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The Standing Committee of European Doctors (CPME) is preparing a vitamin D policy paper it hopes can influence European national associations considering vitamin D medical recommendations. PA International Foundation is hosting an event on the topic in Bruges, Belgium, on October 6, its 14th workshop to be held on the matter. The CPME draft paper will be presented at the convention attended by doctors, scientists, patient groups, media representatives and politicians.

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

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.

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.

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)

Association between serum 25-hydroxyvitamin D and depressive symptoms in Japanese: analysis by survey season A Nanri, T Mizoue, Y Matsushita, K Poudel-Tandukar, M Sato, M Ohta, N Mishima European Journal of Clinical Nutrition (19 August 2009) doi:10.1038/ejcn.2009.96 Short Communication

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

Vitamin D and calcium insufficiency-related chronic diseases: molecular and cellular pathophysiology. Peterlik M, Cross HS. Eur J Clin Nutr. 2009 Dec;63(12):1377-86. Epub 2009 Sep 2. PMID: 19724293 doi:10.1038/ejcn.2009.105 A compromised vitamin D status, characterized by low 25-hydroxyvitamin D (25-(OH)D) serum levels, and a nutritional calcium deficit are widely encountered in European and North American countries, independent of age or gender. Both conditions are linked to the pathogenesis of many degenerative, malignant, inflammatory and metabolic diseases. Studies on tissue-specific expression and activity of vitamin D metabolizing enzymes, 25-(OH)D-1alpha-hydroxylase and 25-(OH)D-24-hydroxylase, and of the extracellular calcium-sensing receptor (CaR) have led to the understanding of how, in non-renal tissues and cellular systems, locally produced 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) and extracellular Ca2+ act jointly as key regulators of cellular proliferation, differentiation and function. Impairment of cooperative signalling from the 1,25-(OH)2D3-activated vitamin D receptor (VDR) and from the CaR in vitamin D and calcium insufficiency causes cellular dysfunction in many organs and biological systems, and, therefore, increases the risk of diseases, particularly of osteoporosis, colorectal and breast cancer, inflammatory bowel disease, insulin-dependent diabetes mellitus type I, metabolic syndrome, diabetes mellitus type II, hypertension and cardiovascular disease. Understanding the underlying molecular and cellular processes provides a rationale for advocating adequate intake of vitamin D and calcium in all populations, thereby preventing many chronic diseases worldwide.

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 May 15;169(10):1223-32. Epub 2009 Apr 9. PMID: 19359375 In summary, the results of this large nested case-control study provide no evidence in support of a protective effect of circulating concentrations of vitamin D on the risk of prostate cancer.

Vitamin D in preventive medicine: are we ignoring the evidence? Zittermann A. Br J Nutr. 2003 May;89(5):552-72. Review. PMID: 12720576 Vitamin D is metabolised by a hepatic 25-hydroxylase into 25-hydroxyvitamin D (25(OH)D) and by a renal 1alpha-hydroxylase into the vitamin D hormone calcitriol. Calcitriol receptors are present in more than thirty different tissues. Apart from the kidney, several tissues also possess the enzyme 1alpha-hydroxylase, which is able to use circulating 25(OH)D as a substrate. Serum levels of 25(OH)D are the best indicator to assess vitamin D deficiency, insufficiency, hypovitaminosis, adequacy, and toxicity. European children and young adults often have circulating 25(OH)D levels in the insufficiency range during wintertime. Elderly subjects have mean 25(OH)D levels in the insufficiency range throughout the year. In institutionalized subjects 25(OH)D levels are often in the deficiency range. There is now general agreement that a low vitamin D status is involved in the pathogenesis of osteoporosis. Moreover, vitamin D insufficiency can lead to a disturbed muscle function. Epidemiological data also indicate a low vitamin D status in tuberculosis, rheumatoid arthritis, multiple sclerosis, inflammatory bowel diseases, hypertension, and specific types of cancer. Some intervention trials have demonstrated that supplementation with vitamin D or its metabolites is able: (i) to reduce blood pressure in hypertensive patients; (ii) to improve blood glucose levels in diabetics; (iii) to improve symptoms of rheumatoid arthritis and multiple sclerosis. The oral dose necessary to achieve adequate serum 25(OH)D levels is probably much higher than the current recommendations of 5-15 microg/d.

