Skip to main content

Sun behaviour and physical activity associated with autumn vitamin D status in 4–8-year-old Danish children

  • Charlotte Mortensen (a1) (a2), Christian Mølgaard (a1), Hanne Hauger (a1), Michael Kristensen (a2) and Camilla T Damsgaard (a1)...

To explore determinants of serum 25-hydroxyvitamin D (s-25(OH)D) during autumn in young, Caucasian children not consuming vitamin D-fortified foods or supplements, and explore differences in sun behaviours between pre-school and school children.


In September–October, s-25(OH)D was measured by LC–MS/MS; physical activity, sun behaviours and vitamin D intake were assessed with questionnaires.


Baseline data from the ODIN Junior trial at 55°N.


Children aged 4–8 years (n 130), of whom 96% gave blood samples.


Mean s-25(OH)D was 56·8 (sd 12·5) nmol/l and positively associated with fat-free mass index (P=0·014). Children being active 6–7 h/week had 5·6 (95% CI 1·1, 10·0) nmol/l higher s-25(OH)D than less active children (P=0·014). Children seeking shade sometimes or rarely/never had 7·0 (95% CI 1·2, 12·9; P=0·018) and 7·2 (95% CI 0·8, 13·6; P=0·028) nmol/l higher s-25(OH)D, respectively, than children always/often seeking shade. Pre-school children had more sun-safe behaviour than school children in terms of use of a hat, sunscreen and sunscreen sun protection factor (P<0·05). In school but not pre-school children, using a hat rarely/never was associated with 12·1 (95% CI 2·5, 21·7; P=0·014) nmol/l higher s-25(OH)D v. always/often (Pinteraction=0·019). Vitamin D intake was not associated with s-25(OH)D (P=0·241).


Physical activity and sun behaviours are associated with s-25(OH)D in young children. Identifying factors influencing autumn s-25(OH)D is relevant to optimize levels before sun exposure diminishes. Strategies to reduce risk of inadequacy should consider risk of skin cancer and sunburn, and could include fortification and/or vitamin D supplementation.

