A systematic review of vitamin D status and dietary intake in various Slovenian populations

Maša Hribar; Evgen Benedik; Matej Gregorič; Urška Blaznik; Andreja Kukec; Hristo Hristov; Katja Žmitek; Igor Pravst

doi:10.2478/sjph-2022-0009

Figures & Tables

PRISMA flow diagram (16) of the literature review process for vitamin D intake and status in various Slovenian populations. Notes: WOS: Web of Science; COBISS: Co-operative Online Bibliographic System & Services, 25(OH)D: 25-hydroxy-vitamin D; VitD: Vitamin D.

Box plots of the weighted mean serum 25(OH) D levels for different bi-monthly periods (n=280; monitoring time frame: 12 months in 2017-2018) with a presentation of outliers (●). Results of a nationally representative Nutrihealth study (ClinicalTrial.gov:NCT03284840) reproduced from (20) with approval of the authors.

Forest plot of studies with at least 50 healthy subjects evaluating the proportion of insufficient serum 25(OH)D level (<50 nmol/L). *Note: In one study (Soltirovska et al. 2015) sampling was carried out across the year, but the majority of the samples were collected during extended summer.

Forest plot of studies with at least 50 healthy subjects evaluating the proportion of non-optimal serum 25(OH)D level (<75 nmol/L). *Note: In one study (Dovnik et al. 2015), the non-optimal 25(OH)D level was set at 80 nmol/L.

Review of reports for vitamin D intake in the Slovenian population_

Authors	Population	Mean vitamin D intake [μg/day]	Data collection	Publication type
Fidler Mis, Kobe et al.	Teenagers	M: 4±4	sq-FFQ (n=2,661)	A
2012 (61)	Age 15-16 years	F: 4±3	3DDR for adjustment
	M: n=1,010		(n=197)
	F: n=1,214

Gregorič 2019 (69, 70)	Elderly in residential home	2 x 24h-recall: 1.1±0.6	2 x 24 h-recall	A, C3
	n=49	3DDR: 1.3±0.7	3DDR
	Age: 65-91 years

Gregorič 2015 (62)	Teenagers from 10 primary	All: 1.7	2 x 24h recall	C1
	schools
	Age 11-15 years n=327	6. grade
	6. grade: age 11-12 years,	F: 1.6±0.9
	mean 12.0±0.1	M: 1.9±1.3
	F: n=79
	M: n=78	8. grade
	8. grade 13-15 years, mean 14.0±0.2	F: 1.5±1.3
	F: n=84	M: 1.9±1.3
	M: n=86

Hribar 2021 (19)	Adolescents	Adolescents	2 x 24h recall	A
	Age: 10-17 years	All: 2.7	adjusted with FPQ
	M: n=238	M: 3.0
	F: n=230	F: 2.4
	Adults	Adults
	Age: 18-64 years	All: 2.9
	M: n=173	M: 3.4
	F: n=191	F: 2.3
	Elderly	Elderly
	Age: 65-74 years	All: 2.5
	M: n=213	M: 2.6
	F: n=203	F: 2.3

Jakše 2020 (71)	Healthy, active adults after	Food, supplements, and plant-	3DDR	A
	dietary intervention study	based meal replacements:
	Age: 18-78 years,	M: 7.1±5.8
	mean 39.6 years	F: 14.2±19.4
	M: n= 42	Food:
	F: n=109	M: 0.5 ±1.1
		F: 0.6 ±1.0
		Supplements, and plant-
		based meal replacements:
		M: 6.6±5.7
		F: 13.6±19.3

Jeretina 2019 (66)	Healthy peri- and	Food: 1.3±0.93	sq-FFQ for fish, milk,	C2
	postmenopausal women	Food and supplements:	and milk products
	Age: 40 - 65 years,	4.1±10.8
	mean 57.1±4.7 years
	n=59

Juvan 1997 (68)	Students eating	2.6	7DDR	C3
	vegetarian diets	Semi-vegetarians: 3.3
	n=14	Lacto-ovo vegetarians: 2.8
	Semi-vegetarians: 21%	Lacto vegetarians: 1.1
	Lacto-ovo vegetarians: 58%
	Lacto vegetarians: 21%

