Modern humans can expect to live a long life and therefore need to make a balanced choice between exposure to carcinogenic UVB radiation and maintaining an optimal vitamin D status
Most countries and many scientific societies have prepared or updated guidelines for vitamin D supplementation, with recommended dosages higher than before
All infants need a daily supplement of vitamin D (preferably 400 international units (IU) per day) during at least their first year of life; however, full implementation of this guideline is problematic in many countries around the world
A large consensus exists that nearly all elderly individuals need a vitamin D supplement; however, disagreement endures with regard to dosage or optimal concentration of 25-hydroxyvitamin D, and implementation is problematic
All children or adults lacking sufficient exposure to sunlight need a vitamin D supplement; however, no agreement has been reached regarding dosage, and implementation is poor
The WHO, supported by its member states, should implement a strategy to eradicate vitamin D (and calcium) deficiency-associated rickets
Vitamin D is essential for calcium and bone homeostasis. Humans are largely dependent on UVB-radiation-induced photosynthesis of vitamin D, as few foods contain vitamin D. However, the same radiation that produces vitamin D is also carcinogenic, albeit with a long lag time, and causes DNA damage. In view of the increasing life expectancy, avoiding excessive sun exposure is prudent. Several groups of people have a shortfall between their requirements for vitamin D and their combined endogenous synthesis and intake from natural foods, and therefore need vitamin D supplementation. Governments and scientific societies are regularly updating their recommendations for intake of vitamin D, especially for groups that should (infants) or prefer to (especially elderly individuals) avoid direct sunlight. An overview of such guidelines is presented in this Review. A fairly large consensus exists that all infants should receive 400 international units (IU) (10 μg) daily during their first year of life and that elderly individuals should have access to vitamin D supplementation (at recommended dosages varying from 400 IU to 800 IU daily in most governmental guidelines but at higher dosages in other guidelines). All guidelines unanimously agree that serum levels of 25-hydroxyvitamin D (25OHD) <25 nmol/l (10 ng/ml) should be avoided at all ages. Children and adults who have limited sun exposure should receive vitamin D supplementation, but the recommended doses vary widely (from 200 IU to 2,000 IU daily), in line with disagreement regarding the minimal desirable serum concentration of 25OHD (which varies from 25 nmol/l to >100 nmol/l).
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Bouillon, R. & Suda, T. Vitamin D: calcium and bone homeostasis during evolution. Bonekey Rep. 3, 480 (2014).
Bouillon, R. et al. Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr. Rev. 29, 726–776 (2008).
Rosen, C. J. et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr. Rev. 33, 456–492 (2012).
Bouillon, R. in Endocrinology: Adult and Pediatric (eds Jameson, J. L. & De Groot, L. J.) 1018–1037.e7 (Elsevier, 2016).
Holick, M. F. Vitamin D: a millenium perspective. J. Cell. Biochem. 88, 296–307 (2003).
O'Riordan, J. & Bijvoet, O. Rickets before the discovery of vitamin D. Bonekey Rep. 3, 478 (2014).
Whistler, D. De morbo puerili Anglorum, quem patrio idiomate indigenae vocant the Rickets (in Latin) (Lugduni Batavorum, 1645).
Hess, A. F. & Unger, L. J. Prophylactic therapy for rickets in a Negro community. JAMA 69, 1583 (1917).
Gibbs, D. Rickets and the crippled child: an historical perspective. J. R. Soc. Med. 87, 729–732 (1994).
Parsons, L. G. Some recent advances in our knowledge on rickets an allied diseases. Lancet 212, 485–489 (1928).
Prentice, A. Vitamin D deficiency: a global perspective. Nutr. Rev. 66, S153–S164 (2008).
Schoenmakers, I. et al. Prevention and consequences of vitamin D deficiency in pregnant and lactating women and children: a symposium to prioritise vitamin D on the global agenda. J. Steroid Biochem. Mol. Biol. 164, 156–160 (2016).
Craig, T. A. et al. Research resource: whole transcriptome RNA sequencing detects multiple 1α, 25-dihydroxyvitamin D3-sensitive metabolic pathways in developing zebrafish. Mol. Endocrinol. 26, 1630–1642 (2012).
Pierens, S. L. & Fraser, D. R. The origin and metabolism of vitamin D in rainbow trout. J. Steroid Biochem. Mol. Biol. 145, 58–64 (2015).
