Vitamin D: An overview of vitamin D status and intake in Europe

In recent years, there have been reports suggesting a high prevalence of low vitamin D intakes and vitamin D deficiency or inadequate vitamin D status in Europe. Coupled with growing concern about the health risks associated with low vitamin D status, this has resulted in increased interest in the topic of vitamin D from healthcare professionals, the media and the public. Adequate vitamin D status has a key role in skeletal health. Prevention of the well‐described vitamin D deficiency disorders of rickets and osteomalacia are clearly important, but there may also be an implication of low vitamin D status in bone loss, muscle weakness and falls and fragility fractures in older people, and these are highly significant public health issues in terms of morbidity, quality of life and costs to health services in Europe. Although there is no agreement on optimal plasma levels of vitamin D, it is apparent that blood 25‐hydroxyvitamin D [25(OH)D] levels are often below recommended ranges for the general population and are particularly low in some subgroups of the population, such as those in institutions or who are housebound and non‐Western immigrants. Reported estimates of vitamin D status within different European countries show large variation. However, comparison of studies across Europe is limited by their use of different methodologies. The prevalence of vitamin D deficiency [often defined as plasma 25(OH)D <25 nmol/l] may be more common in populations with a higher proportion of at‐risk groups, and/or that have low consumption of foods rich in vitamin D (naturally rich or fortified) and low use of vitamin D supplements. The definition of an adequate or optimal vitamin D status is key in determining recommendations for a vitamin D intake that will enable satisfactory status to be maintained all year round, including the winter months. In most European countries, there seems to be a shortfall in achieving current vitamin D recommendations. An exception is Finland, where dietary survey data indicate that recent national policies that include fortification and supplementation, coupled with a high habitual intake of oil‐rich fish, have resulted in an increase in vitamin D intakes, but this may not be a suitable strategy for all European populations. The ongoing standardisation of measurements in vitamin D research will facilitate a stronger evidence base on which policies can be determined. These policies may include promotion of dietary recommendations, food fortification, vitamin D supplementation and judicious sun exposure, but should take into account national, cultural and dietary habits. For European nations with supplementation policies, it is important that relevant parties ensure satisfactory uptake of these particularly in the most vulnerable groups of the population.     

The potential role of vitamin D enhanced foods in improving vitamin D status

Low vitamin D intake and status have been reported worldwide and many studies have suggested that this low status may be involved in the development of several chronic diseases. There are a limited number of natural dietary sources of vitamin D leading to a real need for alternatives to improve dietary intake. Enhancement of foods with vitamin D is a possible mode for ensuring increased consumption and thus improved vitamin D status. The present review examines studies investigating effects of vitamin D enhanced foods in humans and the feasibility of the approach is discussed.     

Maternal vitamin D status and delivery by cesarean

We examined the association of vitamin D deficiency to risk of cesarean delivery using prospective data in a cohort of 1153 low income and minority gravidae. Circulating maternal 25-hydroxyvitamin D and intact parathyroid hormone were measured at entry to care 13.73 ± 5.6 weeks (mean ± SD). Intake of vitamin D and calcium was assessed at three time points during pregnancy. Using recent Institute of Medicine guidelines, 10.8% of the gravidae were at risk of vitamin D deficiency, and 23.8% at risk of insufficiency. Maternal 25-hydroxyvitamin D was related positively to vitamin D and calcium intakes and negatively to circulating concentrations of parathyroid hormone. Risk for cesarean delivery was increased significantly for vitamin D deficient women; there was no increased risk for gravidae at risk of insufficiency. When specific indications were examined, vitamin D deficiency was linked to a 2-fold increased risk of cesarean for prolonged labor. Results were the similar when prior guidelines for vitamin D deficiency (25(OH)D < 37.5nmol/L) and insufficiency (37.5-80 nmol/L) were utilized.     