Corresponding author
*Corresponding author: Email
Hide All
1. Cheng, S, Tylavsky, F, Kröger, H et al. (2003) Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 78, 485492.
2. Wharton, B & Bishop, N (2003) Rickets. Lancet 362, 13891400.
3. Webb, AR (2006) Who, what, where and when – influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 92, 1725.
4. Webb, AR, Kline, L & Holick, MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67, 373378.
5. Spiro, A & Buttriss, JL (2014) Vitamin D: an overview of vitamin D status and intake in Europe. Nutr Bull 39, 322350.
6. Sundhedsstyrelsen (Danish Health Authority) (2017) Anbefalinger om vitamin D (Vitamin D recommendations). (accessed August 2018).
7. Petersen, RA, Damsgaard, CT, Dalskov, S-M et al. (2016) Vitamin D status and its determinants during autumn in children at northern latitudes: a cross-sectional analysis from the optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study. Br J Nutr 115, 239250.
8. Institute of Medicine, Food and Nutrition Board (2011) Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press.
9. Nordic Council of Ministers (2014) Nordic Nutrition Recommendations 2012, Integrating Nutrition and Physical Activity, 5th ed. Copenhagen: Nordic Council of Ministers
10. Ní Chaoimh, C, McCarthy, EK, Hourihane, JO et al. (2018) Low vitamin D deficiency in Irish toddlers despite northerly latitude and a high prevalence of inadequate intakes. Eur J Nutr 57, 783794.
11. Andersen, R, Brot, C, Jakobsen, J et al. (2013) Seasonal changes in vitamin D status among Danish adolescent girls and elderly women: the influence of sun exposure and vitamin D intake. Eur J Clin Nutr 67, 270274.
12. Scientific Advisory Committee on Nutrition (2016) SACN vitamin D and health report. (accessed August 2018).
13. Gordon, CM, DePeter, KC, Feldman, HA et al. (2004) Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158, 531537.
14. Bjarnadottir, A, Kristjansdottir, AG, Hrafnkelsson, H et al. (2015) Insufficient autumn vitamin D intake and low vitamin D status in 7-year-old Icelandic children. Public Health Nutr 18, 208217.
15. Kumar, J, Muntner, P, Kaskel, FJ et al. (2009) Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004. Pediatrics 124, e362e370.
16. Hayek, JE, Pham, TT, Finch, S et al. (2013) Vitamin D status in Montréal preschoolers is satisfactory despite low vitamin D intake. J Nutr 143, 154160.
17. Öhlund, I, Silfverdal, S-A, Hernell, O et al. (2013) Serum 25-hydroxyvitamin D levels in preschool-age children in northern Sweden are inadequate after summer and diminish further during winter. J Pediatr Gastroenterol Nutr 56, 551555.
18. Madsen, KH, Rasmussen, LB, Mejborn, H et al. (2014) Vitamin D status and its determinants in children and adults among families in late summer in Denmark. Br J Nutr 112, 776784.
19. Hansen, L, Tjønneland, A, Køster, B et al. (2016) Sun exposure guidelines and serum vitamin D status in Denmark: the StatusD study. Nutrients 8, 266.
20. Absoud, M, Cummins, C, Lim, MJ et al. (2011) Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS One 6, e22179.
21. Reinau, D, Meier, C, Gerber, N et al. (2012) Sun protective behaviour of primary and secondary school students in North-Western Switzerland. Swiss Med Wkly 142, w13520.
22. Mortensen, C, Damsgaard, CT, Hauger, H et al. (2016) Estimation of the dietary requirement for vitamin D in white children aged 4–8 y: a randomized, controlled, dose–response trial. Am J Clin Nutr 104, 13101317.
23. World Health Organization (2016) Growth reference 5–19 years | Application tools | WHO AnthroPlus software. (accessed January 2016).
24. Kiely, M, Collins, A, Lucey, AJ et al. (2016) Development, validation and implementation of a quantitative food frequency questionnaire to assess habitual vitamin D intake. J Hum Nutr Diet 29, 495504.
25. Pedersen, AN, Fagt, S, Groth, MG et al. (2010) Danskernes Kostvaner 2003–2008: Hovedresultater (Dietary Habits in Denmark 2003–2008: Main Results), 1st release. Søborg: DTU Fødevareinstituttet, Afdelingen for Ernæring (National Food Institute, Division of Nutrition).
26. DTU Fødevareinstituttet, Afdelingen for Ernæring (National Food Institute, Division of Nutrition) (2015) Fødevaredata version 1 | udgave 2015-11-10 (The Danish Food Composition Database version 1 | release 10-11-2015). (accessed January 2016).
27. DTU Fødevareinstituttet, Afdelingen for Ernæring (National Food Institute, Division of Nutrition) (2016) Fødevaredatabanken – version 7.01 (The Danish Food Composition Database – version 7.01; former version). (accessed January 2016).
28. Public Health England (2015) Composition of foods integrated dataset (CoFID). (accessed January 2016).
29. Pichora, EC & Marrett, LD (2010) Sun behaviour in Canadian children: results of the 2006 National Sun Survey. Can J Public Health 101, I14I18.
30. Klostermann, S & Bolte, G (2014) Determinants of inadequate parental sun protection behaviour in their children – results of a cross-sectional study in Germany. Int J Hyg Environ Health 217, 363369.
31. World Health Organization (2011) Global Strategy on Diet, Physical Activity and Health WHO | Physical activity and young people | Recommended levels of physical activity for children aged 5–17 years. (accessed November 2017).
32. Danmarks Meteorologiske Institut (2015) Vejret i Danmark – året 2014 (The weather in Denmark – year 2014). (accessed November 2017).
33. Valtueña, J, Gracia-Marco, L, Huybrechts, I et al. (2013) Cardiorespiratory fitness in males, and upper limbs muscular strength in females, are positively related with 25-hydroxyvitamin D plasma concentrations in European adolescents: the HELENA study. QJM 106, 809821.
34. Foo, LH, Zhang, Q, Zhu, K et al. (2009) Relationship between vitamin D status, body composition and physical exercise of adolescent girls in Beijing. Osteoporos Int 20, 417425.
35. Drincic, AT, Armas, LAG, van Diest, EE et al. (2012) Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring) 20, 14441448.
36. Madsen, KH, Rasmussen, LB, Andersen, R et al. (2013) Randomized controlled trial of the effects of vitamin D-fortified milk and bread on serum 25-hydroxyvitamin D concentrations in families in Denmark during winter: the VitmaD study. Am J Clin Nutr 98, 374381.
37. Houghton, LA, Szymlek-Gay, EA, Gray, AR et al. (2010) Predictors of vitamin D status and its association with parathyroid hormone in young New Zealand children. Am J Clin Nutr 92, 6976.
38. Morris, J, McGee, R & Bandaranayake, M (1998) Sun protection behaviours and the predictors of sunburn in young children. J Paediatr Child Health 34, 557562.
39. Weng, FL, Shults, J, Leonard, MB et al. (2007) Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents. Am J Clin Nutr 86, 150158.
40. Arneson, WL & Arneson, DL (2013) Current methods for routine clinical laboratory testing of vitamin D levels. Lab Med 44, e38e42.
41. Thorisdottir, B, Gunnarsdottir, I, Steingrimsdottir, L et al. (2016) Vitamin D intake and status in 6-year-old Icelandic children followed up from infancy. Nutrients 8, 75.
42. Rockell, JE, Green, TJ, Skeaff, CM et al. (2005) Season and ethnicity are determinants of serum 25-hydroxyvitamin D concentrations in New Zealand children aged 5–14 y. J Nutr 135, 26022608.
43. Wang, TJ, Zhang, F, Richards, JB et al. (2010) Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet 376, 180188.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score