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Objective: To describe the development of a new position statement regarding balancing the risks and benefits of sun exposure for Australian adults., Methods: We conducted a Sun Exposure Summit in March 2021, with presentations from invited experts and a workshop including representation from academic, clinical, policy, and patient stakeholder organisations. The group considered advice about balancing the risks and benefits of sun exposure for Australian adults and developed a revised consensus position statement., Results: The balance of risks and benefits of sun exposure is not the same for everybody. For people at very high risk of skin cancer, the risks of exposure likely outweigh the benefits; sun protection is essential. Conversely, people with deeply pigmented skin are at low risk of skin cancer but at high risk of vitamin D deficiency; routine sun protection is not recommended. For those at intermediate risk of skin cancer, sun protection remains a priority, but individuals may obtain sufficient sun exposure to maintain adequate vitamin D status., Conclusions: The new position statement provides sun exposure advice that explicitly recognises the differing needs of Australia's diverse population., Implications for Public Health: Mass communication campaigns should retain the focus on skin cancer prevention. The new position statement will support the delivery of personalised advice., Competing Interests: Conflicts of interest David Whiteman reports a relationship with Pierre Fabre Australia that includes speaking and lecture fees. Peter Ebeling reports a relationship with Healthy Bones Australia that includes board membership. Peter Ebeling reports a relationship with the American Society for Bone and Mineral Research that includes board membership. Peter Ebeling reports a relationship with International Osteoporosis Foundation that includes: board membership. Peter Ebeling reports a relationship with the Asian Pacific Consortium on Osteoporosis that includes board membership. Craig Sinclair reports a relationship with Cancer Council Victoria that includes employment. Christian Girgis reports a relationship with the Australian and New Zealand Bone and Mineral Society that includes board membership. Christian Girgis reports a relationship with the University of Sydney that includes employment. Stephen Shumack reports a relationship with the Australasian College of Dermatologists that includes non-financial support., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Globally, acute respiratory infections (ARIs) are a leading cause of childhood morbidity and mortality. While ARI-related mortality is low in Australia, First Nations infants are hospitalised with ARIs up to nine times more often than their non-First Nations counterparts. The gap is widest in the Northern Territory (NT) where rates of both acute and chronic respiratory infection are among the highest reported in the world. Vitamin D deficiency is common among NT First Nations neonates and associated with an increased risk of ARI hospitalisation. We hypothesise that perinatal vitamin D supplementation will reduce the risk of ARI in the first year of life., Methods and Analysis: 'D-Kids' is a parallel (1:1), double-blind (allocation concealed), randomised placebo-controlled trial conducted among NT First Nations mother-infant pairs. Pregnant women and their babies (n=314) receive either vitamin D or placebo. Women receive 14 000 IU/week or placebo from 28 to 34 weeks gestation until birth and babies receive 4200 IU/week or placebo from birth until age 4 months. The primary outcome is the incidence of ARI episodes receiving medical attention in the first year of life. Secondary outcomes include circulating vitamin D level and nasal pathogen prevalence. Tertiary outcomes include infant immune cell phenotypes and challenge responses. Blood, nasal swabs, breast milk and saliva are collected longitudinally across four study visits: enrolment, birth, infant age 4 and 12 months. The sample size provides 90% power to detect a 27.5% relative reduction in new ARI episodes between groups., Ethics and Dissemination: This trial is approved by the NT Human Research Ethics Committee (2018-3160). Study outcomes will be disseminated to participant families, communities, local policy-makers, the broader research and clinical community via written and oral reports, education workshops, peer-reviewed journals, national and international conferences., Trial Registration Number: ACTRN12618001174279., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Nearly one in four Australian adults is vitamin D deficient (serum 25-hydroxyvitamin D concentrations [25(OH)D] < 50 nmol L -1 ) and current vitamin D intakes in the Australian population are unknown. Internationally, vitamin D intakes are commonly below recommendations, although estimates generally rely on food composition data that do not include 25(OH)D. We aimed to estimate usual vitamin D intakes in the Australian population., Methods: Nationally representative food consumption data were collected for Australians aged ≥ 2 years (n = 12,153) as part of the cross-sectional 2011-2013 Australian Health Survey (AHS). New analytical vitamin D food composition data for vitamin D 3 , 25(OH)D 3 , vitamin D 2 and 25(OH)D 2 were mapped to foods and beverages that were commonly consumed by AHS participants. Usual vitamin D intakes (µg day -1 ) by sex and age group were estimated using the National Cancer Institute method., Results: Assuming a 25(OH)D bioactivity factor of 1, mean daily intakes of vitamin D ranged between 1.84 and 3.25 µg day -1 . Compared to the estimated average requirement of 10 µg day -1 recommended by the Institute of Medicine, more than 95% of people had inadequate vitamin D intakes. We estimated that no participant exceeded the Institute of Medicine's Upper Level of Intake (63-100 µg day -1 , depending on age group)., Conclusions: Usual vitamin D intakes in Australia are low. This evidence, paired with the high prevalence of vitamin D deficiency in Australia, suggests that data-driven nutrition policy is required to safely increase dietary intakes of vitamin D and improve vitamin D status at the population level., (© 2022 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

The role that vitamin D plays in the cognitive and clinical characteristics of bipolar disorder (BD) is unclear. We examined differences in the levels and deficiency status of vitamin D in an Australian sample of BD patients compared to healthy controls; and determined the extent to which vitamin D is associated with clinical variables and cognitive function in the sample. 22 healthy controls and 55 stable outpatients with a diagnosis of BD and low-grade mood symptomatology provided a sample of blood and completed cognitive tests and clinical measures. Plasma concentrations of 25-hydroxyvitamin D (vitamin D) were assayed and used to segregate participants into subgroups with sufficient or deficient levels of vitamin D. Subgroups were then compared in terms of global cognition and a range of sociodemographic and clinical factors (number of past mood episodes, illness duration, seasonal mood pattern, mood symptom severity), while mean levels of vitamin D were compared between patients and controls. Although almost 27% of the current sample were vitamin D deficient, no significant differences in mean vitamin D levels or the prevalence of vitamin D deficiency were evident between BD patients and controls. Vitamin D was not associated with global cognition in either patients or controls, nor any of the clinical measures assessed in the study. In conclusion, we observed no difference in the vitamin D levels and deficiency status of an Australian sample of healthy individuals and BD patients with low grade mood symptomatology compared to controls. Clinical symptoms and global cognition also appear to be independent of vitamin D levels in BD., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2022. Published by Elsevier B.V.)

