Nutritional status and vitamin D among adults

Nutritional status and vitamin D among adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nutritional status and vitamin D among adults Dewan Imtiaz Rahman, Aliva Salmeen, Monira Akhter This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5219346/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Despite having plenty of sunshine all year round, there is an alarming rise in vitamin D deficiency among the Bangladeshi population. This cross-sectional study explored the association between nutritional status and serum vitamin D level among adults. Two hundred and twelve respondents were purposively selected. Pretested semi-structured questionnaire, and checklist were used to collect data. Among all, 74.5% were female, and 66% were urbanites. The mean age of the respondents was 39.54 (± 13.36) years. The respondents' mean serum Vitamin D level was 20.63 (± 10.16) ng/ml. More than half of the respondents (54.7%) had vitamin D deficiency and 32.5% had vitamin D insufficiency. About three fourth (73.6%) of the respondents were obese or overweight. Vitamin D level was significantly less in urbanites. Gender was associated with serum vitamin D levels. The respondents' Vitamin D levels positively correlated with the sun exposure index. We found that vitamin D level was associated with skin color type and large and small fish intake frequency. Serum level of vitamin D gradually decreased among the overweight and obese. But this difference was not statistically significant. In multiple regression, after controlling the effect of sex, residence, large and small fish consumption, obese had significantly lower (6.82%) mean level of vitamin D than those who belonged to normal Body Mass Index (BMI) category. This study suggests the inclusion of fish in diet, more sun exposure, and maintaining a healthy body weight may assist in improving vitamin D levels of individuals. Vitamin D Nutritional Status Bangladesh Figures Figure 1 Introduction Vitamin D deficiency has been a global problem for two decades. One-fourth of the population in Canada and Australia is vitamin D deficient, compared to 40% of Europeans and Americans[ 1 – 5 ]. Vitamin D deficiency has been prevalent in Middle Eastern countries as well. A study of over half of Israelis indicated that 49.9% had vitamin D deficiency[ 6 ]. In India, 70% of the population was vitamin D deficient, while almost 60% of the population in Pakistan was deficient[ 7 , 8 ]. Despite year-round sunshine, vitamin D deficiency has recently become a severe problem in Bangladesh. Recent studies in Dhaka and Jessore revealed that more than 60% of respondents were deficient in vitamin D[ 9 , 10 ]. Vitamin D insufficiency has been associated with bone diseases such as rickets and osteomalacia for decades. It has been reported in patients with various musculoskeletal (MSK) conditions, including low back and neck pain, fibromyalgia-like pain, arthralgia, and osteoarthritis[ 11 ]. Vitamin D deficiency has recently been linked to diabetes, autoimmune diseases, psychological disorders such as depression, cardiovascular diseases, hypertension, and chronic pulmonary disease, owing to the presence of vitamin D receptors in the heart, brain, lung, and immune cells[ 12 – 14 ]. Vitamin D deficiency is associated with increased incidence and mortality of colon, prostate, and breast cancer[ 15 – 18 ]. Many conditions may influence vitamin D status, like premature and dysmature birth, pigmented skin, low sunshine exposure, excess body weight, malabsorption, and advanced age[ 19 , 20 ]. An association between obesity, low blood vitamin D levels and increased parathyroid hormone (PTH) levels has been shown in observational studies[ 21 , 22 ]. Using national data from the United States, Forrest et al. reported that obese individuals had a nearly twofold increased risk of vitamin D deficiency compared to non-obese individuals[ 1 ]. In addition, sedentism is increasing the burden of obesity and other non-communicable diseases in Bangladesh. A study of a nationally representative sample of Bangladesh revealed that one in four (25%) had a BMI of over 23 kg/m2. Females. Another study in rural Bangladesh found that over 33% of people had a BMI over 23 kg/m2, showing a shift in lifestyle even among the rural population[ 23 ]. To our knowledge, few studies have attempted to investigate the complex relationship between vitamin D and risk factors for non-communicable diseases in Bangladesh. The objective of the study was to determine the association between nutritional status and serum vitamin D level in adults. Materials and methods Study design, setting, and period A cross-sectional study design was used to conduct this study from 31 August to 31 December, 2019 at the Laboratory Services Department of Biochemistry and Molecular Biology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Study population This study considered the people aged 18 years and older who attended the Laboratory Services Department of Biochemistry and Molecular Biology to test blood vitamin D levels. However, pregnant or nursing women, individuals with malignant illnesses, chronic renal or hepatic diseases, abnormal PTH and calcium levels, Cushing Syndrome, or very ill were excluded from the study. Estimated sample size According to a true population mean of serum vitamin D level, µ = 18.60 ngm/dl, and a population standard deviation, σ = 6.59 of the vitamin D level response variable[ 10 ], the sample size required to estimate the average serum vitamin D level among all categories of body mass index with 95% confidence and within 5% of the true value is assumed to be 212, considering a 10% non-response rate. Questionnaire and data collection A pretested Bengali-validated semi-structured questionnaire and checklist were used for data collection. The questionnaire had socio-demographic questions, a 14-item food frequency questionnaire, a Bengali-validated General Physical Activity Questionnaire (GPAQ) to measure metabolic equivalent to task (MET) minutes per week[ 24 ], and questions to measure respondents’ sun exposure index based on sun exposure time, typical outdoor clothing, and calculating exposed body surface area using the rule of three[ 25 ]. Data collection techniques included face-to-face interviews, observation of height and weight, and a review of records for a vitamin D biochemical study report. The respondents were approached purposefully, and those who consented to participate were included. The Fitzpatrick classification chart was used to determine the skin phototype[ 26 ]. According to the Endocrine Society Clinical Practice Guideline, respondents’ serum Vitamin D levels were classified as deficient if less than 20 ng/ml (50 nmol/liter), insufficient if 20–29 ng/ml, and sufficient if higher than 29 ng/ml[ 27 ]. The WHO STEPwise approach to non-communicable disease risk factor surveillance guideline was used to measure the respondents' height and weight[ 28 ]. Body mass index was calculated and Asian classification of Body Mass Index (BMI) was used in this study as Underweight: <18 kg/m 2 , Normal: 18-22.99 kg/m 2 , Overweight: 23-27.49 kg/m 2 and Obese: ≥27.5 kg/m 2 [ 29 ]. Ethical approval Ethical approval for the study was taken from the Institutional Review Board of the National Institute of Preventive and Social Medicine (NIPSOM). The approval number was NIPSOM/IRB/2019/111. Before starting the interview, informed written consent in Bengali was used to take consent. Privacy was ensured during the interview and anthropometric measurement. Statistical analyses For descriptive statistics, frequency and percentage were computed for the categorical variables, while mean along with standard deviation were estimated for the continuous variables. Independent t-test and one-way ANOVA were performed in order to check the bivariate association between binary and multi-category independent variables with the continuous dependent variable, respectively. Multiple regression analysis was attempted with the variables which were found significant in independent t-test, one-way ANNOVA. Then backward elimination process was applied to reach the final model. Statistical significance was set at p<0.05. Data were analyzed using SPSS 20.0. Results Among 212 respondents, the majority hailed from urban areas (66%), while the rest were from rural areas. Considering sex of the respondents, 74.5% were female. The mean age of the respondents was 39.54 (± 13.36) years. The majority of individuals (28.8%) had education level of above primary to secondary. Furthermore, only 11.3% reported that they completed graduation and 16.0% holding post-graduate degrees. A notable proportion, 8.5%, is identified as illiterate. In terms of occupation, the male population predominantly consists of service holders (38.9%) and businessmen (20.4%), while females are primarily housewives (72.8%) (Table 1). Table 1. Background characteristics of the respondents Characteristics Frequency (%) Residence Urban 140 (66.0) Rural 72 (34.0) Sex Female 158 (74.5) Male 54 (25.5) Level of education Illiterate 18 (8.5) Primary and below 19 (9.0) Above primary to secondary 61 (28.8) Above secondary to higher secondary 37 (17.5) Under graduation 12 (5.7) Graduation 24 (11.3) Post-graduation 34 (16.0) Informal Education 7 (3.3) Occupation Male Service holder 21 (38.9) Businessman 11 (20.4) Student 4 (7.4) Other 18 (33.3) Female Housewife 115 (72.8) Service holder 17 (10.8) Student 15 (9.5) Businessman 2 (1.3) Other 9 (5.7) The mean serum Vitamin D level was 20.63 (± 10.16) ng/ml; ranging