{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T19:37:24Z","timestamp":1767901044050,"version":"3.49.0"},"reference-count":39,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2019,7,9]],"date-time":"2019-07-09T00:00:00Z","timestamp":1562630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical research council","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: To investigate the demographic and lifestyles factors associated with vitamin C deficiency and to examine the association between plasma vitamin C level and self-reported physical functional health. Methods: A population-based cross-sectional study using the European Prospective Investigation into Cancer-Norfolk study. Plasma vitamin C level &lt; 11 \u00b5mol\/L indicated vitamin C deficiency. Unconditional logistic regression models assessed the association between vitamin C deficiency and potential risk factors. Associations between quartiles of vitamin C and self-reported functional health measured by the 36-item short-form questionnaire (SF-36) were assessed. Results: After adjustment, vitamin C deficiency was associated with older age, being male, lower physical activity, smoking, more socially deprived area (Townsend index) and a lower educational attainment. Compared to the highest, those in the lowest quartile of vitamin C were more likely to score in the lowest decile of physical function (adjusted odds ratio (aOR): 1.43 (95%CI: 1.21\u20131.70)), bodily pain (aOR: 1.29 (95% CI: 1.07\u20131.56)), general health (aOR: 1.4 (95%CI: 1.18\u20131.66)), and vitality (aOR: 1.23 (95%CI: 1.04\u20131.45)) SF-36 scores. Conclusions: Simple public health interventions should be aimed at populations with risk factors for vitamin C deficiency. Poor self-reported functional health was associated with lower plasma vitamin C levels, which may reflect symptoms of latent scurvy.<\/jats:p>","DOI":"10.3390\/nu11071552","type":"journal-article","created":{"date-parts":[[2019,7,10]],"date-time":"2019-07-10T03:05:26Z","timestamp":1562727926000},"page":"1552","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Plasma Vitamin C Levels: Risk Factors for Deficiency and Association with Self-Reported Functional Health in the European Prospective Investigation into Cancer-Norfolk"],"prefix":"10.3390","volume":"11","author":[{"given":"Stephen J.","family":"McCall","sequence":"first","affiliation":[{"name":"National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK"},{"name":"Ageing Clinical &amp; Experimental Research Group, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan B.","family":"Clark","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert N.","family":"Luben","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas J.","family":"Wareham","sequence":"additional","affiliation":[{"name":"MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kay-Tee","family":"Khaw","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3852-6158","authenticated-orcid":false,"given":"Phyo Kyaw","family":"Myint","sequence":"additional","affiliation":[{"name":"Ageing Clinical &amp; Experimental Research Group, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1111\/j.1476-5381.2009.00282.x","article-title":"Vitamin C: Update on physiology and pharmacology","volume":"157","author":"Mandl","year":"2009","journal-title":"Br. J. Pharmacol."},{"key":"ref_2","unstructured":"Combs, J.P., and Gerald, F. (2017). Vitamin C. The Vitamins: Fundamental Aspects in Nutrition and Health, Academic Press. [5th ed.]."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/jhmas\/XXX.1.40","article-title":"The clinical definition of scurvy and the discovery of vitamin C","volume":"30","author":"Wilson","year":"1975","journal-title":"J. Hist. Med. Allied Sci."},{"key":"ref_4","unstructured":"Prinzo, Z. (1999). Scurvy and Its Prevention and Control in Major Emergencies, World Health Organization."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S0306-9877(96)90011-0","article-title":"Hyperglycemia-induced latent scurvy and atherosclerosis: The scorbutic-metaplasia hypothesis","volume":"46","author":"Price","year":"1996","journal-title":"Med. Hypotheses"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e8861","DOI":"10.1097\/MD.0000000000008861","article-title":"Latent scurvy with tiredness and leg pain in alcoholics: An underestimated disease three case reports","volume":"96","author":"Battistelli","year":"2017","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.3945\/ajcn.2008.27016","article-title":"Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003\u20132004 National Health and Nutrition Examination Survey (NHANES)","volume":"90","author":"Schleicher","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1093\/pubmed\/fdn076","article-title":"Estimated prevalence and predictors of vitamin C deficiency within UK\u2019s low-income population","volume":"30","author":"Erens","year":"2008","journal-title":"J. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ravindran, R.D., Vashist, P., Gupta, S.K., Young, I.S., Maraini, G., Camparini, M., Jayanthi, R., John, N., Fitzpatrick, K.E., and Chakravarthy, U. (2011). Prevalence and risk factors for vitamin C deficiency in north and south India: A two centre population based study in people aged 60 years and over. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0028588"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1136\/pmj.78.919.292","article-title":"Will an orange a day keep the doctor away?","volume":"78","author":"Richardson","year":"2002","journal-title":"Postgrad. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lim, D.J., Sharma, Y., and Thompson, C.H. (2019, June 10). Vitamin C and alcohol: A call to action. Available online: http:\/\/dx.doi.org\/10.1136\/bmjnph-2018-000010.","DOI":"10.1136\/bmjnph-2018-000010"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"870","DOI":"10.2105\/AJPH.94.5.870","article-title":"Vitamin C deficiency and depletion in the United States: The third national health and nutrition examination survey, 1988 to 1994","volume":"94","author":"Hampl","year":"2004","journal-title":"Am. J. Public Health"},{"key":"ref_13","first-page":"19","article-title":"Vitamin C and human health\u2014A review of recent data relevant to human requirements","volume":"66","author":"Weber","year":"1996","journal-title":"Int. J. Vitam. Nutr Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/S0140-6736(00)04128-3","article-title":"Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: A prospective population study","volume":"357","author":"Khaw","year":"2001","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1017\/S1368980007222608","article-title":"Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer\u2013Norfolk (EPIC\u2013Norfolk): A population-based cross-sectional study","volume":"10","author":"Myint","year":"2007","journal-title":"Public Health Nutr."