Vitamin

D nutrition
occupation1
M.

S. Devgun,4

C. Cohen,

Ph.D.,

M. B.,

C. R. Paterson,5

D. M.,

to season

B. E. Johnson,1

Ph.D.,

and

and

F. R. C. P.

ABSTRACT
serum

Seasonal

variations

25-hydroxycholecalciferol

inpatients.

All

three

expected.
the highest
were found
in October
the

in relation

peak

in ultraviolet

levels

groups

WORDS

workers,

seasonal

changes

exposure

was

is that vitamin

workers.
Vitamin

in July.

Am.

and

the

The

possible

Nuir.

assessed

levels
for

reasons

D, 7-dehydrocholesterol,

and

measurements
long-term

workers

for

this

had,

and

150 1-1504,

long

stored

lag

of
hospital

as might

of 25-hydroxycholecalciferol
the outdoor
workers

to be formed
34:

by

workers
outdoor

the highest
in November

D continues

J. Cliii.

were
indoor

are

during

be

whereas
discussed;

the

autumn

1981.

25-hydroxyvitamin

D, ultraviolet

radiation,

latitude

The principal
source
of vitamin
D in man
is its synthesis
in the skin promoted
by ultraviolet
radiation
(UVR).
This synthesis
takes
place in two stages
(1-3).
The first stage is the
photochemical
transformation
of 7-dehydrocholesterol
to previtamin
D, requiring
UVR
in the wavelength
range
280 to 320 nm. This
is followed
by the thermal
isomerisation
of
the
previtamin
to vitamin
D3 (cholecalciferol).
In the serum,
the major
form
of vitamin
D is 25-hydroxyvitamin
D (25-OHD)
and measurements
of the serum
levels of this
metabolite
give a quantitative
assessment
of
the vitamin
D status
of the individual.
It is
not
surprising
that
several
workers
have
noted
that,
at least in Northern
Europe
and
North
America,
there
is a seasonal
variation
in serum
25-OHD
levels
which
reflect
the
seasonal
variation
in environmental
UVR
(4-7).
The city of Dundee,
at 56#{176}30N, is located
at a higher
latitude
than
other
centers
at
which
seasonal
variation
has been
studied.
During
the winter
months,
available
UVR
within
the range
280 to 320 nm is almost
negligible
so that a study of seasonal
variation
in serum
25-OHD
here should
be of particular interest,
not only in comparison
with that
at other
locations,
but also because
the radiation environment
changes
between
one adequate
for vitamin
D formation
to one with
negligible
potential
in this respect.
The American
Journal
of Clinical
Nutrition
34: AUGUST
1981 American
Society for Clinical Nutrition

We have examined
the seasonal
variation
in serum
25-OHD
in outdoor
workers,
indoor
workers,
and in elderly
inpatients
a continuing
care unit who had little or
exposure
to sunlight,
during
1 complete
yr
which
daily
recordings
of the environmental
UVR
were made.
Subjects

and

in
in
no
in

methods

The outdoor
workers,
who might
be expected
to benefit maximally
from
natural
UVR
throughout
the year,
were
18 gardeners
on the staff
of the City of Dundee
District
Council
Parks
Department.
Their
ages
ranged
from
19 to 63 yr. and they spent
the whole
of the working
day (6 to 8 h) out of doors
winter
and summer.
The
indoor workers
were eight members
of the Department
of Biochemical
Medicine
at Ninewells
Hospital (aged 22
to 42 yr).
They
were
exposed
to sunlight
mainly
at
weekends
and in the evenings.
The third group
consisted
of seven
elderly
inpatients
(aged
67 to 93 yr) who,
for
lack of staff,
were
not moved
out of doors
during
the
study
period,
and
did not have
access
to artificial
or
natural
sunlight.
From

the

Departments

Dermatology
and
Dundee,
Scotland.
2 Supported
by
Fund,

London.
Address

reprint

of

Geriatrics,
the

trustees
requests

Biochemical
University
of
to:

Medicine,
of

the

Camilla

Dr.

C.

R.

Dundee,
Samuel
Paterson,

Department
of Biochemical
Medicine,
Ninewells
Hospital,
Dundee,
DD1
9SY,
Scotland.
Research
Assistant
in
Biochemical
Medicine.
Senior
Lecturer
in Biochemical
Medicine.
Senior
Lecturer
in Dermatology.
Consultant
Physician
in
Geriatric
Medicine.
1981,

pp.

1501-1504.

Printed

in U.S.A.

1501

Downloaded from ajcn.nutrition.org by guest on November 4, 2014

KEY

in outdoor

D nutrition

in outdoor

levels at all seasons.

However,
in the indoor
workers
and

the most likely explanation

especially

showed

in vitamin

1502

DEVGUN

AL.

