|Year : 2019 | Volume
| Issue : 4 | Page : 573-577
Investigation of Vitamin D levels in medical staff in a dental clinic
F Dogruel1, ZB Gonen2, DG Canpolat1, H Ocak3, F Bayram4
1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kayseri, Turkey
2 Genome and Stem Cell Research Center, Erciyes University, Kayseri, Turkey
3 Private Dental Clinic, Faculty of Medicine, Kayseri, Turkey
4 Department of Endocrinology and Metabolism, Faculty of Medicine, Kayseri, Turkey
|Date of Acceptance||29-Jan-2019|
|Date of Web Publication||11-Apr-2019|
Dr. F Dogruel
Department of Oral and Maxillofacial Surgery, Erciyes University, Kayseri - 38039
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims: Recently, Vitamin D deficiency is pandemic now. The main reason of vitamin D deficiency is inadequate exposure to sunlight. Vitamin D level in nutrients is low and it can be ineffective to meet the daily requirements. Vitamin D is synthesized in the skin by ultraviolent radiation. In the present study, the authors aimed to investigate serum 25(OH) D levels of the medical staff working in different positions in the Faculty of Dentistry. Subjects and Methods: A total of 51 dentists, 28 dental assistants, 11 secretaries, and 10 nurses working in the Faculty of Dentistry, Erciyes University between November and December 2014 were included to the study. The serum 25(OH) D levels of the participants were evaluated. Results: Of the participants, 62 were females and 38 were males with a mean age of 30.17 ± 5.77 (range: 20–49) years. The mean vitamin D levels were found to be 12.1 ± 8.37 ng/mL (range: 2.1–38.3). A total of 51 participants had severe vitamin D insufficiency, while three participants had normal vitamin D levels with only one dentist. Conclusion: According to the results of present study, dental staff should be considered as a high-risk group for vitamin D deficiency. Vitamin D deficiency and insufficiency is a common problem among medical staffs as in several working groups such as white-collar workers and bankers. Results of present study suggest that insufficient exposure to the sunlight may lead to severe vitamin D deficiency in dental professionals. Vitamin D supplementation may be recommended to the dental staff.
Keywords: Dental professionals, healthcare providers, vitamin D, vitamin D deficiency
|How to cite this article:|
Dogruel F, Gonen Z B, Canpolat D G, Ocak H, Bayram F. Investigation of Vitamin D levels in medical staff in a dental clinic. Niger J Clin Pract 2019;22:573-7
|How to cite this URL:|
Dogruel F, Gonen Z B, Canpolat D G, Ocak H, Bayram F. Investigation of Vitamin D levels in medical staff in a dental clinic. Niger J Clin Pract [serial online] 2019 [cited 2020 Feb 21];22:573-7. Available from: http://www.njcponline.com/text.asp?2019/22/4/573/255934
| Introduction|| |
Vitamin D is a fat-soluble vitamin which has important effects on calcium balance and bone metabolism and it affects almost all cells in the body. In addition, it has beneficial effects on several systems and diseases, such as immune modulation, prevention of development of autoimmune diseases, chronic conditions, and cancer.
