Occupational Medicine 2013;63:485–493

Advance Access publication 11 September 2013 doi:10.1093/occmed/kqt106

Vitamin D status of Canadians employed in

northern latitudes
Y. -S. Chao1, L. Brunel2, P. Faris3 and P. J. Veugelers1
School of Public Health, University of Alberta, Edmonton, Alberta, Canada, 2Santessence, Calgary, Alberta, Canada,
1

Alberta Health Services, Calgary, Alberta, Canada.

3

Correspondence to: Y.-S. Chao, School of Public Health, University of Alberta, 3–50 University Terrace, 8303-112 St,
Edmonton, Alberta T6G 2T4, Canada. Tel: +1 780 492 4302; fax: +1 780 492 5521; e-mail: chaoyisheng@gmail.com

Background Vitamin D deficiency and insufficiency are prevalent worldwide, but relatively few studies have

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examined vitamin D status in working populations.
Aims To assess the prevalence of vitamin D deficiency and insufficiency in Canadian workers and investi-
gate risk factors in this population.
Methods A cross-sectional study using data from a health programme enrolling workers mostly from Northern
Alberta, Canada. As part of the programme, volunteers were invited to complete a lifestyle question-
naire. Blood was taken to determine plasma 25-hydroxyvitamin D (25(OH)D) levels. Logistic and
linear regressions were used to investigate the relationships between individual characteristics and
vitamin D status.
Results Between October 2007 and December 2012, 6101 eligible workers enrolled in the health programme.
The prevalence of vitamin D deficiency (plasma 25(OH)D, levels <27.5 nmol/l) and insufficiency
(<37.5  nmol/l) were 3 and 8%, respectively. Male employees were significantly more likely to be
vitamin D deficient and insufficient than females. Residing at a more northern latitude increased
the likelihood of vitamin D deficiency and insufficiency. Age, assessments made in summer, better
general health and physical activity and use of vitamin D supplementation were all related to lower
likelihood of deficiency and insufficiency.
Conclusions Vitamin D deficiency and insufficiency are a concern in this sample of Canadian workers. Vitamin
D supplementation is recommended to reduce the prevalence of deficiency and insufficiency in this
group.
Key words Canadian workers; deficiency; 25-hydroxyvitamin D; insufficiency; vitamin D.

Introduction prevalence of vitamin D deficiency (<25 nmol/l 25(OH)

Vitamin D deficiency is recognized as a global public
health concern [1]. Serum levels of 25-hydroxyvitamin
D (25(OH)D) <25–50  nmol/l are implicated in the
development of rickets in children and osteomalacia
in adults [2]. Human vitamin D sources include diet,
supplementation, and sunlight exposure [2]. Dietary
sources include oily fish and dairy products fortified
with vitamin D in the USA and Canada [3]. Because
sunlight exposure can be influenced by latitude,
seasons, darker skin tone, clothing and other barriers
[4,5], prevalence rates of vitamin D deficiency and
insufficiency are higher in northern latitudes where
sun exposure is less. For example in the USA, the
D) was reportedly 6% of total population between
2001 and 2004 [6]. More than 10% of Canadians
aged 6–79  years have vitamin D levels insufficient to
maintain bone health (less than 37.5 nmol/l 25(OH)D)
[7]. Within the same geographical areas, groups at risk
of insufficiency include institutionalized individuals,
children, young adults and pregnant women [2].
Although working populations are not considered at
risk, the economic consequences of poor health within
them are greater [8]. Few previous health surveys or
studies have explored the risk factors for deficiency in
working populations, despite estimates of cost savings
that would result from adequate vitamin D intake
among subgroups of working ages [9].

