Personal Sun Exposure and Serum 25‐hydroxy Vitamin D Concentrations

Solar ultraviolet‐B radiation (UVB) is essential for epidermal vitamin D production. We aimed to quantitate the relationship between personal solar UV exposure and serum 25hydroxy vitamin D (25[OH]D) concentration. Blood was collected for 25(OH)D analysis in 207 South Australian adults aged 27–61 years. At the time of blood collection, each participant completed a questionnaire, which included a calendar for recall of sun exposure in the preceding 16 weeks. We examined the association between solar UV exposure and serum 25(OH)D graphically from smoothed scatter plots, and modeled it using multiple linear regression, with age, sex and body mass index as covariates. Estimated erythemal solar UV exposure in the 6 weeks before blood collection best predicted serum 25(OH)D concentrations. Serum 25(OH)D rose with increasing personal solar UV exposure to a maximum of about 89 nmol L^?1 at an estimated mean weekly solar erythemal UV exposure of about 1230 mJ cm^?2. The maximum was the same after accounting for clothing coverage and was reached at an estimated whole body equivalent exposure to ambient UV of ca 700 mJ cm^?2. These results suggest that an average maximum serum 25(OH)D of ca 89 nmol L^?1 is achieved from sun exposure in a healthy Australian adult population.     

Solar UV Exposure of Seafarers along Subtropical and Tropical Shipping Routes

Seafarers working on decks of vessels at low latitudes are exposed to extremely high solar UV radiation. Their risk of developing skin cancer may be enhanced. Solar erythemal UV irradiance and exposure were measured for the first time on merchant vessels going along typical international routes at low latitudes. The measurements taken at horizontal incidence on the observation deck, and on different parts of the seaman (head, shoulder, chest and back) doing typical outdoor work show the highest portion (40–80% of horizontal exposure) incident on the head. 2 years of measurements of solar UV and VIS/NIR irradiance taken on the mast top of the Research Vessel METEOR were added to the data base. Radiative transfer model calculations were performed along all the routes with satellite‐based input data of ozone and aerosol for clear sky health‐effective radiation including vitamin D3 (VD3). Measured data show extremely high noontime UV index values up to 19 with clear sky, and up to 22 due to cloud scattering. Eight hours erythemal exposure values are more than double of typical midlatitude summer values. Based on the results, an algorithm is presented to derive a seafarer's personal erythemal exposure according to his/her personal record of sea service.     

How does the skin sense sun light? An integrative view of light sensing molecules

The consensus on the effects of excessive sun exposure on human health has long emphasized the negative effects of solar UV radiation. Nevertheless, although UV radiation has been demonized, less is known about the consequences of sun exposure while using sunscreen, which can lead to high visible light exposure. UV and visible light play key roles in vitamin D synthesis, reduction of blood pressure, among other beneficial effects. In this review, we aim to provide a comprehensive view of the wide range of responses of the human skin to sunlight by revisiting data on the beneficial and harmful effects of UV and visible light. We start by exploring the interaction of photons in the skin at several levels including physical (depth of photon penetration), chemical (light absorption and subsequent photochemical events), and biological (how cells and tissues respond). Skin responses to sun exposure can only be comprehensively understood through a consideration of the light-absorbing molecules present in the skin, especially the light-sensing proteins called opsins. Indeed, many of the cellular responses to sun exposure are modulated by opsins, which act as the “eyes of the skin”.     

Location and vitamin D synthesis: is the hypothesis validated by geophysical data?

The literature reports strong correlations between UV exposure and latitude gradients of diseases. Evidence is emerging about the protective effects of UV exposure for cancer (breast, colo-rectal, prostate), autoimmune diseases (multiple sclerosis, type II diabetes) and even mental disorders, such as schizophrenia. For the first time, the available levels of vitamin D producing UV or "vitamin D UV" (determined from the previtamin D action spectrum) and erythemal (sunburning) UV from throughout the USA are measured and compared, using measurements from seven locations in the USA are measured and compared, using measurements from seven locations in the US EPA's high accuracy Brewer Spectrophotometer network. The data contest longstanding beliefs on the location-dependence and latitude gradients of vitamin D UV. During eight months of the year centered around summer (March-October), for all sites (from 18 degrees N to 44 degrees N latitude) the level of vitamin D UV relative to erythemal UV was equal (within the 95% confidence interval of the mean level). Therefore, there was no measured latitude gradient of vitamin D UV during the majority of the year across the USA. During the four cooler months (November-February), latitude strongly determines vitamin D UV. As latitude increases, the amount of vitamin D UV decreases dramatically, which may inhibit vitamin D synthesis in humans. Therefore, a larger dose of UV relative to erythemal UV is required to produce the same amount of vitamin D in a high latitude location. However, the data shows that at lower latitude locations (<25 degrees N), wintertime vitamin D UV levels are equal to summertime levels, and the message of increasing UV exposure during winter is irrelevant and may lead to excessive exposure. All results were confirmed by computer modeling, which was also used to generalize the conclusions for latitudes from 0 degrees to 70 degrees N. The results of this paper will impact on research into latitudinal gradients of diseases. In particular, it may no longer be correct to assume vitamin D levels in populations follow significant latitude gradients for a large proportion of the year.     

