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...