© The Author 2013. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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486  OCCUPATIONAL MEDICINE
This study aimed to assess the prevalence of insuffi-
ciency and deficiency in a sample of Canadian workers as
the first attempt to understand the prevalence of vitamin
D deficiency in a working population and to examine
risk factors for vitamin D deficiency or insufficiency to
inform future workplace health programmes to improve
employees’ health and reduce productivity loss resulting
from inadequate vitamin D status.
Methods
This cross-sectional study used information gathered
at baseline interviews from the Pure North S’Energy
(PNS) Foundation, which implemented a workplace
health programme in October 2007. The initial focus
was on workers in oil and gas sites in Northern Alberta,
Canada, but in more recent years, the programme was
extended to workers in other industries in neighbour-
ing Canadian provinces. Participation was voluntary
and free of charge. Although there were no compulsory
follow-up appointments, participants were advised to
attend a follow-up within 6  months. The programme
is described in more detail elsewhere [10]. The pro-
gramme collected data for the purpose of individual
lifestyle counselling. Body height, weight and blood
pressure were measured, and blood was taken to assess
plasma 25(OH)D levels. Latitude was identified from
participants’ current addresses. Participants were asked
to complete a questionnaire on lifestyle, diet and health
behaviour. General health was rated as excellent, very
good, good, fair or needing improvement. Physical
activity was assessed through the survey questions
developed by Godin and Shephard [11] to categorize
individuals’ activity levels into three categories: low,
moderate and high [12]. Dietary information was col-
lected through questions on the number of servings of
the four Canada’s Food Guide food groups [13], as
well as specific questions on fish consumption and pro-
tein sources. The use of oil and margarine (the latter
is often fortified with vitamin D in Canada) [14] was
also documented. The study used baseline data (first
visits only) from workers recruited between October
2007 and December 2012. PNS anonymized data prior
to forwarding it to the University of Alberta for analysis.
Statistics Canada [7] defines vitamin D deficiency as
plasma 25(OH)D levels <27.5 nmol/l and insufficiency
as levels <37.5  nmol/l. Because recent studies have
suggested extra-skeletal benefits, such as reduction of
colorectal cancer and cardiovascular disease risk, for
individuals with plasma levels >75 nmol/l [15,16], vita-
min D status was defined in four categories: deficiency
(≤27.5 nmol/l), insufficiency (≤37.5 nmol/l, bone health
benefits (>37.5 nmol/l and ≤75 nmol/l) and extra-skel-
etal benefits (>75  nmol/l). Descriptive statistics were
expressed as mean ± standard deviation. To test for dif-
ferences across vitamin D status categories, we applied
one-way analysis of variances for continuous variables
or chi-square tests for categorical variables. The national
average plasma 25(OH)D levels and prevalence rates of
insufficiency and deficiency from the Canadian Health
Measures Survey (CHMS) were taken as population
means and proportions and compared with the results
in the study using one-sample t-test or proportion test.
We applied logistic regression to identify risk factors for
vitamin D deficiency and insufficiency. Linear regres-
sion models were used to quantify the plasma 25(OH)
D levels associated with baseline characteristics. In our
analyses, we considered age, sex, sunlight exposure
(summer months and latitudes), general health, body
weight, physical activity, smoking and diet as poten-
tial confounders as these factors are known to affect
plasma 25(OH)D levels [2,17]. Only those independ-
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ent variables significantly associated with the outcomes
in univariable models were used in the multivariable
models. We considered results statistically significant
with P-values <0.05 (two tails). Colinearity was tested
with variance inflation factor (VIF) analysis, and VIF
>10 was considered problematic. All analyses were
conducted using STATA version 12 (College Station,
Texas). The Human Research Ethics Board of the
University of Alberta had approved access to and analy-
sis of the data for the purpose of the study.
Results
We had access to baseline data from 2007 to 2012
for 18 195 volunteers of whom 13 804 were active
workers. Among 12 281 workers tested for plasma
25(OH)D levels, 6113 completed the questionnaire on
demographic information, lifestyle, health behaviour
and vitamin D supplement use. Twelve workers were
excluded for kidney failure (estimated glomerular
filtration rate <15  ml/min/1.73 m2) that severely
interfered with vitamin D metabolism, leaving 6101
data sets eligible for analysis. Subjects were from
Alberta (n = 4793, 79%), British Columbia (811, 13%)
and other Canadian provinces (497, 8%). There were
2921 (48%) male participants and 3180 (52%) female
participants. The mean age was 42 ± 14 years and 24,
43 and 31% of them were younger than 30, 30 to 49
and 50 to 69, respectively, while 2% were older than
70. The mean latitude was 52.9 ± 2.8 degrees and the
maximum and minimum values were 70.7 and 42.8
degrees. The mean plasma 25(OH)D level at first visit
was 84 ± 42 nmol/l and ranged from 10 to 748 nmol/l.
One hundred and eighty-five (3%) participants were
Vitamin D deficient, and 489 (8%) had insufficient
Vitamin D (including deficiency). A  total of 2412
(40%) had Vitamin D levels adequate for bone health,
and 3205 (53%) had levels adequate for extra-skeletal
health. Among the latter, five had levels higher than
375  nmol/l. Compared with the statistics from the
 Y. -S. Chao et al.: Vitamin D Status of Canadians  487

