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Is a lower dose of vitamin D supplementation enough to increase 25(OH)D status in a sunny country? Pignotti GA, Genaro PS, Pinheiro MM, Szejnfeld VL, Martini LA. Eur J Nutr. 2009 Nov 28. [Epub ahead of print] PMID: 19946776 CONCLUSION: The dose given (400 IU/day) was not enough to achieve 25(OH)D concentration, considered optimal for bone health.

Prevalence of vitamin D insufficiency in Brazilian adolescents. Peters BS, dos Santos LC, Fisberg M, Wood RJ, Martini LA. Ann Nutr Metab. 2009;54(1):15-21. Epub 2009 Feb 5. PMID: 19194104 DOI: 10.1159/000199454 CONCLUSIONS: The present study suggests that even in a sunny climate like Brazil the prevalence of vitamin D insufficiency in adolescents is high. Most likely this is due to low intakes of vitamin D in this group. Due to the limited extent of natural dietary sources of vitamin D, a policy of vitamin D food fortification should be considered in the future, and in the meantime greater use of vitamin D supplements in this population group should be encouraged to provide the increased amounts of this essential nutrient for optimal health.

According to a study conducted by University of Wisconsin researchers, even people who are regularly exposed to sunlight can have low vitamin D levels. The study focused on subjects who lived in sunny Hawaii and spent an average of 11.1 hours in the sun each week. (None of the participants in the study used any type of sunscreen.) Despite the exposure, 51 percent of participants were found to be deficient in vitamin D.

Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. Hollis BW, Wagner CL, Drezner MK, Binkley NC. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4. Epub 2007 Jan 10. PMID: 17218096 In the present study, we sought to investigate what circulating 25(OH)D levels would result in populations exhibiting no substrate limitations to the vitamin D-25-hydroxylase. To perform this, we chose two distinct populations. The first were individuals from a year-found sunny environment who spent a good deal of time outdoors. The second were a group of lactating women receiving a substantial daily oral dose of vitamin D3. Surprisingly, a study such as this previously had not been undertaken. There are several reasons for this. First, finding a group of sun-exposed individuals is not an easy task; in fact, we had to go to Hawaii to find them. Secondly, very few studies have been performed where subjects actually received adequate vitamin D3 supplementation to make them replete. Finally, it is very difficult and costly to measure circulating vitamin D3 and relate it to circulating 25(OH)D. The results of our study are far-reaching. This study also demonstrates that individuals can be vitamin D deficient with significant sun exposure if the skin area exposed is limited as was suggested several years ago (19). Finally, whether one receives their vitamin D3 orally or through UV exposure, the vitamin D-25-hydroxylase appears to handle it in an equivalent fashion with respect to maintaining circulating 25(OH)D levels. Thus, we believe that the relationship between circulating vitamin D and 25(OH)D may define adequate nutritional vitamin D status.

Vitamin D status in apparently healthy adults in Kashmir Valley of Indian subcontinent. Zargar AH, Ahmad S, Masoodi SR, Wani AI, Bashir MI, Laway BA, Shah ZA. Postgrad Med J. 2007 Nov;83(985):713-6. PMID: 17989271 doi:10.1136/pgmj.2007.059113 Conclusions: In spite of abundant sunlight, healthy individuals in Kashmir valley are vitamin D deficient, particularly women. Serum 25 (OH) D concentrations are significantly related to sun exposure

Vitamin d deficiency and seasonal variation in an adult South Florida population. Levis S, Gomez A, Jimenez C, Veras L, Ma F, Lai S, Hollis B, Roos BA. J Clin Endocrinol Metab. 2005 Mar;90(3):1557-62. Epub 2005 Jan 5. PMID: 15634725 The prevalence of hypovitaminosis D is considerable even in southern latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis.

Low vitamin D status despite abundant sun exposure. Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, Hollis BW, Drezner MK. J Clin Endocrinol Metab. 2007 Jun;92(6):2130-5. Epub 2007 Apr 10. PMID: 17426097 doi:10.1210/jc.2006-2250 CONCLUSIONS: These data suggest that variable responsiveness to UVB radiation is evident among individuals, causing some to have low vitamin D status despite abundant sun exposure. In addition, because the maximal 25(OH)D concentration produced by natural UV exposure appears to be approximately 60 ng/ml, it seems prudent to use this value as an upper limit when prescribing vitamin D supplementation.