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Vitamin D deficiency and bone health in healthy adults in Finland: could this be a concern in other parts of Europe? Lamberg-Allardt CJ, Outila TA, Kärkkainen MU, Rita HJ, Valsta LM. J Bone Miner Res. 2001 Nov;16(11):2066-73. PMID: 11697803 Low vitamin D status was prevalent in these young adults in northern Europe in winter, although the vitamin D intake met the recommendation. This probably is not a local problem for northern Europe, because the natural sources of vitamin D are scarce and fortification is not very common in Europe, and with the exception of the southern part of Europe, sunshine is not very abundant in this part of the world. Thus, the results of this study indicate that more attention should be focused on vitamin D status and the sources of vitamin D in these countries.

Differences in vitamin D status between countries in young adults and the elderly. McKenna MJ. Am J Med. 1992 Jul;93(1):69-77. PMID: 1385673 PURPOSE: To compare vitamin D status between countries in young adults and in the elderly. MATERIALS AND METHODS: Reports on vitamin D status (as assessed by serum 25-hydroxyvitamin D) from 1971 to 1990 were reviewed. Studies were grouped according to geographic regions: North America (including Canada and the United States); Scandinavia (including Denmark, Finland, Norway, and Sweden); and Central and Western Europe (including Belgium, France, Germany, Ireland, The Netherlands, Switzerland, and the United Kingdom). RESULTS: Vitamin D status varies with the season in young adults and in the elderly, and is lower during the winter in Europe than in both North America and Scandinavia. Oral vitamin D intake is lower in Europe than in both North America and Scandinavia. Hypovitaminosis D and related abnormalities in bone chemistry are most common in elderly residents in Europe but are reported in all elderly populations. CONCLUSIONS: The vitamin D status in young adults and the elderly varies widely with the country of residence. Adequate exposure to summer sunlight is the essential means to ample supply, but oral intake augmented by both fortification and supplementation is necessary to maintain baseline stores. All countries should adopt a fortification policy. It seems likely that the elderly would benefit additionally from a daily supplement of 10 micrograms of vitamin D.

Teenage girls and elderly women living in northern Europe have low winter vitamin D status. Andersen R, Mølgaard C, Skovgaard LT, Brot C, Cashman KD, Chabros E, Charzewska J, Flynn A, Jakobsen J, Kärkkäinen M, Kiely M, Lamberg-Allardt C, Moreiras O, Natri AM, O'brien M, Rogalska-Niedzwiedz M, Ovesen L. Eur J Clin Nutr. 2005 Apr;59(4):533-41. PMID: 15714215 doi:10.1038/sj.ejcn.1602108 CONCLUSION: Vitamin D status is low in northern Europe during winter. More than one-third of the adolescent girls have vitamin D status below 25 nmol/l and almost all are below 50 nmol/l. Two-thirds of the elderly community-dwelling women have vitamin D status below 50 nmol/l. Use of vitamin D supplements is a significant positive determinant for S-25OHD for both girls and women (P = 0.001). SPONSORSHIP: The European Fifth Framework Programme (Contract No. QLK1-CT-2000-00623)

van der Wielen RP, Lowik MR, van den BH, de Groot LC, Haller J, Moreiras O, van Staveren WA (1995) Serum vitamin D concentrations among elderly people in Europe. Lancet 346: 207-210 These findings show that free-living elderly Europeans, regardless of geographical location, are at substantial risk of inadequate vitamin D status during winter and that dietary enrichment or supplementation with vitamin D should be seriously considered during this season.

An estimate of cancer mortality rate reductions in Europe and the US with 1,000 IU of oral vitamin D per day. Grant WB, Garland CF, Gorham ED. Recent Results Cancer Res. 2007;174:225-34. Review. PMID: 17302200

Current micronutrient recommendations in Europe: towards understanding their differences and similarities. Doets EL, de Wit LS, Dhonukshe-Rutten RA, Cavelaars AE, Raats MM, Timotijevic L, Brzozowska A, Wijnhoven TM, Pavlovic M, Totland TH, Andersen LF, Ruprich J, Pijls LT, Ashwell M, Lambert JP, van 't Veer P, de Groot LC. Eur J Nutr. 2008 Apr;47 Suppl 1:17-40. PMID: 18427858 DOI: 10.1007/s00394-008-1003-5 Full text: http://www.eurreca.org/downloadattachment/3199/1535/ejn%201003ov.pdf

Grant WB, Garland CF, Gorham ED. An estimate of cancer mortality rate reductions in Europe and the US with 1,000 IU of oral vitamin D per day. Recent Results Cancer Res. 2007;174:225-34. PMID: 17302200 [PubMed - in process]

Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Thomsen J, Charles P, Eriksen EF. J Intern Med. 2000 Feb;247(2):260-8. PMID: 10692090 Conclusions. Severe vitamin D deficiency is prevalent amongst sunlight-deprived individuals living in Denmark. In veiled Arab women, vitamin D deficiency is the result of a combination of limitations in sunlight exposure and a low oral intake of vitamin D. The oral intake of vitamin D amongst veiled ethnic Danish Moslems was, however, very high, at 13.53 µg (approximately 600 IU), but they were still vitamin D-deficient. Our results suggest that the daily oral intake of vitamin D in sunlight-deprived individuals should exceed 600 IU; most probably it should be 1000 IU day-1 to secure a normal level of 25-hydroxyvitamin D. This finding is in contrast with the commonly used RDA (recommended daily allowance) for adults in Europe: 200 IU day-1.

