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Vitamin D and Public Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 December 2018) | Viewed by 86073

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Special Issue Editors

Prof. Dr. Peter Ebeling

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Guest Editor

Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
Interests: osteoporosis; sarcopenia; vitamin D; calcium; fractures; falls

Dr. David Scott

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Guest Editor

Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
Interests: sarcopenia; obesity; osteoporosis; exercise; nutrition
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Vitamin D deficiency is a global public health issue. Long recognised as having an important role in bone metabolism, higher vitamin D levels have also been associated with improved immune function, muscle, reproductive and cardiometabolic health, as well as reduced risk of cancer and neurodegenerative diseases, including multiple sclerosis. Vitamin D is primarily obtained through ultraviolet-B light exposure from the sun and achieving adequate vitamin D levels is particularly challenging in specific populations including those with low sun exposure and/or darker skin, and older adults. Vitamin D supplementation is generally recommended for those with, or at increased risk of, vitamin D deficiency. To date there is limited evidence from randomised controlled trials that vitamin D supplementation is beneficial for non-skeletal health, but vitamin D screening and prescription are commonplace in the clinical setting. This Special Issue will focus of the role of vitamin D in public health and address current controversies including, but not limited to, associations of vitamin D metabolites with health outcomes, optimal target levels and response to supplemental doses of vitamin D, food fortification and vitamin D, negative outcomes of high-dose vitamin D supplementation, and health economics of vitamin D testing and supplementation.

Prof. Peter Ebeling
Dr. David Scott
Guest Editors

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Keywords

vitamin D
25-hydroxyvitamin D
cholecalciferol
public health
disease
screening
supplementation
health economics

Published Papers (12 papers)

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12 pages, 310 KiB

Open AccessArticle

Associations of Serum 25-Hydroxyvitamin D with Physical Performance and Bone Health in Overweight and Obese Older Adults

by Melissa Dang, Cat Shore-Lorenti, Lachlan B. McMillan, Jakub Mesinovic, Alan Hayes, Peter R. Ebeling and David Scott

Int. J. Environ. Res. Public Health 2019, 16(3), 509; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16030509 - 12 Feb 2019

Cited by 13 | Viewed by 3423

Abstract

Low vitamin D status commonly accompanies obesity, and both vitamin D deficiency and obesity have been associated with falls and fracture risk in older adults. We aimed to determine the associations of serum 25-hydroxyvitamin D (25(OH)D) concentrations with physical performance and bone health in community-dwelling, overweight and obese older men and women. Serum 25(OH)D concentrations were measured in 84 participants with body mass index ≥25 kg/m² (mean ± SD age 62.4 ± 7.9 years; 55% women). Physical function was determined by short physical performance battery, hand grip and quadriceps strength, and stair climb power tests. Body composition and bone structure were assessed by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. Mean ± SD 25(OH)D was 49.6 ± 17.7 nmol/L, and 50% of participants had low 25(OH)D (<50 nmol/L) levels. 25(OH)D concentrations were positively associated with quadricep strength and stair climb power in women (B = 0.15; 95% CI 0.02–0.27 kg and B = 1.07; 95% CI 0.12–2.03 W, respectively) but not in men. There were no associations between 25(OH)D and bone parameters in either sex after multivariable adjustment (all p > 0.05). Lower 25(OH)D concentrations are associated with poorer quadricep strength and muscle power in overweight and obese older women but not men. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

14 pages, 638 KiB

Open AccessArticle

Vitamin D Status and Analysis of Specific Correlates in Preschool Children: A Cross-Sectional Study in Southern Croatia

by Zeljka Karin, Barbara Gilic, Daniela Supe Domic, Zdenko Sarac, Katarina Ercegovic, Natasa Zenic, Ognjen Uljevic, Mia Peric and Josko Markic

Int. J. Environ. Res. Public Health 2018, 15(11), 2503; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15112503 - 08 Nov 2018

