Ce travail de thèse s’articule en deux parties. Dans une première partie (aspects descriptifs, cohortes SU.VI.MAX et NutriNet-Santé), nous avons mis en évidence différents facteurs influençant le statut en vitamine D, parmi lesquels certains sont modifiables et pourraient ainsi faire l’objet de recommandations de santé publique (exposition solaire modérée, activité physique, maintenance d’un poids normal). Sur la base de ces déterminants, nous avons développé le score VDIP permettant d’identifier de manière simple en pratique clinique des adultes à risque d’insuffisance en vitamine D. Enfin, l’étude des connaissances liées à la vitamine D dans un large groupe d’adultes issus de la population générale a mis en évidence une certaine confusion par rapport aux sources de vitamine D et à ses effets santé établis ou non.Dans une seconde partie (aspects étiologiques, étude cas-témoin nichée dans la cohorte SU.VI.MAX), nous avons mis en évidence qu’un statut plus élevé en vitamine D (parmi des concentrations plasmatiques en 25(OH)D faibles à modérées telles qu’observées dans cette étude) pourrait être associé à une diminution de risque de cancer du sein, de cancer de la prostate et de cancers liés au tabac. Ces associations seraient toutefois modifiées par différents facteurs individuels comme le statut pondéral ou la consommation d’alcool (cancer du sein en particulier). L’étude des différents polymorphismes génétiques a permis de confirmer les résultats observés avec le statut en vitamine D.Dans un contexte où la vitamine D suscite une attention grandissante, les résultats de cette thèse contribuent à mieux connaître les facteurs influençant le statut en vitamine D, à fournir un aperçu détaillé des connaissances/croyances concernant la vitamine D en population générale et fournissent de nouveaux éléments pour une meilleure compréhension du rôle de la vitamine D dans l’étiologie des cancers. Ces travaux pourraient ainsi participer, à terme, à l’optimisation des recommandations de santé publique pour l’amélioration du statut en vitamine D de la population et pour la prévention primaire des cancers. / Two main parts structured this PhD thesis. In the first part (descriptive work, SU.VI.MAX and NutriNet-Santé cohorts), we identified factors that influenced vitamin D status, some of which being modifiable (e.g. moderate sun exposure, physical activity, normal weight) and as such constitute interesting targets for public health policies. Using these determinants, we developed the VDIP score in order to simply identify adults at risk of vitamin d insufficiency. Finally, the study dealing with vitamin D-related knowledge showed that the primary sources of vitamin D-related information were the physicians and the media and that some confusion existed regarding the sources and the proven/unproven health effects of vitamin D.In a second part (etiological work, nested case-control study, SU.VI.MAX cohort), we showed that a higher vitamin D status (within the low-to-moderate range of plasma 25(OH)D concentrations observed in this study) may be associated with a decreased risk of breast, prostate and tobacco-related cancers. These associations were modified by individual factors such as weight status and alcohol intake (in particular breast cancer). The studied genetic polymorphisms confirmed the associations observed with vitamin D status.In a context where vitamin D arouses considerable interest, these results may contribute to a better understanding of the factors that influence vitamin D status, to a better insight of what people know and believe regarding vitamin D and to a better understanding of the role of vitamin D in the etiology of cancer. These PhD findings could eventually contribute to the optimization of public health nutritional recommendations for the improvement of vitamin D status in the population and for cancer primary prevention.

