https://imaqpress.com/2889/the-vitamin-d-deficiency-pandemic-a-call-for-awareness/





https://m.youtube.com/watch?v=FH6W5ArDBfo

*************************

https://imaqpress.com/2889/the-vitamin-d-deficiency-pandemic-a-call-for-awareness/

THE VITAMIN D DEFICIENCY PANDEMIC: A CALL FOR AWARENESS

The Vitamin D Deficiency Pandemic: A Call for Awareness
by Shaheera Amjad
May 25, 2021

All my life, I have been very cautious and conscious about the health of my bones and Vitamin D Deficiency; this is due to the fact that most women I have encountered in life have at some point been diagnosed with ailments of bones.

I have always believed in a calcium rich and healthy diet, exercise and active lifestyle. While I may just be in my 20s, I collapsed one day after a long suffering of bone and muscle weakness.

Not diagnosed accurately for a long time; I did not know what was wrong with me after all my precautions. However, recently it was diagnosed as vitamin D deficiency. Despite being an educated person, I was unaware of how integral a role vitamin D plays in our bodies.

Unfortunately, around 1 billion people across the world are suffering from the same in their incognizance. Therefore, I feel it is important to talk about vitamin D deficiency as a major public health concern and spread awareness through this platform.

Ever heard of a �Curious Vitamin�? Well, it is no different from vitamin D. Despite its name, vitamin D is not a not just a vitamin; but a hormone, one which is unique in its kind, produced by our bodies in the presence of sunlight. Approximately, 90% vitamin D replenishment can be achieved by getting 5 to 30 minutes of sun twice a week, hence also called �Sunshine Vitamin�.

In addition to that very few foods naturally contain vitamin D including cod liver oil, egg yolks, salmon and tuna. Getting enough vitamin D is important for optimal health. Vitamin D is best known for promoting healthy bones. However, it has other roles in the body that includes, strengthening the immune system, reducing the likelihood of developing heart disease, depression, and flu, to name but a few!

Unfortunately, Vitamin D deficiency and insufficiency has emerged as a pandemic, afflicting more than one billion people worldwide irrespective of age and gender. The situation is more precarious in developing countries of South Asia. Nimitphong et al. reported that 6-70% population in Southeast Asia and 70% in South Asia have been affected by VDD. Pakistan is a sundrenched South Asian country with cutaneous production of vitamin D possible throughout the year.

However, various surveys indicate that Pakistan occupies a larger share of vitamin D deficient population. A review-based study by Syed et al. conducted between the years 2008 and 2018 generated a cumulative figure of 58.17% for vitamin D-deficient and 26.65% for insufficient population in Pakistan.

Isn�t it surprising to see so much of Vitamin D Deficiency in a country with ample sunshine; a region where one would assume it to be non-existent? Well, developing nations like Pakistan are more predisposed to the damaging effects of VDD for a bulk of reasons including:

Darker skin- have more melanin content that hinders the production of vitamin D.
Genetic factors, poverty, and illiteracy.

Sociocultural behaviors- avoidance of sun exposure, consumption of chapattis high in phytates that interfere with calcium absorption, and malabsorption of Vitamin D. Malnutrition- generally natural food sources have low vitamin D content and therefore require fortification. Unlike many Western countries, Pakistan does not have a mandatory VD fortification policy in place.

Use of sun block, purdah observation and possibly the reason that women in general do not go outside the home may be responsible for VDD. Is it possible to overcome D deficiency by some artificial means? �To ensure that you actually consume the recommended amount, it may not hurt to take a multivitamin or vitamin D supplement,� said Bartels.

For vitamin D supplementation, vitamin D3 is preferred over vitamin D2, because vitamin D3 is most effective in maintaining adequate levels of vitamin D in the human body defined as >50 nmol/L by Institute of Medicine, Food and Nutrition Board. While, <30 nmol/L accounts for deficient, 30-50 nmol/L for insufficient and >125 nmol/L for toxic levels of vitamin D.

It is important to recognize that there is a potential for vitamin D toxicity. Surprisingly, it would not be possible to differentiate deficiency and toxicity without monitoring blood D levels; for both the conditions show similar symptoms of weakness, headache, somnolence, nausea, and severe muscle and bone pain etc. In order to achieve sufficient D level, the Institute of Food and Agricultural Sciences has made recommendations based on international units (IUs) per day as:

Infants: 400 IU
Children and teens: 600 IU
Adults up to age 70: 600 IU
Adults over age 70: 800 IU
Pregnant or breastfeeding women: 600 IU

The above discussion gives rise to a question. Despite the availability of possible solutions, why is VDD pandemic going unchecked? Alamoudi et al. reported that there is lack of awareness and knowledge of vitamin D role and sources in several countries, including Pakistan. Diagnosis, surveillance and epidemiological surveys to gauge up the magnitude of the issue need to be typically focused.

A perusal of the publications in the recent past suggests life style changes, availability of vitamin D rich foods, mandatory vitamin D fortification of the foods, vitamin D supplementation programs, sufficient sun exposure, reduced environmental pollution and facilities for inexpensive and accessible diagnosis of VDD would help mitigate the gravity of the prevalence of VDD in Pakistani populations.

First and foremost, efforts are needed to create awareness among population groups at individual and collective level. One possible way is that physicians should remind patients to adhere to the recommended dosages to avoid deficiency or possible therapeutic toxicity.

Last but not the least, there is even a point to ponder! Don�t you think there exists an interplay between a long evolving vitamin D pandemic and the recent corona virus pandemic? Since low Vitamin D levels have been associated with both a higher number of coronavirus deaths and cases.

