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Dietary, lifestyle, and genetic determinants of vitamin D status: a cross-sectional analysis from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study

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Abstract

Purpose

Considerable variation in 25-hydroxyvitamin D (25(OH)D) in populations worldwide that seems to be independent of latitude has been reported. Therefore, we aimed to assess vitamin D status of a mid-aged German general population and to identify its dietary, lifestyle, anthropometric, and genetic determinants.

Methods

25(OH)D concentrations were measured by LC–MS/MS in plasma samples of a random subcohort of the German arm of the European Prospective Investigation into Cancer and Nutrition (EPIC) comprising 2,100 subjects aged 35–65 years. Associations between potential predictors and 25(OH)D were assessed by linear regression models.

Results

32.8 % of the variance in 25(OH)D was explained by a multivariable regression model, with season being the by far strongest predictor (semi-partial R 2: 14.6 %). Sex, waist circumference, leisure time physical activity, smoking, polymorphisms in the GC, CYP2R1, and DHCR7 genes, supplement use, exogenous hormone use, alcohol consumption, egg consumption, and fish consumption were significantly associated with 25(OH)D concentrations as well. However, none of these factors explained >2.3 % of the variance in 25(OH)D.

Conclusion

Even with a comprehensive set of genetic, anthropometric, dietary, and lifestyle correlates, not more than 32.8 % of the variation in 25(OH)D could be explained in the EPIC-Germany study, implying that vitamin D prediction scores may not provide an appropriate proxy for measured 25(OH)D. Food intake was only a weak predictor of 25(OH)D concentrations, while a strong seasonal fluctuation in 25(OH)D was shown.

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References

  1. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281. doi:10.1056/NEJMra070553

    Article  CAS  Google Scholar 

  2. Norman AW, Bouillon R (2010) Vitamin D nutritional policy needs a vision for the future. Exp Biol Med (Maywood) 235(9):1034–1045. doi:10.1258/ebm.2010.010014

    Article  CAS  Google Scholar 

  3. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77(1):204–210

    CAS  Google Scholar 

  4. Hypponen E, Power C (2007) Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr 85(3):860–868

    CAS  Google Scholar 

  5. Millen AE, Wactawski-Wende J, Pettinger M, Melamed ML, Tylavsky FA, Liu S, Robbins J, LaCroix AZ, LeBoff MS, Jackson RD (2010) Predictors of serum 25-hydroxyvitamin D concentrations among postmenopausal women: the Women’s Health Initiative Calcium plus Vitamin D clinical trial. Am J Clin Nutr 91(5):1324–1335. doi:10.3945/ajcn.2009.28908

    Article  CAS  Google Scholar 

  6. Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, Josse R, Kanis JA, Mithal A, Pierroz DD, Stenmark J, Stocklin E, Dawson-Hughes B (2012) A global representation of vitamin D status in healthy populations. Arch Osteoporos 7(1–2):155–172. doi:10.1007/s11657-012-0093-0

    Article  CAS  Google Scholar 

  7. Toss G, Magnusson P (2012) Vitamin D status: sunshine is nice but other factors prevail. Eur J Nutr. doi:10.1007/s00394-012-0315-7

    Google Scholar 

  8. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine S (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930. doi:10.1210/jc.2011-0385

    Article  CAS  Google Scholar 

  9. Rosen CJ, Adams JS, Bikle DD, Black DM, Demay MB, Manson JE, Murad MH, Kovacs CS (2012) The nonskeletal effects of vitamin D: an endocrine society scientific statement. Endocr Rev 33(3):456–492. doi:10.1210/er.2012-1000

    Article  CAS  Google Scholar 

  10. Freedman DM, Cahoon EK, Rajaraman P, Major JM, Doody MM, Alexander BH, Hoffbeck RW, Kimlin MG, Graubard BI, Linet MS (2013) Sunlight and other determinants of circulating 25-hydroxyvitamin D levels in black and white participants in a nationwide U.S. study. Am J Epidemiol 177(2):180–192. doi:10.1093/aje/kws223