330 nm. The wavelength

response
characteristics
of the
meter
are similar
to those
of lightly
pigmented
human
skin
in terms
of the sunburn
reaction,
i.e., maximal
around
290 nm and falling
rapidly
with increasing
wavelength.
The wavelength
required
for vitamin
D synthesis
in man is probably
similar.

Results
Figure
1 shows
the serum levels of 25-OHD
in the three
groups;
seasonal
variations
were
seen
in all three
but the peak
values
were
seen
in different
months.
Very
low values
were noted
in the elderly
inpatients,
both in
winter
and
in summer.
In each
group
the
seasonal
changes
were
highly
significant
(p
<0.00.1)
using
the paired
t test. At the start
of the study,
the serum
levels
of 25-OHD
in
the elderly
were significantly
lower (p < 0.01)
than those
in the other
two groups.
Also, the
indoor
group
had significantly
lower
values
(p <0.005)
than the outdoor
group.

100

80

Outdoor
workers

60
workers

0
0

40
ifl
cs1

20

15000
C

E
C

9000

0
C)

>
D

3000

Feb

May

Aug

Nov

Feb

1977

FIG.
workers,

1. Seasonal
mean
age

age 80 yr). Results

of the environmental

variation
in serum
25-OHD
41 yr), laboratory
staff (indoor
are

levels in three groups

workers,
mean
age

presented
as means
with vertical
UVR
in the range
290 to 330 nm

bars representing
are also shown.

1978

of subjects:
32 yr), and
the

SEM.

Parks
elderly
The

Department
hospital
simultaneous

staff
inpatients

(outdoor
(mean

measurements

Downloaded from ajcn.nutrition.org by guest on November 4, 2014

From
each group, blood
was obtained
at monthly
intervals and at the same
time of day on each occasion.
All samples
were purified, using silicic acid columns
(mesh
325, 3 cm long) and subsequently
analysed
for 25OHD
by a competitive
protein
binding
assay
(8). The
25-OHD
assay
was found
to be reproducible
and gave
an interassay coefficient of variation of 10%. The serum
samples
were stored
at -20#{176}C and all the samples
from
one
individual
were
analyzed
in a single
batch.
For
quality
control,
a charcoal
precipitated
serum
containing
25-OHD
was used with all assays.
Environmental
UVR
was monitored
by continuous
measurements
with
a meter
based
on the design
of
Robertson
(9) similar
to that fully described
by Berger
(10) in which
the luminescence
excitation
characteristic
(290 to 330 nm) of a magnesium
tungstate
phosphor
are
used in conjunction
with a simple
photoelectric
cell. The
detector,
a unit some
10 x 10 x 15 cm is sealed
with a
quartz
plate
which
transmits
the whole
solar
spectrum
but acts as a dust and water
cover.
Visible
wavelengths
are filtered
out with
a black
Corning
9863 glass,
and
the transmitted
ultraviolet
impinges
on the magnesium
tungstate
phosphor
which
is heat-bonded
to a quartz
plate.
The 290 to 330 nm stimulated
emission
is collected
on the receiving
surface
of a small
photocell
through
an
extra
filter
which
absorbs
extraneous
ultraviolet
above

ET

SEASON,

OCCUPATION.

The
UVR
levels,
as expected,
showed
a
seasonal
variation
with
a maximum
count
rate in July and very low or negligible
levels
from November
to February.
Discussion

VITAMIN

LEVELS

1503

sponse
to food containing
milk and eggs produced
in summer.
Our elderly
inpatients
at no time showed
serum
25-OHD
levels
which
were undetectable.
Our
results,
therefore,
contrast
with
those
on similar
groups
of elderly
people
in
London
(13-15).
These
differences
may
reflect differences
in the dietary
intakes.
Low
levels
of serum
25-OHD
in the elderly
may
be due to various
factors,
including
diet, mcdication,
and age. Reduced
levels
of 7-dehydrocholesterol
or reduced
amounts
of enzymatic
synthesis
in the skin,
liver,
and
the
kidneys
could
also be responsible
in the elderly
inpatients.
It is possible
to make an approximate
comparison
of the effects
of different
solar UVR
environments
on serum
25-OHD
levels
by
examining
the results
of Haddad
and Stamp
(16)
in St. Louis,
MO
(latitude
38#{176}39N)
along
with the UVR
levels derived
from the
National
Institutes
of Health
survey
(17) in
relation
to our own results.
The ratio of summer:winter
UVR levels in St. Louis,
obtained
from average
daily
counts
with a RobertsonBerger
meter,
was 4:1, while the summer:winter serum
25-OHD
ratio was 1.4:1. For Dundee these
figures
are
10:1 and
2:1, respectively.
The absolute
values
for environmental
UVR
are lower
at all times
in Dundee,
and
it is clear that the serum
25-OHD
levels
are
lower
in winter.
However,
the greater
change
in environmental
UVR
at the higher
latitude
is nicely
reflected
in a greater
increase
in
circulating
vitamin
D metabolite.
The levels
of environmental
UVR
during
the year
1977
were
much
less than
those
observed
during
the corresponding
months
in 1978; this could
explain
the differences
observed
in the levels
of serum
25-OHD
in the autumns
of 1977
and
1978. In conclusion,
it is clear
that the
plasma
levels
of 25-OHD
are significantly
affected
by the occupation
of the subject
and
that there
is a delay
in the rise of 25-OHD
to
its peak concentration
which
depends
on the
working
conditions.
U
References
1. Havinga
E. Vitamin
D, example
and challenge.
Experientia
l973;29:l
18 1-93.
2. Esvelt RP, Schnoes
HK,
DeLuca
HF. Vitamin
D3
from
rat skins
irradiated
in vitro
with
ultraviolet
light.
Arch
Biochem
Biophys
1978;l88:282-6.
3. Holick
MF,
Frommer
J, McNeill
5, Richtand
N,

