DNC News

 

Park Hill News: The Race Question…..

 

For years various theories have been proposed to explain the greater frequency of many illnesses seen in African Americans. High blood pressure is probably the best example but there are many others. I've heard theories that range from the plausible to the bizarre, to what could be called racist. For several years the theory was lead in blood from living in inner cities was the cause. So were higher stress levels. Even over consumption of fried foods was suggested in a “Fried Chicken Hypothesis'. None of these possible explanations lasted long. Research in the last four years has finally provided a reasonable explanation that I think will prove true. The explanation is so simple; the surprise is that no one thought of it sooner.

 

We made our mistake in looking for complex socioeconomic causes. The biggest difference between African Americans and White Americans, as much as we try to ignore it, is skin color. Races which evolved further from the equator have lost some of the ability to make melanin and have become pale skinned. Humans get most of their vitamin D from the sun. Darker skin decreases the amount of ultraviolet light that penetrates the skin and in doing so it decreases vitamin D production. This is fine if you live close to the equator or are in the sun most of the day. If you live in the higher latitudes and spend much of your days indoors, you make much less vitamin D. The darker or blacker the skin, the bigger the problem becomes. Vitamin D deficiency is a common problem for all Americans but far more so for African Americans. When you look at the statistics the numbers are shocking. Black skinned Americans are about ten times more likely to be vitamin D deficient as whites. [i] Black women of reproductive age are twenty times as likely to be vitamin D deficient as white women of the same age. [ii] The average white woman has twice the amount of vitamin D in their blood as a black woman. [iii]

 

The list of diseases that we now associate with vitamin D deficiency is almost identical to the list of diseases that African Americans suffer from with greater than expected frequency. The following illnesses are both associated with vitamin D deficiency and are much more common in black Americans than white: [iv] [v] [vi] [vii] [viii] [ix] [x] [xi] [xii]

Coronary heart disease   hypertension

Type two diabetes     colorectal cancer

Prostate cancer     cervical cancer

Renal disease       metabolic syndrome

Multiple sclerosis     rheumatoid conditions

Obesity       periodontal disease

Rickets         osteomalacia

 

The only disease associated with vitamin D deficiency not more common in blacks than whites is osteoporosis. Every other disease associated with vitamin D deficiency is more common in African Americans.

 

Vitamin D deficiency may explain why black babies are more than twice as likely as whites to have low birth weights. [xiii]

 

Of the children diagnosed with vitamin D deficiency rickets in the United States over the last 17 years, 83% were African American. [xiv]

 

Infants derive their vitamin D from breast milk but most nursing moms are so low in vitamin D that they are unable to excrete adequate amounts into their milk. Nursing women need about 4000 IU of vitamin D a day to make breast milk adequate for their infants. The breast milk of black women often has undetectable levels of vitamin D. [xv] [xvi] It takes a white woman about five minutes of full body sun exposure a day to make this much vitamin D.

 

The only significant food source for vitamin D is milk. The government requires dairies to enrich milk with Vitamin D. Cheese, yogurt and ice cream are not enriched and are not significant sources. Whites drink more milk than any other race. Northern Europeans are among the few human races that continue to produce lactase, the enzyme needed to digest milk, into adulthood. Most other races, including blacks, often stop producing this enzyme and get moderate to severe indigestion from milk, a condition referred to as lactose intolerance. As a result blacks consume less milk and get less supplemental vitamin D from foods than whites do. [xvii] [xviii]

 

The answer is simple: because of darker skin pigmentation and lower tolerance and consumption of milk, African Americans are more likely to be Vitamin D deficient than whites and as a result are far more likely to develop a range of health problems associated with vitamin D deficiency.

 

The United States Food and Drug Association knows about this: In 2003, Dr. Mona Calvo of the FDA, wrote, “In sharp contrast to their white counterparts, blacks have a much higher incidence and mortality of certain types of aggressive cancers and autoimmune diseases, including diabetes that cannot be attributed entirely to socioeconomic differences or disparities in health care. The strong association between vitamin D insufficiency and risk of chronic diseases should raise concern about the current mechanisms in place to prevent [vitamin D deficiency].” [xix]

The FDA also knows that the lower milk consumption by blacks contributes to the problem. Another quote from Dr. Calvo, “The racial/ethnicity groups at greatest risk of vitamin D insufficiency consume less milk . . . than do their white counterparts.” Dr. Calvo goes on to write, “African Americans, with the greatest physiological need for dietary sources of vitamin D, have the lowest intake from food alone and food plus supplements.” [xx]

 

It is too soon to blame the FDA for ignoring this information. The data I'm citing come from studies published in the last four years. In the future we should expect to see a movement to fortify more foods with Vitamin D and public awareness campaigns to increase intake. In the meantime black Americans have two choices: regular sun exposure or oral supplementation with Vitamin D. In hindsight maybe we should have recognized what was going on sooner. If this theory is indeed correct, the solution couldn't have more obvious, it is a simple matter of black and white.

