•  
  •  
 

Abstract

Introduction. Indonesia is a tropical country, but the prevalence of vitamin D deficiency in older women is high due to the lack of sun exposure and low vitamin D intake. Some previous studies have reported that people from rural areas have higher serum 25(OH)D levels compared to those from urban areas. This study was conducted to analyze the correlation between sun exposure score and vitamin D intake with serum 25(OH)D levels of older women from rural areas. Methods. This was an analytic cross-sectional study involving older women in two villages from Wonorejo and Kraton Districts, Pasuruan Regency, in June 2020 during the dry season. The sun exposure score was calculated using a sun exposure questionnaire, vitamin D intake was obtained using the 2 x 24-h food recall, and serum 25(OH)D levels were measured using the chemiluminescent immunoassay. The data was analyzed using the Spearman and Pearson correlation test. Results. A total of 40 post-menopausal women aged 60 to 93 years (median age 70 years) were included in this study. The median sun exposure score was 14. The median time spent outdoors was 40 minutes, 90% of subjects wore longsleeved and long skirts, and all of the subjects never put on sunscreen. The mean value of vitamin D intake was 1.73 μg/day (SD 3.21 μg/day), all of the subjects had low vitamin D intake. The primary source of their vitamin D intake was fish (67.5%), predominantly freshwater fish. The mean value of serum 25(OH)D levels was 27.75 ng/mL (SD 13.25 ng/mL), and 30% of them had vitamin D deficiency. The sun exposure score was positively correlated with serum 25(OH)D levels (r=0.425; p=0.006). Meanwhile, there was a correlation between vitamin D intake and serum 25(OH)D levels (p=0.246). Conclusion. There is a significant positive correlation between sun exposure score and serum 25(OH)D levels, but no correlation between vitamin D intake and serum 25(OH)D levels.