Vitamin D is mainly synthesized in the skin by sunlight and it is the only hormone which is synthesized in the skin by exposure to the sunlight. Ultraviolent B (UVB) which is present in the sunlight initiates vitamin D synthesis in skin, UVB causes conversion of provitamin D (7-dehydrocholesterol) to previtamin D3 and, then, to vitamin D3. Vitamin D3, which is synthesized in the skin, is initially hydroxylated in liver and serum 25-hydroxyvitamin D [25(OH) D] levels are produced. Then, it undergoes re-hydroxylation in kidneys and 1,25(OH) D, the active form of vitamin D, is produced. Active vitamin D has direct effects on intestinal calcium absorption, mineralization process in bone, and contraction activity in muscle tissue.,
Although vitamin D deficiency has been associated with only musculoskeletal disorders (i.e. rickets, osteomalacia), recent studies have demonstrated that vitamin D is important life-long for growth, development, and protection of a healthy body. Several types of cancer, coronary artery disease,, and type 1-2 diabetes,,, which are associated with vitamin D deficiency have been extensively investigated. Microbial diseases, multiple sclerosis, rheumatoid arthritis, hypertension, and Alzheimer disease have been associated with vitamin D deficiency.,, Furthermore, it has been demonstrated that mental health is also adversely affected by vitamin D deficiency.,,,
Currently, pandemic vitamin D deficiency is present. The main reason of vitamin D deficiency is insufficient exposure to the sunlight. Vitamin D deficiency is a commonly seen condition in all races, in all geographical regions, and socioeconomic conditions. Except vitamin D-enriched nutrients, vitamin D level in nutrients is low and it can be insufficient to meet the daily requirements. Direct skin exposure to sunlight is necessary for synthesis. As the appropriate angle of beam is between 10.00 A.M. and 03.00 P.M., vitamin D can be synthesized, if the sunlight exposure is between these hours. Living near polar regions, reduced exposure to the sunlight, dark skin, aging, sun protection cream, obesity, increased vitamin D metabolism (i.e., hyperparathyroidism, lymphoma), malabsorption, nephrotic syndrome, chronic renal failure, chronic hepatic failure, and drugs (i.e., anticonvulsants, antituberculosis drugs) are main causes of vitamin D deficiency. Therefore, in addition to dietary habits in the society, the daily environment and working conditions have been also become important.
The medical staffs are at the highest risk, as they spend most of the day, particularly the hours of sunlight exposure, in large concrete buildings and close environments with insufficient light. In the literature, vitamin D deficiency is high among the medical staffs.,, Thus, in the present study, it was aimed to investigate the serum 25(OH)D levels in the dental staffs working in different positions in a university dental hospital.
| Subjects and Methods|| |
The study was approved by the Ethics Committee of Erciyes University and was conducted in accordance with the principles of the Declaration of Helsinki. A written informed consent was obtained from each participant before the study.
A total of 100 individuals including dentists, dental assistant, secretaries, and nurses working in Faculty of Dentistry, Erciyes University, Kayseri, Turkey between November 2014 and February 2015 were included to the study. Those who had chronic disease and drug use, which could affect vitamin D metabolism, and who received vitamin D supplement within the past 3 months were excluded from the study. In all patients, fasting serum 25(OH) D levels were measured using the high-performance liquid chromatography (HPLC) method. The vitamin D levels of the participants were evaluated. Serum's total calcium and phosphate levels were assayed by automated analysis using colorimetric and enzymatic methods. Serum intact parathyroid (PTH) concentrations were measured by an electrochemiluminescence immunoassay in Cobas e 601 (Roche Diagnostics, Mannheim, Germany) with the inter- and intraassay coefficient of variation of 1.1–2.0 and 2.8–3.4%, respectively. Serum 25 (OH)-D was measured by HPLC method with Chromsystems in HPLC Agilent 1100 series (Germany). In addition, serum calcium, phosphorus, and PTH levels were measured in all participants. The daily duration of mean sunlight exposure of the participants was recorded.
According to serum 25(OH) D levels, vitamin D level >30 ng/mL was accepted as normal, vitamin D level of 20–30 ng/mL was accepted as vitamin D insufficiency, <20 ng/mL was accepted as vitamin D deficiency, and <10 ng/mL was accepted as severe vitamin D deficiency.
Statistical analysis was performed using the SPSS for Windows version 16.0 software (SPSS Inc., Chicago, IL, USA). Descriptive data were expressed in mean ± standard deviation (SD). A P value of < 0.05 was considered statistically significant.
| Results|| |
Of a total of 100 individuals, 62 were females and 38 were males with a mean age of 30.17 ± 5.77 (range: 20–49) years. Vitamin D levels were found not statistically different between individuals <30 years of age (n: 54) and >30 years of age (n: 46) (P = 0.4). A total of 51 of the participants were dentists, 28 were dental assistants, 11 were secretaries, and 10 were nurses. All the participants worked from 08.00 am to 17.00 pm and the study group was homogenous in term of mean exposure time to the sunlight. Demographical characteristics of the participants and vitamin D levels are shown in [Table 1].
