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Sun Exposure and Vitamin D for Public Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 December 2019) | Viewed by 45290

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Prof. Dr. Robyn Lucas

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ANU College of Medicine, Biology and Environment, Australian National University
Interests: environmental effects on immune function; epidemiology; developmental origins of health and disease; autoimmune diseases; climate change; ultraviolet radiation; vitamin D
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Research on the health consequences of sun exposure initially focused on risks—skin cancers such as melanoma and keratinocyte cancers, eye disorders such as cataract and pterygium, and immune disorders such as the reactivation of latent virus infections. This was driven by rapidly increasing incidence of skin cancers, and then fears about the health consequences of depletion of stratospheric ozone, first recognised in the 1970s. More recently there has been recognition of the benefits of sun exposure—firstly related to the synthesis of vitamin D, and even more recently, recognition of wide-ranging possible benefits for health and well-being. Interest now goes beyond ultraviolet radiation to sun exposure more broadly, to both the skin and the eyes, and the large number of chromophores and biological pathways that mediate both the risks and benefits of sun exposure. This special issue invites papers on both risks and benefits, but particularly setting those within a context of achieving a balance that optimizes health for a global population.

Prof. Dr. Robyn Lucas
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (11 papers)

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Research

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12 pages, 932 KiB

Open AccessArticle

The Effect of Ultraviolet B Irradiation Compared with Oral Vitamin D Supplementation on the Well-being of Nursing Home Residents with Dementia: A Randomized Controlled Trial

by Bistra I. Veleva, Monique A. A. Caljouw, Jenny T. van der Steen, Bart J. A. Mertens, Victor G. M. Chel and Mattijs E. Numans

Int. J. Environ. Res. Public Health 2020, 17(5), 1684; https://doi.org/10.3390/ijerph17051684 - 5 Mar 2020

Cited by 8 | Viewed by 4225

Abstract

There are indications that ultraviolet B (UVB) exposure has beneficial effects on well-being through mechanisms other than vitamin D synthesis alone. We conducted a randomized controlled multicenter trial to compare the effects of UVB light and vitamin D supplementation (VD) in terms of the well-being of nursing home residents with dementia. Participants were randomly assigned to the intervention group (UVB group, n = 41; half-body UVB irradiation, twice weekly over 6 months, with 1 standard erythema dose (SED)) or to the control group (VD group, n = 37; 5600 International units (IU) cholecalciferol supplementation once a week). The main outcome was well-being, measured by the Cohen-Mansfield Agitation Inventory (CMAI) and the Cornell scale for depression in dementia at 0, 3, and 6 months. Secondary outcomes were QUALIDEM quality of life domains and biochemical parameters of bone homeostasis. Intention-to-treat analysis with linear mixed modeling showed no significant between-group differences on agitation (p = 0.431) or depressive symptoms (p = 0.982). At six months, the UVB group showed less restless/tense behavior compared to the VD group (mean difference of the mean change scores 2.2, 95% CI 0.8 to 3.6; p = 0.003 for group x time interaction) and lower serum 25(OH)D3 concentration (estimated mean difference - 21.9, 95% CI −32.6 to −11.2; p = 0.003 for group difference). The exposure of nursing home residents with dementia to UVB light showed no positive benefits in terms of wellbeing. UVB treatment may have a positive effect on the restless/tense behavior characteristic of advanced dementia but more research is needed to confirm this finding. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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13 pages, 1197 KiB

Open AccessArticle

The Potential of Ultraviolet Radiation Meters in Secondary Schools as a Sun Protection Intervention Mechanism for Adolescents

by Simone Pettigrew, Ashleigh Parnell, Mark Strickland, Rachel Neale and Robyn Lucas

Int. J. Environ. Res. Public Health 2020, 17(4), 1137; https://doi.org/10.3390/ijerph17041137 - 11 Feb 2020

Cited by 7 | Viewed by 2834

Abstract

The aim of this pilot study was to assess whether the installation of ultraviolet radiation (UVR) meters in secondary schools has the potential to improve adolescents’ sun protection-related knowledge, attitudes, and behaviours and reduce their exposure to UVR during school hours. Data were collected from students at two schools via online pre- and post-intervention surveys, measurement of sunscreen usage, polysulfone UVR exposure badges, and photographs of the schoolyards to assess hat and shade use. Several operational issues limited the quantity and quality of data that could be collected, and findings were mixed. While there were no significant changes in either self-reported or observed sun protection behaviours, there were significant improvements in UVR knowledge among students at the intervention school, and reactions to the meter were highly favourable. Students reported consulting the meter regularly and using it to make decisions about their sun protection behaviours. Overall, the study results offer some support for the use of UVR meters in areas frequented by adolescents and provide insights into the process issues that are likely to need to be addressed when attempting to trial sun protection interventions in schools. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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14 pages, 1023 KiB

