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Increasing serum 25-hydroxyvitamin D levels could increase national life expectancy and reduce life expectancy disparities by race in the United States

Posted by wbgrant on 31 Mar 2010 at 18:12 GMT

Sir:
While two recent papers in PLoS Medicine documented important preventable causes of death [smoking 467,000 deaths), hypertension 395,000 deaths), overweight/obesity (216,000 deaths), physical inactivity (191,000 deaths), high dietary salt (102,000 deaths)] [1] and applied them to life expectancy disparities [2], they omit one additional important factor: low serum 25-hydroxyvitamin D [25(OH)D] levels. A recent paper estimated that if the mean serum 25(OH)D levels of all Americans was raised to 42 ng/mL from 16 ng/mL for Black-Americans, 21 ng/mL for Hispanic-Americans, and 26 ng/mL for non-Hispanic White-Americans [3,4], the annual mortality rate could be reduced by 400,000 deaths/year [5].

The diseases with the highest mortality rates for Black-Americans are heart disease, cancers, stroke, diabetes, chronic obstructive pulmonary disease (COPD), septicemia, and influenza and pneumonia [6,7]. Mortality rates for all of these except COPD are higher for Black-Americans than White-Americans. There is good-to-excellent evidence that low serum 25(OH)D level is an important risk factor for all of these diseases: heart disease [8], cancers [9-11], stroke [12], diabetes [8], septicemia [13], and influenza and pneumonia [14-16].

Estimates have been made for a number of countries benefits of increasing serum 25(OH)D levels to 42-45 ng/mL with the finding that mortality rates and economic burdens of disease would be reduced by about 15-20% [5, 17-19]. This corresponds to about a two-year increase in life expectancy. Another review examined the benefit to Black-Americans with the finding that the difference in mean serum 25(OH)D levels for Blacks and Whites corresponds to a 25% difference in mortality rates [20].

Of all the important lifestyle causes of death discussed in these papers, vitamin D deficiency is the easiest to correct: a year’s supply of 3000 IU/day costs about $10 when purchased over the Internet. Each 1000 IU/day increases serum 25(OH)D levels by about 10 ng/mL [9].

William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
www.sunarc.org
wbgrant@infionline.net

References
1. Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 6:e1000058.

2. Danaei G, Rimm EB, Oza S, Kulkarni SC, Murray CJL, et al. (2010) The Promise of prevention: The effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States. PLoS Med doi:10.1371/journal.pmed.1000248

3. Looker AC, Pfeiffer CM, Lacher DA, Schleicher RL, Picciano MF, et al. (2008) Serum
25-hydroxyvitamin D status of the US population: 1988–1994 compared with 2000–
2004. Am J Clin Nutr 88:1519-1527.

4. Ginde AA, Liu MC, Camargo CA Jr. (2009) Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004. Arch Intern Med 169:626-632.

5. Grant WB. (2009) In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermato-Endocrinology 1:207-214.

6. National Center for Health Statistics. Health, United States, 2008 with Chartbook Hyattsville, MD: 2009.
ftp://ftp.cdc.gov/pub/Hea.... (Accessed 01/03/10)

7. Orsi JM, Margellos-Anast H, Whitman S. (2010) Black-White health disparities in the United States and Chicago: a 15-year progress analysis. Am J Public Health 100:349-356.

8. Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, et al. (2010) Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis. Maturitas 65:225-236.

9. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. (2007) Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 85:1586-1591.

10. Grant WB. (2009) How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer? An examination using Hill’s criteria for causality. Dermato-Endocrinology 1:17-24.

11. Garland CF, Gorham ED, Mohr SB, Garland FC. (2009) Vitamin D for Cancer Prevention: Global Perspective. Ann Epi 19:468-463.

12. Pilz S, Dobnig H, Fischer JE, Wellnitz B, Seelhorst U, et al. (2008) Low vitamin D levels predict stroke in patients referred to coronary angiography. Stroke 39:2611-2613.

13. Grant WB. (2009) Solar ultraviolet-B irradiance and vitamin D may reduce the risk of septicemia. Dermato-Endocrinology 1:37-42.

14. Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. (2008) On the epidemiology of influenza. Virol J 5:29.

15. Grant WB, Giovannucci D. (2009) The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918–1919 influenza pandemic in the United States. Dermato-Endocrinology 1:215-219.

16. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, et al. (2010) Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr [Epub]

17. Grant WB, Cross HS, Garland CF, Gorham ED, Moan J, et al. (2009) Estimated benefit of increased vitamin D status in reducing the economic burden of disease in Western Europe. Prog Biophys Mol Biol 99:104-113.

18. Grant WB, Schwalfenberg GK, Genuis SJ, Whiting SJ. (2010) An estimate of the economic burden and premature deaths due to vitamin D deficiency in Canada, Mol Nutr Food Res [Epub ahead of print].

19. Grant WB, Schuitemaker G. (2010) Health benefits of higher serum 25-hydroxyvitamin D levels in The Netherlands. J Steroid Biochem Molec Biol. in press.

20. Grant WB, Peiris AN. (2010) Possible role of serum 25-hydroxyvitamin D in Black–White health disparities in the United States. J Am Med Direct Assoc. in press

Competing interests declared: Disclosure
I receive funding from the UV Foundation (McLean, VA), the Sunlight Research Forum (Veldhoven), Bio-Tech-Pharmacal (Fayetteville, AR), and the Vitamin D Council (San Luis Obispo, CA), and have received funding from the Vitamin D Society (Canada).