cforyourself vitamin d

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Effect of long-term vitamin D3 supplementation vs placebo on risk of depression or clinically relevant depressive symptoms and on change in mood scores: A randomized clinical trial. Glucocorticoid-induced osteoporosis: pathogenesis and management. The combination of high intakes of calcium (about 2,100 mg/day from food and supplements) with moderate amounts of vitamin D (about 19 mcg [765 IU]/day from food and supplements) increased the risk of kidney stones by 17% over 7 years among 36,282 postmenopausal women who were randomly assigned to take 1,000 mg/day calcium and 10 mcg (400 IU)/day vitamin D or a placebo [161]. Pancreatic cancer The USPSTF also reviewed the seven published studies on the effects of vitamin D supplementation (two of them also included calcium supplementation) on the risk of falls in community-dwelling adults aged 65 years or older who did not have osteoporosis or vitamin D deficiency. The fortification of milk (a good source of calcium) and other staples, such as breakfast cereals and margarine, with vitamin D beginning in the 1930s along with the use of cod liver oil made rickets rare in the United States [28,50]. cforyourself vitamin d. tex watson children; cforyourself vitamin d. May 24, 2022. [, McNamara M, Rosenberger KD. Your doctor may recommend a vitamin D tablet for you. However, the incidence of rickets is increasing globally, even in the United States and Europe, especially among immigrants from African, Middle-Eastern, and Asian countries [51]. Vitamin D3 is more efficient than D2. Levels of 50 nmol/L (20 ng/mL) or more are sufficient for most people. Low blood levels of vitamin D have also been associated with: An impairment in memory and thinking skills in older adults. Again, the pattern was similar for the risk of inadequacy. Positive association between circulating 25-hydroxyvitamin D levels and prostate cancer risk: New findings from an updated meta-analysis. [, Taylor CL, Rosen CJ, Dwyer JT. Ann Intern Med 2017;166:155-6. Lancet Diabetes-Endocrinol 2014;2:719-29. Having produced a solution of this blue indicator, some researchers suggest its use as an indicator for the presence of Vitamin C. Vitamin D deficiency or insufficiency did not increase the risk of prostate cancer, and higher 25(OH)D concentrations were not associated with a lower risk. [, Kahwati LC, Weber RP, Pan H, Gourlay M, LeBlanc E, Coker-Schwimmer M, Viswanathan M. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: Evidence report and systematic review for the US Preventive Services Task Force. Vitamin D status and weight loss: A systematic review and meta-analysis of randomized and nonrandomized controlled weight-loss trials. Consumption of human milk alone does not ordinarily enable infants to meet vitamin D requirements, because it provides less than 0.6 to 2.0 mcg/L (25 to 78 IU/L) [1,56,57]. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D. Many tissues have vitamin D receptors, and some convert 25(OH)D to 1,25(OH)2D. However, most evidence indicates that vitamin D3 increases serum 25(OH)D levels to a greater extent and maintains these higher levels longer than vitamin D2, even though both forms are well absorbed in the gut [33-36]. It reflects vitamin D produced endogenously and that obtained from foods and supplements [1]. Vitamin C Products Cforyourself now sells Nutribiotic vitamin C products. J Clin Endocrinol Metab 2014;99:3551-60. Cancer Res 2019;79:274-85. [, Mheid IA, Quyyumi AA. Yao P, Bennett D, Mafham M, Lin X, Chen Z, Armitage J, Clarke R. Vitamin D and calcium for the prevention of fracture: A systematic review and meta-analysis. Vitamin D synthesis following a single bout of sun exposure in older and younger men and women. Int J Obes Relat Metab Disord 1997;21:S24-30. Bone health also depends on support from the surrounding muscles to assist with balance and postural sway and thereby reduce the risk of falling. Conclusions about vitamin D and cancer J Nutr 2014;144:654-9. Screening for vitamin D status is becoming a more common part of the routine laboratory bloodwork ordered by primary-care physicians, irrespective of any indications for this practice [6,52-54]. People who avoid all animal-sourced products can contact dietary supplement manufacturers to ask about their sourcing and processing techniques. Levels of 75 to less than 87.5 nmol/L (30 to less than 35 ng/mL) and 87.5 to less than 100 nmol/L (35 to less than 40 ng/mL) were associated with a 19% and 27% lower risk, respectively. In practice, however, people usually do not apply sufficient amounts of sunscreen, cover all sun-exposed skin, or reapply sunscreen regularly. Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals. Prospective population-based study of the association between serum 25-hydroxyvitamin-D levels and the incidence of specific types of cancer. In the NHANES 20012006 survey, 25(OH)D deficiency (less than 25 nmol/L [10 ng/mL]) was more than twice as common among children and adults who reported oral steroid use (11%) than in nonusers (5%) [174]. A large case-control study included 5,706 individuals who developed colorectal cancer and whose 25(OH)D levels were assessed a median of 5.5 years from blood draw to cancer diagnosis and 7,105 matched controls [101]. [, Dibaba DT. A variety of foods and their vitamin D levels per serving are listed in Table 3. Vitamin D is essential for bone strength and may support the immune system and other functions. Vitamin D (also referred to as "calciferol") is a fat-soluble vitamin that is naturally present in a few foods, added to others, and available as a dietary supplement. In contrast to 25(OH)D, circulating 1,25(OH)2D is generally not a good indicator of vitamin D status because it has a short half-life measured in hours, and serum levels are tightly regulated by parathyroid hormone, calcium, and phosphate [1]. In adults and adolescents, vitamin D deficiency can lead to osteomalacia, in which existing bone is incompletely or defectively mineralized during the remodeling process, resulting in weak bones [46]. It helps the bones absorb calcium, supports the immune system and may aid strength gain and fat loss. One systematic review and meta-analysis of 11 randomized, controlled trials published through 2018 of vitamin D supplementation alone (1020 mcg [400800 IU]/day or more at least every week or as rarely as once a year) for 9 months to 5 years found that the supplements provided no protection from fractures in 34,243 older adults [81]. [, van Duijnhoven FJB, Jenab M, Hveem K, Siersema PD, Fedirko V, Duell EJ, et al. Another reason is that animal foods contain some 25(OH)D. This form of vitamin D is not included in intake surveys and is considerably more potent than vitamins D2 or D3 at raising serum 25(OH)D levels [42]. [. Picciano MF. Few people near the equator develop the disease, whereas the prevalence is higher further north and south. Search for: Menu. Lancet Diabetes Endocrinol 2018;6:834-5. [, Travis RC, Perez-Cornago A, Appleby PN, Albanes D, Joshu CE, Lutsey PL, et al. : CD008422. Long-term vitamin D3 supplementation is more effective than vitamin D2 in maintaining serum 25-hydroxyvitamin D status over the winter months. The significance of vitamin D status in breast cancer: A state of the science review. [, Robien K, Oppeneer SJ, Kelly JA, Hamilton-Reeves JM. While acknowledging that signs and symptoms of toxicity are unlikely at daily intakes below 250 mcg (10,000 IU), the FNB noted that even vitamin D intakes lower than the ULs might have adverse health effects over time. Women with 25(OH)D levels of less than 30 nmol/L (12 ng/mL) had a 43% higher MS risk than women with levels of 50 nmol/L (20 ng/mL) or higher. Vitamin D deficiency. Vitamin C helps in maintaining a healthy immune system, it aids in neutralizing pollutants, is needed for antibody production, acts to increase the absorption of nutrients (including iron) in the gut, and thins the blood. All can be significantly helped with proper amounts of vitamin C. J Clin Endocrinol Metab 2011;96:3838-45. Experts do not believe that excessive sun exposure results in vitamin D toxicity because thermal activation of previtamin D3 in the skin gives rise to various non-vitamin D forms that limit formation of vitamin D3. Hossein-nezhad A, Holick MF. The Dietary Guidelines