20

Med Clin (Barc). 2019;154(1):7–12

www.elsevier.es/medicinaclinica

Original article

An epidemiology survey of vitamin D deficiency and its influencing

factors
Wei Jiang a,1 , Dong-Bo Wu a,1 , Gui-Bao Xiao b , Bei Ding c , En-Qiang Chen a,∗
a
Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China
b
Department of Infectious Diseases, The First People’s Hospital of Ziyang, Ziyang 641300, China
c
ADICON Clinical Laboratory, Chengdu 610000, China

a r t i c l e i n f o a b s t r a c t

Article history: Background: There is growing evidence that vitamin D is related to the development of a variety of
Received 27 July 2018 diseases. The current study was performed to investigate the status of serum vitamin D distribution
Accepted 7 March 2019 among adult Chinese people and reveal the influence of gender, age, seasonality and residential regions
Available online 24 May 2019
on serum vitamin D levels.
Method: This cross-sectional study included 14,302 participants aged from 18 years old to 65 years old
Keywords: from six major cities in China. The basic demographic information and the levels of serum vitamin D
Vitamin D
(25(OH)D) and vitamin D3 (25(OH)D3 ) were collected from Jan 2, 2014 to Dec 25, 2017.
Distribution
Deficiency
Result: The prevalence of 25(OH)D3 concentration <30 ng/mL reached up to 83%, in which the rate of
Influencing factor vitamin D insufficiency (20–29 ng/mL) was 32.7%, and vitamin D deficiency (10–19 ng/mL) accounted for
Adult population 41.9%, and vitamin D severe shortage (<10 ng/mL) accounted for 8.4%. Women were more likely to have
vitamin D3 deficiency and lower serum vitamin D3 concentration than men (both p < 0.001). The mean
concentration of serum 25(OH)D and 25(OH)D3 in summer and autumn were higher than that in spring
and winter (p < 0.001), and the mean concentration of serum 25(OH)D in people from Southern China was
higher than that in people from other regions (p < 0.001). Although the mean concentrations of serum
25(OH)D and 25(OH)D3 were both increased by age, the percentage of patients with serum 25(OH)D3
insufficiency was also increased.
Conclusion: Serum vitamin D deficiency is very common in adults in China. The level of serum vitamin D
may be associated with age, sex, seasonality and residential regions.
© 2019 Elsevier España, S.L.U. All rights reserved.

Un estudio epidemiológico acerca de la deficiencia de vitamina D y sus factores

de influencia

r e s u m e n

Palabras clave: Fondo: Una gran cantidad de investigaciones muestran que la vitamina D está relacionada con el desarrollo
Vitamina D de una variedad de enfermedades. El presente estudio apunta a investigar el estado de la distribución de
Distribución la vitamina D sérica entre los adultos chinos, y revelar la influencia del género, la edad, la estacionalidad
Deficiencia
y las regiones residenciales sobre los niveles séricos de vitamina D.
Factor de influencia
Metodología: El presente estudio transversal incluyó a 14.302 participantes con edades comprendidas
Población adulta
entre de 18 y 65 años, provenientes de las 6 principales ciudades de China. Se recogió la información
demográfica básica y se analizó la concentración sérica de vitamina D 25(OH)D y vitamina D3 25(OH)D3
del 2 de enero de 2014 al 25 de diciembre de 2017.
Resultado: La prevalencia de concentración de 25(OH)D3 Y<Y30Yng/ml alcanzó el 83%, en la que la tasa
de insuficiencia de vitamina D (20-29Yng/ml) fue del 32,7%, la deficiencia de vitamina D (10-19Yng/ml)
alcanzó el 41,9% y la escasez severa de vitamina D (<Y10Yng/ml) alcanzó el 8,4%. Las mujeres eran más
propensas a sufrir deficiencia de vitamina D3 y menor concentración sérica de vitamina D3 que los varones

∗ Corresponding author at: No. 37 Guo Xue Xiang, Wuhou District, Chengdu
610041, Sichuan Province, China.
E-mail address: chenenqiang1983@hotmail.com (E.-Q. Chen).
1
The first two authors contributed equally to this paper.

https://doi.org/10.1016/j.medcli.2019.03.019
2387-0206 2019 Elsevier España, S.L.U. All rights reserved.
0025-7753/©
8 20
W. Jiang et al. / Med Clin (Barc). 2019;154(1):7–12

