Associations Between Serum 25-Hydroxyvitamin D Concentration, Sun Exposure Index, Body Composition, and Repeated Sprint Ability in Male Soccer Referees

Abstract

Despite the high prevalence of hypovitaminosis D among athletes and the proposed role of vitamin D in musculoskeletal health and performance, data on vitamin D status in soccer referees and its relationship with body composition and performance remain scarce. This cross-sectional study evaluated 25(OH)D concentrations and their associations with the sun exposure index (SEI), body composition, and performance in a sample of 21 male referees (30.6 ± 3.4 years) from the Brazilian Football Confederation. Serum 25(OH)D concentration was assessed from blood samples, SEI by questionnaire, body fat percentage (BF%), fat free mass, and bone mineral density (BMD) by dual-energy X-ray absorptiometry, calcium and carbohydrate intake by 24-h recall, and performance by the repeated sprint ability (RSA) test. Associations were examined using linear regression analysis adjusted for (1) age, (2) fat free mass, and (3) carbohydrate or calcium intake. 76% presented serum 25(OH)D concentrations < 30 ng/mL. 25(OH)D was positively associated with SEI (β = 1.17; p = 0.04, Cohen’s f² = 0.19), whereas no significant associations were observed with BMD, BF% or RSA, even after adjustments. There is a high prevalence of hypovitaminosis D among the soccer referees evaluated. Although 25(OH)D was not significantly associated with body composition or performance, its positive association with SEI reinforces the importance of sun exposure.

Keywords

Body composition / Performance / Sports nutrition / Vitamin D / Bone density

References

[1] Farrokhyar F, Tabasinejad R, Dao D, Peterson D, Ayeni OR, Hadioonzadeh R, et al. Prevalence of Vitamin D Inadequacy in Athletes: A Systematic-Review and Meta-Analysis. Sports Med. 2015, 45, 365-378. DOI: 10.1007/s40279-014-0267-6

[2] Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE. The Roles of Vitamin D in Skeletal Muscle: Form, Function, and Metabolism. Endocr. Rev. 2013, 34, 33-83. DOI: 10.1210/er.2012-1012

[3] Pojednic RM, Ceglia L. The Emerging Biomolecular Role of Vitamin D in Skeletal Muscle. Exerc. Sport Sci. Rev. 2014, 42, 76-81. DOI: 10.1249/JES.0000000000000013

[4] Harju T, Gray B, Mavroedi A, Farooq A, Reilly JJ. Prevalence and Novel Risk Factors for Vitamin D Insufficiency in Elite Athletes: Systematic Review and Meta-Analysis. Eur. J. Nutr. 2022, 61, 3857-3871. DOI: 10.1007/S00394-022-02967-Z

[5] Segheto KJ, Juvanhol LL, da Silva DCG, de Carvalho CJ, Hansen F, Gabiatti MP, et al. Does the Relationship between 25-Hydroxyvitamin D Status and Bone Mass Vary According to Skin Color in Adults? Results of a Brazilian Population-Based Study. Arch. Osteoporos. 2021, 16, 31. DOI: 10.1007/s11657-021-00876-y

[6] Zürcher SJ, Quadri A, Huber A, Thomas L, Close GL, Brunner S, et al. Predictive Factors for Vitamin D Concentrations in Swiss Athletes: A Cross-Sectional Study. Sports Med. Int. Open 2018, 2, E148. DOI: 10.1055/A-0669-0791

[7] Ip TST, Fu SC, Ong MTY, Yung PSH. Vitamin D Deficiency in Athletes: Laboratory, Clinical and Field Integration. Asia. Pac. J. Sports Med. Arthrosc. Rehabil. Technol. 2022, 29, 22-29. DOI: 10.1016/j.asmart.2022.06.001

[8] Dominoni LAdC, Gabiatti MP, Piazza FRG, Streb AR, Del Duca GF, Hansen F. Vitamin D Is Associated with Body Composition and Fat Intake, but Not with Cardiometabolic Parameters in Adults with Obesity. Nutr. Res. 2022, 105, 97-104. DOI: 10.1016/j.nutres.2022.06.006

[9] Close GL, Russell J, Cobley JN, Owens DJ, Wilson G, Gregson W, et al. Assessment of Vitamin D Concentration in Non-Supplemented Professional Athletes and Healthy Adults during the Winter Months in the UK: Implications for Skeletal Muscle Function. J. Sports Sci. 2013, 31, 344-353. DOI: 10.1080/02640414.2012.733822

[10] Schenk K, Bizzini M, Gatterer H. Exercise Physiology and Nutritional Perspectives of Elite Soccer Refereeing. Scand. J. Med. Sci. Sports 2018, 28, 782-793. DOI: 10.1111/SMS.12989

