Diet, sun, and lifestyle as determinants of vitamin D status
Corresponding Author
Paul Lips
Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, the Netherlands
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Address for correspondence: Paul Lips, M.D., Ph.D., Department of Internal Medicine, Endocrine Section, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands. [email protected]Search for more papers by this authorNatasja M. van Schoor
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorRenate T. de Jongh
Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorCorresponding Author
Paul Lips
Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, the Netherlands
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Address for correspondence: Paul Lips, M.D., Ph.D., Department of Internal Medicine, Endocrine Section, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands. [email protected]Search for more papers by this authorNatasja M. van Schoor
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorRenate T. de Jongh
Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorAbstract
Vitamin D status can be assessed by measuring concentrations of 25-hydroxyvitamin D (25(OH)D). Sunlight is the most important source of vitamin D and stimulates the production of vitamin D3 in the skin during the summer, depending on age, skin pigmentation, clothing style, and sunscreen use. Seasonal variation in serum 25(OH)D is between 10 and 20 nmol/L in adults and almost absent in nursing home residents. Sunscreen use decreases, but does not abolish, vitamin D production in the skin. Clothing style has a large influence on vitamin D production. Furthermore, vitamin D status can be improved by ingestion of fatty fish and the fortification of milk or orange juice. A high dietary calcium intake has a vitamin D–sparing effect, because it increases the half-life of 25(OH)D. A combination of sunlight exposure, nutrition, food fortification, and supplements is desirable to obtain sufficient vitamin D status in the population of most countries throughout the year.
References
- 1Holick, M.F., T.C. Chen, Z. Lu & E. Sauter. 2007. Vitamin D and skin physiology: a D-lightful story. J. Bone. Miner. Res. 22(suppl 2): V28–V33.
- 2Lips, P. 2006. Vitamin D physiology. Prog. Biophys. Mol. Biol. 92: 4–8.
- 3Lips, P., N.M. van Schoor & N. Bravenboer. 2013. “ Vitamin D-related disorders.” In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 8th ed. C.J. Rosen, Ed.: 613–623. Hoboken: Wiley-Blackwell.
- 4Need, A.G., P.D. O'Loughlin, H.A. Morris, P.S. Coates, M. Horowitz & B.E. Nordin. 2008. Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J. Bone. Miner. Res. 23: 1859–1863.
- 5Bischoff-Ferrari, H.A., T. Dietrich, E.J. Orav & B. Dawson-Hughes. 2004. Positive association between 25-hydroxyvitamin D levels and bone mineral density: a population-based study of younger and older adults. Am. J. Med. 116: 634–639.
- 6Kuchuk, N.O., S.M. Pluijm, N.M. van Schoor, C.W. Looman, J.H. Smit & P. Lips. 2009. Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J. Clin. Endocrinol. Metab. 94: 1244–1250.
- 7Ross, A.C., J.E. Manson, S.A. Abrams, J.F. Aloia, P.M. Brannon, S.K. Clinton, et al. 2011. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J. Clin. Endocrinol. Metab. 96: 53–58.
- 8Holick, M.F., N.C. Binkley, H.A. Bischoff-Ferrari, C.M. Gordon, D.A. Hanley, R.P. Heaney, M.H. Murad & C.M. Weaver. 2011. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 96: 1911–1930.
- 9Bouillon, R., J.H. Auwerx, W.D. Lissens & W.K. Pelemans. 1987. Vitamin D status in the elderly: seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency. Am. J. Clin. Nutr. 45: 755–763.
- 10Bolland, M.J., W.W. Chiu, J.S. Davidson, A. Grey, C. Bacon, G.D. Gamble & I.R. Reid. 2008. The effects of seasonal variation of 25-hydroxyvitamin D on diagnosis of vitamin D insufficiency. N. Z. Med. J. 121: 63–74.
- 11Van Schoor, N.M., D.L. Knol, D.J.H. Deeg, F.P.A.M.N. Peters, A.C. Heijboer & P. Lips. 2014. Longitudinal changes and seasonal variations in serum 25-hydroxyvitamin D levels in different age groups: results of the Longitudinal Aging Study Amsterdam. Osteoporos. Int. 25: 1483–1491.