(pY<Y0,001). La concentración sérica media de 25(OH)D y 25(OH)D3 en verano y otoño era mayor que
en primavera e invierno (pY<Y0,001), y la concentración sérica media de 25(OH)D en personas del sur de
China era mayor que en personas de otras regiones (pY<Y0,001). Aunque nuestro estudio revela que las
concentraciones séricas medias de 25(OH)D y 25(OH)D3 aumentaron levemente con la edad, el porcentaje
de pacientes con insuficiencia sérica de vitamina D 25(OH)D3 también experimentó un incremento.
Conclusión: La deficiencia sérica de vitamina D es muy común en adultos en China. Es probable que el
nivel sérico de vitamina D esté asociado a la edad, el sexo, la estacionalidad y las regiones residenciales.
© 2019 Elsevier España, S.L.U. Todos los derechos reservados.

Introduction Method

Vitamin D is a derivative of fat soluble steroids, and the most Subject

important family members are ergocalciferol (D2 ) and cholecalcif-
erol (D3 ). D3 is synthesized in the skin from 7-dehydrocholesterol
in cell membranes upon exposure to UVB (290–320 nm), while
D2 is plant and yeast derived and produced exogenously by UV
irradiation of ergosterol. Both forms are hydroxylated in the liver
to 25-hydroxyvitamin D, 25(OH)D, which is further hydroxy-
lated to its active form, 1,25-dihydroxyvitamin D, 1,25(OH)2 D,
by 1␣ hydroxylase activity in the kidney and various other tis-
sues. The majority of circulating 25(OH)D and 1,25(OH)2 D is
bound to vitamin D binding protein (DBP) (80–90%) and albu-
min (10–20%), while a small fraction of vitamin D is free.1 As
the consequence, measuring the total levels of serum 25(OH)D
in clinical is considered the best estimate of vitamin D nutri-
tional status. The threshold for optimum serum vitamin D
levels and definitions of sufficiency are controversial.2 How-
ever, most countries and institutions have defined the level
of vitamin D as three categories (“deficiency”, “insufficiency”,
and “normal”). According to The International Osteoporosis
Foundation, we defined the cut-off points for four categories,
respectively 25(OH)D < 10 ng/mL as “vitamin D severe shortage”,
25(OH)D < 20 ng/mL for “vitamin D deficiency”, 20–30 ng/mL for
“vitamin D insufficiency”, and 25(OH)D > 30 ng/mL for “normal”.3,4
The level of 25(OH)D reaching 30 ng/mL is identified as the mini-
mum target for vitamin D supplementation, and the optimal level
is 30–50 ng/mL.5
Rickets was the first disease described in the literature linked
to low vitamin D levels along with malabsorption of calcium and
phosphorous in the early 20th century.6 While over several recent
decades, many conditions and diseases have been recognized to be
associated with low levels of vitamin D, such as bone diseases, mus-
cles, cancer, autoimmune diseases,7–10 etc. Although recognized
the importance of vitamin D, the poor condition of vitamin D defi-
ciency has been existed across countries throughout the world and
impacts 30–50% people.11 In the USA, it was reported that 166 cases
of nutritional rickets have been published in the medical litera-
ture between 1986 and 2003.12 In the French general population,
43–50% of subjects have a 25(OH)D < 20 ng/mL and approximately
80% have a 25(OH)D < 30 ng/mL.13 In addition, many reports indi-
cate that the situation of vitamin D deficiency is not optimistic in
China. However, the overall research about the epidemiology of
vitamin D deficiency in China is still lack.
In this study, we launched a study which includes five major
Chinese regions and 14,302 participants with available serum vita-
min D levels, to explore the distribution of vitamin D deficiency in
China and possible influencing factors.
To explore the Chinese serum vitamin D level, we designed a
cross-sectional study of different populations in different regions of
China. The study was conducted simultaneously from January 2014
to December 2017. Screening healthy adults between the ages of
18 and 65 and eliminating rickets, musculoskeletal diseases, can-
cer, and more, six designated medical institutions detected a total
of 25,836 eligible participants coming mainly from six key cities or
provinces, including Beijing in North China, Nanjing and Shanghai
in East China, Chengdu in West China, Changsha in Central China,
Guangzhou in South China. After excluding those individuals who
did not have adequate blood samples or who lack complete per-
sonal information (n = 11,534), 14,302 individuals (3002 man and
11,299 woman) were eligible for the present analysis.
Data collection
All subjects were medically examined and interviewed
using the standardized questionnaire to collect information on
name, age, gender, region (or permanent residence), visit date
(month/day/year), and serum levels of 25(OH)D and 25(OH)D3 . And
4–5 mL venous blood was drawn from each subject by venipunc-
ture into a vacutainer Li-heparin plasma tube and serum was
harvested following a 10-min centrifugal with 3500 rpm speed.
Each serum was saved on cryogenic tubes and stored on −80 ◦ C
until analysis. Serum 25(OH)D and 25(OH)D3 in serum samples
were measured in ADICON Clinical Laboratory using an automated
electrochemiluminescence-based assay.
Statistical analysis
Categorical variables are expressed as percentages, whereas
continuous variables as means and standard deviations. The 2
test was used to explore the association between categorical vari-
ables, using the two-sample z test for proportions for post hoc
multiple comparisons. The Kolmogorov–Smirnov test was used
to determine normality of distribution of the examined continu-
ous variables. Normally distributed variables were used Student’s t
test, otherwise we used Mann–Whitney U test for the comparison
of mean values between groups. Multivariate logistic regression
analysis was also performed in order to assess the associations of
age cohorts, regions and seasonality with vitamin D severe short-
age, deficiency and insufficiency respectively. OR and 95% CI were
also derived from these analyses after adjusting for several poten-
tial confounding factors. All statistical analyses were performed
 20
W. Jiang et al. / Med Clin (Barc). 2019;154(1):7–12 9