I borrowed heavily in writing this article from John Jacob Cannell, MD, whose website www.Cholecalciferol-Council.com is an excellent source for further information.

 

References:

[i] Am J Clin Nutr . 2004 Dec;80(6 Suppl):1763S-6S.

Racial/ethnic considerations in making recommendations for vitamin D for adult and elderly men and women.

Dawson-Hughes B.

Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University , Boston , MA 02111 , USA . bess.dawson-hughes@tufts.edu

 

Vitamin D is acquired through diet and skin exposure to ultraviolet B light. Skin production is determined by length of exposure, latitude, season, and degree of skin pigmentation. Blacks produce less vitamin D3 than do whites in response to usual levels of sun exposure and have lower 25-hydroxyvitamin D [25(OH)D] concentrations in winter and summer. Blacks in the United States also use dietary supplements less frequently than do whites. However, blacks and whites appear to have similar capacities to absorb vitamin D and to produce vitamin D after repeated high doses of ultraviolet B light. There is a growing consensus that serum 25(OH)D concentrations of at least 75-80 nmol/L are needed for optimal bone health, on the basis of studies of older white subjects living in Europe and the United States . The studies show that increasing serum 25(OH)D concentrations to this level decreases parathyroid hormone (PTH) concentrations, decreases rates of bone loss, and reduces rates of fractures. Among US blacks, low 25(OH)D concentrations are associated with higher concentrations of PTH, which are associated with lower bone mineral density. Vitamin D supplements decrease PTH and bone turnover marker concentrations among blacks. These findings suggest that improving vitamin D status would benefit blacks as well as whites. On the basis of studies conducted in the temperate zone, the intake of vitamin D3 needed to maintain a group average 25(OH)D concentration of 80 nmol/L in winter is approximately 1000 IU/d. Broad-based vitamin D supplementation is needed to remove vitamin D insufficiency as a contributing cause of osteoporosis.

PMID: 15585802 [PubMed - indexed for MEDLINE]

 

 

J Clin Invest . 1985 Aug;76(2):470-3.

Evidence for alteration of the vitamin D-endocrine system in blacks.

Bell NH , Greene A, Epstein S, Oexmann MJ, Shaw S, Shary J.

 

As compared with values in white subjects, bone mass is known to be increased and urinary calcium to be diminished in black individuals. To evaluate the possibility that these changes are associated with alterations in the vitamin D-endocrine system, an investigation was performed in 12 black subjects, 7 men and 5 women, and 14 white subjects, 8 men and 6 women, ranging in age from 20 to 35 yr. All of them were hospitalized on a metabolic ward and were given a constant daily diet containing 400 mg of calcium, 900 mg of phosphorus, and 110 meq of sodium. Whereas mean serum calcium, ionized calcium, and phosphate were the same in the two groups, mean serum immunoreactive parathyroid hormone (350 +/- 34 vs. 225 +/- 26 pg/ml, P less than 0.01) and mean serum 1,25-dihydroxyvitamin D (1,25(OH)2D) (41 +/- 3 vs. 29 +/- 2 pg/ml, P less than 0.01) were significantly higher, and mean serum 25-hydroxy-vitamin D (25-OHD) was significantly lower in the blacks than in the whites (6 +/- 1 vs. 20 +/- 2 ng/ml, P less than 0.001). Mean urinary sodium and 24-h creatinine clearance were the same in the two groups, whereas mean urinary calcium was significantly lower (101 +/- 14 vs. 166 +/- 13 mg/d, P less than 0.01) and mean urinary cyclic AMP was significantly higher (3.11 +/- 0.47 vs. 1.84 +/- 0.25 nM/dl glomerular filtrate, P less than 0.01) in the blacks. Further, the blacks excreted an intravenous calcium load, 15 mg/kg body weight, as efficiently as the whites (49 +/- 3 vs. 53 +/- 3%, NS). Mean serum Gla protein was lower in blacks than in whites (14 +/- 2 vs. 24 +/- 3 ng/ml, P less than 0.02), and increased significantly in both groups in response to 1,25(OH)2D3, 4 micrograms/d for 4 d. There was a blunted response of urinary calcium to 1,25(OH)2D3 in the blacks, and mean serum calcium did not change. The results indicate that alteration of the vitamin D-endocrine system with enhanced renal tubular reabsorption of calcium and increased circulating 1,25(OH)2D as a result of secondary hyperparathyroidism may contribute to the increased bone mass in blacks. Their low serum 25-OHD is attributed to diminished synthesis of vitamin D in the skin because of increased pigment.

 

PMID: 3839801 [PubMed - indexed for MEDLINE]

 

 

 

[ii] Am J Clin Nutr . 2002 Jul;76(1):187-92.

Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994.

Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, Allen C, Doughertly C, Gunter EW, Bowman BA.

 

Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta 30341-3717 , USA .