Aim: To estimate the prevalence of micronutrient deficiencies and anaemia, and their association with body mass index (BMI) categories among Australian adults., Method: We analysed data from the 2011-2013 Australian Health Survey from 3539 participants aged 18 years and over (without known pregnancy) with measured weight and height, and nutrient biomarkers. To address complex sampling, survey weights were used when estimating the prevalence of micronutrient deficiencies (vitamin B 12 deficiency; serum vitamin B 12 <145 pmol/L; iron deficiency; ferritin<30 µg/L and vitamin D deficiency; 25-hydroxyvitamin D<50 nmol/L) and anaemia (haemoglobin <120 g/L for females and <130 g/L for males) and when assessing associations with logistic regression models with adjusted ORs (AORs) for BMI categories: healthy weight (BMI 18.5 to <25.0 kg/m 2 ), reference; overweight (BMI 25.0 to <30.0 kg/m 2 ), obesity class I (BMI 30.0 to <35.0 kg/m 2 ), obesity class II/III (BMI 35.0 kg/m 2 or more)., Result: The prevalence of vitamin B 12 deficiency (range 0.9%─2.8%) and anaemia (range 3.9%─6.7%) were variable across BMI groups. The prevalence of iron deficiency in the obesity class I group was 12.0 percentage points lower than healthy weight group with an AOR of 0.50 (95% CI 0.30 to 0.83). The prevalence of vitamin D deficiency in the obesity class II/III group was 7.9 percentage points higher than the healthy weight group with an AOR of 1.62 (95% CI 1.01 to 2.60). Vitamin B 12 deficiency and anaemia were not consistently associated with BMI groups., Conclusion: We found a consistent association between severe obesity and vitamin D deficiency in Australian adults. We also found obesity class I was negatively associated with iron deficiency, whereas there was no consistent association between BMI groups and vitamin B 12 deficiency and anaemia. Public health strategies are needed to prevent vitamin D deficiency in this high-risk population., Competing Interests: Competing interests: EA was the Founding President, and now serves as the Secretary, of the National Association of Clinical Obesity Services (NACOS). He has received honoraria from Novo Nordisk for speaking and participating at meetings. He has received unrestricted research funding from Novo Nordisk and iNova on behalf of National Association of Clinical Obesity Services., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Vitamin D deficiency is associated with an increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency (25 hydroxy D (25(OH)D) <50 nmol/l) in Australians aged ≥65 years. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population-attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8·3 % of hospitalisations for falls (7991 events) and almost 8 % of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that, even in a sunny country such as Australia, vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians; in countries where the prevalence of vitamin D deficiency is higher, the impact will be even greater. It is important to mitigate vitamin D deficiency, but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities and costs of both approaches.

Background/objectives: Vitamin D deficiency is a public health concern worldwide. Maintaining vitamin D sufficiency during growth periods is essential. We aimed to determine the prevalence and predictors of vitamin D deficiency in Australian adolescents and young adults., Subject/methods: We used data from adolescents (12-17 years, n = 692) and young adults (18-24 years, n = 400) who participated in the nationally representative 2011-2013 Australian Health Survey. Serum 25-hydroxyvitamin D concentrations were measured using a method certified to international standards, with prevalence reported for <50 (vitamin D deficiency), 50-<75, ≥75 and >125 nmol/L. Independent predictors of vitamin D deficiency were determined using a survey-weighted Poisson regression model., Results: Overall, 17% of adolescents and 32% of young adults were vitamin D deficient. In models adjusted for sex, age, region of birth, socioeconomic status, BMI and season (and education, smoking status and physical activity in young adults only), the prevalence ratio (PR) for vitamin D deficiency was more than double in participants born outside Australia (adolescents: PR 2.46; 95% confidence interval (CI) = 1.59, 3.81; young adults: PR 2.12; 95% CI = 1.46, 3.07), and also varied by season (adolescents: spring vs summer PR 2.47; 95% CI = 1.22, 5.01 and winter vs summer PR 2.01; 95% CI = 1.03, 3.92; young adults: winter vs summer; PR 3.32; 95% CI = 1.69, 6.53). Other predictors of vitamin D deficiency were overweight compared with healthy weight (adolescents) and lower physical activity (young adults)., Conclusions: Strategies based on safe sun exposure and dietary approaches are needed to achieve and maintain adequate vitamin D status, particularly in young adults., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.)

Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/l) is recognised as a public health problem globally. The present study details the prevalence and predictors of vitamin D deficiency in a nationally representative sample (n 3250) of Australian Aboriginal and Torres Strait Islander adults aged ≥18 years. We used data from the 2012-2013 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). Serum 25(OH)D concentrations were measured by liquid chromatography-tandem MS. Survey-weighted logistic regression models were used to determine the independent predictors of vitamin D deficiency. Approximately 27 % of adult AATSIHS participants were vitamin D deficient. Vitamin D deficiency was more prevalent in remote areas (39 %) than in non-remote areas (23 %). Independent predictors of vitamin D deficiency included assessment during winter (men, adjusted OR (aOR) 5·7; 95 % CI 2·2, 14·6; women, aOR 2·2; 95 % CI 1·3, 3·8) and spring (men, aOR 3·3; 95 % CI 1·4, 7·5; women, aOR 2·6; 95 % CI 1·5, 4·5) compared with summer, and obesity (men, aOR 2·6; 95 % CI 1·2, 5·4; women, aOR 4·3; 95 % CI 2·8, 6·8) compared with healthy weight. Statistically significant associations were evident for current smokers (men only, aOR 2·0; 95 % CI 1·2, 3·4), remote-dwelling women (aOR 2·0; 95 % CI 1·4, 2·9) and university-educated women (aOR 2·4; 95 % CI 1·2, 4·8). Given the high prevalence of vitamin D deficiency in this population, strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches are needed.

We examine whether new government criteria designed to reduce overuse of vitamin D testing changed testing rates in Australian women. Although testing initially declined, the reduction was not sustained. Women who had more doctor visits and who had been tested previously were more likely to have vitamin D testing., Purpose: Vitamin D testing increased substantially in the 2000s in many countries, particularly in women. Because of concerns about potential over-testing, in 2014, the Australian criteria for subsidised testing were restricted to those at high risk of vitamin D deficiency. We aimed to describe vitamin D testing trends in Australian women (1996 to 2019) and investigate sociodemographic and health factors associated with testing under the new criteria., Methods: We used joinpoint regression to assess changes in national testing trends in Australian women (aged 15+ years) using universal health insurance system data. Additionally, we investigated the factors associated with vitamin D testing through Poisson regression with robust error variance using survey and linked insurance system data from participants born 1946-51 in the Australian Longitudinal Study on Women's Health (ALSWH)., Results: Between 1996 and 2013, vitamin D testing rates increased in all age groups. Rates declined between 2013 and 2016, but increased again between 2016 and 2019. In the ALSWH cohort, a higher likelihood of testing under the new criteria was associated with 12 or more doctor visits per year compared to two or fewer visits per year (relative risk (RR) 1.85; 95% CI 1.61-2.12), and women who had two or more vitamin D tests between 2012 and 2014 compared to no test (RR 1.55; 95% CI 1.48-1.62)., Conclusion: The introduction of new criteria has not led to sustained declines in testing. High testing rates and repeated testing suggest that over-testing for vitamin D deficiency in Australian women is still occurring.