Open AccessArticle

The Epidemiology of Skin Cancer and Public Health Strategies for Its Prevention in Southern Africa

by Caradee Y. Wright, D. Jean du Preez, Danielle A. Millar and Mary Norval

Int. J. Environ. Res. Public Health 2020, 17(3), 1017; https://doi.org/10.3390/ijerph17031017 - 6 Feb 2020

Cited by 26 | Viewed by 7143

Abstract

Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They differ in population size and composition and experience different levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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12 pages, 2192 KiB

Open AccessArticle

Analytical Bias in the Measurement of Plasma 25-Hydroxyvitamin D Concentrations in Infants

by Kristina Rueter, Lucinda J. Black, Anderson Jones, Max Bulsara, Michael W. Clarke, Cristina Gamez, Ee M. Lim, Debra J. Palmer, Susan L. Prescott and Aris Siafarikas

Int. J. Environ. Res. Public Health 2020, 17(2), 412; https://doi.org/10.3390/ijerph17020412 - 8 Jan 2020

Cited by 2 | Viewed by 2458

Abstract

Hypovitaminosis D is prevalent worldwide; however, analytical bias in the measurement of circulating 25-hydroxyvitamin D (25(OH)D) concentrations may affect clinical treatment decisions and research. We performed parallel plasma 25(OH)D analyses using the Abbott Architect i2000 chemiluminescent immunoassay (CIA) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for paired samples from the same infants at 3 (n = 69), 6 (n = 79) and 12 months (n = 73) of age. To test agreement, we used Lin’s concordance correlation coefficient and corresponding 95% confidence interval, Bland–Altman’s limits of agreement, and Bradley–Blackwood (BB) test. Agreement was high at 3 months (coefficient between difference and mean −0.076; BB F = 0.825; p = 0.440), good at 12 months (−0.25; BB F = 2.41; p = 0.097) but missing at 6 months of age (−0.39; BB F = 12.30; p < 0.001). Overall, 18 infants had disparate results based on the cut-off point for vitamin D deficiency (25(OH)D < 50 nmol/L), particularly at three months, with seven (10%) infants deficient according to CIA but not LC–MS/MS, and four (6%) deficient by LC–MS/MS but not CIA. To our knowledge, this is the first study to show that the reported 25(OH)D concentration may be influenced by both age and assay type. Physicians and researchers should be aware of these pitfalls when measuring circulating 25(OH)D concentrations in infants and when developing treatment plans based on measured vitamin D status. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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13 pages, 1209 KiB

Open AccessArticle

Season, Terrestrial Ultraviolet Radiation, and Markers of Glucose Metabolism in Children Living in Perth, Western Australia

by Catherine L. Clarke, Lana M. Bell, Peter Gies, Stuart Henderson, Aris Siafarikas and Shelley Gorman

Int. J. Environ. Res. Public Health 2019, 16(19), 3734; https://doi.org/10.3390/ijerph16193734 - 3 Oct 2019

Cited by 2 | Viewed by 2244

Abstract

Seasonality in glucose metabolism has been observed in adult populations; however, little is known of the associations between season and glucose metabolism in children. In this study, we examined whether markers of glucose metabolism (fasting glucose, insulin and HbA1c) varied by season in a paediatric population (6–13 years of age) located in Perth (Western Australia, n = 262) with data categorised by weight. Linear regression was used to analyse the nature of the relationships between mean daily levels of terrestrial ultraviolet radiation (UVR) (prior to the day of the blood test) and measures of glucose metabolism. Fasting blood glucose was significantly lower in autumn compared to spring, for children in combined, normal and obese weight categories. Fasting insulin was significantly lower in autumn and summer compared to winter for individuals of normal weight. HbA1c was significantly higher in summer (compared with winter and spring) in overweight children, which was in the opposite direction to other published findings in adults. In children with obesity, a strong inverse relationship (r = −0.67, p = 0.002) was observed for fasting glucose, and daily terrestrial UVR levels measured in the previous 6 months. Increased safe sun exposure in winter therefore represents a plausible means of reducing fasting blood sugar in children with obesity. However, further studies, using larger paediatric cohorts are required to confirm these relationships. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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7 pages, 270 KiB

Open AccessArticle

Primary Language in Relation to Knowledge of Diagnosis and Sun-Related Behaviors in Adults with Sun-Exacerbated Dermatoses

by Mayra B. C. Maymone, Stephen A. Wirya, Eric A. Secemsky and Neelam A. Vashi

Int. J. Environ. Res. Public Health 2019, 16(19), 3710; https://doi.org/10.3390/ijerph16193710 - 2 Oct 2019