Sufficient Vitamin D from Casual Sun Exposure?

Next to the adverse effects of solar UV exposure, the beneficial effects mediated by vitamin D₃ have come into the limelight. The question then is “how much sun exposure do we actually need?” Estimates have been made, but the data are not quite adequate. The groups of Drs. Rhodes and Webb bridged the gap between experiments and everyday life by a study in which 109 volunteers were exposed in mid‐winter to simulated solar UV radiation in summertime clothing at dosages of 1.3 SED three times a week. Thus, 90% reached sufficiently high vitamin D statuses (>50 nmol L⁻¹). In this issue, these researchers transpose these experimental exposures in a cabinet to summertime noon exposures of people walking around for about half an hour in open terrain on a clear day in Manchester, UK. This result is an improvement over earlier estimates and shows that casual mid‐day summer sun exposure should indeed suffice.     

Self‐Reported Changes in Sun‐Protection Behaviors at Different Latitudes in Australia

Sun exposure is the most important source of vitamin D, but is also a risk factor for skin cancer. This study investigated attitudes toward vitamin D, and changes in sun‐exposure behavior due to concern about adequate vitamin D. Participants (n = 1002) were recruited from four regions of Australia and completed self‐ and interviewer‐administered surveys. Chi‐square tests were used to assess associations between participants' latitude of residence, vitamin D‐related attitudes and changes in sun‐exposure behaviors during the last summer. Multivariate logistic regression analyses were used to model the association between attitudes and behaviors. Overall, people who worried about their vitamin D status were more likely to have altered sun protection and spent more time in the sun people not concerned about vitamin D. Concern about vitamin D was also more common with increasing latitude. Use of novel item response theory analysis highlighted the potential impact of self‐reported behavior change on skin cancer predisposition due concern to vitamin. This cross‐sectional study shows that the strongest determinants of self‐reported sun‐protection behavior changes due to concerns about vitamin D were attitudes and location, with people at higher latitudes worrying more.     

Association of Increased Sun Exposure Over the Life‐course with a Reduced Risk of Juvenile Idiopathic Arthritis

Cutaneous sun exposure is an important determinant of circulating vitamin D. Both sun exposure and vitamin D have been inversely associated with risk of autoimmune disease. In juvenile idiopathic arthritis (JIA), low circulating vitamin D appears common, but disease‐related behavioral changes may have influenced sun exposure. We therefore aimed to determine whether predisease sun exposure is associated with JIA. Using validated questionnaires, we retrospectively measured sun exposure for 202 Caucasian JIA case–control pairs born in Victoria Australia, matched for birth year and time of recruitment. Measures included maternal sun exposure at 12 weeks of pregnancy and child sun exposure across the life‐course prediagnosis. We converted exposure to UVR dose and looked for case–control differences using logistic regression, adjusting for potential confounders. Higher cumulative prediagnosis UVR exposure was associated with reduced risk of JIA, with a clear dose–response relationship (trend P = 0.04). UVR exposure at 12 weeks of pregnancy was similarly inversely associated with JIA (trend P = 0.011). Associations were robust to sensitivity analyses for prediagnosis behavioral changes, disease duration and knowledge of the hypothesis. Our data indicate that lower UVR exposure may increase JIA risk. This may be through decreased circulating vitamin D, but prospective studies are required to confirm this.     

Solar Ultraviolet Radiation Measurements in One of the Most Populous Cities of the World: Aspects Related to Skin Cancer Cases and Vitamin D Availability

A number of studies published in the scientific literature have shown the relationship between sun exposure and nonmelanoma skin cancer (NMSC) and vitamin D synthesis. However, the paucity of medical data, particularly in developing countries, hampers a global assessment of the impact of sun exposure on NMSC and vitamin D. To improve knowledge on this subject, this paper presents UV index (UVI) measurements performed in São Paulo City (SPC) in the period 2005–2008. It was found that 65% of the UVI measured 2 h around local noon during the summer show very high (8 < UVI < 10) and extreme (UVI > 11) levels according to the World Health Organization (WHO) classification. During the winter, 40% of the measurements around noontime show high or very high levels. In spite of worrisome recent statistics from SPC, showing that NMSCs make up about 28% of over a million of new cases of cancer in 2008, sun protection is not considered a real problem in these urban areas. UV measurements also show that every month of the year UV levels are high enough to ensure vitamin D production in human skin from incidental sun exposure.     