Cited by 16 | Viewed by 3676

Abstract

Vitamin D deficiency is a globally important problem, particularly in children, but there is a lack of information regarding this deficiency in preschool children from southeastern Europe. This study aimed to establish the levels of 25-hydroxyvitamin D (25(OH)D) and associations of gender, time spent outdoors, physical activity (PA), and body mass index (as predictors) with the 25(OH)D level (outcome) in healthy preschool children. The participants were preschoolers (all 5–6 years of age) from southern Croatia. All the participants were tested during their mandatory medical examination 6–7 months prior to school enrollment. The PA was obtained using the preschool-age physical activity questionnaire (Pre-PAQ), which categorizes PA into five levels (from sedentary to vigorous PA). The prevalence of 25(OH)D deficiency was high: 58% of the children had 25(OH)D levels of <50 nmol/L (deficiency), and an additional 29% had an insufficient level of 25(OH)D (50–75 nmol/L). Boys had higher levels of 25(OH)D than girls. A multinomial regression using 25(OH)D categories as the outcome and a sufficient level (>75 nmol/L) as the reference value identified gender as the only significant predictor of 25(OH)D status, with boys being at lower risk for 25(OH)D deficiency than girls. These results showed a high prevalence of 25(OH)D deficiency in preschoolers from the southern part of Croatia, which is additionally alarming based on the geographical position of the studied region (42° N) and its high number of sunshine hours (>2600 h per year). Future studies examining other potential correlates of 25(OH)D in the region are warranted. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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15 pages, 1076 KiB

Open AccessArticle

Knowledge, Attitudes and Perceptions towards Vitamin D in a UK Adult Population: A Cross-Sectional Study

by Clodagh O’Connor, Dominique Glatt, Lois White and Raquel Revuelta Iniesta

Int. J. Environ. Res. Public Health 2018, 15(11), 2387; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15112387 - 27 Oct 2018

Cited by 31 | Viewed by 6959

Abstract

The prevalence of vitamin D deficiency in the United Kingdom is high, despite updated Scientific Advisory Committee on Nutrition (SACN) guidelines. Therefore, our aims were to identify population knowledge, attitudes and perceptions of vitamin D supplementation and factors contributing to supplement use in a UK adult population. A cross-sectional study was performed between April–June 2018 using a newly designed piloted questionnaire. Scores for knowledge were calculated as a percentage (Boland et al. 2015). Logistic regression analysis was used to predict supplement use. 209 participants (82% female), mean (±SD) age 34.9 (±12.3) completed the questionnaire. The mean (±SD) vitamin D knowledge score was 56.6% (±19.9%); only 48% were concerned about their vitamin D concentration and 57% did not take vitamin D. Most participants (86%) wished to learn more about vitamin D. Knowledge score (OR 2.5; p = 0.01; 95% CI 1.2–5.3), concern (OR 2.1; p = 0.03; 95% CI 1.0–4.2) and location (OR 0.3; p = 0.006; 95% CI 0.1–0.7) predicted supplemented use. Individuals living in England had 2.9 (95% CI 1.4–6.3) lower odds of taking vitamin D than those living in Scotland. As a result of these findings, this study suggests that vitamin D supplementation and fortification, alongside education strategies, may be an effective method for improving UK vitamin D health; however, more research is warranted. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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13 pages, 1508 KiB

Open AccessArticle

Vitamin D Supplementation and Nordic Walking Training Decreases Serum Homocysteine and Ferritin in Elderly Women

by Anna Walentukiewicz, Anna Lysak-Radomska, Joanna Jaworska, Krzysztof Prusik, Katarzyna Prusik, Jakub Antoni Kortas, Marcin Lipiński, Anna Babinska, Jedrzej Antosiewicz and Ewa Ziemann

Int. J. Environ. Res. Public Health 2018, 15(10), 2064; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15102064 - 20 Sep 2018