Table 1.  Baseline characteristics of 6101 Canadian workers participating in the Pure North S’Energy Foundation health programme
from 2007 to 2012

Plasma 25(OH)D <27.5 ≥27.5, <37.5 ≥37.5, <75.0 ≥75.0

categories (n = 185) (n = 304) (n = 2407) (n = 3205)

Mean/No. SD/(%) Mean/No. SD/(%) Mean/No. SD/(%) Mean/No. SD/(%)

of obs. of obs. of obs. of obs.

25(OH)D (nmol/l)** 22.06 4.07 32.93 2.78 58.49 10.36 111.25 39.42

Vitamin D supplementation (%)**

 No 177 (96) 272 (89) 2006 (83) 2102 (66)
 Yes 8 (4) 32 (11) 401 (17) 1103 (34)

Age (years)** 36.8 10.8 38.7 12.3 40.9 13.5 43.1 14.5

Gender**
  Male (%) 177 (96) 272 (89) 2006 (83) 2102 (66)

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  Female (%) 8 (4) 32 (11) 401 (17) 1103 (34)
  Latitude (degrees)** 54.20 3.24 53.60 3.07 53.17 2.96 52.49 2.62
  April– October (%)** 75 (40) 139 (46) 1482 (62) 2214 (69)

Weight categories (%)**

 Underweight 3 (2) 3 (1) 24 (1) 49 (2)
  Normal weight 47 (25) 72 (24) 665 (28) 1327 (41)
 Overweight 61 (33) 94 (31) 781 (32) 1100 (34)
 Obesity 74 (40) 135 (44) 937 (39) 729 (23)

General health categories (%)**

 Excellent 4 (2) 7 (2) 89 (4) 260 (8)
  Very good 25 (13) 57 (19) 490 (20) 964 (30)
 Good 70 (38) 106 (35) 940 (39) 1165 (36)
 Fair 35 (19) 55 (18) 465 (19) 391 ((12)
  Needs improvement 51 (28) 79 (26) 423 (18) 425 (13)

Health behaviour
  Smoking (%)** 46 (25) 88 (29) 444 (18.5%) 345 (11)

Physical activity categories (%)**

 Low 91 (49) 136 (45) 945 (39) 959 (30)
 Moderate 92 (50) 161 (53) 1422 (59) 2142 (67)
 High 2 (1) 7 (2) 40 (2) 104 (3)

Food servings/day
 Milk*
  0–2 129 (70) 205 (67) 1511 (63) 2046 (64)
  3–4 47 (25) 82 (27) 688 (29) 909 (28)
  5–7 7 (4) 13 (4) 160 (7) 183 (6)
   8 or more 2 (1) 4 (1) 48 (2) 67 (2)

 Fish**
  0–2 152 (82) 244 (80) 1862 (77) 2423 (76)
  3–4 26 (14) 46 (15) 394 (16) 575 (18)
  5–7 5 (3) 12 (4) 122 (5) 173 (5)
   8 or more 2 (1) 2 (1) 29 (1) 34 (1)

Margarine consumption frequency (%)**

 Never 64 (35) 90 (30) 816 (34) 1470 (46)
 Rarely 61 (33) 88 (29) 714 (30) 947 (30)
 Often 51 (28) 100 (33) 652 (27) 608 (19)
 Always 9 (5) 26 (9) 225 (9) 180 (6)

N = 6101. SD = standard deviation.

