1 Arquivos Brasileiros de Endocrinologia & Metabologia 2006 Vol: 50(4):. DOI: 10.1590/S0004-27302006000400009

Vitamin D deficiency: a global perspective

Vitamin D is essential for the maintenance of good health. Its sources can be skin production and diet intake. Most humans depend on sunlight exposure (UVB 290­315 nm) to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by the skin, leading to transformation of 7-dehydrocholesterol into vitamin D3 (cholecalciferol). Season, latitude, time of day, skin pigmentation, aging, sunscreen use, all influence the cutaneous production of vitamin D3. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risk for other morbidities such as cardiovascular disease, type 1 and type 2 diabetes mellitus and cancer, especially of the colon and prostate. The prevalence of hypovitaminosis D is considerable even in low latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis. Although severe vitamin D deficiency leading to rickets or osteomalacia is rare in Brazil, there is accumulating evidence of the frequent occurrence of subclinical vitamin D deficiency, especially in elderly people. 

Figure 1 Figure 2
  1. Pittas A, Dawson-Hughes B, Li T, Van Dam R, Willett WC, Manson JE, et al. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care29 , 650-6 (2006) .
  2. Garland CF, Garland FC, Gorham E, Lipkin M, Newmark H, Mohr SB, et al. The role of vitamin D in cancer prevention. Am J Pub Health96 , 252-61 (2006) .
  3. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr80(6 Suppl):1678S-88S , (2004) .
  4. Rosen CJ, Morrison A, Zhou H. Elderly women in northern New England exhibit seasonal changes in bone mineral density and calciotropic hormones. Bone Miner25 , 83-92 (1994) .
  5. Lips P, Duong T, Oleksik A, Black DM, Cummings S, Cox D, et al; The Multiple Outcomes of Raloxifene Evaluation Study Group. 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 Endocrionol Metab86 , 1212-8 (2001) .
  6. Haden ST, Fuleihan GE, Agell JE, Cotran NM. Calcidiol and PTH levels in women attending an osteoporosis program. Calcif Tissue Int64 , 275-9 (1999) .
  7. Chapuy MC, Preziosi P, Maaner P, Delmas P. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int7 , 439-43 (1997) .
  8. Thomas MK, Demay MB. Vitamin D deficiency and disorders of vitamin D metabolism. Endocrinol Metab Clin North Am29 , 1-17 (2000) .
  9. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet351 , 805-6 (1998) .
  10. Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, et al. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab89 , 3152-57 (2004) .
  11. Hollis BW. The determination of circulating 25-hydroxyvitamin D: no easy task. J Clin Endocrinol Metab89 , 3149-51 (2004) .
  12. Reid IR, Gallagher DJ, Bosworth J. Prophylaxis against vitamin D deficiency in the elderly by regular sunlight exposure. Age Ageing15 , 35-40 (1986) .
  13. Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF. Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab75 , 1099-103 (1992) .
  14. Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int12 , 931-5 (2001) .
  15. Vander Wielen RPJ, Löwik MRH, Van Den Berg H, De Groot LCPMG, Haller J, Moreiras O, et al. Serum vitamin D concentrations among elderly people in Europe. Lancet346 , 207-10 (1995) .
  16. Barger-Lux MJ, Heaney RP. Effects of above average summer sun exposure on serum 25-hydroxivitamin D and calcium absorption. J Clin Endocrinol Metab87(11) , 4952-6 (2002) .
  17. Levis S, Gomez A, Jimenez C, Veras L, Ma F, Lai S, et al. Vitamin D deficiency and seasonal variation in adult South Florida population. J Clin Endocrinol Metab90(3) , 1557-62 (2005) .
  18. Binkley N, Novotny R, Krueger D, Kawahara-Baccus T, et al. Inadequate vitamin D status despite abundant sun exposure. J Bone Miner Res20(Suppl 1):S45 , (2005) .
  19. Lips P, Wiersinga A, Van Ginkel FC, Jongen MJ. The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J Clin Endocrinol Metab 67 , 644-50 (1988) .
  20. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Ped Adol Med158 , 531-7 (2004) .
  21. Diamond T, Smerdely P, Kormas N, Sekel R, Vu T, Day P. Hip fracture in the elderly men: the importance of subclinical vitamin D deficiency and hypogonadism. Med J Aust169 , 138-41 (1998) .
  22. Serhan E, Newton P, Ali HA. Prevalence of hypovitaminosis D in Indo-Asian patients attending a rheumatology clinic. Bone25 , 609-11 (1999) .
  23. Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B. Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab85 , 4125-30 (2000) .
  24. Holick M, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet radiation. Lancet4 , 1104-5 (1989) .
  25. Sahota O, Masud T, San P. Vitamin D insufficiency increases bone turnover at the hip in patients with established vertebral osteoporosis. Clin Endocrinol (Oxf)51 , 217-21 (1999) .
  26. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA293 , 2257-64 (2005) .
  27. El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, et al. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab91(2) , 405-12 (2006) .
  28. Hatun S, Islam O, Cizmecioglu F, Kara B, Babaoglu K, Berk F, et al. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr , 218-22 (2005) .
  29. Stein E, Laing E, Hall D, Hausman D, Kimlin M, Johnson MA, et al. Serum 25-hydroxyvitamin D concentration in girls aged y living in the southeastern United States. Am J Clin Nutr83:75-81 , 4-8 (2006) .
  30. Bandeira F, Caldas G, Freese E, Griz L, Faria M, Bandeira C. Relationship between serum vitamin D status and clinical manifestations of primary hyperparathyroidism. Endocr Pract8 , 266-70 (2002) .
  31. Bandeira F, Bandeira C, Freese E. Occult vitamin D deficiency and its relationship with bone mineral density among postmenopausal women in Recife, Brazil. J Bone Miner Res18(Supl 2):S407 , (2003) .
  32. Alagol F, Shihadeh Y, Boztepe H, Tanakol R. Sunlight exposure and vitamin D deficiency in Turkish women. J Endocrinol Invest23 , 173-7 (2000) .
  33. Ganage-Yared MH, Chemali R, Yaacoub N, Asmar A. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res15 , 1856-62 (2000) .
  34. Thomas MK, Demay MB. Vitamin D deficiency and disorders of vitamin D metabolism. Endocrinol Metab Clin North Am29 , 1-17 (2000) .
  35. Saraiva GL, Cendoroglo MS, Ramos LR, Araújo LM, Vieira JG, Kunii I, et al. Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of São Paulo (23º 34'S) Brazil. Osteoporos Int16 , 1649-54 (2005) .
  36. Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr80:S , 1706-9 (2004) .