for Americans describes a healthy dietary pattern as one that: This fact sheet by the National Institutes of Health (NIH) Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. Prostate cancer No. This U-shaped association was most pronounced for men with the most aggressive forms of prostate cancer. Most participants were vitamin D sufficient; at baseline, only 2.4% had serum 25(OH)D levels less than 30 nmol/L (12 ng/mL), and 12.9% less than 50 nmol/L (20 ng/mL). Pharmacotherapy 2002;22:814-22. [, Vaes AMM, Tieland M, Toussaint N, Nilwik R, Verdijk LB, van Loon LJC, de Groot CPGM. J Clin Endocrinol Metab 2011;96:1911-30. [, Graeff-Armas LA, Bendik I, Kunz I, Schoop R, Hull S, Beck M. Supplemental 25-hydroxycholecalciferol is more effective than cholecalciferol in raising serum 25-hydroxyvitamin D concentrations in older adults. J Nutr 2018;148:712-20. Effects of vitamin D supplementation in atorvastatin-treated patients: A new drug interaction with an unexpected consequence. $12.99. J Clin Endorcinol Metab 2015;100:2339-46. For a reader-friendly overview of Vitamin D, see our consumer fact sheet on Vitamin D. For information on vitamin D and COVID-19, see Dietary Supplements in the Time of COVID-19. [, Davis CD, Dwyer JT. Vitamin D2 is manufactured using UV irradiation of ergosterol in yeast, and vitamin D3 is typically produced with irradiation of 7-dehydrocholesterol from lanolin obtained from the wool of sheep [13,31]. Effect of vitamin D supplementation on serum lipid profiles: A systematic review and meta-analysis. [, Yin L, Ordonez-Mena JM, Chen T, Schottker B, Arndt V, Brenner H. Circulating 25-hydroxyvitamin D serum concentration and total cancer incidence and mortality: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2016;26:663-73. Metabolism 2016;65:586-97. Scientific Advisory Committee on Nutrition. An animal-free version of vitamin D3 sourced from lichen is also available [32]. Washington DC: Wiley-Blackwell, 2012. Levels of 1,25(OH)2D do not typically decrease until vitamin D deficiency is severe [2]. Nutrition 2015;31:421-9. [, Chakhtoura M, Rahme M, Fuleihan E-H. Vitamin D metabolism in bariatric surgery. Clinical management of low vitamin D: A scoping review of physicians' practices. Vitamin D and calcium: A systematic review of health outcomes. RDAs for vitamin D are listed in both micrograms (mcg) and international units (IU); 1 mcg vitamin D is equal to 40 IU (Table 2). Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%98%) healthy individuals; often used to plan nutritionally adequate diets for individuals. A study of cohorts that included 5,313 participants who developed lung cancer and 5,313 matched controls found no association between serum 25(OH)D levels and risk of subsequent lung cancer, even when the investigators analyzed the data by sex, age, race and ethnicity, and smoking status [104]. More than half the women who developed MS had deficient or insufficient vitamin D levels. [, Quesada-Gomez JM, Bouillon R. Is calcifediol better than cholecalciferol for vitamin D supplementation? Individuals with a body mass index (BMI) of 30 or more have lower serum 25(OH)D levels than individuals without obesity. Importantly, not all observational studies found higher vitamin D status to be beneficial, and the studies varied considerably in study populations, baseline comorbidities, and measurement of vitamin D levels. Allergies, viruses and bacterial infections, auto-immune diseases, any malady that is tissue-related. Three trials conducted since that meta-analysis also found no effect of vitamin D supplementation on depressive symptoms. It's also termed hypervitaminosis D. Vitamin D is a fat-soluble vitamin. U.S. Department of Health and Human Services. Even though sunlight is a major source of vitamin D for some people, the FNB based the vitamin D RDAs on the assumption that people receive minimal sun exposure [1]. J Clin Endocrinol Metab 2014;99:1132-41. Another study that compared 200 male smokers in Finland with pancreatic cancer to 400 matched controls found that participants in the highest quintile of 25(OH)D levels (more than 65.5 nmol/L [26.2 ng/mL]) had a threefold greater risk of developing