scholarly journals Dietary Vitamin D Restriction in Pregnant Female Mice Is Associated With Maternal Hypertension and Altered Placental and Fetal Development

Endocrinology ◽  
2013 ◽  
Vol 154 (7) ◽  
pp. 2270-2280 ◽  
Author(s):  
Nancy Q. Liu ◽  
Yi Ouyang ◽  
Yasemin Bulut ◽  
Venu Lagishetty ◽  
Shiao Y. Chan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Dietary Vitamin ◽  
Vitamin D Status ◽  
Angiotensin Ii Receptor ◽  
Placental Development ◽  
Maternal Hypertension ◽  
Pregnant Mice ◽  
Deficient Mice

Abstract Epidemiology has linked vitamin D deficiency with preeclampsia in humans. We hypothesized that low vitamin D status in pregnant mice may lead to symptoms of preeclampsia. Female BL6 mice were raised on vitamin D-sufficient or -deficient diets from weeks 4 of age and then mated with vitamin D-sufficient BL6 males at week 8. The resulting pregnant mice were either allowed to deliver pups and monitored for blood pressure (BP) and weight of offspring or euthanized at day 14 or 18 of gestation (E14 or E18) for analysis of serum, placental/kidney tissues, and fetuses. At E14 serum concentrations of 25-hydroxyvitamin D (30.1 ± 5.0 vs 1.8 ± 0.6 ng/mL, P < .001) and 1,25-dihydroxyvitamin D (119.5 ± 18.7 vs 37.4 ± 5.1 pg/mL, P < .01) were higher in sufficient vs deficient pregnant mice. At E14 BP was significantly elevated in vitamin D-deficient pregnant mice relative to vitamin D-sufficient mice for both systolic BP (124.89 ± 2.28 vs 105.34 ± 3.61 mm Hg, P < .001) and mean arterial pressure (115.33 ± 1.93 vs 89.33 ± 5.02 mm Hg, P < .001). This elevation continued through pregnancy until 7 days postpartum (PP7) but returned to baseline by PP14. Analysis of maternal kidneys showed increased expression of mRNA for renin and the angiotensin II receptor (3- and 4-fold, respectively) in vitamin D-deficient vs -sufficient mice at E14. Histological analysis of E14 placentas from vitamin D-deficient mice showed decreased vascular diameter within the labyrinth region. E14 and E18 fetuses from vitamin D-deficient mice were larger than those from vitamin D-sufficient mothers. However, by PP14 pups from vitamin D-deficient mothers weighed significantly less than those from vitamin D-sufficient mothers. Resupplementation of vitamin D periconceptually partially reversed the effects of vitamin D deficiency. These data provide further evidence that low vitamin D status may predispose pregnant women to dysregulated placental development and elevated blood pressure.

scholarly journals Association of vitamin D with adiposity measures and other determinants in a cross-sectional study of Cypriot adolescents

2014 ◽  
Vol 18 (1) ◽  
pp. 112-121 ◽  
Author(s):  
Ourania Kolokotroni ◽  
Anna Papadopoulou ◽  
Panayiotis K Yiallouros ◽  
Vasilios Raftopoulos ◽  
Christiana Kouta ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Reference Group ◽  
Serum Vitamin ◽  
Sun Exposure ◽  
Dietary Vitamin ◽  
Vitamin D Status ◽  
Fat Percentage ◽  
Cross Sectional ◽  
Serum Vitamin D

