Lifestyle factors including less cutaneous sun exposure contribute to starkly lower vitamin D levels in U.K. South Asians compared with the white population

Background Long-standing concerns over the vitamin D status of South Asian adults in the U.K. require studies using statistically valid sample sizes to measure annual variation and contributory lifestyle factors. Objectives To measure annual variation in the vitamin D status of U.K. South Asians, to determine the associated lifestyle influences, and to compare these with a similar study of white adults. Methods A single-centre, prospective cohort study measuring circulating 25-hydroxyvitamin D [25(OH)D], sunlight exposure levels and lifestyle factors for 1 year in 125 ambulant South Asian adults with sun-reactive skin type V, aged 20-60 years, in Greater Manchester, U.K. (53·5°N). Results The 25(OH)D levels of South Asians were alarmingly low. In summer, their median 25(OH)D level was 9·0 ng mL-1, [interquartile range (IQR) 6·7-13·1], falling to 5·8 ng mL-1 (IQR 4·0-8·1) in winter. This compared with values in the white population of 26·2 ng mL-1 (IQR 19·9-31·5) in summer and 18·9 ng mL-1 IQR (11·6-23·7) in winter. Median daily dietary vitamin D was lower in South Asians (1·32 μg vs. 3·26 μg for white subjects) and was compounded by low supplement use. Despite similar times spent outdoors, ultraviolet (UV) dosimeters recorded lower personal UV exposure among South Asians, indicating sun avoidance when outside, while sun exposure diaries recorded lower amounts of skin surface exposure. Conclusions The majority of South Asians never reached sufficiency in vitamin D status. Lifestyle differences, with lower oral intake, sun exposure and rates of cutaneous production due to darker skin, indicate that standard advice on obtaining sufficient vitamin D needs modification for the South Asian community in the U.K. What's already known about this topic? South Asians in the U.K. have much lower vitamin D levels than the white population. What does this study add? Behavioural factors significantly contribute to lower vitamin D status, with lower ultraviolet exposure, dietary intake and supplement use contributing. The behavioural data suggest more targeted health messages are needed to address the vitamin D status of the U.K. South Asian population. © 2013 British Association of Dermatologists.