 

BACKGROUND: Recent reports of rickets among African American children drew attention to the vitamin D status of these infants and their mothers. African American women are at higher risk of vitamin D deficiency than are white women, but few studies have examined determinants of hypovitaminosis D in this population. OBJECTIVE: We examined the prevalence and determinants of hypovitaminosis D among African American and white women of reproductive age. DESIGN: We examined 1546 African American women and 1426 white women aged 15-49 y who were not pregnant and who participated in the third National Health and Nutrition Examination Survey (1988-1994). Hypovitaminosis D was defined as a serum 25-hydroxyvitamin D concentration < or =37.5 nmol/L. Multiple logistic regression was used to examine the independent association of dietary, demographic, and behavioral determinants of hypovitaminosis D. RESULTS: The prevalence of hypovitaminosis D was 42.4 +/- 3.1% ( +/- SE) among African Americans and 4.2 +/- 0.7% among whites. Among African Americans, hypovitaminosis D was independently associated with consumption of milk or breakfast cereal <3 times/wk, no use of vitamin D supplements, season, urban residence, low body mass index, and no use of oral contraceptives. Even among 243 African Americans who consumed the adequate intake of vitamin D from supplements (200 IU/d), 28.2 +/- 2.7% had hypovitaminosis D. CONCLUSIONS: The high prevalence of hypovitaminosis D among African American women warrants further examination of vitamin D recommendations for these women. The determinants of hypovitaminosis D among women should be considered when these women are advised on dietary intake and supplement use.

PMID: 12081833 [PubMed - indexed for MEDLINE]

 

 

[iii] Am J Clin Nutr . 1998 Jun;67(6):1232-6.

Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women.

Harris SS, Dawson-Hughes B.

 

Jean Mayer US Department of Agriculture, Human Nutrition Research Center on Aging at Tufts University , Boston , MA 02111 , USA .

 

Seasonal changes in 25-hydroxyvitamin D concentrations were studied in 51 black and 39 white women aged 20-40 y from Boston . Individual measurements were made in February or March (February-March), June or July (June-July), October or November (October-November), and the following February or March (February-March). Samples from the four visits were analyzed in batches at the end of the study. Plasma 25-hydroxyvitamin D was substantially lower in black than in white women at all the time points, including February-March when values were lowest (30.2 +/- 19.7 nmol/L in black and 60.0 +/- 21.4 nmol/L in white women) and June-July when they were highest (41.0 +/- 16.4 nmol/L in black and 85.4 +/- 33.0 nmol/L in white women). Although both groups showed seasonal variation in 25-hydroxyvitamin D concentrations, the mean increase between February-March and June-July was smaller in black women (10.8 +/- 14.0 nmol/L compared with 25.4 +/- 29.8 nmol/L in white women, P = 0.006) and their overall amplitude of seasonal change was lower (P = 0.001). Concentrations of serum parathyroid hormone in February-March were significantly higher (P < 0.005) in black women (5.29 +/- 2.32 pmol/L) than in white women (4.08 +/- 1.41 pmol/L) and were significantly inversely correlated with 25-hydroxyvitamin D in blacks (r = -0.42, P = 0.002) but not in whites (r = -0.19, P = 0.246). Although it is well established that blacks have denser bones and lower fracture rates than whites, elevated parathyroid hormone concentrations resulting from low 25-hydroxyvitamin D concentrations may have negative skeletal consequences within black populations.

 

PMID: 9625098 [PubMed - indexed for MEDLINE]

 

 

[iv] CA Cancer J Clin . 2005 Jan-Feb;55(1):10-30.

Cancer statistics, 2005 .

Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EJ, Thun MJ.

Statistical Research and Applications Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville , MD.

 

Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,372,910 new cancer cases and 570,280 deaths are expected in the United States in 2005. When deaths are aggregated by age, cancer has surpassed heart disease as the leading cause of death for persons younger than 85 since 1999. When adjusted to delayed reporting, cancer incidence rates stabilized in men from 1995 through 2001 but continued to increase by 0.3% per year from 1987 through 2001 in women. The death rate from all cancers combined has decreased by 1.5% per year since 1993 among men and by 0.8% per year since 1992 among women. The mortality rate has also continued to decrease from the three most common cancer sites in men (lung and bronchus, colon and rectum, and prostate) and from breast and colorectal cancers in women. Lung cancer mortality among women has leveled off after increasing for many decades. In analyses by race and ethnicity, African American men and women have 40% and 20% higher death rates from all cancers combined than White men and women, respectively. Cancer incidence and death rates are lower in other racial and ethnic groups than in Whites and African Americans for all sites combined and for the four major cancer sites. However, these groups generally have higher rates for stomach, liver, and cervical cancers than Whites. Furthermore, minority populations are more likely to be diagnosed with advanced stage disease than are Whites. Progress in reducing the burden of suffering and death from cancer can be accelerated by applying existing cancer control knowledge across all segments of the population.

 

PMID: 15661684 [PubMed - in process]

 

[v] J Cardiovasc Risk . 2002 Dec;9(6):323-30.   