AbstractObjectiveTo assess vitamin D status among Cypriot adolescents and investigate potential determinants including BMI and body fat percentage (BF%).DesignParticipants had cross-sectional assessments of serum vitamin D, physical activity, dietary vitamin D intake and sun exposure. Linear and logistic regression models were used to explore the associations of vitamin D with potential predictors.SettingHospitals, Cyprus, November 2007–May 2008.SubjectsAdolescents (n 671) aged 16–18 years.ResultsMean serum vitamin D was 22·90 (sd 6·41) ng/ml. Only one in ten children had sufficient levels of vitamin D (≥30 ng/ml), while the prevalence of vitamin D deficiency (12–20 ng/ml) and severe deficiency (<12 ng/ml) was 31·7 % and 4·0 %, respectively. Lower vitamin D was associated with winter and spring season, female gender, reduced sun exposure in winter and darker skin. Participants with highest BMI and BF% when compared with a middle reference group had increased adjusted odds of vitamin D insufficiency (OR = 3·00; 95 % CI 1·21, 7·45 and OR = 5·02; 95 % CI 1·80, 13·97, respectively). A similar pattern, although not as strong, was shown for vitamin D deficiency with BF% (OR = 1·81; 95 % CI 1·04, 3·16) and BMI (OR = 1·51; 95 % CI 0·85, 2·67). Participants in the lowest BMI and BF% groups also displayed compromised vitamin D status, suggesting a U-shaped association.ConclusionsVitamin D deficiency in adolescence is very prevalent in sunny Cyprus, particularly among females, those with darker skin and those with reduced sun exposure in winter. Furthermore, vitamin D status appears to have a U-shaped association with adiposity measures.

scholarly journals Dietary vitamin D3 deficiency alters intestinal mucosal defense and increases susceptibility to Citrobacter rodentium-induced colitis

2015 ◽  
Vol 309 (9) ◽  
pp. G730-G742 ◽  
Author(s):  
Natasha R. Ryz ◽  
Arion Lochner ◽  
Kirandeep Bhullar ◽  
Caixia Ma ◽  
Tina Huang ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Host Defense ◽  
Vitamin D3 ◽  
Inflammatory Responses ◽  
Active Form ◽  
Dietary Vitamin ◽  
Gene Transcript ◽  
Citrobacter Rodentium ◽  
Deficient Mice

Vitamin D deficiency affects more that 1 billion people worldwide. Although thought to increase risk of bacterial infections, the importance of vitamin D on host defense against intestinal bacterial pathogens is currently unclear since injection of the active form of vitamin D, 1,25(OH)2D3, increased susceptibility to the enteric bacterial pathogen Citrobacter rodentium by suppressing key immune/inflammatory factors. To further characterize the role of vitamin D during bacteria-induced colitis, we fed weanling mice either vitamin D3-deficient or vitamin D3-sufficient diets for 5 wk and then challenged them with C. rodentium. Vitamin D3-deficient mice lost significantly more body weight, carried higher C. rodentium burdens, and developed worsened histological damage. Vitamin D3-deficient mice also suffered greater bacterial translocation to extra-intestinal tissues, including mesenteric lymph nodes, spleen, and liver. Intestinal tissues of infected vitamin D3-deficient mice displayed increased inflammatory cell infiltrates as well as significantly higher gene transcript levels of inflammatory mediators TNF-α, IL-1β, IL-6, TGF-β, IL-17A, and IL-17F as well as the antimicrobial peptide REG3γ. Notably, these exaggerated inflammatory responses accelerated the loss of commensal microbes and were associated with an impaired ability to detoxify bacterial lipopolysaccharide. Overall, these studies show that dietary-induced vitamin D deficiency exacerbates intestinal inflammatory responses to infection, also impairing host defense.

scholarly journals Vitamin D status and its correlation with blood pressure in premenopausal Saudi women: a cross-sectional study.

2016 ◽  
Vol 9 (1) ◽  
Author(s):  
Sarah Al Mazeedi ◽  
Hanan Al Kadi ◽  
Mohammed Ardawi
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Negative Correlation ◽  
Study Group ◽  
Saudi Population ◽  
Vitamin D Status ◽  
Major Health Problem ◽  
Vitamin D Levels ◽  
Blood Pressures

