Affiliations and memberships
- 2018 BNF Prize: British Nutrition Foundation 2018 Prize. Presented by HRH The Princess of Royal, Tuesday 20th November 2018, Royal College of Physicians (RCP), London. Lecture given at the RCP, London, Tuesday 19th November 2019.
- 2018 Leader of the Year: Nomination made by the Staff of the Nutritional Sciences Department at University of Surrey. Final University of Surrey Winner.
- 2017/2018 QAP: Queen’s Anniversary Prize (QAP): University of Surrey Nutritional Sciences Team - Food & Nutrition for Health. Led the Application from Surrey. Received QAP Prize from HRH Prince Charles and HRH The Duchess of Cornwall with University of Surrey Vice-Chancellor, Professor Max Lu at Buckingham Palace, London. February 2018.
- 2016 Colleague of the Year: Nomination made by PhD and PostDocs in Nutrition and Bone Health Team at University of Surrey.
- 2001 Nutrition Society Medal: Diamond Jubilee Conference, Nutrition Society, Sheffield, 2001.
- Young Investigator Award: 1st Joint Meeting of the International Bone and Mineral Society and European Calcified Tissue Society, Madrid, Spain, 2001.
- Young Investigator Award: 7th UK Conference on Osteoporosis, Bath, Avon, 2000.
- Young Investigator Award: 1st World Congress on Osteoporosis, Amsterdam Holland, 1996.
- 1991 PhD Scholarship: Nutritional Consultative Panel of the UK Dairy Industry London.
Severe vitamin D deficiencies in UK South Asian population puts their health at risk
University of Surrey’s Professor Sue Lanham-New awarded top prize for work on diet and nutrition
University of Surrey academic is the first nutritionist to scoop the National Osteoporosis Society Young Scientist prize for ground breaking research
University of Surrey awarded prestigious Queen’s Anniversary Prize for its teaching and research in food and nutrition
- Nutritional Aspects of Bone Health
- Interaction between diet and sunlight exposure on vitamin D status in Caucasian and Asian women (D-FINES) study
- Extent of vitamin D deficiency in Saudi Arabian women and boys and girls
- Impact of veiling on Vitamin D status in Kuwait adolescent girls: impact on bone mass
- Protein and bone health: systematic review and meta-analysis
- Role of dietary and supplemental potassium to osteoporosis prevention
- Nutritional influences on stress fracture incidence in the Royal Marines
- Role of trace elements to bone health
- Nutrition and exercise influences on peak bone mass attainment
- Nutrition and bone in the Swiss elderly
- Role of the skeleton in acid-base homeostasis
- Dr Jacqueline Berry, Vitamin D Research Group, University of Manchester
- Dr Jo Fallowfield, Institute of Naval Medicine, Gosport, Hampshire
- Professor David Torgerson, Centre for Health Economics, University of York
- Professor Richard Eastell, Dr Rosemary Hannon, Bone Metabolism Group, University of Sheffield
- Professor Jalal Khan, King Abdula-Aziz University, Jeddah, Saudi Arabia
- Professor Peter Burckhardt, University Hospital, Lausanne
- Professor David Reid and Dr Helen Macdonald, Osteoporosis Research Unit, University of Aberdeen
- Professor Gordon Ferns and Professor Margot Umpleby, Post-Graduate Medical School, University of Surrey
- Nutritional Sciences Division staff: Dr Warren Lee; Professor Bruce Griffin; Dr Kath Hart; Dr Jonathan Brown; Dr Adam Collins; Dr Babs Engel
Postgraduate research supervision
Current PhD supervision (n 4) [PT/FT] & Post-Doctoral Researchers (n 3)
- Surgeon Ltn Commander Michael Lindsey (PS, MoD)
- Rebecca Vearing (PS, UGPN funded)
- Shatha Alharazy, (CS, Saudi Government)
- Two new PhD students starting in 2020
- Post-Doctoral Research Fellows (n 3)
- Examined n 20 PhD students externally
Completed postgraduate research projects I have supervised
PhD Students successfully completed (n 20) [all within allowed time, PT/FT]
PhD Supervision - as Principal Supervisor (PS) or Co-Supervisor (CS)
- 1999 - 2003 Majid Ghayour-Morbarhan, Iranian Government, CS (within 4 years FT)
- 2000 - 2005 Sawsan Khoja, Saudi Government, PS (within 5 years PT)