沈阳地区婴幼儿维生素D营养状况的调查研究

目的 了解沈阳地区0～3岁婴幼儿维生素D(VitD)营养状况与其性别、年龄以及季节的关系,为本地区婴幼儿合理进行VitD的补充提供科学依据。方法 对沈阳市妇婴医院儿童保健门诊体检的0～3岁婴幼儿,采用化学发光法进行血清25(OH)D水平检测。结果 2 381例婴幼儿25(OH)D总体平均水平为(36.73±18.75)ng/ml,其中25(OH)D水平严重缺乏组8例(0.34%)、缺乏组174例(7.31%)、不足组149例(6.55%)、正常组2 026例(85.09%)、过量组24例(1.01%);不同性别间血清25(OH)D水平差异无统计学意义(P＞0.05);0～1岁婴儿组血清25(OH)D水平低于1～3岁幼儿组,两组差异有统计学意义(P＜0.05);不同季节婴幼儿血清25(OH)D水平冬季最高,春季最低。结论 沈阳地区0～3岁婴幼儿VitD的总体营养状况较好,但仍存在VitD缺乏及过量现象。应注重科学合理补充VitD,避免出现VitD不足、过量及中毒情况。     

Single high-dose vitamin D at birth corrects vitamin D deficiency in infants in Mexico

Abstract

This study examined the prevalence of vitamin D deficiency in mothers and infants in Tijuana, Mexico and determined the effect of a single oral dose of 50?000?IU vitamin D₃ at birth on 25-hydroxyvitamin D (25[OH]D) levels during infancy. Healthy infants were randomized to receive vitamin D₃ or placebo at birth. At birth 23% of infants were vitamin D deficient and 77% had vitamin D insufficiency (mean 25[OH]D level 18.9?ng/ml); 10% of mothers were vitamin D deficient and 61% were insufficient. Infants receiving vitamin D₃ had higher 25(OH)D levels at two months (N?=?29; 33.9 versus 24.2?ng/ml) and six months (N?=?21; 36.5 versus 27.4?ng/ml). Exclusively breastfed infants had lower 25(OH)D levels at two months (14.9 versus 33.4?ng/ml). Vitamin D deficiency is common in infants and mothers in Tijuana, Mexico. A single dose of vitamin D₃ at birth was safe and significantly increased 25(OH)D levels during infancy.     

Incidence and characteristics of vitamin D deficiency rickets in New Zealand children: a New Zealand Paediatric Surveillance Unit study

Objective: To investigate the incidence and characteristics of vitamin D deficiency rickets in New Zealand (NZ). Methods: Prospective surveillance among paediatricians of Vitamin D Deficiency Rickets was conducted by the New Zealand Paediatric Surveillance Unit (NZPSU) for 36 months, from July 2010 to June 2013, inclusive. Inclusion criteria were: children and adolescents <15 years of age with vitamin D deficiency rickets (defined by low serum 25‐hydroxyvitamin D and elevated alkaline phosphatase levels, and/or radiological rickets). Results: Fifty‐eight children with confirmed vitamin D deficiency rickets were identified. Median age was 1.4 (range 0.3–11) years, 47% were male, and 95% of the children were born in NZ; however, the majority of the mothers (68%) were born outside NZ. Overall annual incidence of rickets in children aged <15 years was 2.2/100,000 (95%CI 1.4–3.5); with incidence in those <3 years being 10.5/100,000 (95%CI 6.7–16.6). Skeletal abnormalities, poor growth and motor delay were the most common presenting features, with hypocalcaemic convulsion in 16% of children. Key risk factors identified were: darker skin pigment, Indian and African ethnicity, age <3 years, exclusive breast feeding, and southern latitude, particularly when combined with season (winter/spring). Of the patients reported, none had received appropriate vitamin D supplementation. Conclusions: Vitamin D deficiency rickets remains a problem for NZ children. Key risk factors remain similar to those identified in the international literature. Preventative targeted vitamin D supplementation, as per existing national guidelines, was lacking in all cases reported. Implications: Vitamin D deficiency rickets is the most significant manifestation of vitamin D deficiency in growing children. To reduce the incidence of this disease among those at high risk, increasing awareness and implementation of current public health policies for targeted maternal, infant and child supplementation are required.     