Vitamin D deficiency is a major health problem in the Saudi population. A negative association between blood pressure and vitamin D level has been suggested in several clinical and epidemiological studies and evidence for an effect of vitamin D in lowering blood pressure was reported. These findings indicate that 1,25(OH)2D3 deficiency may play a role in the pathogenesis of hypertension through its effect on the renin-angiotensin system. We are the first to investigate the correlation between blood pressure or renin concentration and vitamin D status in the Saudi population METHODS: we included 201 healthy Saudi premenopausal females (20-45 years old). Blood pressure was measured by a standardized method using an automated blood pressure monitor (BPTru). Fasting blood samples were collected from each participant after 20 minutes of rest in the seated position. Serum cholicalciferol, PTH and renin concentration were measured by sandwich chemiluminescence immunoassaymethod (DiaSorin, Italy). RESULTS: The analysis included 192 subjects who were normotensive (blood pressure <140/90 mmHg).  A total of  34% of women had a severe deficiency (vitamin D ≤ 12.5 nmol/L); 41% had moderate deficiency (vitamin D levels between 12.5 - 25 nmol/L);  23% had mild deficiency (vitamin D level ≥ 25 - < 50 nmol/L); and 2% had insufficiency (vitamin D level  ≥ 50 - ≤ 75 nmol/L). None had a sufficient level of ≥75 nmol/L.  The systolic blood pressure ranged from 79-130.5mmHg and the diastolic from 48.5-85.5 mmHg.  Both systolic and diastolic blood pressures were significantly higher in women that were in the lower 2 quartiles of vitamin D.  However, linear regression analysis adjusting for potential confounders showed that 25(OH)D level was not a predictor of either systolic or diastolic blood pressures.  A negative correlation (although not significant) was found between vitamin D level and plasma renin concentration in this study group. CONCLUSION: Vitamin D deficiency was highly prevalent among the study group. Vitamin D was a not a predictor of either systolic or diastolic blood pressure.  There was a negative correlation between vitamin D level and renin concentration although not statically significant. It is possible that any underlying relationship was obscured by the relatively young age group or due to the narrow blood pressure range of the studied population. A larger sample size including hypertensive subjects may be needed.

scholarly journals Vitamin D Deficiency in Mice Impairs Colonic Antibacterial Activity and Predisposes to Colitis

Endocrinology ◽  
2010 ◽  
Vol 151 (6) ◽  
pp. 2423-2432 ◽  
Author(s):  
Venu Lagishetty ◽  
Alexander V. Misharin ◽  
Nancy Q. Liu ◽  
Thomas S. Lisse ◽  
Rene F. Chun ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Levels ◽  
Enteric Bacteria ◽  
Sodium Sulphate ◽  
Antimicrobial Protein ◽  
Vitamin D Status ◽  
Colon Tissue ◽  
Vitamin D Levels ◽  
Deficient Mice

Vitamin D insufficiency is a global health issue. Although classically associated with rickets, low vitamin D levels have also been linked to aberrant immune function and associated health problems such as inflammatory bowel disease (IBD). To test the hypothesis that impaired vitamin D status predisposes to IBD, 8-wk-old C57BL/6 mice were raised from weaning on vitamin D-deficient or vitamin D-sufficient diets and then treated with dextran sodium sulphate (DSS) to induce colitis. Vitamin D-deficient mice showed decreased serum levels of precursor 25-hydroxyvitamin D3 (2.5 ± 0.1 vs. 24.4 ± 1.8 ng/ml) and active 1,25-dihydroxyvitamin D3 (28.8 ± 3.1 vs. 45.6 ± 4.2 pg/ml), greater DSS-induced weight loss (9 vs. 5%), increased colitis (4.71 ± 0.85 vs. 1.57 ± 0.18), and splenomegaly relative to mice on vitamin D-sufficient chow. DNA array analysis of colon tissue (n = 4 mice) identified 27 genes consistently (P &lt; 0.05) up-regulated or down-regulated more than 2-fold in vitamin D-deficient vs. vitamin D-sufficient mice, in the absence of DSS-induced colitis. This included angiogenin-4, an antimicrobial protein involved in host containment of enteric bacteria. Immunohistochemistry confirmed that colonic angiogenin-4 protein was significantly decreased in vitamin D-deficient mice even in the absence of colitis. Moreover, the same animals showed elevated levels (50-fold) of bacteria in colonic tissue. These data show for the first time that simple vitamin D deficiency predisposes mice to colitis via dysregulated colonic antimicrobial activity and impaired homeostasis of enteric bacteria. This may be a pivotal mechanism linking vitamin D status with IBD in humans.

