Press Information. Vitamin D deficiency

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1 DSM, Corporate Communications P.O. Box 6500, 6401 HJ Heerlen The Netherlands phone +31 (0) Vitamin D is one of the essential nutrients for human health. Unlike other types of vitamins which are primarily acquired through dietary sources, the major source of vitamin D is exposure to sunlight, and it is only found in small amounts in a limited range of foods (for example, through oily fish such as salmon, mackerel, and herring). Consequently, it is very difficult to achieve sufficient vitamin D intake through dietary sources alone, and there is a widespread problem for people with low sunlight exposure, who have to rely solely or more heavily on dietary intake. Furthermore, increasing sun exposure can carry other health risks, which is why it is crucial to find a balance between sun exposure and alternative vitamin D sources. Health care professionals frequently recommend vitamin D supplements as an important additional source of vitamin D for those who do not receive enough sun exposure. The production of vitamin D via the skin The human body is designed to produce vitamin D if the correct sunlight (UVB) hits the skin for at least minutes a day (depending on skin type). However, many factors can interfere with the body s ability to produce vitamin D from sunlight: Insufficient sunlight exposure: This can be due to geographical location (poor UVB at higher latitudes > 37 1 ), winter season, wearing concealing clothing, sunscreen use, air pollution, modern lifestyles with limited outdoor activity, living in an institutional setting, or being house-bound. Age: Infants and babies of vitamin D deficient mothers are at high risk. Natural production of vitamin D through sunlight decreases with age. Skin pigmentation: Dark-skinned individuals are less able to synthesise vitamin D from sunlight Other factors: ethnicity, dietary habits, cultural behaviours, national policies on vitamin D fortification, urbanisation, social and economic status all have an impact on levels of vitamin D. As a result, there are a multitude of factors which have a strong influence on Vitamin D status, and aggravate the problem of vitamin D deficiency. 1 Because the sun is at too low an angle in the sky

2 Page 2 of 5 How much vitamin D do we need? A simple blood test 2 can identify a person s vitamin D status, and reveal whether they are getting enough vitamin D, both from sunlight and dietary sources. Medical professionals currently measure vitamin D status in the blood in either nmol/l or ng/ml 3. Desirable levels of vitamin D are classified as blood concentrations of above 75nmol/L; inadequate levels are classified between 50 and 75; insufficient between 25 and 50, and deficiency below 25nmol/L. The graph above reports that 50% of adult Europeans are below 50nmol /L, 30% are at risk of osteomalacia 4 and 70% are below the desired target level of 75nmol/L. The current intake recommendations for vitamin D in the European Union are between IU 5, but increasingly key opinion leaders are recommending much higher daily intakes, between IU or even 2000 IU for at risk people. Even with a balanced diet this level is difficult to achieve, which is why there is a clear case for supplementation and the fortification of foods. To achieve 800 IU of vitamin D by diet alone would mean consuming 2 portions of oily fish or 40 eggs every day. map is a global concern, even in very sunny climates, and is a major public health problem, which is why experts from the International Osteoporosis Foundation (IOF) and DSM Nutritional Products (DSM) have joined forces to advocate for greater awareness of the global problem of vitamin D deficiency. Both parties have jointly developed an interactive worldwide map on vitamin D levels 6 as a tool for educating the public and providing information to policymakers and health care professionals. A prototype of the European map which is based on peer-reviewed publications has been developed in partnership between IOF and DSM. 2 Vitamin D is easily analysed in a blood sample by measuring 25-hydroxyvitamin D (25(OH)D which is a sensitive marker and reflects both dietary intake and endogenous produced vitamin D upon sunlight exposure 3 The conversion is 1ng/ml = 2.5 nmol/l 4 Osteomalacia is a softening of bones in adults, usually caused by vitamin D deficiency 5 Vitamin D intake is measured in micrograms or IU. 1 microgram of vitamin D equals 40 IU vitamin D 6 As explained on page 1, for the purposes of this project, the blood concentrations of vitamin D are categorized as desirable above 75nmol/L, inadequate between 50 and 75, insufficient t between 25 and 50, and deficiency below 25nmol/L.. (Vitamin D status is measured either in nmol/l or ng/ml, (nmol/l is calculated by multiplying ng/ml by a factor of 2.5).