Table 1 Effects of season factor on serum vitamin D

Demographic and clinical characteristics of the participants.

Characteristic Total sample (n = 14,302) The effect of seasonal factors on vitamin D levels was also shown
Age in Fig. 1(F–H). The levels of serum 25(OH)D and 25(OH)D3 in sum-
Mean (95% CI) 37.98 (37.76–38.19) mer and autumn (mean 22.85 ng/mL and 95% CI 22.64, 23.05 ng/mL
Median (interquartile range) 34 (21) and mean 21.91 ng/mL and 95% CI 21.71, 22.11 ng/mL respectively)
18–44 years 9829 (68.7%) were both significantly higher than that in spring and winter (mean
45–59 years 3098 (21.7%)
21.03 ng/mL and 95% CI 20.72, 21.33 ng/mL and mean 20.03 ng/mL
60–65 years 1374 (9.6%)
and 95% CI 19.74, 20.33 ng/mL respectively). And the percentage
Gender (n, %)
of subjects suffering vitamin D severe shortage and deficiency
Male 3002 (21%)
Female 11,299 (79%)
in spring and winter (12.84% and 44.15% respectively) were also
higher than that in summer and autumn (5.78% and 40.55% respec-
Region (n%)
tively).
North China 626 (4.4%)
East China 3074 (21.5%)
West China 2559 (17.9%) Effects of region factor on serum level of vitamin D
Central China 5146 (36%)
South China 2897 (20.3%) According to the geographical location, living habits and cul-
Serum vitamin D (n%) ture characteristics, we defined 6 cities or provinces as five regions
25(OH)D3 < 10 ng/mL 1197 (8.4%) of China, respectively represented south China, West China, east
25(OH)D3 < 20 ng/mL 7185 (50.3%)
China, central China and north China. It showed that people in
25(OH)D3 < 30 ng/mL 11,874 (83%)
different regions have different levels of serum vitamin D. Accord-
Abbreviations: 25(OH)D3 , 25-hydroxyvitamin D3 ; SD, standard deviation; 95% CI, ing to the heat map of China we made, it showed the values are
95% confidence interval.
respectively 24.04 ng/mL in the southern, 20.74 ng/mL in the cen-
tral, 18.81 ng/mL in the southwest, 22.35 ng/mL in the eastern, and
with the SPSS statistical analysis software version 20.0. All P values 16.54 ng/mL in the northern. According to the sector diagram, the
reported were two-tailed and the level of statistical significance percentage of vitamin D severe shortage in northern is much higher
was set at P < 0.05. than elsewhere and accounts for 24%, as well, almost half of the pop-
ulation is vitamin D deficiency which is 47.4%. On the contrary, the
south has the highest ratio of normal people, which shows 29.4%.
Result
In addition, the east is also slightly better than the west (p < 0.001)
(Fig. 2).
Demographic and clinical characteristics of the study population
Multivariate logistic regression analysis the associations of
As shown in Table 1, a total number of 14,302 participants (male
vitamin D level and clinical data
21% and female 79%) at five major regions in China were analyzed.
The mean age of study participants was 37.98 (median 34) years. In
The OR and 95% CI for vitamin D severe shortage, deficiency
this study, the percentage of subjects with abnormal concentration
and insufficiency stratified by sex, age, regions and seasonal-
of serum vitamin D < 30 ng/mL is high to 83%. In addition, the per-
ity (after adjusting for several potential confounding factors,
centage of people with serum vitamin D level < 10 ng/mL accounts
including smoking, drinking, occupation and year) are shown in
for 8.4%, and the percentage of people with 25(OH)D3 < 20 ng/mL is