Serum vitamin D status and metabolic syndrome: a systematic review and dose-response meta-analysis

BACKGROUD/OBJECTIVESEvidence has suggested an association between serum vitamin D and metabolic syndrome (MetS), but prospective studies are very limited. The objective was to assess the dose-response association between serum vitamin D concentration and MetS risk using a systematic review and meta-analysis of updated observational studies.MATERIALS/METHODSUsing MEDLINE, PubMed, and Embase, a systematic literature search was conducted through February 2020 and the references of relevant articles were reviewed. A random-effects model was used to estimate the summary odds ratio/relative risk and 95% confidence interval (CI). Heterogeneity among studies was evaluated with I² statistic. In total, 23 observational studies (19 cross-sectional studies, and four cohort studies) were included in the meta-analysis.RESULTSThe pooled estimates (95% CI) for MetS per 25-nmol/L increment in serum vitamin D concentration were 0.80 (95% CI, 0.76–0.84; I² = 53.5) in cross-sectional studies, and 0.85 (95% CI, 0.72–0.98; I² = 85.8) in cohort studies. Similar results were observed, irrespectively of age of study population, study location, MetS criteria, and adjustment factors. There was no publication bias for the dose-response meta-analysis of serum vitamin D concentrations and MetS.CONCLUSIONSDose-response meta-analysis demonstrated that a 25-nmol/L increment in the serum vitamin D concentration was associated with 20% and 15% lower risks of MetS in cross-sectional studies and cohort studies, respectively.     

城市居民维生素D营养状况调查

目的调查分析浙江2城市居民维生素D营养状况。方法选取杭州、宁波2城市,按多阶段整群随机抽样方法,采集442名居民的血样,采用放射免疫法进行血清25羟维生素D[25（OH）D]检测,分析2城市居民维生素D营养状况。结果 6岁-、12岁-、18岁-、45岁-和60岁-组血清中25（OH）D中位数分别为53.19（41.85-64.89）、48.76（32.56-60.52）、59.91（48.05-72.79）、68.67（55.50-78.07）和70.97（56.91-84.65）nmol/L。居民维生素D缺乏、不足、正常和适宜人数分别占2.95%、30.84%、44.22%和22.00%。结论所调查的2城市居民维生素D缺乏状况普遍,维生素D营养状况有待改善。     

Evidence of low vitamin D intakes in the Australian population points to a need for data-driven nutrition policy for improving population vitamin D status

Background

Nearly one in four Australian adults is vitamin D deficient (serum 25-hydroxyvitamin D concentrations [25(OH)D] < 50 nmol L^–1) and current vitamin D intakes in the Australian population are unknown. Internationally, vitamin D intakes are commonly below recommendations, although estimates generally rely on food composition data that do not include 25(OH)D. We aimed to estimate usual vitamin D intakes in the Australian population.

Methods

Nationally representative food consumption data were collected for Australians aged ≥ 2 years (n = 12,153) as part of the cross-sectional 2011–2013 Australian Health Survey (AHS). New analytical vitamin D food composition data for vitamin D₃, 25(OH)D₃, vitamin D₂ and 25(OH)D₂ were mapped to foods and beverages that were commonly consumed by AHS participants. Usual vitamin D intakes (µg day^–1) by sex and age group were estimated using the National Cancer Institute method.

Results

Assuming a 25(OH)D bioactivity factor of 1, mean daily intakes of vitamin D ranged between 1.84 and 3.25 µg day^–1. Compared to the estimated average requirement of 10 µg day^–1 recommended by the Institute of Medicine, more than 95% of people had inadequate vitamin D intakes. We estimated that no participant exceeded the Institute of Medicine's Upper Level of Intake (63–100 µg day^–1, depending on age group).

Conclusions

Usual vitamin D intakes in Australia are low. This evidence, paired with the high prevalence of vitamin D deficiency in Australia, suggests that data-driven nutrition policy is required to safely increase dietary intakes of vitamin D and improve vitamin D status at the population level.     