Vitamin D deficiency: a worldwide problem with health consequences. Holick MF, Chen TC. Am J Clin Nutr. 2008 Apr;87(4):1080S-6S. Review. PMID: 18400738 A reevaluation needs to take place of what the adequate intakes of vitamin D should be for children and adults. The literature over the past decade suggests that the Institute of Medicine recommendations in 1997 (83) are inadequate, and some experts including us suggest that both children and adults should take ≥800-1000 IU vitamin D/d from dietary and supplemental sources (4, 9, 77) when sunlight is unable to provide it. This recommendation, however, has not yet been embraced either by official government or pediatric organizations in the United States, Canada, or Europe for either children or adults.

Seasonal affective disorder (SAD) is a type of winter-time depression experienced by people those who live in northern latitudes such as those of New York, Seattle, all of Canada, and Northern Europe. I believe it is primarily a disorder of sunlight/vitamin D deficiency. Vitamin D, when administered in late winter, produces a positive effect on mood in only five days.[1] One theory for this is that vitamin D stimulates the brain to produce more serotonin. In a wintertime experiment, serum vitamin D levels doubled in six months through supplementation and dramatically increased scores on a wellbeing assessment.[2] Two groups were given either 1,000 IU or 4,000 IU of vitamin D daily. And although both groups improved, the higher dose produced better results.

The review, published in Osteoporosis International, provides a global perspective of vitamin D status across different regions of the world and identifies common and significant determinants of hypovitaminosis D. Six regions of the world were reviewed-Asia, Europe, Middle East and Africa, Latin America, North America, and Oceania-through a survey of published literature.

Opinion of the Scientific Committee on Food on the Tolerable Upper Intake Level of Vitamin D (expressed on 4 December 2002)

White Europeans could have evolved as recently as 5,500 years ago, according to research which suggests that the early humans who populated Britain and Scandinavia had dark skins for millenniums. It was only when early humans gave up hunter-gathering and switched to farming about 5,500 years ago that white skin began to be favoured, say the researchers. This is because farmed food was deficient in vitamin D, a vital nutrient. Humans can make this in their skin when exposed to sunlight, but dark skin is much less efficient at it.

Strategies to improve vitamin D status in northern European children: exploring the merits of vitamin D fortification and supplementation. Tylavsky FA, Cheng S, Lyytikäinen A, Viljakainen H, Lamberg-Allardt C. J Nutr. 2006 Apr;136(4):1130-4. PMID: 16549494

Serum Vitamin D and Risk of Prostate Cancer in a Case-Control Analysis Nested Within the European Prospective Investigation into Cancer and Nutrition (EPIC). Travis RC, Crowe FL, Allen NE, Appleby PN, Roddam AW, Tjønneland A, Olsen A, Linseisen J, Kaaks R, Boeing H, Kröger J, Trichopoulou A, Dilis V, Trichopoulos D, Vineis P, Palli D, Tumino R, Sieri S, Bueno-de-Mesquita HB, van Duijnhoven FJ, Chirlaque MD, Barricarte A, Larrañaga N, González CA, Argüelles MV, Sánchez MJ, Stattin P, Hallmans G, Khaw KT, Bingham S, Rinaldi S, Slimani N, Jenab M, Riboli E, Key TJ. Am J Epidemiol. 2009 Apr 9. [Epub ahead of print] PMID: 19359375 doi:10.1093/aje/kwp022

Reginster JY. Prevalence of vitamin D inadequacy in European postmenopausal women. Curr Med Res Opin. 2007 Jul 12; [Epub ahead of print] PMID: 17631697 [PubMed - as supplied by publisher]

Geographical differences in vitamin D status, with particular reference to European countries Lars Ovesen*, Rikke Andersen and Jette Jakobsen Institute of Food Safety and Nutrition, The Danish Veterinary and Food Administration, 30A Sydmarken, 2860 S

Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men. Lee DM, Tajar A, Ulubaev A, Pendleton N, O'Neill TW, O'Connor DB, Bartfai G, Boonen S, Bouillon R, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Punab M, Silman AJ, Vanderschueren D, Wu FC; EMAS study group. J Neurol Neurosurg Psychiatry. 2009 Jul;80(7):722-9. Epub 2009 May 21. PMID: 19460797 doi:10.1136/jnnp.2008.165720 Conclusion: In this study, lower 25(OH)D levels were associated with poorer performance on the DSST. Further research is warranted to determine whether vitamin D sufficiency might have a role in preserving cognitive function in older adults.