Association between physical activity and vitamin D status: A cross-sectional study from the PERSIAN Guilan cohort study

Mohammadreza  Javid; Farahnaz  Joukar; Amirreza  Emamhadi; Niloofar  Faraji; Tahereh  Zeinali; Saman  Maroufizadeh; Mohammadreza  Naghipour; Fariborz Mansour-Ghanaei

doi:10.61882/jcbior.5.3.290

Authors

Mohammadreza Javid Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Farahnaz Joukar Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Amirreza Emamhadi Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Niloofar Faraji Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Tahereh Zeinali Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Saman Maroufizadeh Department of Biostatistics, School of Health, Guilan University of Medical Sciences, Rasht, Iran.
Mohammadreza Naghipour Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Fariborz Mansour-Ghanaei Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran https://orcid.org/0000-0002-6264-0025

DOI:

https://doi.org/10.61882/jcbior.5.3.290

Keywords:

BMI, Physical activity, Vitamin D deficiency, Vitamin D supplement

Abstract

A surprisingly high prevalence of vitamin D (vit D) deficiency has recently been reported worldwide. This study investigated the association between vit D status and physical activity in the Prospective Epidemiological Research Studies in IRAN (PERSIAN) cohort study, while also considering the influence of potential confounders. This cross-sectional study has been conducted on 9522 participants aged 35 to 70. The serum vit D concentrations were measured, and participants were divided into three tertiles of low, moderate, and high levels of physical activity according to the metabolic equivalent of task (MET). The cutoff level for vit D deficiency was considered ≤12 ng/ml. The association of vitamin D deficiency with physical activity (PA) was examined using logistic regression analysis. Odds ratio (OR)s were adjusted for vit D supplement use, sociodemographic characteristics, and additional covariates. About 4428 participants were male, and the mean age of participants was 51.46 ± 8.91 years. The prevalence of vit D deficiency was 22.8% and more common in women than men (23.8% vs. 21.7%). The prevalence of vit D deficiency decreased with increasing physical activity (P<0.001). In the adjusted model for vit D supplements and sociodemographic characteristics, the participants with low physical activity had a higher risk of vit D deficiency than participants with high physical activity. According to our findings, vit D deficiency was associated with a reduced frequency of participation in all forms of physical activity.

References

1. Tabrizi R, Moosazadeh M, Akbari M, Dabbaghmanesh MH, Mohamadkhani M, Asemi Z, et al. High Prevalence of Vitamin D Deficiency among Iranian Population: A Systematic Review and Meta-Analysis. Iran J Med Sci. 2018;43(2):125-139. PMID: 29749981

2. Holick MF. The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Aspects Med. 2008;29(6):361-8. DOI: 10.1016/j.mam.2008.08.008 PMID: 18801384

3. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014;144 Pt A:138-45. DOI: 10.1016/j.jsbmb.2013.11.003 PMID: 24239505

4. Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci. 2018;1430(1):44-79. DOI: 10.1111/nyas.13968 PMID: 30225965

5. Kweder H, Eidi H. Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status. Avicenna J Med. 2018;8(4):139-146. DOI: 10.4103/ajm.AJM_20_18 PMID: 30319955

6. Vatandost S, Jahani M, Afshari A, Amiri MR, Heidarimoghadam R, Mohammadi Y. Prevalence of vitamin D deficiency in Iran: A systematic review and meta-analysis. Nutr Health. 2018;24(4):269-278. DOI: 10.1177/0260106018802968 PMID: 30296903

7. Afzal S, Nordestgaard BG. Vitamin D, Hypertension, and Ischemic Stroke in 116 655 Individuals From the General Population: A Genetic Study. Hypertension. 2017;HYPERTENSIONAHA.117.09411. DOI: 10.1161/HYPERTENSIONAHA.117.09411 PMID: 28760944

8. Vierucci F, Del Pistoia M, Fanos M, Erba P, Saggese G. Prevalence of hypovitaminosis D and predictors of vitamin D status in Italian healthy adolescents. Ital J Pediatr. 2014;40:54. DOI: 10.1186/1824-7288-40-54 PMID: 24902694

