Vitamin D Status Relative to Diet, Lifestyle, Injury and Illness in College Athletes Tanya Halliday

PRESENTATION OVERVIEW Background/History Purpose Methods Results Conclusions Recommendations

BACKGROUND 1650’s - Rickets Epidemic by 20th century in industrialized cities of northern Europe and northeastern United States 1822 – Sunlight as a cure/prevention 1918 – Rickets considered a nutritional deficiency. Fortification of milk and eradication of rickets as a significant health problem.

BACKGROUND 1650’s - Rickets Epidemic by 20th century in industrialized cities of northern Europe and northeastern United States 1822 – Sunlight as a cure/prevention 1918 – Rickets considered a nutritional deficiency. Fortification of milk and eradication of rickets as a significant health problem.

BACKGROUND Can be obtained through the diet or through exposure to UVB rays. Necessary for adequate bone health Recent studies link low vitamin D status to various non-skeletal, chronic and autoimmune diseases May also play a role in immune function and inflammatory modulation

BACKGROUND Can be obtained through the diet or through exposure to UVB rays. Necessary for adequate bone health Recent studies link low vitamin D status to various non-skeletal, chronic and autoimmune diseases May also play a role in immune function and inflammatory modulation

BACKGROUND Can be obtained through the diet or through exposure to UVB rays. Necessary for adequate bone health Recent studies link low vitamin D status to various non-skeletal, chronic and autoimmune diseases May also play a role in immune function and inflammatory modulation

BACKGROUND Can be obtained through the diet or through exposure to UVB rays. Necessary for adequate bone health Recent studies link low vitamin D status to various non-skeletal, chronic and autoimmune diseases May also play a role in immune function and inflammatory modulation

BACKGROUND High prevalence of vitamin D deficiency and insufficiency in the general population Few studies on vitamin D status of athletes. ◦ Deficiency- 25(OH)D < 20 ng/mL ◦ Insufficiency – 25(OH)D <32 ng/mL ◦ Optimal Status – 25(OH)D >40 ng/mL

PURPOSE To evaluate the prevalence of vitamin D insufficiency/deficiency in NCAA Division I athletes throughout the academic year. Determine whether 25(OH)D status is related to vitamin D intake, sun exposure, and body composition. Evaluate whether 25(OH)D status is linked to bone density, development of overuse or inflammatory injuries and/or frequent illness.

METHODS UW Division I athletes (n=41) Longitudinal – tracked vitamin D status at throughout the academic year Vitamin D specific questionnaire Body composition and bone density were evaluated using DEXA Illness and Injuries documented by UW Athletic Training Staff

RESULTS – 25(OH)D Status Fall: 49.0± 16.6 ng/mL ◦ 75.6% > 40ng/mL Winter: 30.5±9.4 ng/mL ◦ 15.2% >40ng/mL Spring: 41.9±14.6 ng/mL ◦ 36% >40ng/mL

RESULTS – Indoor v. Outdoor Outdoor – Football, Soccer, XC/Track & Field, Cheer/Dance Indoor – Swimming, Wrestling, Basketball *

RESULTS- Vitamin D Intake Vitamin D intake was not significantly correlated with vitamin D status. MVI intake in the winter was correlated. Current RDA = 200 IUs/day Majority of athletes consumed more than the current RDA (73.2% in the fall, 87.9% in the winter, and 76% in the spring) The majority of athletes consuming >1,000 IUs/day had sufficient 25(OH)D concentrations above 32 ng/mL.

RESULTS- Vitamin D Intake Vitamin D intake was not significantly correlated with vitamin D status. MVI intake in the winter was correlated. Current RDA = 200 IUs/day Majority of athletes consumed more than the current RDA (73.2% in the fall, 87.9% in the winter, and 76% in the spring) The majority of athletes consuming >1,000 IUs/day had sufficient 25(OH)D concentrations above 32 ng/mL.

RESULTS – Multivitamin Intake * 0 = Never or 1/day

RESULTS – Vitamin D Intake Vitamin D intake was not significantly correlated with vitamin D status. MVI intake in the winter was correlated. Current RDA = 200 IUs/day Majority of athletes consumed more than the current RDA (73.2% in the fall, 87.9% in the winter, and 76% in the spring) The majority of athletes consuming >1,000 IUs/day had sufficient 25(OH)D concentrations above 32 ng/mL.

RESULTS – Vitamin D Intake Vitamin D intake was not significantly correlated with vitamin D status. MVI intake in the winter was correlated. Current RDA = 200 IUs/day Majority of athletes consumed more than the current RDA (73.2% in the fall, 87.9% in the winter, and 76% in the spring) The majority of athletes consuming >1,000 IUs/day had sufficient 25(OH)D concentrations above 32 ng/mL.

RESULTS – UV Exposure In the spring, tanning bed use was correlated with 25(OH) D concentrations (r=0.48; P=0.016) In the fall, training/competition and total time spent outdoors was correlated with 25(OH) concentrations (r=0.40 and 0.42, P<0.01)

RESULTS – UV Exposure In the spring, tanning bed use was correlated with 25(OH) D concentrations (r=0.48; P=0.016) In the fall, training/competition and total time spent outdoors was correlated with 25(OH) concentrations (r=0.40 and 0.42, P<0.01)

RESULTS – Body Composition and Bone Density 25(OH)D concentrations tended to be correlated with body fat percentages. 25(OH)D concentrations were not correlated with bone density.

RESULTS – Body Composition and Bone Density 25(OH)D concentrations tended to be correlated with body fat percentages. 25(OH)D concentrations were not correlated with bone density

RESULTS – Body Composition

RESULTS – Body Composition and Bone Density 25(OH)D concentrations tended to be correlated with body fat percentages. 25(OH)D concentrations were not correlated with bone density

RESULTS – Injury and Illness Frequency of injury was not related to 25(OH)D status. 25(OH)D status was correlated with frequency of illness in the spring. ◦ (r=-0.40; P=0.048)

RESULTS – Injury and Illness Frequency of injury was not related to 25(OH)D status. 25(OH)D status was correlated with frequency of illness in the spring. ◦ (r=-0.40; P=0.048)

RESULTS - Illnesses

CONCLUSIONS Athletes can achieve adequate-optimal vitamin D status in the non-winter months. Could benefit from supplementation during winter months. Maintaining sufficient vitamin D status may reduce risk of illness.

Where Do We Go From Here? Additional research is needed to determine whether vitamin D status influences risk for overuse/inflammatory injuries. Randomized, double-blind vitamin D supplementation v. placebo studies.

Until Then… Aim to increase vitamin D content of diet Consider a supplementation in the winter months. Moderate sun exposure

ACKNOWLEDGEMENTS Joi Thomas, MS, ATC Kent Kleppinger, MD Bruce Hollis, PhD Nikki Peterson Enette Larson-Meyer, PhD,RD,CSSD,FACSM

REFERENCES Cannell JJ, Hollis BW, Zasloff M, and Heaney RP. Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother. 2008;9(1): Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41(5): Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41(5): Gombart AF, Borregaard N, and Koeffler HP. Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up- regulated in myeloid cells by 1,25-dihydroxyvitamin D3. Faseb J. 2005;19(9): Holick, MF.Am J Clin Nutr. 1994;60: Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl):1678S- 88S. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3): Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003;89(5):

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