Yisak et al. reviewed 9 studies, 7 of which showed that COVID-19 infection, prognosis, and mortality were correlated with vitamin D status. While, on the other hand, COVID-19 stay-athome restrictions have deprived people of the unintentional Vitamin D consumption from sun, while performing their outdoor activities.

This is particularly for Pakistan, where the majority of the population does not work in indoor settings.

Despite the many important health benefits of vitamin D, there is still a lot to unravel regarding the definition and causes of vitamin D deficiency, and calculation of population-based prevalence rates. Let�s get tested to contribute in eradicating the pandemic!

REFERENCES

Romaina Iqbal. Departments of Medicine,Community Health Sciences,Aga Khan University, Stadium Road, Karachi, Pakistan.
Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
Nimitphong H and Holick MF (2013). Vitamin D status and sun exposure in Southeast Asia. Dermatoendocrinol., 5: 0-1.
Faiza Syed, Malik Shah Zaman Latif, Iftikhar Ahmed, Sadia Bibi, Saif Ullah, Nauman Khalid . Vitamin D deficiency in Pakistani population: critical overview from 2008 to 2018. Nutrition & Food Science ISSN: 0034-6659-2020.
Meyer HE, Falch JA, Sogaard AJ, Haug E. Vitamin D deficiency and secondary hyperparathyroidism and the association with bone mineral density in persons with Pakistani and Norwegian background living in Oslo, Norway, The Oslo Health Study. Bone 2004; 35: 412-7.
Holvik K, Meyer HE, Hang E, Brunvand L. Prevalence and predictors of vitamin D deficiency in five immigrant groups living in Oslo, Norway. The Oslo immigrant health study. Eur J Clin Nutr 2005; 59: 57-63.
Hiwot Yisak, Amien Ewunetei, Belayneh Kefale, Melkalem Mamuye, Fentaw Teshome, Birhanie Ambaw, and Getachew Yideg Yitbarek. Effects of Vitamin D on COVID-19 Infection and Prognosis: A Systematic Review. Risk Manag Healthc Policy. 2021; 14: 31�38. Published online 2021 Jan 7.

**************************

https://link.springer.com/article/10.1007/s11154-017-9424-1


The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention

by Michael F. Holick
May 17, 2017


Abstract

Vitamin D deficiency and insufficiency is a global health issue that afflicts more than one billion children and adults worldwide. The consequences of vitamin D deficiency cannot be under estimated. There has been an association of vitamin D deficiency with a myriad of acute and chronic illnesses including preeclampsia, childhood dental caries, periodontitis, autoimmune disorders, infectious diseases, cardiovascular disease, deadly cancers, type 2 diabetes and neurological disorders. This review is to put into perspective the controversy surrounding the definition for vitamin D deficiency and insufficiency as well as providing guidance for how to treat and prevent vitamin D deficiency.

References

Holick MF. Vitamin D deficiency. New Engl J Med. 2007;357:266�8.

Article CAS PubMed Google Scholar

Chapuy MC, Schott AM, Garnero P, Hans D, Delmas PD, Meunier J, et al. Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab. 1996;81:1129�33.

CAS PubMed Google Scholar

Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet. 1998;351:805�6.

Article CAS PubMed Google Scholar

Thomas KK, Lloyd-Jones DH, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, Vamvakas EC, Dick IM, Prince RL, Finkelstein JS. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777�83.

Article CAS PubMed Google Scholar

Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, Petruschke RA. Chen E and de Papp prevalence of vitamin D inadequacy among postmenopausal north American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005;90(6):3215�24.

Article CAS PubMed Google Scholar

Valcour A, Blocki F, Hawkins DM, Rao SD. Effects of age and serum 25-OH-vitamin D on serum parathyroid hormone levels. J Clin Endocrinol Metab. 2012;97(11):3989�95.

Article CAS PubMed Google Scholar

IOM (Institute of Medicine) Dietary reference intakes for calcium and vitamin D. Committee to Review Dietary Reference Intakes for Calcium and Vitamin D Washington DC: The National Academies Press Institute of Medicine 2011.

Priemel M, von Domarus C, Klatte TO, Kessler S, Schlie J, Meier S, Proksch N, Pastor F, Netter C, Streichert T, Puschel K, Amling M. 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. 2010;25(2):305�12.

Article CAS PubMed Google Scholar

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911�30.

Article CAS PubMed Google Scholar

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Controversy in clinical Endocrinology: guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab. 2012;97:1153�8.

Article CAS PubMed Google Scholar

Murad MH, Elamin KB, AbuElnour NO, Elamin MB, Alkatib AA, Fatourechi MM, Almandoz JP, Mullan RJ, Lane MA, Liu H, Erwin PJ, Hensrud DD, Montori VM. Interventions to raise vitamin D level and functional outcomes: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2011;96(7):1911�30.

Article PubMed Google Scholar

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. 2014;62:147.

Article Google Scholar

Fischer PR, Thacher TD, Pettifor JM. Pediatric vitamin D and calcium nutrition in developing countries. Rev Endocr Metab Disord. 2008;9(3):181�92.

Article CAS PubMed Google Scholar

Merewood A, Mehta SD, Grossman X, Chen TC, Mathieu JS, Holick MF, et al. Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers. Pediatr. 2010;125:640�7. 416

Article Google Scholar

Zhu Z, Zhan J, Shao J, et al. High prevalence of vitamin D deficiency among children aged 1 month to 16 years in Hangzhou, China. BMC Public Health. 2012;12:126.

Article PubMed PubMed Central Google Scholar

Sacheck J, Goodman E, Chui K, et al. Vitamin D deficiency, adiposity, and cardiometabolic risk in urban schoolchildren. J Pediatr. 2011;159:945�50.