from 7.10 ng/ml to 72.26 ng/ml. Only 12.7% of respondents had sufficient serum vitamin D. Almost seventy-four percent (73.6%) were overweight or obese (Figure 1). Vitamin D level was higher (22.67 ± 11.35 ng/ml) among the rural dwellers than the urbanites (16.95 ± 8.83 ng/ml). The difference was statistically significant (p<0.001). Males had a statistically significant higher mean serum vitamin D level than females. No statistically significant difference in vitamin D levels among different educational and occupational categories was observed (Table 2). Table 2. Socio-demographic characteristics and serum vitamin D level Characteristics Serum vitamin D (ng/ml) (Mean ± SD) P-value Residence Rural 22.67 ± 11.35 ≤0.001 Urban 16.95 ± 8.83 Sex Male 21.78 ± 9.30 0.003 Female 17.76 ± 10.30 Level of education Illiterate 21.36 ± 9.46 0.502 Primary and below 19.05 ± 13.18 Above primary to secondary 18.84 ± 10.06 Above secondary to higher secondary 18.25 ± 9.47 Under graduation 20.03 ± 16.79 Graduation 16.37 ± 9.71 Post-graduation 17.97 ± 7.16 Informal Education 23.16 ± 7.40 Occupation Student 18.92 ± 15.84 0.055 Service holder 16.97 ± 8.76 Businessman 23.93 ± 16.58 Housewife 18.17 ± 8.74 Other 21.38 ± 7.55 Serum vitamin D levels were not affected by the intake of carbohydrates, vegetables, or fruits. There was a slight, non-significant negative connection between serum vitamin D levels and per-person oil use. The frequency of egg and meat eating was not associated with serum vitamin D levels. However, the mean serum vitamin D level gradually decreased as the large fish ingestion frequency reduced. It was higher among the respondents with the intake of four to five times per week (20.16 ± 11.14 ng/ml) and lowest among the never intake (13.13 ± 7.45 ng/ml) group. The finding was statistically significant, but in Post Hoc Games-Howell, a significant difference in mean serum vitamin D among the different groups was not found. Serum mean vitamin D concentration significantly differed among higher to the lower frequency of intake of small fish; Post Hoc Hochberg was done, and mean serum vitamin D level varied significantly (p<0.05) among the respondents who took small fish four to five times per week (20.13 ± 9.79 ng/ml), those who took small fish one to three times per week (19.96 ± 12.44 ng/ml) and respondents who never took small fish (13.70 ± 5.82 ng/ml. Serum vitamin D levels were higher among the respondents who consumed milk or milk products four to five times per week. However, no statistically significant difference in serum vitamin D could be established between different frequencies of milk or milk product consumption (Table 3). Table 3. Food habits, lifestyle, and other factors related to serum Vitamin D Food items Serum vitamin D (ng/ml) (Mean ± SD) P-value Egg Never 18.23 ± 9.12 0.314 Less than one time per week 21.29 ± 12.83 One to three times per week 17.92 ± 10.61 Four to Five times per week 17.87 ± 6.49 Six or more times per week 18.77 ± 7.34 Mutton/beef Never 18.23 ± 9.67 0.101 Less than one time per week 19.94 ± 10.70 One to three times per week 16.97 ± 8.91 Four to Five times per week 18.95 ± 11.79 Six or more times per week Poultry Never 18.05 ± 7.74 0.344 Less than one time per week 20.66 ± 13.20 One to three times per week 18.61 ± 9.84 Four to Five times per week 17.99 ± 7.62 Six or more times per week 12.90 ± 1.88 Large fish Never 13.13 ± 7.45 0.041 Less than one time per week 17.69 ± 12.50 One to three times per week 18.42 ± 10.24 Four to Five times per week 20.16 ± 11.14 Six or more times per week 19.13 ± 7.26 Small fish Never 13.70 ± 5.82 0.011 Less than one time per week 17.10 ± 7.48 One to three times per week 19.96 ± 12.44 Four to Five times per week 20.13 ± 9.79 Six or more times per week 20.35 ± 6.68 Milk Never 17.71 ± 8.53 0.742 Less than one time per week 18.35 ± 11.15 One to three times per week 19.24 ± 8.88 Four to Five times per week 22.13 ± 7.51 Six or more times per week 19.22 ± 10.63 Milk product Never 18.21 ± 8.98 0.249 Less than one time per week 18.99 ± 10.81 One to three times per week 17.75 ± 5.16 Four to Five times per week 27.53 ± 17.91 Six or more times per week 12.68 ± 4.26 Skin color type Type III 17.16 ± 9.83 0.021 Type IV 19.43 ± 9.10 Type V 22.12 ± 14.04 Category according to MET minute Not satisfactory 18.14 ± 9.77 0.441 Satisfactory 19.03 ± 10.40 Nutritional status Underweight 19.58 ± 18.98 0.120 Normal 20.21 ± 12.48 Overweight 19.35 ± 8.98 Obese 16.92 ± 7.83 All the respondents belonged to three categories of skin color, according to Fitzpatrick Skin Type Chart Measurement (FSTCM); type III, IV, and V. The serum vitamin D level of respondents with type V skin type was higher (22.12 ± 14.04 ng/ml) than that of respondents with skin type III (17.16 ± 9.83 ng/ml) ng/ml) and skin type IV (19.43 ± 9.10 ng/ml), and the difference was statistically significant (p<0.05). A post hoc Hochberg analysis revealed a significant difference in serum vitamin D levels between respondents with skin types V and III (p<0.05). The respondent's mean sun exposure index was 0.40, ranging from 0 to 3.08. Sun exposure index and serum vitamin D level had a weak positive correlation (p<0.05). Most respondents (63.2%) belonged to the satisfactory category of MET minutes per week. The serum vitamin D level of the respondents with a satisfactory level of MET minutes per week (19.03 ± 10.40 ng/ml) was higher than that of respondents with not a satisfactory level of MET minutes per week (18.14 ± 9.77 ng/ml). Nevertheless, this difference was not statistically significant (p>0.05). The underweight respondents' serum vitamin D level was 19.58 (± 18.98) ng/ml. Vitamin D of the respondents with normal BMI was 20.21 (± 12.48) ng/ml, and serum concentration of vitamin D gradually decreased among the overweight (19.35 ± 8.98 ng/ml) and obese (16.92 ± 7.83 ng/ml). But this difference was not found to be significant (p>0.05) (Table 3). In multiple regression serum, vitamin D level was significantly associated with place of residence (p<0.001). Urban respondents had 12% less serum vitamin D levels than that rural respondents. The sex of the respondents was also significantly associated with the serum vitamin D level of the respondents (p= 0.009). It was found that females had 7.57% less vitamin D levels than male respondents. Respondents who consumed large fish four to five times per week had 14.56% higher vitamin D levels than respondents who never consumed large fish. Moreover, this difference was statistically significant (p<0.05). It also revealed that those who consumed small fish more than once a week had a statistically higher concentration of serum vitamin D than respondents who never consumed small fish (Table 4). Table 4. Multiple regression showing association between residence, sex, small fish consumption, nutritional status, and serum vitamin D level Variables Unstandardized coefficient P-value Model summary Residence p< 0.001 Adjusted R 2 = 0.1894 Urban -.1149931 < 0.001 Sex Female -.0734296 0.009 Large fish consumption Less than one time per week .0778566 0.272 One to three times per week .0759004 0.232 Four to five times per week .1361291 0.029 Six or more times per week .1139473 0.080 Small fish consumption Less than one time per week .0806868 0.177 One to three times per week .1342352 0.024 Four to five times per week .1472311 0.019 Six or more times per week .1568196 0.029 Nutritional status Underweight .0266128 0.679 Overweight -.0223121 0.482 Obese -.0668846 0.045 And after controlling the effect of residence, sex, large fish, and small fish consumption, respondents who were overweight had 2.22% less serum vitamin D level than those who belonged to the normal nutritional category. However, this difference was not statistically significant (p>0.05). Nevertheless, respondents who were obese had 6.82% less mean vitamin D levels than those with normal BMI. Moreover, it was statistically significant (p<0.05). This model could explain only 18.94% variability of serum vitamin D level among the respondents, and the model was highly significant (p<0.001) (Table 4). Discussion Most studies aiming to explore the relationship between nutritional status and vitamin D level were conducted in other parts of the world [30-33]. Though there is no consensus about the cut-off level of vitamin D for deficiency, most of the studies used the Endocrine Society Clinical Practice Guideline [27]. In this study, respondents had similar socio-demographic characteristics as revealed by Population and Housing Census 2011 of Bangladesh (34) and other studies conducted in similar settings [9]. Vitamin D insufficiency is widespread in the Bangladeshi population, as evidenced by studies conducted among healthy individuals and in hospital settings [9, 10]. This study found 87.2% of the respondents had vitamin D deficiency or insufficiency, which is consistent with the study conducted by Acherjya et al. in Jessore, Bangladesh [10]. About three fourth (73.6%) of the respondents had BMI ≥ 23 kg/m 2 , 40.6% were overweight and 33% were obese. In contrast, a study analyzed data from a nationally representative sample of Bangladeshi people and discovered that around 25% of adults had a BMI of less than 23 kg/m 2 [34]. However, Acherjya et al. showed that 68.80% of respondents were overweight or obese, while Hossain et al. observed that 47.2% of respondents were overweight or obese even when the BMI cut-off point was adjusted to 18.5-25.0 kg/m 2 [9, 10]. Rural residents had a higher mean serum vitamin D level (22.67 ± 11.35 ng/ml) than urban dwellers (16.95 ± 8.83 ng/ml). After adjusting