Fell, G. L., Robinson, K. C., Mao, J., Woolf, C. J. & Fisher, D. E. Skin β-endorphin mediates addiction to UV light. Cell 157, 1527–1534 (2014).
Spiro, A. & Buttriss, J. L. Vitamin D: an overview of vitamin D status and intake in Europe. Nutr. Bull. 39, 322–350 (2014).
Holick, M. F. Resurrection of vitamin D deficiency and rickets. J. Clin. Invest. 116, 2062–2072 (2006).
Ala-Houhala, M. J. et al. Comparison of narrowband ultraviolet B exposure and oral vitamin D substitution on serum 25-hydroxyvitamin D concentration. Br. J. Dermatol. 167, 160–164 (2012).
Petersen, B. et al. Sun and ski holidays improve vitamin D status, but are associated with high levels of DNA damage. J. Invest. Dermatol. 134, 2806–2813 (2014).
Nordic Council of Ministers. Nordic nutrition recommendations 2012: integrating nutrition and physical activity. Norden.org https://www.norden.org/en/theme/nordic-nutrition-recommendation/nordic-nutrition-recommendations-2012 (2014).
German Nutrition Society. New reference values for vitamin D. Ann. Nutr. Metab. 60, 241–246 (2012).
Health Council of the Netherlands. Evaluation of the dietary refence values for vitamin D. Gezondheidsraad.nl https://www.gezondheidsraad.nl/en/task-and-procedure/areas-of-activity/healthy-nutrition/evaluation-of-the-dietary-reference-values (2012).
Paxton, G. A. et al. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement. Med. J. Aust. 198, 142–143 (2013).
Clemens, T. L., Adams, J. S., Henderson, S. L. & Holick, M. F. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3 . Lancet 1, 74–76 (1982).
US Department of Health and Human Services. The Surgeon General's call to action to prevent skin cancer. Surgeongeneral.gov https://www.surgeongeneral.gov/library/calls/prevent-skin-cancer/ (2014).
Wang, T. J. et al. Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet 376, 180–188 (2010).
Bouillon, R. Genetic and environmental determinants of vitamin D status. Lancet 376, 148–149 (2010).
Public Health England. SACN vitamin D and health. gov.uk https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf(2016).
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D (eds Ross, A. C., Taylor, C. L., Yaktine, A. L. & Del Valle, H. B.) (National Academies Press, 2011).
Gallagher, J. C., Sai, A., Templin, T. II & Smith, L. Dose response to vitamin D supplementation in postmenopausal women: a randomized trial. Ann. Intern. Med. 156, 425–437 (2012).
Lips, P. et al. The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J. Clin. Endocrinol. Metab. 67, 644–650 (1988).
Schmorl, G. Die pathologische Anatomie der rachitischen Knochenerkrankung mit Besonder Berücksichtingung iher Histologie und Pathogenes. Erg. Inn. Med. 4, 403 (in German) (1909).
Follis, R. H. Jr, Park, E. A. & Jackson, D. The prevalence of rickets at autopsy during the first two years of age. Bull. Johns Hopkins Hosp. 91, 480–497 (1952).
Ward, L. M., Gaboury, I., Ladhani, M. & Zlotkin, S. Vitamin D-deficiency rickets among children in Canada. CMAJ 177, 161–166 (2007).
Wheeler, B. J., Dickson, N. P., Houghton, L. A., Ward, L. M. & Taylor, B. J. Incidence and characteristics of vitamin D deficiency rickets in New Zealand children: a New Zealand Paediatric Surveillance Unit study. Aust. N. Z. J. Public Health 39, 380–383 (2015).
WHO Unit of Radiation and Environmental Health (RAD). Protecting children from ultraviolet radiation. WHO http://www.who.int/uv/resources/fact/en/fs261protectchild.pdf (2001).
Paller, A. S. et al. New insights about infant and toddler skin: implications for sun protection. Pediatrics 128, 92–102 (2011).
Slusher, T. M. et al. Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates. Pediatrics 133, e1568–e1574 (2014).
Bouillon, R. Why modest but widespread improvement of the vitamin D status is the best strategy? Best Pract. Res. Clin. Endocrinol. Metab. 25, 693–702 (2011).
Bouillon, R., Vanassche, F. A., Vanbaelen, H., Heyns, W. & Demoor, P. Influence of the vitamin D-binding protein on the serum concentration of 1,25-dihydroxyvitamin D3 — significance of the free 1,25-dihydroxyvitamin D3 concentration. J. Clin. Invest. 67, 589–596 (1981).