Objective: To explore the prevalence of micronutrient deficiencies in patients with diabetic foot ulcers and correlate this with foot disease severity and other clinical factors. Approach: Prospective cohort study of diabetic patients with foot ulcers seen in multidisciplinary foot clinics across Adelaide or admitted to the Vascular Surgery Unit at the Royal Adelaide Hospital between February 2017 and September 2018. A total of 131 patients were included in the study. Plasma serum levels of vitamins A, C, D, and E, copper, zinc, and ferritin were measured. Demographic and clinical data, including BMI, smoking status, duration of diabetes, HbA1c, and WIfI score, were obtained. Results: The most prevalent nutritional deficiency found was vitamin D affecting 55.7% of patients. Suboptimal levels of vitamin C affected 73% of patients, comprising marginal levels in 22.2% and deficient levels in 50.8%. Zinc deficiency, vitamin A deficiency, and low ferritin levels were present in 26.9%, 10.9%, and 5.9% of patients, respectively. There was no correlation between BMI, grip strength, duration of diabetes, HbA1c, or smoking status with micronutrient deficiency. Increased severity of diabetic foot disease was associated with lower vitamin C levels ( p  = 0.02). Innovation: This study has demonstrated that the deficiency of micronutrients, especially vitamin D, vitamin C, zinc, and vitamin A, is common in diabetic patients with foot ulcers. Conclusions: The prevalence of micronutrient deficiency is high in a diabetic population with foot ulcers/wounds. Special concerns regarding the high prevalence of vitamin C and zinc deficiency, given their roles in wound healing. Although further research needs to be performed to determine the clinical implications of our findings, micronutrient deficiency should be considered in diabetic patients with foot wounds., (Copyright 2020, Mary Ann Liebert, Inc., publishers.)

Background and Objectives: Diabetes, including gestational diabetes mellitus (GDM), and vitamin D deficiency or insufficiency (VDDI) are recognised public health problems. There is conflicting evidence regarding the relationship between vitamin D deficiency and GDM. The aim of this study was to explore the incidence of VDDI among pregnant women attending a maternity unit in Sydney, Australia, and the relationship between VDDI in early pregnancy and later development of GDM., Method: This was a prospective cohort study in which 25-hydroxyvitamin D was measured in pregnant women during 2011-13. Exclusion criteria included pre existing diabetes, bowel disease and reduced cognitive ability., Results: There were 785 women enrolled in the study and 42 excluded. Findings from this study did not show an association between VDDI in early pregnancy and development of GDM. Important predictors of GDM remained the well known risk factors: family history, ethnicity, body mass index and age., Discussion: Clinical conversations should continue to focus on proven modifiable factors such as weight management and the provision of timely testing appropriate to the risk identified through history-taking.

Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations <50 nmol/L) is a public health issue in Australia and internationally. Those with darker skin require a greater dose of ultraviolet B radiation from sunlight than those with paler skin to synthesise adequate amounts of vitamin D. Using data from the 2011-2013 Australian Health Survey, we investigated the prevalence and predictors of vitamin D deficiency in African immigrants aged ≥18 years living in Australia ( n = 236). Serum 25(OH)D was measured using a liquid chromatography-tandem mass spectrometry method that is certified to international reference measurement procedures. Poisson regression was used to investigate independent predictors of vitamin D deficiency. A total of 36% of adults were vitamin D deficient (35% of men, 37% of women). The prevalence ratio (PR) of vitamin D deficiency decreased by 2% per year of age (PR 0.98; 95% CI (0.97, 0.99); p = 0.004) and was 1.6 times higher in those with low/sedentary, compared to moderate/high, physical activity levels (PR 1.64; 95% CI (1.12, 2.39); p = 0.011). The greatest risk was for those assessed during winter/spring compared with summer/autumn (PR 1.89; 95% CI (1.33, 2.64); p < 0.001). Culturally appropriate messaging on safe sun exposure and dietary vitamin D is warranted in order to promote vitamin D sufficiency in African immigrants living in Australia.

Studies of the relationship between circulating 25-hydroxyvitamin D (25(OH)D) and cancer risk have been inconsistent. We hypothesized that serum 25(OH)D was associated with total non-skin cancer incidence and mortality, and/or specifically with colorectal, lung, breast or prostate cancer in an Australian cohort. Serum 25(OH)D was measured in 3818 participants (2166 females) in the 1994/1995 Busselton Health Survey aged 25 to 84 years at baseline. Cancer mortality and events over 20 years follow-up were determined by data linkage. The mean serum 25(OH)D concentration was 60.6 ± 18.0 nmol/L, with 28%, 54% and 18% of participants in the lower (<50 nmol/L), middle (50-75 nmol/L) and higher (≥75 nmol/L) vitamin D status groups, respectively. During follow-up (excluding the first 2 years), 212 participants died from non-skin cancer and 634, 110 and 44 participants had non-skin, colorectal and lung cancer events, respectively; 113 women had breast cancer and 122 men had prostate cancer events. For colorectal cancer, lower circulating 25(OH)D was associated with significantly higher risk compared with the middle group (covariate-adjusted HR 1.62, 95% CI 1.04, 2.53). For breast cancer, women with a higher 25(OH)D level had lower risk than women in the middle group (HR 0.38, 95% CI 0.16, 0.89) and the lower group (HR 0.37, 95% CI 0.15, 0.89). Serum 25(OH)D was not associated with overall cancer death or event, or with lung or prostate cancer. In this community-based cohort, lower 25(OH)D levels were associated with increased risk of colorectal and breast cancer, but not overall cancer risk., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Low vitamin D status, measured as 25-hydroxyvitamin D (25OHD), has been linked to increased risk of osteoporosis and other disorders. Due to the indoor nature of office work, there may be an increased risk of 25OHD deficiency in this group. The aim of the current study was to evaluate seasonal variations of 25OHD in a population of healthy office workers, and to assess the effect of sun exposure behaviour, skin pigmentation, physical activity (PA) and dietary intake on serum 25OHD concentrations. We assessed the vitamin D status of healthy office workers in Sydney, Australia, at the end of summer (n = 103) and then at the end of winter (n = 71). Data on anthropometry, PA, dietary intake, sun exposure and skin phototype were collected along with blood samples. Serum 25OHD was measured by radioimmunoassay. Mean 25OHD concentration in late summer was 68 ± 27 nmol/L (range: 24-160 nmol/L), and in late winter was 59 ± 32 nmol/L (range: 15-174 nmol/L). 25OHD deficiency (<50 nmol/L) was observed in 29% and 42% of participants at end-summer and end-winter, respectively. Almost 10% of individuals were extremely deficient (<25 nmol/L) at end-winter, particularly those with dark skin (phototypes 5 and 6). Independent predictors of end-summer 25OHD were skin phototype (p < 0.02), summer sun exposure (p < 0.001) and skin area exposed (p = 0.005). The strongest predictor of end-winter 25OHD was end-summer 25OHD concentration (p < 0.001). If this was excluded from the model, the independent predictors of end-winter 25OHD were skin phototype (p < 0.01), sun exposure in winter (p = 0.01) and oily fish consumption (p < 0.05). Sunscreen use was significantly associated with higher vitamin D status (p < 0.05) as those who used sunscreen were also more likely to spend time outdoors. We conclude that sun exposure is beneficial for vitamin D status even with sunscreen use. Vitamin D supplements should be targeted to individuals who are darker skinned or unable to obtain adequate sun exposure, particularly during the winter months., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Vitamin D deficiency is recognised as a public health problem globally, and a high prevalence of deficiency has previously been reported in Australia. This study details the prevalence of vitamin D deficiency in a nationally representative sample of Australian adults aged ≥25 years, using an internationally standardised method to measure serum 25-hydroxyvitamin D (25(OH)D) concentrations and identifies demographic and lifestyle factors associated with vitamin D deficiency. We used data from the 2011-2013 Australian Health Survey (n 5034 with complete information on potential predictors and serum 25(OH)D concentrations). Serum 25(OH)D concentrations were measured by a liquid chromatography-tandem MS that is certified to the reference measurement procedures developed by the National Institute of Standards and Technology, Ghent University and the US Centers for Disease Control and Prevention. Vitamin D deficiency and insufficiency were defined as serum 25(OH)D concentrations &lt;50 nmol/l and 50 to &lt;75 nmol/l, respectively. Overall, 20 % of participants (19 % men; 21 % women) were classified as vitamin D deficient, with a further 43 % classified as insufficient (45 % men; 42 % women). Independent predictors of vitamin D deficiency included being born in a country other than Australia or the main English-speaking countries, residing in southern (higher latitude) states of Australia, being assessed during winter or spring, being obese, smoking (women only), having low physical activity levels and not taking vitamin D or Ca supplements. Given our increasingly indoor lifestyles, there is a need to develop and promote strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches.