Article CAS PubMed PubMed Central Google Scholar

Shivane VK, Sarathi V, Bandgar T, et al. High prevalence of hypovitaminosis D in young healthy adults from the western part of India. Postgrad Med J. 2011;87:514�8.

Article PubMed Google Scholar

van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab. 2011;25(4):671�80.

Article PubMed Google Scholar

Fields J, Trivedi NJ, Horton E, Mechanick JI. Vitamin D in the Persian Gulf: integrative physiology and socioeconomic factors. Curr Osteoporos Rep. 2011;9:243�50.

Article PubMed Google Scholar

Ganji V, Zhang X, Tangpricha V. Serum 25-hydroxyvitamin D concentrations and prevalence estimates of hypovitaminosis D in the U.S. population based on assay adjusted data. J Nutr. 2012;142(3):498�507.

Article CAS PubMed Google Scholar

Zhang R, Naughton DP. Vitamin D in health and disease: current perspectives. Nutr J. 2010;9:65.

Article CAS PubMed PubMed Central Google Scholar

Greene-Finestone LS, Berger C, de Groh M, et al. 25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates. Osteoporos Int. 2011;22:1389�99.

Article CAS PubMed Google Scholar

Gonz�lez-Gross M, Valtue�a J, Breidenassel C, et al. Vitamin D status among adolescents in Europe: the healthy lifestyle in Europe by nutrition in adolescence study. Br J Nutr. 2012;107(5):755�64.

Article PubMed Google Scholar

Daly RM, Gagnon C, Lu ZX, et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clin Endocrinol. 2012;77:26�35.

Article Google Scholar

Hossein-nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proc. 2013;88(7):720�55.

Article CAS PubMed PubMed Central Google Scholar

Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, Shoenfeld Y, Lerchbaum E, Llewellyn DJ, Kienreich K, Soni M. Vitamin D effects on musculoskeletal health, immunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality � a review of recent evidence. Autoimmun Rev. 2013;12:976�89.

Article CAS PubMed Google Scholar

Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third national health and nutrition examination survey, 1988-1994. Am J Clin Nutr. 2002;76:187�92.

PubMed Google Scholar

Lee JM, Smith JR, Philipp BL, Chen TC, Mathieu J, Holick MF. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr. 2007;46:42�4.

Article Google Scholar

Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr. 2007;85(3):788�95.

CAS PubMed PubMed Central Google Scholar

Merewood A, Mehta SD, Chen TC, Holick MF, Bauchner H. Association between severe vitamin D deficiency and primary caesarean section. J Clin Endocrinol Metab. 2009;94(3):940�5.

Article CAS PubMed Google Scholar

Ullah MI, Koch CA, Tamanna S, Rouf S. Shamsuddin. Vitamin D deficiency and the risk of preeclampsia and eclampsia in Bangladesh. Horm Metab Res. 2013;45(9):682�7.

Article CAS PubMed Google Scholar

Kumar J, Muntner P, Kaskel FJ, Hailpern SM. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics. 2009;124(3):e362�70.

Article PubMed PubMed Central Google Scholar

Looker AC, Johnson CL, Lachner DA, Pfeiffer CM, Schleicher RL, Sempos CT. Vitamin D status: United States, 2001-2006. NCHS Data Brief. 2011;56

Wacker M, Holick MF. Sunlight and vitamin D: a global perspective for health. Dermato-Endocrinol. 2013;5(1):51�108.

Article CAS Google Scholar

Holick MF. Biologic effects of sunlight, ultraviolet radiation, visible light, infrared, and vitamin D for health. Anticancer. 2016;36:1345�56.

CAS Google Scholar

Heaney R, Armas LAG, French C. All-sources: basal vitamin D inputs are greater than previously thought and cutaneous inputs are smaller. J Nutr. 2013;143:571�5.

Article CAS PubMed Google Scholar

Crowe FL, Steur M, Allen NE, Appleby PN, Travis RC, Key TJ. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC-Oxford study. Public Health Nutr. 2011;14(2):340�6.

Article PubMed Google Scholar

Manicourt DH, Devogelaer JP. Urban tropospheric ozone increases the prevalence of vitamin D deficiency among Belgian postmenopausal women with outdoor activities during summer. J Clin Endocrinol Metab. 2008;93(10):3893�9.

Article CAS PubMed Google Scholar

Moan J, Dahlback A, Porojnicu AC. At what time should one go out in the sun? Adv Exp Med Biol. 2008;624:86�8.

Article PubMed Google Scholar

Seckmeyer G, Glandorf M, Wichers C, McKenzie R, Henriques D, Carvalho F, Webb A, Siani AM, Bais A, Kjeldstad B, Brogniez C, Werle P, Koskela T, Lakkala K, Gr�bner J, Slaper H, denOuter P, Feister U. Europe's darker atmosphere in the UV-B. Photochem Photobiol Sci 2008, 7(8):925�30.

Brogniez C, Werle P, Koskela T, Lakkala K, Gr�bner J, Slaper H, denOuter P, Feister U. Europe's darker atmosphere in the UV-B. Photochem Photobiol Sci. 2008;7(8):925�30.

Article PubMed Google Scholar

Brinkmann RT, Green AE, Barth CA. Atmospheric scattering of the solar flux in the middle ultraviolet. Appl Opt. 1967;6(3):373�83. doi:10.1364/AO.6.000373.

Article CAS PubMed Google Scholar

Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988;67:373�8.

Article CAS PubMed Google Scholar

Clemens TL, Henderson SL, Adams JS, Holick MF. Increased skin pigment reduces the capacity of skin to synthesis vitamin D3. Lancet. 1982;1(8263):74�6.