},{"key":"ref_16","first-page":"95","article-title":"EPIC-Norfolk: Study design and characteristics of the cohort","volume":"80","author":"Day","year":"1999","journal-title":"Br. J. Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1093\/ajcn\/87.1.64","article-title":"Plasma vitamin C concentrations predict risk of incident stroke over 10 y in 20,649 participants of the European Prospective Investigation into Cancer\u2013Norfolk prospective population study","volume":"87","author":"Myint","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1161\/HYPERTENSIONAHA.111.171108","article-title":"Association between plasma vitamin C concentrations and blood pressure in the European prospective investigation into cancer-Norfolk population-based study","volume":"58","author":"Myint","year":"2011","journal-title":"Hypertension"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"902","DOI":"10.3945\/ajcn.111.032920","article-title":"Plasma carotenoids and vitamin C concentrations and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition","volume":"96","author":"Ros","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","first-page":"25","article-title":"Fluorometric assay of vitamin C in biological materials using a centrifugal analyser with fluorescence attachment","volume":"5","author":"Vuilleumier","year":"1989","journal-title":"J. Micronutr. Anal."},{"key":"ref_21","unstructured":"Lohman, T.G., Roche, A.F., and Martoll, R. (1993). ANTHROPOMETRIC Standardization Reference Manual, Human Kinetic Books; Wiley Online Library. [abridged ed.]."},{"key":"ref_22","unstructured":"Townsend, P., Phillimore, P., and Beattie, A. (1988). Health and Deprivation: Inequality and the North, Routledge."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"522","DOI":"10.2307\/590433","article-title":"The genesis of the Registrar-General\u2019s social classification of occupations","volume":"35","author":"Szreter","year":"1984","journal-title":"Br. J. Sociol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2307\/591056","article-title":"A note on the changing status of the Registrar General\u2019s classification of occupations","volume":"37","author":"Brewer","year":"1986","journal-title":"Br. J. Sociol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/j.1365-277X.2005.00593.x","article-title":"The CAFE computer program for nutritional analysis of the EPIC-Norfolk food frequency questionnaire and identification of extreme nutrient values","volume":"18","author":"Welch","year":"2005","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1079\/PHN2002439","article-title":"Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study","volume":"6","author":"Wareham","year":"2003","journal-title":"Public Health Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1136\/bmj.305.6846.160","article-title":"Validating the SF-36 health survey questionnaire: New outcome measure for primary care","volume":"305","author":"Brazier","year":"1992","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4278\/ajhp.100917-QUAN-312","article-title":"Physical activity and fruit and vegetable intake: Correlations between and within adults in a longitudinal multiethnic cohort","volume":"28","author":"Woolcott","year":"2013","journal-title":"Am. J. Health Promot."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.ejim.2003.08.006","article-title":"Hypovitaminosis C in hospitalized patients","volume":"14","author":"Fain","year":"2003","journal-title":"Eur. J. Int. Med."},{"key":"ref_30","first-page":"23","article-title":"Fruit and vegetable consumption","volume":"13","year":"2002","journal-title":"Health Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0140-6736(02)09328-5","article-title":"MRC\/BHF Heart Protection Study of antioxidant vitamin supplementation in 20 536 high-risk individuals: A randomised placebo-controlled trial","volume":"360","author":"Group","year":"2002","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1001\/archinte.164.21.2335","article-title":"The SU. VI. MAX Study: A randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals","volume":"164","author":"Hercberg","year":"2004","journal-title":"Arch. Int. Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Pullar, J., Bayer, S., and Carr, A. (2018). Appropriate handling, processing and analysis of blood samples is essential to avoid oxidation of vitamin C to dehydroascorbic acid. Antioxidants, 7.","DOI":"10.3390\/antiox7020029"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Grotzkyj Giorgi, M., Howland, K., Martin, C., and Bonner, A.B. (2012). A novel HPLC method for the concurrent analysis and quantitation of seven water-soluble vitamins in biological fluids (plasma and urine): A validation study and application. Sci. World J.","DOI":"10.1100\/2012\/359721"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.annepidem.2005.04.005","article-title":"Relation between self-reported physical functional health and chronic disease mortality in men and women in the european prospective investigation into cancer (EPIC\u2013Norfolk): A prospective population study","volume":"16","author":"Myint","year":"2006","journal-title":"Ann. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/psy.0b013e318068fcd4","article-title":"Self-reported mental health-related quality of life and mortality in men and women in the European Prospective Investigation into Cancer (EPIC-Norfolk): A prospective population study","volume":"69","author":"Myint","year":"2007","journal-title":"Psychosom. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1212\/01.wnl.0000296010.21252.78","article-title":"Physical health-related quality of life predicts stroke in the EPIC-Norfolk","volume":"69","author":"Myint","year":"2007","journal-title":"Neurology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1093\/ije\/dyq061","article-title":"Physical functional health predicts the incidence of coronary heart disease in the European Prospective Investigation into Cancer-Norfolk prospective population-based study","volume":"39","author":"Myint","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1038\/sj.ijo.0802636","article-title":"Obesity, confidant support and functional health: Cross-sectional evidence from the EPIC-Norfolk cohort","volume":"28","author":"Surtees","year":"2004","journal-title":"Int. J. Obes."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/7\/1552\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:03:56Z","timestamp":1760187836000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/7\/1552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,9]]},"references-count":39,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7]]}},"alternative-id":["nu11071552"],"URL":"https:\/\/doi.org\/10.3390\/nu11071552","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,9]]}}}