    Article  Google Scholar 

  11. Bertrand KA, Giovannucci E, Liu Y, Malspeis S, Eliassen AH, Wu K, Holmes MD, Laden F, Feskanich D (2012) Determinants of plasma 25-hydroxyvitamin D and development of prediction models in three US cohorts. Br J Nutr 1–8. doi:10.1017/S0007114511007409

  12. Liu E, Meigs JB, Pittas AG, Economos CD, McKeown NM, Booth SL, Jacques PF (2010) Predicted 25-hydroxyvitamin D score and incident type 2 diabetes in the Framingham Offspring Study. Am J Clin Nutr 91(6):1627–1633. doi:10.3945/ajcn.2009.28441

    Article  CAS  Google Scholar 

  13. Chan J, Jaceldo-Siegl K, Fraser GE (2010) Determinants of serum 25 hydroxyvitamin D levels in a nationwide cohort of blacks and non-Hispanic whites. Cancer Causes Control 21(4):501–511. doi:10.1007/s10552-009-9481-1

    Article  Google Scholar 

  14. Gilbert R, Martin RM, Fraser WD, Lewis S, Donovan J, Hamdy F, Neal DE, Lane JA, Metcalfe C (2012) Predictors of 25-hydroxyvitamin D and its association with risk factors for prostate cancer: evidence from the prostate testing for cancer and treatment study. Cancer Causes Control 23(4):575–588. doi:10.1007/s10552-012-9919-8

    Article  Google Scholar 

  15. Lucas RM, Ponsonby AL, Dear K, Valery PC, Taylor B, van der Mei I, McMichael AJ, Pender MP, Chapman C, Coulthard A, Kilpatrick TJ, Stankovich J, Williams D, Dwyer T (2013) Vitamin D status: Multifactorial contribution of environment, genes and other factors in healthy Australian adults across a latitude gradient. J Steroid Biochem Mol Biol. doi:10.1016/j.jsbmb.2013.01.011

  16. Ahn J, Yu K, Stolzenberg-Solomon R, Simon KC, McCullough ML, Gallicchio L, Jacobs EJ, Ascherio A, Helzlsouer K, Jacobs KB, Li Q, Weinstein SJ, Purdue M, Virtamo J, Horst R, Wheeler W, Chanock S, Hunter DJ, Hayes RB, Kraft P, Albanes D (2010) Genome-wide association study of circulating vitamin D levels. Hum Mol Genet 19(13):2739–2745. doi:10.1093/hmg/ddq155

    Article  CAS  Google Scholar 

  17. Hiraki LT, Major JM, Chen C, Cornelis MC, Hunter DJ, Rimm EB, Simon KC, Weinstein SJ, Purdue MP, Yu K, Albanes D, Kraft P (2013) Exploring the genetic architecture of circulating 25-hydroxyvitamin D. Genet Epidemiol 37(1):92–98. doi:10.1002/gepi.21694

    Article  Google Scholar 

  18. Wang TJ, Zhang F, Richards JB, Kestenbaum B, van Meurs JB, Berry D, Kiel DP, Streeten EA, Ohlsson C, Koller DL, Peltonen L, Cooper JD, O’Reilly PF, Houston DK, Glazer NL, Vandenput L, Peacock M, Shi J, Rivadeneira F, McCarthy MI, Anneli P, de Boer IH, Mangino M, Kato B, Smyth DJ, Booth SL, Jacques PF, Burke GL, Goodarzi M, Cheung CL, Wolf M, Rice K, Goltzman D, Hidiroglou N, Ladouceur M, Wareham NJ, Hocking LJ, Hart D, Arden NK, Cooper C, Malik S, Fraser WD, Hartikainen AL, Zhai G, Macdonald HM, Forouhi NG, Loos RJ, Reid DM, Hakim A, Dennison E, Liu Y, Power C, Stevens HE, Jaana L, Vasan RS, Soranzo N, Bojunga J, Psaty BM, Lorentzon M, Foroud T, Harris TB, Hofman A, Jansson JO, Cauley JA, Uitterlinden AG, Gibson Q, Jarvelin MR, Karasik D, Siscovick DS, Econs MJ, Kritchevsky SB, Florez JC, Todd JA, Dupuis J, Hypponen E, Spector TD (2010) Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet 376(9736):180–188. doi:10.1016/S0140-6736(10)60588-0

