(07-12-2017) Vitamin D deficiency in Europe: pandemic?1,2

Kevin D Cashman3,4,*, Kirsten G Dowling3, Zuzana Škrabáková3,
Marcela Gonzalez-Gross6,7, Jara Valtueña6, Stefaan De Henauw8, Luis
Moreno9, Camilla T Damsgaard10, Kim F Michaelsen10, Christian
Mølgaard10, Rolf Jorde11, Guri Grimnes11, George Moschonis12,
Christina Mavrogianni12, Yannis Manios12, Michael Thamm13, Gert BM
Mensink13, Martina Rabenberg13, Markus A Busch13, Lorna Cox14, Sarah
Meadows14, Gail Goldberg14, Ann Prentice14, Jacqueline M Dekker15,
Giel Nijpels16, Stefan Pilz18, Karin M Swart15, Natasja M van
Schoor15, Paul Lips17, Gudny Eiriksdottir19, Vilmundur Gudnason19,20,
Mary Frances Cotch21, Seppo Koskinen23, Christel Lamberg-Allardt24,
Ramon A Durazo-Arvizu25, Christopher T Sempos22, and Mairead Kiely3,5

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Author Affiliations

3Cork Centre for Vitamin D and Nutrition Research, School of Food
and Nutritional Sciences,
4Department of Medicine, and
5Irish Centre for Fetal and Neonatal Translational Research,
University College Cork, Cork, Ireland;
6ImFINE Research Group, Department of Health and Human
Performance, Technical University of Madrid, Madrid, Spain;
7CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la
Nutrición, CIBERobn, Instituto de Salud Carlos III, Madrid, Spain;
8Department of Public Health, Ghent University, Ghent, Belgium;
9Growth, Exercise, Nutrition and Development Research Group,
Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain;
10Department of Nutrition, Exercise and Sports, Faculty of
Science, University of Copenhagen, Frederiksberg C, Denmark;
11Tromsø Endocrine Research Group, Department of Clinical
Medicine, UiT The Arctic University of Norway, Tromsø, Norway;
12Department of Nutrition and Dietetics, Harokopio University,
Athens, Greece;
13Department of Epidemiology and Health Monitoring, Robert
Koch-Institut, Berlin, Germany;
14Medical Research Council Human Nutrition Research Unit, Elsie
Widdowson Laboratory, Cambridge, United Kingdom;
15Department of Epidemiology and Biostatistics, EMGO Institute for
Health and Care Research,
16Department of General Practice & Elderly Care Medicine, and
17Department of Internal Medicine, Section of Endocrinology, Vrije
Universiteit University Medical Center, Amsterdam, Netherlands;
18Division of Endocrinology and Metabolism, Department of Internal
Medicine, Medical University of Graz, Graz, Austria;
19Icelandic Heart Association, Kopavogur, Iceland;
20University of Iceland, Reykjavik, Iceland;
21Division of Epidemiology and Clinical Applications, National Eye
Institute and
22Office of Dietary Supplements, NIH, Bethesda, MD;
23Department of Health, Functional Capacity and Welfare and
Department of Chronic Disease Prevention, National Institute for
Health and Welfare, Helsinki, Finland;
24Department of Food and Environmental Sciences, Helsinki
University, Helsinki, Finland; and
25Department of Public Health Sciences, Loyola University Stritch
School of Medicine, Chicago, IL

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Author Notes

↵1 Supported by funding from the European Commission under its
Seventh Framework Programme (Food-based solutions for optimal vitamin
D nutrition and health through the life cycle; grant 613977). The
findings and conclusions in this report are those of the authors and
do not necessarily represent the views of the NIH, the US Department
of Health and Human Services, or the US Department of Commerce. This
is a free access article, distributed under terms
(http://www.nutrition.org/publications/guidelines-and-policies/license/)
that permit unrestricted noncommercial use, distribution, and
reproduction in any medium, provided the original work is properly
cited.

↵2 Supplemental Material and Supplemental Figures 1–2 are
available from the “Online Supporting Material” link in the online
posting of the article and from the same link in the online table of
contents at http://ajcn.nutrition.org.

↵*To whom correspondence should be addressed. E-mail: [email protected].

Abstract

Background: Vitamin D deficiency has been described as being pandemic,
but serum 25-hydroxyvitamin D [25(OH)D] distribution data for the
European Union are of very variable quality. The NIH-led international
Vitamin D Standardization Program (VDSP) has developed protocols for
standardizing existing 25(OH)D values from national health/nutrition
surveys.

Objective: This study applied VDSP protocols to serum 25(OH)D data
from representative childhood/teenage and adult/older adult European
populations, representing a sizable geographical footprint, to better
quantify the prevalence of vitamin D deficiency in Europe.

Design: The VDSP protocols were applied in 14 population studies
[reanalysis of subsets of serum 25(OH)D in 11 studies and complete
analysis of all samples from 3 studies that had not previously
measured it] by using certified liquid chromatography–tandem mass
spectrometry on biobanked sera. These data were combined with
standardized serum 25(OH)D data from 4 previously standardized studies
(for a total n = 55,844). Prevalence estimates of vitamin D deficiency
[using various serum 25(OH)D thresholds] were generated on the basis
of standardized 25(OH)D data.

Results: An overall pooled estimate, irrespective of age group, ethnic
mix, and latitude of study populations, showed that 13.0% of the
55,844 European individuals had serum 25(OH)D concentrations <30
nmol/L on average in the year, with 17.7% and 8.3% in those sampled
during the extended winter (October–March) and summer (April–November)
periods, respectively. According to an alternate suggested definition
of vitamin D deficiency (<50 nmol/L), the prevalence was 40.4%.
Dark-skinned ethnic subgroups had much higher (3- to 71-fold)
prevalence of serum 25(OH)D <30 nmol/L than did white populations.

Conclusions: Vitamin D deficiency is evident throughout the European
population at prevalence rates that are concerning and that require
action from a public health perspective. What direction these
strategies take will depend on European policy but should aim to
ensure vitamin D intakes that are protective against vitamin D
deficiency in the majority of the European population.

Source: http://ajcn.nutrition.org/content/early/2016/02/10/ajcn.115.120873

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