Obesity, diabetes, and coronary risk in women.

Pradhan AD, Skerrett PJ, Manson JE.

Division of Preventive Medicine Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA.

 

The latter half of the twentieth century has witnessed rapid advances in cardiovascular epidemiology and medicine. Concurrently, secular trends in lifestyle practices and general improvements in standards of living have resulted in several alarming trends for cardiovascular disease prevention and health promotion. The adoption of unhealthy dietary patterns, growing socio-economic and racial disparities in chronic disease prevalence, low levels of physical activity, and other as yet unidentified genetic and environmental determinants have led to burgeoning rates of both pediatric and adult obesity and diabetes mellitus. Women appear to be at particular risk as the gender advantage for coronary heart disease (CHD) is counterbalanced by an increased incidence of obesity and diabetes. In order to further examine these complex associations, we review the available epidemiological data regarding the impact of obesity and diabetes on cardiovascular health in women.

 

 

[vi] J Clin Hypertens ( Greenwich ). 2003 Nov-Dec;5(6):393-401.

Meeting the challenge to improve the treatment of hypertension in blacks.

Lopes AA, James SA, Port FK, Ojo AO, Agodoa LY, Jamerson KA.

Department of Medicine, Federal University of Bahia , Brazil . aaslopes@ufba.br

 

Hypertension is more prevalent and severe in African descendent populations living outside Africa than in any other population. Given this greater burden of hypertension in blacks, it is increasingly necessary to refine strategies to prevent the disorder as well as improve its treatment and control. This review assesses results from clinical trials on lifestyle and pharmacologic interventions to identify which approaches most effectively prevent adverse hypertension-related outcomes in African descendent populations. The Dietary Approaches to Stop Hypertension (DASH) study provided evidence that a carefully controlled diet rich in fruits, vegetables, low-fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (i.e., the DASH diet) reduces blood pressure in blacks and is well accepted. The combination of the DASH diet with reduction in dietary sodium below 100 mmol/d may provide a reduction in blood pressure beyond that reached by the DASH diet alone. Physical exercise and interventions to reduce psychological stress may also reduce blood pressure in blacks. Strong evidence from numerous studies is a compelling argument for continuing to recommend diuretics and beta blockers as first-line antihypertensive therapy for persons of all races. Some new studies also favor angiotensin-converting enzyme inhibitors as first-line antihypertensive drugs. The African American Study of Kidney Disease and Hypertension provided evidence that an angiotensin-converting enzyme inhibitor-based treatment program is more beneficial than calcium channel blockers and beta blockers in reducing the progression of renal failure in blacks with hypertensive nephropathy. Studies in patients with diabetes have also shown evidence that both angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists are more effective than other classes of antihypertensives in reducing adverse renal events. Studies to evaluate the effects of the new antihypertensives in improving outcomes in blacks living outside the United States are needed.

 

Publication Types:

Review

Review, Tutorial

 

PMID: 14688494 [PubMed - indexed for MEDLINE]

 

[vii] J Public Health Policy. 2004;25(3-4):353-66

The obesity epidemic in the United States .

Morrill AC, Chinn CD.

Capacities Inc., Watertown , Massachusetts 02471 , USA . a.morrill@capacities.org

 

We describe the epidemic of obesity in the United States : escalating rates of obesity in both adults and children, and why these qualify as an epidemic; disparities in overweight and obesity by race/ethnicity and sex, and the staggering health and economic consequences of obesity. Physical activity contributes to the epidemic as explained by new patterns of physical activity in adults and children. Changing patterns of food consumption, such as rising carbohydrate intake--particularly in the form of soda and other foods containing high fructose corn syrup--also contribute to obesity. We present as a central concept, the food environment--the contexts within which food choices are made--and its contribution to food consumption: the abundance and ubiquity of certain types of foods over others; limited food choices available in certain settings, such as schools; the market economy of the United States that exposes individuals to many marketing/advertising strategies. Advertising tailored to children plays an important role.

PMID: 15683071

 

 

[viii] Am J Public Health . 2004 Sep;94(9):1496-500.

Childhood obesity in New York City elementary school students.

Thorpe LE, List DG, Marx T, May L, Helgerson SD , Frieden TR.

New York City Department of Health and Mental Hygiene, Division of Epidemiology, New York , NY 10013 , USA . lthorpe@health.nyc.gov

 

OBJECTIVES: We estimated overweight and obesity in New York City elementary school children. METHODS: A multistage cluster sample of New York City public elementary school children was selected. Nurses measured children's height and weight and used a standard protocol to determine body mass index (BMI). Demographic information was obtained from official school rosters. Overweight and obese were defined as BMI-for-age at or above the 85th and 95th percentiles, respectively. RESULTS: Of 3069 sampled students, 2681 (87%) were measured. The prevalence of overweight was 43% (95% confidence interval [CI] = 39%, 47%), more than half of whom were obese. Overall prevalence of obesity was 24% (95% CI = 21%, 27%), with at least 20% obesity in each grade, including kindergarten. Hispanic children had significantly higher levels (31%; 95% CI = 29%, 34%) than Black (23%; 95% CI = 18%, 28%) or White children (16%; 95% CI = 12%, 20%). Asian children had the lowest level of obesity among all racial/ethnic groups (14.4%, 95% CI = 10.9, 18.7). CONCLUSIONS: Obesity among public elementary school children in New York City is an important public health issue. Particularly high levels among Hispanic and Black children mirror national trends and are insufficiently understood.

