Vitamin D deficiency epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Sadaf Sharfaei M.D.[2]

## Overview

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Vitamin D deficiency is common worldwide, and the incidence is increasing in the recent years. In the US, vitamin D deficiency is more prevalent among non-white ethnic groups. The prevalence is different based on different laboratory methods and the cut-off for the vitamin D deficiency.

## Epidemiology and Demographics

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### Prevalence

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* According to Institute of Medicine (IOM), based on the National Health and Nutrition Examination Survey (NHANES) 2003–2006, there is an overall 18.8% prevalence of serum 25OHD concentrations below 40 nmol/L in the US.[1]

Prevalence of serum 25OHD concentrations below 40 nmol/l

| Total  | Non-Hispanic White  | Non-Hispanic Black  | Mexican American  | Others
Percent  | 18.8 (16.3–21.5)  | 10.6 (8.9–12.4)  | 53.6 (48.9–58.2)  | 27.2 (22.8–32.0)  | 27.2 (23.2–31.7)

* However, data from the National Health and Nutrition Examination Surveys (NHANES) in 2001-2006 shows that one-quarter were at risk of vitamin D inadequacy (serum 25OHD 30–49 nmol/L), and 8% were at risk of vitamin D deficiency (serum 25OHD less than 30 nmol/L).[2]

Serum 25OHD status of persons over 1 year old: United States, 2001-2006

| Possibly harmful  | Sufficient  | Inadequate  | Deficient
Level  | > 125 nmol/L  | 50-124 nmol/L  | 30-49 nmol/L  | <30 nmol/L
Percentage  | 1%  | 67%  | 24%  | 8%

* Statistics from the Canadian Health Measures Survey (CHMS), Cycle 1, 2007–2009 shows that 13% of Canadians have vitamin D level below 40 nmol/L.[1]

* Naugler et al. reported that based on the results from Calgary Laboratory Services and Census Canada data in 2010-2011 on individuals older than 25 years old residing in Calgary, Alberta, 26% of individuals had serum 25OHD levels of less than 50 nmol/L.[3]

### Age

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* In both sexes, the prevalence was lowest in children aged 1–8 years. Risk of deficiency increased significantly with age until age 30 in males and age 18 in females, after which it did not change significantly with age.[2]

### Gender

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* There is a slightly higher prevalence of vitamin D deficiency in female than male. According to the National Health and Nutrition Examination Surveys (NHANES) in 2001-2006, the season-adjusted prevalence at risk of deficiency by age ranged from 1% to 8% in males and 1% to 12% in females.[2]

### Race

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* Non-hispanic white people are at lower risk of vitamin D deficiency than African-Americans, Hispanics and Asians.
* Analysis from Gozdzik A et al. study on 107 young adults in Toronto during winter of 2007, shows an association between serum 25OHD level and skin pigmentation. 34.4% of individuals with European ancestry had serum 25OHD levels of less than 50 nmol/L, whereas East and South Asians had 85.2% and 93.5% respectively.[4]

### Developed Countries

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* Chowdhury R. et al. in meta-analysis of observational studies, reported that the prevalence of vitamin D insufficiency (<75 nmol/L) was 69.5% for the United States and 86.4% for Europe. Severe Vitamin D deficiency (<25 nmol/L) were seen in 15% and 4% of general population in the United States and the Europe.[5]
* In the Uppsala Longitudinal Study of Adult Men, a cohort study on 1194 swedish men during the winter season, there is only 5% prevalence of serum 25OHD levels below 40nmol/L.[6]
* According to the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study on 1006 adolescents of 12.5-17.5 years old age, selected from 9 European countries, 39% of them had insufficient (50-75 nmol/L), 27% had deficient (27.5-49 nmol/L) and 15% had severely deficient (<27·5 nmol/L) levels of serum 25OHD.[7]

### Developing Countries

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* Puri S. et al. reported a result from a study on 3127 apparently healthy Delhi schoolgirls. It showed that 90.8% of them had insufficient serum 25OHD levels (<50 nmol/L) in both groups of low and high socioeconomic strata.[8]
* Vitamin D deficiency is very common among Saudi women. About 80% of women in Adarawi MS et al. study demonstrated vitamin D deficiency (<50 nmol/L).[9]
* There are relatively higher levels of serum 25OHD in Thailand compared to European, Middle eastern and other Asian countries. Chailurkit et al. reported 2.8 to 14.3% vitamin D deficiency (<50 nmol/L) overal in different regions of Thailand.[10]

