Vitamin D plays an important role in bone health, but dietary intakes are below recommendations. The purpose of this cross-sectional study was to compare perceptions of dietary vitamin adequacy with the biomarker of vitamin D exposure [25(OH)D] in two populations with (USA) and without (Germany) fortification among adults not using dietary supplements (n = 200). US adults were more racially diverse and younger, but did not differ with regard to educational attainment, income, UV exposure, or BMI. Mean concentrations were lower, and the prevalence of inadequacy (<20 ng/mL) and suboptimal (<30 ng/mL) 25(OH)D was higher in Germany (23 ng/mL; 70%; 82%) than in the USA (28 ng/mL; 17%; 36%), respectively. Most adults rated vitamin D as important for bone health; but, fewer Germans (22%) than US adults (50%) perceived their diet as adequate. Mean 25(OH)D concentrations and risk of vitamin D inadequacy did not differ by perceptions of dietary adequacy, ratings of a balanced diet, knowledge of vitamin D food sources, or by rankings of importance of vitamin D for health. Fortification with vitamin D in the USA may explain the higher 25(OH) concentrations as UV exposure, and BMI did not differ. Perceptions and knowledge of vitamin D were not related to status in either group.
Vitamin D Biomarker Diet Diet perceptions Serum 25(OH)D
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RLB, CvS, KDS, ND, SRS, and BH conceived and designed the study; SVT and CvS performed all study procedures; SVT and AEC analyzed the data; RLB, SVT, and AEC wrote the paper. JN and AEC reviewed and edited the paper and prepared data presentation. All authors read and approved the final version of the manuscript.
The study was supported through an unrestricted educational grant provided by Reckitt Benckiser, Parsippany, New Jersey, administered by Tonic LLC. The sponsors had no role in the study design, data collection, statistical analyses, interpretation of data, writing of the manuscript, or in the decision to publish the results.
Conflicts of Interest
SVT received postdoctoral training salary support as part of the grant that funded this project. CvS consults for Huntsworth Medical and BASF and received speaker’s honoraria from DSM. None of the other authors have any conflicts of interest to disclose.
Schottker B, Jorde R, Peasey A, et al. Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States. BMJ. 2014;348:g3656.CrossRefGoogle Scholar
Pilz S, Gaksch M, Hartaigh BO, Tomaschitz A, Marz W. Vitamin D in preventive medicine. Anticancer Res. 2015;35:1161–70.PubMedGoogle Scholar
Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004;79:362–71.CrossRefGoogle Scholar
Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev. 2014;6:CD007469.Google Scholar
Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2014;1:CD007470.Google Scholar
Brannon PM, Yetley EA, Bailey RL, Picciano MF. Overview of the conference “Vitamin D and Health in the 21st Century: an Update”. Am J Clin Nutr. 2008;88:483S–90S.CrossRefGoogle Scholar
Brannon PM, Yetley EA, Bailey RL, Picciano MF. Summary of roundtable discussion on vitamin D research needs. Am J Clin Nutr. 2008;88:587S–92S.CrossRefGoogle Scholar
Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.CrossRefGoogle Scholar
Hill Gallant KM, Weaver CM, Towler DA, Thuppal SV, Bailey RL. Nutrition in cardioskeletal health. Adv Nutr. 2016;7:544–55.CrossRefGoogle Scholar
Weaver CM, Gordon CM, Janz KF, et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. 2016;27:1281–386.CrossRefGoogle Scholar
Zhang R, Li B, Gao X, et al. Serum 25-hydroxyvitamin D and the risk of cardiovascular disease: dose-response meta-analysis of prospective studies. Am J Clin Nutr. 2017;105:810–9.CrossRefGoogle Scholar
Sempos CT, Durazo-Arvizu RA, Dawson-Hughes B, et al. Is there a reverse J-shaped association between 25-hydroxyvitamin D and all-cause mortality? Results from the U.S. nationally representative NHANES. J Clin Endocrinol Metab. 2013;98:3001–9.CrossRefGoogle Scholar
