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.
Biography
M. Stolley is a professor, Medical College of Wisconsin, Milwaukee.
Article info
Publication history
Published online: January 02, 2018
Accepted:
October 13,
2017
Received:
April 28,
2017
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT National Institute on Aging, Midwest Roybal Center for Health Promotion and Translation (P30AG022849); National Cancer Institute, Moving Forward (R01CA154406); National Cancer Institute, Cancer Education and Career Development Program (R25CA057699). These funding sources were not involved in the design, data collection, analysis, interpretation, or written dissemination of this work.
AUTHOR CONTRIBUTIONS P. Sheean and M. Stolley contributed to the design, funding acquisition, data collection, statistical analyses, and original drafting of the manuscript. C. Arroyo contributed to the ethical approval, recruitment, data collection, and data management. L. Schiffer and J. Woo contributed to the data management, analyses, and manuscript revisions.
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
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- ErratumJournal of the Academy of Nutrition and DieteticsVol. 118Issue 7
- PreviewIn 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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