    Article  CAS  Google Scholar 

  19. Brouwer-Brolsma EM, Bischoff-Ferrari HA, Bouillon R, Feskens EJ, Gallagher CJ, Hypponen E, Llewellyn DJ, Stoecklin E, Dierkes J, Kies AK, Kok FJ, Lamberg-Allardt C, Moser U, Pilz S, Saris WH, van Schoor NM, Weber P, Witkamp R, Zittermann A, de Groot LC (2013) Vitamin D: do we get enough? A discussion between vitamin D experts in order to make a step towards the harmonisation of dietary reference intakes for vitamin D across Europe. Osteoporos Int 24(5):1567–1577. doi:10.1007/s00198-012-2231-3

    Article  CAS  Google Scholar 

  20. Hintzpeter B, Mensink GB, Thierfelder W, Muller MJ, Scheidt-Nave C (2008) Vitamin D status and health correlates among German adults. Eur J Clin Nutr 62(9):1079–1089. doi:10.1038/sj.ejcn.1602825

    Article  CAS  Google Scholar 

  21. Perna L, Haug U, Schottker B, Muller H, Raum E, Jansen EH, Brenner H (2012) Public health implications of standardized 25-hydroxyvitamin D levels: a decrease in the prevalence of vitamin D deficiency among older women in Germany. Prev Med 55(3):228–232. doi:10.1016/j.ypmed.2012.06.010

    Article  CAS  Google Scholar 

  22. Farrell CJ, Martin S, McWhinney B, Straub I, Williams P, Herrmann M (2012) State-of-the-art vitamin D assays: a comparison of automated immunoassays with liquid chromatography-tandem mass spectrometry methods. Clin Chem 58(3):531–542. doi:10.1373/clinchem.2011.172155

    Article  CAS  Google Scholar 

  23. Federal Office for Radiation Protection (edt.) (2009) Solare bodennahe UV-Strahlung in Deutschland [Solar ground-level UV radiation in Germany]. http://www.bfs.de/de/uv/uv2/uv_messnetz/UV_jb.html. Accessed January 15th 2013

  24. Boeing H, Wahrendorf J, Becker N (1999) EPIC-Germany–A source for studies into diet and risk of chronic diseases. European Investigation into Cancer and Nutrition. Ann Nutr Metab 43(4):195–204. doi:10.1159/000012786

    Article  CAS  Google Scholar 

  25. Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J (1997) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the German part of the EPIC project. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26(suppl 1):S59–S70

    Google Scholar 

  26. Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J (1997) Reproducibility and relative validity of energy and macronutrient intake of a food frequency questionnaire developed for the German part of the EPIC project. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26(suppl 1):S71–S81