*P < 0.05; **P < 0.001. P values were derived from chi-square tests or one-way analysis of variances if the statistics were categorical or continuous, respectively.
488  OCCUPATIONAL MEDICINE
CHMS, the mean 25(OH)D level in this study
sample was higher than the average of 66.5 nmol/l for
Canadians in the age range of 40–59 between 2007 and
2009 (t  =  32.37, P  <  0.001). The prevalence rates of
deficiency and insufficiency in our sample were lower
than those of 4 and 11% found in CHMS participants
aged between 40 and 59 (z  =  −2.72 and −4.89,
respectively, P < 0.01 for both) [7].
Table  1 presents baseline characteristics of subjects
by vitamin D categories. Subjects in the four categories
were different in all characteristics listed. Vitamin D defi-
cient individuals were more likely to live at higher lati-
tudes, to have enrolled in the programme in months of
less sunlight exposure (November to March) and to have
a higher body mass index (P < 0.05 for all). Smoking was
more prevalent among deficient individuals, and levels of
physical activity, numbers of servings of milk (per day)
or fish (per week) and the frequency of margarine con-
sumption were also significantly different between these
four groups.
Tables 2 and 3 present univariable and multivari-
able associations between workers’ baseline character-
istics and the likelihood of vitamin D insufficiency and
deficiency, respectively. There were no characteristics
associated with VIF greater than 10 in these two logit
and linear regression models. Supplementation use, age,
enrolment in summer months and moderate physical
activity were associated with lower likelihood of vitamin
D insufficiency or deficiency. Milk consumption was
related to a lower likelihood of insufficiency only after
controlling for other characteristics. Male sex, residing
at northern latitudes, obesity, smoking and being in the
poorest category of general health were associated with
a higher likelihood of vitamin D insufficiency (P < 0.05
for all).
Table  4 presents associations of baseline character-
istics and plasma 25(OH)D levels. Supplementation
use, age, assessment in summer months and physical
activity were correlated with higher plasma levels, while
being overweight or obese, having general health poorer
than ‘very good’, smoking and margarine use frequency
were negatively associated with 25(OH)D levels. Milk
and fish consumption were not statistically significant
factors after controlling for other characteristics in the
multivariable model.
Discussion
In this sample of workers, 3 and 8% of subjects were
vitamin D deficient and insufficient, respectively. Use
of vitamin D supplementation use was associated with
the largest reduction in the likelihood of deficiency
or insufficiency. Baseline characteristics, includ-
ing age, gender, latitude of residence, season at the
time of assessment, physical activity and self-assessed
general health were associated not only with the like-
lihood of deficiency or insufficiency but also with
plasma 25(OH)D levels. Plasma 25(OH)D levels were
positively associated with these characteristics and
negatively associated with being overweight or obese,
smoking and frequency of margarine use, although
these factors were not significant in models predicting
deficiency risks.
This study has several strengths. Firstly, it used an
objective measure of vitamin D status (plasma 25(OH)
D) and was executed in a large sample of workers con-
sidered at risk in view of the northern latitude of their
work sites. It is also the first attempt to directly analyse
the risks of deficiency or insufficiency in Canadian work-
ers. Additionally, the study helps to estimate the import­
ance of a number of factors in relation to vitamin D
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inadequacy. Although use of vitamin D supplementation
was associated with the greatest reduction in the risk of
deficiency or insufficiency, dietary sources of vitamin D,
especially milk and oily fish [2], did not have a signifi-
cant impact after controlling for other factors. It is pos-
sible that foods rich in vitamin D are for some reason
less important to Canadian workers than to the general
Canadian population, in which they have been found
to be effective in reducing the risks of deficiency and
insufficiency(14).
The absence of an association between fortified food
consumption and deficiency could be due to two of the
weaknesses of this study [1]: the lack of standardized
food frequency measures [18] and imprecise definition
of fish in the questionnaires and [2] self-selection and
self-reporting bias by the respondents. Regarding the
first weakness, participants, mostly Albertan, reported
an average fish consumption of 128 g/week. This is less
than the mean fish consumption in Canada (140 g/
week) [19]. Subjects’ reported average milk consump-
tion (485 ml/day) was more than the average reported
in Alberta (245 ml/day in 2011)  or in Canada (216 ml/
day in 2011) [20]. It is possible that this working popula-
tion consumed less fish and more milk than the national
average because seafood needs to be transported for
long distances whereas dairy products are readily avail-
able in Alberta. However, we are unsure about the extent
of self-selection by those with specific diet habits and
bias due to self-reporting. Another limitation is that the
importance of other significant determinants of vitamin
D levels besides dietary sources (i.e. skin synthesis and
vitamin D metabolism) were not directly assessed. Skin
synthesis accounts for 80–90% of vitamin D supply and
is influenced by exposure time and skin area exposed to
sunlight [21]. The importance of skin synthesis was indi-
rectly evaluated by considering whether baseline assess-
ments had occurred in summer months (April–October)
and subjects’ latitudes of residence. These proxy meas-
ures showed sunlight exposure might be related to better
vitamin D status.
 Y. -S. Chao et al.: Vitamin D Status of Canadians  489