9. Faraji N, Abbaspour S, Ajamian F, Keshavarz P. Role of ENPP1 Gene Variants in the Susceptibility to Diabetic Nephropathy in Patients with type 2 Diabetes Mellitus. Biochem Genet. 2023;61(6):2710–23. Available from: DOI: 10.1007/s10528-023-10402-z

10. Haghighi M, Khoshrang H, Rimaz S, Kalurazi TY, Atrkar Z, Roushan SGT, et al. Evaluation of sequential organ failure assessment (SOFA) score efficiency in predicting the mortality of intensive care unit admitted COVID-19 patients. J Curr Biomed Reports. 2021;2(4):168–75. DOI: 10.52547/JCBioR.2.4.168

11. Motamed B, Alavi Foumani A, Tangestaninezhad A, Almasi M, Faraji N, Jafarinezhad A. The relationship between glycated hemoglobin A1c levels and exacerbation status in the patients with chronic obstructive pulmonary disease. BMC Res Notes. 2022;15(1):326. DOI: 10.1186/s13104-022-06217-7

12. Yaseri M, Fayazi H S, Mortazavi S S, Faraji N. Uric Acid Level and Glycemic Status in Patients With Type 2 Diabetes. JGUMS 2022;30(4):268-275. URL: http://journal.gums.ac.ir/article-1-2393-en.html

13. Kalurazi TY, Shakoori V, Nasiri S, Foumani AA, Hesni E, Mahfoozi L, et al. Clinical characteristics and laboratory findings of patients with COVID-19 in Rasht, Iran. J Curr Biomed Reports. 2022;3(2):91–7. DOI: 10.52547/JCBioR.3.2.91

14. Al Refaie A, Baldassini L, Mondillo C, De Vita M, Giglio E, Tarquini R, et al. Vitamin D and Dyslipidemia: Is There Really a Link? A Narrative Review. Nutrients. 2024;16(8):1144. DOI: 10.3390/nu16081144 PMID: 38674837

15. Zhao H, Zhen Y, Wang Z, Qi L, Li Y, Ren L, Chen S. The Relationship Between Vitamin D Deficiency and Glycated Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes. 2020;13:3899-3907. DOI: 10.2147/DMSO.S275673 PMID: 33116736

16. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20(11):1807-20. DOI: 10.1007/s00198-009-0954-6 PMID: 19543765

17. Saneei P, Salehi-Abargouei A, Esmaillzadeh A. Serum 25-hydroxy vitamin D levels in relation to body mass index: a systematic review and meta-analysis. Obes Rev. 2013;14(5):393-404. DOI: 10.1111/obr.12016 PMID: 23331724

18. Brock KE, Ke L, Tseng M, Clemson L, Koo FK, Jang H, et al. Vitamin D status is associated with sun exposure, vitamin D and calcium intake, acculturation and attitudes in immigrant East Asian women living in Sydney. J Steroid Biochem Mol Biol. 2013;136:214-7. DOI: 10.1016/j.jsbmb.2012.12.005 PMID: 23262263

19. Bassil D, Rahme M, Hoteit M, Fuleihan Gel-H. Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes. Dermatoendocrinol. 2013;5(2):274-98. DOI: 10.4161/derm.25111 PMID: 24194968

20. Specker BL. Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res. 1996;11(10):1539-44. DOI: 10.1002/jbmr.5650111022 PMID: 8889855

21. Kim J, Park J, So WY. Association between Blood Vitamin D Levels and Regular Physical Activity in Korean Adolescents. Healthcare (Basel). 2022;10(7):1277. DOI: 10.3390/healthcare10071277 PMID: 35885804

22. Fernandes MR, Barreto WDR Junior. Association between physical activity and vitamin D: A narrative literature review. Rev Assoc Med Bras (1992). 2017;63(6):550-556. DOI: 10.1590/1806-9282.63.06.550 PMID: 28876433

23. Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA, Hekmatdoost A, et al. Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, Objectives, and Design. Am J Epidemiol. 2018;187(4):647-655. DOI: 10.1093/aje/kwx314 PMID: 29145581