Colon cancer: prognosis for different latitudes, age groups and seasons in Norway

The survival of colon cancer patients in Norway, as determined three years after diagnosis, is dependent on the season of diagnosis. This has been attributed to seasonal variations of the vitamin D status. Since solar radiation and food are the human sources of vitamin D, we divided Norway in three regions: The southeast region with a high annual dose of ultraviolet (UV) to the population, as evidenced by a high incidence rate of squamous cell carcinoma of the skin (SCC), the midwest region and the north region with low annual UV doses. The latter region is characterized by a high consumption of vitamin D, mainly through fish intake. Vacations to southern latitudes were equally frequent for all the three geographical regions. Two age groups were analyzed separately (< or =65 years and >65 years), since the photosynthesis of vitamin D(3) in skin decreases with age. In all three regions, and in both age groups, the survival was highest for summer and autumn diagnosis. The seasonal effect was slightly, but not significantly, better for the younger than for the older age group. The effect was similar for all three geographical regions, irrespective of SCC incidence.     

Occupational Exposure to Solar UVB and Seasonal Monitoring of Serum Levels of 25-hydroxy Vitamin D3: A Case–Control Study

To characterize the relationship between occupational sun exposure and seasonal variations in serum 25-OH-D3, four consecutive measurements of 25-OH-D3, one per season, were taken in 122 outdoor and 104 indoor Israeli workers. Continuous UVB measurements, taken in Beer Sheva, Israel, provided the average daily standard erythema dose (SED) of ambient solar UVB. The average daily exposure of the outdoor and indoor workers to solar UVB was 4.4 ± 1.6 h (4.0–37.6 SED) and 0.9 ± 0.5 h (0.6–8.2 SED), respectively. At each season mean 25-OH-D3 were significantly higher among outdoor workers than among indoor workers. Mean 25-OH-D3 increased significantly from spring to autumn in both gender and occupational groups. Adjusting for confounders, high (>median) 25-OH-D3 among males was significantly associated with occupational sun exposure in the autumn (odds ratio [OR] 4.31; 95% confidence interval [CI] 1.4–13.3), and among females in the spring (OR 3.35; 95% CI 1.53–7.32). Among this working population optimal vitamin D status (≥30 ng mL⁻¹) was approached only in summer by males working either outdoor or indoor. In the rest of the year 25-OH-D3 ranged between ≥20.0 and 29.0 ng mL⁻¹. Monitoring 25-OH-D3 may disclose undesirable vitamin D status following reduced sun exposure for skin cancer prevention among outdoor workers.     

Sun beds and cod liver oil as vitamin D sources

The objective of this study was to (1) to determine the contribution of moderate sun bed exposure to serum 25(OH)D(3) levels; (2) to estimate the decay time of a high 25(OH)D(3) level obtained by sun bed exposure; and (3) to evaluate if the recommended ingestion of vitamin D is sufficient to maintain the 25(OH)D(3) concentration obtained by sun bed exposure. Ten volunteers (20-35 y.o.), skin type I and II, living in Olso, Norway were whole body exposed twice per week to the radiation of a commercial and approved sun bed (Life Sun S 100 W, Wolff System), starting with 0.5 MED (minimal erythema dose) and escalating to up to 1 MED per exposure for 4 weeks. After that, half of the volunteers were given a daily supplement of 200 IU vitamin D in the form of cod liver oil capsules, while the other half of the persons received no supplements. Erythema did not occur at any time and a slight pigmentation was seen in most of the volunteers after the sun bed exposures. Serum level of 25(OH)D(3) increased by about 40% on the average. The initial serum 25(OH)D(3) level was different among the volunteers (40-100 nmol/L). Within eight weeks after the last exposure the 25(OH)D(3) level decreased to the initial value in all volunteers irrespective of vitamin D supplementation or not.     