for sex, large and small fish consumption, and nutritional status of the respondent, urban respondents had 12% less serum vitamin D level than rural respondents. Both were statistically highly significant (p<0.001). This finding is consistent with the cross-sectional studies conducted among healthy individuals in India and Bangladesh among apparently healthy individuals and patients attending hospitals for musculoskeletal problems [9, 10, 35, 36]. It could be attributed to air pollution in urban areas as air pollution from industrial and vehicular emissions containing particulate matter absorb and disperse UV radiation, preventing it from reaching the earth's surface. A study conducted among infants and toddlers in Delhi, India, has shown that air pollution affects vitamin D status [37]. Moreover, there is more sunlight exposure in rural areas than in urban areas, which might be another possible explanation. Males had a higher mean serum vitamin D level (21.78 ± 9.30 ng/ml) than females (17.76 ± 10.30 ng/ml). There was a statistically significant difference. Even after controlling for respondents' residence, large and small fish intake, and nutritional status, females had 7.57 percent lower vitamin D levels than males. Other studies conducted in Bangladesh, Australia, the Middle East, and India have shown similar results [3, 6, 9, 10, 35, 36, 38, 39]. In this study, we found that the type and frequency of carbohydrate, vegetables, fruit, meat, poultry, milk or dairy product intake did not influence the respondents' mean serum vitamin D level. However, in this study, the mean serum vitamin D level was higher among the respondents with the intake of large fish four to five times per week (20.16 ± 11.14 ng/ml) than others. Although the finding was statistically significant (p<0.05), in Post Hoc Games-Howell, no significant mean serum vitamin D difference among different groups was found. Serum mean vitamin D concentration significantly differed among higher to lower frequency of intake of small fish. Post Hoc Hochberg analysis revealed a significant difference in mean serum vitamin D concentration between those who ate small fish four to five times per week, those who ate small fish one to three times per week, and those who ate small fish. The finding is consistent with the study conducted among the general population of Denmark aged 30-60 years to determine lifestyle factors associated with vitamin D status [40]. Our study used a food frequency questionnaire to detect consumption frequency but did not qualify for the amount of intake. Moreover, it confirms that food is a poor source of vitamin D, as suggested by other studies [12, 27]. Respondents with type V skin had a higher serum vitamin D level (22.12 ± 14.04 ng/ml) than those with skin type III (17.16 ± 9.83 ng/ml) or skin type IV (19.43 ± 9.10 ng/ml). And there was a significant difference in vitamin D levels between respondents with skin types V and III, according to Hochberg's post hoc analysis. This conclusion contradicts previous studies that shows that increasing skin pigmentation reduces the transmission of UV rays needed to synthesize vitamin D, resulting in a significant risk of vitamin D deficiency [41, 42]. According to skin tone, Acherjya et al. categorized respondents as Black, Brown, or Fair in their study, but found no link between skin color and vitamin D levels [10]. This study adopted FSTCM, which has not been validated in our country's context. Furthermore, 189 of the 212 respondents had skin types III or IV, with women accounting for 76.19 % and women's serum vitamin D levels were 7.57 percent lower than men. So maybe inadequate observations in other strata is the reason for this inconstancy. The respondents' serum vitamin D level and sun exposure index had a weak positive correlation (p<0.05), the curve estimate found a cubic relationship. This conclusion matched findings from studies in India and Malaysia. [42-44]. Outdoor and indoor physical activity have been found to be correlates or predictors of vitamin D levels [45, 46]. The majority of respondents (63.2%) fell into the satisfactory physical activity category, and their serum vitamin D levels were greater than those of respondents who did not meet the criteria. However, this difference was not statistically significant (p>0.05). Study with more statistical power may be able to prove the link. After controlling for confounders, a bi-directional genetic analysis indicated that a higher BMI is associated with decreased vitamin D levels [21, 22] [47, 48]. Existing literature shows a consistent relationship between increased BMI and reduced serum vitamin D [31]. A study of hospital patients with musculoskeletal symptoms in Bangladesh, showed an association between obesity and vitamin D deficiency [9]. Acherjya et al. conducted a population-based study in Bangladesh and found that overweight and obese had lower serum vitamin D levels than those with normal body mass index, but these differences were not statistically significant [10]. But in this study, mean serum vitamin D levels gradually decreased among the overweight and obese. However, this difference was not found significant in one-way ANOVA (p>0.05). In the multiple regression, after controlling the effect of residence of the respondents, sex, large and small fish consumption frequency, it was found that respondents who were overweight had 2.22% and who were obese had 6.82% less serum vitamin D level than the respondents who belonged to the normal nutritional category. Moreover, the difference of mean serum vitamin D levels between obese and normal body mass index group was statistically significant (p<0.05). This is the first epidemiological study among Bangladeshi adults to investigate the association between nutritional status and vitamin D. This study has several significant strengths and limitations. Validated devices for measuring anthropometric data and validated techniques for data collecting were utilized in this investigation, reducing the risk of measurement error. The assumption of causative characteristics between explanatory factors and outcomes is of limited relevance due to the cross-sectional nature of the investigation. Compared to WHO-recommended cut-offs, Asian body mass index cut-offs were utilized to categorize the nutritional status of the respondents, which may exaggerate the overweight/obesity category. Furthermore, there are possible disadvantages to using BMI as a nutritional status measure. Gender, age, and ethnic variations in body fat composition and distribution contribute to a person's nutritional status. The BMI does not accurately represent a person's lean muscle mass and visceral fat. Other anthropometric measurements, such as waist circumference and waist-hip ratio, should be used in conjunction with BMI to assess abdominal obesity or other body-specific regions. The respondents' self-reported data on known risk factors of undernutrition, overnutrition, and vitamin D deficiency, including dietary intake, physical activity, sedentary behaviour, and sun exposure might have caused recall bias. Every respondent's vitamin D status and body weight could not be determined on an empty stomach. Even though data on food intake frequency was obtained, the amount consumed was not calculated. FSTCM was utilized to assess the skin type of the participants in this study. It is a tried-and-true method for determining skin type that's commonly used in dermatology for clinical and research purposes. However, in our country's context, FSTCM has not been validated. Although the study has a large sample size, these limitations may limit the generalizability of the study's findings. However, thus more population-based studies with analytical design are necessary to understand the association between nutritional status and vitamin D among adults. Declarations Ethics approval and consent to participate Ethical approval for the study was taken from the Institutional Review Board of the National Institute of Preventive and Social Medicine (NIPSOM). The approval number was NIPSOM/IRB/2019/111. Before starting the interview, informed written consent in Bengali was used to take consent. Privacy was ensured during the interview and anthropometric measurement. Availability of Data and Materials Data used in this study is accessible upon reasonable request to the corresponding author. Consent for Publication Not applicable. Competing Interests The authors declare that there are no conflicts of interest. Funding This study did not receive funding from any source. Author’s contribution Study conception and design: Dewan Imtiaz Rahman, Monira Akhter; Methodology: Dewan Imtiaz Rahman; Data collection: Dewan Imtiaz Rahman; Analysis and interpretation of results: Dewan Imtiaz Rahman, Monira Akhter; Draft manuscript preparation: Aliva Salmeen, Dewan Imtiaz Rahman. All authors reviewed the results and approved the final version of the manuscript References Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutrition research. 2011;31(1):48–54. Whiting SJ, Langlois KA, Vatanparast H, Greene-Finestone LS. 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Calcified tissue international. 1988;43(4):199–201. Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S. Evidence for alteration of the vitamin D-endocrine system in obese subjects. The Journal of clinical investigation. 1985;76(1):370–3. Fatema K, Zwar NA, Zeba Z, Milton AH, Rahman B, Ali L. Clinical and biochemical characterization of high risk and not high risk for cardiovascular disease adults in a population from peripheral region of Bangladesh. BMC public health. 