Downloaded from ajcn.nutrition.org by guest on November 4, 2014

Our results,
like those of others,
show seasonal
variations
in 25-OHD
levels
in serum
in the three groups
of subjects
studied.
It was
not
surprising
that
25-OHD
levels
were
higher
in the outdoor
workers
than
in the
indoor
workers,
who in turn had higher
values than
did the elderly
hospital
inpatients.
What
was of particular
interest,
however,
was
that in the elderly
inpatients,
the small
peak
in 25-OHD
levels
occurred
at a similar
time
to the peak
in UVR,
whereas
in the indoor
workers,
the highest
values
were
found
in
October,
and
for the outdoor
workers
the
peak was even later,
in November,
at a time
when
the available
UVR
was declining
rapidly. In this respect
our findings
contrast
with
those
of Stryd
et al. (7) who found
a good
correlation
between
25-OHD
levels in plasma
and monthly
amounts
of sunlight.
However,
their study
was carried
out at latitude
42#{176}
17
and involved
only indoor
workers.
One possible
explanation
for the long lag
periods
we found
could
be that the peak
in
25-OHD
level follows peaks for previtamin
D and vitamin
D which
are stored
and gradually released.
However,
a more likely explanation
is that in the outdoor
workers,
vitamin
D synthesis
continues
well into the autumn
with continued
exposure
and so that vitamin
D stores
continue
to increase.
It is possible
that
in autumn,
as in summer,
the limiting
factor
to vitamin
D production
is not the
supply
of UVR,
but the availability
and/or
the de novo
synthesis
of the vitamin
D precursor,
7-dehydrocholesterol.
It was
to us surprising
that
the elderly
inpatients
did show some seasonal
variation,
although
they were not known
to be exposed
to any
UVR.
In part
the rise in levels
of
serum
25-OHD
in the summer
may be related
to a natural
increase
in the vitamin
D content
of certain
foods during
the same period.
This
is known
to occur;
Chick
and Roscoe
(11)
demonstrated
that fresh vegetables
grown
between
May
and July,
or under
UVR,
had
antirachitic
properties.
Chick
and
Roscoe
(12) also showed
that
rickets
healed
in re-

AND

1504

DEVGUN

Henley
I, Potts IT. Conversion
of 7-dehydrocholesterol to vitamin
D:1 in-vivo:
isolation
and identification of previtamin
D3 from
skin.
In: Norman
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Schaefer
K, Coburn
J, et al. eds. Vitamin
D-biochemical,
chemical
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1977:1357.
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TCB,
Round
IM. Seasonal
changes
in human
plasma
levels
of 25-hydroxyvitamin
D.
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l974;247:563-S.
5. Lund B. Sorensen OH. Measurement
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D in the
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D, Beer
M, Boucher
BJ, Gupta
SP, Cohen
RD. Vitamin
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Lancet
1975; 1:1404-6.
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D in the elderly
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Britain.
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1977; 1:979-80.
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WI,
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IC. Vitamin
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concentrations
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1G. Stamp
TCB.
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Am I Med
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Bethesda,
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8.

and
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D intake
in the Danish
population.
Scand
I Chin Lab Invest
1979;39:23-30.
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EME,
Cole TI, Lawson
DEM.
Diet, Sunlight
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D in healthy
children
and
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Br Med 1 1979:2:221-3.
Stryd
RP, Gilbertson
TJ, Brunden
MN. A seasonal
variation
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D3 serum
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l979;48:77 1-5.
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MA,
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ILH,
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Kodicek E. A competitive
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in the popula-

ET