In the recent past, many studies have been published on the association between vitamin D and bone health or the risk of various chronic diseases. Thus, the D-A-CH reference values [D-A-CH arises from the initial letters of the common country identification for the countries Germany (D), Austria (A) and Switzerland (CH)] for the intake of vitamin D have been revised based on a critical review by the German Nutrition Society. Both dietary intake and endogenous synthesis contribute to the body’s vitamin D status. Since different factors modulate the extent of endogenous vitamin D formation, quantification is hardly possible. Therefore, the new reference values for vitamin D intake are specified for a situation in which endogenous synthesis is completely missing. Based on the findings of the critical review, serum 25-hydroxyvitamin D concentrations of 50 nmol/l or higher are considered an indicator of an optimal vitamin D status. When endogenous synthesis is missing, adequate vitamin D intake is estimated as 20 µg per day for children, adolescents and adults. Dietary vitamin D intake from habitual diet is not sufficient to achieve this value. This gap has to be covered by endogenous vitamin D synthesis and/or additional intake of vitamin D. It is clearly stated that the desired vitamin D supply can be achieved without using vitamin D supplements by frequent sun exposure.

1.
Linseisen J, Bechthold A, Bischoff-Ferrari HA, Hintzpeter B, Leschik-Bonnet E, Reichrath J, Stehle P, Volkert D, Wolfram G, Zittermann A: Vitamin D und Prävention ausgewählter chronischer Krankheiten – Stellungnahme. Bonn, Deutsche Gesellschaft für Ernährung e. V., 2011. www.dge.de.
2.
Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R: Estimates of optimal vitamin D status. Osteoporosis Int 2005;16:713–716.
3.
Holick MF: Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 2009;19:73–78.
4.
Max Rubner-Institut: Nationale Verzehrsstudie II, Ergebnisbericht Teil 2. Karlsruhe, Max Rubner-Institut, 2008.
5.
Mensink GBM, Richter A, Stahl A, Vohmann C, Heseker H: Bestandsaufnahme: Nährstoffversorgung und Lebensmittelverzehr von Kindern und Jugendlichen in Deutschland; in Kersting M (ed): Kinderernährung aktuell. Umschau Zeitschriftenverlag, Sulzbach/Ts, 2009, pp 40–46.
6.
Hollis BW, Roos BA, Draper HH, Lambert PW: Vitamin D and its metabolites in human and bovine milk. J Nutr 1981;111:1240–1248.
7.
Souci SW, Fachmann W, Kraut H: Die Zusammensetzung der Lebensmittel. Nährwert-Tabellen, 7. Auflage. Stuttgart, Medpharm Scientific Publishers, 2008.
8.
Specker BL, Ho ML, Oestreich A, Yin TA, Shui QM, Chen XC, Tsang RC: Prospective study of vitamin D supplementation and rickets in China. J Pediatr 1992;120:1167–1171.
9.
Wagner CL, Greer FR: Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122:1142–1152.
10.
Abrams SA: Vitamin D requirements in adolescents: what is the target? Am J Clin Nutr 2011;93:483–484.
11.
Holick MF: Resurrection of vitamin D deficiency and rickets. J Clin Invest 2006;116:2062–2072.
12.
Institute of Medicine: Dietary Reference Intakes for Calcium and Vitamin D. Washington, National Academies Press, 2011.
13.
Wabitsch M, Koletzko B, Moss A: Vitamin-D-Versorgung im Säuglings-, Kindes- und Jugendalter. Kurzfassung der Stellungnahme der Ernährungskommission der Deutschen Gesellschaft für Kinder- und Jugendmedizin (DGKJ) in Zusammenarbeit mit der Arbeitsgemeinschaft Pädiatrische Endokrinologie (APE). Monatsschr Kinderheilkd 2011;8:766–774.
14.
Greer FR, Marshall S: Bone mineral content, serum vitamin D metabolite concentrations and ultraviolet B light exposure in infants fed human milk with and without vitamin D2 supplements. J Pediatr 1989;114:204–212.
15.
Hollis BW, Wagner CL: Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr 2004;79:717–726.
16.
Hollis BW, Wagner CL: Vitamin D requirements during lactation: high-dose maternal supplementation and therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr 2004;80(6 suppl):1752S–1758S.
17.
Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW: High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med 2006;1:59–70.
18.
Wagner CL, Howard C, Hulsey TC, Lawrence RA, Taylor SN, Will H, Ebeling M, Hutson J, Hollis BW: Circulating 25-hydroxyvitamin D levels in fully breastfed infants on oral vitamin D supplementation. Int J Endocrinol 2010;2010:235035.
19.
