An estimate of the survival benefit of improving vitamin D status in the adult German population

Abstract

IntroductionVitamin D is well known for its effects on calcium and bone metabolism. Vitamin D deficiency results in rickets in infants and small children and in osteomalacia and osteoporosis in adults. However, recent advances in the understanding of vitamin D have revolutionized our view of this old nutritional factor and suggested that it has much wider effects on the body than ever believed before. Major reasons for this situation are insufficient skin exposure to solar ultraviolet B radiation together with inadequate oral vitamin D intake.There is accumulating evidence that vitamin D deficiency/ insufficiency might contribute to the etiology of various chronic diseases such as cardiovascular disease, specific types of cancer, multiple sclerosis, and type 1 diabetes.3,4 Recent studies demonstrated that poor vitamin D status is independently associated with excess cancer mortality 7 and poor outcome in congestive heart failure individuals. 8 In addition, poor vitamin D status is associated with excess all-cause mortality in individuals with end-stage renal disease. 9 In 2007, Autier and Gandini 10 published a meta-analysis of randomized controlled trials on vitamin D and total mortality that were not primarily designed to assess mortality. The authors concluded that vitamin D supplementation is linked to lower all-cause mortality in middle-aged and elderly individuals with low serum concentrations of 25(OH)D than in unsupplemented subjects. Risk reduction was 7% during a mean follow-up of 5.7 years.Background: Inadequate vitamin D status is a worldwide problem. Evidence is accumulating that individuals with low vitamin D status have excess mortality rates. We calculated to which extent annual mortality rates can be reduced in the German population by optimizing vitamin D status.Results: Mean serum concentrations of 25-hydroxyvitamin D in the DEVID study cohort were 41 nmol/l (SD: 22 nmol/l). More than 90% of individuals had 25-hydroxyvitamin D concentrations below the threshold that was associated with lowest mortality risk in the two aforementioned trials (75 nmol/l). According to conservative estimations, at least 2.2% of all deaths or 18,300 lives annually can be saved by achieving 25(oH)D concentrations of at least 75 nmol/l in the entire adult German population. Available data provide evidence for an exponential increase in total mortality with deficient 25-hydroxyvitamin D concentrations.Methods: our calculations are based on (1) an annual mortality rate of 1.34% in the adult German population as provided by the Statistical Yearbook, (2) the actual vitamin D status in German adults with a high mortality risk as assessed in 1,343 individuals from 264 general practitioners in different German regions (DEVID study), and (3) data from two very large prospective cohorts (Dobnig et al. 2008;Melamed et al. 2008) about the excess mortality in individuals with inadequate vitamin D status.Conclusion: Improving vitamin D status in a population with inadequate vitamin D status might be an effective strategy to reduc...

Vitamin D deficiency in Spain: a population-based cohort study

“…Italy has prevalence levels of 17% below 12 ng/ml in winter in the south (Carnevale et al, 2001) and one-third of healthy women o20 ng/ml in the north (Adami et al, 2009), which is very similar to our prevalence. Germany has lower levels of vitamin D than in our study, the prevalence of vitamin D insufficiency in the German National Health Interview and Examination Survey was 450% in the general population and 60% in children (Hintzpeter et al, 2008a, b), with the DEVID (The vitamin in Deutschland) study reporting mean levels of 41 ± 22 nmol/l (Zittermann et al, 2009). In the British population, the prevalence is greater than in Spain, Hyppönen and Power (2007) reported a prevalence of hypovitaminosis D o75 nmol/l in 87.1% of participants in winter and in 60.9% in summer.…”

“…Vitamin D deficiency is common, though its prevalence varies depending on the characteristics of the study population (Carnevale et al, 2001;Isaia et al, 2003;Hyppönen and Power, 2007;Boüüaert et al, 2008;Hintzpeter et al, 2008a, b;Adami et al, 2009;Annweiler et al, 2009;Zittermann et al, 2009;Lips, 2010).…”

The estimated benefits of vitamin D for Germany

“…The DEVID (De Vitamin in Deutschland) study is an investigation performed in 1343 adult individuals who had an outpatient visit with their general practitioner [16] [17], congestive heart failure patients [18], organ transplanted patients [19], and obese patients [20]. In a small study in female students of childbearing age [17], it has been demonstrated that mean winter values of circulating 25(OH)D were only slightly above the deficiency range (33 nmol/L).…”

“…Improving vitamin D status might thus be a promising public health strategy for increasing survival. According to conservative estimations, at least 2.2% of all deaths or 18 300 lives annually could probably be saved by achieving 25(OH)D concentrations of at least 75 nmol/L in the entire German population [16].…”

The Hypercalcemic Effect of Vitamin D3 in Sarcoidosis Could Be a Side Effect of an Endogenous Program Organizing Cancer Apoptosis

“…We calculated an associated mortality rate of 18,000 lives lost each year [166]. The EPOCA theory submitted here is one causal explanation for this large number.…”