Worsening air pollution an unfamiliar cause of low vitamin D levels: A systematic literature review

Jai Aditya Jhamb 1, Sanjiv Rampal 2, Ashish Jaiman 3 * , Ajantha Sinniah 4, Jia Bei Tong 5, Aryaman Jaiman 6
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1 Department of Orthopaedics, Sports Injury Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
2 Department of Orthopaedics and Traumatology, Faculty of Medical and Health Sciences, University Putra Malaysia, Selangor, Malaysia
3 Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
4 Department of Pharmacology, Faculty of Medicine University Malaysia, Malaysia
5 Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
6 Department of Orthopaedics, Agartala Government Medical College, Agartala, Tripura, India
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 5, pp. 4-8. https://doi.org/10.23950/jcmk/13760
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Air pollution is widely recognized as a future biohazard, yet its direct effects on human health, particularly in relation to bone health and vitamin D levels, are inadequately understood. While the detrimental impact on respiratory and cardiovascular health is well-documented, the correlation with vitamin D deficiency remains weak.
To explore the relationship between air pollution and vitamin D levels, an extensive search of scientific literature was conducted. This comprehensive search encompassed databases such as PubMed, Cochrane Library, and DOAJ, while also examining the bibliographies of relevant articles. The inclusion criteria focused on studies that specifically investigated the association between air pollution and vitamin D levels, while excluding systematic reviews, case reports, editor's letters, and studies lacking pertinent explanations or causative factors. Each included study underwent rigorous evaluation of its methodological quality, with data extraction performed to assess the reliability and robustness of the evidence for each research question.
The majority of studies have consistently demonstrated a negative correlation between ambient air pollution and vitamin D levels in humans. Several mechanisms have been proposed to explain this relationship, including reduced exposure to sunlight due to increased air pollution, production of reactive oxygen particles, and inflammation leading to decreased vitamin D synthesis. Moreover, certain pollutants, such as particulate matter and nitrogen dioxide, have been found to have a more pronounced impact on vitamin D levels. Variables such as age, gender, season, and geographical location may also influence the association between air pollution and vitamin D levels. Lifestyle factors, including indoor confinement and pre-existing vitamin D deficiency, may exacerbate the detrimental effects of air pollution.
In conclusion, air pollution detrimentally affects vitamin D levels primarily through increased body inflammation and the generation of free radicals. The presence of elevated levels of particulate matter and nitrogen dioxide further compounds this effect. Additionally, decreased cutaneous production of activated vitamin D, resulting from reduced ultraviolet B radiation penetration due to decreased Air Quality Index, contributes to the negative impact. Studies suggest that the intake of exogenous vitamin D supplements and adherence to a calcium-rich diet may confer benefits to individuals residing in highly polluted areas. To address this issue, public health policies should emphasize outdoor exposure to sunlight, promote healthy dietary choices, and reduce overall exposure to pollutants.


Jhamb JA, Rampal S, Jaiman A, Sinniah A, Tong JB, Jaiman A. Worsening air pollution an unfamiliar cause of low vitamin D levels: A systematic literature review. J CLIN MED KAZ. 2023;20(5):4-8. https://doi.org/10.23950/jcmk/13760


  • Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357(3):266-81. https://doi.org/10.1056/NEJMra070553
  • Christodoulou S, Goula T, Ververidis A, Drosos G. Vitamin D and bone disease. Biomed Res Int. 2013; 2013:396541. https://doi.org/10.1155/2013/396541
  • Cashman KD. Vitamin D in childhood and adolescence. Postgrad Med J. 2007; 83(978):230-5. https://doi.org/10.1136/pgmj.2006.052787
  • Hosseinpanah F, Pour SH, Heibatollahi M, Moghbel N, Asefzade S, Azizi F. The effects of air pollution on vitamin D status in healthy women: a cross sectional study. BMC Public Health. 2010; 10:519. https://doi.org/10.1186/1471-2458-10-519
  • van Driel M, van Leeuwen JPTM. Vitamin D endocrinology of bone mineralization. Mol Cell Endocrinol. 2017; 453:46-51. https://doi.org/10.1016/j.mce.2017.06.008
  • Bikle DD. Vitamin D metabolism and function in the skin. Mol Cell Endocrinol. 2011; 347(1-2):80-9. https://doi.org/10.1016/j.mce.2011.05.017
  • Plum LA, DeLuca HF. Vitamin D, disease and therapeutic opportunities. Nat Rev Drug Discov. 2010; 9(12):941-55. https://doi.org/10.1038/nrd3318
  • Wei SQ. Vitamin D and pregnancy outcomes. Curr Opin Obstet Gynecol. 2014; 26(6):438-47. https://doi.org/10.1097/GCO.0000000000000117
  • Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006; 81(3):353-73. https://doi.org/10.4065/81.3.353
  • Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014; 144 Pt A:138-45. https://doi.org/10.1016/j.jsbmb.2013.11.003
  • van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab. 2011;25(4):671-80. https://doi.org/10.1016/j.beem.2011.06.007
  • Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, Calvo MS, Cashman KD, Combs G, De-Regil LM, Jefferds ME, Jones KS, Kapner H, Martineau AR, Neufeld LM, Schleicher RL, Thacher TD, Whiting SJ. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci. 2018; 1430(1):44-79. https://doi.org/10.1111/nyas.13968
  • Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004; 79(3):362-71. https://doi.org/10.1093/ajcn/79.3.362
  • Shaddick G, Thomas ML, Amini H, Broday D, Cohen A, Frostad J, Green A, Gumy S, Liu Y, Martin RV, Pruss-Ustun A, Simpson D, van Donkelaar A, Brauer M. Data Integration for the Assessment of Population Exposure to Ambient Air Pollution for Global Burden of Disease Assessment. Environ Sci Technol. 2018; 52(16):9069-9078. https://doi.org/10.1021/acs.est.8b02864
  • Hoseinzadeh E, Taha P, Wei C, Godini H, Ashraf GM, Taghavi M, Miri M. The impact of air pollutants, UV exposure and geographic location on vitamin D deficiency. Food Chem Toxicol. 2018; 113:241-254. https://doi.org/10.1016/j.fct.2018.01.052
  • Agarwal KS, Mughal MZ, Upadhyay P, Berry JL, Mawer EB, Puliyel JM. The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child. 2002; 87(2):111-3. https://doi.org/10.1136/adc.87.2.111
  • Lekamwasam S, Wijerathne L, Rodrigo M, Hewage U. Age-related trends in phalangeal bone mineral density in Sri Lankan men and women aged 20 years or more. J Clin Densitom. 2009; 12(1):58-62. https://doi.org/10.1016/j.jocd.2008.09.006
  • Liu C, Fuertes E, Flexeder C, Hofbauer LC, Berdel D, Hoffmann B, Kratzsch J, von Berg A, Heinrich J; GINIplus Study Group; LISAplus Study Group. Associations between ambient air pollution and bone turnover markers in 10-year old children: results from the GINIplus and LISAplus studies. Int J Hyg Environ Health. 2015; 218(1):58-65. https://doi.org/10.1016/j.ijheh.2014.07.006
  • Feizabad E, Hossein-Nezhad A, Maghbooli Z, Ramezani M, Hashemian R, Moattari S. Impact of air pollution on vitamin D deficiency and bone health in adolescents. Arch Osteoporos. 2017; 12(1):34. https://doi.org/10.1007/s11657-017-0323-6
  • He H, Zeng Y, Wang X, Yang L, Zhang M, An Z. Meteorological Condition and Air Pollution Exposure Associated with Vitamin D Deficiency: A Cross-Sectional Population-Based Study in China. Risk Manag Healthc Policy. 2020; 13:2317-2324. https://doi.org/10.2147/RMHP.S273145