Association between vitamin D deficiency and prevalence of metabolic syndrome in female population: a systematic review

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Nazila Fathi Maroufi ◽  
Pourya Pezeshgi ◽  
Zohreh Mortezania ◽  
Pirouz Pourmohammad ◽  
Reyhaneh Eftekhari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
High Blood Pressure ◽  
Fast Blood Sugar ◽  
Syndrome X ◽  
Vitamin D Status ◽  
Female Population

AbstractBackgroundThe increasing prevalence of metabolic syndrome (MS) especially in female population, has become a major problem in health care systems. In this regards, it is necessary to identify the risk factors. Vitamin D deficiency is now proposed as one of the possible risk factors for metabolic syndrome, we investigated the relationship between vitamin D status and MS in female.MethodsWe searched observational studies with keywords Vitamin D, metabolic syndrome, metabolic syndrome X, insulin-resistance syndrome, metabolic cardiovascular syndrome and Reaven Syndrome X and female in pubmed, scopus, science direct, cochrane, web of science, google scholar and SID databases, regardless of publication time. Two hundred ninety five studies were found, and finally only 12 articles were selected according to exclusion and inclusion criteria.ResultsIn nine studies that reported the prevalence of MS, the prevalence of MS among women with vitamin D deficiency was higher than female with normal vitamin D (34.5 vs. 30.2%). The prevalence of abdominal obesity, high blood pressure, high TG and HDL deficiency is higher in women with vitamin D deficiency. Also, the mean waist circumference, blood pressure, fast blood sugar (FBS), TG and BMI were higher. The most incident factor was high blood pressure (61.4 vs. 56.5%) and the lowest prevalence is associated with high FBS (32.2 vs. 33.5% in the other group).ConclusionThe prevalence of MS is significantly associated with vitamin D deficiency, and among related factors, HDL, TG and blood pressure are statistically associated with vitamin D status.

scholarly journals Vitamin D status and dietary intake in young university students in the UK

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Honglin Dong ◽  
Viktorija Asmolovaite ◽  
Nareen Marseal ◽  
Maryam Mearbon
Keyword(s):  
Vitamin D ◽  
University Students ◽  
Dietary Intake ◽  
Vitamin D Deficiency ◽  
Dietary Vitamin ◽  
Small Scale ◽  
Vitamin D Status ◽  
Content Type ◽  
Vitamin D Intake ◽  
Dietary Vitamin D

Purpose Vitamin D deficiency is prevalent worldwide. This paper aims to investigate the vitamin D status and dietary intake in young university students. Design/methodology/approach Forty-one healthy students aged 18–29 years from Coventry University UK were recruited during January-February 2019, including white Caucasians (n = 18), African-Caribbeans (n = 14) and Asians (n = 9). Plasma 25(OH)D concentrations were measured and dietary vitamin D intake was determined. Chi-square and simple linear regression were used to analyse the data. Findings The plasma 25(OH)D concentrations were (36.0 ± 22.2) nmol/L in all subjects, (46.5 ± 25.3) nmol/L in white Caucasians, (22.6 ± 7.4) nmol/L in African-Caribbeans and (37.4 ± 21.7 nmol/L) in Asians. The majority (85.7%) of African-Caribbeans were vitamin D deficient compared with 22.2% of white Caucasians and 33.3% of Asians (p = 0.001). Overweight/obese subjects showed a significant higher proportion of vitamin D deficiency (65%) than normal weight subjects (28.6%) (p = 0.04). The average dietary vitamin D intake in all subjects was (4.6 ± 3.9) µg/day. Only 12.1% of the subjects met the recommended dietary vitamin D intake of 10 µg/day. Dietary vitamin D intake (p = 0.04) and ethnicity (p = 0.01) were significant predictors of 25(OH)D levels and accounted for 13% and 18.5% of 25(OH)D variance, respectively. Research limitations/implications This small-scale study showed an alarmingly high prevalence of vitamin D deficiency among subjects from African-Caribbean origin during wintertime. Education programs and campaigns are urgently needed to fight the vitamin D deficiency in this population. Originality/value The targeted population were in a critical period of transition from adolescence toward adulthood involving in changes in behaviours and nutrition.