2015;15(1):559. National Institute of Preventive and Social Medicine MoHafWB, World Health Organization,. Bangladesh NCD Risk Factor Survey 2018 Dhaka, Bangladesh2018 [cited 2019 14 Dec]. Available from: http://nipsom.gov.bd/pdf/Bangladesh_NCD_Risk_Factor_Survey_2018_STEPS_Result_Factsheet.pdf . Minimas D. A critical evaluation of the Lund and Browder chart. WOUNDS UK. 2007;3(3):58. Fitzpatrick TB. The Validity and Practicality of Sun-Reactive Skin Types I Through VI. Archives of Dermatology. 1988;124(6):869–71. doi: 10.1001/archderm.1988.01670060015008 . Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(7):1911–30. doi: 10.1210/jc.2011-0385 . World Health Organization. WHO STEPS surveillance manual: the WHO STEPwise approach to chronic disease risk factor surveillance: Geneva: World Health Organization; 2017 [cited 2019 14 Dec]. Available from: https://www.who.int/ncds/surveillance/steps/STEPS_Manual.pdf . Stegenga H, Haines A, Jones K, Wilding J. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. BMJ: British Medical Journal. 2014;349:g6608. doi: 10.1136/bmj.g6608 . Vanlint S. Vitamin D and obesity. Nutrients. 2013;5(3):949–56. Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT, et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS medicine. 2013;10(2):e1001383. Lamendola CA, Ariel D, Feldman D, Reaven GM. Relations between obesity, insulin resistance, and 25-hydroxyvitamin D. The American Journal of Clinical Nutrition. 2012;95(5):1055–9. doi: 10.3945/ajcn.111.032060 . Drincic AT, Armas LAG, van Diest EE, Heaney RP. Volumetric Dilution, Rather Than Sequestration Best Explains the Low Vitamin D Status of Obesity. Obesity. 2012;20(7):1444–8. doi: 10.1038/oby.2011.404 . Rahman M, Williams G, Mamun AA. Hypertension and diabetes prevalence among adults with moderately increased BMI (23·0–24·9 kg/m2): findings from a nationwide survey in Bangladesh. Public Health Nutrition. 2017;20(8):1343–50. Epub 01/23. doi: 10.1017/S1368980016003566 . Bachhel R, Singh NR, Sidhu JS. Prevalence of vitamin D deficiency in north-west Punjab population: A cross-sectional study. Int J Appl Basic Med Res. 2015;5(1):7–11. doi: 10.4103/2229-516X.149220. PubMed PMID: 25664260. Kumar GT, Chugh R, Eggersdorfer M. Poor vitamin D status in healthy populations in India: a review of current evidence. Int J Vitam Nutr Res. 2015;85(3–4):185–201. Agarwal K, Mughal M, Upadhyay P, Berry J, Mawer E, Puliyel J. The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Archives of disease in childhood. 2002;87(2):111–3. Islam MZ, Akhtaruzzaman M, Lamberg-Allardt C. Hypovitaminosis D is common in both veiled and nonveiled Bangladeshi women. Asia Pacific journal of clinical nutrition. 2006;15(1):81. Hussain AN, Alkhenizan AH, El Shaker M, Raef H, Gabr A. Increasing trends and significance of hypovitaminosis D: a population-based study in the Kingdom of Saudi Arabia. Archives of osteoporosis. 2014;9(1):190. Thuesen B, Husemoen L, Fenger M, Jakobsen J, Schwarz P, Toft U, et al. Determinants of vitamin D status in a general population of Danish adults. Bone. 2012;50(3):605–10. Clemens T, Henderson S, Adams J, Holick M. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. The Lancet. 1982;319(8263):74–6. Bukhary NBI, Isa ZM, Shamsuddin K, Lin KG, Mahdy ZA, Hassan H, et al. Risk factors for antenatal hypovitaminosis D in an urban district in Malaysia. BMC Pregnancy Childbirth. 2016;16(1):156-. doi: 10.1186/s12884-016-0939-3 . PubMed PMID: 27411716. Jani R, Palekar S, Munipally T, Ghugre P, Udipi S. Widespread 25-Hydroxyvitamin D Deficiency in Affluent and Nonaffluent Pregnant Indian Women. BioMed research international. 2014;2014:892162. doi: 10.1155/2014/892162 . Azevedo M, Bandeira L, Luza C, Lemos A, Bandeira F. Vitamin D Deficiency, Skin Phototype, Sun Index, and Metabolic Risk Among Patients with High Rates of Sun Exposure Living in the Tropics. The Journal of clinical and aesthetic dermatology. 2018;11(8):15. Scragg R, Camargo Jr CA. Frequency of leisure-time physical activity and serum 25-hydroxyvitamin D levels in the US population: results from the Third National Health and Nutrition Examination Survey. American journal of epidemiology. 2008;168(6):577–86. Millen AE, Wactawski-Wende J, Pettinger M, Melamed ML, Tylavsky FA, Liu S, et al. Predictors of serum 25-hydroxyvitamin D concentrations among postmenopausal women: the Women’s Health Initiative Calcium plus Vitamin D clinical trial. The American journal of clinical nutrition. 2010;91(5):1324–35. Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, et al. The relationship between obesity and serum 1, 25-dihydroxy vitamin D concentrations in healthy adults. The Journal of Clinical Endocrinology & Metabolism. 2004;89(3):1196–9. Lagunova Z, Porojnicu AC, Lindberg F, Hexeberg S, Moan J. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer research. 2009;29(9):3713–20. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5219346","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371558894,"identity":"067129ee-fb00-446f-8d79-43526e12d11c","order_by":0,"name":"Dewan Imtiaz Rahman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYDCCwwwMzGAGMwPzgw8VIAZzA9Fa2AxnnAExGAloOQDTAgTSvG0gioAWvuO8Dz8X5tjlmbPzHjCcOa82mr8dqOVHxTacWiQPsxtLz9yWXGzZzJfw4OO247kzDjM2MPacuY1Ti8FhNqB7tjEnbjjMY2A4c9ux3AagFmbGNrxamH/zbqsHa5HmnXMsdz4RWtiAthyGammoyd1ASIskUIs177bjQC18aYYzjh3I3QjUchCfX/jOH2O+zbutOnHD+bOHH3yoqcudd/7wwQc/KnBrQQI8IOIwmHmAGPUwLXVEKh4Fo2AUjIKRBAAfV1ykFpTQ/wAAAABJRU5ErkJggg==","orcid":"","institution":"National Institute of Preventive and Social Medicine (NIPSOM)","correspondingAuthor":true,"prefix":"","firstName":"Dewan","middleName":"Imtiaz","lastName":"Rahman","suffix":""},{"id":371558895,"identity":"226b72e7-a79b-4442-aeab-883bafc98f21","order_by":1,"name":"Aliva Salmeen","email":"","orcid":"","institution":"University of Cambridge","correspondingAuthor":false,"prefix":"","firstName":"Aliva","middleName":"","lastName":"Salmeen","suffix":""},{"id":371558896,"identity":"54b89ee2-6e3a-47c9-a301-c90c2e074ef4","order_by":2,"name":"Monira Akhter","email":"","orcid":"","institution":"Colonel Malek Medical College","correspondingAuthor":false,"prefix":"","firstName":"Monira","middleName":"","lastName":"Akhter","suffix":""}],"badges":[],"createdAt":"2024-10-07 15:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5219346/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5219346/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67818017,"identity":"6df7c926-e860-4c33-bd61-6babb3aa39ce","added_by":"auto","created_at":"2024-10-30 04:49:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":112660,"visible":true,"origin":"","legend":"\u003cp\u003eSerum vitamin D level and nutritional status of the respondents\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5219346/v1/425a28b98e3e6698826755b9.png"},{"id":67818019,"identity":"7e3fd44a-7d52-4c57-9ad8-23e2ae5978dd","added_by":"auto","created_at":"2024-10-30 04:49:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":751453,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5219346/v1/29305b39-7fd9-4ace-8f62-0f96e13af4aa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nutritional status and vitamin D among adults","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVitamin D deficiency has been a global problem for two decades. One-fourth of the population in Canada and Australia is vitamin D deficient, compared to 40% of Europeans and Americans[\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Vitamin D deficiency has been prevalent in Middle Eastern countries as well. A study of over half of Israelis indicated that 49.9% had vitamin D deficiency[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In India, 70% of the population was vitamin D deficient, while almost 60% of the population in Pakistan was deficient[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite year-round sunshine, vitamin D deficiency has recently become a severe problem in Bangladesh. Recent studies in Dhaka and Jessore revealed that more than 60% of respondents were deficient in vitamin D[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVitamin D insufficiency has been associated with bone diseases such as rickets and osteomalacia for decades. It has been reported in patients with various musculoskeletal (MSK) conditions, including low back and neck pain, fibromyalgia-like pain, arthralgia, and osteoarthritis[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Vitamin D deficiency has recently been linked to diabetes, autoimmune diseases, psychological disorders such as depression, cardiovascular diseases, hypertension, and chronic pulmonary disease, owing to the presence of vitamin D receptors in the heart, brain, lung, and immune cells[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Vitamin D deficiency is associated with increased incidence and mortality of colon, prostate, and breast cancer[\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany conditions may influence vitamin D status, like premature and dysmature birth, pigmented skin, low sunshine exposure, excess body weight, malabsorption, and advanced age[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. An association between obesity, low blood vitamin D levels and increased parathyroid hormone (PTH) levels has been shown in observational studies[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Using national data from the United States, Forrest et al. reported that obese individuals had a nearly twofold increased risk of vitamin D deficiency compared to non-obese individuals[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, sedentism is increasing the burden of obesity and other non-communicable diseases in Bangladesh. A study of a nationally representative sample of Bangladesh revealed that one in four (25%) had a BMI of over 23 kg/m2. Females. Another study in rural Bangladesh found that over 33% of people had a BMI over 23 kg/m2, showing a shift in lifestyle even among the rural population[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo our knowledge, few studies have attempted to investigate the complex relationship between vitamin D and risk factors for non-communicable diseases in Bangladesh. The objective of the study was to determine the association between nutritional status and serum vitamin D level in adults.