Article CAS PubMed Google Scholar

Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab. 1987;64:1165�8.

Article CAS PubMed Google Scholar

Matsuoka LY, Wortsman J, Hanifan N, Holick MF. Chronic sunscreen use decreases circulating concentrations of 25-hydroxyvitamin D. A preliminary study. Arch Dermatol. 1988;124:1802�4.

Article CAS PubMed Google Scholar

Godar DE, Pope SJ, Grant WB, Holick MF. Solar UV doses of adult and vitamin D3 production. Dermato-Endocrinol. 2011;3(4):1�8. 437

Article Google Scholar

Keegan RJ, Lu Z, Bogusz JM, Williams JE, Holick MF. Photobiology of vitamin D in mushrooms and its bioavailability in humans. Dermato-Endocrinol. 2013;5(1):165�76.

Article Google Scholar

Tang HM, Cole DEC, Rubin LA, Pierratos A, Siu S, Vieth R. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998;68:854�8.

Google Scholar

Heaney RP, Recker RR, Grote J, Horst RL, Armas LAG. Vitamin D3 is more potent than vitamin D2 in humans. J Clin Endocrinol Metab. 2011;152(2):741.

Google Scholar

Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89(11):5387�91.

Article CAS PubMed Google Scholar

Heaney RP, Recker RR, Grote J, Horst RL, Armas LA. Vitamin D(3) is more potent than vitamin D(2) in humans. J Clin Endocrinol Metab. 2011;96(3):E447�52.

Article CAS PubMed Google Scholar

Oliveri B, Mastaglia SR, Brito GM, Seijo M, Keller GA, Somoza J, Diez RA, Di Girolamo G. Vitamin D3 seems more appropriate than D2 to sustain adequate levels of 25OHD: a pharmacokinetic approach. Eur J Clin Nutr. 2015;69(6):697�702.

Article CAS PubMed Google Scholar

Biancuzzo RM, Cai MH, Winter MR, Klein EK, Ameri A, Reitz R, Salameh W, Young A, Bibuld D, Chen TC, Holick MF. Fortification of orange juice with vitamin D2 or vitamin D3 is as effective as an oral supplement in maintaining vitamin D status in adults. Am J Clin Nutr. 2010;91:1621�6.

Article CAS PubMed PubMed Central Google Scholar

Biancuzzo RM, Clarke N, Reitz RE, Travison TG, Holick MF. Serum concentrations of 1,25-dihydroxyvitamin D2 and 1,25-dihydroxyvitamin D3 in response to vitamin D2 and vitamin D3 supplementation. J Clin Endocrinol Metab. 2013;98(3):973�9.

Article CAS PubMed PubMed Central Google Scholar

Pietras SM, Obayan BK, Cai MH, Holick MF. Vitamin D2 treatment for vitamin D deficiency and insufficiency for up to 6 years. Arch Intern Med. 2009;169:1806�8.

Article PubMed Google Scholar

Chowdhury R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury S, Kiefte-de-Jong JC, Khan H, Baena CP, Prabhakaran D, Hoshen MB, Feldman BS, Pan A, Johnson L, Crowe F, Hu FB, Franco OH. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.

Article PubMed PubMed Central Google Scholar

Chun RF, Hernandez I, Pereira R, Swinkles L, Huijs T, Zhou R, Liu NQ, Shieh A, Guemes M, Mallya SM, Adams JS, Hewison M. Differential responses to vitamin D2 and vitamin D3 are associated with variations in free 25-hydroxyvitamin D. Endocrinology. 2016;157:3420�30.

Article CAS PubMed Google Scholar

Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S�6S.

CAS PubMed Google Scholar

Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77:204�10.

CAS PubMed Google Scholar

Demetriou ETW, Travison TG, Holick MF. Treatment with 50,000 IU vitamin D2 every other week and effect on Serum 25-hydroxyvitamin D2, 25-hydroxyvitamin D3 and total 25-hydroxyvitamin D in a clinical setting. Endocr Prac. 2012;18(3):399�402.

Article Google Scholar

Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers. PLoS One. 2014; doi:10.1371/journal.pone.0111265. 520.

Hollis BW, Johnson D, Hulsey TC, Ebeling M. Wagner. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011;26(10):2341�57. doi:10.1002/jbmr.463.

Article CAS PubMed PubMed Central Google Scholar

Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690�3.

CAS PubMed Google Scholar

Boonchaya-anant P, Holick MF, Apovian CM. Serum 25-hydroxyvitamin D levels and metabolic health status in extremely obese individuals. Obes J. 2014;22(12):2539�43. doi:10.1002/oby.20877. 516.

CAS Google Scholar

Dabai NS, Pramyothin P, Holick MF. The effect of ultraviolet radiation from a novel portable flourescent lamp on serum 25-hydroxyvitamin D3 Levels in healthy adults with Fitzpatrick skin types II and III. Photodermatol Photoimmunol Photomed. 2012;28(6):307�11. 474

Article CAS PubMed PubMed Central Google Scholar

Koutkia P, Lu Z, Chen TC, Holick MF. Treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation. Gastroenterol. 2001;121:1485�8.

Article CAS Google Scholar

Chandra P, Wolfenden LL, Ziegler TR, Tian J, Luo M, Stecenkoo AA, Chen TC, Holick MF, Tangpricha V. Treatment of vitamin D deficiency with UV light in patients with malabsorption syndromes: a case series. Phtodermatol Photoimunol Photmed. 2007;23(5):179�85.

Article CAS Google Scholar

Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG, Taylor SN, Morella K, Lawrence RA, Hulsey TC. Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics. 2015;136:625�34.

