Korean J Fam Pract. 2018; 8(4): 550-556  https://doi.org/10.21215/kjfp.2018.8.4.550
Relationship between Serum Vitamin D and Smoking in Korean Male Aged 50 and Over: Analysis of Data from Korea National Health and Nutrition Examination Survey, 2011-2012
Jung Eun Kim, You Hyun Song, Jung Hae Moon, Ji Young Lee, Jun Ho Choi, Yoon Joo Jo, Soo Kyung Yang, Hee Cheol Kang*
Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
Hee Cheol Kang Tel: +82-2-2228-2332, Fax: +82-2-362-2473 E-mail: kanghc@yuhs.ac ORCID: http://orcid.org/0000-0002-0309-7448
Received: July 4, 2017; Revised: October 16, 2017; Accepted: October 22, 2017; Published online: August 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The relationship between smoking and vitamin D status has been investigated in several studies. However, previous studies have shown conflicting results. The purpose of this study was to evaluate the association of smoking status with serum vitamin D in Korean men aged 50 years and older.
Methods: Korean men aged 50 years and older who participated in the 5th Korea National Health and Nutrition Examination Survey (2011–2012, n=2,256) were included in our analysis. The subjects were categorized into current, former, and non-smoker groups based on smoking status, and the general characteristics of each group were analyzed. The current smoker group was divided into four subgroups based on the number of cigarettes smoked per day, smoking duration (years), and measured serum vitamin D levels.
Results: The means of vitamin D concentrations (ng/mL) were 19.77 (standard error [SE]=0.46), 19.59 (SE=0.24), and 18.78 (SE=0.33) for non-smokers, former smokers, and current smokers, respectively. After adjustments for multiple confounders (age, education status, occupation, physical activity, body mass index, self-reported hypertension, cardiovascular disease, and respiratory disease), vitamin D concentrations decreased by 1.11 (P for trend 0.032) from non- to current smokers.
Conclusion: Vitamin D concentrations were lower in current smokers than non-smokers. However, the association did not show a dose–response pattern.
Keywords: Vitamin D; Smoking Status; Occupation; Cross-Sectional Analysis; Health Survey
  1. Yoo HN, Kim HS. Vitamin D deficiency and Metabolic Syndrome among Korean Adolescents: Based on Korea National Health and Nutrition Examination Survey V (KNHANES). J Korean Soc Sch Health 2016; 29: 22-32.
  2. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, DawsonHughes B. Fracture prevention with vitamin D supplementation: a metaanalysis of randomized controlled trials. JAMA 2005; 293: 2257-64.
    Pubmed CrossRef
  3. Song Y, Wang L, Pittas AG, Del Gobbo LC, Zhang C, Manson JE, et al. Blood 25-hydroxy vitamin D levels and incident type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care 2013; 36: 1422-8.
    Pubmed KoreaMed CrossRef
  4. Elamin MB, Abu Elnour NO, Elamin KB, Fatourechi MM, Alkatib AA, Almandoz JP, et al. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2011; 96: 1931-42.
    Pubmed CrossRef
  5. Shinkov A, Borissova AM, Dakovska L, Vlahov J, Kassabova L, Svinarov D. Winter 25-hydroxyvitamin D levels in young urban adults are affected by smoking, body mass index and educational level. Eur J Clin Nutr 2015; 69:355-60.
    Pubmed CrossRef
  6. Kassi EN, Stavropoulos S, Kokkoris P, Galanos A, Moutsatsou P, Dimas C, et al. Smoking is a significant determinant of low serum vitamin D in young and middle-aged healthy males. Hormones (Athens) 2015; 14: 245-50.
  7. Colao A, Muscogiuri G, Rubino M, Vuolo L, Pivonello C, Sabatino P, et al. Hypovitaminosis D in adolescents living in the land of sun is correlated with incorrect life style: a survey study in Campania region. Endocrine 2015; 49: 521-7.
    Pubmed CrossRef
  8. Lange NE, Sparrow D, Vokonas P, Litonjua AA. Vitamin D deficiency, smoking, and lung function in the Normative Aging Study. Am J Respir Crit Care Med 2012; 186: 616-21.
    Pubmed KoreaMed CrossRef
  9. Cutillas-Marco E, Fuertes-Prosper A, Grant WB, Morales-Suárez-Varela M. Vitamin D deficiency in South Europe: effect of smoking and aging. Photodermatol Photoimmunol Photomed 2012; 28: 159-61.
    Pubmed CrossRef
  10. Grimnes G, Almaas B, Eggen AE, Emaus N, Figenschau Y, Hopstock LA, et al. Effect of smoking on the serum levels of 25-hydroxyvitamin D depends on the assay employed. Eur J Endocrinol 2010; 163: 339-48.
    Pubmed CrossRef
  11. WHO Framework Convention on Tobacco Control. Reporting on the implementation of the WHO framework convention on tobacco control. Geneva:WHO FCTC; 2012. p 38.
  12. Jung KJ, Yun YD, Baek SJ, Jee SH, Kim IS. Smoking-attributable mortality among Korean adults, 2012. J Korea Soc Health Inform Stat 2013; 38: 36-48.
  13. Song YLA, Kim JY. The relationship between family factors and drinking/smoking among middle-aged men. Korean J Health Educ Promot 2013; 30:13-25.
  14. WHO. Guidelines for the conduct of tobacco smoking surveys for the general population. Geneva: World Health Organization; 1983. Report No.:Document No. WHO/SMO/83.4.
  15. Jiang CQ, Chan YH, Xu L, Jin YL, Zhu T, Zhang WS, et al. Smoking and serum vitamin D in older Chinese people: cross-sectional analysis based on the Guangzhou biobank cohort study. BMJ Open 2016; 6: e010946.
    Pubmed KoreaMed CrossRef
  16. Jung IK. Prevalence of vitamin D deficiency in Korea: Results from KNHANES 2010 to 2011. J Nutr Health 2013; 46: 540-51.
  17. Brot C, Jorgensen NR, Sorensen OH. The influence of smoking on vitamin D status and calcium metabolism. Eur J Clin Nutr 1999; 53: 920-6.
    Pubmed CrossRef
  18. O’Shaughnessy PJ, Monteiro A, Bhattacharya S, Fowler PA. Maternal smoking and fetal sex significantly affect metabolic enzyme expression in the human fetal liver. J Clin Endocrinol Metab 2011; 96: 2851-60.
    Pubmed CrossRef
  19. Choi EJ, Seo MK, Kim DJ, Roh JM, Seo KH, Park SW. Women’s use of tobacco and alcohol and countermeasures. Seoul: Korea Institute for Health and Affairs; 2009 Jan. Report No.: 2008-10.

This Article