- 12Chel, V.G.M., M.E. Ooms, C. Popp-Snijders, S. Pavel, A.A. Schothorst, C.C.E. Meulemans & P. Lips. 1998. Ultraviolet irradiation corrects vitamin D deficiency and suppresses secondary hyperparathyroidism in the elderly. J. Bone. Miner. Res. 13: 1238–1242.
- 13MacDonald, H.M., A. Mavroeidi, W.D. Fraser, A.L. Darling, A.J. Black, L. Aucott, F. O'Neill, K. Hart, J.L. Berry, S.A. Lanham-New & D.M. Reid. 2011. Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northern latitudes: a major cause of concern? Osteoporos. Int. 22: 2461–2472.
- 14Fitzpatrick, T.B. 1988. The validity and practicality of sun-reactive skin types I to VI. Arch. Dermatol. 124: 869–871.
- 15Fioletov, V.E., L.J.B. McArthur, T.W. Mathews & L. Marrett. 2010. Estimated ultraviolet exposure levels for a sufficient vitamin D status in North America. J. Photochem. Photobiol. B. 100: 57–66
- 16Looker, A.C., C.M. Pfeiffer, D.A. Lacher, R.L. Schleicher, M.F. Picciano & E.A. Yetley. 2008. Serum 25-hydroxyvitamin D status of the US population: 1988–1994 compared with 2000–2004. Am. J. Clin. Nutr. 88: 1519–1527.
- 17Prentice, A. 2008. Vitamin D deficiency: a global perspective. Nutr. Rev. 66(suppl 2): S153–S164.
- 18Bouillon, R., N.M. van Schoor, E. Gielen, S. Boonen, C. Mathieu, D. Vanderschueren & P. Lips. 2013. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J. Clin. Endocrinol. Metab. 98: E1283–E1304.
- 19Young, A. on behalf of the ICEPURE team. 2013. Holiday UVR exposure and sunscreen use on vitamin D status. In Vitamin D Workshop, San Francisco, abstract, p. 30.
- 20Chel, V.G., M.E. Ooms, S. Pavel, F. de Gruijl, A. Brand & P. Lips. 2011. Prevention and treatment of vitamin D deficiency in Dutch psychogeriatric nursing home residents by weekly half-body UVB exposure after showering: a pilot study. Age Ageing 40: 211–214.
- 21Van der Wielen, R.P., M.R. Löwik, H. van den Berg, L.C. de Groot, J. Haller, O. Moreiras & W.A. van Staveren. 1995. Serum vitamin D concentrations among elderly people in Europe. Lancet 346: 207–210.
- 22Lips, P., T. Duong, A.M. Oleksik, D. Black, S. Cummings, D. Cox & T. Nickelsen; for the MORE Study Group. 2001. A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J. Clin. Endocrinol. Metab. 86: 1212–1221
- 23Alagol, F., Y. Shihadeh, H. Boztepe, R. Tanakol, S. Yarman, H. Azizlerli & O. Sandalci. 2000. Sunlight exposure and vitamin D deficiency in Turkish women. J. Endocrinol. Invest. 23: 173–177.
- 24Mishal, A.A. 2001. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporosis. Int. 12: 931–935.
- 25Sedrani, S.H., A.W.T.H. Elidrissy & K.M. El Arabi. 1983. Sunlight and vitamin D status in normal Saudi subjects. Am. J. Clin. Nutr. 38: 129–132
- 26van der Meer, I., A.J.P. Boeke, P. Lips, I. Grootjans-Geerts, J.D. Wuister, W.L. Devillé, J.P. Wielders, L.M. Bouter & B.J.C. Middelkoop. 2008. Fatty fish and supplements are the greatest modifiable contributors to the serum 25-hydroxyvitamin D concentration in a multiethnic population. Clin. Endocrinol. 68: 466–472
- 27Snijder M.B., R.M. van Dam, M. Visser, D.J.H. Deeg, J.M. Dekker, L.M. Bouter, J.C. Seidell & P. Lips. 2005. Adiposity in relation to vitamin D status and parathyroid hormone levels. A population-based study in older men and women. J. Clin. Endocrinol. Metab. 90: 4119–4123.