Cited by 14 | Viewed by 3872

Abstract

The aim of the study was to verify if coupling 12 weeks of vitamin D supplementation and Nordic walking training favoured lowering the homocysteine (Hcy) level. Ninety-four elderly women were divided into three groups: Nordic walking (NW), supplemented (SG) and control (CG). The NW and SG groups received a weekly dose of 28,000 IU of vitamin D3. A blood analysis was performed at baseline, 1h after the first training session and at the end of the experiment. The amino acid profile (methionine and cysteine) and homocysteine concentration were determined. Additionally, the concentration of myokine was assessed. The first session of NW training reduced serum homocysteine, particularly among women with baseline homocysteine above 10 µmol·L⁻¹: 12.37 ± 2.75 vs. 10.95 ± 3.94 µmol·L⁻¹ (p = 0.05). These changes were accompanied by shifts in the cysteine (p = 0.09) and methionine (p = 0.01) concentration, regardless of the Hcy concentration. Twelve weeks of training significantly decreased the homocysteine (9.91 ± 2.78, vs. 8.90 ± 3.14 µmol·L⁻¹, p = 0.05) and ferritin (94.23 ± 62.49 vs. 73.15 ± 47.04 ng·mL⁻¹, p = 0.05) concentrations in whole NW group. Also, in the NW group, ferritin correlated with the glucose level (r = 0.51, p = 0.00). No changes in the myokine levels were observed after the intervention. Only the brain-derived neurotrophic factor dropped in the NW (42.74 ± 19.92 vs. 31.93 ± 15.91 ng·mL⁻¹, p = 0.01) and SG (37.75 ± 8.08 vs. 16.94 ± 12.78 ng·mL⁻¹, p = 0.00) groups. This study presents a parallel decrease of homocysteine and ferritin in response to regular training supported by vitamin D supplementation. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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12 pages, 1387 KiB

Open AccessArticle

Vitamin D₃ Supplementation Reduces the Symptoms of Upper Respiratory Tract Infection during Winter Training in Vitamin D-Insufficient Taekwondo Athletes: A Randomized Controlled Trial

by Hyun Chul Jung, Myong-Won Seo, Sukho Lee, Sung Woo Kim and Jong Kook Song

Int. J. Environ. Res. Public Health 2018, 15(9), 2003; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15092003 - 14 Sep 2018

Cited by 24 | Viewed by 8813

Abstract

Vitamin D insufficiency may be associated with increased risk of upper respiratory tract infection (URTI) in athletes. This study examined the effects of vitamin D₃ supplementation on salivary immune functions and symptoms of URTI in vitamin D-insufficient taekwondo athletes. Twenty-five male taekwondo athletes, aged 19–22 years with vitamin D insufficiency [serum 25-hydroxyvitamin-D concentrations (25(OH)D, 31.3 ± 1.39 nmol/L)], participated in this study. They were randomized to receive 5000 IU/day of vitamin D₃ (n = 13) or placebo capsule (n = 12) during 4 weeks of winter training. Blood samples were collected two times (pre- and post-tests) for analyzing serum 25(OH)D concentration while salivary samples were obtained three times (pre-, mid-, and post-tests) for secretory immunoglobulin A (SIgA) and lactoferrin analyses. The symptoms of URTI were reported daily during the intervention. Serum 25(OH)D concentration significantly increased by 255.6% in the vitamin D group, whereas in the placebo group it did not change (p < 0.001). While the significant increase in SIgA was observed in both groups (p < 0.001), elevated salivary lactoferrin level in response to winter training was found only in the placebo group (p = 0.011). The change in serum 25(OH)D concentration was negatively associated with total URTI symptoms (r = −0.435, p = 0.015). Vitamin D₃ supplementation may be effective in reducing the symptoms of URTI during winter training in vitamin D-insufficient taekwondo athletes. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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10 pages, 310 KiB

