Vitamin D deficiency in Europe: Pandemic?

Kevin D. Cashman, Kirsten G. Dowling, Zuzana Škrabáková, Marcela Gonzalez-Gross, Jara Valtueña, Stefaan De Henauw, Luis Moreno, Camilla T. Damsgaard, Kim F. Michaelsen, Christian Mølgaard, Rolf Jorde, Guri Grimnes, George Moschonis, Christina Mavrogianni, Yannis Manios, Michael Thamm, Gert B.M. Mensink, Martina Rabenberg, Markus A. Busch, Lorna CoxSarah Meadows, Gail Goldberg, Ann Prentice, Jacqueline M. Dekker, Giel Nijpels, Stefan Pilz, Karin M. Swart, Natasja M. Van Schoor, Paul Lips, Gudny Eiriksdottir, Vilmundur Gudnason, Mary Frances Cotch, Seppo Koskinen, Christel Lamberg-Allardt, Ramon A. Durazo-Arvizu, Christopher T. Sempos, Mairead Kiely

Research output: Contribution to journalArticlepeer-review

936 Scopus citations


Background: Vitamin D deficiency has been described as being pandemic, but serum 25-hydroxyVitamin D [25(OH)D] distribution data for the European Union are of very variable quality. The NIHled international Vitamin D Standardization Program (VDSP) has developed protocols for standardizing existing 25(OH)D values from national health/nutrition surveys. Objective: This study applied VDSP protocols to serum 25(OH)D data from representative childhood/teenage and adult/older adult European populations, representing a sizable geographical footprint, to better quantify the prevalence of Vitamin D deficiency in Europe. Design: The VDSP protocols were applied in 14 population studies [reanalysis of subsets of serum 25(OH)D in 11 studies and complete analysis of all samples from 3 studies that had not previously measured it] by using certified liquid chromatography-tandem mass spectrometry on biobanked sera. These data were combined with standardized serum 25(OH)D data from 4 previously standardized studies (for a total n = 55,844). Prevalence estimates of Vitamin D deficiency [using various serum 25(OH)D thresholds] were generated on the basis of standardized 25(OH)D data. Results: An overall pooled estimate, irrespective of age group, ethnic mix, and latitude of study populations, showed that 13.0% of the 55,844 European individuals had serum 25(OH)D concentrations <30 nmol/L on average in the year, with 17.7% and 8.3% in those sampled during the extended winter (October-March) and summer (April-November) periods, respectively. According to an alternate suggested definition of Vitamin D deficiency (<50 nmol/ L), the prevalence was 40.4%. Dark-skinned ethnic subgroups had much higher (3- to 71-fold) prevalence of serum 25(OH)D <30 nmol/L than did white populations. Conclusions: Vitamin D deficiency is evident throughout the European population at prevalence rates that are concerning and that require action from a public health perspective. What direction these strategies take will depend on European policy but should aim to ensure Vitamin D intakes that are protective against Vitamin D deficiency in the majority of the European population.

Original languageEnglish
Pages (from-to)1033-1044
Number of pages12
JournalAmerican Journal of Clinical Nutrition
Issue number4
StatePublished - 1 Apr 2016
Externally publishedYes


  • 25(OH)D
  • Europe
  • Prevalence
  • Standardized
  • Vitamin D deficiency


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