 

PMID: 15333301 [PubMed - indexed for MEDLINE]

 

 

 

[ix] Dent Clin North Am . 2003 Jan;47(1):103-14, x.

Destructive periodontal diseases in minority populations.

Craig RG, Yip JK, Mijares DQ, Boylan RJ, Haffajee AD, Socransky SS.

Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA. rgc1@nyu.edu

 

Disparities in the prevalence and severity of destructive periodontal diseases have been reported for American minority populations and have raised the following questions. Are differences in destructive periodontal disease prevalence and severity due to genetic or other confounding variables associated with ethnicity race? Do risk factors for destructive periodontal diseases differ among American minority populations or differ from the population at large? Answers to these questions will have profound impact on the direction of future research and the allocation of resources to address disparities in destructive periodontal diseases in American minority populations. Risk assessment studies that examined a set of clinical, demographic, immunologic, and microbiologic parameters of Asian Americans, African Americans, and Hispanic Americans resident in the greater New York City region suggest that occupational status, monitored as a surrogate variable for socioeconomic status, may be a more robust risk factor than ethnicity/race for destructive periodontal diseases in these populations.

 

PMID: 12519008 [PubMed - indexed for MEDLINE]

 

 

[x] [x] Mult Scler . 2003 Jun;9(3):293-8.

 

Multiple sclerosis characteristics in African American patients in the New York State Multiple Sclerosis Consortium .

 

Weinstock-Guttman B, Jacobs LD, Brownscheidle CM, Baier M, Rea DF, Apatoff BR, Blitz KM, Coyle PK, Frontera AT, Goodman AD, Gottesman MH, Herbert J, Holub R, Lava NS, Lenihan M, Lusins J, Mihai C, Miller AE, Perel AB, Snyder DH, Bakshi R, Granger CV, Greenberg SJ, Jubelt B, Krupp L, Munschauer FE, Rubin D, Schwid S, Smiroldo J; New York State Multiple Sclerosis Consortium.

 

William C. Baird Multiple Sclerosis Research Center , The Jacobs Neurological Institute, Buffalo , NY 14203 , USA . BWeinstock-Guttman@KaleidaHealth.org

 

The objective of this study was to determine the clinical characteristics of multiple sclerosis (MS) in African American (AA) patients in the New York State Multiple Sclerosis Consortium (NYSMSC) patient registry. The NYSMSC is a group of 18 MS centers throughout New York State organized to prospectively assess clinical characteristics of MS patients. AAs comprise 6% (329) of the total NYSMSC registrants (5602). Demographics, disease course, therapy, and socioeconomic status were compared in AA registrants versus nonAfrican Americans (NAA). There was an increased female preponderance and a significantly younger age at diagnosis in the AA group. AA patients were more likely to have greater disability with increased disease duration. No differences were seen in types of MS and use of disease modifying therapies. Our findings suggest a racial influence in MS. Further genetic studies that consider race differences are warranted to elucidate mechanisms of disease susceptibility.

 

PMID: 12814178 [PubMed - indexed for MEDLINE]

 

 

[xi] J Rheumatol . 2004 Sep;31(9):1823-8.

Deaths from arthritis and other rheumatic conditions, United States, 1979-1998.

Sacks JJ, Helmick CG, Langmaid G.

Arthritis Program, Health Care and Aging Studies Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. jjs3@cdc.gov

 

OBJECTIVE: To analyze US trends in deaths from arthritis and other rheumatic conditions (AORC). METHODS: Multiple cause of death tapes from the National Center for Health Statistics from 1979 to 1998 were reviewed. Age, sex, and race-specific death rates were calculated. RESULTS: During 1979-1998, the annual number of AORC deaths rose from 5537 to 9367. In 1979, the crude death rate from AORC was 2.46 per 100,000 population; by 1998, it was 3.48. Rates age-standardized to the year 2000 population were 2.75 and 3.51, respectively. Annual crude and age-standardized death rates were higher among women than men and higher among blacks than whites and increased for all groups over the 20 years. Death rates were dramatically higher with increasing age. Three categories of AORC accounted for almost 80% of deaths: diffuse connective tissue diseases (34%), other specified rheumatic conditions (23%), and rheumatoid arthritis (22%). CONCLUSION: There are marked age, sex, and race-specific disparities in AORC death rates. AORC death rates may be underestimated because of (1) nonrecognition of inflammatory arthritis and (2) attribution of cause of death to conditions made more likely by arthritis, e.g., cardiovascular disease, or to complications from arthritis therapy. Further research into the causes of the disparities in death rates and the increase in death rates for men, women, blacks, and whites is necessary.