Osteoporosis literally means 'porous bone" and is characterized by an increase in bone fragility and susceptibility to fracture, which typically involves the wrist, spine and hip (South African Medical Association (SAMA) Working Group, 2000). In South Africa osteoporosis and fractures are more common in whites than in blacks. African-American men experience hip fractures at a rate of only half of that of Caucasian men. The bone mass in Africans were found to be 6 - 12 % higher than in Caucasians at all ages. A higher peak bone density at skeletal maturity in African-Americans were found, so that despite comparable age related bone loss, African Americans reach the fracture threshold less frequently than whites. Age-related bone loss that begins later, is less severe, or occurs in different skeletal sites in African-Americans than whites (Luckey et al., 1996). American whites have a higher bone turnover than American blacks, but in contrast to this American data. South African blacks may have a higher bone turnover and lower bone density than whites (Daniels et a/., 1995). If it is compared with Caucasians a lower rate of hip fracture in South African blacks were found, despite lower bone density at all ages (Villa, 1994). The lower fracture rate in blacks than in whites is because of greater bone mass and higher bone turnover leading to more frequent renewal of damaged bone. Blacks excrete less urinary calcium, and show no skeletal sensitivity towards the parathyroid hormone. Few studies focus on older black South African men and osteoporosis. Objectives The aim of this study was to investigate the relationship of calcium intake, vitamin D status, anthropometry and physical activity and bone density in black South African men. Methods A case-control study design was used, in which variables associated with bone density were compared. The case group were men with fractures of the proximal femur, the proximal humerus or the distal radius and an equal number of age-matched healthy black men (with not more than a 5-year age difference) with no fracture (the proximal femur and humerus and distal radius) previously, was recruited as a control group. Bone density was measured with DEXA. Fat percentage was measured with a Tanita scale. Biochemical analyses were done. Questionnaires were used to gather demographic, activity and dietary information. To our knowledge, this is the first case-control study on osteoporotic fractures in South African black men. Results Both the groups' bone mineral densities were lower than recommended. The bone density of the case group for lumbar and hip regions was 0.86 and 0.88 and the control group's bone density for lumbar region was 0.95 and hip region 0.91. The control group was more physically active and had a better nutritional status than the case group. The control group's calcium intake was higher but the vitamin D status was lower than the case group. Both calcium and vitamin D status were not statistically significant (pc0.5), between the two groups. Body mass indices of the groups were the same. The serum albumin was higher in the control group than in the case group. The case group serum calcium was higher than the control group. Both serum albumin and serum calcium were statistical significant between the two groups. There were no statistically significant differences in any of the other biochemical variables between the two groups. Serum phosphate and serum vitamin D were statistical significant for bone density of the hip and lumbar regions. Conclusion To conclude it seems logical to suggest a healthy diet with optimal macro- and micro nutrient intake. Maintain ideal body weight and body fat percentage and recommend regular but moderate-weight-bearing exercise from a young age throughout adult life, as part of a strategy to prevent and treat osteoporosis. In the present study black South African men present with low bone mineral density, but other studies indicated a lower rate of hip fracture in South African blacks, despite lower bone density at all ages. It can be recommended that other factors may play a role in black South African men with osteoporosis. Factors such as serum phosphorus, 25-hydroxy-vitamin D, body mass index (BMI), physical activity index (PAI), animal protein, total fat intake and dietary calcium are important determinants of BMD in older South African blacks, as shown in the present study. Osteoporosis is a multi factorial problem and must be treated that way. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2004.

Osteoporosis literally means 'porous bone" and is characterized by an increase in bone fragility and susceptibility to fracture, which typically involves the wrist, spine and hip (South African Medical Association (SAMA) Working Group, 2000). In South Africa osteoporosis and fractures are more common in whites than in blacks. African-American men experience hip fractures at a rate of only half of that of Caucasian men. The bone mass in Africans were found to be 6 - 12 % higher than in Caucasians at all ages. A higher peak bone density at skeletal maturity in African-Americans were found, so that despite comparable age related bone loss, African Americans reach the fracture threshold less frequently than whites. Age-related bone loss that begins later, is less severe, or occurs in different skeletal sites in African-Americans than whites (Luckey et al., 1996). American whites have a higher bone turnover than American blacks, but in contrast to this American data. South African blacks may have a higher bone turnover and lower bone density than whites (Daniels et a/., 1995). If it is compared with Caucasians a lower rate of hip fracture in South African blacks were found, despite lower bone density at all ages (Villa, 1994). The lower fracture rate in blacks than in whites is because of greater bone mass and higher bone turnover leading to more frequent renewal of damaged bone. Blacks excrete less urinary calcium, and show no skeletal sensitivity towards the parathyroid hormone. Few studies focus on older black South African men and osteoporosis. Objectives The aim of this study was to investigate the relationship of calcium intake, vitamin D status, anthropometry and physical activity and bone density in black South African men. Methods A case-control study design was used, in which variables associated with bone density were compared. The case group were men with fractures of the proximal femur, the proximal humerus or the distal radius and an equal number of age-matched healthy black men (with not more than a 5-year age difference) with no fracture (the proximal femur and humerus and distal radius) previously, was recruited as a control group. Bone density was measured with DEXA. Fat percentage was measured with a Tanita scale. Biochemical analyses were done. Questionnaires were used to gather demographic, activity and dietary information. To our knowledge, this is the first case-control study on osteoporotic fractures in South African black men. Results Both the groups' bone mineral densities were lower than recommended. The bone density of the case group for lumbar and hip regions was 0.86 and 0.88 and the control group's bone density for lumbar region was 0.95 and hip region 0.91. The control group was more physically active and had a better nutritional status than the case group. The control group's calcium intake was higher but the vitamin D status was lower than the case group. Both calcium and vitamin D status were not statistically significant (pc0.5), between the two groups. Body mass indices of the groups were the same. The serum albumin was higher in the control group than in the case group. The case group serum calcium was higher than the control group. Both serum albumin and serum calcium were statistical significant between the two groups. There were no statistically significant differences in any of the other biochemical variables between the two groups. Serum phosphate and serum vitamin D were statistical significant for bone density of the hip and lumbar regions. Conclusion To conclude it seems logical to suggest a healthy diet with optimal macro- and micro nutrient intake. Maintain ideal body weight and body fat percentage and recommend regular but moderate-weight-bearing exercise from a young age throughout adult life, as part of a strategy to prevent and treat osteoporosis. In the present study black South African men present with low bone mineral density, but other studies indicated a lower rate of hip fracture in South African blacks, despite lower bone density at all ages. It can be recommended that other factors may play a role in black South African men with osteoporosis. Factors such as serum phosphorus, 25-hydroxy-vitamin D, body mass index (BMI), physical activity index (PAI), animal protein, total fat intake and dietary calcium are important determinants of BMD in older South African blacks, as shown in the present study. Osteoporosis is a multi factorial problem and must be treated that way. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2004.

