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ODIN: Wages war against vitamin D deficiency in Europe

Winter in a Mediterranean country may not be the answer to vitamin D deficiency. The largest investigation ever on food-based solutions for optimal vitamin D nutrition and health shows that even southern Europeans may be at risk of low vitamin D status.
ODIN: Wages war against vitamin D deficiency in Europe
The latest results from the ODIN project provide firm evidence that vitamin D deficiency is widespread across Europe at rates indicative of a serious public health problem.

The ODIN mission was to develop effective, safe and sustainable solutions to prevent vitamin D deficiency and improve vitamin D-related health outcomes using a food-first approach.

“ODIN’s ambitious programme included both dose-response and food-based randomised controlled trials, research in primary food production and food technology, data mining of epidemiological cohort studies and dietary modelling experiments,” outlines Prof. Mairead Kiely, project coordinator.

Results show a large proportion of D deficiency

The Prevalence of vitamin D deficiency in Europe clearly shows the wide variation across populations from Norway to Greece. Groups sampled were kids, teens, adults, ethnic adults and older adults. Rates of vitamin D deficiency are roughly twice those reported in the United States. Notably, people of ethnic origin living in Europe are at much higher risk than their white counterparts. Prof Kevin Cashman, joint ODIN co-ordinator, stresses that “the overall prevalence of very low vitamin D status, at 13 % overall, translates into an enormous number of individuals living in Europe.”

For regions less comprehensively surveyed, ODIN scientists in Athens and Belgrade led systematic literature reviews of available data on serum 25-hydroxyvitamin D (25(OH)D) concentrations in southern European and eastern Mediterranean countries as well as vitamin D intakes and status in central and eastern European countries. Infants and elderly adults were the most susceptible age groups for low vitamin D status among southern and eastern Mediterranean countries.

In countries that lack large-scale representative datasets, ODIN has highlighted the need for strategic investment in quality surveillance and bio-banking systems among many countries in the Mediterranean, Central and Eastern European regions.

Non-skeletal health outcomes in older adults

Among older adults who had been prospectively followed, ODIN scientists led by Prof Stefan Pilz (Austria) and Prof Rolf Jorde (Norway), demonstrated a stepwise increase in mortality risk from cardiovascular disease as vitamin D status decreased.

In systematic review of multiple studies (meta-analyses) summarising data from randomised controlled trials of vitamin D effects on non-skeletal health outcomes, Prof Lars Rejnmark (Denmark) summarised 54 publications with data from 210 randomised controlled trials. Beneficial effects of vitamin D supplementation were observed in 3 out of 7 studies on respiratory tract infections and in 8 out of 12 meta-analyses on mortality.

The authors recommended cautious interpretation as most studies had been initiated to examine skeletal health outcomes. Nonetheless, these two publications are of particular relevance to public health strategies aimed at preventing vitamin D deficiency and improving vitamin D status in the general population.

Food-first strategies for vitamin D deficiency prevention

As much of Europe is in the grip of up to six months of grey sky winter, a time when UVB availability is insufficient to produce cholecalciferol, vitamin D3, in the skin, dietary vitamin D is critical.

Food fortification increased serum 25(OH)D in randomised controlled trials and fresh evidence from Finland has demonstrated its effectiveness as a public health strategy for prevention of deficiency.

ODIN researchers have performed extensive analysis and dietary modelling of complex food consumption data and the project has incorporated new data coming from studies on cheese, eggs as well as mushrooms and there is ongoing work in meat. To enable these analyses, ODIN compiled a specialised, quality assured, fully referenced food composition dataset of vitamin D, based on EuroFIR standards, using the FoodEXplorer™ tool to retrieve documented analytical data for vitamin D.

After a tireless four-year research programme, Prof. Kiely concludes, “The ODIN hypothesis – careful application of fortification and bio-fortification strategies could safely increase intakes of vitamin D across the distribution and prevent deficiency – appears to be technically feasible. There is lots more to be done – we need to pay particular attention to ethnic minority groups resident at northerly latitude. Adolescents and young adults must be prioritised for the health of future generations.”

Keywords

ODIN, vitamin D, food, deficiency, Europe
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