 

PMID: 15338507 [PubMed - indexed for MEDLINE]

 

 

[xii] Am J Clin Nutr. 2004 Mar;79(3):362-71.

Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis.

Holick MF.

 

Vitamin D, Skin, and Bone Research Laboratory, Section of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Boston University School of Medicine, Boston , MA 02118 -2394, USA .

 

The purpose of this review is to put into perspective the many health benefits of vitamin D and the role of vitamin D deficiency in increasing the risk of many common and serious diseases, including some common cancers, type 1 diabetes, cardiovascular disease, and osteoporosis. Numerous epidemiologic studies suggest that exposure to sunlight, which enhances the production of vitamin D(3) in the skin, is important in preventing many chronic diseases. Because very few foods naturally contain vitamin D, sunlight supplies most of our vitamin D requirement. 25-Hydroxyvitamin D [25(OH)D] is the metabolite that should be measured in the blood to determine vitamin D status. Vitamin D deficiency is prevalent in infants who are solely breastfed and who do not receive vitamin D supplementation and in adults of all ages who have increased skin pigmentation or who always wear sun protection or limit their outdoor activities. Vitamin D deficiency is often misdiagnosed as fibromyalgia. A new dietary source of vitamin D is orange juice fortified with vitamin D. Studies in both human and animal models add strength to the hypothesis that the unrecognized epidemic of vitamin D deficiency worldwide is a contributing factor of many chronic debilitating diseases. Greater awareness of the insidious consequences of vitamin D deficiency is needed. Annual measurement of serum 25(OH)D is a reasonable approach to monitoring for vitamin D deficiency. The recommended adequate intakes for vitamin D are inadequate, and, in the absence of exposure to sunlight, a minimum of 1000 IU vitamin D/d is required to maintain a healthy concentration of 25(OH)D in the blood.

 

Publication Types:

Review

Review, Tutorial

 

PMID: 14985208 [PubMed - indexed for MEDLINE]

 

[xiii] Ethn Dis . 2000 Autumn;10(3):432-45. Related

Low birth-weight infants: the continuing ethnic disparity and the interaction of biology and environment.

 

Fuller KE.

 

Center for the Study of Race and Ethnicity in Medicine, University of Kansas School of Medicine, Kansas City, 66160, USA.

 

African-American infants weigh on average 200-300 grams less at birth than do European-American infants, leading to a two-fold higher rate of low birth-weight (LBW) infants. This birth weight disparity has not changed significantly over the past 95 years. Numerous research studies have been undertaken to elucidate this disparity. While various factors have been found to be associated with increased risk for having a LBW infant, including maternal anthropometrics, health and age, prenatal care, and socioeconomic status, none have been found to entirely and adequately explain the continued birth-weight differential. Researchers have concluded that there is something different in the environment and/or genetics of African-American women compared to European-American women, but are at a loss to clearly define the factor other than to say it must relate to the racism suffered by African-American women leading to more stress during pregnancy. While racism is probably an additional factor, one genetic/environmental variable, which has been overlooked, is the interaction of heavy pigmentation with degree of latitude. Heavy pigmentation blocks ultraviolet B (UVB) radiation. At high latitudes, such as in the US region, inadequate exposure to UVB radiation prevents the conversion of the prohormone to the hormonal form of vitamin D. The resulting low levels of serum vitamin D in the pregnant woman disrupt calcium homeostasis leading to intrauterine growth retardation, premature labor, and hypertension: all risk factors for LBW infants.

 

Publication Types:

Review

 

PMID: 11110360 [PubMed - indexed for MEDLINE]

 

[xiv] Am J Clin Nutr . 2004 Dec;80(6 Suppl):1697S-705S.

 

Nutritional rickets among children in the United States : review of cases reported between 1986 and 2003.

 

Weisberg P, Scanlon KS , Li R, Cogswell ME.

 

Maternal Child Nutrition Branch, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta , GA 30341-3724 , USA .

 

Reports of hypovitaminosis D among adults in the United States have drawn attention to the vitamin D status of children. National data on hypovitaminosis D among children are not yet available. Reports from 2000 and 2001 of rickets among children living in North Carolina , Texas , Georgia , and the mid-Atlantic region, however, confirmed the presence of vitamin D deficiency among some US children and prompted new clinical guidelines to prevent its occurrence. We reviewed reports of nutritional rickets among US children <18 y of age that were published between 1986 and 2003. We identified 166 cases of rickets in 22 published studies. Patients were 4-54 mo of age, although in 17 studies the maximal age was <30 mo. Approximately 83% of children with rickets were described as African American or black, and 96% were breast-fed. Among children who were breast-fed, only 5% of records indicated vitamin D supplementation during breast-feeding. The American Academy of Pediatrics (AAP) recently recommended a minimal intake of 200 IU/d vitamin D for all infants, beginning in the first 2 mo of life. AAP recommends a vitamin D supplement for breast-fed infants who do not consume at least 500 mL of a vitamin D-fortified beverage. Given our finding of a disproportionate number of rickets cases among young, breast-fed, black children, we recommend that education regarding AAP guidelines emphasize the higher risk of rickets among these children. Education should also emphasize the importance of weaning children to a diet adequate in both vitamin D and calcium.