24. Mansour-Ghanaei F, Joukar F, Naghipour MR, Sepanlou SG, Poustchi H, Mojtahedi K, et al. The PERSIAN Guilan Cohort Study (PGCS). Arch Iran Med. 2019;22(1):39-45. PMID: 30821159

25. Kazemi Karyani A, Karmi Matin B, Soltani S, Rezaei S, Soofi M, Salimi Y, et al. Socioeconomic gradient in physical activity: findings from the PERSIAN cohort study. BMC Public Health. 2019;19(1):1312. DOI: 10.1186/s12889-019-7715-z PMID: 31638932

26. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575-81. DOI: 10.1249/MSS.0b013e31821ece12 PMID: 21681120

27. Joukar F, Naghipour M, Hassanipour S, Salari A, Alizadeh A, Saeidi-Saedi H, et al. Association of Serum Levels of Vitamin D with Blood Pressure Status in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS). Int J Gen Med. 2020;13:99-104. DOI: 10.2147/IJGM.S244472 PMID: 32210606

28. Uday S, Högler W. Nutritional rickets & osteomalacia: A practical approach to management. Indian J Med Res. 2020;152(4):356-367. DOI: 10.4103/ijmr.IJMR_1961_19 PMID: 33380700

29. Scragg R, Camargo CA Jr. Frequency of leisure-time physical activity and serum 25-hydroxyvitamin D levels in the US population: results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2008;168(6):577-86; discussion 587-91. DOI: 10.1093/aje/kwn163 PMID: 18579538

30. Hintzpeter B, Mensink GB, Thierfelder W, Müller MJ, Scheidt-Nave C. Vitamin D status and health correlates among German adults. Eur J Clin Nutr. 2008;62(9):1079-89. DOI: 10.1038/sj.ejcn.1602825 PMID: 17538533

31. Jääskeläinen T, Knekt P, Marniemi J, Sares-Jäske L, Männistö S, Heliövaara M, et al. Vitamin D status is associated with sociodemographic factors, lifestyle and metabolic health. Eur J Nutr. 2013;52(2):513-25. DOI: 10.1007/s00394-012-0354-0 PMID: 22538929

32. Abboud M, Rybchyn MS, Rizk R, Fraser DR, Mason RS. Sunlight exposure is just one of the factors which influence vitamin D status. Photochem Photobiol Sci. 2017;16(3):302-313. DOI: 10.1039/c6pp00329j PMID: 28139795

33. Ford ES, Ajani UA, McGuire LC, Liu S. Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care. 2005;28(5):1228-30. DOI: 10.2337/diacare.28.5.1228 PMID: 15855599

34. Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL, et al. Adiposity, cardiometabolic risk, and vitamin D status: the Framingham Heart Study. Diabetes. 2010;59(1):242-8. DOI: 10.2337/db09-1011 PMID: 19833894

35. Teitelbaum SL, Halverson JD, Bates M, Wise L, Haddad JG. Abnormalities of circulating 25-OH vitamin D after jejunal-lleal bypass for obesity: evidence of an adaptive response. Ann Intern Med. 1977;86(3):289-93. DOI: 10.7326/0003-4819-86-3-289 PMID: 842987

36. Tzotzas T, Papadopoulou FG, Tziomalos K, Karras S, Gastaris K, Perros P, et al. Rising serum 25-hydroxy-vitamin D levels after weight loss in obese women correlate with improvement in insulin resistance. J Clin Endocrinol Metab. 2010;95(9):4251-7. DOI: 10.1210/jc.2010-0757 PMID: 20534751

37. Maïmoun L, Sultan C. Effect of physical activity on calcium homeostasis and calciotropic hormones: a review. Calcif Tissue Int. 2009;85(4):277-86. DOI: 10.1007/s00223-009-9277-z PMID: 19760298

38. Fukumoto S. Phosphate metabolism and vitamin D. Bonekey Rep. 2014;3:497. DOI: 10.1038/bonekey.2013.231 PMID: 24605214

