European Journal of Nutrition

, Volume 52, Issue 7, pp 1733–1742 | Cite as

New perspectives on vitamin D sources in Germany based on a novel mathematical bottom-up model of 25(OH)D serum concentrations

  • Jonathan Brown
  • Anita Ignatius
  • Michael Amling
  • Florian Barvencik
Original Contribution



Up-to-date knowledge about vitamin D supply and serum concentration in Germany is not sufficient. Our purpose was to compare a novel holistic bottom-up modeling of 25(OH)D concentrations with vitamin D sources such as sunlight, food and supplements for all federal states taking seasonal and geographical variations into account. The second purpose was to update and detail vitamin D supply through food in Germany.


To confirm the model of 25(OH)D concentrations, we used the population (1,763 men and 2,267 women, 18–79 years) participated in the representative German National Health Interview and Examination Survey 1998 and the integrated German Nutrition Survey.


The maximum model value is 67.5 nmol/L in July and minimum model value is 29.3 nmol/L in January, while the average model value is 45.0 nmol/L. Men have a mean daily intake of 137 IU (3.42 μg) and women of 112 IU (2.79 μg). Correlation between model and actual data is 0.77 (p = 0.003).


A comparison of the model data with population-based values showed good agreement. None of the vitamin D sources can provide the German population with enough vitamin D.


Vitamin D Vitamin D deficiency UVB exposure Vitamin D supplementation Vitamin D in natural food 

Supplementary material

394_2012_477_MOESM1_ESM.ppt (314 kb)
Supplementary material 1 A. Ten measuring points for mean daily ambient erythemal UV in Germany from the “German federal office for radiation protection”. The distribution of the measuring points is well suited for an interpolation of data (PPT 314 kb)
394_2012_477_MOESM2_ESM.ppt (692 kb)
Supplementary material 2 A. Seasonal variations of hours of daylight for the 16 German federal states. The x-axis shows months of the year, while the y-axis hours of daylight. Abbreviations: BW = Baden-Wuerttemberg, BY = Bavaria, BE = Berlin, BB = Brandenburg, HB = Bremen, HH = Hamburg, HE = Hesse, MV = Mecklenburg-Western Pomerania, NI = Lower Saxony, NW = North Rhine-Westphalia, RP = Rhineland-Palatinate, SL = Saarland, SN = Saxony, ST = Saxony-Anhalt, SH = Schleswig-Holstein, TH = Thuringia (PPT 691 kb)
394_2012_477_MOESM3_ESM.ppt (325 kb)
Supplementary material 3 A. Comparison of average vitamin D status of all German federal states. It becomes obvious that minimum concentrations are almost constant among all states. This is due to the fact that 25(OH)D concentrations fall to a nadir with absence of sun. Maximum concentrations however, differ as SED is correlated to federal state latitude. B. Correlation of latitude of German federal states and average vitamin D status. Abbreviations: BW = Baden-Wuerttemberg, BY = Bavaria, BE = Berlin, BB = Brandenburg, HB = Bremen, HH = Hamburg, HE = Hesse, MV = Mecklenburg-Western Pomerania, NI = Lower Saxony, NW = North Rhine-Westphalia, RP = Rhineland-Palatinate, SL = Saarland, SN = Saxony, ST = Saxony-Anhalt, SH = Schleswig-Holstein, TH = Thuringia. Statistical analysis was performed using SPSS version 18. Results were considered statistically significant when a two-tailed p value was less than 0.05. C. Comparison of the size of Germany and USA. As this model was validated for a small geographic region, it becomes obvious that this model could be easily adapted and used for bigger countries such as the USA (PPT 325 kb)
394_2012_477_MOESM4_ESM.doc (131 kb)
Supplementary material 4 (DOC 131 kb)
394_2012_477_MOESM5_ESM.docx (28 kb)
Supplementary material 5 (DOCX 28 kb)