Cited by 2 | Viewed by 2026

Abstract

Objective: To evaluate how patients’ primary spoken language influences the understanding of their disorder and their subsequent sun-related behaviors. Methods: This was a cross-sectional study conducted between February 2015 and July 2016 in two outpatient dermatology clinics among 419 adults with a sun-exacerbated dermatosis. The primary outcome was a successful match between the patient-reported diagnosis on a survey and the dermatologist-determined diagnosis. Results: Of participants, 42% were native English speakers, and 68% did not know their diagnosis. Fewer non-native English speakers identified one risk factor for their condition (46% versus 54%, p < 0.01). A greater number of non-native English speakers were less familiar with medical terminology. Native English speakers were 2.5 times more likely to know their diagnosis compared to non-native speakers (adjusted odds (aOR) 2.5, 95% confidence interval, 1.32 to 4.5; p = 0.005). Additional factors associated with higher odds of knowing the diagnosis included: Higher education, sunscreen use, female gender, symptoms for 1–5 years, and diagnosis of melasma and postinflammatory hyperpigmentation (PIH). Conclusions: Knowledge of the diagnosis and understanding of factors that may influence skin disease may promote conscious sun behavior. Patients who knew that their diagnosis was sun-exacerbated had higher odds of wearing sunscreen. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

9 pages, 849 KiB

Open AccessArticle

Prevalence and Predictors of Vitamin D Deficiency among African Immigrants Living in Australia

by Kahlea Horton-French, Eleanor Dunlop, Robyn M. Lucas, Gavin Pereira and Lucinda J. Black

Int. J. Environ. Res. Public Health 2019, 16(16), 2855; https://doi.org/10.3390/ijerph16162855 - 10 Aug 2019

Cited by 5 | Viewed by 3159

Abstract

Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations <50 nmol/L) is a public health issue in Australia and internationally. Those with darker skin require a greater dose of ultraviolet B radiation from sunlight than those with paler skin to synthesise adequate amounts of vitamin D. Using data from the 2011–2013 Australian Health Survey, we investigated the prevalence and predictors of vitamin D deficiency in African immigrants aged ≥18 years living in Australia (n = 236). Serum 25(OH)D was measured using a liquid chromatography–tandem mass spectrometry method that is certified to international reference measurement procedures. Poisson regression was used to investigate independent predictors of vitamin D deficiency. A total of 36% of adults were vitamin D deficient (35% of men, 37% of women). The prevalence ratio (PR) of vitamin D deficiency decreased by 2% per year of age (PR 0.98; 95% CI (0.97, 0.99); p = 0.004) and was 1.6 times higher in those with low/sedentary, compared to moderate/high, physical activity levels (PR 1.64; 95% CI (1.12, 2.39); p = 0.011). The greatest risk was for those assessed during winter/spring compared with summer/autumn (PR 1.89; 95% CI (1.33, 2.64); p < 0.001). Culturally appropriate messaging on safe sun exposure and dietary vitamin D is warranted in order to promote vitamin D sufficiency in African immigrants living in Australia. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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Review

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20 pages, 2190 KiB

Open AccessReview

Balance between Health Risks and Benefits for Outdoor Workers Exposed to Solar Radiation: An Overview on the Role of Near Infrared Radiation Alone and in Combination with Other Solar Spectral Bands

by Carlo Grandi and Maria Concetta D’Ovidio

Int. J. Environ. Res. Public Health 2020, 17(4), 1357; https://doi.org/10.3390/ijerph17041357 - 20 Feb 2020

Cited by 24 | Viewed by 4452

Abstract

Near infrared or infrared A (IRA) accounts for over 40% of the solar spectrum (SS) and is able to reach subcutaneous tissue as well as the retina. Outdoor workers are occupationally exposed to solar radiation (SR), but the level of exposure may differ widely depending on the job performed, time spent outdoors, latitude, altitude, season, personal protection, etc. Until now, risk assessment and management for outdoor workers has focused on the prevention of both acute and long-term effects on the eye and the skin due to solar ultraviolet radiation (UVR) with little consideration of the other components of the SS (a possible exception is represented by visible radiation with reference to the eye). A growing body of evidence coming from in vitro studies indicates that IRA is involved in cellular reactive oxygen species (ROS) production and may interfere with the respiratory chain in the mitochondria. Moreover, it can modulate gene expression and some metabolic pathways. The biological action of IRA is only partly attributable to a thermal mechanism, should it be also involved in photochemical ones. The cellular and molecular pathways affected by IRA are partly similar and partly different with respect to those involved in the case of visible ultraviolet A (UVA) and ultraviolet B (UVB) radiation. Consequently, the net effect of the SS is very difficult to predict at different levels of the biological organization, making more difficult the final balance of health risk and benefits (for the skin, eye, immune system, blood pressure, etc.) in a given exposure situation. Moreover, few in vivo studies and no epidemiological data are presently available in this regard. Investigating this topic may contribute to better defining the individual exposome. More practically, it is expected to bring benefits to the risk assessment and management for outdoor workers exposed to SS, contributing to: (1) better definition of the individual profiles of susceptibility, (2) more focused preventive and protective measures, (3) better implementation of the health surveillance and (4) a more effective information and training. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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19 pages, 869 KiB