- 2000 - 2005 Jaana Nurmi-Lawton, NOS, PS (within 5 years PT)
- 2002 - 2006 Khulood Al, Kuwait Government, PS (within 4 years FT)
- 2003 - 2008 Richard Gannon, BBSRC, PS (within 4 years FT)
- 2006 - 2010 Eyad Al-Shammari, Saudi Government, PS (within 4 years FT)
- 2006 - 2010 Emma Wynn, Swiss Foundation, PS (within 5 years PT)
- 2008 - 2012 Ohood Hakim, Saudi Government, PS (within 4 years FT)
- 2007 - 2012 Trish Davey, Ministry of Defence, PS (within 5 years PT)
- 2008 - 2013 Maryam AlGhamdi, Saudi Government , PS (within 5 years PT)
- 2009 - 2013 Khulood Hussein, Saudi Government, PS (within 4 years FT)
- 2009 - 2013 Andrea Darling, University Scholarship, PS (within 4 years FT)
- 2011 - 2015 Najlaa Al-Mana, Saudi Government, CS (within 4 years FT)
- 2011 - 2016 Louise Wilson, BBSRC funded, PS (within 4 years FT)
- 2011 - 2016 Pippa Gibson, Charity funded, CS (within 4 years FT)
- 2011 - 2016 Tahany Aldonel, Saudi Government, CS (within 5 years PT)
- 2013 - 2017 Taryn Smith, EU, CS (within 4 years FT)
- 2014 - 2018 Funmi Akinyemi, Schlumberger Found’n, PS (within 4 years FT)
- 2015 – 2019 Marcela Mendes, Brazilian Government, PS (within 4 years FT)
- 2015 – 2019 Saskia Wilson-Barnes, EU, PS (with 4 years FT)
I teach on the following courses:
I contribute to the following modules:
- BMS2012: Micronutrients
- BMS2027: Nutritional Needs of Population Groups
- BMS3013: Reproduction and Growth
- BMS3015: Vitamins and Minerals
- BMS3016: Nutrition Research Methodology
- BMS3017: Practical Nutrition
- BMS3033: Sports Nutrition.
I teach on the following courses:
MUSCULOSKELETAL HEALTH: RESULTS OF THE D-FINES STUDY,
Results: As shown in the Figure above, a mixed between-within subjects ANOVA showed there was no significant main effect of season F(3,59.0)=1.467, p=0.233. However, there was a significant between subjects effect of group F(3,61)=3.099, p=0.033, with post hoc tests showing significant differences between the two C groups (p=0.007) and between the postmenopausal A and premenopausal C groups (p=0.042) but no significant differences between the other groups. Last, there was no significant interaction between season and group F(9,143.741)=0.540, p=0.843. The lower sCTX in the younger premenopausal groups is as would be expected. However, unexpectedly, there was a non-significant trend in the postmenopausal groups for the A women to have a lower mean sCTX than the C women. In contrast, in the premenopausal women, the sCTX was lower in the C group. Therefore it appears that it is menopausal status, not ethnicity which is likely the main reason for the group differences. Indeed, there was no significant difference between ethnic groups of the same menopausal status. Conclusions: Overall, no evidence for a seasonal variation in bone resorption was found here but there was evidence for a menopausal difference in bone resorption. However, numbers of participants in this preliminary analysis was small, and the trend for an ethnic difference in the postmenopausal women might be statistically significant with higher subject numbers. Further analysis with a larger sample is planned.
A mixed between-within subjects ANOVA showed there was no significant main effect of season on sCTX F(3,59.0)=1.467, p=0.233. However, there was a significant between subjects effect of group F(3,61)=3.099, p=0.033, with post hoc tests showing significant differences between the two C groups (p=0.007) and postmenopausal A and premenopausal C groups (p=0.042) but no significant differences between the other groups. Last, there was no significant interaction between season and group F(9,143.741)=0.540, p=0.843. It appears that it is menopausal status, not ethnicity which is likely the main reason for the group differences. Indeed, there was no significant difference between ethnic groups of the same menopausal status. Overall, no evidence for a seasonal variation in bone resorption was found here but there was evidence for a menopausal difference in bone resorption.