Hollis, B. W. et al. Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics 136, 625–634 (2015).
Kovacs, C. S. Maternal mineral and bone metabolism during pregnancy, lactation, and post-weaning recovery. Physiol. Rev. 96, 449–547 (2016).
Beser, E. & Cakmakci, T. Factors affecting the morbidity of vitamin D deficiency rickets and primary protection. East Afr. Med. J. 71, 358–362 (1994).
Park, E. A. The therapy of rickets. JAMA 115, 370–379 (1940).
Lightwood, R. Idiopathic hypercalcaemia with failure to thrive: nephrocalcinosis. Proc. R. Soc. Med. 45, 401–401 (1952).
Schlingmann, K. P. et al. Mutations in CYP24A1 and idiopathic infantile hypercalcemia. N. Engl. J. Med. 365, 410–421 (2011).
Vidailhet, M. et al. Vitamin D: still a topical matter in children and adolescents. A position paper by the Committee on Nutrition of the French Society of Paediatrics. Arch. Pediatr. 19, 316–328 (2012).
Cools, M. et al. Calcium and bone homeostasis in heterozygous carriers of CYP24A1 mutations: a cross-sectional study. Bone 81, 89–96 (2015).
Abrams, S. A. & Committee on Nutrition. Calcium and vitamin d requirements of enterally fed preterm infants. Pediatrics 131, e1676–e1683 (2013).
Agostoni, C. et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 50, 85–91 (2010).
Misra, M. et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 122, 398–417 (2008).
Tergestina, M., Rebekah, G., Job, V., Simon, A. & Thomas, N. A randomized double-blind controlled trial comparing two regimens of vitamin D supplementation in preterm neonates. J. Perinatol. 36, 763–767 (2016).
Winzenberg, T., Powell, S., Shaw, K. A. & Jones, G. Effects of vitamin D supplementation on bone density in healthy children: systematic review and meta-analysis. BMJ 342, c7254 (2011).
Lee, Y. A. et al. Adequate vitamin D status and adiposity contribute to bone health in peripubertal nonobese children. J. Bone Miner. Metab. 31, 337–345 (2013).
Wagner, C. L. & Greer, F. R. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 122, 1142–1152 (2008).
American Academy of Pediatrics Committee on Nutrition. The prophylactic requirement and the toxicity of vitamin D. Pediatrics 31, 512–525 (1963).
Braegger, C. et al. Vitamin D in the healthy European paediatric population. J. Pediatr. Gastroenterol. Nutr. 56, 692–701 (2013).
Munns, C. F. et al. Global consensus recommendations on prevention and management of nutritional rickets. J. Clin. Endocrinol. Metab. 101, 394–415 (2016).
Munns, C. F. et al. Global consensus recommendations on prevention and management of nutritional rickets. Horm. Res. Paediatr. 85, 83–106 (2016).
Saggese, G. et al. Vitamin D in childhood and adolescence: an expert position statement. Eur. J. Pediatr. 174, 565–576 (2015).
European Food Safety Authority. Draft scientific opinion. Scientific opinion on dietary reference values for vitamin D. EFSA https://www.efsa.europa.eu/sites/default/files/consultation/160321.pdf (2016).
Bouillon, R. et al. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J. Clin. Endocrinol. Metab. 98, E1283–E1304 (2013).
Need, A. G. et al. Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J. Bone Miner. Res. 23, 1859–1863 (2008).
Binkley, N., Sempos, C. T. & Vitamin D Standardization Program (VDSP). Standardizing vitamin D assays: the way forward. J. Bone Miner. Res. 29, 1709–1714 (2014).
Gallo, S. et al. Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: a randomized trial. JAMA 309, 1785–1792 (2013).
Jeans, P. C. & Stearns, G. Effect of vitamin D on linear growth in infancy: II. Effect of intakes above 1,800 U.S.P. units daily. J. Pediatr. 13, 730–740 (1938).
Mittal, H. et al. 300,000 IU or 600,000 IU of oral vitamin D3 for treatment of nutritional rickets: a randomized controlled trial. Indian Pediatr. 51, 265–272 (2014).
Markestad, T. et al. Intermittent high-dose vitamin D prophylaxis during infancy: effect on vitamin D metabolites, calcium, and phosphorus. Am. J. Clin. Nutr. 46, 652–658 (1987).
