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Prevalence and Risk Factors of Vitamin D Deficiency

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Micronutrients and Human Health".

Deadline for manuscript submissions: 15 June 2026 | Viewed by 6573

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Special Issue Editor

Dr. Konstantin Horas

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Guest Editor

1. Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
2. Frankfurt Centre for Bone Health and Endocrinology, 60313 Frankfurt, Germany
3. ATOS Hospital, 65203 Wiesbaden, Germany
Interests: vitamin D; fracture; osteoporosis; osteoarthritis; bone oncology

Special Issue Information

Dear Colleagues,

Vitamin D deficiency is frequently seen in the general population of many countries around the world. Moreover, its prevalence increases with age; thus, countries with an ageing population are particularly affected by vitamin D deficiency. Today, numerous clinical studies have reported a high prevalence of hypovitaminosis D and vitamin D deficiency in patients with innumerable diseases. For example, several studies have linked low serum vitamin D levels to increased cancer incidence and mortality. Other studies describe the favourable effects of vitamin D on the progression and outcome of, e.g., musculoskeletal disorders. In addition, vitamin D is believed to play a role in decreasing the risk of many chronic illnesses, autoimmune diseases, infectious diseases, and cardiovascular diseases. Likewise, vitamin D supplementation is known to prevent nutritional disorders, such as rickets, and potentially lower the risk of many other diseases.

In this Special Issue on the prevalence and risk factors of vitamin D deficiency, we welcome submissions focusing on epidemiologic studies and clinical trials to examine vitamin D and its supplementation.

Dr. Konstantin Horas
Guest Editor

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Keywords

vitamin D
hypovitaminosis D
25 (OH)D
prevalence
risk factors

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Published Papers (5 papers)

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Research

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17 pages, 800 KB

Open AccessArticle

Association Between Vitamin D Deficiency, Malnutrition, and Systemic Inflammation in Advanced Colorectal Cancer: A Hospital-Based Cross-Sectional Study

by Daylia Thet, Chidchanok Rungruang, Nutthada Areepium, Nattaya Teeyapun and Tippawan Siritientong

Nutrients 2026, 18(7), 1059; https://doi.org/10.3390/nu18071059 - 26 Mar 2026

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Abstract

Background/Objectives: Vitamin D deficiency and malnutrition may lead to poor outcomes in colorectal cancer (CRC) patients. This study aims to perform an integrative analysis of serum vitamin D, nutritional status, anthropometric parameters and biochemical profiles in advanced CRC patients. Methods: The study included 58 advanced CRC patients. Serum vitamin D levels were measured by a chemiluminescence immunoassay. Nutritional status was evaluated with the Mini Nutritional Assessment (MNA). Body composition profiles were assessed using a bioelectrical impedance analyzer, and handgrip strength was measured with a handgrip dynamometer. Biochemical and clinical parameters were retrieved from an electronic database. Correlation, regression and receiver operating characteristic (ROC) analyses were performed. Results: Abnormal nutritional status and vitamin D deficiency were diagnosed in 55.17% and 50.00% of patients, respectively. Sarcopenia was diagnosed in 29.31%. Serum vitamin D concentrations were negatively correlated with absolute neutrophil counts (ANC). MNA scores showed significant negative correlations with ANC, platelet count, alkaline phosphatase and carcinoembryonic antigen. In multivariable regression models, albumin remained statistically associated with both serum vitamin D levels (β 7.049; 95% CI: 1.686–12.413; p = 0.011) and MNA score (β 6.951; 95% CI: 4.623–9.278; p < 0.001). Furthermore, albumin showed exploratory performance in ROC analyses for malnutrition and vitamin D deficiency (AUC^ROC 0.814 and 0.725, respectively), which should be interpreted cautiously given potential overlap with MNA-defined nutritional status and the limited sample size. Conclusions: Vitamin D deficiency, malnutrition and systemic inflammation commonly co-occur and are closely interrelated in patients with advanced CRC. A comprehensive assessment of nutritional status in a CRC supportive care setting is recommended. Full article

(This article belongs to the Special Issue Prevalence and Risk Factors of Vitamin D Deficiency)