No / Vitamin D deficiency is thought to impair insulin action and glucose metabolism; however, previous studies have not examined ethnic differences or the influence of calcium and parathyroid hormone. We investigated this in a cohort of predominantly white European and south Asian women during pregnancy. Methods: In this cross-sectional study from an urban population in northern England (53.8°N), 1467 women were recruited when undergoing glucose tolerance testing (75 g oral glucose tolerance test) at 26 weeks' gestation. Results: Gestational diabetes mellitus (GDM) was diagnosed in 137 women (9.3%). Median 25-hydroxyvitamin D concentration for the study population was 9.3 ng/mL (interquartile range 5.2, 16.9) and was higher in European [15.2 ng/mL (10.7, 23.5)] than in south Asian women [5.9 ng/mL (3.9, 9.4), P < .001]. After appropriate adjustment for confounders, 25-hydroxyvitamin D showed a weak inverse association with fasting plasma glucose (FPG; mean difference 1.0% per 1 SD; the ratio of geometric means (RGM) 0.99, 95% confidence interval (CI) 0.98, 1.00), and PTH was weakly associated with FPG (RGM 1.01, 95% CI 1.00, 1.02), but neither was associated with fasting insulin, postchallenge glucose, or GDM. Serum calcium (albumin adjusted) was strongly associated with fasting insulin (RGM 1.06; 95% CI 1.03, 1.08), postchallenge glucose (RGM 1.03, 95% CI 1.01, 1.04), and GDM (odds ratio 1.33, 95% CI 1.06, 1.66) but not with FPG. Associations were similar in European and south Asian women. Conclusions: These findings do not indicate any important association between vitamin D status and glucose tolerance in pregnancy. Relationships between circulating calcium and glucose metabolism warrant further investigation.

African Americans have increased risk for cardiovascular and cerebral vascular disease relative to Caucasian Americans. While it is generally accepted that arteries become stiffer at a younger age in African Americans; less is known regarding cerebral vascular function / reactivity (CVMR) to hypercapnia in African Americans. Furthermore, little is known regarding the relationship between arterial stiffness and CVMR, particularly in young healthy adults. We hypothesized that African Americans have stiffer arteries (i.e. arterial stiffness) and reduced CVMR during hypercapnia relative to Caucasian Americans. We also hypothesized that there would be a negative relationship between arterial stiffness and CVMR. Lastly, we hypothesized that these responses would be related to a decrease in Vitamin D status in this population and there would be correlation between Vitamin D status and CVMR. In 11 African American and 19 Caucasian American subjects central arterial stiffness was indexed from carotid-femoral pulse wave velocity (PWV). CVMR was assessed by the cerebral vascular conductance (CVC) response to rebreathing-induced hypercapnia. Vitamin D status was assessed from plasma 25(OH) Vitamin D. PWV was elevated in the African Americans (African American: 581.16 ± 27.7 cm/sec vs. Caucasian American: 502.98 ± 17.6 cm/sec; P < 0.01). CVMR was significantly reduced during hypercapnic rebreathing in the African Americans (African American: 3.05 ± 0.38% of baseline/mmHg vs. Caucasian American: 5.09 ± 0.29% of baseline/mmHg; P < 0.001). When data from all subjects was included there was a trend towards a negative relationship (R = 0.32, P = 0.10) between PWV and CVMR. Vitamin D status was significantly lower in African Americans (African American: 14.96 ± 0.97 ng/ml vs. Caucasian American: 32.73 ± 0.99 ng/ml; P < 0.001); however, there was no significant relationship between Vitamin D status and CVMR (R = 0.23 P = 0.23). In conclusion, these data indicate that African Americans have impaired cerebral vascular responses to hypercapnia, stiffer arteries, and lower Vitamin D status when compared with Caucasian Americans. In addition, there may be a negative relationship between CVMR and PWV; however, no significant correlation between Vitamin D status and vascular function including PWV or CVMR was observed in this study. / text