![]() For this reason, concern has been raised regarding negative impacts of the UVB exposure-limiting attempts on vitamin D status, since vitamin D production is directly related to sunlight exposure. It is, however, well-known that vitamin D plays an important role during growth, and that a sub-optimal vitamin D status throughout childhood may increase the risk for later osteoporosis development. Some of the studies have even indicated that the association may be U-shaped, meaning that not only is there an increased risk among those with very low levels of vitamin D, but also among those with very high levels. However, the literature is inconsistent on the association between vitamin D and incidence, prognosis and mortality of these chronic diseases. Insufficient vitamin D status may be related to several undesirable health consequences with regard to bone and skeletal development, and numerous studies have also related low levels of vitamin D to several chronic diseases, including cancer, heart disease, diabetes, and multiple sclerosis. Sun exposure guidelines and protection programs also exist in several other countries, including the UK, Australia and the US, and the World Health Organization (WHO) also advocates healthy sun behavior. These guidelines aim to limit Danes’ sun exposure during the time of day with the highest UV-index and should be applied whenever the UV-index is above three. The campaign includes four guidelines that focus on seeking shade, wearing a sunhat, wearing protective clothing and using sunscreen. The Danish Sun Safety campaign entitled “Reduce your sun exposure between 12 and 3 p.m.” was launched in 2007 with the goal of reducing skin cancer incidence. During 2009–2013, more than 2000 new cases of malignant melanoma were diagnosed in Denmark, and more than 250 deaths were registered annually. However, prolonged exposure to UVB radiation is also the major risk factor for both non-melanoma skin cancer and malignant melanoma. Vitamin D production is highly dependent on solar exposure, and it is estimated that between 80% and 90% of our vitamin D status stems from UVB-induced production. In conclusion, adherence to the sun exposure guidelines on shade and protective clothing was associated with lower vitamin D status among Danish adults, but not children. No associations were found with wearing a sunhat, and there were no clear associations for children. Use of sunscreen was associated with adequate vitamin D status, as those who always sought shade compared to those who did not had an OR (95% CI) of 1.68 (1.25–2.35) of having ≥50 nmol/L during both spring and autumn. Adherence to all four guidelines was also associated with lower vitamin D concentrations (autumn: 9.7 nmol/L lower (−14.3–−5.1 nmol/L). For adults, those who always sought shade or wore protective clothing compared to those who did not had lower levels of vitamin D (autumn concentrations for shade: 7.2 nmol/L lower (−11.0–−3.6 nmol/L) for protective clothing: 9.9 nmol/L lower (−13.6–−6.2 nmol/L). The odds ratio (OR) of either low (<25 or 50 nmol/L) or adequate/high (≥50 nmol/L) vitamin D status was examined using logistic regression. ![]() ![]() Using linear regression, we associated serum vitamin D concentrations to questionnaire responses on: seeking shade, wearing a sunhat, wearing protective clothing or using sunscreen. In total, 3194 Danes (2625 adults, 569 children) were recruited among the general population, and more than 92% had blood samples taken both autumn and spring. Our aim was to investigate the relationship between adherence to the Danish sun exposure guidelines and vitamin D status. Little is known on how vitamin D status is affected by adherence to UVB-limiting sun exposure guidelines.
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