Vitamin D Status and Its Consequences for Health in South Africa

Abstract

In this review, reports were retrieved in which vitamin D status, as assessed by serum 25-hydroxyvitamin D [25(OH)D] levels, was measured in South African population groups with varied skin colours and ethnicities. Healthy children and adults were generally vitamin D-sufficient [25(OH)D level >50 nmol/L] but the majority of those aged above 65 years were deficient. A major role for exposure to solar ultraviolet radiation (UVR) in determining 25(OH)D levels was apparent, with the dietary contribution being minor. Limited data exist regarding the impact of recent changes in lifestyles on vitamin D status, such as urbanisation. With regard to disease susceptibility, 11 of 22 relevant publications indicated association between low 25(OH)D levels and disease, with deficiency most notably found in individuals with tuberculosis and HIV-1. Information on the relationship between vitamin D receptor variants and ethnicity, disease or treatment response in the South African population groups demonstrated complex interactions between genetics, epigenetics and the environment. Whether vitamin D plays an important role in protection against the range of diseases that currently constitute a large burden on the health services in South Africa requires further investigation. Only then can accurate advice be given about personal sun exposure or dietary vitamin D supplementation.

Keywords: 25(OH)D levels; HIV-1; sun exposure; tuberculosis; vitamin D receptor.

Figure 1

The number of publications investigating the association between vitamin D status and disease in the Provinces of South Africa. Green indicates a significant association, and white indicates no significant association. The size of the Venn diagrams is proportional to the number of studies. Map adapted from Global Security [19] and the Venn diagrams were plotted using GraphPad PRISM 6.