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

2. PRESENTATION OVERVIEW Background/History Purpose Methods Results Conclusions Recommendations

3. 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.

4. http://www.talkorigins.org/faqs/homs/rickets.jpg

5. 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.

7. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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

16. 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

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

18. 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.

19. 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.

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

21. 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.

22. 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.

23. 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)

24. 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)

25. 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.

26. 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

27. RESULTS – Body Composition

28. 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

29. 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)

30. 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)

31. RESULTS - Illnesses

32. 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.

33. 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.

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

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

36. REFERENCES Cannell JJ, Hollis BW, Zasloff M, and Heaney RP. Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother. 2008;9(1):107-18. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41(5):1102-10. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41(5):1102-10. 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):1067-77. Holick, MF.Am J Clin Nutr. 1994;60:619-30. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl):1678S- 88S. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-81. Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003;89(5):552-72.

37. QUESTIONS?