Table 2. Based on this data, female was found to be 1.845 (95%CI:
high to 50.3%.
1.485–2.292) (p < 0.001), 1.988 (95%CI: 1.735–2.279) (p < 0.001),
and 1.294 (95%CI: 1.127–1.486) (p < 0.001), times more likely
Effects of gender and age on serum vitamin D to be vitamin D severe shortage, deficiency and insufficiency
compared with male. In addition, participants measured during
In this study, we found that the mean level of 25(OH)D and spring and winter had the highest odds for vitamin D severe
25(OH)D3 in male subjects (mean 23.83 ng/mL and 95% CI 23.41, shortage (OR: 2.485; 95%CI: 2.128, 2.902) (p < 0.001), deficiency
24.24 ng/mL and mean 23.27 ng/mL and 95% CI 22.86, 23.68 ng/mL (OR: 1.501; 95%CI: 1.348–1.670) (p < 0.001), and insufficiency (OR:
respectively) were significantly higher than that in female subjects 1.029; 95%CI: 0.920–1.151) (p = 0.616), compared with them mea-
(mean 21.74 ng/mL and 95% CI 21.55, 21.93 ng/mL and mean 20.68 sured during summer and autumn. Refer to the age section of
and 95% CI 20.50, 20.86 ng/mL respectively) (both P < 0.001). In China, we simply divided the age into three layers and conducted
addition, we find that female is more likely to have vitamin D defi- a regression analysis. We found that all p-values were greater than
ciency and vitamin D severe shortage (43.2% and 8.5% respectively) 0.05 in the results of multivariate regression analysis in Table 2,
than male (36.7% and 5.6% respectively) (Fig. 1A–C). although the p-value was less than 0.001 when the age factor
Besides, we also analyzed the effects of age distribution on vita- was analyzed with one-way ANOVA, which indicated that age was
min D levels. After dividing the participants into 10 groups as not a significant independent risk factor for adults aged 18–65.
depicted in Fig. 1D, there was no significant trend in serum con- Lastly, regional factor was also associated with the difference of
centrations of 25(OH)D and 25(OH)D3 as the age increase. But, it the vitamin D level. The difference in vitamin D severe short-
also showed tow meaningful troughs in the curve. From 18 to 35, age (OR: 16.132, 95%CI: 11.16–23.31) (p < 0.001), deficiency (OR:
the mean serum level rise to a peak, and then went down to a trough 5.766, 95%CI: 4.201–7.913) (p < 0.001) and insufficiency (OR: 2.295;
in around 45 years old. Then, mean serum level rise again until 60 95%CI: 1.631–3.229) (p < 0.001) were found in North China as com-
years old. These peaks and valleys might indicate a dynamic alter- pared with South China.
ation of serum vitamin D level in Chinese population. Beyond that,
we also analyzed the changes in the percentages of different cate- Discussion
gories of vitamin D deficiency in each age group. Though the mean
level of serum vitamin D slightly increased with age, the proportion In this study, we tested serum vitamin D levels in 14,302 vol-
of vitamin D deficiency was also increased (Fig. 1E). unteers from five nationally representative cities for the first time,
10 20
W. Jiang et al. / Med Clin (Barc). 2019;154(1):7–12

P<0.001
A 40
B 40
P<0.001 C
100
17.70 16.80

Serum vitamin D (ng/mL)

30
Serum vitamin D (ng/mL)
30

Percentage of patients ( %)
80
normal

3
30.90
40.00 insufficiency
20 20 60
deficiency
severe shortage
40
10 10 43.20
36.70
20

0 5.60 9.10
0 0
male female male female male female

D 24
E 50

Percentage of patients ( %)
Mean serum level (ng/mL)

