Abstract
Objective
To determine the prevalence of vitamin D deficiency (VDD) (25-hydroxyvitamin D level
<20 ng/mL) and severe VDD (25[OH]D level <10 ng/mL) in a Minnesota immigrant and refugee
population.
Patients and Methods
This retrospective study evaluated a cohort of adult immigrants and refugees seen
at Health Partners Center for International Health in St Paul, Minnesota. Study participants
were all patients seen from August 1, 2008, through July 31, 2009, with a first vitamin
D screen (N=1378). Outcomes included overall prevalence of VDD and severe VDD. Covariates
included country of origin, sex, age, month of test, and body mass index (BMI).
Results
Vitamin D deficiency was significantly more prevalent in our Minnesota clinic immigrant
and refugee population than among US-born patients (827 of 1378 [60.0%] vs 53 of 151
[35.1%]; P<.001). Severe VDD was also significantly more prevalent (208 of 1378 [15.1%] vs 12
of 151 [7.9%]; P=.02). Prevalence of VDD varied significantly according to country of origin (42 of
128 Russian patients [32.8%] vs 126 of 155 Ethiopian patients [81.3%]; P<.001). The BMI correlated negatively with VDD (488 of 781 [62.5%] when BMI was ≥25
vs 292 of 520 [56.2%] when BMI was <25; P=.02). Vitamin D deficiency was present in 154 of 220 individuals (70.0%) 16 to 29
years old vs 123 of 290 (42.4%) in those older than 66 years (P<.001).
Conclusion
Immigrants and refugees in a Minnesota clinic have a substantially higher rate and
severity of VDD when compared with a US-born population. Country of origin, age, and
BMI are specific risk factors for VDD and should influence individualized screening
practices.
Abbreviations and Acronyms:
BMI (body mass index), CIH (Center for International Health), 25(OH)D (25-hydroxyvitamin D), VDD (vitamin D deficiency)To read this article in full you will need to make a payment
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References
- Vitamin D deficiency.N Engl J Med. 2007; 357: 266-281
- Vitamin D deficiency and mortality risk in the general population: meta-analysis of prospective cohort studies.Am J Clin Nutr. 2012; 95: 91-100
- Vitamin D supplementation and total mortality.Arch Intern Med. 2007; 167: 1730-1737
- Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality.Arch Intern Med. 2008; 168: 1340-1349
- Vitamin D for cancer prevention: global perspective.Ann Epidemiol. 2009; 19: 468-483
- Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention.Anticancer Res. 2011; 31: 617-622
Bischoff-Ferrari H, Willett W. The Nutrition Source. Comment on the IOM Vitamin D and Calcium Recommendations. For Adult Bone Health, Too Low on Vitamin D—and too Generous on Calcium. https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d-fracture-prevention/index.html. Accessed December 15, 2011.
- Bone density in an immigrant population from Southeast Asia.Osteoporosis Int. 2001; 12: 595-604
- Bone mineral density of recent African immigrants in the United States.J Natl Med Assoc. 2006; 98: 746-752
- Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center Longitudinal Study.Mayo Clin Proc. 2011; 86: 1050-1055
- Vitamin D deficiency is associated with tuberculosis and latent tuberculosis in immigrants from sub-Saharan Africa.Clin Infect Dis. 2008; 46: 443-446
- Serum 25-hydroxyvitamin D in a West African population of tuberculosis patients and unmatched healthy controls.Am J Clin Nutr. 2007; 86: 1376-1383
- High-dose vitamin D3 during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomized controlled trial.Lancet. 2011; 377: 242-250
- Vitamin D is required for IFN-gamma-mediated antimicrobial activity of human macrophages.Sci Transl Med. 2011; 3: 104ra102
- Can vitamin D reduce total mortality [editorial].Arch Intern Med. 2007; 167: 1709-1710
- Tuberculosis in South Asians living in the United States.Arch Intern Med. 2008; 168: 936-942
- Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population.Am J Cardiol. 2010; 106: 963-968
- Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis.Maturitas. 2010; 65: 225-236
Minnesota Department of Health Data 2010. http://www.health.state.mn.us/. Accessed June 1, 2011.