Table 2.  Odds ratios (95% confidence intervals) of vitamin D insufficiency (including deficiency; plasma 25(OH)D < 37.5 nmol/l)
among 6101 participating Canadian workers

Outcome: vitamin D Univariable models Multivariable models

insufficiency and deficiency (n = 6101) (n = 6101)
(25(OH)D < 37.5 nmol/l)
OR (95% CI) P OR (95% CI) P

Baseline characteristics

  Vitamin D 0.24 (0.18–0.34) <0.001 0.27 (0.19–0.37) <0.001

supplementation
  Age (per 10 years) 0.80 (0.75–0.85) <0.001 0.77 (0.72–0.83) <0.001
  Male (compared 1.67 (1.38–2.01) <0.001 1.56 (1.27–1.91) <0.001
with female)
 Latitude 3.24 (2.41–4.35) <0.001 2.44 (1.73–3.43) <0.001
(per 10 degrees)
  Summer months 0.40 (0.33–0.49) <0.001 0.38 (0.32–0.47) <0.001
(April–October)

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Physical activity categories

 Low (Reference) (Reference)

 Moderate 0.60 (0.49–0.72) <0.001 0.67 (0.54–0.83) <0.001
 High 0.52 (0.26–1.04) NS 0.61 (0.29–1.27) NS

Body weight categories

 Underweight 1.38 (0.59–3.23) NS 0.98 (0.40–2.37) NS

  Normal weight (Reference) (Reference)
 Overweight 1.38 (1.08–1.77) <0.05 1.28 (0.98–1.66) NS
 Obesity 2.10 (1.66–2.65) <0.001 1.65 (1.27–2.15) <0.001

General health status

 Excellent (Reference) (Reference)

  Very good 1.79 (0.94–3.39) NS 1.49 (0.77–2.91) NS
 Good 2.65 (1.43–4.93) <0.01 1.70 (0.88–3.28) NS
 Fair 3.34 (1.76–6.32) <0.001 1.83 (0.93–3.63) NS
  Needs improvement 4.86 (2.60–9.11) <0.001 2.82 (1.43–5.55) <0.01

Smoking 2.31 (1.87–2.85) <0.001 1.70 (1.35–2.15) <0.001

Milk servings/day

 0–2 (Reference) (Reference)

 3–4 0.86 (0.70–1.06) NS 0.78 (0.63–0.98) <0.05
 5–7 0.62 (0.39–0.99) <0.05 0.56 (0.35–0.91) <0.05
  8 or more 0.56 (0.24–1.27) NS 0.41 (0.17–0.98) <0.05

Fish servings/week

 0–2 (Reference) (Not used for multivariable

analysis)
 3–4 0.80 (0.62–1.04) NS
 5–7 0.62 (0.38–1.03) NS
  8 or more 0.69 (0.25–1.90) NS

Margarine consumption frequency

 Never (Reference) (Reference)

 Rarely 1.33 (1.05–1.68) <0.05 1.02 (0.79–1.30) NS
 Often 1.78 (1.41–2.25) <0.001 1.09 (0.85–1.41) NS
 Always 1.28 (0.88–1.88) NS 0.75 (0.50–1.12) NS

OR, odds ratios; NS, not significant.

490  OCCUPATIONAL MEDICINE

Table 3.  Odds ratios (95% confidence intervals) of vitamin D deficiency (plasma 25(OH)D < 27.5 nmol/l) among 6101 participating
Canadian workers

Outcome: vitamin D Univariable models Multivariable models (n = 6101)

deficiency (n = 6101)
(plasma 25(OH)D
< 27.5 nmol/l)
OR (95% CI) P OR (95% CI) P

Baseline characteristics
  Vitamin D 0.13 (0.06–0.26) <0.001 0.15 (0.08–0.31) <0.001
supplementation
  Age (per 10 years) 0.76 (0.69–0.83) <0.001 0.75 (0.67–0.84) <0.001
  Male (compared 1.82 (1.35–2.46) <0.001 1.80 (1.30–2.49) <0.001
with female)
  Latitude (per 10 4.14 (2.78–6.16) <0.001 3.48 (2.15–5.62) <0.001
degrees)
  Summer months 0.37 (0.27–0.50) <0.001 0.36 (0.26–0.48) <0.001
(April–October)

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Physical activity categories
 Low (Reference) (Reference)
 Moderate 0.55 (0.41–0.74) <0.001 0.60 (0.43–0.84) <0.01
 High 0.30 (0.07–1.22) NS 0.33 (0.08–1.44) NS