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, setting, and period\u003c/h2\u003e \u003cp\u003eA cross-sectional study design was used to conduct this study from 31 August to 31 December, 2019 at the Laboratory Services Department of Biochemistry and Molecular Biology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThis study considered the people aged 18 years and older who attended the Laboratory Services Department of Biochemistry and Molecular Biology to test blood vitamin D levels. However, pregnant or nursing women, individuals with malignant illnesses, chronic renal or hepatic diseases, abnormal PTH and calcium levels, Cushing Syndrome, or very ill were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eEstimated sample size\u003c/h3\u003e\n\u003cp\u003eAccording to a true population mean of serum vitamin D level, \u0026micro;\u0026thinsp;=\u0026thinsp;18.60 ngm/dl, and a population standard deviation, σ\u0026thinsp;=\u0026thinsp;6.59 of the vitamin D level response variable[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the sample size required to estimate the average serum vitamin D level among all categories of body mass index with 95% confidence and within 5% of the true value is assumed to be 212, considering a 10% non-response rate.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire and data collection\u003c/h3\u003e\n\u003cp\u003eA pretested Bengali-validated semi-structured questionnaire and checklist were used for data collection. The questionnaire had socio-demographic questions, a 14-item food frequency questionnaire, a Bengali-validated General Physical Activity Questionnaire (GPAQ) to measure metabolic equivalent to task (MET) minutes per week[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and questions to measure respondents\u0026rsquo; sun exposure index based on sun exposure time, typical outdoor clothing, and calculating exposed body surface area using the rule of three[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Data collection techniques included face-to-face interviews, observation of height and weight, and a review of records for a vitamin D biochemical study report. The respondents were approached purposefully, and those who consented to participate were included.\u003c/p\u003e \u003cp\u003eThe Fitzpatrick classification chart was used to determine the skin phototype[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to the Endocrine Society Clinical Practice Guideline, respondents\u0026rsquo; serum Vitamin D levels were classified as deficient if less than 20 ng/ml (50 nmol/liter), insufficient if 20\u0026ndash;29 ng/ml, and sufficient if higher than 29 ng/ml[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The WHO STEPwise approach to non-communicable disease risk factor surveillance guideline was used to measure the respondents' height and weight[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Body mass index was calculated and Asian classification of Body Mass Index (BMI) was used in this study as Underweight: \u0026lt;18 kg/m\u003csup\u003e2\u003c/sup\u003e, Normal: 18-22.99 kg/m\u003csup\u003e2\u003c/sup\u003e, Overweight: 23-27.49 kg/m\u003csup\u003e2\u003c/sup\u003e and Obese: \u0026ge;27.5 kg/m\u003csup\u003e2\u003c/sup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was taken from the Institutional Review Board of the National Institute of Preventive and Social Medicine (NIPSOM). The approval number was NIPSOM/IRB/2019/111. Before starting the interview, informed written consent in Bengali was used to take consent. Privacy was ensured during the interview and anthropometric measurement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analyses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor descriptive statistics, frequency and percentage were computed for the categorical variables, while mean along with standard deviation were estimated for the continuous variables. Independent t-test and one-way ANOVA were performed in order to check the bivariate association between binary and multi-category independent variables with the continuous dependent variable, respectively. Multiple regression analysis was attempted with the variables which were found significant in independent t-test, one-way ANNOVA. Then backward elimination process was applied to reach the final model. Statistical significance was set at p\u0026lt;0.05. Data were analyzed using SPSS 20.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 212 respondents, the majority hailed from urban areas (66%), while the rest were from rural areas. Considering sex of the respondents,\u0026nbsp;74.5% were female.\u0026nbsp;The mean age of the respondents was 39.54 (\u0026plusmn; 13.36) years. The majority of individuals (28.8%) had education level of above primary to secondary. Furthermore, only 11.3% reported that they completed graduation and 16.0% holding post-graduate degrees. A notable proportion, 8.5%, is identified as illiterate. In terms of occupation, the male population predominantly consists of service holders (38.9%) and businessmen (20.4%), while females are primarily housewives (72.8%) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Background characteristics of the respondents\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eResidence\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e140 (66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e72 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSex\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e158 (74.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e54 (25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eLevel of education\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e18 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003ePrimary and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e19 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eAbove primary to secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e61 (28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eAbove secondary to higher secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e37 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eUnder graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e12 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e24 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003ePost-graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e34 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46%;\"\u003e\n \u003cp\u003eInformal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e7 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOccupation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 11%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eService holder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e21 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eBusinessman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e11 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e4 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e18 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 11%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e115 (72.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eService holder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e17 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e15 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eBusinessman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53%;\"\u003e\n \u003cp\u003e9 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThe mean serum Vitamin D level was 20.63 (\u0026plusmn; 10.16) ng/ml; ranging from 7.10 ng/ml to 72.26 ng/ml. Only 12.7% of respondents had sufficient serum vitamin D. Almost seventy-four percent (73.6%) were overweight or obese (Figure 1).\u003c/p\u003e\n\u003cp\u003eVitamin D level was higher (22.67 \u0026plusmn; 11.35 ng/ml)\u0026nbsp;among the rural dwellers than the urbanites (16.95 \u0026plusmn; 8.83 ng/ml). The difference was statistically significant (p\u0026lt;0.001).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMales had a statistically significant higher mean serum vitamin D level than\u0026nbsp;females. No statistically significant difference in vitamin D levels among different educational and occupational categories was observed\u0026nbsp;(Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eSocio-demographic characteristics and serum vitamin D level\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSerum vitamin D (ng/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e22.67 \u0026plusmn; 11.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 22%;\"\u003e\n \u003cp\u003e\u0026le;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e16.95 \u0026plusmn; 8.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e21.78 \u0026plusmn; 9.