[11] Vieira CMA, Costa EC, Aoki MS. O Nível de Aptidão Física Afeta o Desempenho do Árbitro de Futebol. Revista Brasileira de Educação Física 2010, 24, 445-452. DOI: 10.1590/S1807-55092010000400002

[12] Weston M, Drust B, Gregson W. Intensities of Exercise during Match-Play in FA Premier League Referees and Players. J. Sports Sci. 2011, 29, 527-532. DOI: 10.1080/02640414.2010.543914

[13] Reilly T, Gregson W. Special Populations: The Referee and Assistant Referee. J. Sports Sci. 2006, 24, 795-801. DOI: 10.1080/02640410500483089

[14] Palacios C, Gil K, Pérez CM, Joshipura K. Determinants of Vitamin D Status among Overweight and Obese Puerto Rican Adults. Ann. Nutr. Metab. 2012, 60, 35-43. DOI: 10.1159/000335282

[15] Conway JM, Ingwersen LA, Moshfegh AJ. Accuracy of Dietary Recall Using the USDA Five-Step Multiple-Pass Method in Men: An Observational Validation Study. J. Am. Diet. Assoc. 2004, 104, 595-603. DOI: 10.1016/j.jada.2004.01.007

[16] Willett W. Nutritional Epidemiology; Oxford University Press: Oxford, UK, 2013; ISBN 9780199979448.

[17] Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2011, 96, 1911-1930. DOI: 10.1210/jc.2011-0385

[18] Rampinini E, Bishop D, Marcora SM, Ferrari Bravo D, Sassi R, Impellizzeri FM. Validity of Simple Field Tests as Indicators of Match-Related Physical Performance in Top-Level Professional Soccer Players. Int. J. Sports Med. 2007, 28, 228-235. DOI: 10.1055/s-2006-924340.

[19] Cohen J. Statistical Power Analysis for the Behavioral Sciences Second Edition, 2nd ed.; Lawrence Erlbaum Associates: New York, NY, USA, 1988.

[20] Galan F, Ribas J, Sánchez-Martinez PM, Calero T, Sánchez AB, Muñoz A. Serum 25-Hydroxyvitamin D in Early Autumn to Ensure Vitamin D Sufficiency in Mid-Winter in Professional Football Players. Clin. Nutr. 2012, 31, 132-136. DOI: 10.1016/j.clnu.2011.07.008

[21] Hamilton B, Whiteley R, Farooq A, Chalabi H. Vitamin D Concentration in 342 Professional Football Players and Association with Lower Limb Isokinetic Function. J. Sci. Med. Sport 2014, 17, 139-143. DOI: 10.1016/j.jsams.2013.03.006

[22] Perrone MA, Pieri M, Caminiti G, Ali W, Bernardini S, Parisi A, et al. Vitamin D Deficiency in Professional Football Players during Competitive Season of Italian First Division (Serie A). Sports 2024, 12, 153. DOI: 10.3390/SPORTS12060153

[23] Książek A, Zagrodna A, Lombardi G, Słowińska-Lisowska M. Seasonal Changes in Free 25-(OH)D and Vitamin D Metabolite Ratios and Their Relationship with Psychophysical Stress Markers in Male Professional Football Players. Front. Physiol. 2023, 14, 1258678. DOI: 10.3389/FPHYS.2023.1258678

[24] Allison RJ, Farooq A, Hamilton B, Close GL, Wilson MG. No Association between Vitamin D Deficiency and Markers of Bone Health in Athletes. Med. Sci. Sports Exerc. 2015, 47, 782-788. DOI: 10.1249/MSS.0000000000000457

[25] Longo GZ, da Silva DCG, Gabiatti MP, Hansen F, Ferreira FG, Silva DAS, et al. The Interaction between Higher 25(OH)D Concentrations and Physical Activity on Inflammatory Biomarkers: Evidence from a Cross-Sectional Brazilian Population. Nutr. Res. 2026, 153, 32-40. DOI: 10.1016/j.nutres.2026.06.008

[26] Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased Bioavailability of Vitamin D in Obesity. Am. J. Clin. Nutr. 2000, 72, 690-693. DOI: 10.1093/ajcn/72.3.690

[27] Savastano S, Barrea L, Savanelli MC, Nappi F, Di Somma C, Orio F, et al. Low Vitamin D Status and Obesity: Role of Nutritionist. Rev. Endocr. Metab. Disord. 2017, 18, 215-225. DOI: 10.1007/s11154-017-9410-7

[28] Drincic AT, Armas LAG, Van Diest EE, Heaney RP. Volumetric Dilution, Rather than Sequestration Best Explains the Low Vitamin D Status of Obesity. Obesity 2012, 20, 1444-1448. DOI: 10.1038/OBY.2011.404

[29] Halliday TM, Peterson NJ, Thomas JJ, Kleppinger K, Hollis BW, Larson-Meyer DE. Vitamin D Status Relative to Diet, Lifestyle, Injury, and Illness in College Athletes. Med. Sci. Sports Exerc. 2011, 43, 335-343. DOI: 10.1249/MSS.0b013e3181eb9d4d