Article PubMed PubMed Central Google Scholar

Gordon CM, Williams AL, Feldman HA, May J, Sinclair L, Vasquez A, Cox JE. Treatment of hypovitaminosis D in infants and toddlers. J Clin Endocrinol Metab. 2008;93(7):2716�21.

Article CAS PubMed PubMed Central Google Scholar

Holick MF. Case 3-2009: a 9-month-old boy with seizures. New Eng J Med CPC. 2009;360(4):398�407.

Article CAS Google Scholar

Holick MF. Vitamin D is not as toxic as was once thought: A historical and an up-to-date perspective. 2015 May. Mayo Clin Proc. 90(5):561�4. 530

Araki T, Holick MF, Alfonso BD, Charlap E, Romero CM, Rizk D, Newman LG. Vitamin D intoxication with severe hypercalcemia due to manufacturing and labelling errors for two dietary supplements made in the United States. J Clin Endocrinol Metab. 2011;96(12):3603�8. 451

Article CAS PubMed Google Scholar

Koutkia P, Chen TC, Holick MF. Vitamin D intoxication associated with an over-the-counter supplement. N Engl J Med. 2001;345(1):66�7.

Article CAS PubMed Google Scholar

Jacobus, C.H., Holick, M.F., Shao, Q., Chen, T.C., Holm I.A., Kolodny, J.M., El-Hajj Fuleihan, G. and Seely, E. Hypervitaminosis D associated with drinking milk. N Engl J Med. 1992. 326(18):1173�1177. 120.

Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999, 69(5):842�856.

Melamed ML, Michos ED, Post W, Astor B. 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168(15):1629�37.

Article PubMed PubMed Central Google Scholar

Grant WB, Karras SN, Bischoff-Ferrari HA, Annweiler C, Boucher BJ, Juzeniene A, Garland CF, Holick MF. Do studies reporting 'U'-shaped serum 25-hydroxyvitamin D-health outcome relationships reflect adverse effects? Dermato-Endocrinology. 2016;8(1):e1187349.

Article PubMed PubMed Central Google Scholar

Kroll MH, Bi C, Garber CC, et al. Temporal relationship between vitamin D status and parathyroid hormone in the United States. PLoS One. 2015;10(3):e 0118108. doi:10.1371/journal.pone.0118108.eCollection 2015.

Article Google Scholar

Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Manson JE, Mayne ST, Ross AC, Shapses SA, Taylor CL. IOM Committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab. 2012;97(4):1146�52.

Article CAS PubMed PubMed Central Google Scholar

Płudowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sok�ł D, Czech-Kowalska J, Dębski R, Decsi T, Dobrzańska A, Franek E, Głuszko P, Grant WP, Holick MF, Yankovskaya L, Konstantynowicz J, Książyk JB, Księżopolska-Orłowska K, Lewiński A, Litwin M, Lohner S, Lorenc RS, Łukaszkiewicz J, Marcinowska-Suchowierska E, Milewicz A, Misiorowski W, Nowicki M, Povoroznyuk V, Rozentryt P, Rudenka E, Shoenfeld Y, Socha P, Solnica B, Szalecki M, Tałałaj M, Varbiro S, Żmijewski MA. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe � recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013;64(4):319�27. 502

Article PubMed Google Scholar

Luxwolda MF, Kuipers RS, Kema IP, Dijck-Brouwer DA, Muskiet FA. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Br J Nutr. 2012;108(9):1557�61.

Article CAS PubMed Google Scholar

El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, Choucair M, Arabi A, Vieth R. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006;91:405�12.

Article PubMed Google Scholar

Donneyong MM, Taylor KC, Kerber RA, Hornung CA, Scragg R. Is outdoor recreational activity an independent predictor of cardiovascular disease mortality - NHANES III? Nutr Metab Cardiovasc Dis. 2016;26(8):735�42.

Article CAS PubMed Google Scholar

Lindqvist PG, Epstein E, Nielsen K, Landin-Olsson M, Ingvar C, Olsson H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the melanoma in southern Sweden cohort. J Intern Med. 2016;280(4):375�87.

Article CAS PubMed Google Scholar

Wolpowitz D, Gilchrest BA. The vitamin D questions: how much do you need and how should you get it? J Am Acad Dermatol. 2006;54:301�17.

Article PubMed Google Scholar

Karimi K, Lindgren TH, Koch CA, Brodell RT. Obesity as a risk factor for malignant melanoma and non-melanoma skin cancer. Rev Endocr Metab Disord. 2016;17(3):389�403.94.

Article CAS PubMed Google Scholar

Kennedy C, Bajdik CD, Willemze R, de Gruijl FR, Bavinck JN. The influence of painful sunburns and lifetime of sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi and skin cancer. J Invest Dermatol. 2003;120(6):1087�93.

Article CAS PubMed Google Scholar

Moan J, Porojnicu AC, Dahlback A, Setlow RB. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci U S A. 2008;105(2):668�73.

Article CAS PubMed PubMed Central Google Scholar

Felton SJ, Cooke MS, Kift R, et al. Concurrent beneficial (vitamin D production) and hazardous (cutaneous DNA damage) impact of repeated low-level summer sunlight exposures. Br J Dermatol. 2016;175:1320�8.

Article CAS PubMed PubMed Central Google Scholar

Holick MF. Can you have your cake and eat it too? The sunlight D-lema. Br J Dermatol. 2016;175:1129�31.

Article CAS PubMed Google Scholar

Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP, Sorensen OH. Vitamin D status and its adequacy in health Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Brit J Nutr. 2001;86:S97�103.

Article CAS PubMed Google Scholar

Baggerly C, Cuom R, French C, Garland C, Gorham E, Grant W, Heaney R, Holick M. Sunlight and vitamin D: necessary for public health. J Am Coll Nutr. 2015;34(4):359�65.