Open AccessArticle

The State of Knowledge about Nutrition Sources of Vitamin D, Its Role in the Human Body, and Necessity of Supplementation among Parents in Central Poland

by Katarzyna Zadka, Ewelina Pałkowska-Goździk and Danuta Rosołowska-Huszcz

Int. J. Environ. Res. Public Health 2018, 15(7), 1489; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15071489 - 14 Jul 2018

Cited by 18 | Viewed by 4533

Abstract

The percentage of children with vitamin D deficiency in Poland is alarming. The aim of the study was to assess the knowledge about sources of food and the function of vitamin D, as well as the frequency of its supplementation. A survey was conducted among the parents of children from Central Poland attending primary schools, and a questionnaire containing mainly open-ended questions was used to collect the data. Most mothers knew at least one of the functions of vitamin D in the body but had a low level of knowledge about its dietary sources. Only a small group of respondents supplemented themselves and their children with vitamin D. Statistically significant influences on the level of knowledge about the functions and sources of vitamin D were place of residence (i.e., better knowledge in the countryside) and mothers’ level of education (i.e., the better educated, the greater knowledge). In the case of monthly income level, such impact was observed only in relation to the knowledge of vitamin D functions. Concerning the frequency of supplementation, only maternal level of education had a statistically significant effect (i.e., the higher the education level, the higher the frequency of supplementation). In addition, mothers who were aware of functions of vitamin D and nutritional sources, significantly more frequently supplemented vitamin D. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

Review

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23 pages, 3284 KiB

Open AccessReview

Vitamin D Status and Mortality: A Systematic Review of Observational Studies

by Alicia K Heath, Iris Y Kim, Allison M Hodge, Dallas R English and David C Muller

Int. J. Environ. Res. Public Health 2019, 16(3), 383; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16030383 - 29 Jan 2019

Cited by 68 | Viewed by 8523

Abstract

Epidemiological evidence suggests that vitamin D deficiency is associated with increased mortality, but it is unclear whether this is explained by reverse causation, and if there are specific causes of death for which vitamin D might be important. We conducted a systematic review of observational studies investigating associations between circulating 25-hydroxyvitamin D (25(OH)D) concentration and all-cause or cause-specific mortality in generally healthy populations. Relevant studies were identified using PubMed and EMBASE searches. After screening 722 unique records and removing those that were ineligible, 84 articles were included in this review. The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality. This association appeared to be non-linear, with progressively lower mortality with increasing 25(OH)D up to a point, beyond which there was no further decrease. There is moderate evidence that vitamin D status is inversely associated with cancer mortality and death due to respiratory diseases, while for cardiovascular mortality, there is weak evidence of an association in observational studies, which is not supported by the data from intervention or Mendelian randomization studies. The relationship between vitamin D status and other causes of death remains uncertain due to limited data. Larger long-term studies are required to clarify these associations. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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10 pages, 290 KiB

Open AccessReview

Controversies Surrounding Vitamin D: Focus on Supplementation and Cancer

by Salvatore Minisola, Federica Ferrone, Vittoria Danese, Veronica Cecchetti, Jessica Pepe, Cristiana Cipriani and Luciano Colangelo

Int. J. Environ. Res. Public Health 2019, 16(2), 189; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16020189 - 11 Jan 2019

Cited by 28 | Viewed by 4513

Abstract

There has recently been a huge number of publications concerning various aspects of vitamin D, from the physiological to therapeutic fields. However, as a consequence of this very fast-growing scientific area, some issues still remain surrounded by uncertainties, without a final agreement having been reached. Examples include the definitions of vitamin D sufficiency and insufficiency, (i.e., 20 vs. 30 ng/mL), the relationship between 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, (i.e., linear vs. no linear), the referent to consider, (i.e., total vs. free determination), the utility of screening versus universal supplementation, and so on. In this review, the issues related to vitamin D supplementation in subjects with documented hypovitaminosis, and the role of vitamin D in cancer will be concisely considered. Daily, weekly, or monthly administration of cholecalciferol generally leads to essentially similar results in terms of an increase in 25(OH)D serum levels. However, we should also consider possible differences related to a number of variables, (i.e., efficiency of intestinal absorption, binding to vitamin D binding protein, and so on). Thus, adherence to therapy may be more important than the dose regimen chosen in order to allow long-term compliance in a sometimes very old population already swamped by many drugs. It is difficult to draw firm conclusions at present regarding the relationship between cancer and vitamin D. In vitro and preclinical studies seem to have been more convincing than clinical investigations. Positive results in human studies have been mainly derived from post-hoc analyses, secondary end-points or meta-analyses, with the last showing not a decrease in cancer incidence but rather in mortality. We must therefore proceed with a word of caution. Until it has been clearly demonstrated that there is a causal relationship, these positive “non-primary, end-point results” should be considered as a background for generating new hypotheses for future investigations. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