维生素D和维生素D缺乏性佝偻病的研究

进入21世纪,维生素D缺乏性佝偻病又出现了上升趋势.该文探讨了其病因:纯母乳喂养时间过长而未添加维生素D,尤其是那些摄入母亲自身是维生素D缺乏者乳汁的婴儿;由于各种原因造成婴儿日照时间减少,从而使得婴儿体内由皮肤转化的内源性维生素D的量大大减少;在很多温带地区移民人群中佝偻病的高发病率.因此,维生素D缺乏可能是一项国际妇幼保健问题,需再次强调对儿童及孕妇额外补充维生素D及日照的重要性.     

住院治疗中新生儿维生素A、D、E水平单中心现况调查

目的 调查河南安阳地区住院治疗中新生儿维生素A、D、E水平及相关影响因素,为早期防治维生素A、D、E缺乏提供科学依据。方法 选取2017年5月-2019年2月在安阳市人民医院新生儿科住院治疗的329例新生儿为研究对象。采用高效液相色谱法和液相串联质谱法检测新生儿维生素A、D、E。结果 1)新生儿维生素A水平为(0.17±0.09) mg/L,维生素D水平为(14.21±12.05) ng/ml,维生素E水平为(6.50±3.80) mg/L。2) 足月儿与早产儿的维生素A水平,不同性别新生儿的维生素D水平,高危儿与非高危儿的维生素E水平差异均有统计学意义(P＜0.05)。不同体重组维生素A、D、E水平差异无统计学意义(P＞0.05)。3) 维生素A亚临床缺乏,维生素D及维生素E缺乏比例较高。4) 不同季节出生的新生儿维生素D水平差异有统计学意义(P＜0.05)。孕末期3个月补充维生素D剂量≥400 U/d与＜400 U/d的新生儿维生素D水平差异有统计学意义(P＜0.05)。结论 河南安阳地区住院治疗中新生儿大部分存在维生素A、D、E缺乏,是否足月、是否为高危儿可能分别与维生素A、E水平有关。不同性别、季节及孕末期补充维生素D的剂量与维生素D水平有关。     

冬季妊娠中期孕妇25-羟维生素D的营养状况

目的 探讨冬季妊娠中期孕妇的25-羟维生素D[25(OH)D]营养状况及其与孕妇年龄、血红蛋白水平的相关关系。方法 选取2009年12月至2010年2月在南京医科大学第一附属医院就诊的78名正常妊娠中期孕妇为研究对象。于孕24 ～ 28周取空腹静脉血,检测血清25(0H)D和全血血红蛋白水平。采用Pearson相关分析研究血清25(OH)D水平与孕妇年龄、血红蛋白水平的相关性。结果 冬季妊娠中期孕妇25(OH)D缺乏(≤25.0 nmol/L)的发生率为65.38％,25(OH)D不足[25.0 nmol/L＜25 (OH)D≤50.0 nmol/L]的发生率为30.77％,25(OH)D正常者占3.85％。冬季妊娠中期孕妇血清25(OH)D水平与血红蛋白水平呈正相关(r=0.2746,P=0.015)。结论 冬季妊娠中期孕妇普遍存在25(OH)D不足或缺乏,低血红蛋白水平的孕妇尤甚。     

孕期鼠补充维生素D对子鼠胸腺维生素D受体表达

目的 研究给予母孕期大鼠补充不同剂量维生素D,检测子代鼠胸腺中VDR表达变化。方法 健康雌性Wistar大鼠18只,雄性Wistar大鼠9只,以每日晚间17时将雌鼠、雄鼠按2∶1合笼,次日8时对雌鼠阴道分泌物涂片,在40倍光学显微镜检查到精子表示受孕,记为妊娠0 d( gestational day 0,GD0) 。将孕鼠随机入对照组、维生素D低剂量、维生素D高剂量组。于GD 15 d起对照组每日给予肌肉注射生理盐水0.25 ml/(kg·次),低剂量组给予肌肉注射维生素D 20 μg/kg,高剂量组给予肌肉注射维生素D 100 μg/kg,直至子鼠娩出。子鼠哺乳21 d后分离子鼠胸腺,Real-time PCR检测VDRmRNA表达水平,Western blot检测VDR蛋白表达水平。结果 通过Real-tine PCR分析仔鼠胸腺VDR基因表达三组之间差异无统计学意义(P＞0.05)。Western blot检测VDR蛋白水平的表达显示,低剂量及高剂量组VDR蛋白的表达量均高于对照组,三组之间差异存在统计学意义(P＜0.05)。结论 给予母鼠补充维生素D,其仔鼠胸腺VDR蛋白表达量明显增加,与维生素D补充量呈正相关。     

