BMC Public HealthBMC series 201717:519, DOI: 10.1186/s12889-017-4436-z
Daniel Sowah†, Xiangning Fan†, Liz Dennett, Reidar Hagtvedt and Sebastian Straube straube at ualberta.ca †Contributed equally
The review just only discusses occupations
Many additional people at high risk of being deficient who get little Vitamin D from the sun
Note: Early morning and late afternoon sun does NOT produce Vitamin D
Walking the dog, jogging, or bicycling before or after work does not help
Indoor workers – especially those who do not get mid-day sunshine
- also: shift workers, miners, submariners, astronauts,
Non-workers of any age who do not feel comfortable outdoors – such as
- Fibromyalgia, Multiple Sclerosis, etc.
- Elderly (get only 1/4 as much vitamin D from the same sun exposure)
tend to wear more clothes as get older, fear skin cancer,
- People with limited mobility
- “Look different” : disfigured, blotchy facial skin, severe burns, lack of hair,
- intellectually disabled
- Photosensitive, red hair
- Concerned about skin cancer
- Obese( who actually need more vitamin D, but often feel uncomfortable outdoors)
- Dark-skinned people living in a light-skinned community
- Maximum security prisoners
Environment: public or personal
- Excessive smog, urban haze
- Live or work near lots of traffic – being outdoors is not comfortable
- Live or work near many tall buildings which block the light
- Wear excessive clothes
- Wear sunscreen whenever outdoors (Should put sunscreen on AFTER getting benefits of the sun)
- Perhaps workers with lots of sunlight coming into windows (including long-haul truck drivers)
- 40 percent lower vitamin D level if work other shifts (Italy) – June 2015
- Night cleaners deficient in vitamin D - Nov 2015
- Burka clothing reduces vitamin D levels, which causes pregnancy problems – Oct 2015
- The only supplement NASA gives crews is vitamin D - Sept 2015
- Optimize vitamin D from the sun – 14 ways
- 1400 IU of Vitamin D from Summer noonday German sun from a 10 minute walk – Feb 2018
- No – 10 minutes per day of sun-UVB is NOT enough
- 20 cent vitamin D pill similar to 2 hours sunbathing at 60 degree latitude – RCT Aug 2013
- Allergic to the sun (Polymorphic light eruption) – you may need UVB or vitamin D
- Whites were 2X more likely to be vitamin D deficient if wear long sleeves – Jan 2012
- If ten patients walked into my office today, I know that nine of them would be deficient in vitamin D - June 2014
- Excessive clothes and being indoors results in very low vitamin D levels – Nov 2011
- UVA decreased serum levels of vitamin D - RCT Oct 2012 - getting sunlight only thru windows
- Indoor workers have lower vitamin D levels than outdoor workers, unless lead smelter – June 2017
Vitamin D deficiency is prevalent worldwide, but some groups are at greater risk. We aim to evaluate vitamin D levels in different occupations and identify groups vulnerable to vitamin D deficiency.
An electronic search conducted in Medline, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text generated 2505 hits; 71 peer-reviewed articles fulfilled the inclusion criteria. Occupations investigated included outdoor and indoor workers, shiftworkers, lead/smelter workers, coalminers, and healthcare professionals. We calculated the pooled average metabolite level as mean ± SD; deficiency/insufficiency status was described as % of the total number of subjects in a given category.
Compared to outdoor workers, indoor workers had lower 25-hydroxyvitamin D (25-(OH)D) levels (40.6 ± 13.3 vs. 66.7 ± 16.7 nmol/L; p < 0.0001). Mean 25-(OH)D levels (in nmol/L) in shiftworkers, lead/smelter workers and coalminers were 33.8 ± 10.0, 77.8 ± 5.4 and 56.6 ± 28.4, respectively. Vitamin D deficiency (25-(OH)D < 50 nmol/L), was high in shiftworkers (80%) and indoor workers (78%) compared to outdoor workers (48%). Among healthcare professionals, medical residents and healthcare students had the lowest levels of mean 25-(OH)D, 44.0 ± 8.3 nmol/L and 45.2 ± 5.5 nmol/L, respectively. The mean 25-(OH)D level of practising physicians, 55.0 ± 5.8 nmol/L, was significantly different from both medical residents (p < 0.0001) and healthcare students (p < 0.0001). Nurses and other healthcare employees had 25-(OH)D levels of 63.4 ± 4.2 nmol/L and 63.0 ± 11.0 nmol/L, respectively, which differed significantly compared to practising physicians (p = 0.01), medical residents (p < 0.0001) and healthcare students (p < 0.0001).
Rates of vitamin D deficiency among healthcare professionals were: healthcare students 72%, medical residents 65%, practising physicians 46%, other healthcare employees 44%, and nurses 43%. Combined rates of vitamin D deficiency or insufficiency (25-(OH)D < 75 nmol/L) were very high in all investigated groups.
Potential confounders such as gender and body composition were not consistently reported in the primary studies and were therefore not analyzed. Furthermore, the descriptions of occupational characteristics may be incomplete. These are limitations of our systematic review.
Our review demonstrates that shiftworkers, healthcare workers and indoor workers are at high risk to develop vitamin D deficiency, which may reflect key lifestyle differences (e.g. sunlight exposure). This may help target health promotion and preventive efforts.