Top

Published in:

Open Access 01-12-2018 | Research article

Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis

Authors: Martina Rabenberg, Christa Scheidt-Nave, Markus A. Busch, Michael Thamm, Nina Rieckmann, Ramón A. Durazo-Arvizu, Kirsten G. Dowling, Zuzana Škrabáková, Kevin D. Cashman, Christopher T. Sempos, Gert B. M. Mensink

Published in: BMC Public Health | Issue 1/2018

Abstract

Background

Comparability of 25-hydroxyvitamin D (25(OH)D) measurements is hampered by method-related differences in measurement values. International standardization of laboratory assays has been suggested to solve this problem.

Methods

As part of the European Commission–funded project ‘Food-based solutions for optimal vitamin D nutrition and health through the life cycle’ (ODIN), original measurements of serum 25(OH)D of three German national health surveys conducted between 1998 and 2011 have been standardized retrospectively. In these representative population-based samples including persons aged between 1 and 79 years, the original 25(OH)D values were compared with those after standardization. Mean values and prevalences of vitamin D deficiency, insufficiency, and sufficiency (25(OH)D levels < 30, 30- < 50, and > =50 nmol/l, respectively) were calculated by sex and age groups based on original and standardized 25(OH)D data.

Results

In comparison to the original 25(OH)D levels, the standardized levels showed higher means overall and in age- and sex-specific analyses. After standardization, the prevalence of vitamin D deficiency was lower in all surveys while the prevalence of vitamin D sufficiency was higher. Nevertheless, even after standardization ~ 15% of adults and 12.5% of children had serum 25(OH)D levels < 30 nmol/l. Thus, the proportion of deficient vitamin D levels in the German population is still considerable.

Conclusions

The use of standardization of 25(OH)D levels has a substantial impact on estimates of the vitamin D status in Germany. Since clinical diagnostic, therapeutic and public health decision-making require valid and comparable data, standardization and calibration of commercial, clinical and research laboratory assays for 25(OH)D measurement should become common practice. Until then, researchers, health practitioners and policy makers should be aware of the peculiarities of the measurement methods when comparing and interpreting 25(OH)D levels.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81. https://doi.org/10.1056/NEJMra070553.CrossRefPubMed

Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80:1678S–88S. https://www.ncbi.nlm.nih.gov/pubmed/15585788 CrossRefPubMed

Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, D.C.: The National Academies Press; 2011.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30. https://doi.org/10.1210/jc.2011-0385.CrossRefPubMed

Scientific Advisory Committee on Nutrition Vitamin D and Health 2016. Available from: https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report Accessed 27 Jan 2018.

Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, et al. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas. 2010;65:225–36. https://doi.org/10.1016/j.maturitas.2009.12.013.CrossRefPubMed

Jenab M, Bueno-de-Mesquita HB, Ferrari P, van Duijnhoven FJ, Norat T, Pischon T, et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations:a nested case-control study. BMJ. 2010;340:b5500. https://doi.org/10.1136/bmj.b5500.CrossRefPubMedPubMedCentral

Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19:73–8. https://doi.org/10.1016/j.annepidem.2007.12.001.CrossRefPubMed

Tai SS, Bedner M, Phinney KW. Development of a candidate reference measurement procedure for the determination of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 in human serum using isotope-dilution liquid chromatography-tandem mass spectrometry. Anal Chem. 2010;82:1942–8. https://doi.org/10.1021/ac9026862.CrossRefPubMedPubMedCentral

10.

Wallace AM, Gibson S, de la Hunty A, Lamberg-Allardt C, Ashwell M. Measurement of 25-hydroxyvitamin D in the clinical laboratory: current procedures, performance characteristics and limitations. Steroids. 2010;75:477–88. https://doi.org/10.1016/j.steroids.2010.02.012.CrossRefPubMed

11.

Binkley N, Sempos CT, Vitamin DSP. Standardizing vitamin D assays: the way forward. J Bone Miner Res. 2014;29:1709–14. https://doi.org/10.1002/jbmr.2252.CrossRefPubMedPubMedCentral

12.