Objectives: To assess changes in the frequency of vitamin D testing and detection of moderate/severe vitamin D deficiency (<30 nmol/L) among adults after the introduction of new Medicare Benefits Schedule (MBS) rebate criteria (November 2014), and their relationship to sociodemographic and clinical characteristics., Design: Dynamic (open) cohort study SETTING: Primary care PARTICIPANTS: About 1.5 million 'active' patients aged 18+ years visiting a general practitioner and included in the National Prescribing Service MedicineInsight database., Outcome Measures: The frequency of vitamin D testing (per 1000 consultations) and moderate/severe vitamin D deficiency (%) recorded between October 2013 and March 2016, stratified by the release of the new MBS criteria for rebate., Results: More patients were female (57.7%) and 30.2% were aged 60+ years. Vitamin D testing decreased 47% (from 40.3 to 21.4 tests per 1000 consultations) after the new MBS criteria, while the proportion of tests with no indication for being performed increased from 71.3% to 76.5%. The proportion of patients identified as moderate/severe vitamin D deficient among those tested increased from 5.4% to 6.5%. Practices located in high socioeconomic areas continued to have the highest rates of testing, but moderate/severe vitamin D deficiency detection remained 90% more frequent in practices from low socioeconomic areas after the rebate change. Furthermore, the frequency of individuals being tested was reduced independent of the patients' sociodemographic or clinical condition, and the gap in the prevalence of vitamin D deficiency detection between those meeting or not meeting the criteria for being tested remained the same. Moderate/severe vitamin D deficiency detection decreased slightly among patients with hyperparathyroidism or chronic renal failure., Conclusions: Although the new criteria for rebate almost halved the frequency of vitamin D testing, it also lessened the frequency of testing among those at higher risk of deficiency, with only a small improvement in vitamin D deficiency detection., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Ensuring that the entire Australian population is Vitamin D sufficient is challenging, given the wide range of latitudes spanned by the country, its multicultural population and highly urbanised lifestyle of the majority of its population. Specific issues related to the unique aspects of vitamin D metabolism during pregnancy and infancy further complicate how best to develop a universally safe and effective public health policy to ensure vitamin D adequacy for all. Furthermore, as Australia is considered a "sunny country", it does not yet have a national vitamin D food supplementation policy. Rickets remains very uncommon in Australian infants and children, however it has been recognised for decades that infants of newly arrived immigrants remain particularly at risk. Yet vitamin D deficiency rickets is entirely preventable, with the caveat that when rickets occurs in the absence of preexisting risk factors and/or is poorly responsive to adequate treatment, consideration needs to be given to genetic forms of rickets.

Purpose The purpose of this paper is to investigate if any exposure to segregation minimal association in a single male prison population had any association with an increased risk of vitamin D deficiency. Design/methodology/approach A retrospective case study was undertaken with all inmates who had a 25-hyrdoxy-vitamin D test taken during the study period deemed eligible. Hand searching of the medical records by an independent party identified eligible participants whose data were recorded for analysis. Findings In total, 124 prisoners were deemed eligible for inclusion; 67 were vitamin D sufficient and 57 were vitamin D deficient by Australian standards. Time in segregation minimal association was shown not to be significant, however, smoking (OR 2.93, 95% CI 1.27-6.81, p=0.012) and having Asian ethnicity (OR 4.16, 95% CI 1.56-11.10, p=0.004) independently significantly increased the risk of vitamin D deficiency. Research limitations/implications This research is limited by its study design, small sample size and single location. Originality/value This paper presents the first published research into vitamin D levels in a prison population in Australia, and provides a basis for a larger prospective cohort study.

Australia has reported the highest rates of food allergy, using the gold standard, oral food challenge. This phenomenon, which appears linked to the "modern lifestyle" and has coincided with the explosion of the new diseases of affluence in the 21st century, dubbed "affluenza," has spurred a multitude of theories and academic investigations. This review focuses on potentially modifiable lifestyle factors for the prevention of food allergy and presents the first data to emerge in the Australian context that centers around the dual allergen exposure hypothesis, the vitamin D hypothesis, and the hygiene hypothesis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Hepatic osteodystrophy (HO) is a major complication of cirrhosis. However, the prevalence of HO in a general cirrhotic patient population is not well defined as previous studies were in single aetiology or pre-liver transplant patients., Aims: The aims of this study were to investigate the prevalence of HO and vitamin D deficiency in patients with cirrhosis of mixed aetiology and disease severity and to determine the risk factors for HO., Methods: This is a single-centre cross-sectional study of all patients newly diagnosed with cirrhosis between September 2009 and December 2012. All patients underwent bone mineral density assessment using dual energy X-ray absorptiometry within 3 months of diagnosis. Demographic and biochemical factors, severity of underlying liver disease, previous fragility fractures, smoking status and alcohol use were collected on diagnosis. Logistic regression analysis was used to assess risk factors for HO., Results: Among the 406 patients (67% males), the median (range) age was 56 years (21-85) and most (84%) were Childs-Pugh A or B with a median (range) model for end-stage liver disease score of 11 (5-40). Alcohol (41%) was the most common underlying aetiology. The prevalence of HO and vitamin D deficiency (≤50 nmol/L) was 56% and 54%, respectively, and previous fragility fractures had occurred in 3%. Increasing age (odds ratio (95% confidence interval): 1.49 per 10 years (1.02-2.18), P = 0.04), excessive alcohol intake (2.34 (1.03-5.32), P = 0.04) and lower body mass index (0.92 per kg/m2 (0.87-0.98), P = 0.009) were independent risk factors for HO., Conclusion: There is a high prevalence of HO and vitamin D deficiency in patients with cirrhosis at presentation irrespective of disease severity or underlying aetiology., (© 2015 Royal Australasian College of Physicians.)