Open AccessReview

Vitamin D Exposure and Ovarian Cancer Risk and Prognosis

by Kevin L’Espérance, Geetanjali D. Datta, Samia Qureshi and Anita Koushik

Int. J. Environ. Res. Public Health 2020, 17(4), 1168; https://doi.org/10.3390/ijerph17041168 - 12 Feb 2020

Cited by 11 | Viewed by 3134

Abstract

Given the poor prognosis of ovarian cancer and limited population-level strategies for early detection and long-term treatment success, knowledge of modifiable risk factors for prevention and improved prognosis is important. Vitamin D has received wide scientific interest in cancer research as having the potential to be one such factor. We carried out a systematic narrative review of the literature on vitamin D and ovarian cancer risk and survival. We included 17 case-control and cohort studies on ovarian cancer incidence. Five analyses were of sun exposure, among which three reported an inverse association. Of 11 analyses of dietary vitamin D, two reported an inverse association. Among five studies of 25(OH)D levels, an inverse association was reported in two. Across all studies the findings were inconsistent, but some recent studies have suggested that vitamin D exposure at earlier ages may be important. Only three studies examining vitamin D exposure in relation to survival among ovarian cancer survivors were identified and the findings were inconsistent. The evidence to date supports a null influence of vitamin D on both ovarian cancer risk and survival. Future research should ensure that exposure assessment captures vitamin D exposure from all sources and for the etiologically or prognostically pertinent period. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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7 pages, 289 KiB

Open AccessFeature PaperReview

Evolution, Prehistory and Vitamin D

by Paul Jarrett and Robert Scragg

Int. J. Environ. Res. Public Health 2020, 17(2), 646; https://doi.org/10.3390/ijerph17020646 - 19 Jan 2020

Cited by 3 | Viewed by 4764

Abstract

Aspects of human evolutionary biology and prehistory are discussed in relation to vitamin D. The evolution of hairlessness, combined with the need for efficient eccrine sweat production for cooling, provided evolutionary pressure to protect the skin from ultraviolet damage by developing cutaneous pigmentation. There was a subsequent loss of pigmentation as humans journeyed to northern latitudes. Their increasing mastery of technology outstripped evolution’s finite pace as further dispersal occurred around the globe. A timeline for the development of clothing to provide warmth, and the consequent shielding from ultraviolet light, which diminished vitamin D synthesis, can be inferred by an examination of mutations in the human louse. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

15 pages, 3111 KiB

Open AccessReview

Acute Respiratory Tract Infection and 25-Hydroxyvitamin D Concentration: A Systematic Review and Meta-Analysis

by Hai Pham, Aninda Rahman, Azam Majidi, Mary Waterhouse and Rachel E. Neale

Int. J. Environ. Res. Public Health 2019, 16(17), 3020; https://doi.org/10.3390/ijerph16173020 - 21 Aug 2019

Cited by 96 | Viewed by 8227

Abstract

Observational studies and randomised controlled studies suggest that vitamin D plays a role in the prevention of acute respiratory tract infection (ARTI); however, findings are inconsistent and the optimal serum 25-hydroxyvitamin D (25(OH)D) concentration remains unclear. To review the link between 25(OH)D concentration and ARTI, we searched PubMed and EMBASE databases to identify observational studies reporting the association between 25(OH)D concentration and risk or severity of ARTI. We used random-effects meta-analysis to pool findings across studies. Twenty-four studies were included in the review, 14 were included in the meta-analysis of ARTI risk and five in the meta-analysis of severity. Serum 25(OH)D concentration was inversely associated with risk and severity of ARTI; pooled odds ratios (95% confidence interval) were 1.83 (1.42–2.37) and 2.46 (1.65–3.66), respectively, comparing the lowest with the highest 25(OH)D category. For each 10 nmol/L decrease in 25(OH)D concentration, the odds of ARTI increased by 1.02 (0.97–1.07). This was a non-linear trend, with the sharpest increase in risk of ARTI occurring at 25(OH)D concentration < 37.5 nmol/L. In conclusion, there is an inverse non-linear association between 25(OH)D concentration and ARTI. Full article

(This article belongs to the Special Issue Sun Exposure and Vitamin D for Public Health)

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