Determining an Effective UV Radiation Exposure Time for Vitamin D Synthesis in the Skin Without Risk to Health: Simplified Estimations from UV Observations

UV radiation contains erythemally weighted UV, as well as UV that synthesizes vitamin D₃. Here, we attempted to determine the relationship between these factors by numerical simulation of atmospheric parameters, such as total ozone, using a simplified “SMART2” model for radiative transfer. Both forms of UV were almost linearly correlated with each other for a comparably large UV radiation exposure, larger than UV Index ~1.6. If erythemally weighted UV, which carries a risk of sunburn, is known, the amount of UV exposure needed for vitamin D synthesis in the epidermis can be estimated using this relationship. The production of 10 μg (400 IU) of vitamin D per day takes approximately 1/3 of the time needed to reach the minimal erythemal dose (MED) for an effective skin area of 600 cm² for skin phototype III. For an area of 1200 cm², 1/6 of that exposure time suffices. From a UV Index that is commonly used, the risks and benefits can be evaluated using this linear relationship, which will enable people to effectively manage their UV exposure and consider the risks and benefits to optimize health outcomes.     

Exposed Body Surface Area—A Determinate for UV Radiant Energy in Human UV Exposure Studies

Solar ultraviolet (UV) exposure of people and related health risk is mainly examined by estimating the received UV radiant exposure. However, for several effects such as DNA damage, vitamin D photosynthesis or the probability of developing skin cancer, UV radiant energy is important and with that the size of exposed skin area. There is also a complex interaction between body shape and behavior like sun exposure habits, so that careful analysis is necessary when estimating health effects from UV exposure. In this paper, knowledge on body shape and methods of calculating the total body surface area (BSA) are summarized. BSA depends mainly on the height and weight of a person as well as on gender, ethnicity and body shape. BSA and body shape differ significantly between different populations and both change during life. This paper proposes formulas for BSA that consider height, weight, gender, ethnicity and body shape. As the exposed BSA depends on clothing, finally an approach is presented which aims to calculate the size of body parts released by real garments. In summary, this paper will enable future researchers to quantify the exposed BSA by best matching their study population and consequently investigate risks caused by solar UV exposure.     

Low Sun Exposure and Vitamin D Deficiency as Risk Factors for Inflammatory Bowel Disease,With a Focus on Childhood Onset

The incidence and prevalence of inflammatory bowel disease (IBD) are increasing worldwide. Some ecological studies show increasing incidence with increasing latitude. Ambient ultraviolet radiation varies inversely with latitude, and sun exposure of the skin is a major source of vitamin D. Vitamin D deficiency is common in patients with IBD. Sun exposure and vitamin D have immune effects that could plausibly reduce, or be protective for, IBD. One quarter of new IBD cases are diagnosed in childhood or adolescence, but most research is for adult‐onset IBD. Here, we review the evidence for low sun exposure and/or vitamin D deficiency as risk factors for IBD, focusing where possible on pediatric IBD, where effects of environmental exposures may be clearer. The literature provides some evidence of a latitude gradient of IBD incidence, and evidence for seasonal patterns of timing of birth or disease onset is inconsistent. High prevalence of vitamin D deficiency occurs in people with IBD, but cannot be interpreted as being a causal risk factor. Evidence of vitamin D supplementation affecting disease activity is limited. Further research on predisease sun exposure and well‐designed supplementation studies are required to elucidate whether these potentially modifiable exposures are indeed risk factors for IBD.     

A Comparison of Solar Ultraviolet Radiation Exposure in Urban Canyons in Venice,Italy and Johannesburg,South Africa

Urban environments can have high-risk spaces that can provide excess personal sun exposure, such as urban or street canyons, and the spaces between buildings, among others. In these urban spaces, sun exposure can be high or low depending on several factors. Polysulphone film (PSF) was used to assess possible daily solar ultraviolet radiation (UVR) exposure in urban canyons in Venice, Italy and, for the first time in Africa, in Johannesburg, South Africa. The photodegradation of PSF upon solar exposure was monitored at a wavelength of 330 nm by ultraviolet-visible spectrophotometry, and the resultant change was converted to standard erythemal dose (SED) units (1 SED = 100 J m⁻²). Mean daily ambient solar UVR exposure measured for Venice and Johannesburg ranged between 20–28 SED and 33–43 SED, respectively. Canyon-located PSF exposures were lower in Venice (1–9 SED) than those in Johannesburg (9–39 SED), depending mainly on the sky view factor and orientation to the sun. There was large variation in solar UVR exposure levels in different urban canyons. These preliminary results should be bolstered with additional studies for a better understanding of excess personal exposure risk in urban areas, especially in Africa.     

