Abstract

Vitamin D status varies across all continents and countries. Vitamin D status usually is adequate in Latin America and Australia, but in contrast it is very low in the Middle East and some countries in Asia. Trends in vitamin D status, whether it improves or declines over the years, carry important messages. Trends usually are small, but can be predictors and indicators of general health. Vitamin D status has improved in the older population in the United States, and improvement relates to dairy use and vitamin D supplements. To the contrary, vitamin D status has declined in the Inuit population of Canada due to a change from a traditional fish diet to a Western diet. A large improvement was seen in Finland after mandatory fortification of dairy products was introduced. Determinants of decline are less sun exposure, increased use of sunscreen, increase of body mass index (BMI), less physical activity, and poor socioeconomic status. Determinants of increase are food fortification with vitamin D and vitamin D supplements. Food fortification can lead to a population-wide increase in vitamin D status as shown by the Finnish example. (c) 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.


Authors

Lips, Paul;  de Jongh, Renate T.;  van Schoor, Natasja M.

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  • pre-publication peer review (FINAL ROUND)
    Decision Letter
    2021/11/18

    18-Nov-2021

    Dear Paul:

    It is a pleasure to accept your manuscript entitled "Trends in vitamin D status around the world" in its current form for publication in JBMR Plus. If there were further comments from the reviewer(s) who read your manuscript, they will be included at the foot of this letter.

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    Deputy Editor Comments to Author:
    Thank you for addressing the concerns raised by the three reviewers. Your manuscript is now ready for publication in JBMR Plus. One minor change in proofs is required - JBMR+ needs to be changed to JBMR Plus.

    Reviewer(s)' Comments to Author:
    Not received.

    Decision letter by
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    Author Response
    2021/11/18

    Dear Peter,
    We thank the reviewers of our paper for their constructive remarks. We revised our paper according to their comments.
    The answers to the reviewer´s comments are detailed in the attached file.
    We hope that the paper now is suitable for publication in the special issue of JBMR+ dedicated to the late Anthony Norman.
    Kind regards
    Paul Lips



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  • pre-publication peer review (ROUND 1)
    Decision Letter
    2021/09/14

    14-Sep-2021

    RE: JBMR Plus MS# JBM4-07-21-0094 : Trends in vitamin D status around the world

    Dear Paul:

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    Deputy Editor Comments to Author:

    three referees have evaluated your manuscript and made some suggestions for further improvements of an excellent overview

    therefore we look forward to see a revised MS in the near future

    Reviewer(s)' Comments to Author:

    Reviewer: 1

    Comments to the Author
    1. The manuscript describes the trends in vitamin D status around the world. However, it is unclear what period they are referring to. Trends over what time period?

    1. It is unclear if the manuscript is intended to be a systematic review, narrative review, or commentary.

    2. The abstract does not even make a mention of Asia, Europe, and Northern America. Comparing 'southeast' Asia with northern Asia is hardly justified. Where does South Asia fit in? Some of the lowest 25OHD levels, globally, have been reported from South Asia.

    3. The methodology of the study is not described. How was the data collected, or the cited articles chosen? The methodology section mentions only issues related to vitamin D measurement. the last two sentences of the methodology section seem to be superfluous.

    4. A table showing 25(OH)D level of each study/country described by the authors would be a better way to show the data.

    5. The authors need to highlight any new information the manuscript provides

    Reviewer: 2

    Comments to the Author
    The review by Lips and colleagues is a very good summary of trends in vitamin D status over time and regions around the world. It gives the reader some food for thought as well as potential reasons for such changes, which could colour approaches to correction or prevention of low vitamin D status. The following are some comments that the authors could consider:

    1. A minor edit of the title might even better describe the content/focus of the review material - ‘Temporal and regional’ trends in vitamin D status around the world ?
    2. Page 2: First line of the Introduction, while aware it is mentioned in the next paragraph (Methodological issues), perhaps …. While vitamin D status, as reflected by circulating 25-hydroxyvitamin D concentrations, can be considered satisfactory….
    3. Page 2: define DEQAS as first use as used again thereafter.
    4. Page 2: In addition to reference number 6 from 2012, there has also been a more recent assessment of the performance of different types of assays within DEQAS;
      Carter GD, Berry J, Durazo-Arvizu R, Gunter E, Jones G, Jones J, Makin HLJ, Pattni P,
      Sempos CT, Twomey P, Williams EL, Wise SA. Hydroxyvitamin D assays: An historical perspective from DEQAS. J Steroid Biochem Mol Biol. 2018 Mar;177:30-35.
    5. Page 2: the last sentence: Perhaps minor word changes? ‘Vitamin D-effective UVB availability’ depends on latitude, time of the day….. while ‘exposure and response of skin to this UVB in terms of vitamin D production’ is determined by skin pigmentation, clothing ………. The present wording ‘Sunshine exposure depends’ could also depend on clothing, shade etc
    6. First line of page 3: The use of vitamin D supplements can be very effective ‘at increasing circulating 25(OH)D’, but lack……. This sentence might need a reference also.
    7. While the definitions [e.g., severe vitamin D deficiency (serum 25(OH)D <30 nmol/L) and (vitamin D deficiency (serum 25(OH)D <50 nmol/L) read fine in the section called ‘Current vitamin D status’, structurally it might be easier for reader if these were included in the previous section on ‘Methodological issues’. The meaning of the two terms are clear then for subsequent sections.
    8. The point made under the ‘North America’ section about comparing standardized 25(OH)D over time will yield the more accurate comparison, but that this is not always feasible, would also fit well in the ‘Methodological issues’ section, as it comes up under one or two of the regional sections (North America, Europe etc).
    9. As mentioned above if you wish to highlight the temporal as well as regional trends in vitamin D status the section on Page 3 could be re-labelled ‘Trends in vitamin D status: temporal’ and regional’ or some such.
    10. Page 4. Maybe include timeframe (years) for sentence …. In the UK, an increase in vitamin D status from X to Y was attributed to …
    11. Page 4: there are also temporal trend data from Germany which is based on standardized data of adults;
      Rabenberg M, Scheidt-Nave C, Busch MA, Thamm M, Rieckmann N, Durazo-Arvizu RA, Dowling KG, Škrabáková Z, Cashman KD, Sempos CT, Mensink GBM. Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis. BMC Public Health. 2018 Jul 6;18(1):845. doi: 10.1186/s12889-018-5769-y. PMID: 29980236; PMCID: PMC6035438.

    12. Page 5. The first line in the Africa section might include the reference number (46) at the end. Is it worth highlighted that data on temporal changes within Africa are lacking ?

    Reviewer: 3

    Comments to the Author
    Very well done
    Suggestions:
    1. They have dedicated this publication to Anthony Norman which is commendable. However it is unclear what they mean by series of manuscripts?
    There is no reference for this nor is this at all explained.
    2. There is a table/figure but does not appear to be referenced in the manuscript.
    3. They document various Food sources being fortified with vitamin D including juice products. It would be worthwhile to include where this occurs i.e. only in the United States with a reference.
    India in 2017 approved the fortification of cooking oil and milk with vitamin D2. It would be worthwhile to note this rather than giving a reference
    that is a review article.
    4. The authors may not be aware that there is a dairy company in the UAE that fortifies milk. Al Rawabi milk has 800 IUs and 100 g

    Decision letter by
    Cite this decision letter
    Reviewer report
    2021/09/08

    Very well done
    Suggestions:
    1. They have dedicated this publication to Anthony Norman which is commendable. However it is unclear what they mean by series of manuscripts?
    There is no reference for this nor is this at all explained.
    2. There is a table/figure but does not appear to be referenced in the manuscript.
    3. They document various Food sources being fortified with vitamin D including juice products. It would be worthwhile to include where this occurs i.e. only in the United States with a reference.
    India in 2017 approved the fortification of cooking oil and milk with vitamin D2. It would be worthwhile to note this rather than giving a reference
    that is a review article.
    4. The authors may not be aware that there is a dairy company in the UAE that fortifies milk. Al Rawabi milk has 800 IUs and 100 g

