Socioecological Factors Associated with Vitamin D Deficiency: Implications for Adults with Obesity and Chronic Pain.

摘要

Blacks and Hispanics are disproportionately affected by vitamin D deficiency (NHANES, 2012). Preventing this deficiency is a national priority as its deficit is linked to chronic diseases, increasing the disease burden within the US population (Annweiler, et al., 2013, Anglin et al., 2013, Anderson et al., 2010, Chung et al, 2009, Holick, 2011, Institute of Medicine, 2002, CDC, 2012). Focusing on not only race and ethnicity but also socioecological determinants can increase identification of those at risk and promote appropriate treatment and surveillance. Prevention and treatment guidelines provide some direction in screening and treatment (Ramdin, 2015), but do not provide the socioecological aspect among vulnerable populations. A systematic review of the literature on screening for vitamin D deficiency found that there were recommended screening guidelines. Objective testing of the 25 hydroxyvitamin D was to be done in at-risk populations [Blacks and Hispanics and the elderly over 65 years old] but not in the general population. A follow up systematic review on treatment (Ramdin, 2015) found that there was various dosing being used to treat problems, despite what was documented as standard recommended treatment.;Subsequently, a research study was conducted examining vitamin D concentrations among adults seeking integrative medical care in an urban setting. The aim of the study was to explore the socioecological factors associated with vitamin D concentrations in adults who had chronic illnesses, and to determine if there was an association between vitamin D deficiency and obesity and vitamin D and chronic pain. A secondary data analysis was done examining the medical records of 1268 adults seen at an inner city integrative medicine clinic in the northeast US from 2007-2012. The resulting study sample was non-institutionalized adults 18 years and older comprised of 80% women, average age 52 years-old and 20% men average age 55 years-old. The results indicated that seasonality, ethnicity and age were strongly associated with vitamin D deficiency in this population with p values <0.0001. There was evidence to support that adults with high body mass index (BMI kg/m 2) are more likely to have 25-hydroxyvitamin D concentration less than the optimal 50 nmol/mL. There was an inverse relation with vitamin D concentration and BMI; the higher the BMI, the lower the vitamin D concentration. Adults with BMI between 25 and 30 had approximately a 30% chance of having low vitamin D levels with p values <0.001. There was some association of 25(OH)D and moderate level pain.;Keywords: Vitamin D deficiency, BMI, Chronic pain, Chronic illness.