pancreatic cancer over 16.7 years than those in the lowest quintile (less than 32 nmol/L [12.8 ng/mL]) [106]. Calcium plus vitamin D supplementation and the risk of postmenopausal weight gain. However, normal-weight participants had greater reductions in cancer incidence and mortality rates than those with overweight or obesity. It also helps keep your muscles, nerves, and immune system working normally. The investigators randomly assigned participants to receive either a bolus oral dose of 2,500 mcg (100,000 IU) vitamin D3 followed by 100 mcg (4,000 IU)/day or a placebo for 16 weeks. In addition, older adults are likely to spend more time than younger people indoors, and they might have inadequate dietary intakes of the vitamin [1]. Neurology 2017;89: 1578-83. Eggs. 183 prepared by the Tufts Evidence-based Practice Center under Contract No. [, Scragg R, Stewart AW, Waayer D, Lawes CMM, Toop L, Sluyter J, et al. Nutrients 2018, 10, 59; doi:10.3390/nu10010059. Plant milk alternatives (such as beverages made from soy, almond, or oats) are often fortified with similar amounts of vitamin D to those in fortified cow's milk (about 3 mcg [120 IU]/cup); the Nutrition Facts label lists the actual amount [24]. In another study, 10 mcg (400 IU)/day vitamin D and 1,000 mg/day calcium supplementation slightly, but significantly, reduced weight gain amounts in comparison with placebo in postmenopausal women, especially those with a baseline total calcium intake of less than 1,200 mg/day [153]. For more information about building a healthy dietary pattern, refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture's MyPlate. [, Yetley EA. However, women with vitamin D intakes higher than 15 mcg (600 IU)/day at the start of the trial and who received the supplements experienced a 28% increased risk of invasive (but not in situ) breast cancer. Here are my top 8 foods rich in vitamin D to start adding into your regimen: 1. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers. [, Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng T-YD, Hong C-C, et al. Ann Intern Med 2014;160:558-64. [, Golzarand M, Shab-Bidar S, Koochakpoor G, Speakman JR, Djafarian K. Effect of vitamin D3 supplementation on blood pressure in adults: An updated meta-analysis. Two earlier prospective studies of similar designone in the United States with 444 non-Hispanic White individuals [140] and the other with 576 individuals in northern Sweden [141]found that levels of 25(OH)D greater than 99.1 nmol/L (39.6 ng/mL) and at least 75 nmol/L (30 ng/mL), respectively, were associated with a 6162% lower risk of MS. No clinical trials have examined whether vitamin D supplementation can prevent the onset of MS, but several have investigated whether supplemental vitamin D can help manage the disease. It means you need fats in your body for proper absorption of vitamin D. Since vitamin D maintains calcium and phosphorous levels in our bodies, it is an essential vitamin for good bone, muscle, and teeth health. In serum, 25(OH)D has a fairly long circulating half-life of 15 days [1]. Vitamin D is important for bone and muscle strength and immune function. Vitamin D supplementation and risk of toxicity in pediatrics: A review of current literature. [, Chalcraft JR, Cardinal LM, Wechsler PJ, Hollis BW, Gerow KG, Alexander BM, et al. Includes a variety of protein foods such as lean meats; poultry; eggs; seafood; beans, peas, and lentils; nuts and seeds; and soy products. Fat malabsorption is associated with medical conditions that include some forms of liver disease, cystic fibrosis, celiac disease, Crohns disease, and ulcerative colitis [1,63]. The vitamin D reduced insulin resistance to a small but significant degree, especially in people taking more than 50 mcg (2,000 IU)/day who were vitamin D deficient at baseline, had good glycemic control, did not have obesity, and were of Middle Eastern ethnicity. J Clin Endocrin Metab 2013;98:4339-45. Pages 41-78 in Feldman D, Pike JW, Bouillon R, Giovannucci E, Goltzman D, Hewison M, eds. Salmon. However, whether these lower levels in persons with dark skin have significant health consequences is not clear [14]. [, Bouillon