Snellman G, Melhus H, Gedeborg R, Byberg L, Berglund L, Wernroth L, et al. Determining vitamin D status: a comparison between commercially available assays. PLoS One. 2010;5:e11555. https://doi.org/10.1371/journal.pone.0011555.CrossRefPubMedPubMedCentral

13.

Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, et al. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab. 2004;89:3152–7. https://doi.org/10.1210/jc.2003-031979.CrossRefPubMed

14.

Carter GD, Carter R, Jones J, Berry J. How accurate are assays for 25-hydroxyvitamin D? Data from the international vitamin D external quality assessment scheme. Clin Chem. 2004;50:2195–7. https://doi.org/10.1373/clinchem.2004.040683.CrossRefPubMed

15.

Sempos CT, Vesper HW, Phinney KW, Thienpont LM, Coates PM, Vitamin DSP. Vitamin D status as an international issue: national surveys and the problem of standardization. Scand J Clin Lab Invest Suppl. 2012;243:32–40. https://www.ncbi.nlm.nih.gov/pubmed/22536760.

16.

Cashman KD, Kiely M, Kinsella M, Durazo-Arvizu RA, Tian L, Zhang Y, et al. Evaluation of vitamin D standardization program protocols for standardizing serum 25-hydroxyvitamin D data: a case study of the program's potential for national nutrition and health surveys. Am J Clin Nutr. 2013;97:1235–42. https://doi.org/10.3945/ajcn.112.057182.CrossRefPubMedPubMedCentral

17.

Sarafin K, Durazo-Arvizu R, Tian L, Phinney KW, Tai S, Camara JE, et al. Standardizing 25-hydroxyvitamin D values from the Canadian health measures survey. Am J Clin Nutr. 2015;102:1044–50. https://doi.org/10.3945/ajcn.114.103689.CrossRefPubMedPubMedCentral

18.

Schleicher RL, Sternberg MR, Looker AC, Yetley EA, Lacher DA, Sempos CT, et al. National Estimates of serum Total 25-Hydroxyvitamin D and metabolite concentrations measured by liquid chromatography-tandem mass spectrometry in the US population during 2007-2010. J Nutr. 2016;146:1051–61. https://doi.org/10.3945/jn.115.227728.CrossRefPubMedPubMedCentral

19.

Cashman KD, Dowling KG, Skrabakova Z, Kiely M, Lamberg-Allardt C, Durazo-Arvizu RA, et al. Standardizing serum 25-hydroxyvitamin D data from four Nordic population samples using the vitamin D standardization program protocols: shedding new light on vitamin D status in Nordic individuals. Scand J Clin Lab Invest. 2015;75:549–61. https://doi.org/10.3109/00365513.2015.1057898.CrossRefPubMed

20.

Hintzpeter B, Mensink GB, Thierfelder W, Muller MJ, Scheidt-Nave C. Vitamin D status and health correlates among German adults. Eur J Clin Nutr. 2008;62:1079–89. https://doi.org/10.1038/sj.ejcn.1602825.CrossRefPubMed

21.

Hintzpeter B, Scheidt-Nave C, Muller MJ, Schenk L, Mensink GB. Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr. 2008;138:1482–90. http://www.ncbi.nlm.nih.gov/pubmed/18641195 CrossRefPubMed

22.

Rabenberg M, Scheidt-Nave C, Busch MA, Rieckmann N, Hintzpeter B, Mensink GB. Vitamin D status among adults in Germany - results from the German health interview and examination survey for adults (DEGS1). BMC Public Health. 2015;15:641. https://doi.org/10.1186/s12889-015-2016-7.CrossRefPubMedPubMedCentral

23.

Cashman KD, Dowling KG, Skrabakova Z, Gonzalez-Gross M, Valtuena J, De Henauw S, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103:1033–44. https://doi.org/10.3945/ajcn.115.120873.CrossRefPubMedPubMedCentral

24.

Bellach BM, Knopf H, Thefeld W. Der Bundes-Gesundheitssurvey. 1997/98. Gesundheitswesen. 1998;60(Suppl 2):S59–68. http://www.ncbi.nlm.nih.gov/pubmed/10063725.PubMed

25.