SOUTHERN ENGLAND: MULTILEVEL MODELLING ANALYSIS OF THE D-FINES STUDY,
(25(OH)D) remains to be fully determined. The aim of this study was to examine these factors in combination using a
repeated measures multilevel modelling approach. The D-FINES study investigated 373 Surrey Caucasian and Asian
women in four seasons of the year for 25(0H)D, dietary vitamin D and UVB exposure. To capitalise on the clustered
nature of the repeated seasonal measurements within individuals, multilevel modelling was undertaken using MLwiN
v.2.1software. Thus seasonal data (dietary vitamin D (DietaryVitD), UV exposure (UVdosi), vitamin D status (VitDstatus))
were included at level one (ij) and individual level data (ethnicity, menopausal status (0=Caucasian, 1=Asian;
0=Premenopausal, 1=Postmenopausal)) at level two (j). Using a random intercept model, the following equation was
constructed, which was significantly different from an intercept only model (Log likelihood test- Chi square X2= 2216.51,
df=5, p 25(OH)Dij= 0j-0.130(0.283)DietaryVitDij + 1.199(0.201)UVdosiij -27.559(2.637) Ethnicity_j: -6.082(2.051)Menopause_1j ? 0.020(0.008)UVdosi2ij+ e
ij0j=56.650(1.825) + u0j
This model showed no effect of diet on 25(OH)D, but did show a significant interaction between Standard Erythema Dose
(SED)UV and 25(OH)D. Being of Caucasian ethnicity was associated with a 27.6 nmol/l higher 25(OH)D than Asian
ethnicity, and being of premenopausal status was associated with a 6.1 nmol/l higher 25(OH)D than postmenopausal
status. Total body fat mass and seasonal dietary calcium had initially been included in the model but were removed as
they were not significant parameters. Dietary vitamin D was retained, even though not a significant parameter as it was of
high theoretical and practical importance. The implications of this model are that UV exposure has an effect on vitamin D
status but dietary vitamin D does not. Ethnicity has a greater influence than menopausal status. This work is funded by
the FSA (Project No. NO5064). This work was funded by the UK Foods Standards Agency (NO5064). The views
expressed are those of the authors alone.
IN SOUTHERN ENGLAND: MULTILEVEL MODELLING ANALYSIS OF THE D-FINES STUDY,
The D-FINES study was funded by the UK Food Standards Agency. All views are those of the authors alone
Results from the systematic review of K2 studies showed a significant negative association of K2 on ucOC in intervention studies. The intervention studies, but not cross-sectional studies, independently associated vitamin K2 with fracture risk. No effect of vitamin K2 supplementation on bone resorption was found for any study type, but the intervention studies were associated with increased BMD. This was supported by results from the vitamin K2 meta-analysis for a reduction in ucOC (p,0.00001, Z=8.75, weighted mean difference=95% CI (-68.54 to-43.45)) and increased BMD from combined sites (p=0.004, Z=3.86, weighted mean difference= 95% CI (1.24-6.48)).
These findings suggest vitamin K; especially K2, may be beneficial for bone health, as ucOC is an independent risk factor for osteoporotic fracture. In this analysis, K2, but not K1 supplementation, was associated with increased BMD. However, overall the results from the studies were too conflicting to recommend routine supplementation. Further, higher quality and more homogenous studies are needed before any clear conclusions can be made about vitamin K and bone health.
function in different UK ethnic groups. The D-FINES study examined a total of 373 Surrey-dwelling Caucasian (C) and
Asian (A) women in four seasons of the year for diet, sunlight exposure, 25-hydroxyvitamin D (25(OH)D) and grip
strength (GS). In the autumn season, lumbar spine bone mineral density (LSBMD) was also measured. The specific aim
of this work was to examine differences in LSBMD and GS in A and C pre and postmenopausal women according to
25(OH)D. When women were grouped by 25(OH)D ( adjusting for BMI showed a significant difference in LS BMD between the groups for summer (p=0.042), autumn
(p=0.002) winter (p=0.028) and spring (p=0.019) 25(OH)D. The 25(OH)D significantly lower LS BMD than those with >75nmol/l. For GS, controlling for lean arm mass, a statistically significant
difference between the four ethnic/menopausal groups (F=24.851, p effect of season (F= 0.503, p=0.681) and no significant interaction between season and ethnic/menopausal group
(F=0.303, p=0.974). Significant positive partial correlations were found for all women (p 25(OH)D and GS. For all C as one group, significant positive correlations were found between 25(OH)D and GS in
summer (r=0.307), autumn (r=0.223), winter (r=0.222) and spring (r=0.242), with p was not found for the A groups combined, or for the four groups separately (p>0.05). In summary, LS BMD was found to
be significantly higher in individuals with 25(OH)D >75nmol/l compared to those with that poor 25(OH)D is associated with a detrimental effect on bone health. If maintained, these findings could potentially
translate into increased fracture risk long-term. Furthermore, 25(OH)D was positively correlated with GS in all women in
all seasons, indicating low 25(OH)D may decrease GS, most likely via poorer muscle function. These findings are a
cause for public health concern.