39. Mason RS, Rybchyn MS, Abboud M, Brennan-Speranza TC, Fraser DR. The Role of Skeletal Muscle in Maintaining Vitamin D Status in Winter. Curr Dev Nutr. 2019;3(10):nzz087. DOI: 10.1093/cdn/nzz087 PMID: 31598576

40. Al-Eisa ES, Alghadir AH, Gabr SA. Correlation between vitamin D levels and muscle fatigue risk factors based on physical activity in healthy older adults. Clin Interv Aging. 2016;11:513-22. DOI: 10.2147/CIA.S102892 PMID: 27217733

41. Bignotti B, Cadoni A, Martinoli C, Tagliafico A. Imaging of skeletal muscle in vitamin D deficiency. World J Radiol. 2014;6(4):119-24. DOI: 10.4329/wjr.v6.i4.119 PMID: 24778774

42. Alfafiq MS, Tarawan VM, Sylviana N, Goenawan H, Lesmana R, Susianti S. Effects of Vitamin D on Satellite Cells: A Systematic Review of In Vivo Studies. Nutrients. 2022;14(21):4558. DOI: 10.3390/nu14214558 PMID: 36364820

43. Jensen NS, Wehland M, Wise PM, Grimm D. Latest Knowledge on the Role of Vitamin D in Hypertension. Int J Mol Sci. 2023;24(5):4679. DOI: 10.3390/ijms24054679 PMID: 36902110

44. Berridge MJ. Vitamin D deficiency and diabetes. Biochem J. 2017;474(8):1321-1332. DOI: 10.1042/BCJ20170042 PMID: 28341729

45. Jorde R, Sneve M, Emaus N, Figenschau Y, Grimnes G. Cross-sectional and longitudinal relation between serum 25-hydroxyvitamin D and body mass index: the Tromsø study. Eur J Nutr. 2010;49(7):401-7. DOI: 10.1007/s00394-010-0098-7 PMID: 20204652

46. Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168(15):1629-37. DOI: 10.1001/archinte.168.15.1629 PMID: 18695076

47. Gill TK, Hill CL, Shanahan EM, Taylor AW, Appleton SL, Grant JF, et al. Vitamin D levels in an Australian population. BMC Public Health. 2014;14:1001. DOI: 10.1186/1471-2458-14-1001 PMID: 25256413

48. Kamycheva E, Joakimsen RM, Jorde R. Intakes of calcium and vitamin d predict body mass index in the population of Northern Norway. J Nutr. 2003;133(1):102-6. DOI: 10.1093/jn/133.1.102 PMID: 12514276

49. van den Heuvel EG, van Schoor N, de Jongh RT, Visser M, Lips P. Cross-sectional study on different characteristics of physical activity as determinants of vitamin D status; inadequate in half of the population. Eur J Clin Nutr. 2013;67(4):360-5. DOI: 10.1038/ejcn.2013.22 PMID: 23403871

50. Brock K, Cant R, Clemson L, Mason RS, Fraser DR. Effects of diet and exercise on plasma vitamin D (25(OH)D) levels in Vietnamese immigrant elderly in Sydney, Australia. J Steroid Biochem Mol Biol. 2007;103(3-5):786-92. DOI: 10.1016/j.jsbmb.2006.12.048 PMID: 17215122

51. Daly RM, Gagnon C, Lu ZX, Magliano DJ, Dunstan DW, Sikaris KA, et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clin Endocrinol (Oxf). 2012;77(1):26-35. DOI: 10.1111/j.1365-2265.2011.04320.x PMID: 22168576

52. Tardelli VS, Lago MPPD, Silveira DXD, Fidalgo TM. Vitamin D and alcohol: A review of the current literature. Psychiatry Res. 2017;248:83-86. DOI: 10.1016/j.psychres.2016.10.051 PMID: 28033511

53. Kimlin MG, Lucas RM, Harrison SL, van der Mei I, Armstrong BK, Whiteman DC, et al. The contributions of solar ultraviolet radiation exposure and other determinants to serum 25-hydroxyvitamin D concentrations in Australian adults: the AusD Study. Am J Epidemiol. 2014;179(7):864-74. DOI: 10.1093/aje/kwt446 PMID: 24573539