 

Publication Types:

Meta-Analysis

Review

Review, Tutorial

 

PMID: 15585790 [PubMed - indexed for MEDLINE]

 

 

[xv] Am J Clin Nutr. 2004 Dec;80(6 Suppl):1752S-8S.

Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant.

 

Hollis BW, Wagner CL.

 

Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. hollisb@musc.edu

 

Scientific data pertaining to vitamin D supplementation during lactation are scarce. The daily recommended intake for vitamin D during lactation has been arbitrarily set at 400 IU/d (10 microg/d). This recommendation is irrelevant with respect to maintaining the nutritional vitamin D status of mothers and nursing infants, especially among darkly pigmented individuals. Our objective was to examine the effect of high-dose maternal vitamin D2 supplementation on the nutritional vitamin D status of mothers and nursing infants. Fully lactating women (n = 18) were enrolled at 1 mo after birth to 1 of 2 treatment arms, ie, 1600 IU vitamin D2 and 400 IU vitamin D3 (prenatal vitamin) or 3600 IU vitamin D2 and 400 IU vitamin D3, for a 3-mo study period. High-dose (1600 or 3600 IU/d) vitamin D2 supplementation for a period of 3 mo safely increased circulating 25-hydroxyvitamin D [25(OH)D] concentrations for both groups. The antirachitic activity of milk from mothers receiving 2000 IU/d vitamin D increased by 34.2 IU/L, on average, whereas the activity in the 4000 IU/d group increased by 94.2 IU/L. Nursing infant circulating 25(OH)D2 concentrations reflected maternal intake and the amount contained in the milk. With limited sun exposure, an intake of 400 IU/d vitamin D would not sustain circulating 25(OH)D concentrations and thus would supply only limited amounts of vitamin D to nursing infants in breast milk. A maternal intake of 2000 IU/d vitamin D would elevate circulating 25(OH)D concentrations for both mothers and nursing infants, albeit with limited capacity, especially with respect to nursing infants. A maternal intake of 4000 IU/d could achieve substantial progress toward improving both maternal and neonatal nutritional vitamin D status.

 

PMID: 15585800 [PubMed - indexed for MEDLINE]

 

 

[xvi] Am J Clin Nutr . 2004 May;79(5):717-26.

Assessment of dietary vitamin D requirements during pregnancy and lactation.

 

Hollis BW, Wagner CL.

 

Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, 114 Doughty Street, PO Box 205770, Charleston, SC 29403, USA. hollisb@musc.edu

 

Concerns about vitamin D have resurfaced in medical and scientific literature because the prevalence of vitamin D deficiency in the United States , particularly among darkly pigmented persons, has increased. The primary goals of this review were to discuss past and current literature and to reassess the dietary reference intake for vitamin D in adults, with particular focus on women during pregnancy and lactation. The appropriate dose of vitamin D during pregnancy and lactation is unknown, although it appears to be greater than the current dietary reference intake of 200-400 IU/d (5-10 microg/d). Doses of < or =10 000 IU vitamin D/d (250 microg/d) for up to 5 mo do not elevate circulating 25-hydroxyvitamin D to concentrations > 90 ng/mL, whereas doses < 1000 IU/d appear, in many cases, to be inadequate for maintaining normal circulating 25-hydroxyvitamin D concentrations of between 15 and 80 ng/mL. Vitamin D plays no etiologic role in cardiac valvular disease, such as that observed in Williams syndrome, and, as such, animal models involving vitamin D intoxication that show an effect on cardiac disease are flawed and offer no insight into normal human physiology. Higher doses of vitamin D are necessary for a large segment of Americans to achieve concentrations equivalent to those in persons who live and work in sun-rich environments. Further studies are necessary to determine optimal vitamin D intakes for pregnant and lactating women as a function of latitude and race.

PMID: 15113709 [PubMed - indexed for MEDLINE]

 

 

[xvii] Am J Clin Nutr . 2004 Dec;80(6 Suppl):1710S-6S.

Vitamin D fortification in the United States and Canada : current status and data needs.

 

Calvo MS, Whiting SJ, Barton CN.