This work was funded by the UK Foods Standards Agency (NO5064). The views expressed are those of the authors
However, there is controversy as to whether vitamin D2 and vitamin D3 are equally effective at raising vitamin D status (25OHD concentration). The primary and secondary aims of this PhD project were: to investigate the effects of both these forms of vitamin D independently on vitamin D status, markers of bone and cardiovascular health, and gene expression; as well as to examine whether common genetic variants affect response to either form of vitamin D.
A cohort of 90 South Asian and 245 Caucasian women were recruited onto a randomised-controlled trial; the D2-D3 Study. Participants were given either 15 µg/d of vitamin D2, 15 µg/d of vitamin D3 or placebo, in fortified foods, for 12 weeks.
At baseline, serum total 25OHD concentrations were significantly lower in the South Asian women (27.6 nmol/L) than the Caucasian women (60.3 nmol/L). In both the South Asian and Caucasian women, 25OHD concentrations significantly decreased in the placebo intervention (-5% and -15% respectively, p Interestingly, whole blood transcriptome analysis indicated that the vitamin D2 and D3 interventions triggered a difference in expression of entirely different genes, and predicted therefore a difference in the activity of the respective metabolic and cellular pathways. The associations between genetic polymorphisms and change in 25OHD concentration in response to vitamin D also appear to differ depending on the form of vitamin D taken, although baseline 25OHD concentration ma
There is a lack of longitudinal data assessing seasonal variation in vitamin D status in young South Asian women living in northern latitudes. Studies of postmenopausal South Asian women suggest a lack of seasonal change in 25-hydroxy vitamin D [25(OH)D], although it is unclear whether this is prevalent among premenopausal South Asians. We aimed to evaluate, longitudinally, seasonal changes in 25(OH)D and prevalence of vitamin D deficiency in young UK-dwelling South Asian women as compared with Caucasians. We also aimed to establish the relative contributions of dietary vitamin D and sun exposure in explaining serum 25(OH)D.
This is a 1-year prospective cohort study assessing South Asian (n = 35) and Caucasian (n = 105) premenopausal women living in Surrey, UK (51° N), aged 20?55 years. The main outcome measured was serum 25(OH)D concentration. Secondary outcomes were serum parathyroid hormone, self-reported dietary vitamin D intake and UVB exposure by personal dosimetry.
Serum 25(OH)D Conclusions
Year-round vitamin D deficiency was extremely common in South Asian women. These findings pose great health threats regarding the adverse effects of vitamin D deficiency in pregnancy and warrant urgent vitamin D public health policy and action.
The primary aim of this Thesis was to estimate the dietary vitamin D intakes required to maintain serum 25-hydroxyvitamin D [25(OH)D] concentrations above specific cut-off thresholds (25, 30, 40 and 50 nmol/l) during the winter-time in white Caucasian adolescents residing in the UK (51°N). Secondary aims were to: 1) investigate vitamin D status in relation to musculoskeletal and cardiometabolic health outcomes and; 2) explore familial associations in vitamin D status, dietary intakes and musculoskeletal health in mother-child pairs. This was achieved via a dose-response trial in 110 adolescents (14-18 years), who were randomly allocated to receive 0 (placebo), 10 or 20 ¼g vitamin D3 daily for 20 weeks during the winter-time. A final aim of this Thesis was to assess the vitamin D status and prevalence of vitamin D deficiency in a small study of African Caribbean and South Asian adolescent and young adult females (16-25 years) in comparison to their white Caucasian counterparts.