The mean vitamin D levels among the dental staff was 12.05 ± 7.42 ng/mL (range: 2.1–38.3), the mean level of PTH 36.3 ± 15.9 (range 11.6–94.4), Ca 9.38 ± 0.3 mg/dL (range 8.1–10.2), andP3.22 ± 0.5 (range 1.9–5.5) mg/dL. The levels of PTH, Ca, andPare shown in [Table 2].
The mean level of vitamin D was found as 13.5 ± 8.1 ng/mL (range: 3.4–38.3) in males and 11.1 ± 6.8 ng/mL (range: 2.1–28.9) in females. No statistically significant difference in the vitamin D levels was found between the male and female participants (P = 0.12).
While severe vitamin D deficiency was found in 51 participants (6.53 ± 2.03), vitamin D deficiency was found in 36 participants (14.48 ± 2.5), and vitamin D insufficiency was found in 10 participants (24.55 ± 3.31). Only three participants (35.03 ± 3.77) had normal vitamin D levels and only 1 dentist (35.9) had the normal range of vitamin D [Figure 1]. There was no statistically significant correlation between vitamin D and PTH P = 0.171 [Figure 2]. There was no significant difference between the sunlight exposure time of the participants. All of the participants exposed to the sunlight less than 2 hours in a day.
|Figure 2: The correlation graph between the levels of serum 25OHD and plasma PTH.|
Click here to view
| Discussion|| |
In the present study, it was aimed to investigate the serum 25(OH)D levels of the dental staffs at the first time in the literature. Considering the working conditions, the medical staff are at the highest risk for vitamin D deficiency.,, Recent studies have demonstrated that vitamin D may have a role in the protection of immune system and bone health. Vitamin D deficiency decreases intestinal calcium absorption and, to a less extent, phosphate absorption, thereby, leading to secondary parathyroidism. Although insufficient vitamin D intake contributes to the development of vitamin D deficiency, one of the main reason is insufficient exposure to the sunlight. According to geographical latitude of Turkey, vitamin D is mostly synthesized between May and November. The participants reported that they worked in closed environments due to busy schedule and their exposure to sunlight was less than 2 hours in a day and they only exposed sunlight during the annual leave.
In the present study, the mean vitamin D level was found 12.05 ± 7.4 ng/mL (range: 2.10–38.3). In the study of Yıldız et al., the mean vitamin D level was 12.5 ± 0.6 ng/mL among 96 medical staff. In the study of Erden et al., the mean vitamin D level was 8.98 ± 4.89 ng/mL among medical staff working in anesthesia department. In another study, Rajebi et al. found vitamin D level to be 11.7 ± 9.3 ng/mL in 114 nurses. Medical staffs are not exposed to sufficient UVB light due to long working hours and they do not take sufficient vitamin D replacement; therefore, the majority of the staff are at high risk for vitamin D deficiency. In a prospective study, which was performed in fellows of the Department of Internal Medicine in the United States, low 25(OH)D levels (<20 ng/mL) were found in 74% of the participants at the end of winter and in 26% of the participants at the end of summer. In another cross-sectional study which was performed in fellows in Brazil, 25(OH) D level was found to be <20 ng/mL in 57.4% of the participants.
The main function of vitamin D is to preserve calcium/phosphorus balance of the organism together with PTH by intestinal calcium and phosphorus absorption. The efficacy of vitamin D is not limited only with maintenance of bone health by regulation of calcium homeostasis, it has also proapoptotic, anti-inflammatory, and immunomodulatory roles and it increases insulin production and decreases renin synthesis. There is an inverse relationship between 25(OH)D levels and PTH levels. As vitamin D level decreases, parathyroid glands response by increasing PTH synthesis and secretion. In the study of Oǧuz et al., in which they investigated the predictive role of calcium, phosphorus, and PTH in predicting 25(OH)D deficiency, the mean PTH values were found to be significantly higher in the vitamin D deficiency group, compared to the other groups. However, the authors concluded that PTH alone was not sufficient to demonstrate vitamin D deficiency and, even when all parameters were evaluated; it was insufficient to have a predictive role.
