title: Serum vitamin D levels, diabetes and cardio-metabolic risk factors in Aboriginal and Torres Strait Islander Australians.
abstract: BACKGROUND
  Low levels of serum 25-hydroxy vitamin D (25(OH)D), have been associated with development of type 2 diabetes and cardiovascular disease (CVD); however there are limited data on serum 25(OH)D in Indigenous Australians, a population at high risk for both diabetes and CVD. We aimed to assess levels of serum 25(OH)D in Aboriginal and Torres Strait Islander Australians and to explore relationships between 25(OH)D and cardio-metabolic risk factors and diabetes.
  
  
  METHODS
  592 Aboriginal and/or Torres Strait Islander Australian participants of The eGFR (estimated glomerular filtration rate) Study, a cross-sectional analysis of a cohort study performed in 2007-2011, from urban and remote centres within communities, primary care and tertiary hospitals across Northern Territory, Far North Queensland and Western Australia. Assessment of serum 25(OH)D, cardio-metabolic risk factors (central obesity, diabetes, hypertension, history of cardiovascular disease, current smoker, low HDL-cholesterol), and diabetes (by history or HbA1c ≥6.5%) was performed. Associations were explored between 25(OH)D and outcome measures of diabetes and number of cardio-metabolic risk factors.
  
  
  RESULTS
  The median (IQR) serum 25(OH)D was 60 (45-77) nmol/L, 31% had 25(OH)D <50 nmol/L. For participants with 25(OH)D < 50 vs ≥50 nmol/L, cardio-metabolic risk profile differed for: diabetes (54%, 36% p < 0.001), past history of cardiovascular disease (16%, 9%, p = 0.014), waist-hip ratio (0.98, 0.92, p < 0.001), urine albumin-creatinine ratio (2.7, 1.5 mg/mmol, p < 0.001). The OR (95% CI) for diabetes was 2.02 (1.03 - 3.95) for people in the lowest vs highest tertiles of 25(OH)D (<53 vs >72 nmol/L, respectively) after adjusting for known cardio-metabolic risk factors.
  
  
  CONCLUSIONS
  The percentage of 25(OH)D levels <50 nmol/L was high among Aboriginal and Torres Strait Islander Australians from Northern and Central Australia. Low 25(OH)D level was associated with adverse cardio-metabolic risk profile and was independently associated with diabetes. These findings require exploration in longitudinal studies.
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia ; Division of Medicine, Royal Darwin Hospital, Darwin, Australia.
authors.forename: Louise J
authors.initials: LJ
authors.lastname: Maple-Brown
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia ; Division of Medicine, Royal Darwin Hospital, Darwin, Australia.
authors.forename: Jaquelyne T
authors.initials: JT
authors.lastname: Hughes
authors.affiliation: Melbourne Pathology, Melbourne, Australia ; Department of Medicine, Monash University, Melbourne, Australia.
authors.forename: Zhong X
authors.initials: ZX
authors.lastname: Lu
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia ; University of South Australia, Adelaide, Australia.
authors.forename: Kanakamani
authors.initials: K
authors.lastname: Jeyaraman
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Lawton
authors.affiliation: SydPath, St Vincents Hospital, Sydney, Australia ; University of NSW, Sydney, Australia.
authors.forename: Graham Rd
authors.initials: GR
authors.lastname: Jones
authors.affiliation: Austin Health, Melbourne, Australia ; University of Melbourne, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ellis
authors.affiliation: Cairns Base Hospital and Diabetes Centre, Cairns, Australia.
authors.forename: Ashim
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: St Vincent's Hospital, Melbourne, Australia ; University of Melbourne, Melbourne, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: MacIsaac
authors.affiliation: Austin Health, Melbourne, Australia ; University of Melbourne, Melbourne, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Jerums
authors.affiliation: University of South Australia, Adelaide, Australia.
authors.forename: Kerin
authors.initials: K
authors.lastname: O'Dea
keywords: 25-hydroxy vitamin D; Aboriginal; Cardiovascular risk; Type 2 diabetes