    Google Scholar 

  27. Langenberg C, Sharp S, Forouhi NG, Franks PW, Schulze MB, Kerrison N, Ekelund U, Barroso I, Panico S, Tormo MJ, Spranger J, Griffin S, van der Schouw YT, Amiano P, Ardanaz E, Arriola L, Balkau B, Barricarte A, Beulens JW, Boeing H, Bueno-de-Mesquita HB, Buijsse B, Chirlaque Lopez MD, Clavel-Chapelon F, Crowe FL, de Lauzon-Guillan B, Deloukas P, Dorronsoro M, Drogan D, Froguel P, Gonzalez C, Grioni S, Groop L, Groves C, Hainaut P, Halkjaer J, Hallmans G, Hansen T, Huerta Castano JM, Kaaks R, Key TJ, Khaw KT, Koulman A, Mattiello A, Navarro C, Nilsson P, Norat T, Overvad K, Palla L, Palli D, Pedersen O, Peeters PH, Quiros JR, Ramachandran A, Rodriguez-Suarez L, Rolandsson O, Romaguera D, Romieu I, Sacerdote C, Sanchez MJ, Sandbaek A, Slimani N, Sluijs I, Spijkerman AM, Teucher B, Tjonneland A, Tumino R, van der AD, Verschuren WM, Tuomilehto J, Feskens E, McCarthy M, Riboli E, Wareham NJ (2011) Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia 54 (9):2272–2282. doi:10.1007/s00125-011-2182-9

    Google Scholar 

  28. Li K, Kaaks R, Linseisen J, Rohrmann S (2012) Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg). Euro J Nutr 51(4):407–413. doi:10.1007/s00394-011-0224-1

    Article  CAS  Google Scholar 

  29. Cust AE, Smith BJ, Chau J, van der Ploeg HP, Friedenreich CM, Armstrong BK, Bauman A (2008) Validity and repeatability of the EPIC physical activity questionnaire: a validation study using accelerometers as an objective measure. Int J Behav Nutr Phys Act 5:33. doi:10.1186/1479-5868-5-33

    Article  Google Scholar 

  30. Herman JR, Krotkov N, Celarier E, Larko D, Labow G (1999) Distribution of UV radiation at the Earth’s surface from TOMS-measured UV-backscattered radiances. J Geophys Res-Atmos 104 (D10):12059–12076. doi:10.1029/1999jd900062

    Google Scholar 

  31. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2011) Summary. In: Ross AC, Taylor CL, Yaktine AL, Valle HBD (eds) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, pp 1–15

    Google Scholar 

  32. Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65 (4 suppl):1220S–1228S (discussion 1229S–1231S)

    Google Scholar 

  33. Lai JK, Lucas RM, Banks E, Ponsonby AL, Ausimmune Investigator G (2012) Variability in vitamin D assays impairs clinical assessment of vitamin D status. Intern Med J 42(1):43–50. doi:10.1111/j.1445-5994.2011.02471.x

    Article  CAS  Google Scholar 

  34. Thorand B, Zierer A, Huth C, Linseisen J, Meisinger C, Roden M, Peters A, Koenig W, Herder C (2011) Effect of serum 25-hydroxyvitamin D on risk for type 2 diabetes may be partially mediated by subclinical inflammation: results from the MONICA/KORA Augsburg study. Diabetes Care 34(10):2320–2322. doi:10.2337/dc11-0775

    Article  CAS  Google Scholar 

  35. de Koning L, Al-Turkmani MR, Berg AH, Shkreta A, Law T, Kellogg MD (2013) Variation in clinical vitamin D status by DiaSorin Liaison and LC-MS/MS in the presence of elevated 25-OH vitamin D2. Clin Chim Acta 415:54–58. doi:10.1016/j.cca.2012.09.002

    Article  Google Scholar 

  36. Priemel M, von Domarus C, Klatte TO, Kessler S, Schlie J, Meier S, Proksch N, Pastor F, Netter C, Streichert T, Puschel K, Amling M (2010) Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res 25(2):305–312. doi:10.1359/jbmr.090728

    Article  CAS  Google Scholar 

  37. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2011) Review of potential indicators of adequacy and selection of indicators: Calcium and vitamin D. In: Ross AC, Taylor CL, Yaktine AL, Valle HBD (eds) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, pp 125–344

    Google Scholar 

  38. Flynn A, Hirvonen T, Mensink GB, Ocke MC, Serra-Majem L, Stos K, Szponar L, Tetens I, Turrini A, Fletcher R, Wildemann T (2009) Intake of selected nutrients from foods, from fortification and from supplements in various European countries. Food Nutr Res 53(0). doi:10.3402/fnr.v53i0.2038