It was estimated that vitamin D intakes of 10.1, 13.1, 23.3 and ~30 ¼g/day would maintain serum 25(OH)D concentrations > 25, 30, 40 and 50 nmol/l respectively in 97.5% of the adolescents. Adolescents with serum 25(OH)D concentrations below 50 nmol/l had significantly lower radial trabecular volumetric bone mineral density and presented with a poorer cardiometabolic profile, with greater waist circumference and higher triglyceride and glucose concentrations than their more replete counterparts. However cardiometabolic risk was lost after controlling for potential confounders. Positive, sex-specific associations were found for serum 25(OH)D concentrations and radial mass, total area and cortical volumetric bone mineral density in mother-child pairs, but not for dietary vitamin D and calcium intakes. A high prevalence of vitamin D deficiency was found in African Caribbean and South Asian females (serum 25(OH)D In conclusion, dietary vi
Objective: We aimed to investigate whether vitamin D2 or vitamin D3 fortified in juice or food, at a relatively low dose of 15 ¼g/d, was effective in increasing serum total 25(OH)D and to compare their respective efficacy in South Asian and white European women over the winter months within the setting of a large randomized controlled trial.
Design: A randomized, double-blind, placebo-controlled food-fortification trial was conducted in healthy South Asian and white European women aged 20?64 y (n = 335; Surrey, United Kingdom) who consumed placebo, juice supplemented with 15 ¼g vitamin D2, biscuit supplemented with 15 ¼g vitamin D2, juice supplemented with 15 ¼g vitamin D3, or biscuit supplemented with 15 ¼g vitamin D3 daily for 12 wk. Serum 25(OH)D was measured by liquid chromatography?tandem mass spectrometry at baseline and at weeks 6 and 12 of the study.
Results: Postintervention in the 2 ethnic groups combined, both the vitamin D3 biscuit and the vitamin D3 juice groups showed a significantly greater absolute incremental change () in total 25(OH)D when compared with the vitamin D2 biscuit group [ (95% CI): 15.3 nmol/L (7.4, 23.3 nmol/L) (P
Conclusions: With the use of a daily dose of vitamin D relevant to public health recommendations (15 ¼g) and in vehicles relevant to food-fortification strategies, vitamin D3 was more effective than vitamin D2 in increasing serum 25(OH)D in the wintertime. Vitamin D3 may therefore be a preferential form to optimize vitamin D status within the general population. This trial was registered at www.controlled-trials.com as ISRCTN23421591.
vitamin D can be met by both endogenous synthesis from sunlight and by dietary sources. This
complicates the determination of dietary requirements for vitamin D, which along with the
definition of optimal vitamin D status, have been highly controversial and much debated over recent
years. Adolescents are a population group at high risk of low vitamin D status, which is concerning
given the important role of vitamin D, and calcium, in promoting normal bone mineralisation and
attainment of peak bone mass during this rapid growth phase. Dietary vitamin D recommendations
are important from a public health perspective in helping to avoid deficiency and optimise vitamin
D status for health. However limited experimental data from winter-based dose-response
randomised trials in adolescents has hindered the development of evidence-based dietary
requirements for vitamin D in this population group. This review will highlight how specifically
designed randomised trials and the approach adopted for estimating such requirements can lead to
improved recommendations. Such data indicates that vitamin D intakes of between 10 and ~30
µg/day may be required to avoid deficiency and ensure adequacy in adolescents, considerably
greater than the current recommendations of 10-15 µg/day. Finally this review will consider the
implications of this on public health policy, in terms of future refinements of vitamin D requirement
recommendations and prioritisation of public health strategies to help prevent vitamin D deficiency
Objectives: To determine in UK children with biopsy-proven NAFLD: (i) vitamin D status throughout a 12-month period; (ii) interactions between key vitamin D-related genetic variants (NADSYN1/DHCR7, VDR, GC, CYP2R1) and disease severity.
Methods: In 103 pediatric patients with NAFLD, serum 25-hydroxyvitamin D (25OHD) levels and genotypes were determined contemporaneously to liver biopsy and examined in relation to NAFLD activity score and fibrosis stage.
Results: Only 19.2% of children had adequate vitamin D status; most had mean 25OHD levels considered deficient (
Conclusions: Children with NAFLD in the UK have particularly low winter vitamin D status; with vitamin D insufficiency prevalent throughout the year. Polymorphisms in the vitamin D metabolic pathway are associated with histological severity of pediatric NAFLD.
Background: Epidemiological studies have supported inverse associations between low serum 25-hydroxyvitamin D [25(OH)D] and cardiometabolic risk markers, but few randomized trials have investigated the effect of vitamin D supplementation on these markers in adolescents.