3 Page 3 of 5 The maps aim to: Provide an overview and illustrate the vitamin D status in Europe Raise awareness of differences in vitamin D levels across Europe Pinpoint the missing data in each region for specific population groups Educate health care professionals Provide guidance to ultimately improve inadequate vitamin D levels in various regions of Europe and beyond First findings in Europe The key take-home messages from the maps are: is an issue in Europe as assessed by vitamin D levels in the blood, a sensitive functional biomarker of vitamin D status. Postmenopausal women and elderly in particular appear to be an at-risk group for low vitamin D status. Low vitamin D status has a significant impact on human health and in particular on osteoporosis and subsequent risk of falling and fractures. Low vitamin D status has a significant impact on health care costs. As a further increase in life expectancy among the European population is anticipated, low vitamin D status will become even more of an issue in the near future. The scientific evidence on the low vitamin D status in Europe clearly calls for action. The health benefits of vitamin D and the consequences of deficiency Research shows that desirable vitamin D levels (above 75nmol/L) make a significant contribution to supporting bone health. Specific benefits include: An improvement in Bone Mineral Density Reduced risk of fractures Increased muscle strength and function Reduced risk of falling

4 Page 4 of 5 The European Food Safety Agency (EFSA) s recent process of defining permissible health claims recognises the essential role that vitamin D plays in human health, and in particular, bone health. The claims listed below have been reviewed and approved by EFSA: 7 Vitamin D: Contributes to the maintenance of normal bones and teeth. Calcium and vitamin D are needed for normal growth and development of bone in children. Contributes to the normal absorption/utilisation of calcium and phosphorus and maintenance of normal blood calcium concentrations. Contributes to the maintenance of normal muscle function. In elderly people, vitamin D deficiency is linked to reduced physical performance and increased risk of osteoporosis (see further explanation below) and fall-related osteoporotic fractures. In children severe vitamin D deficiency results in inadequate mineralization of bone, leading to growth retardation and bone deformities known as rickets, and osteomalacia in adults. Why is vitamin D so important in preventing osteoporosis? Osteoporosis is a silent disease, often without symptoms, and which frequently remains undiagnosed until the first fracture occurs. Of the estimated 9 million osteoporotic fractures that occurred worldwide in the year 2000, 1.6 million were hip fractures, 1.7 million were forearm fractures, and 1.4 million were clinical vertebral fractures; with the greatest number of osteoporotic fractures occurring in Europe (34.8% of the total). Although osteoporosis can be easily diagnosed and treated, it is estimated that only one out of every three vertebral fractures coming to clinical attention. Despite this, it is known that having one spine fracture increases the risk for sustaining additional spine fractures five-fold within the next year, a phenomenon commonly known as the 'fracture cascade'. Osteoporosis is a major public health problem, with enormous social and economic impact. In the European Union, someone has a fracture as a result of osteoporosis every 30 seconds, and with an ageing population, the yearly incidence of hip fracture alone in the EU is expected to more than double over the next decade. In Europe, osteoporotic fractures are responsible for a higher disease 'burden', in terms of disability and excess mortality, than many other chronic diseases.. Furthermore, in women over 45 years of age, osteoporosis accounts for more days spent in hospital than many other diseases. In terms of economic impact, it is estimated that the cost of all osteoporotic fractures in Europe is provisionally 25 billion. Despite these statistics, many countries continue to place osteoporosis low on the list of priorities in their health care agendas. For further information on osteoporosis please visit: 7 Source of Vitamin D= 15% RDA min. For further information please visit

5 Page 5 of 5 How does vitamin D make a difference? The proven benefit of vitamin D in supporting healthy bones, means that it plays a vital role in the prevention of osteoporosis and osteoporotic fractures. It has a two-fold effect: i) improving Bone Mineral Density, which lowers risks of fracture, whilst ii) also improving muscle strength, balance and leg function which decreases the risk of falling and thereby decreases risk of fractures again. Vitamin D Muscle strength Balance Leg function Bone Mineral Density (BMD) Risk of falling Risk of Fractures Adapted from Bischoff-Ferrari, JAMA 2005, JBMR 2003 Vitamin D is necessary for healthy bones throughout life, and if a problem arises, it can be very easily solved. If vitamin D deficiency is identified at any stage, it can be simply corrected by increasing intake, which will deliver improvements to bone health. Conclusions is clearly a public health issue in Europe It is difficult to compensate for a lack of sunlight exposure with dietary improvements alone Post-menopausal and elderly women appear to be particular at-risk groups for low vitamin D status. Low vitamin D status has a significant impact on human health and in particular on osteoporosis and subsequent risks of falling and fractures. Low vitamin D status, and subsequent falling and fractures, has a significant impact on health care costs. As a further increase in life expectancy among the European population is anticipated, low vitamin D status will become even more of an issue in the near future. The scientific evidence on the low vitamin D status in Europe clearly calls for action, and dietary fortification/supplementation programs should be further developed. Both the International Osteoporosis Foundation (IOF) and DSM agree that more advocacy is needed to align the recommended vitamin D intake levels in Europe and beyond, with more progressive, evidence-based proposals of 1,000-2,000 IU per day, especially for risk groups such as women and the elderly. In addition, both parties support: The initiation of a European awareness program on the health impact of vitamin D deficiency, tailored to the public / media / health authorities and health professionals. The further identification of ways to close the deficiency gap (e.g. by improving lifestyle and nutrition, and considering dietary supplements and the development of fortification programs). The implementation of further studies to measure vitamin D status and its risk factors where data is scarce.