Thefeld W, Stolzenberg H, Bellach BM. Bundes-Gesundheitssurvey: Response, Zusammensetzung der Teilnehmer und Non-Responder-Analyse. Gesundheitswesen. 1999;61:Spec No:S57–61. http://www.ncbi.nlm.nih.gov/pubmed/10726397.PubMed

26.

Mensink GB, Beitz R. Food and nutrient intake in east and West Germany, 8 years after the reunification--the German nutrition survey 1998. Eur J Clin Nutr. 2004;58:1000–10. https://doi.org/10.1038/sj.ejcn.1601923.CrossRefPubMed

27.

Kamtsiuris P, Lange M, Hoffmann R, Schaffrath Rosario A, Dahm S, Kuhnert R, et al. The first wave of the German health interview and examination survey for adults (DEGS1): sample design, response, weighting and representativeness. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:620–30. https://doi.org/10.1007/s00103-012-1650-9.CrossRefPubMed

28.

Scheidt-Nave C, Kamtsiuris P, Gosswald A, Holling H, Lange M, Busch MA, et al. German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave. BMC Public Health. 2012;12:730. https://doi.org/10.1186/1471-2458-12-730.CrossRefPubMedPubMedCentral

29.

Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U, et al. The challenge of comprehensively mapping children's health in a nation-wide health survey: design of the German KiGGS-study. BMC Public Health. 2008;8:196. https://doi.org/10.1186/1471-2458-8-196.CrossRefPubMedPubMedCentral

30.

Kamtsiuris P, Lange M, Schaffrath Rosario A. Der Kinder- und Jugendgesundheitssurvey (KiGGS): Stichprobendesign, Response und Nonresponse-Analyse. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50:547–56. https://doi.org/10.1007/s00103-007-0215-9.CrossRefPubMed

31.

Tian L, Durazo-Arvizu RA, Myers G, Brooks S, Sarafin K, Sempos CT. The estimation of calibration equations for variables with heteroscedastic measurement errors. Stat Med. 2014;33:4420–36. https://doi.org/10.1002/sim.6235.CrossRefPubMed

32.

Stepman HC, Vanderroost A, Van Uytfanghe K, Thienpont LM. Candidate reference measurement procedures for serum 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 by using isotope-dilution liquid chromatography-tandem mass spectrometry. Clin Chem. 2011;57:441–8. https://doi.org/10.1373/clinchem.2010.152553.CrossRefPubMed

33.

Mineva EM, Schleicher RL, Chaudhary-Webb M, Maw KL, Botelho JC, Vesper HW, et al. A candidate reference measurement procedure for quantifying serum concentrations of 25-hydroxyvitamin D(3) and 25-hydroxyvitamin D(2) using isotope-dilution liquid chromatography-tandem mass spectrometry. Anal Bioanal Chem. 2015;407:5615–24. https://doi.org/10.1007/s00216-015-8733-z.CrossRefPubMedPubMedCentral

34.

Joint Committee for Traceability in Laboratory Medicine database. Laboratory medicine and in-vitro diagnostics 2016. Available from: http://www.bipm.org/jctlm/home.do Accessed 27 Jan 2018.

35.

Centers for Disease Control and Prevention. Laboratory Quality Assurance and Standardization Programs 2016. Available from: https://www.cdc.gov/labstandards/hs.html Accessed 27 Jan 2018.

36.

Lehmann B. Zur Physiologie von Vitamin D. In: Reichrath J, Lehmann B, Spitz J, editors. Vitamin D - Update 2012. Oberhaching: Dustri-Verlag Dr. Karl Feistle; 2012.

37.

Yetley EA, Pfeiffer CM, Schleicher RL, Phinney KW, Lacher DA, Christakos S, et al. NHANES monitoring of serum 25-hydroxyvitamin D: a roundtable summary. J Nutr. 2010;140:2030S–45S. https://doi.org/10.3945/jn.110.121483.CrossRefPubMedPubMedCentral

38.

Carter GD. 25-hydroxyvitamin D: a difficult analyte. Clin Chem. 2012;58:486–8. https://doi.org/10.1373/clinchem.2011.180562.CrossRefPubMed

39.