The relationship between ultraviolet radiation exposure and vitamin D status

This paper reviews the main factors influencing the synthesis of vitamin D, with particular focus on ultraviolet radiation exposure. On the global level, the main source of vitamin D is the sun. The effect of solar radiation on vitamin D synthesis depends to some extent on the initial vitamin D levels. At moderate to high latitudes, diet becomes an increasingly important source of vitamin D due to decreased solar intensity and cold temperatures, which discourage skin exposure. During the mid-winter season, these factors result in decreased solar radiation exposure, hindering extensively the synthesis of vitamin D in these populations.     

Circulating levels of vitamin D, vitamin D receptor polymorphisms, and colorectal adenoma: a meta-analysis

Growing evidence suggests an elevated risk for colorectal neoplasia among individuals with low levels of vitamin D, the biological actions of which are mediated by the vitamin D receptor (VDR). To investigate the association among vitamin D status, VDR polymorphisms (FokI, and BsmI), and colorectal adenoma, we conducted a meta-analysis of nine studies of circulating levels of 25-hydroxyvitamin D (25(OH)D) and five studies of FokI or BsmI polymorphisms in relation to colorectal adenomas. Study-specific relative risks (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model. A total of 3398 colorectal adenomas for 25(OH)D and 1754 colorectal adenomas for VDR were included in the meta-analysis. We identified a significant inverse association between colorectal adenoma (combined RR, 0.93; 95% CI, 0.87-0.98 per 10 ng/mL increase in 25(OH)D levels). When we examined FokI and BsmI polymorphisms in the meta-analysis, we found no association for either FokI (combined RR, 1.00; 95% CI, 0.95-1.06) or BsmI (combined RR, 0.99; 95% CI, 0.93-1.05) in the additive model. These data suggest an inverse association between circulating 25(OH)D levels and colorectal adenoma risk.     

双胎脐血维生素D水平与孕母维生素D营养状况的关系

[目的]探讨双胎脐血维生素D水平与孕母维生素D营养状况的关系,进行孕期营养指导.[方法]以2008年3月～2009年3月分娩的37对双胞胎和双胎母亲为研究对象,测定脐血与分娩时母亲血清25羟-维牛素D3[25-(OH)D3]水平,对双胎孕妇于孕4～6月、分娩前进行膳食指导、膳食调查和问卷调查.[结果]双胎儿脐血25-(OH)D3水平为(66.59±32.04)nmol/L;对应母血水平为(67.70±34.39)nmol/L.脐血与母血之间、双胎脐血之间均数比较,差异均无显著性.母血正常组,母血与脐血水平呈正相关(r=0.83.P＜0.01);母血低常组,母血与脐血水平呈负相关(r=0.71,P＜0.01).母孕期平均每日户外活动时间(r=0.85.P=0.00);每天进食含有维生素D食物的种类(r=0.52,P=0.04);孕期补充维生索D史(F=7.55,P=0.01)与母血25-(OH)D3水平有关.母血、脐血25-(OH)D3均正常的孕母孕期平均每日户外活动时间为(1.98±0.82)h;每天进食含有维生素D的食物的种类为(2.01±0.76)种,有服用维生素D制剂的占80%.[结论]双胎脐血维生素D水平与孕母维生素D营养状况密切相关;为维持孕母、胎儿维生素D的正常水平,双胎孕母孕期应采取综合预防措施.     