Objective: The objective of this study was to investigate the effect of winter-time cholecalciferol (vitamin D3) supplementation on cardiometabolic risk markers in white, healthy 14-18 year-old adolescents in the UK (51°N) as part of the ODIN Project.
Methods: In a dose-response trial, 110 adolescents (15.9±1.4 years; 43% male; 81% normal weight) were randomly assigned to receive 0, 10 or 20 ¼g/day vitamin D3 for 20 weeks (October-March). Cardiometabolic risk markers including BMI-for-age z-score (BMIz), waist circumference, systolic and diastolic blood pressure, fasting plasma triglycerides, cholesterol (total, HDL, LDL and total:HDL) and glucose were measured at baseline and endpoint as secondary outcomes, together with serum 25(OH)D. Intervention effects were evaluated in linear regression models as between-group differences at endpoint, adjusted for the baseline value of the outcome variable and additionally for age, sex, Tanner stage, BMIz and baseline serum 25(OH)D.
Results: Mean±SD baseline serum 25(OH)D was 49.1±12.3 nmol/L and differed between groups at endpoint with concentrations of 30.7±8.6, 56.6±12.4 and 63.9±10.6 nmol/L in the 0, 10 and 20 ¼g/day groups respectively (Pd0.001). Vitamin D3 supplementation had no effect on any of the cardiometabolic risk markers (all P>0.05), except for lower HDL (-0.12 mmol/L, 95% CI -0.21, 0.04, P=0.003) and total cholesterol (-0.21 mmol/L, 95% CI -0.42, 0.00, P=0.05) in the 20 compared to the 10 ¼g/day group, which disappeared in the fully adjusted analysis (P=0.27 and P=0.30 respectively).
Conclusions: Supplementation with vitamin D3 at 10 and 20 ¼g/25 day, which increased serum 25(OH)D concentrations during the winter-time, had no effect on markers of cardiometabolic risk in healthy 14-18 year-old adolescents. This trial was registered at clinicaltrials.gov as NCT02150122.
Objective: Vitamin D deficiency (serum 25-hydroxyvitamin DÂ25nmol/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.
Design: Cross-sectional analysis of baseline vitamin D supplement use data.
Setting: UK Biobank cohort.
Subjects: In total, n 8024 South Asians (Bangladeshi, Indian, Pakistani), aged 40-69 years.
Results: Twenty-three % of men and 39% of women (PÂ0.001) [22% of Bangladeshis, 32% of Indians, 25% of Pakistanis (PÂ0.001)] took a vitamin D containing supplement. Median vitamin D intakes from diet were low at 1.0-3.0 micrograms per day, being highest in Bangladeshis and lowest in Indians (PÂ0.001). Logistic regression modelling showed that females had a higher odds of vitamin D supplement use than males (odds ratio (OR) = 2.02; 95% confidence interval (CI) 1.79 to 2.28). A lower supplement usage was seen in younger persons (40-60 years) (OR=0.75; 95% CI 0.65 to 0.86 reference= Ã60 years), and those living outside of Greater London (OR=0.53 to 0.77), with borderline trends for a lower body mass index, higher oily fish intake and higher household income associated with increased odds of vitamin D supplement use.
Conclusions: Vitamin 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 sub-groups.
at 55°N Has No Effect on Markers of
Cardiometabolic Risk in Healthy Children
Aged 4?8 Years, The Journal of Nutrition 148 (8) pp. 1261-1268 Oxford University Press
profiles in many observational studies in children, but very few randomized controlled trials have investigated this.
Objective: We explored the effect of winter-time cholecalciferol (vitamin D3) supplementation on cardiometabolic risk
markers in young, white, 4- to 8-y-old healthy Danish children (55°N) as part of the pan-European ODIN project.
Methods: In the ODIN Junior double-blind, placebo-controlled, dose-response trial, 119 children (mean ± SD age:
6.7 ± 1.5 y; 36% male; 82% normal weight) were randomly allocated to 0, 10 or 20 ¼g/d of vitamin D3 for 20 wk
(October?March). Cardiometabolic risk markers including BMI-for-age z score (BMIz), waist circumference, systolic and
diastolic blood pressure, serum triglycerides and cholesterol (total, LDL, HDL, and total:HDL), plasma glucose and insulin,
and whole-blood glycated hemoglobin were measured at baseline and endpoint as secondary outcomes together
with serum 25(OH)D. Intervention effects were evaluated in linear regression models as between-group differences at
endpoint adjusted for baseline value of the outcome, and additionally for age, sex, baseline serum 25(OH)D, BMIz, time
since breakfast, and breakfast content.