14 pages, 606 KiB

Open AccessReview

Summary Outcomes of the ODIN Project on Food Fortification for Vitamin D Deficiency Prevention

by Mairead Kiely and Kevin D. Cashman

Int. J. Environ. Res. Public Health 2018, 15(11), 2342; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15112342 - 24 Oct 2018

Cited by 38 | Viewed by 5289

Abstract

Food-based solutions for optimal vitamin D nutrition and health through the life cycle (ODIN) was a cross-disciplinary, collaborative project, including 30 partners from 19 countries, which aimed to develop evidence-based solutions to prevent low vitamin D status (25-hydroxyvitamin D (25(OH)D) < 30 nmol/L) using a food-first approach. This paper provides a summary overview of some of the important ODIN outcomes and outlines some outstanding data requirements. In a study of almost 56,000 individuals, the first internationally standardised dataset of vitamin D status showed that 13% of EU residents overall, across a latitude gradient of 35° N to 69° N, had serum 25(OH)D < 30 nmol/L and 40% were < 50 nmol/L. The risk of low vitamin D status was several-fold higher among persons of ethnic minority. However, additional data from quality bio-banked sera would be required to improve these estimates. To address the question of dietary requirements for vitamin D among under-researched life-stage and population groups, four dose-response RCTs conducted in Northern Europe showed that vitamin D₃ intakes of 8 and 13 μg/day prevented 25(OH)D decreasing below 30 nmol/L in white children and adolescents and 20 and 30 μg/day, respectively, achieved ≥50 nmol/L. Among white women during pregnancy, 30 μg/day is required to prevent umbilical cord 25(OH)D, representing new-born vitamin D status, below 25 nmol/L. While 8 μg/day protected white women in Finland at the 30 nmol/L cut-off, 18 μg/day was needed by women of East African descent to prevent 25(OH)D decreasing below 30 nmol/L during wintertime. Replicate RCTs are needed in young children <5 years and in school-age children, teens and pregnant women of ethnic minority. Using a series of food production studies, food-based RCTs and dietary modelling experiments, ODIN research shows that diverse fortification strategies could safely increase population intakes and prevent low vitamin D status. Building on this solid technological platform, implementation research is now warranted to scale up interventions in real-world settings to eradicate vitamin D deficiency. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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19 pages, 376 KiB

Open AccessReview

The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data

by Stefan Pilz, Armin Zittermann, Rima Obeid, Andreas Hahn, Pawel Pludowski, Christian Trummer, Elisabeth Lerchbaum, Faustino R. Pérez-López, Spyridon N. Karras and Winfried März

Int. J. Environ. Res. Public Health 2018, 15(10), 2241; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15102241 - 12 Oct 2018