[30] Heller JE, Thomas JJ, Hollis BW, Larson-Meyer DE. Relation between Vitamin D Status and Body Composition in Collegiate Athletes. Int. J. Sport Nutr. Exerc. Metab. 2015, 25, 128-135. DOI: 10.1123/ijsnem.2013-0250

[31] Peeling P, Fulton SK, Binnie M, Goodman C. Training Environment and Vitamin D Status in Athletes. Int. J. Sports Med. 2013, 34, 248-252. DOI: 10.1055/s-0032-1321894

[32] Vlachopoulos D, Ubago-Guisado E, Barker AR, Metcalf BS, Fatouros IG, Avloniti A, et al. Determinants of Bone Outcomes in Adolescent Athletes at Baseline: The PRO-BONE Study. Med. Sci. Sports Exerc. 2017, 49, 1389-1396. DOI: 10.1249/MSS.0000000000001233

[33] Ducher G, Kukuljan S, Hill B, Garnham A, Nowson S, Kimlin M, et al. Vitamin D Status and Musculoskeletal Health in Adolescent Male Ballet Dancers: A Pilot Study. J. Danc. Med. Sci. 2011, 15, 99-107. DOI: 10.1177/1089313X1101500301

[34] de la Puente Yagüe M, Yurrita LC, Cabañas MJC, Cenzual MAC. Role of Vitamin D in Athletes and Their Performance: Current Concepts and New Trends. Nutrients 2020, 12, 579. DOI: 10.3390/NU12020579

[35] Mason RS, Rybchyn MS, Abboud M, Brennan-Speranza TC, Fraser DR. The Role of Skeletal Muscle in Maintaining Vitamin D Status in Winter. Curr. Dev. Nutr. 2019, 3, nzz087. DOI: 10.1093/cdn/nzz087

[36] Rybchyn MS, Abboud M, Puglisi DA, Gordon-Thomson C, Brennan-Speranza TC, Mason RS, et al. Skeletal Muscle and the Maintenance of Vitamin D Status. Nutrients 2020, 12, 3270. DOI: 10.3390/nu12113270

[37] Allison RJ, Farooq A, Cherif A, Hamilton B, Close GL, Wilson MG. Why Don’t Serum Vitamin D Concentrations Associate with BMD by DXA? A Case of Being “bound” to the Wrong Assay? Implications for Vitamin D Screening. Br. J. Sports Med. 2018, 52, 522-526. DOI: 10.1136/bjsports-2016-097130

[38] Dolan E, Dumas A, Esteves GP, Takarabe LL, Perfeito LAM, Keane KM, et al. The Influence of Nutrition Intervention on the P1NP and CTX-1 Response to an Acute Exercise Bout: A Systematic Review with Meta-Analysis. Sports Med. 2024, 54, 2889-2906. DOI: 10.1007/s40279-024-02087-0

[39] Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients); National Academies Press: Washington, DC, USA, 2005; ISBN 030908525X.

[40] Rampinini E, Sassi A, Morelli A, Mazzoni S, Fanchini M, Coutts AJ. Repeated-Sprint Ability in Professional and Amateur Soccer Players. Appl. Physiol. Nutr. Metab. 2009, 34, 1048-1054. DOI: 10.1139/H09-111

[41] Buchheit M, Bishop D, Haydar B, Nakamura FY, Ahmaidi S. Physiological Responses to Shuttle Repeated-Sprint Running. Int. J. Sports Med. 2010, 31, 402-409. DOI: 10.1055/S-0030-1249620

[42] FIFA FITNESS TESTS FOR MATCH OFFICIALS. 2024. Available online: https://digitalhub.fifa.com/m/4b958c43c4b415a1/original/Fitness-tests-for-Match-Officials_EN.pdf (accessed on 25 August 2026)

[43] Koundourakis NE, Androulakis NE, Malliaraki N, Margioris AN. Vitamin D and Exercise Performance in Professional Soccer Players. PLoS ONE 2014, 9, e101659. DOI: 10.1371/journal.pone.0101659

[44] Orysiak J, Mazur-Rozycka J, Fitzgerald J, Starczewski M, Malczewska-Lenczowska J, Busko K. Vitamin D Status and Its Relation to Exercise Performance and Iron Status in Young Ice Hockey Players. PLoS ONE 2018, 13, e0195284. DOI: 10.1371/journal.pone.0195284

[45] Wilson-Barnes SL, Hunt JEA, Williams EL, Allison SJ, Wild JJ, Wainwright J, et al. Seasonal Variation in Vitamin D Status, Bone Health and Athletic Performance in Competitive University Student Athletes: A Longitudinal Study. J. Nutr. Sci. 2020, 9, e8. DOI: 10.1017/JNS.2020.1