Article PubMed PubMed Central Google Scholar

Osmancevic A, Gillstedt M, Landin-Wilhelmsen K, Wennberg Larko AM, Larko O, Holick M, Krogstad AL. Size of the exposed body surface area, skin erythema and body mass index predict skin production of vitamin D. 2015 June. J Photochem Photobiol B Biol. 2015;149:224�9.

Article CAS Google Scholar

Vieth R. The Pharmacology of Vitamin D, including fortification strategies. Chapter 61 in Vitamin D, 2 Edition. D Feldman, JW Pike, FH Glorieux eds. Elsevier Acad. Press 30 Corporate Dr., Suite 400, Burlington, MA 01803. 2005. pp 995�1015.

Rich-Edwards JW, Davaasambuu G, Kleinman K, Sumberzul N, Holick MF, Lkhagvasuren T, Dulguun B, Burke A, Frazier AL. Randomized trial of fortified milk and supplements to raise 25-hydroxyvitamin D concentrations in schoolchildren in Mongolia. Am J Clin Nutr. 2011;94:578�84. 449

Article CAS PubMed Google Scholar

Download references

Author information

Authors and Affiliations

Endocrinology, Nutrition and Diabetes, Department of Medicine, Boston University Medical Center, Boston, MA, 02118, USA

Michael F. Holick

Authors
Michael F. Holick
View author publications
You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael F. Holick.

Ethics declarations

This is a review and therefore there are no issues regarding compliance and ethical standards.

Conflict of interest

The author declares that he is a consultant for Quest Diagnostics, Ontometrics Inc. and is on speaker�s Bureau for Sanofi Inc.

Rights and permissions

Reprints and permissions

About this article


Cite this article

Holick, M.F. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord 18, 153�165 (2017). https://doi.org/10.1007/s11154-017-9424-1