  1. 1.
    Bouillon R, Carmeliet G, Verlinden L, van Etten E, Verstuyf A, Luderer HF, Lieben L, Mathieu C, Demay M (2008) Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev 29:726–776CrossRefGoogle Scholar
  2. 2.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefGoogle Scholar
  3. 3.
    Melamed ML, Michos ED, Post W, Astor B (2008) 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637CrossRefGoogle Scholar
  4. 4.
    Chiu KC, Chu A, Go VLW, Saad MF (2004) Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. Am J Clin Nutr 79:820–825Google Scholar
  5. 5.
    Hypponen E, Läärä E, Reunanen A, Järvelin M-R, Virtanen SM (2001) Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 358:1500–1503CrossRefGoogle Scholar
  6. 6.
    Pittas AG, Dawson-Hughes B, Li T, Van Dam RM, Willett WC, Manson JE, Hu FB (2006) Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care 29:650–656CrossRefGoogle Scholar
  7. 7.
    Ahonen MH, Tenkanen L, Teppo L, Hakama M, Tuohimaa P (2000) Prostate cancer risk and prediagnostic serum 25-hydroxyvitamin D levels (Finland). Cancer Causes Control 11:847–852CrossRefGoogle Scholar
  8. 8.
    Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, Barnhill R (2005) Sun exposure and mortality from melanoma. J Natl Cancer Inst 97:195–199CrossRefGoogle Scholar
  9. 9.
    Chang ET, Smedby KEM, Hjalgrim H, Porwit-MacDonald A, Roos GR, Glimelius B, Adami H-O (2005) Family history of hematopoietic malignancy and risk of lymphoma. J Natl Cancer Inst 97:1466–1474CrossRefGoogle Scholar
  10. 10.
    Feskanich D, Ma J, Fuchs CS, Kirkner GJ, Hankinson SE, Hollis BW, Giovannucci EL (2004) Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomark Prev 13:1502–1508Google Scholar
  11. 11.
    Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, Holick MF (2006) The role of vitamin D in cancer prevention. Am J Public Health 96:252–261CrossRefGoogle Scholar
  12. 12.
    Giovannucci E (2006) The epidemiology of vitamin D and colorectal cancer: recent findings. Curr Opin Gastroenterol 22:24–29CrossRefGoogle Scholar
  13. 13.
    Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL, Giovannucci E, Wei M, Holick MF (2005) Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol 97:179–194CrossRefGoogle Scholar
  14. 14.
    Holick MF (2006) Calcium plus vitamin D and the risk of colorectal cancer. New Engl J Med 354:2287–2288CrossRefGoogle Scholar
  15. 15.
    Luscombe CJ, Fryer AA, French ME, Liu S, Saxby MF, Jones PW, Strange RC (2001) Exposure to ultraviolet radiation: association with susceptibility and age at presentation with prostate cancer. Lancet 358:641–642CrossRefGoogle Scholar
  16. 16.
    Annweiler C, Schott AM, Rolland Y, Blain H, Herrmann FR, Beauchet O (2010) Dietary intake of vitamin D and cognition in older women. Neurology 75:1810–1816CrossRefGoogle Scholar
  17. 17.
    Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJB (2009) Athletic performance and vitamin D. Med Sci Sport Exer 41:1102–1110CrossRefGoogle Scholar
  18. 18.
    Cantorna MT, Zhu Y, Froicu M, Wittke A (2004) Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr 80:1717S–1720SGoogle Scholar
  19. 19.
    Zittermann A (2006) Vitamin D and disease prevention with special reference to cardiovascular disease. Prog Biophys Mol Biol 92:39–48CrossRefGoogle Scholar
  20. 20.
    Ponsonby A-L, McMichael A, van der Mei I (2002) Ultraviolet radiation and autoimmune disease: insights from epidemiological research. Toxicology 181–182:71–78CrossRefGoogle Scholar
  21. 21.
    Roux C, Bischoff-Ferrari HA, Papapoulos SE, de Papp AE, West JA, Bouillon R (2008) New insights into the role of vitamin D and calcium in osteoporosis management: an expert roundtable discussion. Curr Med Res Opin 24:1363–1370CrossRefGoogle Scholar
  22. 22.
    von Domarus C, Brown J, Barvencik F, Amling M, Pogoda P (2011) How much vitamin D do we need for skeletal health? Clin Orthop Relat R:1–7Google Scholar
  23. 23.
    Priemel M, Domarus C, Klatte TO, Kessler S, Schlie J, Meier S, Proksch N, Pastor F, Netter C, Streichert T, Püschel K, Amling M (2010) Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 25:305–312CrossRefGoogle Scholar
