Nutritional Deficiencies

Vitamin D - updated: 28 September 2009

Naar een toereikende inname van vitamine D

Gezondheidsraad, 2008; publicatienr. 2008/15.

ISBN-13: 978-90-5549-729-4

Bepaalde groepen in de bevolking blijken niet voldoende vitamine D binnen te krijgen via de voeding. Ook komen ze niet voldoende buiten om genoeg aan te maken in de huid. Vooral ouderen lopen de kans op een tekort, omdat de productie in de huid terugloopt met de leeftijd. Maar ook mensen met een donkere huid – die minder vitamine D produceert – hebben geregeld een tekort. Verder zijn er speciale groepen die risico lopen, zoals zwangere vrouwen, gesluierde vrouwen, kinderen en ouderen in verpleeg- en verzorgingstehuizen. Voor al deze risicogroepen is het gebruik van supplementen aan te bevelen. Voor alle anderen is het advies: eet gezond, gebruik genoeg margarine, halvarine en bak- en braadproducten (want daar is extra vitamine D aan toegevoegd), en ga dagelijks minstens een kwartier naar buiten. Deze boodschap moet door eenduidige voorlichting onder de aandacht worden gebracht. Anders dan de vitamine D-inname blijkt de jodiuminname van de Nederlandse bevolking wel goed. Daar is consolideren dus voldoende. Dit schrijft de Gezondheidsraad in twee adviezen die vandaag worden aangeboden aan de minister van Volksgezondheid, Welzijn en Sport.

Publication Types:

• Government Guideline

Online - Abstract

Online - Press Release

Online - Article

Vitamin D: important from before the cradle and to the grave

Ned Tijdschr Geneeskd. 2006 Mar 4;150(9):470-2

Grootjans-Geerts I.

Approximately one hundred years ago, vitamin D was recognized as being important for bone health. Nowadays there is increasing evidence that even before birth as well as during lifetime, vitamin D plays a role in the prevention of several chronic diseases as well as cancer. Human beings depend on exposure to the sun to satisfy their daily requirements of vitamin D. Moreover, most doctors in the Netherlands are unaware that the production of vitamin D only takes place in the spring and summertime in the Dutch climate. One Dutch study reports hypovitaminosis D not only in more than half of non-western immigrant mothers and their newborns, but also in 10% of the western mothers and their babies. On a worldwide level, numerous studies report low vitamin-D status in western countries due to our modern way of living, the immigration of dark-skinned people to higher latitudes and the homebound elderly. For some years now the scientific world has called for action on this point; something that in practice appears to be difficult to achieve. Aiming for optimal vitamin-D levels means suppletion either through tablets or food fortification. In general, people do not like to take tablets ('we eat healthy foods already') and many avoid the sun because they are afraid of cancer. Vitamin D is not a commercially rewarding product and has no marketing industry. Although multivitamins are marketed and pushed by industry, they hardly contain the necessary amounts of vitamin D. The population in the Netherlands should be better informed on this issue and general practitioners need more tools in order to play a greater role in informing and advising their patients.

Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants

Br Med J. 1980 Jul 5;281(6232):11-4

Cockburn F, Belton NR, Purvis RJ, Giles MM, Brown JK, Turner TL, Wilkinson EM, Forfar JO, Barrie WJ, McKay GS, Pocock SJ.

Pregnant women receiving daily supplements of 400 IU (10 microgram) of vitamin D2 from the 12th week of pregnancy had plasma calcium concentrations higher at 24 weeks but similar at delivery to those in control pregnant women who did not receive the supplements. Infants of the women receiving the supplements had higher calcium, lower phosphorus, and similar magnesium concentrations on the sixth day of life and a lower incidence of hypocalcaemia than infants of the control women. Plasma concentrations of 25-hydroxycholecalciferol, which showed a seasonal variation, were higher in mothers and infants in the treated group. Cord-blood calcium, magnesium, phosphorus, and 25-hydroxycholecalciferol concentrations correlated with maternal values at delivery. Breast-fed infants had higher calcium and magnesium and lower phosphorus and 25-hydroxycholecalciferol concentrations than artificially fed infants. A defect of dental enamel was found in a high proportion of infants (many of whom had suffered from hypocalcaemia) born to the control women. These results suggest that vitamin D supplementation during pregnancy would be beneficial for mothers, whose intake from diet and skin synthesis is appreciably less than 500 IU of vitamin D daily.

The vitamin D epidemic and its health consequences

J Nutr. 2005 Nov;135(11):2739S-48S

Holick MF.

Vitamin D deficiency is now recognized as an epidemic in the United States. The major source of vitamin D for both children and adults is from sensible sun exposure. In the absence of sun exposure 1000 IU of cholecalciferol is required daily for both children and adults. Vitamin D deficiency causes poor mineralization of the collagen matrix in young children's bones leading to growth retardation and bone deformities known as rickets. In adults, vitamin D deficiency induces secondary hyperparathyroidism, which causes a loss of matrix and minerals, thus increasing the risk of osteoporosis and fractures. In addition, the poor mineralization of newly laid down bone matrix in adult bone results in the painful bone disease of osteomalacia. Vitamin D deficiency causes muscle weakness, increasing the risk of falling and fractures. Vitamin D deficiency also has other serious consequences on overall health and well-being. There is mounting scientific evidence that implicates vitamin D deficiency with an increased risk of type I diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and many common deadly cancers. Vigilance of one's vitamin D status by the yearly measurement of 25-hydroxyvitamin D should be part of an annual physical examination.