In the literature, there are few studies evaluating vitamin D levels among medical staff in different countries. In a study which was performed in 340 physicians and nurses in Qatar, vitamin D level was found to be below 30 ng/mL in 97% of the participants. In another study in healthy population in India, one of the subgroups was determined as physicians and nurses and vitamin D level was found to be low in this group. In another study which was performed among the hospital staff in India, vitamin D level was found to be low in 66% of the participants. In addition, vitamin D levels at the end of winter and at the end of summer were measured in medical staff including medical students in Boston, and it was found that 32% of the young adult population had vitamin D deficiency at the end of winter. The mean level of 25(OH)D was found to be quite low in these studies in both patients and healthy individuals, and the results of the present study are similar to these previous findings.
Vitamin D deficiency has been gradually increasing all over the world. In previous studies, reduced UVB and sunlight exposure have been associated with an increased prevalence of vitamin D deficiency.,,,, In addition, serum 25(OH)D level shows seasonal variation: it reaches the peak level in the summer months., In countries which are present at and above 37°North latitude, the angle of sunlight during November–February is oblique, and most of them are absorbed in ozone layer of the atmosphere. As less UVB light reaches the earth surface in winter, the tendency for vitamin D deficiency is high in people living at and above 37°North latitude., The latitude of Iran is at 36°00′ North. It has been reported that there is no significant seasonal variation in serum vitamin D levels. However, it has been reported that vitamin D deficiency is frequent during winter–spring period in Denmark, which is located at 56°00′ North latitude. Turkey is located at 39°57′ North latitude between Iran and Denmark. In present study, severe vitamin D deficiency was found in 51 participants, vitamin D deficiency was found in 36 participants and vitamin D insufficiency was found in 10 participants. Only three participants had normal vitamin D levels and only one dentist had the normal range of vitamin D. Therefore, dental staff should be considered high-risk group for vitamin D deficiency.
In conclusion, vitamin D deficiency and insufficiency is a common problem among dental staffs according to results of present study. It has been understood that vitamin D insufficiency has increased to the highest degree all over the world among medical staffs, white-collar workers, and bankers. Limited exposure to the sunlight might cause severe vitamin D deficiency in healthy individuals. Dental staffs are also at risk for several chronic diseases in the long term due to constantly low vitamin D levels. This patient group may admit to orthopedics or physical therapy policlinics mainly complain from musculoskeletal system diseases and diffuse body aches and this situation leads to both workforce and time consumption. Therefore, based on the results of present study, vitamin D supplementation is recommended to the dental staffs to prevent aforementioned problems.
The study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
It was presented as a poster in Turkish Congress of Endocrine and Metabolism Disorders May 2015, Turkey.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Goltzman D. Functions of vitamin D in bone. Histochem Cell Biol 2018;149:305-12.
Holick MF. Vitamin D status: Measurement, interpretation, and clinical application. Ann Epidemiol 2009;19:73-8.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al
. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30.
Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80:1678-88.
Yılmaz M, Yılmaz N. The role of vitamin D in the brain and related neurological diseases. J Clin Exp Invest 2013;4:411-5.
Holick MF. Vitamin D deficiency, medical progress. N Engl J Med 2007;357:266-81.
Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: Results of a randomized trial. Am J Clin Nutr 2007;85:1586-91.
Baz-Hecht M, Goldfine AB. The impact of vitamin D deficiency on diabetes and cardio vascular risk. Curr Opin Endocrinol Diabetes Obes 2010;17:113-9.
Swales HH, Wang TJ. Vitamin D and cardiovascular disease risk: Emerging evidence. Curr Opin Cardiol 2010;25:513-7.
Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in Type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007;92:2017-29.
Janner M, Ballinari P, Mullis PE, Flück CE. High prevalence of vitamin D deficiency in children and adolescents with type 1 diabetes. Swiss Med Wkly 2010;140:w13091.
