Prevalence of Vitamin D Inadequacy in Athletes: A Systematic-Review and Meta-Analysis

BackgroundVitamin D is essential for maintaining optimal bone health. The prevalence of vitamin D inadequacy in athletes is currently unclear.ObjectiveThe objective of this study is to determine the prevalence of vitamin D inadequacy in athletes.MethodsWe conducted a systematic review and meta-analysis. Multiple databases were searched and studies assessing serum 25-hydroxyvitamin D [25(OH)D] status in athletes were identified. Serum 25(OH)D is measured to clinically determine vitamin D status. Reviewers independently selected the eligible articles, assessed the methodological quality, and extracted data. Disagreements were resolved by consensus. Weighted proportions of vitamin D inadequacy [serum 25(OH)D <32 ng/mL] were calculated (DerSimonian–Laird random-effects model) and compared using Chi-squared (χ2) test. Subgroup analyses were conducted and risk ratios (RRs) with 95 % confidence intervals (CIs) were reported.ResultsTwenty-three studies with 2,313 athletes [mean (standard deviation) age 22.5 (5.0) years, 76 % male] were included. Of 2,313 athletes, 56 % (44–67 %) had vitamin D inadequacy that significantly varied by geographical location (p < 0.001). It was significantly higher in the UK and in the Middle East. The risk significantly increased for winter and spring seasons (RR 1.85; 95 % CI 1.27–2.70), indoor sport activities (RR 1.19; 95 % CI 1.09–1.30), and mixed sport activities (RR 2.54; 95 % CI 1.03–6.26). The risk was slightly higher for >40°N latitude [RR 1.14 (95 % CI 0.91–1.44)] but it increased significantly [RR 1.85 (1.35–2.53)] after excluding the Middle East as an outlier. Seven studies with 359 athletes reported injuries. The prevalence of injuries in athletes was 43 % (95 % CI 20–68) [bone related = 19 % (95 % CI 7–36); muscle and soft-tissue = 37.5 % (95 % CI 11.5–68.5)].ConclusionDespite the limitations of the current evidence, the prevalence of vitamin D inadequacy in athletes is prominent. The risk significantly increases in higher latitudes, in winter and early spring seasons, and for indoor sport activities. Regular investigation of vitamin D status using reliable assays and supplementation is essential to ensure healthy athletes. The prevalence of injuries in athletes is notable but its association with vitamin D status is unclear. A well-designed longitudinal study is needed to answer this possible association.