Publication Types:

• Research Support, Non-U.S. Gov't

Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level

American Journal of Clinical Nutrition, Vol. 73, No. 2, 288-294, February 2001

Reinhold Vieth, Pak-Cheung R Chan and Gordon D MacFarlane

Background: The Food and Nutrition Board of the National Academy of Sciences states that 95 µg vitamin D/d is the lowest observed adverse effect level (LOAEL). Objective: Our objective was to assess the efficacy and safety of prolonged vitamin D3 intakes of 25 and 100 µg (1000 and 4000 IU)/d. Efficacy was based on the lowest serum 25-hydroxyvitamin D [25(OH)D] concentration achieved by subjects taking vitamin D3; potential toxicity was monitored by measuring serum calcium concentrations and by calculating urinary calcium-creatinine ratios. Design: Healthy men and women (n = 61) aged 41 ± 9 y ( ± SD) were randomly assigned to receive either 25 or 100 µg vitamin D3/d for 2–5 mo, starting between January and February. Serum 25(OH)D was measured by radioimmunoassay. Results: Baseline serum 25(OH)D was 40.7 ± 15.4 nmol/L ( ± SD). From 3 mo on, serum 25(OH)D plateaued at 68.7 ± 16.9 nmol/L in the 25-µg/d group and at 96.4 ± 14.6 nmol/L in the 100-µg/d group. Summertime serum 25(OH)D concentrations in 25 comparable subjects not taking vitamin D3 were 46.7 ± 17.8 nmol/L. The minimum and maximum plateau serum 25(OH)D concentrations in subjects taking 25 and 100 µg vitamin D3/d were 40 and 100 nmol/L and 69 and 125 nmol/L, respectively. Serum calcium and urinary calcium excretion did not change significantly at either dosage during the study. Conclusions: The 100-µg/d dosage of vitamin D3 effectively increased 25(OH)D to high-normal concentrations in practically all adults and serum 25(OH)D remained within the physiologic range; therefore, we consider 100 µg vitamin D3/d to be a safe intake.

Publication Types:

• Review

Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety

Am J Clin Nutr. 1999 May;69(5):842-56

Vieth R.

For adults, the 5-microg (200 IU) vitamin D recommended dietary allowance may prevent osteomalacia in the absence of sunlight, but more is needed to help prevent osteoporosis and secondary hyperparathyroidism. Other benefits of vitamin D supplementation are implicated epidemiologically: prevention of some cancers, osteoarthritis progression, multiple sclerosis, and hypertension. Total-body sun exposure easily provides the equivalent of 250 microg (10000 IU) vitamin D/d, suggesting that this is a physiologic limit. Sailors in US submarines are deprived of environmentally acquired vitamin D equivalent to 20-50 microg (800-2000 IU)/d. The assembled data from many vitamin D supplementation studies reveal a curve for vitamin D dose versus serum 25-hydroxyvitamin D [25(OH)D] response that is surprisingly flat up to 250 microg (10000 IU) vitamin D/d. To ensure that serum 25(OH)D concentrations exceed 100 nmol/L, a total vitamin D supply of 100 microg (4000 IU)/d is required. Except in those with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D concentrations <140 nmol/L, which require a total vitamin D supply of 250 microg (10000 IU)/d to attain. Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of > or = 1000 microg (40000 IU)/d. Because vitamin D is potentially toxic, intake of >25 microg (1000 IU)/d has been avoided even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 50 microg (2000 IU)/d is too low by at least 5-fold.

Publication Types:

• Review

Vitamin D status in postmenopausal women living at higher latitudes in the UK in relation to bone health, overweight, sunlight exposure and dietary vitamin D.

Bone. 2008 May;42(5):996-1003.

Macdonald HM, Mavroeidi A, Barr RJ, Black AJ, Fraser WD, Reid DM.

For 5 months a year the UK has insufficient sunlight for cutaneous synthesis of vitamin D and winter requirements are met from stores made the previous summer. Although there are few natural dietary sources, dietary intake may help maintain vitamin D status. We investigated the relationship between 25-hydroxyvitamin D (25(OH)D), bone health, overweight, sunlight exposure and dietary vitamin D in 3113 women (age 54.8 [SD 2.3] years) living at latitude 57 degrees N between 1998-2000. Serum 25(OH)D was measured by high performance liquid chromatography (HPLC), dietary intakes (food frequency questionnaire, n=2598), sunlight exposure (questionnaire, n=2402) and bone markers were assessed. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in all women at the sampling visit and 6 years before. Seasonal variation in 25(OH)D was not substantial with a peak in the autumn (23.7 [9.9] ng/ml) and a nadir in spring (19.7 [7.6] ng/ml). Daily intake of vitamin D was 4.2 [2.5] mug from food only and 5.8 [4.0] mug including vitamin D from cod liver oil and multivitamins. The latter was associated with 25(OH)D at each season whereas vitamin D simply from food was associated with 25(OH)D in winter and spring only. Sunlight exposure was associated with 25(OH)D in summer and autumn. 25(OH)D was negatively associated with increased bone resorption and bone loss (P<0.05) remaining significant after adjustment for confounders (age, weight, height, menopausal status/HRT use, physical activity and socio-economic status). Using an insufficiency cut-off of <28 ng/ml 25(OH)D, showed lower concentrations of bone resorption markers in the upper category (fDPD/Cr 5.1 [1.7] nmol/mmol compared to 5.3 [2.1] nmol/mmol, P=0.03) and no difference in BMD or bone loss. 25(OH)D was lower (P<0.01) and parathyroid hormone higher (P<0.01) in the top quintile of body mass index. In conclusion, low vitamin D status is associated with greater bone turnover, bone loss and obesity. Diet appears to attenuate the seasonal variation of vitamin D status in early postmenopausal women at northerly latitude where quality of sunlight for production of vitamin D is diminished.

Publication Types:

• Study

Publication Types:

• Review