Background: Vitamin D deficiency is one of the most common chronic medical conditions in the world and also prevalent in Australia. A growing body of evidence suggests that low vitamin D also has adverse effects on cardiovascular health, including coronary risk factors and adverse cardiovascular outcomes such as myocardial infarction, cardiac failure and stroke. There is some evidence suggesting that a greater proportion of people with cardiovascular disease have low vitamin D compared to the general population. We examined the prevalence of vitamin D deficiency and insufficiency in elective cardiothoracic surgical patients presenting to the Alfred Hospital in Melbourne, Australia and compared this to recent Victorian statistics for people of the same age group., Methods: Consecutive adult elective cardiothoracic surgical patients listed for either coronary artery bypass graft surgery or heart valve repair or replacement surgery attending The Alfred Hospital, Melbourne between July 2011 and October 2012 were invited to participate. This ensured that patients were enrolled over all four seasons. Fasting serum samples were taken on the day of surgery, immediately after admission. Eighty volunteers participated in the study. Of the group, 40% were due to have coronary artery bypass graft surgery, 35% valve surgery and 25% a combination of the two; 74% reported having hypertension, 69% hyperlipidaemia, 26% diabetes and 39% had a BMI >30 kg/m(2)., Results: Test results revealed that 92.5% of patients had Vitamin D levels < 75 nmol/L, 67.5% had levels < 60 nmol/L, 52.5% had levels between 30-59 nmol/L and 15% had levels < 30 nmol/L. Inadequate vitamin D levels were found in 80% of obese patients (BMI > 30 kg/m(2)) compared to 59% of non-obese patients., Conclusions: Based on our small screening study, a substantial proportion of elective cardiothoracic surgical patients have less than optimal serum vitamin D3 levels prior to surgery. We found two-thirds of patients had serum vitamin D levels below 60 nmol/L, placing them at higher risk of falls. This finding is of concern as these patients would have received multiple consultations with various medical practitioners prior to hospital admission and yet their inadequate vitamin D status remained. Failing to identify patients with low vitamin D and correcting it with supplementation places older adults at unnecessary risk, especially of falls, which are associated with a high risk of mortality. In an ageing population with CVD, vitamin D status needs to be assessed and any inadequacy corrected. Whether low vitamin D status prior to cardiac surgery affects post-surgery outcomes, is another issue which deserves future investigation., (Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Pregnancy is a time of vulnerability for vitamin D insufficiency, and there is an emerging literature associating low levels of 25(OH)-vitamin D with depressive symptoms. However, the link between 25(OH)-vitamin D status in pregnancy and altered risk of postnatal depressive symptoms has not been examined. We hypothesise that low levels of 25(OH)-vitamin D in maternal serum during pregnancy will be associated with a higher incidence of postpartum depressive symptoms. We prospectively collected sera at 18 weeks gestation from 796 pregnant women in Perth (1989-1992) who were enrolled in the Western Australian Pregnancy Cohort (Raine) Study and measured levels of 25(OH)-vitamin D. Women reported postnatal depressive symptoms at 3 days post-delivery. Women in the lowest quartile for 25(OH)-vitamin D status were more likely to report a higher level of postnatal depression symptoms than women who were in the highest quartile for vitamin D, even after accounting for a range of confounding variables including season of birth, body mass index and sociodemographic factors. Low vitamin D during pregnancy is a risk factor for the development of postpartum depression symptoms.

Objective: There has been a dramatic increase in vitamin D testing in Australia in recent years, prompting calls for targeted testing. We sought to develop a model to identify people most at risk of vitamin D deficiency., Design and Participants: This is a cross-sectional study of 644 60- to 84-year-old participants, 95% of whom were Caucasian, who took part in a pilot randomized controlled trial of vitamin D supplementation., Measurements: Baseline 25(OH)D was measured using the Diasorin Liaison platform. Vitamin D insufficiency and deficiency were defined using 50 and 25 nmol/l as cut-points, respectively. A questionnaire was used to obtain information on demographic characteristics and lifestyle factors. We used multivariate logistic regression to predict low vitamin D and calculated the net benefit of using the model compared with 'test-all' and 'test-none' strategies., Results: The mean serum 25(OH)D was 42 (SD 14) nmol/1. Seventy-five per cent of participants were vitamin D insufficient and 10% deficient. Serum 25(OH)D was positively correlated with time outdoors, physical activity, vitamin D intake and ambient UVR, and inversely correlated with age, BMI and poor self-reported health status. These predictors explained approximately 21% of the variance in serum 25(OH)D. The area under the ROC curve predicting vitamin D deficiency was 0·82. Net benefit for the prediction model was higher than that for the 'test-all' strategy at all probability thresholds and higher than the 'test-none' strategy for probabilities up to 60%., Conclusion: Our model could predict vitamin D deficiency with reasonable accuracy, but it needs to be validated in other populations before being implemented., (© 2013 John Wiley & Sons Ltd.)

• The recommended level for serum 25-hydroxyvitamin D (25(OH)D) in infants, children, adolescents and during pregnancy and lactation is ≥ 50 nmol/L. This level may need to be 10-20 nmol/L higher at the end of summer to maintain levels ≥ 50 nmol/L over winter and spring. • Sunlight is the most important source of vitamin D. The US recommended dietary allowance for vitamin D is 600 IU daily in children aged over 12 months and during pregnancy and lactation, assuming minimal sun exposure. • Risk factors for low vitamin D are: lack of skin exposure to sunlight, dark skin, southerly latitude, conditions affecting vitamin D metabolism and storage (including obesity) and, for infants, being born to a mother with low vitamin D and exclusive breastfeeding combined with at least one other risk factor. • Targeted measurement of 25(OH)D levels is recommended for infants, children and adolescents with at least one risk factor for low vitamin D and for pregnant women with at least one risk factor for low vitamin D at the first antenatal visit. • Vitamin D deficiency can be treated with daily low-dose vitamin D supplements, although barriers to adherence have been identified. High-dose intermittent vitamin D can be used in children and adolescents. Treatment should be paired with health education and advice about sensible sun exposure. Infants at risk of low vitamin D should be supplemented with 400 IU vitamin D₃ daily for at least the first year of life. • There is increasing evidence of an association between low vitamin D and a range of non-bone health outcomes, however there is a lack of data from robust randomised controlled trials of vitamin D supplementation.