White JH. Vitamin D signaling, infectious diseases, and regulation of innate immunity. Infect Immun 2008;76:3837-43.
Khalsa S. The Vitamin D Revolution, How the Power of This Amazing Vitamin Can Change Your Life. NewYork: Hay House Inc.; 2009. p. 117-27.
Kaludjerovic J, Vieth R. Relationship between vitamin D during perinatal development and health. J Midwifery Womens Health 2010;55:550-60.
Oudshoorn C, Mattace-Raso FU, van der Velde N, Colin EM, van der Cammen TJ. Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer's disease. Dement Geriatr Cogn Disord 2008;25:539-43.
Türkiye Endokrinoloji ve Metabolizma Derneǧi. Osteoporoz Metabolik Kemik Hastalıkları Tanı ve Tedavi Kılavuzu: TEMD. 13th
ed, p. 119-125 Ankara, 2018.
DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004;80869:1689-96.
Föcker M, Antel J, Ring S, Hahn D, Kanal Ö, Öztürk D, et al
. Vitamin D and mental health in children and adolescents. Eur Child Adolesc Psychiatry 2017;26:1043-66.
Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010;95:471-8.
Oǧuz B, Zuhur SS, Altuntaş Y. The diagnostic values of serum parathyroid hormone, calcium and phosphorus levels for the prediction of vitamin D deficiency. Turkiye Klinikleri J Endocrin 2014;9:45-52.
Yıldız MS, Yıldız İ, Kilic A, Varkal MA, Saygılı S. One of the risk groups for vitamin D deficiency: Health workers. J Ist Faculty Med 2015;78:2:41-5.
Premaor MO, Paludo P, Manica D, Paludo AP, Rossatto ER, Scalco R, et al.
Hypovitaminosis D and secondary hyperparathyroidism in resident physicians of a general hospital in southern Brazil. J Endocrinol Invest 2008;31:991-5.
Erden G, Ozdemir S, Ozturk G, Erden A, Kara D, Isik S, et al.
Vitamin D levels of anesthesia personnel, office workers and outdoor workers in Ankara, Turkey. Clin Lab 2016;62:931-7.
Rajebi H, Khodadad A, Fahimi G, Abolhassani H. Vitamin D deficiency among female nurses of children's medical center hospital and its related factors. Acta Med Iran 2016;54:146-50.
Haney EM, Stadler D, Bliziotes MM. Vitamin D insufficiency in internal medicine residents. Calcif Tissue Int 2005;76:11-6.
Khundmiri SJ, Murray RD, Lederer E. PTH and vitamin D. Compr Physiol 2016;6:561-601.
Mahdy S, Al-Emadi SA, Khanjar IA, Hammoudeh MM, Sarakbi HA, Siam AM, et al.
Vitamin D status in health care professionals in Qatar. Saudi Med J 2010;31:74-7.
Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N. Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr 2000;72:472-5.
Arya V, Bhambri R, Godbole MM, Mithal A. Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int 2004;15:56-61.
Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young adults. Am J Med 2002;112:659-62.
Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med 2009;169:626-32.
Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP, Sorensen OH. Vitamin D status and its adequacy in healthy Danish perimenopausal women: Relationships to dietary intake, sun exposure and serum parathyroid hormone. Br J Nutr 2001;86:97-103.
Hill TR, McCarthy D, Jakobsen J, Lamberg-Allardt C, Kiely M, Cashman KD. Seasonal changes in vitamin D status and bone turnover in healthy Irish postmenopausal women. Int J Vitam Nutr Res 2007;77:320-5.
Valtueña J, González-Gross M, Huybrechts I, Breidenassel C, Ferrari M, Mouratidou T, et al.
Factors associated with vitamin D deficiency in European adolescents: The HELENA study. J Nutr Sci Vitaminol (Tokyo) 2013;59:161-71.
Heidari B, Haji Mirghassemi MB. Seasonal variations in serum vitamin D according to age and sex. Caspian J Intern Med 2012;3:535-40.
[Figure 1], [Figure 2]
[Table 1], [Table 2]