scholarly journals Determinants of serum 25-hydroxyvitamin D levels in healthy young adults living in the Western Cape, South Africa

2019 ◽  
Vol 61 (4) ◽  
pp. 26
Author(s):  
J. Visser ◽  
K. Knight ◽  
L. Philips ◽  
W. Visser ◽  
M. Wallace ◽  
...  
Keyword(s):  
South Africa ◽  
Vitamin D ◽  
Young Adults ◽  
Vitamin D Deficiency ◽  
Skin Tone ◽  
Dietary Vitamin ◽  
Vitamin D Status ◽  
Vitamin D Intake ◽  
Vitamin D Levels ◽  
Dietary Vitamin D

Background: Vitamin D deficiency is fast emerging as a global pandemic. In South Africa few studies have been conducted to determine the vitamin D status of the healthy population.Methods: This prospective study with an analytical component investigated vitamin D status of healthy undergraduate students at two time points (winter and summer) at Stellenbosch University. Serum 25(OH)D was determined, anthropometric measurements taken and dietary vitamin D intake estimated (food-frequency questionnaire). Skin tone was determined (Fitzpatrick skin type classification), and a skin reflectometry device used to measure dermal melanin content.Results: Results of 242 students indicated a mean serum 25(OH)D of 63.80 ± 41.35 ng/ml and a high prevalence of vitamin D sufficiency (88%). Significantly more females experienced suboptimal vitamin D levels than males (18 vs. 5%; p 0.01). Participants with lighter skin tones had higher levels of 25(OH)D than those with darker skin tones (chi-square = 24.02; p = 0.02). The majority (60.74%) had a normal BMI, although there was no significant relationship between BMI and serum 25 (OH)D (Spearman’s r=–0.11; p = 0.09). Total mean dietary vitamin D intake was 7.99 ± 13.81 mcg, with 87.2% having inadequate intake ( 15 mcg). The relationship between total vitamin D intake and serum 25(OH)D was found to be significant in winter (p 0.001) and summer (p = 0.01). Serum vitamin D levels were significantly higher in the winter phase (p 0.001).Conclusions: A low prevalence of vitamin D deficiency was found amongst healthy young adults, despite low dietary vitamin D intakes. Significant relationships were found between serum 25(OH)D and gender, skin tone and vitamin D intake. Further studies need to be conducted, especially in high-risk groups, before results are applied to the greater South African public.

scholarly journals Relationship between Serum 25OH-Vitamin D2 Level and Vitamin D Status of Children Aged 3–5 Years in China

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4135
Author(s):  
Xuehong Pang ◽  
Zhenyu Yang ◽  
Jie Wang ◽  
Yifan Duan ◽  
Liyun Zhao ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Health Surveillance ◽  
Dietary Vitamin ◽  
Total Serum ◽  
Vitamin D2 ◽  
Vitamin D Status ◽  
Nutrition And Health ◽  
Dietary Vitamin D

Background: Vitamin D deficiency is prevalent globally and there is lack of evidence as to how 25(OH)D2 contributes to vitamin D status. The aim of this study was to describe vitamin D status and to assess the role of vitamin D2, a dietary vitamin D source, against the vitamin D status of children aged 3–5 years in China. Methods: Data were extracted from the Chinese National Nutrition and Health Surveillance (CNNHS) in 2013. The concentration of serum 25(OH)D2 and 25(OH)D3 was measured by using LC-MS/MS. Results: A total of 1435 subjects were enrolled and serum 25(OH)D were analyzed. The prevalence of total serum 25(OH)D < 30 nmol/L was 8.9%. Serum 25(OH)D2 was detected in 10.9% of the studied children. After adjusting for confounding factors, total 25(OH)D concentration was 8.48 nmol/L lower and odds ratio of vitamin D deficiency was 4.20 times (OR (95%CI): 4.20 (1.64, 10.77)) in children without 25(OH)D2 than those with 25(OH)D2 detected. Conclusions: Vitamin D deficiency was common among children aged 3–5 years in China. Vitamin D2 may play a role in preventing vitamin D deficiency in Chinese children aged 3–5 years.