Vitamin D is synthesised in the skin through the action of UVB radiation (sunlight), and 25-hydroxy vitamin D (25OHD) measured in serum as a marker of vitamin D status. Several studies, mostly conducted in high latitudes, have shown an association between type 1 diabetes mellitus (T1DM) and low serum 25OHD. We conducted a case-control study to determine whether, in a sub-tropical environment with abundant sunlight (latitude 27.5°S), children with T1DM have lower serum vitamin D than children without diabetes. Fifty-six children with T1DM (14 newly diagnosed) and 46 unrelated control children participated in the study. Serum 25OHD, 1,25-dihydroxy vitamin D (1,25(OH)(2) D) and selected biochemical indices were measured. Vitamin D receptor (VDR) polymorphisms Taq1, Fok1, and Apa1 were genotyped. Fitzpatrick skin classification, self-reported daily hours of outdoor exposure, and mean UV index over the 35 d prior to blood collection were recorded. Serum 25OHD was lower in children with T1DM (n = 56) than in controls (n = 46) [mean (95%CI) = 78.7 (71.8-85.6) nmol/L vs. 91.4 (83.5-98.7) nmol/L, p = 0.02]. T1DM children had lower self-reported outdoor exposure and mean UV exposure, but no significant difference in distribution of VDR polymorphisms. 25OHD remained lower in children with T1DM after covariate adjustment. Children newly diagnosed with T1DM had lower 1,25(OH)(2) D [median (IQR) = 89 (68-122) pmol/L] than controls [121 (108-159) pmol/L, p = 0.03], or children with established diabetes [137 (113-153) pmol/L, p = 0.01]. Children with T1DM have lower 25OHD than controls, even in an environment of abundant sunlight. Whether low vitamin D is a risk factor or consequence of T1DM is unknown., (© 2012 John Wiley & Sons A/S.)

In this qualitative study, researchers examined cultural and attitudinal factors that might be related to sun-exposure behaviors among East Asian women living in Australia. Researchers asked Chinese (n = 20) and Korean (n = 16) immigrant women who participated in a larger cross-sectional quantitative study of vitamin D blood levels to volunteer to participate in an in-depth interview in 2010. These women reported a number of cultural factors related to their attitudes and behaviors with regard to sun exposure. They expressed preference for fair skin, a tradition of covering skin when outdoors, and no sunbathing culture. They believed that fair skin was more beautiful than tanned skin. They reported that beauty was the reason for active avoidance of sunlight exposure. Although they reported knowledge of the need for sun avoidance due to skin cancer risk, few reported knowledge about the benefits of sun exposure for adequate vitamin D levels. These findings may provide some reasons for vitamin D deficiency previously reported in these populations. Thus, researchers recommend that these attitudes of excessive sun protection and limiting sun exposure be further investigated as they may have implications for planning and delivery of health promotion programs to this growing population of immigrants in Australia.

Purpose: We performed a single-day cross-sectional study to assess the prevalence of vitamin D deficiency as well as folate status in healthy young female volunteers well educated with respect to health information., Methods: We assessed dietary intake of vitamin D and calcium, serum concentrations of 25-OH-vitamin D(3), folate, red blood cell folate and other dietary, laboratory, and lifestyle parameters in 215 young healthy women (age 18-30 years) on a single day at the end of the winter months. Primary aim was to investigate the prevalence of hypovitaminosis D. Folic acid status was a secondary study aim., Results: Mean daily ingestion of vitamin D was 2.25 μg/day with a daily calcium intake of 749 mg/day. 6.9% had hypovitaminosis D (25-OH-vitamin D(3) <30 nmol/L) and 89.3% were vitamin D insufficient (<75 nmol/L). Preplanned subpopulation comparison (lower vs. upper quartile) revealed a significant negative correlation (P = 0.048) between plasma PTH and 25-OH-vitamin D(3) levels. Fifteen individuals (6.9%) were folic acid deficient (<140 ng/mL RBC folate). Only 9.3% reached RBC folate concentrations regarded as optimal for the prevention of fetal neural tube defects (>400 ng/mL)., Conclusions: The prevalence of hypovitaminosis D in healthy young women trained in health care professions is low but 89.3% can be classified as vitamin D insufficient in spring. Folate status can also be considered not sufficient. Considering the emerging role of higher vitamin D plasma levels for many health conditions, a timely correction of vitamin D status in the general Austrian population appears appropriate.

This study aimed to assess the attitudes, practices and knowledge of general practitioners (GPs) with regards to vitamin D. A cross-sectional survey of a random sample of GPs stratified by location of practice (rural/remote or metropolitan) and employment status (full-time or part-time) in New South Wales (NSW), Australia was conducted. Of 500 respondents, 58.1% (95% CI 53.8-62.4) reported that up to 39% of their tested patients showed vitamin D deficiency or insufficiency and a further 37.7% (95% CI 33.5-41.9) of respondents said that over 40% of their patients were vitamin D insufficient. Vitamin D supplementation and advice to receive more natural sunlight were the most common ways vitamin D insufficiency was managed (97.1%; 95% CI 95.6-98.6 and 82%, 95% CI 78.6-85.4, respectively). Some gaps in knowledge were identified. Most respondents (64%; 95% CI 59.8-68.2) believed that a person of average sun sensitivity required 10 min of direct sun exposure during summer in peak UV time and a further 21.6% (95% CI 18.0-25.2) believed that people required 30 min of direct sun. A third of respondents (33.1%; 95% CI 29.0-37.2) advised their patients to use sun protection at all times during winter. In general, the attitude items showed that respondents expressed greater concern about vitamin D deficiency than skin cancer. The results reveal some confusion in general practice regarding vitamin D, sun exposure, sun protection and skin cancer risk. Some of the advice that GPs are offering may needlessly increase their patients' risk for vitamin D insufficiency or skin cancer., (Copyright © 2011 UICC.)

Vitamin D deficiency and tuberculosis (TB) are associated in adults, but data in children are scarce. We screened refugee children routinely for vitamin D status and TB. Vitamin D values were significantly lower in latent TB (n = 81) and TB infection (n = 11) than in children without TB (n = 236). We conclude that refugee children with TB have reduced vitamin D levels.

