European Journal of Nutrition

, Volume 57, Issue 6, pp 2001–2036 | Cite as

A systematic review of vitamin D status in southern European countries

  • Yannis Manios
  • George Moschonis
  • Christina-Paulina Lambrinou
  • Konstantina Tsoutsoulopoulou
  • Panagiota Binou
  • Alexandra Karachaliou
  • Christina Breidenassel
  • Marcela Gonzalez-Gross
  • Mairead Kiely
  • Kevin D. Cashman



Despite an acknowledged dearth of data on serum 25-hydroxyvitamin D (25(OH)D) concentrations from Southern European countries, inter-country comparison is hampered by inconsistent data reporting. The purpose of the current study was to conduct a systematic literature review of available data on serum 25(OH)D concentrations and estimate vitamin D status in Southern European and Eastern Mediterranean countries, both at a population level and within key population subgroups, stratified by age, sex, season and country.


A systematic review of the literature was conducted to identify and retrieve scientific articles reporting data on serum 25(OH)D concentration and/or vitamin D status following standard procedures.


Data were extracted from 107 studies, stratified by sex and age group, representing 630,093 individuals. More than one-third of the studies reported mean 25(OH)D concentrations below 50 nmol/L and ~ 10% reported mean serum 25(OH)D concentrations below 25 nmol/L. Overall, females, neonates/ infants and adolescents had the higher prevalence of poor vitamin D status. As expected, there was considerable variability between studies. Specifically, mean 25(OH)D ranged from 6.0 (in Italian centenarians) to 158 nmol/L (in elderly Turkish men); the prevalence of serum 25(OH)D < 50 nmol/L ranged from 6.8 to 97.9% (in Italian neonates).


Contrary to expectations, there was a high prevalence of low vitamin D status in the Southern Europe and the Eastern Mediterranean regions, despite abundant sunshine. These data further emphasize the need for strategies, such as fortification of foods with vitamin D and/or vitamin D supplementation, which will be tailored to the needs of specific population groups with higher risk of insufficiency or deficiency, to efficiently tackle the pandemic of hypovitaminosis D in Europe.


Vitamin D South Europe East Mediterranean Prevalence 



YM, GM, CPL, KT, PB, AK, CB and MGG contributed to the systematic review of the literature. All authors contributed to the writing, critical review and approval of the final version of the manuscript for publication. The present review was supported by funding received from the European Commission under its Seventh Framework Programme (FP7) ODIN (grant agreement no. 613977). The authors would like to thank Dr. Colette O’Neill, University College Cork, for her help in preparation of the vitamin D status maps.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

The current review includes anonymized data from epidemiological and clinical studies on vitamin D status.

Supplementary material

394_2017_1564_MOESM1_ESM.doc (84 kb)
Supplementary material 1 (DOC 83 KB)
394_2017_1564_MOESM2_ESM.doc (77 kb)
Supplementary material 2 (DOC 77 KB)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Yannis Manios
    • 1
  • George Moschonis
    • 2
  • Christina-Paulina Lambrinou
    • 1
  • Konstantina Tsoutsoulopoulou
    • 1
  • Panagiota Binou
    • 1
  • Alexandra Karachaliou
    • 1
  • Christina Breidenassel
    • 3
  • Marcela Gonzalez-Gross
    • 3
  • Mairead Kiely
    • 4
    • 5
  • Kevin D. Cashman
    • 4
    • 6
  1. 1.Department of Nutrition and Dietetics, School of Health Science and EducationHarokopio UniversityAthensGreece
  2. 2.Department of Rehabilitation, Nutrition and Sport, College of Science, Health and EngineeringLa Trobe UniversityMelbourneAustralia
  3. 3.ImFINE Research Group, Department of Health and Human PerformanceUniversidad Politécnica de MadridMadridSpain
  4. 4.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional SciencesUniversity College CorkCorkIreland
  5. 5.The Irish Centre for Fetal and Neonatal Translational Research (INFANT)University College CorkCorkIreland
  6. 6.Department of MedicineUniversity College CorkCorkIreland

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