  39. Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF (2010) Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr 140(4):817–822. doi:10.3945/jn.109.118539

    Article  CAS  Google Scholar 

  40. Beitz R, Mensink GBM, Rams S, Döring A (2004) Vitamin- und Mineralstoffsupplementierung in Deutschland [Use of vitamin and mineral supplements in Germany]. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 47(11):1057–1065. doi:10.1007/s00103-004-0924-2

    Article  CAS  Google Scholar 

  41. Brown J, Amling M, Barvencik F (2011) Möglichkeiten zur Verbesserung des Vitamin-D-Status der Bevölkerung [Options for improving vitamin D status of the population, Article in German]. J Mineralstoffwechsel 18(3):104–109

    Google Scholar 

  42. Max Rubner-Institut Federal Research Institute of Nutrition and Food (Edt.) (2008) Nationale Verzehrsstudie II, Ergebnisbericht, Teil 2 [National Nutrition Survey II, Final Report, Part 2]. http://www.mri.bund.de/fileadmin/Institute/EV/NVSII_Abschlussbericht_Teil_2.pdf. Accessed January 15th

  43. Failler P (2007) Future prospects for fish and fishery products. 4. Fish consumption in the European Union in 2015 and 2030. Part 1. European overview. In: FAO Fisheries Circular., vol 972/4, Part 1. Food and Agriculture Organization of the United Nations (FAO), Rome, pp 20–21

  44. Jakobsen MU, Dethlefsen C, Due KM, May AM, Romaguera D, Vergnaud AC, Norat T, Sorensen TI, Halkjaer J, Tjonneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Teucher B, Kuhn T, Bergmann MM, Boeing H, Naska A, Orfanos P, Trichopoulou A, Palli D, Santucci De Magistris M, Sieri S, Bueno-de-Mesquita HB, van der AD, Engeset D, Hjartaker A, Rodriguez L, Agudo A, Molina-Montes E, Huerta JM, Barricarte A, Amiano P, Manjer J, Wirfalt E, Hallmans G, Johansson I, Khaw KT, Wareham NJ, Key TJ, Chajes V, Slimani N, Riboli E, Peeters PH, Overvad K (2013) Fish consumption and subsequent change in body weight in European women and men. Br J Nutr 109 (2):353–362. doi:10.1017/S0007114512001079

    Google Scholar 

  45. Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80(6 suppl):1678S–1688S

    CAS  Google Scholar 

  46. Gagnon C, Baillargeon J-P, Desmarais G, Fink GD (2010) Prevalence and predictors of vitamin D insufficiency in women of reproductive age living in northern latitude. Euro J Endocrinol 163(5):819–824. doi:10.1530/eje-10-0441

    Article  CAS  Google Scholar 

  47. Harris SS, Dawson-Hughes B (1998) The association of Oral Contraceptive Use with Plasma 25-hydroxyvitamin D Levels. J Am Coll Nutr 17(3):282–284

    Article  CAS  Google Scholar 

  48. Rejnmark L, Lauridsen AL, Brot C, Vestergaard P, Heickendorff L, Nexo E, Mosekilde L (2006) Vitamin D and its binding protein Gc: long-term variability in peri- and postmenopausal women with and without hormone replacement therapy. Scand J Clin Lab Invest 66(3):227–238. doi:10.1080/00365510600570623

    Article  CAS  Google Scholar 

  49. Volkert D (2011) The role of nutrition in the prevention of sarcopenia. Wien Med Wochenschr 161(17–18):409–415. doi:10.1007/s10354-011-0910-x

    Article  Google Scholar 

  50. Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL, Robins SJ, O’Donnell CJ, Hoffmann U, Jacques PF, Booth SL, Vasan RS, Wolf M, Wang TJ (2010) Adiposity, cardiometabolic risk, and vitamin D status: the Framingham Heart Study. Diabetes 59(1):242–248. doi:10.2337/db09-1011