## References

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1. ↑ 1.0 1.1 "Proportion of the Population Above and Below 40 nmol/L Serum 25-Hydroxyvitamin D Concentrations and Cumulative Distribution of Serum 25-Hydroxyvitamin D Concentrations: United States and Canada - Dietary Reference Intakes for Calcium and Vitamin D - NCBI Bookshelf".
2. ↑ 2.0 2.1 2.2 Looker AC, Johnson CL, Lacher DA, et al. Vitamin D status: United States, 2001–2006. NCHS data brief, no 59. Hyattsville, MD: National Center for Health Statistics. 2011.
3. ↑ Naugler, Christopher; Zhang, Jianguo; Henne, Dan; Woods, Paul; Hemmelgarn, Brenda R (2013). "Association of vitamin D status with socio-demographic factors in Calgary, Alberta: an ecological study using Census Canada data". BMC Public Health. 13 (1). doi:10.1186/1471-2458-13-316. ISSN 1471-2458.
4. ↑ Gozdzik, Agnes; Barta, Jodi Lynn; Wu, Hongyu; Wagner, Dennis; Cole, David E; Vieth, Reinhold; Whiting, Susan; Parra, Esteban J (2008). "Low wintertime vitamin D levels in a sample of healthy young adults of diverse ancestry living in the Toronto area: associations with vitamin D intake and skin pigmentation". BMC Public Health. 8 (1). doi:10.1186/1471-2458-8-336. ISSN 1471-2458.
5. ↑ Chowdhury, R.; Kunutsor, S.; Vitezova, A.; Oliver-Williams, C.; Chowdhury, S.; Kiefte-de-Jong, J. C.; Khan, H.; Baena, C. P.; Prabhakaran, D.; Hoshen, M. B.; Feldman, B. S.; Pan, A.; Johnson, L.; Crowe, F.; Hu, F. B.; Franco, O. H. (2014). "Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies". BMJ. 348 (apr01 2): g1903–g1903. doi:10.1136/bmj.g1903. ISSN 1756-1833.
6. ↑ Melhus H, Snellman G, Gedeborg R, Byberg L, Berglund L, Mallmin H, Hellman P, Blomhoff R, Hagström E, Arnlöv J, Michaëlsson K (2010). "Plasma 25-hydroxyvitamin D levels and fracture risk in a community-based cohort of elderly men in Sweden". J. Clin. Endocrinol. Metab. 95 (6): 2637–45. doi:10.1210/jc.2009-2699. PMID 20332246.
7. ↑ González-Gross M, Valtueña J, Breidenassel C, Moreno LA, Ferrari M, Kersting M, De Henauw S, Gottrand F, Azzini E, Widhalm K, Kafatos A, Manios Y, Stehle P (2012). "Vitamin D status among adolescents in Europe: the Healthy Lifestyle in Europe by Nutrition in Adolescence study". Br. J. Nutr. 107 (5): 755–64. doi:10.1017/S0007114511003527. PMID 21846429.
8. ↑ Puri S, Marwaha RK, Agarwal N, Tandon N, Agarwal R, Grewal K, Reddy DH, Singh S (2008). "Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle". Br. J. Nutr. 99 (4): 876–82. doi:10.1017/S0007114507831758. PMID 17903343.
9. ↑ Ardawi MS, Qari MH, Rouzi AA, Maimani AA, Raddadi RM (2011). "Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women". Osteoporos Int. 22 (2): 463–75. doi:10.1007/s00198-010-1249-7. PMID 20431993.
10. ↑ Chailurkit, La-or; Aekplakorn, Wichai; Ongphiphadhanakul, Boonsong (2011). "Regional variation and determinants of vitamin D status in sunshine-abundant Thailand". BMC Public Health. 11 (1). doi:10.1186/1471-2458-11-853. ISSN 1471-2458.

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