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13 pages, 2331 KB

Open AccessArticle

Vitamin D Status in Rheumatology Patients with Inflammatory Compared with Non-Inflammatory Diagnoses: Inflammatory and Autoimmune Markers Are Not Associated with Vitamin D Levels

by Arne Schäfer, Magdolna Szilvia Kovacs, Axel Nigg and Martin Feuchtenberger

Nutrients 2026, 18(2), 326; https://doi.org/10.3390/nu18020326 - 20 Jan 2026

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Abstract

Background/Objectives: Vitamin D levels tend to be lower in patients with inflammatory rheumatic diseases (IRDs), including rheumatoid arthritis (RA), but there are minimal data on vitamin D levels in rheumatology patients with inflammatory vs. non-inflammatory diagnoses. Methods: In this retrospective, observational study, we used electronic health record data from patients presenting for their first visit at a large rheumatology clinic to assess vitamin D levels and deficiency based on diagnosis, and to evaluate the association between vitamin D and inflammatory markers (including C-reactive protein [CRP]) or autoimmune markers (including rheumatoid factor [RF], anti-citrullinated peptide antibody, and anti-nuclear antibodies). Logistic regression analysis with 13 clinical variables was used to evaluate the association between vitamin D levels and IRD diagnosis, and linear regression was used to evaluate the association between vitamin D levels and CRP or RF. Results: The patient cohort included 4979 patients; 1385 (27.8%) had an IRD. Vitamin D levels were significantly lower in the IRD vs. non-inflammatory subgroup (mean [SD] of 26.6 [13.3] vs. 27.7 [14.3]; p = 0.009), but the difference was not clinically relevant given the small effect size. Vitamin D deficiency rates (<20 ng/mL) were not significantly different between the subgroups, and vitamin D was not associated with an IRD diagnosis in logistic regression analysis. In linear regression analysis, vitamin D was not associated with CRP or RF in the full patient cohort or in the subgroup with RA (n = 539). Conclusions: We conclude that vitamin D levels do not differ substantially based on IRD versus non-inflammatory diagnosis, CRP levels, or RF levels in this clinical cohort. Full article

(This article belongs to the Special Issue Prevalence and Risk Factors of Vitamin D Deficiency)

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13 pages, 2442 KB

Open AccessArticle

Prevalence of Vitamin D Hypovitaminosis in Croatia: A Cross-Sectional Study Based on Routine Clinical Examinations

by Jelena Kelemen, Luka Bulić, Petar Brlek, Renata Zadro, Jelena Pavlović, Marin Vučić, Eva Brenner and Dragan Primorac

Nutrients 2025, 17(24), 3863; https://doi.org/10.3390/nu17243863 - 11 Dec 2025

Cited by 1 | Viewed by 1294

Abstract

Background/Objectives: Vitamin D deficiency is recognized as a global public health concern due to its implications for bone health, immune regulation, and chronic disease risk. Despite its significance, comprehensive data on the prevalence of hypovitaminosis D in the Croatian population remain limited. This study aimed to determine the distribution of 25-hydroxyvitamin D (25-OH D) levels in a group of patients who underwent routine clinical examination, evaluate the prevalence of deficiency, and assess potential associations with demographic factors such as age and sex. Methods: This cross-sectional study included 829 individuals aged 19–85 years who underwent routine clinical testing at our institution. Serum 25-OH D concentrations were measured and classified as normal (≥75 nmol/L), deficient (<75 nmol/L, ≥50 nmol/L), or severely deficient (<50 nmol/L). Data on age and sex were extracted, and statistical analyses included descriptive statistics, tests for normality (Kolmogorov–Smirnov), comparisons (Mann–Whitney U, Kruskal–Wallis), and correlation testing (Spearman’s rho). Significance was set at p < 0.05. Results: The cohort consisted of 525 females (63.3%) and 304 males (36.7%), with a mean age of 49.2 ± 15.8 years. The mean and median serum 25-OH D concentrations were 53.5 and 53.0 nmol/L, respectively (IQR: 40.0–65.0). Severe deficiency (<50 nmol/L) was present in 43.7% of participants, while an additional 49.2% exhibited moderate deficiency, leaving only 7.1% with sufficient levels. No statistically significant differences in vitamin D levels were observed between sexes, nor was there a significant correlation between age and vitamin D concentration (p > 0.05). Conclusions: Vitamin D deficiency is highly prevalent in the Croatian population, with more than 90% of individuals showing suboptimal serum levels. The absence of significant associations with age or sex suggests a widespread deficiency pattern, underscoring the need for nationwide preventive strategies, including dietary supplementation and public health education initiatives to improve vitamin D status. Full article

(This article belongs to the Special Issue Prevalence and Risk Factors of Vitamin D Deficiency)

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11 pages, 439 KB

Open AccessArticle

High Prevalence of Vitamin D Deficiency in Patients Undergoing Total Shoulder or Elbow Arthroplasty

by Miledi Hoxha, Tizian Heinz, Maximilian Rudert, Kilian List, Leonard Achenbach, Gerrit Maier, Manuel Weißenberger and Konstantin Horas