References

1. Setiati S. Vitamin D status among Indonesian elderly women living in institutionalized care units. Acta Med Indones. 2008;40(2):78- 83. 2. Arifin Z, Hestiantoro A, Baziad A. Pemberian susu yang difortifikasi kalsium kadar tinggi dan vitamin D dalam memperbaiki turnover tulang perempuan pascamenopause. Maj Obs Gin Indo. 2010;34(1):31-8. 3. Vera, Setiati S, Govinda A. Determinan diagnostik klinis defisiensi vitamin D pada wanita berusia lebih dari 50 tahun. JPDI. 2015;2(1):38-48. 4. Maddah M, Sharami SH, Neyestani TR. Vitamin D insufficiency among postmenopausal women in urban and rural areas in Guilan, Northern Iran. J Nutriti Elder. 2009;28(4):386-93. 5. Nurbazlin M, Chee WSS, Rokiah PR, Tan ATB, Chew YY, Nusaibah ARS, et al. Effects of sun exposure on 25(OH) vitamin D concentration in urban and rural women in Malaysia. Asia Pacif J Clin Nutr. 2013;22(3):391-9 6. Sari DK, Tala ZZ, Lestari S, Hutagalung SV, Ganie RA. Lifestyle Differences in Rural and Urban Areas Affected the Level of Vitamin D in Women with Single Nucleotide Polymorphism in North Sumatera. Asian J Clin Nutri. 2017;9(2):57-63. 7. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, DawsonHughes B. Estimation of optimal serum concentrations of 25- hydroxyvitamin D for multiple health outcomes. Americ J Clin Nutri. 2006;84:18-28. 8. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-81. 9. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RB, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endoc & Metab. 2011;96:1911-30. 10. Huang CH, Huang YTA, Lai YC, Sun CK. Prevalence and predictors of hypovitaminosis D among the elderly in subtropical region. PLoS ONE. 2017;12(7):e0181063. 11. Oudshoorn C, van der Cammen TJM, McMurdo MET, van Leeuwen JP, Colin EM. Ageing and vitamin D deficiency: effects on calcium homeostasis and considerations for vitamin D supplementation. British J Nutri. 2009:101(11):1597-606. 12. Hossein-Nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proceed. 2013;88(7):720-55. 13. Meehan M, Penckofer S. The role of vitamin D in the aging adult. J Aging & Geron. 2014;2(2):60-71. 14. Setiati S, Oemardi M, Sutrisna B, Supartondo. The role of ultraviolet B from sun exposure on vitamin D3 and parathyroid hormone level in elderly women in Indonesia. Asian J Geron & Geri. 2007;2(3):126- 32. 15. Yosephin B, Khomsan A, Briawan D, Rimbawan. Peranan ultraviolet B sinar matahari terhadap status vitamin D dan tekanan darah pada wanita usia subur. Jurnal Kes Mas Nas. 2014;8(6):256-60. 16. Hanwell HEC, Vieth R, Cole DEC, Scillitani A, Modoni S, Frusciante V, et al. Sun exposure questionnaire predicts circulating 25-hydroxyvitamin D concentrations in Caucasian hospital workers in southern Italy. J Stero Biochem & Molecul Biol. 2010;121(1- 2):334-7. 17. McAdler MM. The relationship between vitamin D status of adult women and diet, sun exposure skin reflectance, body composition, and insulin sensitivity (Thesis). San Luis Obispo: California Polytechnic State University; 2013. 18. Adyanita VA, Widajanti N, Wibisono S. Comparison of the 25(OH) D levels between sarcopenia and frailty in elder women: a crosssectional observation analytic study in elderly community in Surabaya. Syst Rev Pharma. 2020;11(4):359-64. 19. Indirayani HW, Widajanti N, Firdausi H. Hubungan defisiensi kalsidiol serum dan derajat sarkopenia pada komunitas usia lanjut di Surabaya. JPDI. 2020;7(1):29-33. 20. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endoc Rev. 2001;22(4):477-501. 21. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Inves. 1985;76:1536-8. 22. Nimitphong H, Holick MF. Vitamin D status and sun exposure in Southeast Asia. Dermato-Endoc. 2013;5(1):34-7. 23. Lee SH, Park SJ, kim KM, Lee DJ, Kim WJ, Park RW, et al. Effect of sunlight exposure on serum 25-hydroxyvitamin D concentration in women with vitamin d deficiency: using ambulatory lux meter and sunlight exposure questionnaire. Korean J Fam Med. 2012;33(6):381-9. 24. Rimahardika R, Subagio HW, Wijayanti HS. Asupan vitamin D dan paparan sinar matahari pada orang yang bekerja di dalam ruangan dan di luar ruangan. J of Nutri Coll. 2017;6(4):333-42. 25. Sari DK, Damanik HA, Lipoeto NI, Lubis Z. Occurence of vitamin D deficiency among woman in North Sumatera, Indonesia. Malay J Nutri. 2014;20(1):63-70. 26. Yoo K, Cho J, Ly S. Vitamin D intake and serum 25-hydroxyvitamin D levels in Korean adults: analysis of the 2009 Korea National Health and Nutrition Examination Survey (KNHANES IV-3) using a newly established vitamin D database. Nutrients. 2016;8(610):1-13. 27. Sebbar E, Sam H, Saalaoui E, Choukri M. Dietary intake of vitamin D in the Moroccan elderly. Inter J Med Res & Health Sciences. 2018;7(1):53-6. 28. Chiu KC, Chu A, Go VLW, Saad MF. Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. Am J Clin Nutr. 2004;79:820-5. 29. Mitri J, Muraru MD, Pittas AG. Vitamin D and type 2 diabetes: a systematic review. Europ J Clin Nutri. 2011;65(9):1005-15. 30. Gouni-Berthold I, Krone W, Berthold HK. Vitamin D and cardiovascular disease. Curr Vasc Pharm. 2009;4(7):414-2. 31. Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF. Clothing prevents ultraviolet-B radiationdependent photosynthesis of vitamin D3. J Clin Endoc & Metab. 1992;75(4):1099-103. 32. Tsiaras W, Weinstock M. Factors influencing vitamin D status. Acta Derma Vener. 2011;91(2):115-24. 33. Elizondo-Montemayor L, Castillo EC, Rodríguez-López C, Villarreal-Calderón JR, Gómez-Carmona M, Tenorio-Martínez S, et al. Seasonal variation in vitamin D in association with age, inflammatory cytokines, anthropometric parameters, and lifestyle factors in older adults. Mediat of Inflam. 2017;2017:5719461. 34. Harahap IMA. Hubungan asupan vitamin D terhadap kadar 25(OH) D serum pada perempuan usia 20-40 tahun di Desa Aman Damai Kecamatan Sirapit Kabupaten Langkat (Skripsi). Medan: Universitas Sumatera Utara; 2017. 35. Naugler C, Zhang J, Henne D, Woods P, Hemmelgarn BR. Association of vitamin D status with socio-demographic factors in Calgary, Alberta: an ecological study using Census Canada data. BMC Pub Health. 2013;13(1):316. 36. Hoge A, Donneau AF, Streel S, Kolh P, Chapelle JP, Cavaller E, et al. Vitamin D deficiency is common among adults in Wallonia (Belgium, 51°30’ North): findings from the Nutrition, Environment and Cardio-Vascular Health study. Nutri Res. 2015;35(8):716-25. 37. Kuchuk NO, Pluijm SM, van Schoor NM, Looman CWN, Smit JH, Lips P. Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J of Clin Endoc & Metab. 2009;94(4):1244-50. 38. Lucas R, McMichael T, Smith W, Armstrong B. Solar ultraviolet radiation: global burden of disease from solar ultraviolet radiation. In: Prüss-Üstün A, Zeeb H, Mathers C, Repacholi M, editors. Environmental burden of disease series, No. 13. Geneva: WHO Library; 2006. 39. Oliveria SA, Saraiya M, Geller AC, Heneghan MK, Jorgensen C. Sun exposure and risk of melanoma. Arch Dis in Child. 2006;91:131–8. 40. Hoel DG, Berwick M, Gruijl FR, Holick MF. The risks and benefits of sun exposure. Dermatoendocrinol. 2016;8(1):e1248325. 41. Nakamura K. Fish as a major source of vitamin D in the Japanese diet. Nutrition. 2002;18:415-6.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.