Abstract
Even though sunlight is viewed as the most important determinant of 25-hydroxyvitamin D (25(OH)D) status, several European studies have observed higher 25(OH)D concentrations among north-Europeans than south-Europeans. We studied the association between geographical latitude (derived from ecological data) and 25(OH)D status in six European countries using harmonised immunoassay data from 81084 participants in the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project (male sex 48·9 %; median age 50·8 years; examination period 1984-2014). Quantile regression models, adjusted for age, sex, decade and calendar week of sampling and time from sampling to analysis, were used for between-country comparisons. Up until the median percentile, the ordering of countries by 25(OH)D status (from highest to lowest) was as follows: Sweden (at 65·6-63·8°N), Germany (at 48·4°N), Finland (at 65·0-60·2°N), Italy (at 45·6-41·5°N), Scotland (at 58·2-55·1°N) and Spain (at 41·5°N). From the 75th percentile and upwards, Finland had higher values than Germany. As an example, using the Swedish cohort as a comparator, the median 25(OH)D concentration was 3·03, 3·28, 5·41, 6·54 and 9·28 ng/ml lower in the German, Finnish, Italian, Scottish and Spanish cohort, respectively (P-value < 0·001 for all comparisons). The ordering of countries was highly consistent in subgroup analyses by sex, age, and decade and season of sampling. In conclusion, we confirmed the previous observation of a north-to-south gradient of 25(OH)D status in Europe, with higher percentile values among north-Europeans than south-Europeans.
Highlights
Vitamin D is a nutrient that has spurred substantial scientific debate over the last 30 years, mostly due to its role in musculoskeletal health[1]
In countries with multiple recruitment areas, the within-country median difference in 25(OH)D concentration ranged from 0·35 ng/ml in Sweden to 2·81 ng/ml in Finland. In this cross-sectional study, which included more than 80 000 participants from six European countries, we observed a northto-south gradient of 25(OH)D status, with higher percentile values in the northernmost countries (i.e. Sweden and Finland) compared with the southernmost countries (i.e. Spain and Italy)
Several other studies with harmonised or standardised data on 25(OH)D have reported on a north-to-south gradient in Europe[16,17,18,19,20,21,22,23]
Summary
Vitamin D is a nutrient that has spurred substantial scientific debate over the last 30 years, mostly due to its role in musculoskeletal health[1]. In several European multicentre studies (n 824 to 55 844 participants) with harmonised (i.e. analysed in the same lab and with the same assay method) or standardised (i.e. using a Vitamin D Standardisation Program protocol[15]) data on 25(OH)D, there has been a positive association between geographical latitude and 25(OH)D status[16,17,18,19,20,21,22,23]; that is, the opposite of what is naively expected if sunlight is the main determinant of 25(OH)D. Using harmonised data on 25(OH)D from more than 80 000 participants in the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project, we conducted the largest study to date on the association between geographical latitude and 25(OH)D status in Europe
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