 

Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Laurel , MD 20910 , USA . mona.calvo@cfsan.fda.gov

 

Most circulating 25-hydroxyvitamin D originates from exposure to sunlight; nevertheless, many factors can impair this process, necessitating periodic reliance on dietary sources to maintain adequate serum concentrations. The US and Canadian populations are largely dependent on fortified foods and dietary supplements to meet these needs, because foods naturally rich in vitamin D are limited. Fluid milk and breakfast cereals are the predominant vehicles for vitamin D in the United States , whereas Canada fortifies fluid milk and margarine. Reports of a high prevalence of hypovitaminosis D and its association with increased risks of chronic diseases have raised concerns regarding the adequacy of current intake levels and the safest and most effective way to increase vitamin D intake in the general population and in vulnerable groups. The usual daily intakes of vitamin D from food alone and from food and supplements combined, as estimated from the US third National Health and Nutrition Examination Survey, 1988-1994, show median values above the adequate intake of 5 microg/d for children 6-11 y of age; however, median intakes are generally below the adequate intake for female subjects > 12 y of age and men > 50 y. In Canada , there are no national survey data for estimation of intake. Cross-sectional studies suggest that current US/Canadian fortification practices are not effective in preventing hypovitaminosis D, particularly among vulnerable populations during the winter, whereas supplement use shows more promise. Recent prospective intervention studies with higher vitamin D concentrations provided evidence of safety and efficacy for fortification of specific foods and use of supplements.

PMID: 15585792 [PubMed - indexed for MEDLINE]

 

 

[xviii] J Natl Med Assoc . 2004 Dec;96(12 Suppl):5S-31S.

Consensus report of the National Medical Association. The role of dairy and dairy nutrients in the diet of African Americans.

Wooten WJ, Price W.

National Medical Association, Women Section, San Diego , CA , USA .

PMID: 15624290 [PubMed - indexed for MEDLINE]

 

 

 

Nutr Rev. 2003 Mar;61(3):107-13.

Prevalence of vitamin D insufficiency in Canada and the United States : importance to health status and efficacy of current food fortification and dietary supplement use.

Calvo MS, Whiting SJ.

Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, Food and Drug Administration, HFS-025, 8301 Muirkirk Road, Laurel, MD 20708, USA.

 

Several recent studies have identified a surprisingly high prevalence of vitamin D insufficiency in otherwise healthy adults living in Canada and the United States . Most striking are the effects of latitude, season, and race. Also noteworthy is that dietary vitamin D is not reaching the population in greatest need, nor is it very protective against insufficiency. Fluid milk, as the predominant vehicle for vitamin D fortification, is apparently not very effective in staving off vitamin D insufficiency in adults in all populations at all times of the year.

PMID: 12723644 [PubMed - indexed for MEDLINE]

 

 

[xix] Nutr Rev . 2003 Mar;61(3):107-13.

Prevalence of vitamin D insufficiency in Canada and the United States : importance to health status and efficacy of current food fortification and dietary supplement use .

Calvo MS, Whiting SJ.

 

Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, Food and Drug Administration, HFS-025, 8301 Muirkirk Road, Laurel, MD 20708, USA.

 

Several recent studies have identified a surprisingly high prevalence of vitamin D insufficiency in otherwise healthy adults living in Canada and the United States . Most striking are the effects of latitude, season, and race. Also noteworthy is that dietary vitamin D is not reaching the population in greatest need, nor is it very protective against insufficiency. Fluid milk, as the predominant vehicle for vitamin D fortification, is apparently not very effective in staving off vitamin D insufficiency in adults in all populations at all times of the year.

PMID: 12723644 [PubMed - indexed for MEDLINE]

 

 

[xx] Am J Clin Nutr . 2004 Dec;80(6 Suppl):1710S-6S

Vitamin D fortification in the United States and Canada : current status and data needs.

Calvo MS, Whiting SJ, Barton CN.

 

Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Laurel , MD 20910 , USA . mona.calvo@cfsan.fda.gov

 

Most circulating 25-hydroxyvitamin D originates from exposure to sunlight; nevertheless, many factors can impair this process, necessitating periodic reliance on dietary sources to maintain adequate serum concentrations. The US and Canadian populations are largely dependent on fortified foods and dietary supplements to meet these needs, because foods naturally rich in vitamin D are limited. Fluid milk and breakfast cereals are the predominant vehicles for vitamin D in the United States , whereas Canada fortifies fluid milk and margarine. Reports of a high prevalence of hypovitaminosis D and its association with increased risks of chronic diseases have raised concerns regarding the adequacy of current intake levels and the safest and most effective way to increase vitamin D intake in the general population and in vulnerable groups. The usual daily intakes of vitamin D from food alone and from food and supplements combined, as estimated from the US third National Health and Nutrition Examination Survey, 1988-1994, show median values above the adequate intake of 5 microg/d for children 6-11 y of age; however, median intakes are generally below the adequate intake for female subjects > 12 y of age and men > 50 y. In Canada , there are no national survey data for estimation of intake. Cross-sectional studies suggest that current US/Canadian fortification practices are not effective in preventing hypovitaminosis D, particularly among vulnerable populations during the winter, whereas supplement use shows more promise. Recent prospective intervention studies with higher vitamin D concentrations provided evidence of safety and efficacy for fortification of specific foods and use of supplements.

 

PMID: 15585792 [PubMed - indexed for MEDLINE]

 


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