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 22%;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.76 \u0026plusmn; 10.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e21.36 \u0026plusmn; 9.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"8\" style=\"width: 22%;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003ePrimary and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.05 \u0026plusmn; 13.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eAbove primary to secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.84 \u0026plusmn; 10.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eAbove secondary to higher secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.25 \u0026plusmn; 9.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eUnder graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e20.03 \u0026plusmn; 16.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e16.37 \u0026plusmn; 9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003ePost-graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.97 \u0026plusmn; 7.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eInformal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e23.16 \u0026plusmn; 7.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.92 \u0026plusmn; 15.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 22%;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eService holder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e16.97 \u0026plusmn; 8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eBusinessman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e23.93 \u0026plusmn; 16.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.17 \u0026plusmn; 8.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e21.38 \u0026plusmn; 7.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSerum vitamin D levels were not affected by the intake of carbohydrates, vegetables, or fruits. There was a slight, non-significant negative connection between serum vitamin D levels and per-person oil use. The frequency of egg and meat eating was not associated with serum vitamin D levels. However, the mean serum vitamin D level gradually decreased as the large fish ingestion frequency reduced.\u0026nbsp;It was higher among the respondents with the intake of four to five times per week (20.16 \u0026plusmn; 11.14 ng/ml) and lowest among the never intake (13.13 \u0026plusmn; 7.45 ng/ml) group. The finding was statistically significant, but in Post Hoc Games-Howell, a significant difference in mean serum vitamin D among the different groups was not found. Serum mean vitamin D concentration significantly differed among higher to the lower frequency of intake of small fish; Post Hoc Hochberg was done, and mean serum vitamin D level varied significantly (p\u0026lt;0.05) among the respondents who took small fish four to five times per week (20.13 \u0026plusmn; 9.79 ng/ml), those who took small fish one to three times per week (19.96 \u0026plusmn; 12.44 ng/ml) and respondents who never took small fish (13.70 \u0026plusmn; 5.82 ng/ml.\u0026nbsp;Serum vitamin D levels were higher among the respondents who consumed milk or milk products four to five times per week. However, no statistically significant difference in serum vitamin D could be established between different frequencies of milk or milk product consumption (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Food habits, lifestyle, and other factors related to serum Vitamin D\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSerum vitamin D (ng/ml)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 28%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEgg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.23 \u0026plusmn; 9.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e21.29 \u0026plusmn; 12.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOne to three times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.92 \u0026plusmn; 10.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eFour to Five times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.87 \u0026plusmn; 6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSix or more times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.77 \u0026plusmn; 7.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMutton/beef\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.23 \u0026plusmn; 9.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.94 \u0026plusmn; 10.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOne to three times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e16.97 \u0026plusmn; 8.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eFour to Five times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.95 \u0026plusmn; 11.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSix or more times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoultry\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.05 \u0026plusmn; 7.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e20.66 \u0026plusmn; 13.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOne to three times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.61 \u0026plusmn; 9.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eFour to Five times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.99 \u0026plusmn; 7.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSix or more times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e12.90 \u0026plusmn; 1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLarge fish\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e13.13 \u0026plusmn; 7.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.69 \u0026plusmn; 12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOne to three times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.42 \u0026plusmn; 10.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eFour to Five times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e20.16 \u0026plusmn; 11.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSix or more times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.13 \u0026plusmn; 7.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmall fish\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e13.70 \u0026plusmn; 5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.10 \u0026plusmn; 7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOne to three times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.96 \u0026plusmn; 12.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eFour to Five times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e20.13 \u0026plusmn; 9.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSix or more times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e20.35 \u0026plusmn; 6.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMilk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.71 \u0026plusmn; 8.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.742\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.35 \u0026plusmn; 11.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOne to three times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.24 \u0026plusmn; 8.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eFour to Five times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e22.13 \u0026plusmn; 7.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSix or more times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.22 \u0026plusmn; 10.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMilk product\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.21 \u0026plusmn; 8.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.99 \u0026plusmn; 10.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOne to three times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.75 \u0026plusmn; 5.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eFour to Five times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e27.53 \u0026plusmn; 17.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSix or more times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e12.68 \u0026plusmn; 4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkin color type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e17.16 \u0026nbsp;\u0026plusmn; 9.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width: 28%;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eType IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.43 \u0026nbsp;\u0026plusmn; 9.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eType V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e22.12 \u0026nbsp;\u0026plusmn; 14.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory according to MET minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNot satisfactory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e18.14 \u0026plusmn; 9.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 27%;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eSatisfactory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 19.03 \u0026plusmn; 10.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.58\u0026nbsp;\u0026plusmn; 18.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 27%;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e20.21 \u0026plusmn; 12.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e19.35 \u0026plusmn; 8.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37%;\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 34%;\"\u003e\n \u003cp\u003e16.92 \u0026plusmn; 7.