The vitamin D debate: translating controlled experiments into reality for human sun exposure times

Exposure to sunlight, specifically the ultraviolet radiation, has both positive and negative health effects. Maximizing the benefits (vitamin D synthesis) while minimizing the damage is a multifaceted problem in which many of the elements are poorly quantified. Here we show how rigorously conducted large sample size laboratory studies of the effect of ultraviolet radiation dose on vitamin D status can be applied to real-life situations. This was achieved by modeling the radiation incident on different surfaces for different solar locations, and equating with the controlled exposures in the laboratory studies. Results from both model and experimental data show that relatively short exposures of a modest amount of unprotected skin to summer sunlight in northern climes, on a regular basis during lunchtime hours, increases vitamin D to sufficiency status (≥20 ng mL(-1) ) in the white Caucasian population. While both sun exposure conditions and human skin responses are variable in real life, these quantitative findings provide a guide for authorities devising sunlight exposure recommendations.     

Comparisons of estimated economic burdens due to insufficient solar ultraviolet irradiance and vitamin D and excess solar UV irradiance for the United States

Vitamin D sufficiency is required for optimal health, and solar ultraviolet B (UVB) irradiance is an important source of vitamin D. UVB and/or vitamin D have been found in observational studies to be associated with reduced risk for over a dozen forms of cancer, multiple sclerosis, osteoporotic fractures, and several other diseases. On the other hand, excess UV irradiance is associated with adverse health outcomes such as cataracts, melanoma, and nonmelanoma skin cancer. Ecologic analyses are used to estimate the fraction of cancer mortality, multiple sclerosis prevalence, and cataract formation that can be prevented or delayed. Estimates from the literature are used for other diseases attributed to excess UV irradiation, additional cancer estimates, and osteoporotic fractures. These results are used to estimate the economic burdens of insufficient UVB irradiation and vitamin D insufficiency as well as excess UV irradiation in the United States for these diseases and conditions. We estimate that 50,000-63,000 individuals in the United States and 19,000-25,000 in the UK die prematurely from cancer annually due to insufficient vitamin D. The U.S. economic burden due to vitamin D insufficiency from inadequate exposure to solar UVB irradiance, diet, and supplements was estimated at $40-56 billion in 2004, whereas the economic burden for excess UV irradiance was estimated at $6-7 billion. These results suggest that increased vitamin D through UVB irradiance, fortification of food, and supplementation could reduce the health care burden in the United States, UK, and elsewhere. Further research is required to confirm these estimates.     

Standard ultraviolet daylight for nonextreme exposure conditions

The skin is exposed to ultraviolet radiation (UVR) from natural or artificial sources on a daily basis. The effects of chronic low dose exposure merit investigation, even when these effects are neither conspicuous nor clinically assessable. The purpose of the present study was to define a relative spectral UV irradiance that is representative of frequent nonextreme sun exposure conditions and therefore more appropriate for studies of the long-term and daily effects of solar UV on the skin. Solar spectral UV irradiance values were calculated for different dates and locations by using a radiative transfer model. The spectral irradiance values obtained when the solar elevation is lower than 45 degrees were averaged. An important feature is the dUVA (320-400 nm) to dUVB (290-320 nm) irradiance values ratio, which was found to be 27.3 for the overall average. When the months corresponding to extreme irradiance values (low or high) were excluded from the calculations, the dUVA to dUVB ratio ranged from 27.2 to 27.5. The mean spectral irradiance of the model presented here represents environmental UV exposure conditions and can be used both as a standard to investigate the biological effects of a nonextreme UVR and to assess the effectiveness of products for daily skin protection.     

Spectral monitoring of biologically active solar UVB radiation using an in vitro model of vitamin D synthesis

Vitamin D synthetic capacity of sunlight is the most well known beneficial effect of solar UV radiation. The article describes the new method of biological dosimetry of solar (and artificial) UV radiation based on an in vitro model of vitamin D synthesis (D-dosimeter). Particular attention is given to spectrophotometric analysis of the multicomponent mixture of vitamin D photoisomers that has been developed for the most effective use of D-dosimeter in situ.     

Relationship between vitamin D status and skin phototype in general adult population

A link between bone mineral density and skin color has been reported recently, and pigmentation has been shown to affect cutaneous vitamin D production. In the present study, we investigated the relationship between phototype, global self-assessed sun exposure, geographical location and vitamin D serum levels in 1191 French adults. When the factors were analyzed separately, individuals with lower phototypes as well as those with lower sun exposure showed significantly lower levels of vitamin D than those with darker phototypes or those with higher sun exposure. However, when factors were analyzed as a whole, the vitamin D status was no longer linked with the phototype, but with sun exposure and geographical location. Since phototypes and global self-assessments of sun exposure were positively linked, our data suggest that lower vitamin D levels in fair-skinned individuals are due to their sun exposure behavior.