The main source of vitamin D for Australians is exposure to sunlight. Thus, levels of serum 25-hydroxyvitamin D3, the indicator of vitamin D status, vary according to the season and are lower at the end of winter.
In Australia and New Zealand, the prevalence of vitamin D deficiency varies, but is acknowledged to be much higher than previously thought. One study found marginal deficiency in 23% of women, and another frank deficiency in 80% of dark-skinned and veiled women. The groups at greatest risk of vitamin D deficiency in Australia are dark-skinned and veiled women (particularly in pregnancy), their infants, and older persons living in residential care.
Only a few foods (eg, fish with a high fat content) contain significant amounts of vitamin D. In Australia, margarine and some milk and milk products are currently fortified with vitamin D.
The average estimated dietary intake of vitamin D for men is 2.6–3.0 µg/day and for women is 2.0–2.2 µg/day. The estimated dietary requirement of vitamin D is at least 5.0 µg/day and may be higher for older people.
Adequate intake of vitamin D is unlikely to be achieved through dietary means, particularly in the groups at greatest risk, although vitamin D-fortified foods may assist in maintaining vitamin D status in the general population.
An appropriate health message for vitamin D needs to balance the need for sunshine against the risk of skin cancer.
- 1. National Health and Medical Research Council. Recommended dietary intakes for use in Australia. Canberra: AGPS, 1991.
- 2. Pascoe J, Henry, M, Nicholson G, et al. Vitamin D status of women in the Geelong Osteoporosis Study: association with diet and casual exposure to sunlight. Med J Aust 2001; 175: 401-405.
- 3. Majid Molla A, Badawi M, al-Yashi S, et al. Risk factors for nutritional rickets among children in Kuwait. Pediatr Int 2000; 42: 280-284.
- 4. Welch T, Bergstrom W, Tsang R. Vitamin D-deficient rickets: the re-emergence of a once conquered disease. J Pediatr 2000; 137: 143-145.
- 5. Shah M, Salhab N, Patterson D, et al. Nutritional rickets still afflict children in north Texas. Tex Med 2000; 96: 64-68.
- 6. Heaney R. Lessons for nutritional science from vitamin D. Am J Clin Nutr 1999; 69: 825-826.
- 7. Heaney R. Vitamin D: how much do we need, and how much is too much? Osteoporos Int 2000; 11: 553-555.
- 8. Sanders K, Nicholson G, Ugoni A, et al. Health burden of hip and other fractures in Australia beyond 2000. Projections based on the Geelong Osteoporosis Study. Med J Aust 1999; 170: 467-470. <eMJA full text>
- 9. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992; 327: 1637-1642.
- 10. Mellanby E. Accessory food factors (vitamins) in the feeding of infants. Lancet 1920; 1: 856-862.
- 11. Norman A. Intestinal calcium absorption: a vitamin D-hormone-mediated adaptive response. Am J Clin Nutr 1990; 51: 290-300.
- 12. Brown A, Dusso A, Slatopolsky E. Vitamin D. Am J Phys 1999; 277: F157-F175.
- 13. Kim J, Moon S. Time spent outdoors and seasonal variation in serum concentration of 25-hydroxyvitamin D in Korean women. Int J Food Sci 2000; 51: 439-451.
- 14. Grover S, Morley R. Vitamin D deficiency in veiled or dark-skinned pregnant women. Med J Aust 2001; 175: 251-252. <eMJA full text>
- 15. Nozza J, Rodda C. Vitamin D deficiency in mothers of infants with rickets. Med J Aust 2001; 175: 253-255. <eMJA full text>
- 16. MacGrath J, Kimlin M, Saha S, et al. Vitamin D insufficiency in south-east Queensland. Med J Aust 2001; 174: 150-151.
- 17. Stein M. Falls relate to vitamin D and parathyroid hormone in Australian nursing homes and hostels. J Am Geriatr Soc 1999; 47: 1265-1266.
- 18. Nowson C, MacInnis R, Stein M, et al. Vitamin D deficiency in residential care facilities in Australia. Proc Nut Soc Aust 2000; 24: 154 (abstract).
- 19. Glerup H, Mikkelsen K, Poulsen L, et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med 2000; 247: 260-268.
- 20. Holick M. Sunlight "D"ilemma: risk of skin cancer or bone disease and muscle weakness. Lancet 2001; 357: 4-6.
- 21. Food and Nutrition Board. Dietary reference intakes for Ca, P, Mg, vitamin D and F. Washington: National Academy Press, 1997.
- 22. Utiger RD. The need for more vitamin D [editorial; comment]. N Engl J Med 1998; 338: 828-829.
- 23. Lethonen-Veromaa M, Mottonen T, Irjala K, et al. Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year old Finnish girls. Eur J Clin Nutr 1999; 53: 746-751.
- 24. Gregory J, Foster K, Tyler H, Wiseman M. The Dietary and Nutritional Survey of British Adults. London: HMSO, 1990.
- 25. Kinyamu HK, Gallagher JC, Rafferty KA, et al. Dietary calcium and vitamin D intake in elderly women: effect on serum parathyroid hormone and vitamin D metabolites. Am J Clin Nutr 1998; 67: 342-348.
- 26. Australia New Zealand Food Authority (ANZFA). Review of vitamins and minerals standard. Canberra: ANZFA ,1999, Proposal 16.6.
- 27. Lamberg-Allardt C. Vitamin D intake, sunlight exposure and 25-hydroxyvitamin D levels in the elderly during one year. Ann Nutr Metab 1984; 28: 144-150.
- 28. McKenna M. Differences in vitamin D levels between countries in young adults and the elderly. Am J Med 1992; 93: 69-77.
- 29. Lamberg-Allardt CJ, Outila TA, Karkkainen MU, et al. Vitamin D deficiency and bone health in healthy adults in Finland: could this be a concern in other parts of Europe? J Bone Miner Res 2001; 16: 2066-2073.
- 30. Finch S, Doyle W, Lowe C, et al. National Diet and Nutrition Survey: people aged 65 years and over. Vol 1: Report of the Diet and Nutrition Survey. London: TSO, 1998.
- 31. Foote J, Giuliano A, Harris R. Older adults need guidance to meet nutritional recommendations. J Am Coll Nutr 2000; 19: 628-640.
- 32. Morabia A, Bernstein M, Antonini S. Smoking, dietary calcium and vitamin D deficiency in women: a population-based study. Eur J Clin Nutr 2000; 54: 684-689.
- 33. Lee L, Drake W, Kendler D. Intake of calcium and vitamin D in three Canadian long-term facilities. J Am Diet Assoc 2002; 102: 244-247.
- 34. Compston JE. Vitamin D deficiency: time for action. Evidence supports routine supplementation for elderly people and others at risk [editorial]. BMJ 1998; 317: 1466-1467.
- 35. Keane EM, Healy M, O'Moore R, et al. Vitamin D-fortified liquid milk: benefits for the elderly community-based population. Calcif Tissue Int 1998; 62: 300-302.
- 36. Scragg R, Khaw K, Murphy S. Life-style factors associated with winter serum 25-hydroxyvitamin D levels in elderly adults. Age Ageing 1995; 24: 271-275.
- 37. Rasmussen LB, Hansen GL, Hansen E, et al. Vitamin D: should the supply in the Danish population be increased? Int J Food Sci Nutr 2000; 51: 209-215.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.