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

Robert P. Heaney is John A. Creighton University Professor, Creighton University, Omaha, Nebraska, United States. Hominid evolution took place in an environment (equatorial East Africa) that provided a superabundance of both calcium and vitamin D, the first in available foods and the second through conversion of 7-dehydrocholesterol to pre-vitamin D in the skin, a reaction catalysed by the intense solar ultraviolet (UV) radiation. Seemingly as a consequence, the evolving human physiology incorporated provisions to prevent the potential of toxic excesses of both nutrients. For vitamin D the protection was of two sorts: skin pigmentation absorbed the critical UV wavelengths and thereby limited dermal synthesis of cholecalciferol; and slow delivery of vitamin D from the skin into the bloodstream left surplus vitamin in the skin, where continuing sun exposure led to its photolytic degradation to inert compounds. For calcium, the adaptation consisted of very inefficient calcium absorption, together with poor to absent systemic conservation. The latter is reflected in unregulated dermal calcium losses, a high sensitivity of renal obligatory calcium loss to other nutrients in the diet and relatively high quantities of calcium in the digestive secretions. Today, chimpanzees in the original hominid habitat have diets with calcium nutrient densities in the range of 2 to 2.5 mmol per 100 kcal, and hunter-gatherer humans in Africa, South America and New Guinea still have diets very nearly as high in calcium (1.75 to 2 mmol per 100 kcal) (Eaton and Nelson, 1991). With energy expenditure of 3 000 kcal per day (a fairly conservative estimate for a contemporary human doing physical work), such diets would provide substantially in excess of 50 mmol of calcium per day. By contrast, median intake in women in North America and in many European countries today is under 15 mmol per day. Two factors altered the primitive situation: the migration of humans from Africa to higher latitude

Depression may be triggered by low vitamin D levels in the blood, according to a new study published in the Aug 19, 2009 issue of European Journal of Clinical Nutrition. The study led by Nanri A and colleagues from International Medical center of Japan in Shinjuku-ku, Tokyo, Japan found that in November, people with their serum levels of vitamin D falling in the highest quartile were 49 percent less likely to feel depressed. The study involved 527 municipal employees aged 21 to 67 who worked in two municipal offices in Japan. It was meant to examine the association between vitamin D deficiency and depression

NEW YORK (Reuters Health) - New research suggests that low vitamin D levels in the body are associated with thinking or "cognitive" impairments in older men, but whether vitamin D supplements can help is not yet known. In the study, an investigation of European men, subjects with low levels of vitamin D scored worse on a standard test of cognitive ability than did their peers with normal levels, Dr. David M. Lee, from the University of Manchester, UK, and co-researchers found. Although, the authors emphasize, the difference in scores was not that great.

The Vitamin D Pandemic and its Health Consequences\nPresented by Michael Holick, PhD, MD, Professor of medicine, physiology and biophysics and director of the General Clinical Research Center at Boston University Medical Center\nKeynote address at the opening ceremony of the 34th European Symposium on Calcified Tissues, Copenhagen 5 May, 2007\n

Vitamin D supplement in early childhood and risk for Type I (insulin-dependent) diabetes mellitus. The EURODIAB Substudy 2 Study Group. [No authors listed] Diabetologia. 1999 Jan;42(1):51-4. PMID: 10027578 DOI: 10.1007/s001250051112 In conclusion, this large multicentre trial covering many different European settings consistently showed a protective effect of vitamin D supplementation in infancy. The findings indicate that activated vitamin D might contribute to immune modulation and thereby protect or arrest an ongoing immune process initiated in susceptible people by early environmental exposures.

Vitamin D fortification as public health policy: significant improvement in vitamin D status in young Finnish men. Laaksi IT, Ruohola JP, Ylikomi TJ, Auvinen A, Haataja RI, Pihlajamäki HK, Tuohimaa PJ. Eur J Clin Nutr. 2006 Aug;60(8):1035-8. Epub 2006 Feb 15. PMID: 16482069