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll the respondents belonged to three categories of skin color, according to Fitzpatrick Skin Type Chart Measurement (FSTCM); type III, IV, and V. The serum vitamin D level of respondents with type V skin type was higher (22.12 \u0026plusmn; 14.04 ng/ml) than that of respondents with skin type III (17.16 \u0026plusmn; 9.83 ng/ml) ng/ml) and skin type IV (19.43 \u0026plusmn; 9.10 ng/ml), and the difference was statistically significant (p\u0026lt;0.05). A post hoc Hochberg analysis revealed a significant difference in serum vitamin D levels between respondents with skin types V and III (p\u0026lt;0.05). The respondent\u0026apos;s mean sun exposure index was 0.40, ranging from 0 to 3.08. Sun exposure index and serum vitamin D level had a weak positive correlation (p\u0026lt;0.05). Most respondents (63.2%) belonged to the satisfactory category of MET minutes per week. The serum vitamin D level of the respondents with a satisfactory level of MET minutes per week (19.03 \u0026plusmn; 10.40 ng/ml) was higher than that of respondents with not a satisfactory level of MET minutes per week (18.14 \u0026plusmn; 9.77 ng/ml). Nevertheless, this difference was not statistically significant (p\u0026gt;0.05). The underweight respondents\u0026apos; serum vitamin D level was 19.58 (\u0026plusmn; 18.98) ng/ml. Vitamin D of the respondents with normal BMI was 20.21 (\u0026plusmn; 12.48) ng/ml, and serum concentration of vitamin D gradually decreased among the overweight (19.35 \u0026plusmn; 8.98 ng/ml) and obese (16.92 \u0026plusmn; 7.83 ng/ml). But this difference was not found to be significant (p\u0026gt;0.05) (Table 3).\u003c/p\u003e\n\u003cp\u003eIn multiple regression serum, vitamin D level was significantly associated with place of residence (p\u0026lt;0.001). Urban respondents had 12% less serum vitamin D levels than that rural respondents. The sex of the respondents was also significantly associated with the serum vitamin D level of the respondents (p= 0.009). It was found that females had 7.57% less vitamin D levels than male respondents. Respondents who consumed large fish four to five times per week had 14.56% higher vitamin D levels than respondents who never consumed large fish. Moreover, this difference was statistically significant (p\u0026lt;0.05). It also revealed that those who consumed small fish more than once a week had a statistically higher concentration of serum vitamin D than respondents who never consumed small fish (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Multiple regression showing association between residence, sex, small fish consumption, nutritional status, and serum vitamin D level\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnstandardized\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ecoefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esummary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"18\" style=\"width: 151px;\"\u003e\n \u003cp\u003ep\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e= 0.1894\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-.1149931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-.0734296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLarge fish consumption\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.0778566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eOne to three times per week \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.0759004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eFour to five times per week\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.1361291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSix or more times per week\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.1139473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmall fish consumption\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eLess than one time per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.0806868\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eOne to three times per week \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.1342352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eFour to five times per week\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.1472311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSix or more times per week\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.1568196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eUnderweight\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e.0266128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eOverweight\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-.0223121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eObese\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-.0668846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnd after controlling the effect of residence, sex, large fish, and small fish consumption, respondents who were overweight had 2.22% less serum vitamin D level than those who belonged to the normal nutritional category. However, this difference was not statistically significant (p\u0026gt;0.05). Nevertheless, respondents who were obese had 6.82% less mean vitamin D levels than those with normal BMI. Moreover, it was statistically significant (p\u0026lt;0.05). This model could explain only 18.94% variability of serum vitamin D level among the respondents, and the model was highly significant (p\u0026lt;0.001) (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMost studies aiming to explore the relationship between\u0026nbsp;nutritional status and vitamin D level were conducted in other parts of the world\u0026nbsp;[30-33]. Though there is no consensus about the cut-off level of vitamin D for deficiency, most of the studies used the\u0026nbsp;Endocrine Society Clinical Practice Guideline\u0026nbsp;[27].\u003c/p\u003e\n\u003cp\u003eIn this study, respondents had similar socio-demographic characteristics as revealed by Population and Housing Census 2011 of Bangladesh (34) and other studies conducted in similar settings\u0026nbsp;[9].\u0026nbsp;Vitamin D insufficiency is widespread in the Bangladeshi population, as evidenced by studies conducted among healthy individuals and in hospital settings\u0026nbsp;[9, 10]. This study found\u0026nbsp;87.2%\u0026nbsp;of the respondents had vitamin D deficiency or\u0026nbsp;insufficiency, which is consistent with the study conducted by Acherjya et al. in Jessore, Bangladesh\u0026nbsp;[10].\u003c/p\u003e\n\u003cp\u003eAbout three fourth (73.6%) of the respondents had BMI \u0026ge; 23 kg/m\u003csup\u003e2\u003c/sup\u003e,\u0026nbsp;40.6%\u0026nbsp;were overweight and 33% were obese. In contrast, a study analyzed data from a nationally representative sample of Bangladeshi people and discovered that around 25% of adults had a BMI of less than 23 kg/m\u003csup\u003e2\u003c/sup\u003e [34]. However, Acherjya et al. showed that 68.80% of respondents were overweight or obese, while Hossain et al. observed that 47.2% of respondents were overweight or obese even when the BMI cut-off point was adjusted to 18.5-25.0 kg/m\u003csup\u003e2\u003c/sup\u003e [9, 10].\u003c/p\u003e\n\u003cp\u003eRural residents had a higher mean serum vitamin D level (22.67 \u0026plusmn; 11.35 ng/ml) than urban dwellers (16.95 \u0026plusmn; 8.83 ng/ml). After adjusting for sex, large and small fish consumption, and nutritional status of the respondent, urban respondents had 12% less serum vitamin D level than rural respondents. Both were statistically highly significant (p\u0026lt;0.001). This finding is consistent with the cross-sectional studies conducted among healthy individuals in India and Bangladesh among apparently healthy individuals and patients attending hospitals for musculoskeletal problems\u0026nbsp;[9, 10, 35, 36]. It could be attributed to air pollution in urban areas as air pollution from industrial and vehicular emissions containing particulate matter absorb and disperse UV radiation, preventing it from reaching the earth\u0026apos;s surface. A study conducted among infants and toddlers in Delhi, India, has shown that air pollution affects vitamin D status\u0026nbsp;[37]. Moreover, there is more sunlight exposure in rural areas than in urban areas, which might be another possible explanation.\u003c/p\u003e\n\u003cp\u003eMales had a higher mean serum vitamin D level (21.78 \u0026plusmn; 9.30 ng/ml) than females (17.76 \u0026plusmn; 10.30 ng/ml). There was a statistically significant difference. Even after controlling for respondents\u0026apos; residence, large and small fish intake, and nutritional status, females had 7.57 percent lower vitamin D levels than males. Other studies conducted in Bangladesh, Australia, the Middle East, and India have shown similar results\u0026nbsp;\u0026nbsp;[3, 6, 9, 10, 35, 36, 38, 39].\u003c/p\u003e\n\u003cp\u003eIn this study, we found that the type and frequency of carbohydrate, vegetables, fruit, meat, poultry, milk or dairy product intake did not influence the respondents\u0026apos; mean serum vitamin D level. However, in this study, the mean serum vitamin D level was higher among the respondents with the intake of large fish four to five times per week (20.16 \u0026plusmn; 11.14 ng/ml) than others. Although the finding was statistically significant (p\u0026lt;0.05), in Post Hoc Games-Howell, no significant mean serum vitamin D difference among different groups was found. Serum mean vitamin D concentration significantly differed among higher to lower frequency of intake of small fish. Post Hoc Hochberg analysis revealed a significant difference in mean serum vitamin D concentration between those who ate small fish four to five times per week, those who ate small fish one to three times per week, and those who ate small fish. The finding is consistent with the study conducted among the general population of Denmark aged 30-60 years to determine lifestyle factors associated with vitamin D status\u0026nbsp;[40]. Our study used a food frequency questionnaire to detect consumption frequency but did not qualify for the amount of intake. Moreover, it confirms that food is a poor source of vitamin D, as suggested by other studies\u0026nbsp;[12, 27].