R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol 2017;13:466-79. [, McCullough ML, Zoltick ES, Weinstein SJ, Fedirko V, Wang M, Cook NR, et al. The second trial included 155 adults aged 6080 years who had clinically relevant depressive symptoms, no major depressive disorder, and serum 25(OH)D levels less than 50 to 70 nmol/L (20 to 28 ng/mL) depending on the season; in addition, they were not taking antidepressants [133,134]. Summary. A systematic review and meta-analysis of 15 weight-loss intervention studies that used caloric restriction, exercise, or both, but not necessarily vitamin D supplementation or other treatments, found that people who lost weight had significantly greater increases in serum 25(OH)D levels than those who maintained their weight [152]. A prospective nested case-control study of vitamin D status and pancreatic cancer risk in male smokers. [. [, Drincic A, Fuller E, Heaney RP, Armas LAG. Hello and welcome to Cforyourself. Vitamin D and bone density, fractures, and falls: The end of the story? The vitamin D supplements were associated with serum 25(OH)D levels of 54 to 135 nmol/L (21.6 to 54 ng/mL). Talk with your doctor or nurse about vitamin D at your child's next check-up if you have questions. Whole foods are an excellent choice." They also stated that "an orange provides not only vitamin C but also carotene, calcium, and free sugars for energy. In a trial in Norway, 511 men and women aged 2580 years (mean age 62 years) with prediabetes received 500 mcg (20,000 IU) vitamin D3 or a placebo each week for 5 years [149]. [, Schwartz JB. Consume fatty. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) One recent clinical trial, for example, randomized 78 frail and near-frail adults aged 65 years and older to receive 20 mcg (800 IU) vitamin D3, 10 mcg 25(OH)D, or placebo daily for 6 months. 6.Mushrooms. For this. Effects of vitamin D supplementation on musculoskeletal health: A systematic review, meta-analysis, and trial sequential analysis. [, Taylor CL, Roseland JM, Coates PM, Pehrsson PR. [, Heath AK, Hodge AM, Ebeling PR, Eyles DW, Kvaskoff D, Buchanan DD, et al. Hypercalcemia, in turn, can lead to nausea, vomiting, muscle weakness, neuropsychiatric disturbances, pain, loss of appetite, dehydration, polyuria, excessive thirst, and kidney stones. The use of sunscreen also limits vitamin D synthesis from sunlight. doi: 10.3390/nu10040493. Proportions at risk of deficiency were lowest among children aged 15 years (0.5%), peaked at 7.6% in adults aged 2039 years, and fell to 2.9% among adults aged 60 years and older; patterns were similar for risks of inadequacy. J Am Geriatr Soc 1984;32:405-7. After $3 OFF. Hypercalcaemia following vitamin D and thiazide therapy in the elderly. [, Jagannath VA, Filippini G, Di Pietrantonj C, Asokan GV, Robak EW, Whamond L, Robinson SA. Ready-to-eat breakfast cereals often contain added vitamin D, as do some brands of orange juice, yogurt, margarine, and other food products. Many other countries around the world and some professional societies have somewhat different guidelines for vitamin D intakes [15]. [, Keum N, Lee DH, Greenwood DC, Manson JE, Giovannucci E. Vitamin D supplementation and total cancer incidence and mortality: A meta-analysis of randomized controlled trials. Studies examining the effects of supplemental vitamin D on muscle strength and on rate of decline in muscle function have had inconsistent results [55]. Most trials of the effects of vitamin D supplements on bone health also included calcium supplements, so isolating the effects of each nutrient is difficult. For example, an analysis was conducted of 19 prospective studies that provided data on prediagnostic levels of 25(OH)D for 13,462 men who developed prostate cancer and 20,261 control participants [113]. Experts have reached no firm consensus on whether vitamin D can help prevent MS given the lack of clinical trial evidence [142]. [, LeFevre ML. Effects of atorvastatin on vitamin D levels in patients with acute ischemic heart disease. Crit Rev Food Sci Nutr 2015;55:1193-205. One study included 1,119 men treated for prostate cancer whose plasma 25(OH)D levels were measured 4.9 to 8.6 years after their