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Epidemiology

Sunlight exposure, consumption of vitamin D-rich foods and vulvovaginal candidiasis in an African population: a prevalence case–control study

European Journal of Clinical Nutrition volume 74, pages 518–526 (2020)Cite this article

Subjects

Abstract

Background/objectives

To date, only two studies have investigated the relationship between vitamin D (vitD) deficiency and candidiasis in spite of vitD’s antimicrobial and immunomodulatory roles. We examined the relationship between sunlight exposure and consumption of vitD-rich foods, markers of vitD status, and vulvovaginal candidiasis (VVC) in an African population to add to the limited evidence and stimulate additional research.

Subjects/methods

Three hundred cases (females diagnosed as suffering from VVC) and three hundred controls (females diagnosed as suffering from any condition other than VVC) were selected from three health facilities in Cape Coast, Ghana. Sunlight exposure was assessed in a structured questionnaire with a food frequency questionnaire used to ascertain the frequency of consumption of vitD-rich foods.

Results

Self-reported low sunlight exposure was associated with 3.38 (95% CI:1.99, 5.74) increased odds of VVC. Low and moderate sunlight exposure estimated by outdoor visits was also associated with increased odds of VVC. In sensitivity analysis restricted to matched sunlight exposure data, low and moderate exposure was associated with 5.78 (95% CI: 2.57, 12.99) and 3.53 (95% CI: 1.85, 6.75) increased odds of VVC. Odds of VVC increased with decreasing levels of consumption of vitD-rich foods (Likelihood-ratio test trend p = 0.1382). In the joint analysis, low and moderate vitD intake was associated with much higher increased odds of VVC.

Conclusions

Our findings should be confirmed in prospective studies and clinical trials to strengthen the evidence base for preventive action and to also inform clinical decision making.

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Code availability

The Stata syntaxes for generating the results are available upon request from the corresponding author.

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Acknowledgements

The authors will like to thank all the patients who agreed to participate in this work. No funding was received for this work. AKA conceived and designed the study, analyzed the data and contributed to the writing of the paper. FKB, AA, and EAF collected the data with FKB contributing to the writing of the paper. CLW reviewed drafts for important intellectual content. All authors approved the final submitted manuscript.

Author information

Authors and Affiliations

  1. Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana

    A. K. Amegah, F. K. Baffour, A. Appiah & E. Adu-Frimpong

  2. Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana

    A. K. Amegah

  3. Medical University of South Carolina Children’s Hospital, Charleston, SC, USA

    C. L. Wagner

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  1. A. K. Amegah
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  2. F. K. Baffour
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Correspondence to A. K. Amegah.

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Amegah, A.K., Baffour, F.K., Appiah, A. et al. Sunlight exposure, consumption of vitamin D-rich foods and vulvovaginal candidiasis in an African population: a prevalence case–control study. Eur J Clin Nutr 74, 518–526 (2020). https://doi.org/10.1038/s41430-019-0517-7

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