Background: High prevalence rates of suboptimal vitamin D levels have been observed in women who are not considered 'at risk'. The effect of behavioural factors such as sun exposure, attire, sunscreen use and vitamin D supplementation on vitamin D levels in pregnancy is unknown., Aim: To determine prevalence and predictive factors of suboptimal vitamin D levels in 2 antenatal clinics in Australia--Campbelltown, NSW and Canberra, ACT., Methods: A cross-sectional study of pregnant women was performed with a survey of demographic and behavioural factors and a mid-pregnancy determination of maternal vitamin D levels., Results: The prevalence of vitamin D deficiency (≤25 nmol/L) and insufficiency (26-50 nmol/L) was 35% in Canberra (n=100) and 25.7% in Campbelltown (n=101). The majority of participants with suboptimal D levels had vitamin D insufficiency. Among the vitamin D-deficient women, 38% were Caucasian. Skin exposure was the main behavioural determinant of vitamin D level in pregnancy in univariate analysis. Using pooled data ethnicity, season, BMI and use of vitamin D supplements were the main predictive factors of suboptimal vitamin D. Vitamin D supplementation at 500 IU/day was inadequate to prevent insufficiency., Conclusions: Behavioural factors were not as predictive as ethnicity, season and BMI. As most participants had one of the predictive risk factors for suboptimal vitamin D, a case could be made for universal supplementation with a higher dose of vitamin D in pregnancy and continued targeted screening of the women at highest risk of vitamin D deficiency., (© 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Vitamin D is necessary to maintain healthy bones, and may prevent other chronic diseases. There is limited information regarding the vitamin D status of people living in climates with relatively high ambient ultraviolet radiation. We therefore aimed to determine serum 25(OH)D levels in a group of office-workers in subtropical Australia. We collected blood from 129 office workers in summer (n = 129) and 175 in winter (91 in both seasons). Serum 25(OH)D was estimated using a commercial chemiluminescent immunoassay and we asked participants to complete questionnaires about sun exposure and diet for the month prior to blood collection. Summer and winter mean serum 25(OH)D was 74 (95% CI 70-77) nmol L(-1) and 54 (95% CI 51-57) nmol L(-1), respectively. In summer, 14% of participants were classed as "insufficient," compared with 51% in winter. High 25(OH)D levels in summer were associated with time spent outdoors in nonpeak UV periods, while in winter high levels were associated with intake of vitamin D from food or supplements. The high prevalence of vitamin D insufficiency observed in this population highlights the need for further examination of the relation between sunlight and vitamin D production to enable more accurate sun exposure recommendations., (© 2011 The Authors. Photochemistry and Photobiology © 2011 The American Society of Photobiology.)

Vitamin D deficiency is common in newly resettled refugee children and is associated with significant morbidity including rickets. To determine risk factors and burden of vitamin D deficiency in newly resettled refugee children in Australia. A descriptive epidemiological study and survey on refugee children attending an outpatient general health clinic at the Children's Hospital Westmead, Sydney. 215 patients were examined (age range 0-17 years), (76%) majority were from Africa. Mean serum 25OHD level was 46 nmol/L (SD = 24) (sufficiency range 50-150 nmol/L). 40% had mild deficiency (26-50 nmol/L), 19% moderate deficiency (13-25 nmol/L) and 2% were severely deficient (<13 nmol/L). Deficiency was most common in East African (72%) and Middle Eastern (66%) refugees, children in early puberty (89%) and those living in Australia >6 months (71%). Deficient children were more likely to have had movement restrictions and longer time in hiding in their country of refuge (OR 3:1[CI 0.9-9.7], P = .062).

Migration to industrialised countries poses a "double whammy" for type 2 diabetes among sub-Saharan African migrant and refugee adults. This population group has been found to be at an increased risk of obesity and type 2 diabetes, which may be further aggravated by inadequate vitamin D status. Thus, this study aimed to describe the demographics of vitamin D insufficiency, obesity, and risk factors for type 2 diabetes among sub-Saharan African migrants and refugees aged 20 years or older living in Melbourne, Australia (n=49). Data were obtained by a questionnaire, medical assessment, and fasting blood samples. The mean serum 25-hydroxyvitamin D level was 27.3 nmol/L (95% CI: 22.2, 32.4 nmol/L); with 25-hydroxyvitamin D levels <50 nmol/L occurring in 88% of participants. Participants displayed a cluster of risk factors for type 2 diabetes and cardiovascular disease: 62% were overweight or obese, 47% had insulin resistance (HOMA-IR >=2), 25% had low density lipoprotein cholesterol levels >=3.5 mmol/L, 24.5% had high density lipoprotein cholesterol levels <=1.03 mmol/L, 34.6% had borderline or high levels of total cholesterol (>=5.2 mmol/L), 18.2% had borderline or high levels of triglyceride (>=1.7 mmol/L), and 16% had hypertension (systolic blood pressure >=140 mmHg or diastolic blood pressure >=90 mmHg). These findings suggest that sub-Saharan African migrants and refugees may be at risk of type 2 diabetes and atherosclerosis-related diseases such as ischemic heart disease, stroke, and peripheral vascular disease. Well-designed vitamin D interventions that incorporate lifestyle changes are urgently needed in this sub-population.

There is an urgent need to generate and test candidate risk factors that may explain gradients in the incidence of schizophrenia. Based on clues from epidemiology, we proposed that developmental vitamin D deficiency may contribute to the risk of developing schizophrenia. This hypothesis may explain diverse epidemiological findings including season of birth, the latitude gradients in incidence and prevalence, the increased risk in dark-skinned migrants to certain countries, and the urban-rural gradient. Animal experiments demonstrate that transient prenatal hypovitaminosis D is associated with persisting changes in brain structure and function, including convergent evidence of altered dopaminergic function. A recent case-control study based on neonatal blood samples identified a significant association between neonatal vitamin D status and risk of schizophrenia. This article provides a concise summary of the epidemiological and animal experimental research that has explored this hypothesis.

Background: Most studies reporting malnutrition in the elderly relate to high-level care. However, one third of Australians in aged care reside in low-level care facilities. Data is limited on their nutritional status., Objective: To investigate the nutritional status of elderly in low-level care facilities., Design: A cross sectional study design., Setting: 14 low-level aged care facilities in metropolitan Melbourne., Participants: Convenience sample of 103 ambulatory elderly (86 +/- 6.6 years (mean +/- SD), 76% female, comprising 15% of the hostel population) able to perform daily functions of living., Measurements: Nutritional intake assessed by three-day weighed food records, and nutritional status by haematological and biochemical markers and body composition (dual energy X-ray absorptiometry)., Results: FOOD served did not supply the estimated average requirements (EAR) for 5 of the 14 nutrients analysed. Compared with EAR, 34% of participants were protein malnourished and 62% had energy intake deficits. Micronutrient intake was low for calcium, magnesium, folate, zinc (for men) and dietary fibre. Vitamin D deficiency (serum 25OH Vitamin D < 50 nmol/L) was present in 58% of residents. More men than women had low haemoglobin (P < 0.000), low red blood cells (P < 0.000), and a raised white blood cell count (P = 0.004). Forty three percent of men and 21% women had sarcopenia, 28% of men and 44% women had excess body fat (> 28% and >40%, respectively) and 14% of men and 12 % of women were sarcopenic-obese. Only 12% showed no sign of undernutrition using seven different nutritional indicators. Around 65% had two or more indicators of undernutrition., Conclusion: These findings highlight the need for the supply of more, better quality, nutrient dense food to residents and better detection of undernutrition in aged care facilities. Maintenance of nutritional status has the potential to reduce morbidity and delay the transition to high-level care.