    Reviewed by
    Cite this review
    Reviewer report
    2021/08/23

    The review by Lips and colleagues is a very good summary of trends in vitamin D status over time and regions around the world. It gives the reader some food for thought as well as potential reasons for such changes, which could colour approaches to correction or prevention of low vitamin D status. The following are some comments that the authors could consider:

    1. A minor edit of the title might even better describe the content/focus of the review material - ‘Temporal and regional’ trends in vitamin D status around the world ?
    2. Page 2: First line of the Introduction, while aware it is mentioned in the next paragraph (Methodological issues), perhaps …. While vitamin D status, as reflected by circulating 25-hydroxyvitamin D concentrations, can be considered satisfactory….
    3. Page 2: define DEQAS as first use as used again thereafter.
    4. Page 2: In addition to reference number 6 from 2012, there has also been a more recent assessment of the performance of different types of assays within DEQAS;
      Carter GD, Berry J, Durazo-Arvizu R, Gunter E, Jones G, Jones J, Makin HLJ, Pattni P,
      Sempos CT, Twomey P, Williams EL, Wise SA. Hydroxyvitamin D assays: An historical perspective from DEQAS. J Steroid Biochem Mol Biol. 2018 Mar;177:30-35.
    5. Page 2: the last sentence: Perhaps minor word changes? ‘Vitamin D-effective UVB availability’ depends on latitude, time of the day….. while ‘exposure and response of skin to this UVB in terms of vitamin D production’ is determined by skin pigmentation, clothing ………. The present wording ‘Sunshine exposure depends’ could also depend on clothing, shade etc
    6. First line of page 3: The use of vitamin D supplements can be very effective ‘at increasing circulating 25(OH)D’, but lack……. This sentence might need a reference also.
    7. While the definitions [e.g., severe vitamin D deficiency (serum 25(OH)D <30 nmol/L) and (vitamin D deficiency (serum 25(OH)D <50 nmol/L) read fine in the section called ‘Current vitamin D status’, structurally it might be easier for reader if these were included in the previous section on ‘Methodological issues’. The meaning of the two terms are clear then for subsequent sections.
    8. The point made under the ‘North America’ section about comparing standardized 25(OH)D over time will yield the more accurate comparison, but that this is not always feasible, would also fit well in the ‘Methodological issues’ section, as it comes up under one or two of the regional sections (North America, Europe etc).
    9. As mentioned above if you wish to highlight the temporal as well as regional trends in vitamin D status the section on Page 3 could be re-labelled ‘Trends in vitamin D status: temporal’ and regional’ or some such.
    10. Page 4. Maybe include timeframe (years) for sentence …. In the UK, an increase in vitamin D status from X to Y was attributed to …
    11. Page 4: there are also temporal trend data from Germany which is based on standardized data of adults;
      Rabenberg M, Scheidt-Nave C, Busch MA, Thamm M, Rieckmann N, Durazo-Arvizu RA, Dowling KG, Škrabáková Z, Cashman KD, Sempos CT, Mensink GBM. Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis. BMC Public Health. 2018 Jul 6;18(1):845. doi: 10.1186/s12889-018-5769-y. PMID: 29980236; PMCID: PMC6035438.

    12. Page 5. The first line in the Africa section might include the reference number (46) at the end. Is it worth highlighted that data on temporal changes within Africa are lacking ?

    Reviewed by
    Cite this review
    Reviewer report
    2021/08/17

    1. The manuscript describes the trends in vitamin D status around the world. However, it is unclear what period they are referring to. Trends over what time period?

    2. It is unclear if the manuscript is intended to be a systematic review, narrative review, or commentary.

    3. The abstract does not even make a mention of Asia, Europe, and Northern America. Comparing 'southeast' Asia with northern Asia is hardly justified. Where does South Asia fit in? Some of the lowest 25OHD levels, globally, have been reported from South Asia.

    4. The methodology of the study is not described. How was the data collected, or the cited articles chosen? The methodology section mentions only issues related to vitamin D measurement. the last two sentences of the methodology section seem to be superfluous.

    5. A table showing 25(OH)D level of each study/country described by the authors would be a better way to show the data.

    6. The authors need to highlight any new information the manuscript provides

    Reviewed by
    Cite this review
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