Abrams SA, Hicks PD, Hawthorne KM: Higher serum 25-hydroxyvitamin D levels in school-age children are inconsistently associated with increased calcium absorption. J Clin Endocrinol Metab 2009;94:2421–2427.
20.
Viljakainen HT, Natri AM, Kärkkäinen M, Huttunen MM, Palssa A, Jakobsen J, Cashman KD, Mølgaard C, Lamberg-Allardt C: A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res 2006;21:836–844.
21.
Cashman KD, FitzGerald AP, Viljakainen HT, Jakobsen J, Michaelsen KF, Lamberg-Allardt C, Mølgaard C: Estimation of dietary requirement for vitamin D in healthy adolescent white girls. Am J Clin Nutr 2011;93:549–555.
22.
Cashman KD, Hill TR, Lucey AJ, Taylor N, Seamans KM, Muldowney S, Fitzgerald AP, Flynn A, Barnes MS, Horigan G, Bonham MP, Duffy EM, Strain JJ, Wallace JM, Kiely M: Estimation of the dietary requirement for vitamin D in healthy adults. Am J Clin Nutr 2008;88:1535–1542.
23.
Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C: Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 2000;15:1113–1118.
24.
Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H: Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int 2009;20:315–322.
25.
Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M: Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003;18:343–351.
26.
Autier P, Gandini S: Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 2007;167:1730–1737.
27.
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J: Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009;339:b3692.
28.
Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J: Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 2009;169:551–561.
29.
LaCroix AZ, Kotchen J, Anderson G, Brzyski R, Cauley JA, Cummings SR, Gass M, Johnson KC, Ko M, Larson J, Manson JE, Stefanick ML, Wactawski-Wende J: Calcium plus vitamin D supplementation and mortality in postmenopausal women: the Women’s Health Initiative calcium-vitamin D randomized controlled trial. J Gerontol A Biol Sci Med Sci 2009;64:559–567.
30.
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C: Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2011;(7):CD007470.
31.
Cashman KD, Wallace JM, Horigan G, Hill TR, Barnes MS, Lucey AJ, Bonham MP, Taylor N, Duffy EM, Seamans K, Muldowney S, Fitzgerald AP, Flynn A, Strain JJ, Kiely M: Estimation of the dietary requirement for vitamin D in free-living adults ≥64 y of age. Am J Clin Nutr 2009;89:1366–1374.
32.
European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies: Scientific opinion on the substantiation of a health claim related to vitamin D and risk of falling pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA Journal 2011;9:2382.
33.
Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N: IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010;21:1151–1154.
34.
Specker BL, Tsang RC, Hollis BW: Effect of race and diet on human milk vitamin D and 25-hydroxyvitamin D. Am J Dis Child 1985;139:1134–1137.
35.
Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL: Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011;26:2341–2357.
36.
Wagner CL, Taylor SN, Hollis BW: Does vitamin D make the world go ‘round’? Breastfeed Med 2008;3:239–250.
37.
Loomis WF: Skin-pigment regulation of vitamin-D biosynthesis in man. Science 1967;157:501–506.
38.
Need AG, Morris HA, Horowitz M, Nordin C: Effects of skin thickness, age, body fat, and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr 1993;58:882–885.
39.
Holick MF: Vitamin D. The underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 2002;9:87–98.
40.
Holick MF: Vitamin D deficiency. N Engl J Med 2007;357:266–281.
41.
Zittermann A: The estimated benefits of vitamin D for Germany. Mol Nutr Food Res 2010;54:1164–1171.
42.
Fitzpatrick TB: The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988;124; 869–871.
43.
Holick MF, Jenkins M: The UV Advantage, ed 2. New York, iBooks, 2009.
44.
Terushkin V, Bender A, Psaty EL, Engelsen O, Wang SQ, Halpern AC: Estimated equivalency of vitamin D production from natural sun exposure versus oral vitamin D supplementation across seasons at two US latitudes. J Am Acad Dermatol 2010;62:e1–e9.
45.
Holick MF: Vitamin D; in Shils M, Shike M, Ross AC, Caballero B, Cousins RJ (eds): Modern Nutrition in Health and Disease, 10th ed Lippincott Williams & Wilkins, 2006.
46.
Reichrath J, Nürnberg B: Cutaneous vitamin D synthesis versus skin cancer development: the Janus faces of solar UV-radiation. Dermatoendocrinol 2009;1:253–261.
47.
MacLaughlin J, Holick MF: Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985;76:1536–1538.
48.
Hauner H, Bechthold A, Boeing H, Broenstrup A, Buyken A, Leschik-Bonnet E, Linseisen J, Schulze M, Strohm D, Wolfram G: Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab 2012;60(suppl 1):1–58.
49.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA: The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96:53–58.
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