diagnosis. [. Overview of the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Neurology 2012;79:2140-5. However, as people ageand particularly in women during menopausebone breakdown rates overtake rates of bone building. J Nutr 2020;150:73-81. Older adults Pages 939-57 in Feldman D, Pike JW, Bouillon R, Giovannucci E, Goltzman D, Hewison M, eds. Your skin can produce large quantities of vitamin D on its own when exposed to the sun's UV-B rays. Circulating vitamin D and colorectal cancer risk: An international pooling project of 17 cohorts. [, Helzlsouer KJ for the VDPP Steering Committee. Jamieson Vitamin D3 1000 IU, 375 Tablets, 2-pack. Questions about vitamin D for primary care practice: Input from an NIH conference. Because vitamin D is fat soluble, its absorption depends on the guts ability to absorb dietary fat [4]. Arterioscler Thromb Vasc Biol 2012;32:2794-802. Pediatrics 2008;122:1142-52. [, Laurent MR, Gielen E, Pauwels S, Vanderschueren D, Bouillon R. Hypervitaminosis D associated with tanning bed use: A case report. [, Caan B, Neuhouser M, Aragaki A, Lewis CB, Jackson R, LeBoff MS, et al. One clinical trial randomized 260 Black women aged 60 years and older (mean age 68.2 years) to receive 60 to 120 mcg (2,400 to 4,800 IU) per day vitamin D3 supplementation to maintain serum 25(OH)D levels above 75 nmol/L (30 ng/mL) for 3 years [84]. J Midwifery Womens Health 2019;64:276-88. The factors that affect UV radiation exposure, individual responsiveness, and uncertainties about the amount of sun exposure needed to maintain adequate vitamin D levels make it difficult to provide guidelines on how much sun exposure is required for sufficient vitamin D synthesis [15,28]. Four percent had levels higher than 125 nmol/L (50 ng/mL). Thiazide diuretics (e.g., Hygroton, Lozol, and Microzide) decrease urinary calcium excretion. However, the supplementation had no significant effects on fasting blood glucose, hemoglobin A1c, or fasting insulin levels. CMAJ 2007;177:161-6. In one Minnesota county, the incidence rate of rickets in children younger than 3 years in the decade beginning in 2000 was 24.1 per 100,000 [48]. Adv Nutr 2012;3:353-61. Bone mineral density, bone mass, and fracture risk are correlated with serum 25(OH)D levels in White Americans and Mexican Americans, but not in Black Americans [14,83]. Pediatrics 2020;145:e20193574. Multiple sclerosis However, other, shorter (from 24 weeks to 5 years) clinical trials of vitamin D supplementation alone or with calcium in adults found greater risks of hypercalcemia and hypercalciuria, but not of kidney stones [162,163]. Vitamin D- fortified. Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Some people take very high doses of vitamin D supplements. Vitamin D supplementation and prevention of type 2 diabetes. US Preventive Services Task Force recommendation statement. Observational studies suggest that adequate vitamin D levels might reduce the risk of contracting MS and, once MS is present, decrease the risk of relapse and slow the disease's progression [138]. Breast cancer Weisberg P, Scanlon KS, Li R, Cogswell ME. J Clin Endocrinol Metab 2012;97:1146-52. Evidence Report/Technology Assessment No. J Natl Cancer Inst 2007;99:1563-5. Supplemental vitamin D and incident fractures in midlife and older adults. [, Thacher TM, Fischer PR, Tebben PJ, Singh RJ, Cha SS, Maxson JA, Yawn BP. MS is an autoimmune disease of the central nervous system that damages the myelin sheath surrounding and protecting nerve cells in the brain and spinal cord. In contrast to observational studies, clinical trials provide little support for the benefits of vitamin D supplementation for glucose homeostasis. In contrast, a meta-analysis of 6 trials in 49,282 older adults found that daily vitamin D (10 or 20 mcg [400 IU or 800 IU]/day) and calcium (800 or 1,200 mg/day) supplementation for a mean of 5.9 years reduced the risk of any fracture by 6% and of hip fracture by 16% [81]. uss canberra crew list. A daily walk or some other form of outdoor physical activity in the early morning or late afternoon is . 32 ] 1997 ; 21: S24-30 D deficiency is severe [ 2 ] M. 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