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRespondents with type V skin had a higher serum vitamin D level (22.12 \u0026plusmn; 14.04 ng/ml) than those with skin type III (17.16 \u0026plusmn; 9.83 ng/ml) or skin type IV (19.43 \u0026plusmn; 9.10 ng/ml). And there was a significant difference in vitamin D levels between respondents with skin types V and III, according to Hochberg\u0026apos;s post hoc analysis. This conclusion contradicts previous studies that shows that increasing skin pigmentation reduces the transmission of UV rays needed to synthesize vitamin D, resulting in a significant risk of vitamin D deficiency\u0026nbsp;[41, 42].\u0026nbsp;According to skin tone, Acherjya et al. categorized respondents as Black, Brown, or Fair in their study, but found no link between skin color and vitamin D levels\u0026nbsp;[10].\u0026nbsp;This study adopted FSTCM, which has not been validated in our country\u0026apos;s context. Furthermore, 189 of the 212 respondents had skin types III or IV, with women accounting for 76.19 % and women\u0026apos;s serum vitamin D levels were 7.57 percent lower than men. So maybe inadequate observations in other strata is the reason for this inconstancy.\u0026nbsp;The respondents\u0026apos; serum vitamin D level and sun exposure index had a weak positive correlation (p\u0026lt;0.05), the curve estimate found a cubic relationship. This conclusion matched findings from studies in India and Malaysia.\u0026nbsp;[42-44].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOutdoor and indoor physical activity have been found to be correlates or predictors of vitamin D levels\u0026nbsp;[45, 46]. The majority of respondents (63.2%) fell into the satisfactory physical activity category, and their serum vitamin D levels were greater than those of respondents who did not meet the criteria. However, this difference was not statistically significant (p\u0026gt;0.05). Study with more statistical power may be able to prove the link.\u003c/p\u003e\n\u003cp\u003eAfter controlling for confounders, a bi-directional genetic analysis indicated that a higher BMI is associated with decreased vitamin D levels\u0026nbsp;[21, 22]\u0026nbsp;[47, 48]. Existing literature shows a consistent relationship between increased BMI and reduced serum vitamin D\u0026nbsp;[31]. A study of hospital patients with musculoskeletal symptoms in Bangladesh, showed an association between obesity and vitamin D deficiency \u0026nbsp;[9]. Acherjya et al. conducted a population-based study in Bangladesh and found that overweight and obese had lower serum vitamin D levels than those with normal body mass index, but these differences were not statistically significant\u0026nbsp;[10]. But in this study,\u0026nbsp;mean\u0026nbsp;serum vitamin D levels gradually decreased\u0026nbsp;among the overweight and obese. However, this difference was not found significant in one-way ANOVA (p\u0026gt;0.05). In the multiple regression, after controlling the effect of residence of the respondents, sex, large and small fish consumption frequency, it was found that\u0026nbsp;respondents who were overweight had 2.22% and who were obese had 6.82% less serum vitamin D level than the respondents who belonged to the normal nutritional category. Moreover, the difference of mean serum vitamin D levels between obese and normal body mass index group was statistically significant (p\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis is the first epidemiological study among Bangladeshi adults to investigate the association between nutritional status and vitamin D. This study has several significant strengths and limitations. Validated devices for measuring anthropometric data and validated techniques for data collecting were utilized in this investigation, reducing the risk of measurement error. The assumption of causative characteristics between explanatory factors and outcomes is of limited relevance due to the cross-sectional nature of the investigation. Compared to WHO-recommended cut-offs, Asian body mass index cut-offs were utilized to categorize the nutritional status of the respondents, which may exaggerate the overweight/obesity category. Furthermore, there are possible disadvantages to using BMI as a nutritional status measure. Gender, age, and ethnic variations in body fat composition and distribution contribute to a person\u0026apos;s nutritional status. The BMI does not accurately represent a person\u0026apos;s lean muscle mass and visceral fat. Other anthropometric measurements, such as waist circumference and waist-hip ratio, should be used in conjunction with BMI to assess abdominal obesity or other body-specific regions. The respondents\u0026apos; self-reported data on known risk factors of undernutrition, overnutrition, and vitamin D deficiency, including dietary intake, physical activity, sedentary behaviour, and sun exposure might have caused recall bias.\u0026nbsp;Every respondent\u0026apos;s vitamin D status and body weight could not be determined on an empty stomach. Even though data on food intake frequency was obtained, the amount consumed was not calculated. FSTCM was utilized to assess the skin type of the participants in this study. It is a tried-and-true method for determining skin type that\u0026apos;s commonly used in dermatology for clinical and research purposes. However, in our country\u0026apos;s context, FSTCM\u0026nbsp;has not been validated.\u003c/p\u003e\n\u003cp\u003eAlthough the study has a large sample size, these limitations may limit the generalizability of the study\u0026apos;s findings. However, thus more population-based studies with analytical design are necessary to understand the association between nutritional status and vitamin D among adults.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was taken from the Institutional Review Board of the National Institute of Preventive and Social Medicine (NIPSOM). The approval number was NIPSOM/IRB/2019/111. Before starting the interview, informed written consent in Bengali was used to take consent. Privacy was ensured during the interview and anthropometric measurement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used in this study is accessible upon reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funding from any source.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception and design: Dewan Imtiaz Rahman, Monira Akhter; Methodology: Dewan Imtiaz Rahman; Data collection: Dewan Imtiaz Rahman; Analysis and interpretation of results: Dewan Imtiaz Rahman, Monira Akhter; Draft manuscript preparation: Aliva Salmeen, Dewan Imtiaz Rahman. 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Anticancer research. 2009;29(9):3713\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vitamin D, Nutritional Status, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-5219346/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5219346/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDespite having plenty of sunshine all year round, there is an alarming rise in vitamin D deficiency among the Bangladeshi population. This cross-sectional study explored the association between nutritional status and serum vitamin D level among adults. Two hundred and twelve respondents were purposively selected. Pretested semi-structured questionnaire, and checklist were used to collect data. Among all, 74.5% were female, and 66% were urbanites. The mean age of the respondents was 39.54 (\u0026plusmn;\u0026thinsp;13.36) years. The respondents' mean serum Vitamin D level was 20.63 (\u0026plusmn;\u0026thinsp;10.16) ng/ml. More than half of the respondents (54.7%) had vitamin D deficiency and 32.5% had vitamin D insufficiency. About three fourth (73.6%) of the respondents were obese or overweight. Vitamin D level was significantly less in urbanites. Gender was associated with serum vitamin D levels. The respondents' Vitamin D levels positively correlated with the sun exposure index. We found that vitamin D level was associated with skin color type and large and small fish intake frequency. Serum level of vitamin D gradually decreased among the overweight and obese. But this difference was not statistically significant. In multiple regression, after controlling the effect of sex, residence, large and small fish consumption, obese had significantly lower (6.82%) mean level of vitamin D than those who belonged to normal Body Mass Index (BMI) category. This study suggests the inclusion of fish in diet, more sun exposure, and maintaining a healthy body weight may assist in improving vitamin D levels of individuals.\u003c/p\u003e","manuscriptTitle":"Nutritional status and vitamin D among adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-30 04:49:31","doi":"10.21203/rs.3.rs-5219346/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c8c19ad-8925-4618-ad37-7020eb8dd08c","owner":[],"postedDate":"October 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-30T04:49:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-30 04:49:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5219346","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5219346","identity":"rs-5219346","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}