Vitamin D Deficiency: A Global Health Problem
Holick MF • New England Journal of Medicine
Key Finding
Vitamin D deficiency affects an estimated 1 billion people worldwide, with consequences extending far beyond bone health to include increased risk of cancer, autoimmune disease, and cardiovascular disease.
Key Findings
- 1Vitamin D deficiency defined as 25(OH)D < 20 ng/mL; insufficiency 21-29 ng/mL
- 2Affects estimated 1 billion people worldwide across all ages and ethnicities
- 3Causes include limited sun exposure, dark skin, age, obesity, and malabsorption
- 4Consequences extend to cancer, autoimmune disease, cardiovascular disease, and infections
- 5Treatment: 50,000 IU D2 weekly for 8 weeks, then maintenance of 1,000-2,000 IU daily
Original title: “Vitamin D Deficiency”
Plain English Summary
This landmark NEJM review by Dr. Michael Holick established the modern understanding of vitamin D deficiency as a widespread pandemic. It defines deficiency as 25(OH)D below 20 ng/mL and insufficiency as 21-29 ng/mL, recommending levels of 30-100 ng/mL for optimal health. The paper covers causes, consequences, and treatment of vitamin D deficiency.
In-Depth Analysis
This seminal New England Journal of Medicine review established vitamin D deficiency as a major global health concern.
Definition of Deficiency
- •Deficiency: 25(OH)D < 20 ng/mL (50 nmol/L)
- •Insufficiency: 25(OH)D 21-29 ng/mL (52.5-72.5 nmol/L)
- •Sufficiency: 25(OH)D ≥ 30 ng/mL (≥75 nmol/L)
Prevalence
- •40-100% of US and European elderly are deficient
- •36% of healthy young adults deficient
- •Higher rates in dark-skinned individuals (up to 40-45% of African Americans)
Health Consequences
Beyond rickets and osteomalacia, deficiency is associated with:
- •Increased risk of common cancers (colon, prostate, breast)
- •Autoimmune diseases (MS, type 1 diabetes, rheumatoid arthritis)
- •Cardiovascular disease
- •Infectious diseases
- •Depression and cognitive decline
Treatment Recommendations
- •Deficiency treatment: 50,000 IU vitamin D2 weekly for 8 weeks
- •Maintenance: 1,000-2,000 IU daily
- •Safe upper limit: Up to 10,000 IU daily unlikely to cause toxicity
Paradigm Relevance
How this study applies to different clinical perspectives:
Standard Medical
RelevantConventional clinical guidelines used by most doctors
Research Consensus
RelevantCurrent scientific understanding, often ahead of guidelines
Metabolic Optimization
RelevantProactive targets for optimal health, not just disease absence
Study Details
- Type
- Review Article
Related Biomarkers
Calculate & Evaluate on Metabolicum
Original Source
DOI (Digital Object Identifier) is a permanent link to this publication. Unlike website URLs that can change, a DOI always resolves to the correct source.
Related Studies
Health Effects of Vitamin D supplementation: Lessons Learned from Randomized Controlled Trials and Mendelian Randomization Studies
Bouillon R, et al • J Bone Miner Res • 2023
Cancer mortality: daily dosing RR 0.88 (95% CI 0.78-0.98, 10 trials); bolus RR 1.07 (ineffective); VITAL: normal BMI cancer OR 0.76; shift focus to deficient individuals
Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials
Keum N, et al • Annals of Oncology • 2019
Cancer mortality: 13% reduction (RR 0.87, 95% CI 0.79-0.96, p=0.005); Cancer incidence: no effect (RR 0.98, 95% CI 0.93-1.03, p=0.42)
International Vitamin D Supplementation Guidelines
Pludowski P, et al • Journal of Steroid Biochemistry and Molecular Biology • 2018
Target 25(OH)D levels of 30-50 ng/mL (75-125 nmol/L) recommended for general health; higher targets (40-60 ng/mL) for specific conditions.