Among African immigrants in Melbourne, Victoria, Australia, we demonstrated lower geometric mean vitamin D levels in immigrants with latent tuberculosis infection than in those with no Mycobacterium tuberculosis infection (P=.007); such levels were also lower in immigrants with tuberculosis or past tuberculosis than in those with latent tuberculosis infection (P=.001). Higher vitamin D levels were associated with lower probability of any M. tuberculosis infection (P=.001) and lower probability of tuberculosis or past tuberculosis (compared with latent tuberculosis infection; P=.001).

Background: It has been well established that women who wear a veil for cultural reasons and dark skinned migrants from Africa have an increased prevalence of vitamin D deficiency. Many refugee patients also come from countries where their skin is covered or they are indoors for most of the day., Objective: This article explores the risk, diagnosis and management of vitamin D deficiency in the Australian refugee population., Discussion: In 2004-2005, 75% of the 7000 refugees settling in Australia were from African countries and 20% were from the Middle East. Refugees may be exposed to less sunlight in Australia than in their country of origin because of an indoor lifestyle or an increased latitude. Refugee health centres confirm that vitamin D deficiency is present in 40-80% of refugee patients. Importantly, this is often asymptomatic. General practitioners are encouraged to test for vitamin D deficiency in refugees, especially as part of the initial health assessment.

Over recent years, evidence has been accumulating that vitamin D has a positive impact on our overall health. This may have an impact on the future of our public health advice related to skin cancer prevention. This paper explores, from a public health perspective based on Australian experience, how skin cancer prevention messages should be managed in light of new information about vitamin D and, in particular, the times when sun protection advice should be provided and how the vitamin D message can be complementary to the sun protection message.

In a study of 185 elderly living in assisted care and 192 frail aged living in the community in the Sydney metropolitan area, nursing home residents were found to be at a 3-fold and hostel dwellers at a 2-fold risk of Vitamin D [25(OH)D] deficiency (<25 nmol/L) compared to self care residents. Middle Eastern people were found to be at 4-fold risk and Vietnamese a 3-fold risk of deficiency compared to their Australian counterparts. In recently arrived Chinese immigrants, Vitamin D deficiency, was found in 28%, and marginal levels (<37 nmol/L) in 60%, compared to the 34 and 76% found in our nursing home population, and 25 and 57% in hostel care residents. Of the Middle Eastern elderly, 58% were deficient and 83% marginal; although only 18% of Vietnamese were deficient, 68% had marginal Vitamin D status. Other factors associated with Vitamin D deficiency were mobility and sun exposure in assisted care, and low dietary Vitamin D and calcium intake, reduced exercise levels and high % body fat levels in the immigrant groups.

Objectives: To determine the prevalence of vitamin D deficiency in older people in residential care and the influence that the level of vitamin D may have on their incidence of falls., Design: Prospective cohort., Setting: Residential care facilities for older people in several states of Australia., Participants: Six hundred sixty-seven women in low-level care and 952 women in high-level care, mean age 83.7 years., Measurements: Serum 25-hydroxyvitamin D (25D) levels and recognized risk factors for falls including current medication use, a history of previous fractures, weight, tibial length (as a surrogate for height), cognitive function, walking ability, and frequency of going outdoors were determined. The women in low-level care and high-level care were followed for an average of 145 and 168 days, respectively. Falls were recorded prospectively in diaries completed monthly by residential care staff., Results: Vitamin D deficiency (defined as a serum 25D level below 25 nmol/L) was present in 144 (22%) women in low-level care and 428 (45%) in high-level care. After excluding 358 bed-bound residents and adjusting for weight, cognitive status, psychotropic drug use, previous Colles fracture, and the presence of wandering behavior, log serum 25D level remained independently associated with time to first fall. The adjusted hazards ratio was 0.74 (95% confidence interval=0.59-0.94; P=.01), implying a 20% reduction in the risk of falling with a doubling of the vitamin D level., Conclusion: Vitamin D deficiency is common in residential care in Australia. A low level of serum vitamin D is an independent predictor of incident falls.

The main source of vitamin D for Australians is exposure to sunlight. Thus, levels of serum 25-hydroxyvitamin D(3), the indicator of vitamin D status, vary according to the season and are lower at the end of winter. In Australia and New Zealand, the prevalence of vitamin D deficiency varies, but is acknowledged to be much higher than previously thought. One study found marginal deficiency in 23% of women, and another frank deficiency in 80% of dark-skinned and veiled women. The groups at greatest risk of vitamin D deficiency in Australia are dark-skinned and veiled women (particularly in pregnancy), their infants, and older persons living in residential care. Only a few foods (eg, fish with a high fat content) contain significant amounts of vitamin D. In Australia, margarine and some milk and milk products are currently fortified with vitamin D. The average estimated dietary intake of vitamin D for men is 2.6-3.0 g/day and for women is 2.0-2.2 g/day. The estimated dietary requirement of vitamin D is at least 5.0 g/day and may be higher for older people. Adequate intake of vitamin D is unlikely to be achieved through dietary means, particularly in the groups at greatest risk, although vitamin D-fortified foods may assist in maintaining vitamin D status in the general population. An appropriate health message for vitamin D needs to balance the need for sunshine against the risk of skin cancer.

Objectives: To determine whether falling relates to serum levels of vitamin D and parathyroid hormone., Design: A cross-sectional study with retrospective analysis., Setting: An aged-care institution in Melbourne Australia., Participants: Ambulant nursing home and hostel residents (n = 83)., Measurements: Frequency of falling, frequency of going outdoors, use of cane or walker, age, sex, weight, type of accommodation, and duration of residence. Serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone (PTH). Plasma concentrations of albumin, calcium, phosphate, and creatinine. Use of furosemide or non-benzodiazepine anticonvulsants., Results: Median age of residents was 84 years. The cohort was vitamin D deficient with a median (interquartile range) 25-hydroxyvitamin D level of 27 (18-37) nmol/L (one-third the reference range median), P < .001. The median (interquartile range) PTH of 5.2 (3.8-7.7) pmol/L exceeded the reference range median, P < .001. Residents who fell (n = 33) had lower serum 25-hydroxyvitamin D levels than other residents (medians 22 vs 29 nmol/L, P = .02) and higher serum PTH levels (medians 6.2 vs 4.8 pmol/L, P < .01). Sixty residents lived in the hostel (72%), and 41 (49%) walked without any walking aid. In a multiple logistic regression for falling, higher serum PTH remained independently associated with falling, with an odds ratio (95% confidence interval) for falling of 5.6 (1.7-18.5) per unit of the natural logarithm of serum PTH. Other terms in the regression were hostel accommodation, odds ratio .04 (.01-.25), and ability to walk without aids, odds ratio .07 (.01-.37)., Conclusions: In ambulant nursing home and hostel residents, residents who fall have lower serum 25-hydroxyvitamin D and higher serum parathyroid hormone levels than other residents. The association between falling and serum PTH persists after adjustment for other variables.