Gaksch M, Jorde R, Grimnes G, et al. Vitamin D and mortality: individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One. 2017;12:e0170791.CrossRefGoogle Scholar
Mondul AM, Weinstein SJ, Layne TM, Albanes D. Vitamin D and cancer risk and mortality: state of the science, gaps, and challenges. Epidemiol Rev. 2017;39:28–48.CrossRefGoogle Scholar
American Dietetic Association. Position of the American Dietetic Association: fortification and nutritional supplements. J Am Diet Assoc. 2005;105:1300–11.CrossRefGoogle Scholar
Fulgoni VL 3rd, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: where do Americans get their nutrients? J Nutr. 2011;141:1847–54.CrossRefGoogle Scholar
Bailey RL, Fulgoni VL 3rd, Keast DR, Lentino CV, Dwyer JT. Do dietary supplements improve micronutrient sufficiency in children and adolescents? J Pediatr. 2012;161:837–42.CrossRefGoogle Scholar
Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173:355–61.CrossRefGoogle Scholar
Bailey RL, Fulgoni VL 3rd, Keast DR, Dwyer JT. Examination of vitamin intakes among US adults by dietary supplement use. J Acad Nutr Diet. 2012;112:657–63. e654CrossRefGoogle Scholar
Bailey RL, Fulgoni VL 3rd, Keast DR, Dwyer JT. Dietary supplement use is associated with higher intakes of minerals from food sources. Am J Clin Nutr. 2011;94:1376–81.CrossRefGoogle Scholar
Blumberg JB, Frei BB, Fulgoni VL, Weaver CM, Zeisel SH. Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in U.S. adults. Nutrients. 2017;9(8):849.CrossRefGoogle Scholar
Bailey RL, Denby N, Haycock B, Sherif K, Steinbaum S, von Schacky C. Perceptions of a healthy diet: insights from a 3-Country survey. Nutr Today. 2015;50:282–7.CrossRefGoogle Scholar
Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academics Press; 2011.Google Scholar
Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. J. Bone Miner Res. 2011;26:455–7.CrossRefGoogle Scholar
Bailey RL, Carmel R, Green R, et al. Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12. Am J Clin Nutr. 2011;94:552–61.CrossRefGoogle Scholar
Pfeiffer CM, Sternberg MR, Hamner HC, et al. Applying inappropriate cutoffs leads to misinterpretation of folate status in the US population. Am J Clin Nutr. 2016;104:1607–15.CrossRefGoogle Scholar
Raghavan R, Ashour FS, Bailey R. A review of cutoffs for nutritional biomarkers. Adv Nutr. 2016;7:112–20.CrossRefGoogle Scholar
Taylor CL, Carriquiry AL, Bailey RL, Sempos CT, Yetley EA. Appropriateness of the probability approach with a nutrient status biomarker to assess population inadequacy: a study using vitamin D. Am J Clin Nutr. 2013;97:72–8.CrossRefGoogle Scholar
Hower J, Knoll A, Ritzenthaler KL, Steiner C, Berwind R. Vitamin D fortification of growing up milk prevents decrease of serum 25-hydroxyvitamin D concentrations during winter: a clinical intervention study in Germany. Eur J Pediatr. 2013;172:1597–605.CrossRefGoogle Scholar
Madsen KH, Rasmussen LB, Andersen R, et al. Randomized controlled trial of the effects of vitamin D-fortified milk and bread on serum 25-hydroxyvitamin D concentrations in families in Denmark during winter: the VitmaD study. Am J Clin Nutr. 2013;98:374–82.CrossRefGoogle Scholar
Sempos CT, Vesper HW, Phinney KW, Thienpont LM, Coates PM, Vitamin DSP. Vitamin D status as an international issue: national surveys and the problem of standardization. Scand J Clin Lab Invest Suppl. 2012;243:32–40.PubMedGoogle Scholar
Brooks SPJ, Sempos CT. The importance of 25-hydroxyvitamin D assay standardization and the vitamin D standardization program. J AOAC Int. 2017;100(5):1223–4.CrossRefGoogle Scholar
Schleicher RL, Sternberg MR, Looker AC, et al. National estimates of serum total 25-hydroxyvitamin D and metabolite concentrations measured by liquid chromatography-tandem mass spectrometry in the US population during 2007–2010. J Nutr. 2016;146:1051–61.CrossRefGoogle Scholar
O’Neill CM, Kazantzidis A, Ryan MJ, et al. Seasonal changes in vitamin D-effective UVB availability in Europe and Associations with population serum 25-hydroxyvitamin D. Nutrients. 2016;8(9):533.CrossRefGoogle Scholar