Countries often only consider their own vitamin D publications (example – South Africa) – Oct 2016

Vitamin D Status and Its Consequences for Health in South Africa

Int. J. Environ. Res. Public Health 2016, 13(10), 1019; doi:10.3390/ijerph13101019 (registering DOI)
Mary Norval 1, Anna K. Coussens 2, Robert J. Wilkinson 2,3,4, Liza Bornman 5, Robyn M. Lucas 6 and Caradee Y. Wright 7,*
1 Biomedical Science, University of Edinburgh Medical School, Edinburgh EH8 9AG, UK
2 Clinical Infectious Disease Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town 7701, South Africa
3 Department of Medicine, Imperial College London, London SW7 2AZ, UK
4 Mill Hill Laboratory, Francis Crick Institute, London NW1 2BE, UK
5 Department of Biochemistry, Faculty of Science, University of Johannesburg, Gauteng 2006, South Africa
6 National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia
7 South African Medical Research Council, Environment and Health Research Unit and University of Pretoria, Department of Geography, Geoinformatics and Meteorology, Pretoria 0001, South Africa
* Author to whom correspondence should be addressed.

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In this review, reports were retrieved in which vitamin D status, as assessed by serum 25-hydroxyvitamin D [25(OH)D] levels, was measured in South African population groups with varied skin colours and ethnicities. Healthy children and adults were generally vitamin D-sufficient [25(OH)D level >50 nmol/L] but the majority of those aged above 65 years were deficient. A major role for exposure to solar ultraviolet radiation (UVR) in determining 25(OH)D levels was apparent, with the dietary contribution being minor. Limited data exist regarding the impact of recent changes in lifestyles on vitamin D status, such as urbanisation. With regard to disease susceptibility, 11 of 22 relevant publications indicated association between low 25(OH)D levels and disease, with deficiency most notably found in individuals with tuberculosis and HIV-1. Information on the relationship between vitamin D receptor variants and ethnicity, disease or treatment response in the South African population groups demonstrated complex interactions between genetics, epigenetics and the environment. Whether vitamin D plays an important role in protection against the range of diseases that currently constitute a large burden on the health services in South Africa requires further investigation. Only then can accurate advice be given about personal sun exposure or dietary vitamin D supplementation.