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690 Am J Clin Nutr 2000;72:6903. Printed in USA. 2000 American Society for Clinical Nutrition
VITAMIN D AND OBESITY 691
In vitro studies
The direct effect of obesity on the synthetic capacity of the
skin to produce vitamin D3 was studied in whole skin (epidermis
and dermis) obtained during surgery from 2 obese subjects (age:
27 and 84 y) and 2 nonobese subjects (age: 42 and 73 y) with
skin type III. The skin specimens were frozen and stored at
70 C promptly after removal. Before analysis, the skin sam-
FIGURE 1. Mean ( SEM) serum vitamin D3 (cholecalciferol) ples were thawed at room temperature and the epidermis, where
concentrations before () and 24 h after () whole-body irradiation most of the synthesis of vitamin D3 takes place, was separated
(27 mJ/cm2) with ultraviolet B radiation. The response of the obese sub- from the dermis (15). Individual skin pieces (1 cm2) were
jects was attenuated when compared with that of the control group. exposed to simulated sunlight for the same period of time, after
There was a significant time-by-group interaction, P = 0.003. *Signifi-
which the epidermis was immediately removed and analyzed for
cantly different from before values (P < 0.05).
its combined vitamin D3 content (the combination of previtamin D3
and vitamin D3) as described previously (15). The vitamin D3
precursor 7-dehydrocholesterol and its photoproduct previta-
Methods min D3 were measured in triplicate by HPLC (15).
The study of cutaneous vitamin D3 synthesis in response to
DISCUSSION
FIGURE 3. Mean ( SEM) serum 25-hydroxyvitamin D [25(OH)D] The present study of the synthesis and processing of vitamin D
concentrations in the control () and obese () groups 024 h after oral
confirmed that obese patients have lower basal 25(OH)D and
intake of vitamin D2 (ergocalciferol; 50 000 IU, 1.25 mg). The slight
higher serum parathyroid hormone concentrations than do nonobese
increase in the obese group was not significant. *Significant time-by-
group interaction, P < 0.05 (ANOVA). persons (15). To determine why obese individuals are prone to
vitamin D deficiency, we conducted a series of studies to deter-
mine their capability to handle vitamin D originating from either
obese subjects showing an attenuated response to UV-B irradia- the oral route or from the skin. Because vitamin D is fat soluble
tion. When the results were recalculated as the difference between and is readily stored in adipose tissue, it could be sequestered in
basal and postirradiation vitamin D3 concentrations, they were the larger body pool of fat of obese individuals. We observed that
2. Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH. Low circulating vita-
min D in obesity. Calcif Tissue Int 1988;43:199201.
3. Compston JE, Vedi S, Ledger JE, Webb A, Gazet JC, Pilkington
TRE. Vitamin D status and bone histomorphometry in gross obesity.
Am J Clin Nutr 1981;34:235963.
4. Hey H, Stockholm KH, Lund BJ, Sorensen OH. Vitamin D defi-
ciency in obese patients and changes in circulating vitamin D
metabolites following jejunoileal bypass. Int J Obes 1982;6:4739.
5. Hyldstrup L, Andersen T, McNair P, Breum L, Transbol I. Bone
metabolism in obesity: changes related to severe overweight and
dietary weight reduction. Acta Endocrinol 1993;129:3938.
6. Bell NH, Epstein S, Shary J, Greene V, Oexmann MJ, Shaw S. Evi-
dence of a probable role for 25-hydroxyvitamin D in the regulation
of human calcium metabolism. J Bone Miner Res 1988;3:48995.
7. Andersen T, McNair P, Fogh-Andersen H, Nielsen TT, Hyldstrup L,
Transbol I. Increased parathyroid hormone as a consequence of
FIGURE 5. Correlation between BMI and peak serum vitamin D3
changed complex binding of plasma calcium in morbid obesity.
(cholecalciferol) concentrations after whole-body irradiation (27 mJ/cm2)
Metabolism 1985;35:14751.
with ultraviolet B radiation in control () and obese () subjects. The
8. Matsuoka LY, Wortsman J, Haddad JG, Kolm P, Hollis BW. Racial
correlation coefficient (r = 0.55) was highly significant (P = 0.003).
pigmentation and the cutaneous synthesis of vitamin D. Arch Der-
matol 1991;127:5368.
ingested orally, obese and nonobese subjects were challenged 9. Matsuoka LY, Ide L, Wortsman J. MacLaughlin JA, Holick MF.
with an oral dose of 50 000 IU vitamin D2. There was no relation Sunscreens suppress cutaneous vitamin D 3 synthesis. J Clin
between basal vitamin D2 concentrations and 25(OH)D. Peak Endocrinol Metab 1987;64:11658.
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin
Nutr 2000;72:6903.
On page 692, column 2, paragraph 1, the text should read as follows: "Conversely, there were 2 correlations that
Erratum
Kumanyika SK, Obarzanek E, Stevens VJ, Hebert PR, Whelton PK. Weight-loss experience of black and white
participants in NHLBI-sponsored clinical trials. Am J Clin Nutr 1991;53(suppl):1631S8S.
The first authors last name should be spelled as above and not as published in the Journal.
1342 Am J Clin Nutr 2003;77:1342. Printed in USA. 2003 American Society for Clinical Nutrition