Holick, M. F. et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 1911–1930 (2011).
Chawes, B. L. et al. Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomized clinical trial. JAMA 315, 353–361 (2016).
Litonjua, A. A. et al. Effect of prenatal supplementation with vitamin D on asthma or recurrent wheezing in offspring by age 3 years: the VDAART randomized clinical trial. JAMA 315, 362–370 (2016).
Munger, K. L. et al. Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the Finnish maternity cohort. JAMA Neurol. 73, 515–519 (2016).
EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific opinion on the tolerable upper intake level of vitamin D. EFSA J. 10, 2813 (2012).
Hoge Gezondheidsraad. Voedingsaanbevelingen voor België. VIGEZ http://www.vigez.be/files/voedingenbeweging/publicatie_hoge_gezondheidsraad_2009.pdf (in Dutch) (2009).
Ceccaldi, P. F. et al. French prenatal vitamin D recommended supplementation: enough or not? J. Gynecol. Obstet. Biol. Reprod. (Paris) 46, 35–41 (2017).
Dijkstra, S. H. et al. High prevalence of vitamin D deficiency in newborn infants of high-risk mothers. Arch. Dis. Child. 92, 750–753 (2007).
Abbasian, M. et al. Vitamin D deficiency in pregnant women and their neonates. Glob. J. Health Sci. 8, 54008 (2016).
Tabesh, M., Salehi-Abargouei, A., Tabesh, M. & Esmaillzadeh, A. Maternal vitamin D status and risk of pre-eclampsia: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 98, 3165–3173 (2013).
Cooper, C. et al. Maternal gestational vitamin D supplementation and offspring bone health (MAVIDOS): a multicentre, double-blind, randomised placebo-controlled trial. Lancet Diabetes Endocrinol. 4, 393–402 (2016).
De-Regil, L. M., Palacios, C., Lombardo, L. K. & Pena-Rosas, J. P. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst. Rev. 1, CD008873 (2016).
Hollis, B. W. & Wagner, C. L. Vitamin D and pregnancy: skeletal effects, nonskeletal effects, and birth outcomes. Calcif. Tissue Int. 92, 128–139 (2013).
Wagner, C. L. et al. Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009–2011 rates. J. Steroid Biochem. Mol. Biol. 155, 245–251 (2016).
von Mutius, E. & Martinez, F. D. Inconclusive results of randomized trials of prenatal vitamin D for asthma prevention in offspring: curbing the enthusiasm. JAMA 315, 347–348 (2016).
World Health Organization. Guideline: vitamin D supplementation in pregnant women. WHO http://apps.who.int/iris/bitstream/10665/85313/1/9789241504935_eng.pdf (2012).
Hilger, J. et al. A systematic review of vitamin D status in populations worldwide. Br. J. Nutr. 111, 23–45 (2014).
Mithal, A. et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos. Int. 20, 1807–1820 (2009).
Orwoll, E. et al. Vitamin D deficiency in older men. J. Clin. Endocrinol. Metab. 94, 1214–1222 (2009).
Lee, D. M. et al. Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men. J. Neurol. Neurosurg. Psychiatry 80, 722–729 (2009).
Arabi, A., El Rassi, R. & El-Hajj Fuleihan, G. Hypovitaminosis D in developing countries—prevalence, risk factors and outcomes. Nat. Rev. Endocrinol. 6, 550–561 (2010).
Schleicher, R. L. et al. National estimates of serum total 25-hydroxyvitamin D and metabolite concentrations measured by liquid chromatography–tandem mass spectrometry in the US population during 2007–2010. J. Nutr. 146, 1051–1061 (2016).
Luxwolda, M. F. et al. Vitamin D status indicators in indigenous populations in East Africa. Eur. J. Nutr. 52, 1115–1125 (2013).
Durazo-Arvizu, R. A. et al. 25-hydroxyvitamin D in African-origin populations at varying latitudes challenges the construct of a physiologic norm. Am. J. Clin. Nutr. 100, 908–914 (2014).
Holick, M. F. et al. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J. Clin. Endocrinol. Metab. 97, 1153–1158 (2012).
Baggerly, C. A. et al. Sunlight and vitamin D: necessary for public health. J. Am. Coll. Nutr. 34, 359–365 (2015).
Holick, M. F. Biological effects of sunlight, ultraviolet radiation, visible light, infrared radiation and vitamin D for health. Anticancer Res. 36, 1345–1356 (2016).