Body weight categories

 Underweight 1.73 (0.53–5.70) NS 1.77 (0.60–5.21) NS
  Normal weight (Reference) (Reference)
 Overweight 1.36 (0.92–1.99) NS 1.23 (0.82–1.85) NS
 Obesity 1.80 (1.25–2.61) <0.01 1.28 (0.85–1.93) NS

General health
 Excellent (Reference) (Reference)
  Very good 1.47 (0.51–4.26) NS 1.30 (0.44–3.83) NS
 Good 2.82 (1.02–7.77) <0.05 1.91 (0.67–5.49) NS
 Fair 3.42 (1.21–9.69) <0.05 2.03 (0.68–6.08) NS
  Needs improvement 4.90 (1.76–13.65) <0.01 3.10 (1.04–9.22) <0.05

Smoking 1.90 (1.35–2.67) <0.001 1.24 (0.87–1.78) NS

Milk servings/day
 0–2 (Reference) (Not used for
multivariable analysis)
 3–4 0.82 (0.58–1.15) NS
 5–7 0.57 (0.27–1.24) NS
  8 or more 0.49 (0.12–2.00) NS

Fish servings/week
 0–2 (Reference) (Not used for
multivariable analysis)
 3–4 0.76 (0.50–1.16) NS
 5–7 0.49 (0.20–1.19) NS
  8 or more 0.92 (0.22–3.78) NS

Margarine consumption frequency

 Never (Reference) (Not used for
multivariable analysis)
 Rarely 1.29 (0.91–1.85) NS
 Often 1.39 (0.96–2.02) NS
 Always 0.78 (0.38–1.57) NS
 Y. -S. Chao et al.: Vitamin D Status of Canadians  491

Table 4.  Baseline characteristics and associated plasma 25(OH)D levels (95% confidence intervals) among 6101 participating Canadian
workers

Outcome: plasma Univariable models (n = 6101) Multivariable models (n = 6101)

25(OH)D (nmol/l)
β (95% CI) P β (95% CI) P

Baseline characteristics

  Vitamin D 23.74 (21.16–26.31) <0.001 21.05 (18.49–23.60) <0.001

supplementation
  Age (per 10 years) 2.64 (1.90–3.37) <0.001 2.67 (1.94–3.39) <0.001
  Male (compared with −10.22 (−12.30 to −8.13) <0.001 −6.38 (−8.46 to −4.31) <0.001
female)
  Latitude (per 10 degrees) −23.45 (−26.90 to −19.99) <0.001 −12.40 (−15.61 to −9.18) <0.001
  Summer months 8.46 (6.26–10.67) <0.001 8.04 (5.99–10.09) <0.001
(April–October)

Physical activity categories

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 Low (Reference) (Reference)
 Moderate 8.17 (5.97–10.37) <0.001 4.80 (2.65–6.95) <0.001
 High 18.23 (11.07–25.39) <0.001 13.51 (6.68–20.34) <0.001

Body weight categories

 Underweight 7.60 (−5.16 to 20.35) NS 11.68 (−0.66 to 24.02) NS

  Normal weight (Reference) (Reference)
 Overweight −8.67 (−11.33 to −6.01) <0.001 −6.99 (−9.61 to −4.37) <0.001
 Obesity −20.43 (−22.91 to −17.96) <0.001 −16.23 (−18.84 to −13.62) <0.001

General health

 Excellent (Reference) (Reference)

  Very good −6.36 (−10.81 to −1.91) <0.01 −2.53 (−6.90 to 1.84) NS
 Good −14.11 (−18.42 to −9.79) <0.001 −4.76 (−9.23 to −0.28) <0.05
 Fair −21.23 (−25.85 to −16.60) <0.001 −7.71 (−12.52 to −2.89) <0.01
  Needs improvement −19.66 (−24.54 to −14.78) <0.001 −5.89 (−11.08 to −0.71) <0.05
 Smoking −15.41 (−17.99 to −12.83) <0.001 −8.89 (−11.38 to −6.41) <0.001

Milk servings/day

 0–2 (Reference) (Reference)

 3–4 −1.39 (−3.65 to 0.87) NS 0.16 (−1.99 to 2.30) NS
 5–7 −4.35 (−8.27 to −0.43) <0.05 −1.32 (−5.07 to 2.43) NS
  8 or more −1.40 (−7.98 to 5.18) NS 3.93 (−2.58 to 10.45) NS