  24. 24.
    Bischoff-Ferrari HA, Dietrich T, Orav EJ, Dawson-Hughes B (2004) Positive association between 25-hydroxy vitamin d levels and bone mineral density: a population-based study of younger and older adults. Am J Med 116:634–639CrossRefGoogle Scholar
  25. 25.
    Hintzpeter B, Mensink GBM, Thierfelder W, Muller MJ, Scheidt-Nave C (2007) Vitamin D status and health correlates among German adults. Eur J Clin Nutr 62:1079–1089CrossRefGoogle Scholar
  26. 26.
    Hintzpeter B, Scheidt-Nave C, Muller MJ, Schenk L, Mensink GBM (2008) Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 138:1482–1490Google Scholar
  27. 27.
    Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378CrossRefGoogle Scholar
  28. 28.
    DGE German Association for Nutrition (Deutsche Gesellschaft für Ernährung—DGE). Reference values for nutritional intake D-A-CH—vitamin D (Calciferole). Version current 2012. Internet: Accessed 24 April 2012
  29. 29.
    Zittermann A, Helden RV, Grant WB, Kipshoven C, Ringe JD (2009) An estimate of the survival benefit of improving vitamin D status in the adult German population. Dermatoendocrinol 1(6):300–306CrossRefGoogle Scholar
  30. 30.
    Zittermann A (2010) The estimated benefits of vitamin D for Germany. Mol Nutr Food Res 54:1164–1171Google Scholar
  31. 31.
    MRI Max Rubner-Institut (MRI)—Federal ministry of food, agriculture and consumer protection. National nutritional survey II—part 2. Version current 2008. Internet: Accessed 15 August 2011
  32. 32.
    BLE Federal association of the German meat industry. Meat consumption per capita from “Federal agency for agriculture and food” (Bundesamt für Landwirtschaft und Ernährung—BLE). Version current 2006. Internet: Accessed 14 August 2011
  33. 33.
    Milch&Markt German milk industry. Numbers and data of the German milk industry. Version 2008. Internet: Accessed 14 August 2011
  34. 34.
    ZMP, MIV central price and market report authority (Zentrale Preis- und Marktberichtstelle–ZMP). What do we eat. Version 2002. Internet: Accessed 14 August 2011
  35. 35.
    Chen TC, Chimeh F, Lu Z, Mathieu J, Person KS, Zhang A, Kohn N, Martinello S, Berkowitz R, Holick MF (2007) Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys 460:213–217CrossRefGoogle Scholar
  36. 36.
    Baraké R, Weiler H, Payette H, Gray-Donald K (2010) Vitamin D supplement consumption is required to achieve a minimal target 25-Hydroxyvitamin D concentration of ≥75 nmol/L in older people. J Nutr 140:551–556CrossRefGoogle Scholar
  37. 37.
    Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842–856Google Scholar
  38. 38.
    O’Donnell S, Cranney A, Horsley T, Weiler HA, Atkinson SA, Hanley DA, Ooi DS, Ward L, Barrowman N, Fang M, Sampson M, Tsertsvadze A, Yazdi F (2008) Efficacy of food fortification on serum 25-hydroxyvitamin D concentrations: systematic review. Am J Clin Nutr 88:1528–1534CrossRefGoogle Scholar
  39. 39.
    Niramitmahapanya S, Harris SS, Dawson-Hughes B (2011) Type of dietary fat is associated with the 25-Hydroxyvitamin D3 increment in response to vitamin D supplementation. J Clin Endocrinol Metab 96:3170–3174CrossRefGoogle Scholar
  40. 40.
    Diffey BL (2010) Modelling the seasonal variation of vitamin D due to sun exposure. Brit J Dermatol 162:1342–1348CrossRefGoogle Scholar
  41. 41.
    Knuschke P, Kurpiers M, Koch R, Kuhlisch W, Witte K (2004) Mean individual UV-exposures in the population. BMBF report (Federal Ministry of Education and Research—Bundesministerium für Bildung und Forschung) with the reference number 07UVB54C/3Google Scholar
  42. 42.
    Barmettler A, Brodbeck R (2011) The time function. Version current 6 December 2010. Internet: Accessed 14 August 2011
  43. 43.
    VuMA Consumption and media analysis (Verbraucher- und Mediananalyse-VuMA). Basis analysis. Version 2011. Internet: Accessed 14 August 2011
  44. 44.
    Rigel DS, Rigel EG, Rigel AC (1999) Effects of altitude and latitude on ambient UVB radiation. J Am Acad Dermatol 40:114–116CrossRefGoogle Scholar
  45. 45.
    Rigel EG, Lebwohl MG, Rigel AC, Rigel DS (2003) Ultraviolet radiation in alpine skiing: magnitude of exposure and importance of regular protection. Arch Dermatol 139:60–62CrossRefGoogle Scholar