Nutrients 2025, 17(16), 2635; https://doi.org/10.3390/nu17162635 - 14 Aug 2025

Cited by 2 | Viewed by 1224

Abstract

Background: Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is now robust evidence that perioperative vitamin D levels in patients scheduled for total joint replacement (TJA) affect outcome and the healing process. To date, only few studies focus on vitamin D levels of patients scheduled for total arthroplasty of the upper extremity (shoulder and elbow). For this reason, the objective of this study is to determine the prevalence of vitamin D deficiency in this patient collective. Methods: In a monocentric cohort study, serum levels of 25-hydroxyvitamin D (25OHD) were measured preoperatively in all patients undergoing total shoulder or elbow arthroplasty. Demographic and perioperative data as well as comorbidities were recorded from medical records to assess for potential risk factors for hypovitaminosis D. Multivariate regression analyses were used to identify risk factors for vitamin D insufficiency and deficiency. Results: Collectively, 108 patients with total joint replacement of the upper extremity were included over a period of twelve months. Notably, 28.7% (31/108) of patients reported a regular intake of vitamin D supplements. 62.3% (19/31) of those had sufficient vitamin D levels, while 38.7% (12/31) had insufficient and further 6% (2/31) deficient vitamin D levels (<20 ng/mL). Remarkably, 87% of patients that did not report a regular vitamin D intake (n = 77) showed low serum vitamin D levels. In particular, 63.6% (49/77) were vitamin D deficient, 23.4% (18/77) vitamin D insufficient and only 13% of patients had vitamin D serum levels above or equal to 30 ng/mL that are considered sufficient (mean serum 25(OH)D = 36.4 ng/mL for vitamin D substitution vs. 18.4 ng/mL for no substitution; p < 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, p = 0.044) and the highest levels in summer (p = 0.005 vs. spring). Conclusion: Patients undergoing total shoulder or elbow arthroplasty have an increased risk profile for hypovitaminosis D (vitamin D supplementation had 94% lower odds of being deficient; OR = 0.06, p = 0.001). Seasonal circumstances at the point of arthroplasty seem to be a key risk factor for low vitamin D levels. For this reason, it would be advisable to consider preoperative serum vitamin D level measurement as an integral part of the regularly performed preoperative care. Full article

(This article belongs to the Special Issue Prevalence and Risk Factors of Vitamin D Deficiency)

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Open AccessEditor’s ChoiceReview

Vitamin D in Infectious Diseases: A Narrative Review Focusing on COVID-19, Long COVID, and Influenza

by Olga Adriana Caliman-Sturdza, Roxana Elena Gheorghita, Iuliana Soldanescu, Mihai Dimian and Serghei Mangul

Nutrients 2026, 18(4), 634; https://doi.org/10.3390/nu18040634 - 14 Feb 2026

Viewed by 1918

Abstract

Vitamin D is a secosteroid hormone traditionally recognized for its role in bone and mineral metabolism, but it is increasingly understood to also function as an important immunomodulator influencing susceptibility to and outcomes of infectious diseases. This narrative review summarizes current evidence on the immunological, clinical, and preventive effects of vitamin D in the context of novel coronavirus disease (COVID-19), post-acute sequelae of SARS-CoV-2 infection (long COVID), and influenza. Mechanistically, vitamin D enhances innate immune defenses through the induction of antimicrobial peptides, including cathelicidin and defensins, and modulates adaptive immunity by suppressing maladaptive Th1/Th17 responses while promoting regulatory T-cell activity. Observational studies have frequently associated vitamin D deficiency with more severe COVID-19 outcomes; however, these associations may be influenced by confounding factors and reverse causality. Some meta-analyses suggest that vitamin D supplementation reduced rates of intensive care unit admission and ventilatory support, particularly among older adults and individuals with low baseline serum 25-hydroxyvitamin D concentrations. Emerging evidence also indicates that inadequate vitamin D status may be associated with an increased risk and symptom burden of long COVID, although causality has not been established. In the case of influenza, a limited number of randomized controlled trials (RCTs) and meta-analyses report a modest but statistically significant reduction in infection risk, especially with daily or weekly vitamin D supplementation in populations with low baseline vitamin D levels. Clinical guidelines consistently recommend maintaining adequate vitamin D status for general health but do not endorse high-dose vitamin D as a treatment for COVID-19 due to inconsistent trial findings. Overall, vitamin D should not be considered a standalone therapeutic agent; rather, maintaining sufficient vitamin D levels represents a low-risk, potentially beneficial strategy to support immune resilience against respiratory viral infections. Full article

(This article belongs to the Special Issue Prevalence and Risk Factors of Vitamin D Deficiency)

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