title: Vitamin D deficiency in Europe: pandemic?
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.
  
  
  METHODS
  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.
authors: Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, Department of Medicine, and k.cashman@ucc.ie.
authors: Kevin D
authors: http://orcid.org/0000-0002-8185-1039
authors: KD
authors: Cashman
authors: Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences.
authors: Kirsten G
authors: KG
authors: Dowling
authors: Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences.
authors: Zuzana
authors: Z
authors: Škrabáková
authors: ImFINE Research Group, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain; CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III, Madrid, Spain;
authors: Marcela
authors: M
authors: Gonzalez-Gross
authors: ImFINE Research Group, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain;
authors: Jara
authors: J
authors: Valtueña
authors: Department of Public Health, Ghent University, Ghent, Belgium;
authors: Stefaan
authors: S
authors: De Henauw
authors: Growth, Exercise, Nutrition and Development Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain;
authors: Luis
authors: L
authors: Moreno
authors: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark;
authors: Camilla T
authors: CT
authors: Damsgaard
authors: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark;
authors: Kim F
authors: KF
authors: Michaelsen
authors: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark;
authors: Christian
authors: C
authors: Mølgaard
authors: Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway;
authors: Rolf
authors: R
authors: Jorde
authors: Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway;
authors: Guri
authors: G
authors: Grimnes
authors: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece;
authors: George
authors: G
authors: Moschonis
authors: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece;
authors: Christina
authors: C
authors: Mavrogianni
authors: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece;
authors: Yannis
authors: Y
authors: Manios
authors: Department of Epidemiology and Health Monitoring, Robert Koch-Institut, Berlin, Germany;
authors: Michael
authors: M
authors: Thamm
authors: Department of Epidemiology and Health Monitoring, Robert Koch-Institut, Berlin, Germany;
authors: Gert Bm
authors: GB
authors: Mensink
authors: Department of Epidemiology and Health Monitoring, Robert Koch-Institut, Berlin, Germany;
authors: Martina
authors: M
authors: Rabenberg
authors: Department of Epidemiology and Health Monitoring, Robert Koch-Institut, Berlin, Germany;
authors: Markus A
authors: MA
authors: Busch
authors: Medical Research Council Human Nutrition Research Unit, Elsie Widdowson Laboratory, Cambridge, United Kingdom;
authors: Lorna
authors: L
authors: Cox
authors: Medical Research Council Human Nutrition Research Unit, Elsie Widdowson Laboratory, Cambridge, United Kingdom;
authors: Sarah
authors: S
authors: Meadows
authors: Medical Research Council Human Nutrition Research Unit, Elsie Widdowson Laboratory, Cambridge, United Kingdom;
authors: Gail
authors: G
authors: Goldberg
authors: Medical Research Council Human Nutrition Research Unit, Elsie Widdowson Laboratory, Cambridge, United Kingdom;
authors: Ann
authors: A
authors: Prentice
authors: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research.
authors: Jacqueline M
authors: JM
authors: Dekker
authors: Department of General Practice & Elderly Care Medicine, and.
authors: Giel
authors: G
authors: Nijpels
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria;
authors: Stefan
authors: S
authors: Pilz
authors: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research.
authors: Karin M
authors: KM
authors: Swart
authors: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research.
authors: Natasja M
authors: NM
authors: van Schoor
authors: Department of Internal Medicine, Section of Endocrinology, Vrije Universiteit University Medical Center, Amsterdam, Netherlands;
authors: Paul
authors: P
authors: Lips
authors: Icelandic Heart Association, Kopavogur, Iceland;
authors: Gudny
authors: G
authors: Eiriksdottir
authors: Icelandic Heart Association, Kopavogur, Iceland; University of Iceland, Reykjavik, Iceland;
authors: Vilmundur
authors: V
authors: Gudnason
authors: Division of Epidemiology and Clinical Applications, National Eye Institute and.
authors: Mary Frances
authors: MF
authors: Cotch
authors: Department of Health, Functional Capacity and Welfare and Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland;
authors: Seppo
authors: S
authors: Koskinen
authors: Department of Food and Environmental Sciences, Helsinki University, Helsinki, Finland; and.
authors: Christel
authors: C
authors: Lamberg-Allardt
authors: Department of Public Health Sciences, Loyola University Stritch School of Medicine, Chicago, IL.
authors: Ramon A
authors: RA
authors: Durazo-Arvizu
authors: Office of Dietary Supplements, NIH, Bethesda, MD;
authors: Christopher T
authors: CT
authors: Sempos
authors: Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland;
authors: Mairead
authors: M
authors: Kiely
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002853:Chromatography, Liquid; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009752:Nutritional Status; D058873:Pandemics; D015995:Prevalence; D012621:Seasons; D053719:Tandem Mass Spectrometry; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: 25(OH)D; Europe; prevalence; standardized; vitamin D deficiency