  46. 46.
    Khoo A-L, Koenen HJPM, Chai LYA, Sweep FCGJ, Netea MG, van der Ven AJAM, Joosten I (2012) Seasonal variation in vitamin D3 levels is paralleled by changes in the peripheral blood human T cell compartment. PLoS ONE 7:e29250CrossRefGoogle Scholar
  47. 47.
    Reusch J, Ackermann H, Badenhoop K (2009) Cyclic changes of vitamin D and PTH are primarily regulated by solar radiation: 5-year analysis of a German (50Å N) population. Horm Metab Res 41(402):407Google Scholar
  48. 48.
    Mithal A, Wahl D, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman J, El-Hajj Fuleihan G, Josse R, Lips P, Morales-Torres J, Group obotIOFCoSANW (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1820Google Scholar
  49. 49.
    Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77:204–210Google Scholar
  50. 50.
    Adams JS, Clemens TL, Parrish JA, Holick MF (1982) Vitamin-D synthesis and metabolism after ultraviolet irradiation of normal and vitamin-D-deficient subjects. New Engl J Med 306:722–725CrossRefGoogle Scholar
  51. 51.
    Thompson GR, Lewis B, Booth CC (1966) Absorption of vitamin D3–3H in control subjects and patients with intestinal malabsorption. J Clin Investig 45:94–102CrossRefGoogle Scholar
  52. 52.
    Jones G (2008) Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 88:582S–586SGoogle Scholar
  53. 53.
    Vieth R (2005) The role of vitamin D in the prevention of osteoporosis. Ann Med 37:278–285CrossRefGoogle Scholar
  54. 54.
    MacLaughlin J, Holick MF (1985) Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76:1536–1538CrossRefGoogle Scholar
  55. 55.
    Destatis Federal Office of Statistics (Statistisches Bundesamt). Have you ever been to a tanning shop. Version current 2011. Internet: Accessed 14 August 2011
  56. 56.
    Stiftung-Warentest Stiftung Warentest (Leading German consumer safety group). Tanning shop—what you need to know. Version October 2007. Internet: Accessed 14 August 2011
  57. 57.
    ISD ISD (Initiative of black people in Germany). German newspaper slammed for racist cover. Version 6 May 2007. Internet:,1518,557861,00.html. Accessed 14 August 2011
  58. 58.
    Biancuzzo RM, Young A, Bibuld D, Cai MH, Winter MR, Klein EK, Ameri A, Reitz R, Salameh W, Chen TC, Holick MF (2010) Fortification of orange juice with vitamin D2 or vitamin D3 is as effective as an oral supplement in maintaining vitamin D status in adults. Am J Clin Nutr 91:1621–1626CrossRefGoogle Scholar
  59. 59.
    Tangpricha V, Koutkia P, Rieke SM, Chen TC, Perez AA, Holick MF (2003) Fortification of orange juice with vitamin D: a novel approach for enhancing vitamin D nutritional health. Am J Clin Nutr 77:1478–1483Google Scholar
  60. 60.
    Burgaz A, Akesson A, Oster A, Michaëlsson K, Wolk A (2007) Associations of diet, supplement use, and ultraviolet B radiation exposure with vitamin D status in Swedish women during winter. Am J Clin Nutr 86:1399–1404Google Scholar
  61. 61.
    Kyriakidou-Himonas M, Aloia JF, Yeh JK (1999) Vitamin D supplementation in postmenopausal black women. J Clin Endocrinol Metab 84:3988–3990CrossRefGoogle Scholar
  62. 62.
    Byrne P, Freaney R, McKenna M (1995) Vitamin D supplementation in the elderly: review of safety and effectiveness of different regimes. Calcif Tissue Int 56:518–520CrossRefGoogle Scholar
  63. 63.
    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 JMW, Kiely M (2008) Estimation of the dietary requirement for vitamin D in healthy adults. Am J Clin Nutr 88:1535–1542CrossRefGoogle Scholar
  64. 64.
    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 (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the institute of medicine: what clinicians need to know. J Clin Endocr Metab 96:53–58CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Jonathan Brown
    • 1
  • Anita Ignatius
    • 2
  • Michael Amling
    • 1
  • Florian Barvencik
    • 1
  1. 1.Department of Osteology and BiomechanicsUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Institute of Orthopaedic Research and BiomechanicsUlm UniversityUlmGermany

Personalised recommendations