  • Zhao Y, Wang L, Liu H, Cao Z, Su X, Cai J, Hua J. Particulate Air Pollution Exposure and Plasma Vitamin D Levels in Pregnant Women: A Longitudinal Cohort Study. J Clin Endocrinol Metab. 2019; 104(8):3320-3326. https://doi.org/10.1210/jc.2018-02713
  • Manicourt DH, Devogelaer JP. Urban tropospheric ozone increases the prevalence of vitamin D deficiency among Belgian postmenopausal women with outdoor activities during summer. J Clin Endocrinol Metab. 2008; 93(10):3893-9. https://doi.org/10.1210/jc.2007-2663
  • Calderón-Garcidueñas L, Mora-Tiscareño A, Francolira M, Torres-Jardón R, Peña-Cruz B, Palacios-López C, Zhu H, Kong L, Mendoza-Mendoza N, Montesinoscorrea H, Romero L, Valencia-Salazar G, Kavanaugh M, Frenk S. Exposure to urban air pollution and bone health in clinically healthy six-year-old children. Arh Hig Rada Toksikol. 2013; 64(1):23-34. https://doi.org/10.2478/10004-1254-64-2013-2219
  • Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington (DC): National Academies Press (US); 1997. Available from: https://www.ncbi.nlm.nih.gov/books/NBK109825/ https://doi.org/10.17226/5776
  • Pekkinen M, Viljakainen H, Saarnio E, Lamberg-Allardt C, Mäkitie O. Vitamin D is a major determinant of bone mineral density at school age. PLoS One. 2012; 7(7):e40090. https://doi.org/10.1371/journal.pone.0040090
  • Calderón-Garcidueñas L, Vincent R, Mora-Tiscareño A, Franco-Lira M, Henríquez-Roldán C, Barragán-Mejía G, Garrido-García L, Camacho-Reyes L, Valencia-Salazar G, Paredes R, Romero L, Osnaya H, Villarreal-Calderón R, Torres-Jardón R, Hazucha MJ, Reed W. Elevated plasma endothelin-1 and pulmonary arterial pressure in children exposed to air pollution. Environ Health Perspect. 2007; 115(8):1248-53. https://doi.org/10.1289/ehp.9641
  • Calderón-Garcidueñas L, Villarreal-Calderon R, Valencia-Salazar G, Henríquez-Roldán C, Gutiérrez-Castrellón P, Torres-Jardón R, Osnaya-Brizuela N, Romero L, Torres-Jardón R, Solt A, Reed W. Systemic inflammation, endothelial dysfunction, and activation in clinically healthy children exposed to air pollutants. Inhal Toxicol. 2008; 20(5):499-506. https://doi.org/10.1080/08958370701864797
  • Kelishadi R, Moeini R, Poursafa P, Farajian S, Yousefy H, Okhovat-Souraki AA. Independent association between air pollutants and vitamin D deficiency in young children in Isfahan, Iran. Paediatr Int Child Health. 2014; 34(1):50-5. https://doi.org/10.1179/2046905513Y.0000000080
  • Baïz N, Dargent-Molina P, Wark JD, Souberbielle JC, Slama R, Annesi-Maesano I; EDEN Mother-Child Cohort Study Group. Gestational exposure to urban air pollution related to a decrease in cord blood vitamin d levels. J Clin Endocrinol Metab. 2012; 97(11):4087-95. https://doi.org/10.1210/jc.2012-1943
  • Barati, M., Alizadeh-sani, M., Safari, H., Taghizadeh Jazdani, S., Taghizadeh Jazdani, R. Associations of Environmental Factors and Prevalence of Vitamin D Deficiency in Iran. Journal of Nutrition, Fasting and Health. 2018; 6(4):182-190. https://doi.org/10.22038/jnfh.2019.34216.1135
  • Gill TK, Hill CL, Shanahan EM, Taylor AW, Appleton SL, Grant JF, Shi Z, Dal Grande E, Price K, Adams RJ. Vitamin D levels in an Australian population. BMC Public Health. 2014; 14:1001. https://doi.org/10.1186/1471-2458-14-1001
  • Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, Kim KJ, Rhee Y, Lim SK. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011; 96(3):643-51. https://doi.org/10.1210/jc.2010-2133
  • Barrett H, McElduff A. Vitamin D and pregnancy: An old problem revisited. Best Pract Res Clin Endocrinol Metab. 2010; 24(4):527-39. https://doi.org/10.1016/j.beem.2010.05.010
  • Turton CW, Stanley P, Stamp TC, Maxwell JD. Altered vitamin-D metabolism in pregnancy. Lancet. 1977;1(8005):222-5. https://doi.org/10.1016/s0140-6736(77)91017-0