    Article  CAS  Google Scholar 

  51. Sulistyoningrum DC, Green TJ, Lear SA, Devlin AM (2012) Ethnic-specific differences in vitamin d status is associated with adiposity. PLoS ONE 7(8):e43159. doi:10.1371/journal.pone.0043159

    Article  CAS  Google Scholar 

  52. Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G (1991) Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 115(7):505–512

    Article  CAS  Google Scholar 

  53. Meier C, Woitge HW, Witte K, Lemmer B, Seibel MJ (2004) Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: a randomized controlled open-label prospective trial. J Bone Miner Res 19(8):1221–1230. doi:10.1359/jbmr.040511

    Article  CAS  Google Scholar 

  54. Viljakainen HT, Vaisanen M, Kemi V, Rikkonen T, Kroger H, Laitinen EK, Rita H, Lamberg-Allardt C (2009) Wintertime vitamin D supplementation inhibits seasonal variation of calcitropic hormones and maintains bone turnover in healthy men. J Bone Miner Res 24(2):346–352. doi:10.1359/jbmr.081009

    Article  CAS  Google Scholar 

  55. Webb AR (2006) Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 92(1):17–25. doi:10.1016/j.pbiomolbio.2006.02.004

    Article  CAS  Google Scholar 

  56. Kotsopoulos J, Tworoger SS, Campos H, Chung FL, Clevenger CV, Franke AA, Mantzoros CS, Ricchiuti V, Willett WC, Hankinson SE, Eliassen AH (2010) Reproducibility of plasma and urine biomarkers among premenopausal and postmenopausal women from the Nurses’ Health Studies. Cancer Epidemiol Biomarkers Prev 19(4):938–946. doi:10.1158/1055-9965.EPI-09-1318

    Article  CAS  Google Scholar 

  57. Platz EA, Leitzmann MF, Hollis BW, Willett WC, Giovannucci E (2004) Plasma 1,25-dihydroxy- and 25-hydroxyvitamin D and subsequent risk of prostate cancer. Cancer Causes Control 15(3):255–265. doi:10.1023/B:CACO.0000024245.24880.8a

    Article  Google Scholar 

  58. Sonderman JS, Munro HM, Blot WJ, Signorello LB (2012) Reproducibility of serum 25-hydroxyvitamin D and vitamin D-binding protein levels over time in a prospective cohort study of black and white adults. Am J Epidemiol 176(7):615–621. doi:10.1093/aje/kws141

    Article  Google Scholar 

  59. Jorde R, Sneve M, Hutchinson M, Emaus N, Figenschau Y, Grimnes G (2010) Tracking of serum 25-hydroxyvitamin D levels during 14 years in a population-based study and during 12 months in an intervention study. Am J Epidemiol 171(8):903–908. doi:10.1093/aje/kwq005

    Article  Google Scholar 

  60. Rosen CJ (2011) Clinical practice. Vitamin D insufficiency. N Engl J Med 364(3):248–254. doi:10.1056/NEJMcp1009570

    Article  CAS  Google Scholar 

  61. Schottker B, Jansen EH, Haug U, Schomburg L, Kohrle J, Brenner H (2012) Standardization of misleading immunoassay based 25-hydroxyvitamin D levels with liquid chromatography tandem-mass spectrometry in a large cohort study. PLoS ONE 7(11):e48774. doi:10.1371/journal.pone.0048774

    Article  Google Scholar 

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Acknowledgments

The authors thank the participants of the EPIC study. The present work was part of the joint project Vitamin D and Cardiovascular Health funded by the German Federal Ministry of Education and Research (Grant 0315668).

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The authors declare that they have no conflict of interest.

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Kühn, T., Kaaks, R., Teucher, B. et al. Dietary, lifestyle, and genetic determinants of vitamin D status: a cross-sectional analysis from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study. Eur J Nutr 53, 731–741 (2014). https://doi.org/10.1007/s00394-013-0577-8

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