BACKGROUND African-American breast cancer survivors commonly demonstrate low serum 25-hydroxyvitamin D (25(OH)D). Decreased cutaneous conversion, high levels of adiposity, and even breast cancer treatment may influence vitamin D status. Previous investigations have analyzed African-American women in aggregate with other breast cancer survivors and have not comprehensively addressed these influential factors. OBJECTIVES To determine the prevalence of low serum 25(OH)D in an exclusively African-American cohort of female breast cancer survivors with overweight/obesity and to evaluate the role of ultraviolet (UV) light exposure, body composition, and dietary sources of vitamin D on serum 25(OH)D levels. DESIGN Cross-sectional. PARTICIPANTS Pre- and postmenopausal African-American breast cancer survivors (n=244) were recruited from various neighborhoods in the city of Chicago, IL, between September 2011 and September 2014 for a larger weight loss trial. MAIN OUTCOME MEASURES Demographic, clinical, anthropometric (body mass index [calculated as kg/m2], waist circumference, and hip circumference), blood specimen, dietary intake (food frequency questionnaire), and sun behavior data were collected by trained study personnel before trial participation. Dual-energy x-ray absorptiometry was used to quantify adiposity (total, percentage, regional, visceral) and lean mass. Serum 25(OH)D was used as the biomarker reflective of vitamin D status. STATISTICAL ANALYSES Mean (±standard deviation), frequencies, and multivariate linear regression modeling. RESULTS The average participant was 57.4 years old (±10.0), 6.9 years (±5.2) from initial breast cancer diagnosis with a body mass index of 36.2 (±6.2). The majority of participants (60%) reported habitual oral vitamin D supplementation with mean intake of 327 IU (±169). Vitamin D deficiency was prevalent in 81% and 43%, when the cut points of the Endocrine Society (<30 ng/mL or <75 nmol/L) and the Institute of Medicine (<20 ng/mL or <50 nmol/L) were applied, respectively. A multivariate model adjusting for age, seasonality of blood draw, total energy intake, use of supplemental vitamin D, darker skin pigmentation, breast cancer stage, and waist-to-hip ratio was able to explain 28.8% of the observed variance in serum 25(OH)D concentrations. No significant associations were detected for body mass index or any dual-energy x-ray absorptiometry measures of body composition. CONCLUSIONS Considering the number of women who endorsed use of vitamin D supplementation, the prevalence of vitamin D deficiency among these African-American breast cancer survivors was high. Vitamin D supplementation, sun behavior, and waist-to-hip ratio may serve as future points of intervention to improve the vitamin D status of this minority survivor population.

中文翻译：

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非裔美国女性乳腺癌幸存者中低血清 25-羟基维生素 D 的患病率和预测因素

背景 非洲裔美国乳腺癌幸存者通常表现出低血清 25-羟基维生素 D (25(OH)D)。皮肤转化率降低、肥胖水平高，甚至乳腺癌治疗都可能影响维生素 D 状态。以前的调查对非裔美国妇女与其他乳腺癌幸存者进行了汇总分析，但并未全面解决这些影响因素。目的 确定非裔美国人超重/肥胖女性乳腺癌幸存者队列中低血清 25(OH)D 的患病率，并评估紫外线 (UV) 光照射、身体成分和维生素膳食来源的作用D 对血清 25(OH)D 水平的影响。设计横截面。参与者 2011 年 9 月至 2014 年 9 月期间，从伊利诺伊州芝加哥市的不同社区招募了绝经前和绝经后非裔美国人乳腺癌幸存者（n=244），以进行更大规模的减肥试验。主要观察指标 人口统计学、临床、人体测量学（体重指数 [以 kg/m2 计算]、腰围和臀围）、血样、膳食摄入量（食物频率问卷）和阳光行为数据由经过培训的研究人员收集试验参与。双能 X 射线吸收测定法用于量化肥胖（总量、百分比、区域、内脏）和瘦体重。血清 25(OH)D 用作反映维生素 D 状态的生物标志物。统计分析平均值（±标准偏差）、频率和多元线性回归建模。结果 参与者的平均年龄为 57.4 岁 (±10.0)，与初始乳腺癌诊断相隔 6.9 岁 (±5.2)，体重指数为 36.2 (±6.2)。大多数参与者 (60%) 报告了习惯性口服维生素 D 补充剂，平均摄入量为 327 IU (±169)。当内分泌学会（<30 ng/mL 或 <75 nmol/L）和医学研究所（<20 ng/mL 或 <50 nmol/L）的临界点时，81% 和 43% 的人普遍缺乏维生素 D ) 分别应用。调整年龄、抽血的季节性、总能量摄入、补充维生素 D 的使用、较深的皮肤色素沉着、乳腺癌分期和腰臀比的多变量模型能够解释 28.8% 的血清观察差异25 (OH)D 浓度。未检测到体重指数或任何身体成分双能 X 射线吸收测定法的显着关联。结论 考虑到支持使用维生素 D 补充剂的女性人数，这些非裔美国乳腺癌幸存者中维生素 D 缺乏症的患病率很高。维生素 D 补充剂、阳光行为和腰臀比可能作为未来干预点，以改善这一少数族裔幸存者的维生素 D 状况。