Bhan, A., Rao, A. D. & Rao, D. S. Osteomalacia as a result of vitamin D deficiency. Endocrinol. Metab. Clin. North Am. 39, 321–331 (2010).
Compston, J. E., Vedi, S. & Croucher, P. I. Low prevalence of osteomalacia in elderly patients with hip fracture. Age Ageing 20, 132–134 (1991).
Herm, F. B., Killguss, H. & Stewart, A. G. Osteomalacia in Hazara District, Pakistan. Trop. Doct. 35, 8–10 (2005).
Priemel, M. et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J. Bone Miner. Res. 25, 305–312 (2010).
Rosen, C. J. et al. IOM committee members respond to Endocrine Society vitamin D guideline. J. Clin. Endocrinol. Metab. 97, 1146–1152 (2012).
Cosman, F. et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos. Int. 25, 2359–2381 (2014).
van der Wielen, R. P. et al. Serum vitamin D concentrations among elderly people in Europe. Lancet 346, 207–210 (1995).
Cashman, K. D. et al. Vitamin D deficiency in Europe: pandemic? Am. J. Clin. Nutr. 103, 1033–1044 (2016).
Hill, T. R. et al. Serum 25-hydroxyvitamin D concentration and its determinants in the very old: the Newcastle 85+ Study. Osteoporos. Int. 27, 1199–1208 (2016).
Quesada, J. M., Jans, I., Benito, P., Jimenez, J. A. & Bouillon, R. Vitamin D status of elderly people in Spain. Age Ageing 18, 392–397 (1989).
Clemens, T. L., Zhou, X. Y., Myles, M., Endres, D. & Lindsay, R. Serum vitamin D2 and vitamin D3 metabolite concentrations and absorption of vitamin D2 in elderly subjects. J. Clin. Endocrinol. Metab. 63, 656–660 (1986).
MacLaughlin, J. & Holick, M. F. Aging decreases the capacity of human skin to produce vitamin D3 . J. Clin. Invest. 76, 1536–1538 (1985).
Bischoff-Ferrari, H. A. et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N. Engl. J. Med. 367, 40–49 (2012).
Boonen, S. et al. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative meta-analysis of randomized controlled trials. J. Clin. Endocrinol. Metab. 92, 1415–1423 (2007).
Weaver, C. M. et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos. Int. 27, 367–376 (2016).
Bolland, M. J., Grey, A., Gamble, G. D. & Reid, I. R. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2, 307–320 (2014).
Sanders, K. M. et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 303, 1815–1822 (2010).
Sanders, K. M. & Seibel, M. J. Therapy: new findings on vitamin D3 supplementation and falls — when more is perhaps not better. Nat. Rev. Endocrinol. 12, 190–191 (2016).
Smith, H. et al. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women — a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford) 46, 1852–1857 (2007).
Bischoff-Ferrari, H. A. et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339, b3692 (2009).
Bischoff-Ferrari, H. A. et al. Monthly high-dose vitamin D treatment for the prevention of functional decline: a randomized clinical trial. JAMA Intern. Med. 176, 175–183 (2016).
Rosen, C. J. & Taylor, C. L. Common misconceptions about vitamin D — implications for clinicians. Nat. Rev. Endocrinol. 9, 434–438 (2013).
Abrams, S. A., Coss-Bu, J. A. & Tiosano, D. Vitamin D: effects on childhood health and disease. Nat. Rev. Endocrinol. 9, 162–170 (2013).
Pradhan, A. D. & Manson, J. E. Update on the Vitamin D and OmegA-3 trial (VITAL). J. Steroid Biochem. Mol. Biol. 155, 252–256 (2016).
Rautiainen, S., Manson, J. E., Lichtenstein, A. H. & Sesso, H. D. Dietary supplements and disease prevention — a global overview. Nat. Rev. Endocrinol. 12, 407–420 (2016).
Fuleihan Gel, H. et al. Serum 25-hydroxyvitamin D levels: variability, knowledge gaps, and the concept of a desirable range. J. Bone Miner. Res. 30, 1119–1133 (2015).
Norman, A. W., Bouillon, R., Whiting, S. J., Vieth, R. & Lips, P. 13th Workshop consensus for vitamin D nutritional guidelines. J. Steroid Biochem. Mol. Biol. 103, 204–205 (2007).