Agborsangaya C, Toriola AT, Grankvist K, Surcel HM, Holl K, Parkkila S, et al. The effects of storage time and sampling season on the stability of serum 25-hydroxy vitamin D and androstenedione. Nutr Cancer. 2010;62:51–7. https://doi.org/10.1080/01635580903191460.CrossRefPubMed

40.

Ocke MC, Schrijver J, Obermann-de Boer GL, Bloemberg BP, Haenen GR, Kromhout D. Stability of blood (pro)vitamins during four years of storage at −20 degrees C: consequences for epidemiologic research. J Clin Epidemiol. 1995;48:1077–85. http://www.ncbi.nlm.nih.gov/pubmed/7775995 CrossRefPubMed

41.

Ersfeld DL, Rao DS, Body JJ, Sackrison JL Jr, Miller AB, Parikh N, et al. Analytical and clinical validation of the 25 OH vitamin D assay for the LIAISON automated analyzer. Clin Biochem. 2004;37:867–74. https://doi.org/10.1016/j.clinbiochem.2004.06.006.CrossRefPubMed

42.

Schleicher RL, Sternberg MR, Lacher DA, Sempos CT, Looker AC, Durazo-Arvizu RA, et al. The vitamin D status of the US population from 1988 to 2010 using standardized serum concentrations of 25-hydroxyvitamin D shows recent modest increases. Am J Clin Nutr. 2016;104:454–61. https://doi.org/10.3945/ajcn.115.127985.CrossRefPubMedPubMedCentral

43.

Farrell CJ, Martin S, McWhinney B, Straub I, Williams P, Herrmann M. State-of-the-art vitamin D assays: a comparison of automated immunoassays with liquid chromatography-tandem mass spectrometry methods. Clin Chem. 2012;58:531–42. https://doi.org/10.1373/clinchem.2011.172155.CrossRefPubMed

44.

Antoniucci DM, Black DM, Sellmeyer DE. Serum 25-hydroxyvitamin D is unaffected by multiple freeze-thaw cycles. Clin Chem. 2005;51:258–61. https://doi.org/10.1373/clinchem.2004.041954.CrossRefPubMed

45.

Sempos CT, Durazo-Arvizu RA, Binkley N, Jones J, Merkel JM, Carter GD. Developing vitamin D dietary guidelines and the lack of 25-hydroxyvitamin D assay standardization: the ever-present past. J Steroid Biochem Mol Biol. 2015; https://doi.org/10.1016/j.jsbmb.2015.08.027.

46.

Manson JE, Brannon PM, Rosen CJ, Taylor CL. Vitamin D deficiency - is there really a pandemic? N Engl J Med. 2016;375:1817–20. https://doi.org/10.1056/NEJMp1608005.CrossRefPubMed

47.

Cashman KD, Sheehy T, O'Neill CM. Is vitamin D deficiency a public health concern for low middle income countries? A systematic literature review. Eur J Nutr. 2018; https://doi.org/10.1007/s00394-018-1607-3.

48.

Gaksch M, Jorde R, Grimnes G, Joakimsen R, Schirmer H, Wilsgaard T, et al. Vitamin D and mortality: individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One. 2017;12:e0170791. https://doi.org/10.1371/journal.pone.0170791.CrossRefPubMedPubMedCentral

Title: Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis
Authors: Martina Rabenberg
Christa Scheidt-Nave
Markus A. Busch
Michael Thamm
Nina Rieckmann
Ramón A. Durazo-Arvizu
Kirsten G. Dowling
Zuzana Škrabáková
Kevin D. Cashman
Christopher T. Sempos
Gert B. M. Mensink
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-018-5769-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Optimal dietary patterns designed from local foods to achieve maternal nutritional goals

A haven of green space: learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children

Lung cancer screening: assessment of health literacy and readability of online educational resources

Diagnosis of diabetes mellitus and living with a chronic condition: participatory study

Exploring the relationships between sexual violence, mental health and perpetrator identity: a cross-sectional Australian primary care study

The impact of a social norms approach on reducing levels of misperceptions around smokefree hospital entrances amongst patients, staff, and visitors of a NHS hospital: a repeated cross-sectional survey study