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Impact of season and different vitamin D thresholds on prevalence of vitamin D deficiency in epidemiological cohorts—a note of caution

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We investigated the impact of different cut-offs on the prevalence of 25-hydroxyvitamin D [25-(OH)D] deficiency.


We used baseline data of 4149 participants (45–75 years, 50% women) of the population-based Heinz Nixdorf Recall study. Serum 25-(OH)D was measured with the Roche Cobas assay. Quartiles (p25, p50, and p75) were calculated. Data were stratified by months, sex, and age. According to the recommendations of ‘Dachverband Osteologie’, Endocrine Society and National Institute of Health we used 25-(OH)D thresholds of 12, 20, and 30 ng/ml to estimate vitamin D deficiency.


Overall the median of 25-(OH)D was 19.8 ng/ml (p25 = 14.4 ng/ml, p75 = 26.6 ng/ml), with highest concentrations in July (p50 = 23.8 ng/ml, p25 = 18.2 ng/ml, and p75 = 31.2 ng/ml) and lowest in March (p50 = 15.8 ng/ml, p25 = 11.5 ng/ml, and p75 = 20.6 ng/ml). Prevalence of vitamin D deficiency rose from 16, 51 up to 83% using the cut-offs of <12, <20 ng/ml, and <30 ng/ml, respectively. With respect to seasonal variance, prevalence of vitamin D deficiency rose to 92% in February/March using the cut-off <30 ng/ml (<12: 28%, <20 ng/ml: 71%) whereas in June/July prevalence of vitamin D deficiency decreased to 71% (<12: 6%, <20 ng/ml: 30%). The chance to attest the diagnosis of vitamin D deficiency for cut-off 12 ng/ml in March is 6.4-fold higher than in June, for cut-off 20 ng/ml, 5.5-fold higher and for cut-off 30 ng/ml, 3.1-fold higher.


Guidelines to define vitamin D deficiency revealed extremely different prevalence rates ranging between 6 and 92%. Accounting for collection time and antecedent sun exposure are important to reduce bias in research studies and improve decision-making in clinical care. Vitamin D thresholds have to be rethought.

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We are indebted to all the study participants and to the dedicated personnel of both the study center of the HNR study and the EBT-scanner facilities Prof. D. Grönemeyer, Bochum and Dr. R. Seibel, Mülheim as well as to the investigative group, in particular to U. Roggenbuck, U. Slomiany, E.M. Beck, A. Öffner, S. Münkel, M. Bauer, S. Schrader, R. Peter, and H. Hirche. We acknowledge the support of the SarstedtAG&Co. (Nümbrecht, Germany) concerning laboratory equipment. We thank Prof. K. Lauterbach (Adjunct Prof., Harvard School of Public Health, Boston, USA) for his valuable contributions in an earlier phase of the study. We thank the Heinz Nixdorf Foundation [Chairman: Martin Nixdorf; Past Chairman: Dr Jur Gerhard Schmidt (deceased)], for their generous support of this study. This study is also supported by the German Federal Ministry of Education and Research (BMBF) that transferred the monitoring of the study Deutsches Zentrum für Luft- und Raumfahrt (DLR), Bonn, Germany. An international advisory board and quality control as well as event committee were established, but had no role concerning the study design, data collection, analysis, interpretation, or writing the report. The Deutsche Forschungsgemeinschaft (DFG) supported the study (DFG project: ER 155/6-1 and ER 155/6-2). This study is also supported by the Kulturstiftung Essen.

Author Contributions

S.H.S.: analysis and interpretation of data, drafting the manuscript. K.H.J. and R.E.: study concept and design. H.L., K.H.J., R.E., D.F., S.M.: assisted with drafting the manuscript for intellectual content. All authors read and approved the final manuscript.

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Correspondence to Sara Schramm.

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The study was approved by the institutional ethics committee.

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Schramm, S., Lahner, H., Jöckel, KH. et al. Impact of season and different vitamin D thresholds on prevalence of vitamin D deficiency in epidemiological cohorts—a note of caution. Endocrine 56, 658–666 (2017).

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