Download citation

Published: 17 May 2017

Issue Date: June 2017

DOI: https://doi.org/10.1007/s11154-017-9424-1

Keywords

Vitamin D deficiency
Vitamin D insufficiency
Sunlight
Rickets
Vitamin D2
Vitamin D3
25-hydroxyvitamin D
Vitamin D toxicity
Article PubMed Google Scholar
Manicourt DH, Devogelaer JP. Urban tropospheric ozone increases the prevalence of vitamin D deficiency among Belgian postmenopausal women with outdoor activities during summer. J Clin Endocrinol Metab. 2008;93(10):3893�9.
Article CAS PubMed Google Scholar
Moan J, Dahlback A, Porojnicu AC. At what time should one go out in the sun? Adv Exp Med Biol. 2008;624:86�8.
Article PubMed Google Scholar
Seckmeyer G, Glandorf M, Wichers C, McKenzie R, Henriques D, Carvalho F, Webb A, Siani AM, Bais A, Kjeldstad B, Brogniez C, Werle P, Koskela T, Lakkala K, Gr�bner J, Slaper H, denOuter P, Feister U. Europe's darker atmosphere in the UV-B. Photochem Photobiol Sci 2008, 7(8):925�30.
Brogniez C, Werle P, Koskela T, Lakkala K, Gr�bner J, Slaper H, denOuter P, Feister U. Europe's darker atmosphere in the UV-B. Photochem Photobiol Sci. 2008;7(8):925�30.
Article PubMed Google Scholar
Brinkmann RT, Green AE, Barth CA. Atmospheric scattering of the solar flux in the middle ultraviolet. Appl Opt. 1967;6(3):373�83. doi:10.1364/AO.6.000373.
Article CAS PubMed Google Scholar
Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988;67:373�8.
Article CAS PubMed Google Scholar
Clemens TL, Henderson SL, Adams JS, Holick MF. Increased skin pigment reduces the capacity of skin to synthesis vitamin D3. Lancet. 1982;1(8263):74�6.
Article CAS PubMed Google Scholar
Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab. 1987;64:1165�8.
Article CAS PubMed Google Scholar
Matsuoka LY, Wortsman J, Hanifan N, Holick MF. Chronic sunscreen use decreases circulating concentrations of 25-hydroxyvitamin D. A preliminary study. Arch Dermatol. 1988;124:1802�4.
Article CAS PubMed Google Scholar
Godar DE, Pope SJ, Grant WB, Holick MF. Solar UV doses of adult and vitamin D3 production. Dermato-Endocrinol. 2011;3(4):1�8. 437
Article Google Scholar
Keegan RJ, Lu Z, Bogusz JM, Williams JE, Holick MF. Photobiology of vitamin D in mushrooms and its bioavailability in humans. Dermato-Endocrinol. 2013;5(1):165�76.
Article Google Scholar
Tang HM, Cole DEC, Rubin LA, Pierratos A, Siu S, Vieth R. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998;68:854�8.
Google Scholar
Heaney RP, Recker RR, Grote J, Horst RL, Armas LAG. Vitamin D3 is more potent than vitamin D2 in humans. J Clin Endocrinol Metab. 2011;152(2):741.
Google Scholar
Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89(11):5387�91.
Article CAS PubMed Google Scholar
Heaney RP, Recker RR, Grote J, Horst RL, Armas LA. Vitamin D(3) is more potent than vitamin D(2) in humans. J Clin Endocrinol Metab. 2011;96(3):E447�52.
Article CAS PubMed Google Scholar
Oliveri B, Mastaglia SR, Brito GM, Seijo M, Keller GA, Somoza J, Diez RA, Di Girolamo G. Vitamin D3 seems more appropriate than D2 to sustain adequate levels of 25OHD: a pharmacokinetic approach. Eur J Clin Nutr. 2015;69(6):697�702.
Article CAS PubMed Google Scholar
Biancuzzo RM, Cai MH, Winter MR, Klein EK, Ameri A, Reitz R, Salameh W, Young A, Bibuld D, Chen TC, Holick MF. Fortification of orange juice with vitamin D2 or vitamin D3 is as effective as an oral supplement in maintaining vitamin D status in adults. Am J Clin Nutr. 2010;91:1621�6.
Article CAS PubMed PubMed Central Google Scholar
Biancuzzo RM, Clarke N, Reitz RE, Travison TG, Holick MF. Serum concentrations of 1,25-dihydroxyvitamin D2 and 1,25-dihydroxyvitamin D3 in response to vitamin D2 and vitamin D3 supplementation. J Clin Endocrinol Metab. 2013;98(3):973�9.
Article CAS PubMed PubMed Central Google Scholar
Pietras SM, Obayan BK, Cai MH, Holick MF. Vitamin D2 treatment for vitamin D deficiency and insufficiency for up to 6 years. Arch Intern Med. 2009;169:1806�8.
Article PubMed Google Scholar
Chowdhury R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury S, Kiefte-de-Jong JC, Khan H, Baena CP, Prabhakaran D, Hoshen MB, Feldman BS, Pan A, Johnson L, Crowe F, Hu FB, Franco OH. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.
Article PubMed PubMed Central Google Scholar
Chun RF, Hernandez I, Pereira R, Swinkles L, Huijs T, Zhou R, Liu NQ, Shieh A, Guemes M, Mallya SM, Adams JS, Hewison M. Differential responses to vitamin D2 and vitamin D3 are associated with variations in free 25-hydroxyvitamin D. Endocrinology. 2016;157:3420�30.
Article CAS PubMed Google Scholar
Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S�6S.
CAS PubMed Google Scholar
Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77:204�10.
CAS PubMed Google Scholar
Demetriou ETW, Travison TG, Holick MF. Treatment with 50,000 IU vitamin D2 every other week and effect on Serum 25-hydroxyvitamin D2, 25-hydroxyvitamin D3 and total 25-hydroxyvitamin D in a clinical setting. Endocr Prac. 2012;18(3):399�402.
Article Google Scholar
Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers. PLoS One. 2014; doi:10.1371/journal.pone.0111265. 520.
Hollis BW, Johnson D, Hulsey TC, Ebeling M. Wagner. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011;26(10):2341�57. doi:10.1002/jbmr.463.
Article CAS PubMed PubMed Central Google Scholar
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690�3.
CAS PubMed Google Scholar
Boonchaya-anant P, Holick MF, Apovian CM. Serum 25-hydroxyvitamin D levels and metabolic health status in extremely obese individuals. Obes J. 2014;22(12):2539�43. doi:10.1002/oby.20877. 516.
CAS Google Scholar
Dabai NS, Pramyothin P, Holick MF. The effect of ultraviolet radiation from a novel portable flourescent lamp on serum 25-hydroxyvitamin D3 Levels in healthy adults with Fitzpatrick skin types II and III. Photodermatol Photoimmunol Photomed. 2012;28(6):307�11. 474
Article CAS PubMed PubMed Central Google Scholar
Koutkia P, Lu Z, Chen TC, Holick MF. Treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation. Gastroenterol. 2001;121:1485�8.
Article CAS Google Scholar
Chandra P, Wolfenden LL, Ziegler TR, Tian J, Luo M, Stecenkoo AA, Chen TC, Holick MF, Tangpricha V. Treatment of vitamin D deficiency with UV light in patients with malabsorption syndromes: a case series. Phtodermatol Photoimunol Photmed. 2007;23(5):179�85.
Article CAS Google Scholar
Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG, Taylor SN, Morella K, Lawrence RA, Hulsey TC. Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics. 2015;136:625�34.
Article PubMed PubMed Central Google Scholar
Gordon CM, Williams AL, Feldman HA, May J, Sinclair L, Vasquez A, Cox JE. Treatment of hypovitaminosis D in infants and toddlers. J Clin Endocrinol Metab. 2008;93(7):2716�21.
