Obesity and vitamin D status may help explain the racial and ethnic disparities in ampullary cancer survival rates
J. SURGICAL ONCOLOGY 2017;1
- Do blacks have a 5 year life penalty due to low vitamin D JAMA 2007
- Striking ethnic health disparity – blacks dying due to lack of vitamin D – Nov 2011
- Blacks die more often than whites of many diseases (they have less vitamin D) – 2012
- Diabetes (Type 1) 14X more likely in dark skin children with low levels of vitamin D – May 2015
- Blacks may not need as much Vitamin D (for their bones)
Blacks die more often than whites of many diseases (they have less vitamin D) – 2012 has the following
Cancer Facts & Figures for African Americans Cancer.org
- “African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers”
- Has a huge number of tables and charts, Note: Vitamin D is not mentioned
Leading Causes of Death as of March 2018
|All Ages Death rate||Black||White||Ratio|
Rates per 100,000 Age adjusted Non-Hispanic
The health disparity for dark skinned people is almost the same as whites having a low level of vitamin D
| Black |
|White - low D |
vs White - high D
- Half of obese black teens achieved at least 30 ng of Vitamin D with 5,000 IU daily – June 2018
- Stroke outcome 6.9 X worse if black and overweight (all three related via low vitamin D) – March 2018
- Indoor pollution is a problem with obese black asthmatic children – May 2018
- Blacks are more obese, have lower Vitamin D, and have more Cancer etc. than whites – Feb 2018
- Increase in Vitamin D deficiency with weight and skin darkness – chart – March 2016
- 5,000 IU daily or 50,000 IU Vitamin D weekly repleted many dark skinned adolescents – RCT Dec 2015
- Obese diabetics with dark skins not benefit from 6,000 IU of vitamin D daily (no surprise) – RCT March 2015
- African-Americans at high risk of obesity and diabetes - 2011
- Bariatric surgery less than 30 ng of vitamin D – 82 pcnt teens, 100 pcnt of black teens – June 2012
- Low vitamin D associated with obesity-related diseases for ethnic minorities – Sept 2011
- Reasons for low response to vitamin D
- Telomeres improved when obese blacks took 2000 IU of vitamin D daily – Oct 2011
- Black women lacking Calcium and Vitamin D weighed more – Aug 2011
- Dark skinned obese not helped much by weekly 50000 IU dose of vitamin D – May 2011
- Obese children had low vitamin D – fat under dark skin – fat in white body – Mar 2011
- Obesity in American-Indians and African-American teens
- Vitamin D3 in obese and non obese African American children – 2008
- Low vitamin D in teens: especially black or overweight – June 2010
To the Editor:
The recent paper by Nassour and colleagues reported race/ ethnicity disparities in ampullary cancer survival. Median survival times were
- 18.9 months for blacks,
- 23.9 months for whites,
- 32.7 months for Hispanics, and
- 37.4 months for Asians.1
Some factors related to survival such as socioeconomic status and treatment utilization were mentioned but thought not to explain all of the disparities.
One factor overlooked is the race/ethnicity prevalence of obesity. Obesity is an important risk factor for adverse effects on the gastrointestinal tract2 and cancer in general.3 In the period 2011-2014,
obesity rates in the US were
- 48.1% for non-Hispanic black,
- 42.8% for Hispanic,
- 34.5% for non-Hispanic white, and
- 11.7% for non- Hispanic Asian.4
A linear two-tailed regression fit to the data is Survival rate = 38.4-0.37 x Obsesity rate, r = 0.94, P = 0.06. Thus, obesity rates may help explain the relative survival rates for blacks and Asians compared to Hispanics and whites.
Another overlooked factor is vitamin D status. There is mounting evidence that vitamin D reduces incidence and mortality rates for many types of cancer, and the mechanisms whereby vitamin D reduces risk of cancer and increases survival are well known.5-8 Vitamin D status has been suggested to explain the portion of reduced survival for blacks compared to whites for many types of cancer.9
Older black Americans have mean 25-hydroxyvitamin D concentrations of about
- 16 ng/mL,
- Hispanics 21 ng/mL, and
- whites, 26 ng/mL.10
Those 25- hydroxyvitamin D (25[OH]D) concentrations are inversely related to survival times for blacks, Hispanics, and whites. A linear two-tailed regression fit to the data is Survival rate = -3.8 + 1.4 x 25(OH)D, r = 0.98, P = 0.10. In addition, 25(OH)D concentrations are generally inversely correlated with body mass index. While it would be difficult for ampullary cancer patients to reduce their body weight, it would be easy to increase 25(OH)D concentrations. Raising concentrations to 40-60 ng/mL using 5000-10 000 lU/d vitamin D3 should be considered.
DISCLOSURES: I receive funding from Bio-Tech Pharmacal (Fayetteville, AR, USA).
William B. Grant, PhD, Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603. wbgrant at infionline.net
- Nassour I, Mokdad AA, Minter RM, et al. Racial and ethnic disparities in a national cohort of ampullary cancer patients. J Surg Oncol. 2017. https://www.ncbi.nlm.nih.gov/pubmed/28968918. https://doi.org/10.1002/jso.24835. [Epub ahead of print].
- Feakins RM. Obesity and metabolic syndrome: pathological effects on the gastrointestinal tract. Histopathology. 2016;68:630-640.
- Steele CB, Thomas CC, Henley SJ, et al. Vital signs: trends in incidence of cancers associated with overweight and Obesity-United States, 2005-2014. MMWR Morb Mortal Wkly Rep. 2017;66:1052-1058.
- Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;(219):1-8. https://www.ncbi.nlm.nih.gov/pubmed/2663 3046
- Grant WB. Roles of solar UVB and vitamin D in reducing cancer risk and increasing survival. Anticancer Res. 2016;36:1357-1370.
- Moukayed M, Grant WB. The roles of UVB and vitamin D in reducing risk of cancer incidence and mortality: a review of the epidemiology, clinical trials, and mechanisms. Rev Endocr Metab Disord. 2017; 18:167-182.
- Grant WB, Boucher BJ. Randomized controlled trials of vitamin D and cancer incidence: a modeling study. PLoS ONE. 2017;12:e0176448.
- Tretli S, Schwartz GG, Torjesen PA, Robsahm TE. Serum levels of 25- hydroxyvitamin D and survival in Norwegian patients with cancer of breast, colon, lung, and lymphoma: a population-based study. Cancer Causes Control. 2012;23:363-370.
- Grant WB, Peiris AN. Differences in vitamin D status may account for unexplained disparities in cancer survival rates between African and White Americans. Dermatoendocrinol. 2012;4:85-94.
- Ginde AA, Liu MC, Camargo CA, Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009;169:626-632.