40
21

30
18 Vitamin D3 Vitamin D normal insufficiency
deficiency severe shortage
20

15
10

12 0
?20 ~25 ~30 ~35 ~40 ~45 ~50 ~55 ~60 ?65 ?20 ~25 ~30 ~35 ~40 ~45 ~50 ~55 ~60 ?65
Age (year) Age (year)

F 40
P<0.001 G 40
P<0.001 H
100
16.54 17.22
Serum vitamin D3 (ng/mL)

30 30
Serum vitamin D (ng/mL)

80

Percentage ( %)
26.46 normal
36.45 insufficiency
20 20 60
deficiency
severe shortage
40
44.15
10 10
40.55
20

16.54
5.78
0 0 0
spring & winter summer & autumn spring & winter summer & autumn spring & winter summer & autumn

Fig. 1. Effects of influencing factors on serum vitamin D levels. (A) Serum vitamin D between male and female subjects; (B) Serum vitamin D3 between male and female
subjects; (C) between male and female subjects; (D) The line graph describes the trend of the value of vitamin D and vitamin D3 in the 10 age groups; (E) the four lines
describe the trend of the percentage of different vitamin D3 levels in the 10 age groups; (F) the level of vitamin D measured in summer and autumn compared to spring
and winter; (G) the level of vitamin D3 measured in summer and autumn compared to spring and winter; (H) the percentages of vitamin D severe shortage, deficiency,
insufficiency and normal in group of summer and autumn compared to spring and winter group.

and analyzed the major risk factors associated with vitamin D defi- to UVB (290–320 nm). Gary G. Schwartz’s found that the level of
ciency. We guarantee the authenticity of the data and the accuracy sunlight exposure was associated with the risk of vitamin D related
of the results and make the following discussion. diseases.26 Deluca HF’s study also proved that the trail of UVB radi-
Vitamin D deficiency is now being considered one of the most ation might stop the progression of multiple sclerosis.27 Similar
important health concerns worldwide.14 It has been estimated that results had been found in our study. Preliminary analysis of statisti-
upwards of 30–50 percent of both children and adults in the United cal data showed that the level of 25(OH)D was higher in the summer
States, Canada, Mexico, Europe, Asia, New Zealand, and Australia and autumn than spring and winter because of the long days, as
are vitamin D deficient, even in areas where there is plenty of the same as in the southern China than northern China because
sunshine such as Mideast Countries including Saudi Arabia, Qatar, of the strong ultraviolet radiation. Secondly, we also observed the
United Arab Emirates, and India.15–18 H. Göring’s report presented differences of serum vitamin D levels in gender which showed that
that Vitamin D deficiency was a common phenomenon in Euro- mean serum 25(OH)D concentrations were significantly higher in
peans and Vitamin D deficiency might play the potential role in the male compared with female and furthermore the prevalence rates
extinction of the Vikings of Greenland.19 At the same time, Nasser of both vitamin D deficiency and insufficiency were significantly
M’s study found that vitamin D deficiency was common in the Mid- higher in female compared with male. The same conclusion appears
dle East and in Saudi Arabia, in particular.20 Vitamin D deficiency in the study of Greek scholars28 and in the report from part of
among Saudi pregnant women ranged from 90 to 100%, especially China.25 Thirdly, our research has found that age cannot be an inde-
postmenopausal women, and it was extremely common in the pendent risk factors for vitamin D deficiency in adults. Age is a
pediatric population of Saudi Arabia.21 A similar report from an significant risk factor in single-factor variance analysis, however, P
Asian country showed that serum vitamin D levels in South Korea value is greater than 0.05 in multi-factor regression analysis. Other
decreased year by year, and the proportion of vitamin D deficiency studies showed that the mean serum 25(OH)D concentrations are
increased year by year.22 In our study, it was worth noting that over in inverse proportion to age and the prevalence of vitamin D defi-
70% of the participants from five major Chinese cities had a serum ciency was in directly proportional to age,29 but in contrast with
25(OH)D level of less than 30 nmol/L, and nearly half of the them a study conducted by Engelman et al.30 Last but not least, there is
were vitamin D deficiency, which is similar to other researches in clear evidence that consuming vitamin D-fortified food and/or vita-
China.23–25 min D supplementation has a positive impact on serum 25(OH)D.
However, what factors related to the prevalence of vitamin Guidelines in many countries recommend that different groups of
D deficiency is ambiguous. According to other literature reports, people should intake vitamin D with food or supplements.31 This
firstly, sunshine and ultraviolet radiation (UVB) can seriously affect study did not collect the participants’ dietary habits because of the
the serum level of vitamin D. Lots of researches have been proved difficulty in operation. Thus, we did not discuss the effect of diet on
that cholecalciferol (D3) is synthesized in the skin upon exposure serum vitamin D in different regions of China.
 20
W. Jiang et al. / Med Clin (Barc). 2019;154(1):7–12 11