Cited by 107 | Viewed by 17749

Abstract

Vitamin D deficiency is common and there exists a huge gap between recommended dietary vitamin D intakes and the poor vitamin D supply in the general population. While vitamin D is important for musculoskeletal health, there are accumulating data suggesting that vitamin D may also be important for fertility, pregnancy outcomes and lactation. Significant changes in vitamin D metabolism during pregnancy such as increased production of the “active vitamin D hormone” calcitriol support the important role of vitamin D in this setting. Observational studies show that vitamin D deficiency is a risk marker for reduced fertility and various adverse pregnancy outcomes and is associated with a low vitamin D content of breast milk. Meta-analyses of randomized controlled trials (RCTs) document that physiological vitamin D supplementation during pregnancy is safe and improves vitamin D and calcium status, thereby protecting skeletal health. Although certain RCTs and/or meta-analyses reported some other beneficial effects, it is still not clear whether vitamin D supplementation improves fertility or decreases the risk of adverse pregnancy outcomes such as low birth weight, pre-eclampsia and neonatal mortality, or reduces wheeze/asthma in the infants. Nevertheless, vitamin D supplementation in pregnant women is frequently required to achieve a sufficient vitamin D status as recommended by nutritional vitamin D guidelines. In this review, we provide an overview of systematic reviews, meta-analyses and large trials reporting clinical data on the role of vitamin D for fertility, pregnancy and lactation. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

16 pages, 1304 KiB

Open AccessReview

Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies

by Pedro Henrique Franca Gois, Martin Wolley, Dwarakanathan Ranganathan and Antonio Carlos Seguro

Int. J. Environ. Res. Public Health 2018, 15(8), 1773; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15081773 - 17 Aug 2018

Cited by 74 | Viewed by 12063

Abstract

Vitamin D (VD) is a pro-hormone essential for life in higher animals. It is present in few types of foods and is produced endogenously in the skin by a photochemical reaction. The final step of VD activation occurs in the kidneys involving a second hydroxylation reaction to generate the biologically active metabolite 1,25(OH)₂-VD. Extrarenal 1α-hydroxylation has also been described to have an important role in autocrine and paracrine signaling. Vitamin D deficiency (VDD) has been in the spotlight as a major public healthcare issue with an estimated prevalence of more than a billion people worldwide. Among individuals with chronic kidney disease (CKD), VDD prevalence has been reported to be as high as 80%. Classically, VD plays a pivotal role in calcium and phosphorus homeostasis. Nevertheless, there is a growing body of evidence supporting the importance of VD in many vital non-skeletal biological processes such as endothelial function, renin-angiotensin-aldosterone system modulation, redox balance and innate and adaptive immunity. In individuals with CKD, VDD has been associated with albuminuria, faster progression of kidney disease and increased all-cause mortality. Recent guidelines support VD supplementation in CKD based on extrapolation from cohorts conducted in the general population. In this review, we discuss new insights on the multifactorial pathophysiology of VDD in CKD as well as how it may negatively modulate different organs and systems. We also critically review the latest evidence and controversies of VD monitoring and supplementation in CKD patients. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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Other

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17 pages, 2930 KiB

Open AccessPerspective

Shedding Light on Vitamin D Status and Its Complexities during Pregnancy, Infancy and Childhood: An Australian Perspective

by Nelfio Di Marco, Jonathan Kaufman and Christine P. Rodda

Int. J. Environ. Res. Public Health 2019, 16(4), 538; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16040538 - 13 Feb 2019

Cited by 10 | Viewed by 5581

Abstract

Ensuring that the entire Australian population is Vitamin D sufficient is challenging, given the wide range of latitudes spanned by the country, its multicultural population and highly urbanised lifestyle of the majority of its population. Specific issues related to the unique aspects of vitamin D metabolism during pregnancy and infancy further complicate how best to develop a universally safe and effective public health policy to ensure vitamin D adequacy for all. Furthermore, as Australia is considered a “sunny country”, it does not yet have a national vitamin D food supplementation policy. Rickets remains very uncommon in Australian infants and children, however it has been recognised for decades that infants of newly arrived immigrants remain particularly at risk. Yet vitamin D deficiency rickets is entirely preventable, with the caveat that when rickets occurs in the absence of preexisting risk factors and/or is poorly responsive to adequate treatment, consideration needs to be given to genetic forms of rickets. Full article

(This article belongs to the Special Issue Vitamin D and Public Health)

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