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Vitamin D: introduction

Vitamin D is a fat-soluble vitamin. Very few foods naturally contain vitamin D (fatty fish
livers are the exception), so dermal synthesis is the major natural source of the vitamin.
Vitamin D from the diet or dermal synthesis is biologically inactive and requires enzymatic
conversion to active metabolites. Vitamin D is converted enzymatically in the liver to 25-
hydroxyvitamin D (25[OH]D), the major circulating form of vitamin D, and then in the
kidney to 1,25-dihydroxyvitamin D, the active form of vitamin D.

Vitamin D is well known for its essential role in maintaining healthy bones. Deficiency
causes bones to become soft and weak: a condition known as rickets in children and
osteomalacia in adults. The majority of vitamin D is produced via skin synthesis under the
action of sunlight, with smaller amounts from dietary sources such as oily fish, meat and
eggs. Adequate exposure to ultraviolet (UV) light is therefore necessary to maintain levels.

Other physiological roles of vitamin D in maintaining health are now recognized. Some
evidence suggests that vitamin D deficiency is associated with increased risk of
cardiovascular diseases, some cancers, type 2 diabetes and multiple sclerosis. In addition,
there is also some evidence that low levels are associated with increased risk of all cause
mortality. It is also possible that the relationship is mediated through the association of
vitamin D deficiency with other risk factors, such as lack of physical activity and obesity.

Vitamin D production is in part dependent on skin pigmentation with paler-skinned


individuals able to synthesis vitamin D more efficiently under UV exposure; therefore,
darker-skinned individuals who move to a region experiencing low sunlight are at particular
risk of deficiency.
The Scientific Advisory Committee on Nutrition (2016) recommends that individuals should
have serum concentrations of vitamin D above a ‘population protective level’ of 25 nmol/L
throughout the year. This concentration is considered sufficient to prevent rickets in children
and osteomalacia in adults. Elsewhere, serum concentrations below 50 nmol/L are
considered to be deficient, and higher concentrations such as 75 nmol/L have been
recommended for optimal bone health.

There have been few well-conducted randomized controlled trials of vitamin D


supplementation in healthy adults and those that have been performed have not shown clear
evidence of a benefit from taking supplements. In a recent meta-analysis found that vitamin
D supplementation alone did not reduce cancer incidence or mortality. The potential risks of
excessive sun exposure must also be considered in the context of attempts to increase vitamin
D levels. Clearer evidence is required regarding the health effects, safety and practicality of
increasing population vitamin D levels.

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