Results: Mean ± SD serum 25(OH)D was 56.7 ± 12.3 nmol/L at baseline and differed between groups at endpoint
with concentrations of 31.1 ± 7.5, 61.8 ± 10.6, and 75.8 ± 11.5 nmol/L in the 0-, 10-, and 20 ¼g/d groups, respectively
(P for baseline value of the outcome (all P e 0.05), and additional covariate adjustment did not change the results notably.
Conclusions: Preventing the winter decline in serum 25(OH)D with daily vitamin D3 supplementation of 10 or 20 ¼g had
no cardiometabolic effects in healthy 4- to 8-y-old Danish children. This trial was registered at www.clinicaltrials.gov as
with recent research also suggesting a beneficial link between vitamin D and other nonskeletal
health outcomes, including immune function, cardiovascular health and cancer.
Despite this, vitamin D deficiency remains a global public health issue, with a renewed
focus in the UK following the publication of Public Health England?s new Dietary
Vitamin D Requirements. Natural sources of vitamin D (dietary and UVB exposure) are
limited, and thus mechanisms are needed to allow individuals to achieve the new dietary
recommendations. Mandatory or voluntary vitamin D food fortification may be one of
the mechanisms to increase dietary vitamin D intakes and subsequently improve vitamin
D status. However, for the food industry and public to make informed decisions, clarity
is needed as to whether vitamins D2 and D3 are equally effective at raising total 25-hydroxyvitamin
D (25(OH)D) concentrations as the evidence thus far is inconsistent. This review
summarises the evidence to date behind the comparative efficacy of vitamins D2 and D3 at
raising 25(OH)D concentrations, and the potential role of vitamin D food fortification as a
public health policy to support attainment of dietary recommendations in the UK. The comparative
efficacy of vitamins D2 and D3 has been investigated in several intervention trials,
with most indicating that vitamin D3 is more effective at raising 25(OH)D concentrations.
However, flaws in study designs (predominantly under powering) mean there remains a
need for a large, robust randomised-controlled trial to provide conclusive evidence, which
the future publication of the D2?D3 Study should provide (BBSRC DRINC funded: BB/
I006192/1). This review also highlights outstanding questions and gaps in the research
that need to be addressed to ensure the most efficacious and safe vitamin D food fortification
practices are put in place. This further research, alongside cost, availability and ethical considerations
(vitamin D3 is not suitable for vegans), will be instrumental in supporting government,
decision-makers, industry and consumers in making informed choices about
potential future vitamin D policy and practice.
The effects of urban living on health are becoming increasingly important, due to an increasing global population residing in urban areas. Concomitantly, due to immigration, there is a growing number of ethnic minority individuals (African, Asian or Middle Eastern descent) living in westernised Higher Latitude Countries (HLC) (e.g. Europe, Canada, New Zealand). Of concern is the fact that there is already a clear vitamin D deficiency epidemic in HLC, a problem which is likely to grow as the ethnic minority population in these countries increases. This is because 25-hydroxyvitamin D (25(OH)D) status of ethnic groups is significantly lower compared to native populations.
Environmental factors contribute to a high prevalence of vitamin D deficiency in HLC, particularly during the winter months when there is no sunlight of appropriate wavelength for vitamin D synthesis via the skin. Also, climatic factors such as cloud cover may reduce vitamin D status even in the summer. This may be further worsened by factors related to urban living, including air pollution, which reduces UVB exposure to the skin, and less occupational sun exposure (may vary by individual HLC). Tall building height may reduce sun exposure by making areas more shaded. In addition, there are ethnicity-specific factors which further worsen vitamin D status in HLC urban dwellers, such as low dietary intake of vitamin D from foods, lower production of vitamin D in the skin due to increased melanin and reduced skin exposure to UVB due to cultural dress style and sun avoidance.
A multidisciplinary approach applying knowledge from engineering, skin photobiology, nutrition, town planning and social science is required to prevent vitamin D deficiency in urban areas. Such an approach could include reduction of air pollution, modification of sun exposure advice to emphasise spending time each day in non-shaded urban areas (e.g. parks, away from tall buildings), and advice to ethnic minority groups to increase sun exposure, take vitamin D supplements and/or increase consumption of vitamin D rich foods in a way that is safe and culturally acceptable. This review hopes to stimulate further research to assess the impact of high latitude, urban environment and ethnicity on the risk of vitamin D deficiency.
