• Camille E Powe, Michele K Evans, Julia Wenger, Alan B Zonderman, Anders H Berg, Michael Nalls, Hector Tamez, Dongsheng Zhang, Ishir Bhan, S Ananth Karumanchi, Neil R Powe, and Ravi Thadhani.
• From the Department of Medicine, Brigham and Women's Hospital (C.E.P.), Division of Nephrology, Massachusetts General Hospital (J.W., H.T., I.B., R.T.), Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School (A.H.B.), Division of Nephrology, Beth Israel Deaconess Medical Center (D.Z., S.A.K.), and Howard Hughes Medical Institute (D.Z., S.A.K.) - all in Boston; the Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore (M.K.E., A.B.Z.); the Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD (M.N.); and the Department of Medicine, San Francisco General Hospital and University of California, San Francisco, San Francisco (N.R.P.).
• N. Engl. J. Med. 2013 Nov 21; 369 (21): 1991-2000.

BackgroundLow levels of total 25-hydroxyvitamin D are common among black Americans. Vitamin D-binding protein has not been considered in the assessment of vitamin D deficiency.MethodsIn the Healthy Aging in Neighborhoods of Diversity across the Life Span cohort of blacks and whites (2085 participants), we measured levels of total 25-hydroxyvitamin D, vitamin D-binding protein, and parathyroid hormone as well as bone mineral density (BMD). We genotyped study participants for two common polymorphisms in the vitamin D-binding protein gene (rs7041 and rs4588). We estimated levels of bioavailable 25-hydroxyvitamin D in homozygous participants.ResultsMean (±SE) levels of both total 25-hydroxyvitamin D and vitamin D-binding protein were lower in blacks than in whites (total 25-hydroxyvitamin D, 15.6±0.2 ng per milliliter vs. 25.8±0.4 ng per milliliter, P<0.001; vitamin D-binding protein, 168±3 μg per milliliter vs. 337±5 μg per milliliter, P<0.001). Genetic polymorphisms independently appeared to explain 79.4% and 9.9% of the variation in levels of vitamin D-binding protein and total 25-hydroxyvitamin D, respectively. BMD was higher in blacks than in whites (1.05±0.01 g per square centimeter vs. 0.94±0.01 g per square centimeter, P<0.001). Levels of parathyroid hormone increased with decreasing levels of total or bioavailable 25-hydroxyvitamin D (P<0.001 for both relationships), yet within each quintile of parathyroid hormone concentration, blacks had significantly lower levels of total 25-hydroxyvitamin D than whites. Among homozygous participants, blacks and whites had similar levels of bioavailable 25-hydroxyvitamin D overall (2.9±0.1 ng per milliliter and 3.1±0.1 ng per milliliter, respectively; P=0.71) and within quintiles of parathyroid hormone concentration.ConclusionsCommunity-dwelling black Americans, as compared with whites, had low levels of total 25-hydroxyvitamin D and vitamin D-binding protein, resulting in similar concentrations of estimated bioavailable 25-hydroxyvitamin D. Racial differences in the prevalence of common genetic polymorphisms provide a likely explanation for this observation. (Funded by the National Institute on Aging and others.).

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