Fish servings/week

 0–2 (Reference) (Reference)

 3–4 3.43 (0.65–6.22) <0.05 1.70 (−0.88 to 4.27) NS
 5–7 5.77 (−0.53 to 12.08) NS 4.10 (−2.12 to 10.32) NS
  8 or more 0.01 (−8.89 to 8.90) NS −1.62 (−10.47 to 7.22) NS

Margarine consumption frequency

 Never (Reference) (Reference)

 Rarely −8.82 (−11.43 to −6.20) <0.001 −3.95 (−6.38 to −1.52) <0.01
 Often −15.46 (−18.07 to −12.85) <0.001 −6.44 (−8.88 to −4.01) <0.001
 Always −16.58 (−20.15 to −13.02) <0.001 −6.98 (−10.34 to −3.62) <0.001
 Constant 143.16 (125.44–160.89) <0.001

β = regression coefficients.
492  OCCUPATIONAL MEDICINE
The process of transforming vitamin D into its
active forms involves the liver and kidneys, and
active molecules are distributed to all tissues [21].
There were insufficient subjects with liver or kidney
disorders for separate analysis, and they were therefore
excluded. Obesity, which is closely related to vitamin D
distribution volume [22], was significantly associated
only with plasma 25(OH)D levels and risks of vitamin D
insufficiency. The reduction in vitamin D bioavailability
due to obesity [23] might not play an important role in
deficiency risks.
Other characteristics associated with vitamin D metab-
olism include ageing and physical activity. Although there
is biological evidence that ageing decreases the capac-
ity of the human skin to produce vitamin D [24], age
was positively associated with plasma 25(OH)D levels
and a lower likelihood of deficiency or insufficiency. The
beneficial effect of older age was also observed in other
studies [25]. Correlates of age, such as having more time
for sunlight exposure and being more receptive to health
promotion messages, may have contributed to these
observations [25].
We observed an important correlation between
physical activity (moderate levels compared with low)
and vitamin D adequacy, which is consistent with
observations in both cross-sectional and prospect­
ive studies [26]. This relationship may be due to the
strong association between physical activity and obe-
sity, which decreases the bioavailability of vitamin D
[2,23]. Other studies have suggested that physical
activity helps to maintain vitamin D physiologically
[27] and that exercise is often correlated with sunlight
exposure, which in turn contributes to higher plasma
25(OH)D concentrations [28,29]. However, we did
not find higher levels of physical activity to be sig-
nificantly associated with vitamin D adequacy, which
might be because of limited numbers of subjects with
high levels of activity.
A further weakness of this study relates to its
nature. Because it involved information gathered
in a workplace health programme, the socioeco-
nomic status of the employees was considered to be
homogenous, and no questions concerning individ-
ual income, wealth, education, job status, race and
ethnicity or family composition were asked, although
these factors are important associates of 25(OH)D
serum levels [6,7].
In conclusion, vitamin D deficiency and insuf-
ficiency were sufficiently prevalent to be a source of
concern among this sample of Canadian workers.
Vitamin D supplementation was the modifiable risk
factor with the strongest association with 25(OH)D
levels. Others have recommended vitamin D supple-
mentation as an effect­ive means to reduce the burden
of vitamin D deficiency and insufficiency [2,17], and
our results suggest that this conclusion is also applica-
ble to our study population of workers at high north-
ern latitudes.
Key points
•• Vitamin D insufficiency and deficiency rates
were lower in this sample of Canadian work-
ers, compared with subjects of similar ages in
the general Canadian population.
•• Age, gender, latitude of residence, season of
assessment, physical activity, general health
and use of vitamin D supplementation were
significantly associated with the likelihood of
both deficiency and insufficiency of vitamin D
in this study, while obesity and smoking were
Downloaded from http://occmed.oxfordjournals.org/ at Kainan University on March 9, 2015
associated with the risk of insufficiency only.
•• Although lower than the general Canadian
population prevalence, the rates of vitamin
D insufficiency and deficiency in this work-
ing population suggest a need for greater use
of vitamin D supplementation to protect its
health and economic productivity.
Acknowledgements
The authors wish to thank the Pure North S’Energy Foundation
for allowing their data to be analysed for the purpose of this
contribution. They also wish to thank Peter Tran and Jason
Liang for data management and validation.
Conflicts of interest
None declared.
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