- Dietary habits of the Somali population in Liverpool, with respect to foods containing calcium and vitamin D: a cause for concern?.J Hum Nutr Diet. 2006; 19: 125-127
- Hypovitaminosis D in immigrant women: slow to be diagnosed.BMJ. 1996; 312: 570-572
- Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D.BMC Fam Pract. 2006; 7: 4
- Musculoskeletal pain in female asylum seekers and hypovitaminosis D3.BMJ. 2004; 329: 156-157
- Vitamin D deficiency among Asian immigrants to Britain.Lancet. 1973; 1: 907-910
- Health issues in newly arrived African refugees attending general practice clinics in Melbourne.Med J Aust. 2006; 185: 602-606
- Vitamin D deficiency in a multinational refugee population.Intern Med J. 2007; 37: 792-797
- Vitamin D deficiency is common and unrecognized among recently arrived adult immigrants from the horn of Africa.Intern Med J. 2003; 33: 47-51
- Vitamin D deficiency in Asian immigrants.Br Med J. 1979; 2: 206
- Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview.Osteoporos Int. 2011; 22: 1009-1021
Nazarian S, Jones SA, Madar A, Semakula C, St. Peter JV. Vitamin D deficiency is highly prevalent in Somali immigrants to the U.S. and represents an easily treatable public health concern. Poster presented at: Endocrine Society Annual Meeting; Toronto, Ontario, Canada; June 2-5, 2007.
- Prevalence of vitamin D deficiency among immigrants to South Dakota.S D Med. 2010; 63: 51-55
- Prevalence of vitamin D insufficiency and clinical associations among veiled East African women in Washington State.J Womens Health. 2007; 16: 206-213
The Minnesota State Demographic Center. http://www.demography.state.mn.us/. Accessed January 8, 2012.
- Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004.Arch Intern Med. 2009; 169: 626-632
- Impact of vitamin D deficiency on the productivity of a health care workforce.J Occup Environ Med. 2012; 54: 117-121
- Dietary Reference Intakes for Calcium and Vitamin D.National Academies Press, Washington, DC2010
- The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know.J Clin Endocrinol Metab. 2011; 96: 53-58
- 14th Vitamin D Workshop consensus on vitamin D nutritional guidelines.J Steroid Biochem Mol Biol. 2010; 121: 4-6
- Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab. 2011; 96: 1911-1930
- Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: recommendations for clinical practice.Autoimmun Rev. 2010; 9: 709-715
- Prevalence of vitamin D insufficiency in an adult normal population.Osteoporosis Int. 1997; 7: 439-443
- Hiding from the sun: vitamin D deficiency in refugees.Aust Fam Physician. 2007; 36: 355-357
- Vitamin D status and nutrition in Europe and Asia.J Steroid Biochem Mol Biol. 2007; 103: 620-625
- Recommended summer sunlight exposure amounts fail to produce sufficient vitamin D status in UK adults of South Asian origin.Am J Clin Nutr. 2011; 94: 1219-11224
- High prevalence of vitamin D inadequacy and implications for health.Mayo Clin Proc. 2006; 81: 353-373
- Serum 25-hydroxyvitamin D concentrations fluctuate seasonally in young adults of diverse ancestry living in Toronto.J Nutr. 2010; 140: 2213-2220
- Vitamin D intake: a global perspective of current status.J Nutr. 2005; 135: 310-316
- Deficiency of sunlight and vitamin D.BMJ. 2008; 336: 1318-1319
- Adequacy of vitamin D replacement in severe deficiency is dependent on body mass index.Am J Med. 2009; 122: 1056-1060
- Vitamin D status in different subgroups of British Asians.Br Med J. 1976; 2: 1351-1354
- Vitamin D concentrations in an UK inner-city multicultural outpatient population.Ann Clin Biochem. 2006; 43: 468-473
- Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.Mayo Clin Proc. 2003; 78: 1463-1470
- Unrecognised severe vitamin D deficiency.BMJ. 2008; 336: 1371-1374
- Immigrant Medicine.Saunders, Philadelphia, PA2007 (234, 259-260, 530-531)
- Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.Public Health Rep. 2003; 118: 293-302
- Access to care for chronic pain: racial and ethnic differences.J Pain. 2005; 6: 301-314
Article Info
Footnotes
Grant Support: This study was supported by Health Partners Research Foundation Institute for Medical Education and the Regions Hospital Department of Internal Medicine.
Identification
Copyright
© 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- CorrectionMayo Clinic ProceedingsVol. 88Issue 4
- PreviewThere is an error in the recently published article, “Effect of Country of Origin, Age, and Body Mass Index on Prevalence of Vitamin D Deficiency in a US Immigrant and Refugee Population” in the January 2013 issue of Mayo Clinic Proceedings (2013;88(1):31-37). There is a significant correlation between BMI and VDD, not a significant negative correlation as previously published. The word “negatively/negative” should be removed from the following 2 sentences, respectively.
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