of Nursing, University of Illinois at Chicago.

      Biography

      L. Schiffer is a research data analyst, University of Illinois at Chicago.

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      M. Stolley is a professor, Medical College of Wisconsin, Milwaukee.

      Linked Article

      • Erratum
        Journal of the Academy of Nutrition and DieteticsVol. 118Issue 7
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          In Table 2 (p 574) of the article “Prevalence and Predictors of Low Serum 25-Hydroxyvitamin D among Female African-American Breast Cancer Survivors” in the April 2018 issue of the Journal of the Academy of Nutrition and Dietetics, two of the subheads under Institute of Medicine were mistakenly mislabeled. The authors regret this error. The Table 2, column 5 head should read: Sufficient 25(OH)D ≥20 ng/mL (≥50 nmol/L). The Table 2, column 6 head should read Insufficient 25(OH)D <20 ng/mL (<50 nmol/L).
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