North China

8%

20.60%
47.40%

24%

West China
Central China
normal
East China
(>30 ng/ml)
15.50%
11.10%
insufficiency
41.60% 18.20%
(20-30 ng/ml)
27.40% 45.10%
44.50%
38.70% severe shortage
15.50%
29.80% (10-20 ng/ml)
deficiency
7.50%
5.10% (<10 ng/ml)
South China

32.30% 29.40% vitamin D3 (ng/mL)

5.50% 32.80% 16.54 24.04

Fig. 2. The mean serum vitamin D3 levels in five regions. The epidemiological distribution was speculated and the Chinese heat map produced based on the serum vitamin
D3 value of the population in five regions.

Table 2
Multivariate logistic regression analyses examining the associations of vitamin D severe shortage deficiency and insufficiency.

Severe shortage (<10 nmol/L) Deficiency (10–20 nmol/L) Insufficiency (20–30 nmol/L)

OR 95%CI p-Value OR 95%CI p-Value OR 95%CI p-Value

Gender
Male 1.00 1.000 1.000
Female 1.845 1.485–2.292 <0.001 1.988 1.735–2.279 <0.001 1.294 1.127–1.486 <0.001

Age (year)
18–44 1.00 1.00 1.00
45–59 1.030 0.829–1.278 0.792 0.912 0.791–1.051 0.205 1.140 0.985–1.319 0.079
60–65 1.194 0.902–1.581 0.216 0.794 0.656–0.960 0.017 1.197 0.989–1.449 0.065

Season
Summer and autumn 1.00 1.00 1.00
Spring and winter 2.485 2.128–2.902 <0.001 1.501 1.348–1.670 <0.001 1.029 0.920–1.151 0.616

Region of China
South (Guangzhou) 1.00 1.00 1.00
East (Nanjing and Shanghai) 2.633 2.030–3.413 <0.001 3.030 2.589–3.546 <0.001 1.502 1.275–1.769 <0.001
North (Beijing) 16.132 11.16–23.31 <0.001 5.766 4.201–7.913 <0.001 2.295 1.631–3.229 <0.001
Central (Changsha) 4.410 3.409–5.709 <0.001 5.940 5.076–6.950 <0.001 3.284 2.800–3.851 <0001
West (Chengdu) 5.547 4.447–6.919 <0.001 2.484 2.141–2.882 <0.001 1.588 1.36–1.852 <0.001

Although this study enrolled 14,302 participants, there were still
several shortcomings on the analysis of the situation of vitamin D
in the study. Firstly, we choose six districts, located in the central,
east, southwest, south, north part of China respectively, however,
these cities can only represent a part of China. Some cities such as
Tibet located in high altitude with unique folk customs were not
discussed in our study. Secondly, considering the tendency of vol-
unteers, our study cannot completely satisfy the random sampling
principle, which may lead to the sampling bias of our data. Actually,
a lower proportion of women may reduce the gender difference in
vitamin D. Thirdly, given the varied dietary habits of people in dif-
ferent parts of China, sunlight and UVR may be partly responsible
for the differences of serum vitamin D concentration. Moreover, in
the age factor analysis, this study cannot consider the effects of pre-
existing diseases in subjects, in actually, other studies have already
report that disease and vitamin D can interact.10,32
In summary, the prevalence of vitamin D deficiency reported in
the present study is considerably high. More seriously, the group of
severe shortage of vitamin D is also relatively huge. Our study indi-
cates that the concentration of serum vitamin D and D3 might be
12
W. Jiang et al. / Med Clin (Barc). 2019;154(1):7–12
closely relationship with sex, season, and region in Chinese person.
However, the age may play an interesting rule in this study, which
may need more research in the future. Thus, we advise that govern-
ment can carry out population census of vitamin D to early prevent
vitamin D deficiency, and that women and the northern people can
regular supply vitamin D, especially in spring and winter.
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
None.
Acknowledgement
We thank the data support from ADICON Clinical Laborato-
ries. Inc and we also thank all participants sharing their laboratory
examination results.
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