- 28van den Heuvel, E.G.H.M., N.M. van Schoor, R.T. de Jongh, M. Visser & P. Lips. 2013. Cross-sectional study on different characteristics of physical activity as determinants of vitamin D status; inadequate in half of the population. Eur. J. Clin. Nutr. 67: 360–365.
- 29Nakamura, K., M. Nashimoto & M. Yamamoto. 2000. Serum 25-hydroxyvitamin D concentrations and related dietary factors in peri- and postmenopausal Japanese women. Am. J. Clin. Nutr. 71: 1161–1165.
- 30Brustad, M., T. Sandanger, L. Aksnes & E. Lund. 2004. Vitamin D status in a rural population of northern Norway with high fish liver consumption. Public Health Nutr. 7: 783–789.
- 31McKenna, M.J. 1992. Differences in vitamin D status between countries in young adults and the elderly. Am. J. Med. 93: 69–77.
- 32Tylavsky, F.A., S. Cheng, A. Lyytikäinen, H. Viljakainen & C. Lamberg-Allardt. 2006. Strategies to improve vitamin D status in Northern European children: exploring the merits of vitamin D fortification and supplementation. J. Nutr. 136: 1130–1134
- 33Biancuzzo, R.M., A. Young, D. Bibuld, M.H. Cai, M.R. Winter, E.K. Klein, et al. 2010. 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. 91: 1621–1626
- 34Kara, C., F. Gunindi, A. Ustyol & M. Aydin. 2014. Vitamin D intoxication due to an erroneously manufactured dietary supplement in seven children. Pediatrics 133: e240–e244.
- 35Lips, P. 2012. Interaction between vitamin D and calcium. Scand. J. Clin. Lab. Invest. 72(Suppl 243): 60–64.
- 36Clements, M.R. 1987. A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature 325: 62–65.
- 37Anderson, P.H., A.M. Lee, S.M. Anderson, R.K. Sawyer, P.D. O'Loughlin & H.A. Morris. 2010. The effect of dietary calcium on 1,25(OH)2D3 synthesis and sparing of serum 25(OH)D3 levels. J. Steroid Biochem. Mol. Biol. 121: 288–292.
- 38Davies, M, S.E. Heys, P.L. Selby, J.L. Berry & E.B. Mawer. 1997. Increased catabolism of 25-hydroxyvitamin D in patients with partial gastrectomy and elevated 1,25-dihydroxyvitamin D levels. Implications for metabolic bone disease. J. Clin. Endocrinol. Metab. 82: 209–212.
- 39Dagnelie, P.C., F.J. Vergote, W.A. van Staveren, H. van den Berg, P.G. Dingjan & J.G. Hautvast. 1990. High prevalence of rickets in infants on macrobiotic diets. Am. J. Clin. Nutr. 51: 202–208.
- 40Lips, P. 2001. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocrine Rev. 22: 477–501.
- 41Torrenté de la Jara, G., A. Pécoud & B. Farrat. 2004. Musculoskeletal pain in female asylum seekers and hypovitaminosis D3. BMJ. 329: 56–57.
10.1136/bmj.329.7458.156 Google Scholar
- 42Van der Meer, I.M., N.S. Karamali, A.J. Boeke, P. Lips, B.J. Middelkoop, I. Verhoeven & J.D. Wuister. 2006. High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands. Am. J. Clin. Nutr. 84: 350–353.
- 43Grover, S.R. & R. Morley. 2001. Vitamin D deficiency in veiled or dark-skinned pregnant women. Med. J. Aust. 175: 251–252.
- 44Wicherts, I.S., A.J. Boeke, I.M. van der Meer, N.M. van Schoor, D.L. Knol & P. Lips. 2011. Sunlight exposure or vitamin D supplementation for vitamin D-deficient non-western immigrants: a randomized clinical trial. Osteoporosis Int. 22: 873–882