There is a lack of research into 25-hydroxyvitamin D (25(OH)D) status, light exposure and sleep patterns in South Asian populations. In addition, results of research studies are conflicting as to whether there is an association between 25(OH)D status and sleep quality.
We investigated 25(OH)D status, self-reported and actigraphic sleep quality in n = 35 UK dwelling postmenopausal women (n = 13 South Asians, n = 22 Caucasians), who kept daily sleep diaries and wore wrist-worn actiwatch (AWL-L) devices for 14 days. A subset of n = 27 women (n = 11 South Asian and n = 16 Caucasian) also wore a neck-worn AWL-L device to measure their light exposure.
For 25(OH)D concentration, South Asians had a median ± IQR of 43.8 ± 28.2 nmol/L, which was significantly lower than Caucasians (68.7 ± 37.4 nmol/L)(P = 0.001). Similarly, there was a higher sleep fragmentation in the South Asians (mean ± SD 36.9 ± 8.9) compared with the Caucasians (24.7 ± 7.1)(P = 0.002). Non-parametric circadian rhythm analysis of rest/activity patterns showed a higher night-time activity (L5) (22.6 ± 14.0 vs. 10.5 ± 4.4; P = 0.0008) and lower relative amplitude (0.85 ± 0.07 vs. 0.94 ± 0.02; P Â 0.0001) in the South Asian compared with the Caucasian women. More South Asians (50%) met the criteria for sleep disorders (PSQI score Ã5) than did Caucasians (27%) (P = 0.001, Fishers Exact Test). However, there was no association between 25(OH)D concentration and any sleep parameter measured (P Ã 0.05) in either ethnic group. South Asians spent significantly less time in illuminance levels over 200 lx (P = 0.009) than did Caucasians.
Overall, our results show that postmenopausal South Asian women have lower 25(OH)D concentration than Caucasian women. They also have higher sleep fragmentation, as well as a lower light exposure across the day. This may have detrimental implications for their general health and further research into sleep quality and light exposure in the South Asian ethnic group is warranted.
We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.
By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled ?Musculoskeletal Health in the 21st Century? and held at the University of Surrey from 30th June-1st July 2015.
The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.
Vitamin D deficiency (Â25nmol/L) and insufficiency (Â50nmol/L) has become an increasingly popular topic. Current research focusses upon the potential ergogenic effects of vitamin D (vitD) in sporting performance; however, the relationship between vitD (dietary intake and nutritional status) and bone health within a University athlete cohort remains under-investigated. Therefore, the aims of this Thesis were to (1) examine vitD status longitudinally across the University competitive seasons and; (2) examine the implications that vitD deficiency/ insufficiency may have upon physical performance parameters or bone health.
In the first study, fifty-seven competitive University level- athletes from varied sports were observed from autumn to spring. Radial bone mineral density (BMD) and physical performance parameters were investigated; for the analysis of vitD and parathyroid hormone, blood samples were collected. Within the cohort 7% presented with deficiency during the autumn; increasing to 44% during spring. However, this did not have a significant effect upon physical performance and bone health despite an average status of 31.5±16.4 nmol/L in spring.
In the second study, 34 University athletes and sixteen sedentary students were recruited and followed from spring to summer. Whole body, hip and tibial scans were conducted to determine BMD and bone mineral content (BMC). Physical performance parameters including jump height, aerobic fitness, muscular strength and blood biochemistry were also collected. During the summer term, 26% of the cohort were vitD insufficient. Moreover, an insufficient vitD status was associated with a lowered jump height (p=0.015) but not aerobic fitness (p=0.07). There was also a significant positive relationship between vitD status, femoral neck BMC (r=0.685; pÂ0.02) and BMD (r=0.679; pÂ0.02). Our results show that BMD was higher in weight bearing athletes. The final study found that racket sport athletes had a significantly superior bone profile in their dominant arm when contrasted to controls.
Overall, these findings suggest that an insufficient vitD status was associated with lower indices of muscular power and aerobic fitness in University students. Therefore, being vitD replete may not only play an important role in musculoskeletal health but could also be a key determining factor in athletic performance.