scholarly journals Ethnic disparities in the dietary requirement for vitamin D during pregnancy: considerations for nutrition policy and research

2017 ◽  
Vol 77 (2) ◽  
pp. 164-173 ◽  
Author(s):  
Karen M. O'Callaghan ◽  
Mairead E. Kiely
Keyword(s):  
Vitamin D ◽  
Ethnic Minority ◽  
Vitamin D Deficiency ◽  
Ethnic Minorities ◽  
Minority Groups ◽  
Sufficient Evidence ◽  
Dietary Vitamin ◽  
Inverse Association ◽  
Vitamin D Status ◽  
Dietary Requirements

Despite the inverse association between skin colour and efficiency of cutaneous vitamin D synthesis, in addition to the widely accepted racial disparity in vitamin D status, populations of ethnic minority are understudied in terms of setting target serum 25-hydroxyvitamin D concentrations and corresponding dietary requirements for vitamin D. In minority groups, prevention of vitamin D deficiency on a population basis is challenging due to the lack of clarity surrounding the metabolism and transport of vitamin D. Authoritative agencies have been unable to define pregnancy-specific dietary recommendations for vitamin D, owing to an absence of sufficient evidence to confirm whether nutritional requirements for vitamin D are altered during pregnancy. While the question of setting race- and pregnancy-specific dietary reference values for vitamin D has not been addressed to date, endemic vitamin D deficiency has been reported among gravidae worldwide, specifically among ethnic minorities and white women resident at high latitude. In light of the increased risk of nutritional rickets among infants of ethnic minority, coupled with growing evidence for potential non-skeletal roles of vitamin D in perinatal health, determination of the dietary vitamin D requirement that will prevent deficiency during pregnancy is a research priority. However, systematic approaches to establishing dietary requirements are limited by the quality of the available evidence and the under-representation of minority groups in clinical research. This review considers the evidence for racial differences in vitamin D status and response to vitamin D supplementation, with particular application to pregnancy-specific requirements among ethnic minorities resident at high latitudes.

Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study

2015 ◽  
Vol 85 (1-2) ◽  
pp. 23-30 ◽  
Author(s):  
Aneta Aleksova ◽  
Rita Belfiore ◽  
Cosimo Carriere ◽  
Salam Kassem ◽  
Salvatore La Carrubba ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Primary Source ◽  
Sun Exposure ◽  
Female Gender ◽  
Developed Countries ◽  
Vitamin D Status ◽  
High Exposure

Abstract. Background: Hypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area. Methods: Vitamin D status was identified in 478 subjects diagnosed with acute myocardial infarction. Results: The median serum 25-hydroxyvitamin D concentration was 14.5 [7.8 - 22.7] ng/mL. Vitamin D deficiency and insufficiency were present in 324 (68 %) and 107 (22 %) subjects, respectively. Vitamin D deficiency was less frequent among subjects enrolled in the period from July to the end of September (p < 0.001). In a multivariate analysis vitamin D deficiency was predicted by older age (p = 0.02), female gender (p = 0.002), higher body mass index (p = 0.05), autumn/winter sampling (p < 0.001), increased parathyroid hormone (p = 0.03) and alkaline phosphatase (p = 0.003). Conclusions: We observed very high prevalence of vitamin D deficiency among subjects with myocardial infarction in all seasons of enrollment. However, it was lower in the summer when sun exposure is higher. The exposure to sunlight may be a cost-saving therapeutic strategy for the management of vitamin D deficiency.

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