Standing Committee of European Doctors. Vitamin D nutritional policy in Europe. CPME http://doc.cpme.eu:591/adopted/2009/CPME_AD_Brd_241009_179_final_EN.pdf (2009).
Dawson-Hughes, B. et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos. Int. 21, 1151–1154 (2010).
Rizzoli, R. et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Maturitas 79, 122–132 (2014).
Perez-Lopez, F. R. et al. EMAS position statement: vitamin D and postmenopausal health. Maturitas 71, 83–88 (2012).
American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for prevention of falls and their consequences. J. Am. Geriatr. Soc. 62, 147–152 (2014).
Gallagher, J. C., Peacock, M., Yalamanchili, V. & Smith, L. M. Effects of vitamin D supplementation in older African American women. J. Clin. Endocrinol. Metab. 98, 1137–1146 (2013).
Ng, K. et al. Dose response to vitamin D supplementation in African Americans: results of a 4-arm, randomized, placebo-controlled trial. Am. J. Clin. Nutr. 99, 587–598 (2014).
Laurent, M. R., Gielen, E., Pauwels, S., Vanderschueren, D. & Bouillon, R. Hypervitaminosis D associated with tanning bed use: a case report. Ann. Intern. Med. 166, 155–156 (2017).
Fraser, D. The relation between infantile hypercalcemia and vitamin D — public health implications in North America. Pediatrics 40, 1050–1061 (1967).
Fraser, D., Kidd, B. S., Kooh, S. W. & Paunier, L. A new look at infantile hypercalcemia. Pediatr. Clin. North Am. 13, 503–525 (1966).
Skversky, A. L., Kumar, J., Abramowitz, M. K., Kaskel, F. J. & Melamed, M. L. Association of glucocorticoid use and low 25-hydroxyvitamin D levels: results from the National Health and Nutrition Examination Survey (NHANES): 2001–2006. J. Clin. Endocrinol. Metab. 96, 3838–3845 (2011).
Schleicher, R. L. et al. The vitamin D status of the US population from 1988 to 2010 using standardized serum concentrations of 25-hydroxyvitamin D shows recent modest increases. Am. J. Clin. Nutr. 104, 454–461 (2016).
Manson, J. E., Brannon, P. M., Rosen, C. J. & Taylor, C. L. Vitamin D deficiency — is there really a pandemic? N. Engl. J. Med. 375, 1817–1820 (2016).
National Institute of Nutrition. Dietary guidelines for Indians — a manual. Ninindia.org http://ninindia.org/dietaryguidelinesforninwebsite.pdf (2011).
Tsuboyama-Kasaoka, N. et al. Dietary intake of nutrients with adequate intake values in the dietary reference intakes for Japanese. J. Nutr. Sci. Vitaminol. 59, 584–595 (2013).
Okazaki, R. et al. Assessment criteria for vitamin D deficiency/insufficiency in Japan: proposal by an expert panel supported by the Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, the Japanese Society for Bone and Mineral Research and the Japan Endocrine Society [Opinion]. J. Bone Miner. Metab. 35, 1–5 (2017).
Colditz, G. A. Overview of the epidemiology methods and applications: strengths and limitations of observational study designs. Crit. Rev. Food Sci. Nutr. 50 (Suppl. 1), 10–12 (2010).
Giovannucci, E. Epidemiology of vitamin D and colorectal cancer: casual or causal link? J. Steroid Biochem. Mol. Biol. 121, 349–354 (2010).
Martinez, M. E., Marshall, J. R. & Giovannucci, E. Diet and cancer prevention: the roles of observation and experimentation. Nat. Rev. Cancer 8, 694–703 (2008).
Perrine, C. G., Sharma, A. J., Jefferds, M. E., Serdula, M. K. & Scanlon, K. S. Adherence to vitamin D recommendations among US infants. Pediatrics 125, 627–632 (2010).
Cavelaars, A. E. et al. Nutri-RecQuest: a web-based search engine on current micronutrient recommendations. Eur. J. Clin. Nutr. 64 (Suppl. 2), S43–S47 (2010).
The author thanks E. Van Herck for expert assistance.
The author has received small lectures fees from Amgen, Chugai, NovoNordisk and Teijin, and is co-inventor and co-owner of the Katholieke Universiteit (KU) Leuven (Belgium) patent on vitamin D analogues, which is licensed to Hybrigenix (France).
European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)
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Bouillon, R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol 13, 466–479 (2017). https://doi.org/10.1038/nrendo.2017.31
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