不同季节112例母婴维生素D营养状况分析

目的 以血清25-(OH)D为检测指标, 了解不同季节、不同居住环境孕妇及其新生儿的维生素D营养状况及母婴血清维生素D的相关性。方法 选取冬季(2010年12月-2011年2月)和夏季(2011年6月-2011年8月)在河北北方学院附属第二医院妇产科正常分娩的孕妇及其新生儿为研究对象。72对孕妇及其新生儿为冬季组, 40对孕妇及其新生儿为夏季组。孕妇于分娩前采集静脉血, 新生儿于娩出后采集脐血, 分离血清。酶联免疫法测定血清25-(OH)D水平。维生素D营养状况采用三分法:1)维生素D缺乏:25-(OH)D＜50 nmol/L;2)维生素D不足:50 nmol/L≤25-(OH)D＜75 nmol/L;3)维生素D充足:25-(OH)D≥75 nmol/L。结果 1)冬季和夏季孕妇血清25-(OH)D水平分别为(19.48±7.04)nmol/L和(53.15±17.50)nmol/L, 冬季显著低于夏季;对应的新生儿脐血25-(OH)D水平分别为(19.95±6.79)nmol/L和(47.39±15.31)nmol/L, 冬季显著低于夏季。2)冬季孕妇25-(OH)D水平为9.19~36.99 nmol/L, 新生儿25-(OH)D水平为7.78~37.36 nmol/L, 冬季孕妇及新生儿维生素D缺乏率为100%。夏季孕妇25-(OH)D水平为26.72~103.90 nmol/L, 新生儿25-(OH)D水平为20.76~79.91 nmol/L, 夏季孕妇和新生儿维生素D缺乏率分别为47.5%和62.5%。3)孕妇与新生儿25-(OH)D水平具有显著正相关(r=0.902)。4)冬季组孕妇及其新生儿25-(OH)D水平无城乡之间的差异;夏季组孕妇及其新生儿25-(OH)D水平存在城乡之间的差异, 农村孕妇及其新生儿25-(OH)D水平高于城市。结论 孕妇及其新生儿25-(OH)D水平存在明显的季节差异。冬季孕妇及其新生儿普遍维生素D缺乏, 即使夏季孕妇及其新生儿维生素D缺乏比率也较高。     

Association between vitamin D status and lipid profile in children and adolescents: a systematic review and meta-analysis

This systematic review and meta-analysis was performed on the relationship of serum 25-hydroxy-vitamin D [25(OH)D] and lipid profile in the pediatric age group. Electronic search was conducted in international databases. Our search yielded to 3213 articles, with initial searching of title and abstracts, 3192 of them were excluded and 21 remained. A meta-analysis of 17 cross-sectional studies, including 25?394 subjects, was conducted according to Strobe guideline. We found an inverse weak significant association between 25(OH)D and triglycerides (r?=??0.135, CI; ?0.243, ?0.025), total cholesterol (r?=??0.086, CI; ?0.0205, 0.035) and LDL-C (r?=??0.025, CI; ?0.22, 0.17), and direct association with HDL-C (r?=?0.156, CI; ?0.021, 0.324). In the pooled analysis, we used a random effects model as the heterogeneity between studies was significant (I^2?=?97.04%, p?I^2?=?96.09%, p?I^2?=?96.14%, p?I^2?=?99%, p?相似文献   

A food frequency questionnaire for the assessment of calcium, vitamin D and vitamin K: a pilot validation study

The study objective was to validate a food frequency questionnaire (FFQ) to assess calcium, vitamin D and vitamin K intakes in overweight and obese postmenopausal community-dwelling women. The FFQ was validated against intakes derived from a 5-day diet record (5DDR) that also included assessment of supplement intake. Strong correlations between methods were observed for all nutrients (r = 0.63, 0.89, 0.54 for calcium, vitamin D and vitamin K, respectively) and cross-classification analyses demonstrated no major misclassification of participants into intake quartiles. Bland-Altman analysis showed that the FFQ overestimated intakes for calcium, by 576 mg/day (95% CI, -668 to 1,821 mg/day), for vitamin D by 75 IU/day (95% CI, -359 to 510 IU/day), and for vitamin K by 167 mcg/day (95% CI, -233 to 568 mcg/day). This pilot study showed promising validation evidence for the use of this FFQ, which focuses on calcium, vitamin D and vitamin K intakes in postmenopausal women, as a screening tool in clinical and research settings.