Article CAS PubMed PubMed Central Google Scholar
Holick MF. Case 3-2009: a 9-month-old boy with seizures. New Eng J Med CPC. 2009;360(4):398�407.
Article CAS Google Scholar
Holick MF. Vitamin D is not as toxic as was once thought: A historical and an up-to-date perspective. 2015 May. Mayo Clin Proc. 90(5):561�4. 530
Araki T, Holick MF, Alfonso BD, Charlap E, Romero CM, Rizk D, Newman LG. Vitamin D intoxication with severe hypercalcemia due to manufacturing and labelling errors for two dietary supplements made in the United States. J Clin Endocrinol Metab. 2011;96(12):3603�8. 451
Article CAS PubMed Google Scholar
Koutkia P, Chen TC, Holick MF. Vitamin D intoxication associated with an over-the-counter supplement. N Engl J Med. 2001;345(1):66�7.
Article CAS PubMed Google Scholar
Jacobus, C.H., Holick, M.F., Shao, Q., Chen, T.C., Holm I.A., Kolodny, J.M., El-Hajj Fuleihan, G. and Seely, E. Hypervitaminosis D associated with drinking milk. N Engl J Med. 1992. 326(18):1173�1177. 120.
Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999, 69(5):842�856.
Melamed ML, Michos ED, Post W, Astor B. 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008;168(15):1629�37.
Article PubMed PubMed Central Google Scholar
Grant WB, Karras SN, Bischoff-Ferrari HA, Annweiler C, Boucher BJ, Juzeniene A, Garland CF, Holick MF. Do studies reporting 'U'-shaped serum 25-hydroxyvitamin D-health outcome relationships reflect adverse effects? Dermato-Endocrinology. 2016;8(1):e1187349.
Article PubMed PubMed Central Google Scholar
Kroll MH, Bi C, Garber CC, et al. Temporal relationship between vitamin D status and parathyroid hormone in the United States. PLoS One. 2015;10(3):e 0118108. doi:10.1371/journal.pone.0118108.eCollection 2015.
Article Google Scholar
Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Manson JE, Mayne ST, Ross AC, Shapses SA, Taylor CL. IOM Committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab. 2012;97(4):1146�52.
Article CAS PubMed PubMed Central Google Scholar
Płudowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sok�ł D, Czech-Kowalska J, Dębski R, Decsi T, Dobrzańska A, Franek E, Głuszko P, Grant WP, Holick MF, Yankovskaya L, Konstantynowicz J, Książyk JB, Księżopolska-Orłowska K, Lewiński A, Litwin M, Lohner S, Lorenc RS, Łukaszkiewicz J, Marcinowska-Suchowierska E, Milewicz A, Misiorowski W, Nowicki M, Povoroznyuk V, Rozentryt P, Rudenka E, Shoenfeld Y, Socha P, Solnica B, Szalecki M, Tałałaj M, Varbiro S, Żmijewski MA. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe � recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013;64(4):319�27. 502
Article PubMed Google Scholar
Luxwolda MF, Kuipers RS, Kema IP, Dijck-Brouwer DA, Muskiet FA. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Br J Nutr. 2012;108(9):1557�61.
Article CAS PubMed Google Scholar
El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, Choucair M, Arabi A, Vieth R. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006;91:405�12.
Article PubMed Google Scholar
Donneyong MM, Taylor KC, Kerber RA, Hornung CA, Scragg R. Is outdoor recreational activity an independent predictor of cardiovascular disease mortality - NHANES III? Nutr Metab Cardiovasc Dis. 2016;26(8):735�42.
Article CAS PubMed Google Scholar
Lindqvist PG, Epstein E, Nielsen K, Landin-Olsson M, Ingvar C, Olsson H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the melanoma in southern Sweden cohort. J Intern Med. 2016;280(4):375�87.
Article CAS PubMed Google Scholar
Wolpowitz D, Gilchrest BA. The vitamin D questions: how much do you need and how should you get it? J Am Acad Dermatol. 2006;54:301�17.
Article PubMed Google Scholar
Karimi K, Lindgren TH, Koch CA, Brodell RT. Obesity as a risk factor for malignant melanoma and non-melanoma skin cancer. Rev Endocr Metab Disord. 2016;17(3):389�403.94.
Article CAS PubMed Google Scholar
Kennedy C, Bajdik CD, Willemze R, de Gruijl FR, Bavinck JN. The influence of painful sunburns and lifetime of sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi and skin cancer. J Invest Dermatol. 2003;120(6):1087�93.
Article CAS PubMed Google Scholar
Moan J, Porojnicu AC, Dahlback A, Setlow RB. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci U S A. 2008;105(2):668�73.
Article CAS PubMed PubMed Central Google Scholar
Felton SJ, Cooke MS, Kift R, et al. Concurrent beneficial (vitamin D production) and hazardous (cutaneous DNA damage) impact of repeated low-level summer sunlight exposures. Br J Dermatol. 2016;175:1320�8.
Article CAS PubMed PubMed Central Google Scholar
Holick MF. Can you have your cake and eat it too? The sunlight D-lema. Br J Dermatol. 2016;175:1129�31.
Article CAS PubMed Google Scholar
Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP, Sorensen OH. Vitamin D status and its adequacy in health Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Brit J Nutr. 2001;86:S97�103.
Article CAS PubMed Google Scholar
Baggerly C, Cuom R, French C, Garland C, Gorham E, Grant W, Heaney R, Holick M. Sunlight and vitamin D: necessary for public health. J Am Coll Nutr. 2015;34(4):359�65.
Article PubMed PubMed Central Google Scholar
Osmancevic A, Gillstedt M, Landin-Wilhelmsen K, Wennberg Larko AM, Larko O, Holick M, Krogstad AL. Size of the exposed body surface area, skin erythema and body mass index predict skin production of vitamin D. 2015 June. J Photochem Photobiol B Biol. 2015;149:224�9.
Article CAS Google Scholar
Vieth R. The Pharmacology of Vitamin D, including fortification strategies. Chapter 61 in Vitamin D, 2 Edition. D Feldman, JW Pike, FH Glorieux eds. Elsevier Acad. Press 30 Corporate Dr., Suite 400, Burlington, MA 01803. 2005. pp 995�1015.
Rich-Edwards JW, Davaasambuu G, Kleinman K, Sumberzul N, Holick MF, Lkhagvasuren T, Dulguun B, Burke A, Frazier AL. Randomized trial of fortified milk and supplements to raise 25-hydroxyvitamin D concentrations in schoolchildren in Mongolia. Am J Clin Nutr. 2011;94:578�84. 449
Article CAS PubMed Google Scholar
Download references
Author information
Authors and Affiliations
Endocrinology, Nutrition and Diabetes, Department of Medicine, Boston University Medical Center, Boston, MA, 02118, USA
Michael F. Holick
Authors
Michael F. Holick
View author publications
You can also search for this author in PubMed Google Scholar
Corresponding author
Correspondence to Michael F. Holick.
Ethics declarations
This is a review and therefore there are no issues regarding compliance and ethical standards.
Conflict of interest
The author declares that he is a consultant for Quest Diagnostics, Ontometrics Inc. and is on speaker�s Bureau for Sanofi Inc.