Koch and Gregorič	Nationally representative	Consumed with breakfast	24h-recall	A
2009 (63)	data from secondary	M: 0.3±0.5
	school students	F: 0.2±0.4
	Age: mean 18 years
	M: n=216
	F: n=237

Kocuvan Mijatov and	Adult female coeliac		3DDR	A
Mičetić-Turk 2016 (72)	disease patients	2.6
	Age: 23 - 76 years
	n=40

Lichthammer, Nagy et	Teenage and adult		sq-FFQ	A
al. 2015 (65)	population	All: 2.57
	Age: 15-75 years, mean 38.8 n=81	-------14-18 years: 3.7±3.3 19-29 years: 3.0±2.1
		30-69 years: 2.5±1.7

Lopert 2019 (73)	Female patients with	>70 years: 1.0±2.4	FFQ, 24h-recall	C2
	osteoporosis	FFQ: 1.8
	Age: mean 71.4 years	24h-recall: 1.4
	n=43

Poličnik, Pokorn	Pre-school children in		3DDR	A
et al. 2013 (60)	Central Slovenia	All: 1.1±0.7
	Age: 2-6 years, average 4.2	M: 1.0±0.7
	n=129	F: 1.1±0.7
	M: n=68
	F: n=61

Soltirovska Salamon,	Pregnant women in		4DDR	A
Benedik et al. 2015 (17)	third trimester
	Age: 30.6±4.4 years
	n=132

Urh, Babnik et	Elderly in a residential home		7DDR	A
al. 2017 (67)	Age: mean 82.2 years	2.6
	n=48

Zdešar-Kotnik 2019 (64)	Pupils of 1. years of		2x24h-recall	C1
	Secondary school	M: 1.4 (0.8 – 2.5)
	M: Age: 13.5 years; n=162	F: 1.0 (0.6 – 1.7)
	F: Age: 15.4 years; n=180

Review of reports for vitamin D status in the Slovenian population_

References	Data collection period	Study population	N	Serum 25(OH)D
				Mean conc.±SD or (95% CI) [nmol/L]	Prevalence of conc. < 50 nmol/L	Prevalence of conc. > 50 nmol/L	Publ. type
				Avberšek-Lužnik	Jan 2014 -	Self-paying subjects	73	65.1±33.0	<25 nmol/L: 9.6%	25-75 nmol/L:	B
				2016 (23)	Dec 2015	from laboratory				49.3%
		information system		Apr-Sept:	25-75 nmol/L:
		in Gorenjska region		75.3±37.1	49.3%	>75 nmol/L: 41.1%
		Age: 19-90; mean		Oct-Mar:
		49 years		55.7±25.7

Blazina, Bratanič	Oct - May	Children and	D1: 55	D1: 55.1	‘Common’		A
et al. 2010 (43)		adolescents with			deficiency
	(year not	celiac disease on	D2: 19	D2: 53.9	between Dec
	provided)	strictly compliant			and Apr
		to a gluten-free diet
		(D1) and not strictly
		compliant to a
		gluten-free diet (D2):
		D1 age: 11.4±4.3
		years; 3.8–17.6 years
		D2 age: 13.4±4.8
		years; 3.8–20.7 years

Dovnik, Mujezinović	Sept 2013	Pregnant women	398	Mothers:	Mothers: <25	Mothers 50–80	A,
et al. 2014, Dovnik, Mujezinović et al. 2015,	Dec 2013	and neonates	Mothers:	43.4±23.8	nmol/L: 23.6%	nmol/L: 27.9%	A, B,
Dovnik, Mujezinović et		Age:	Sept 100	Sep: 54.3±25.2	Sept: 10.0%	Sept: 40.0%	B,
	Mar 2014		Dec 99	Dec: 33.3±18.6	Dec: 41.4%	Dec: 16.2%
al. 2015, Dovnik 2016,		All: 29.6±4.7 years	Mar 10	Mar: 28.5±17.1	Mar: 34.0%	Mar: 12.0%	B,

Dovnik, Mujezinović et al. 2017, Dovnik,	Jun 2014	Sept: 29.1±4.2 years Dec: 29.3±5.2 years	Jun 99	Jun: 54.8±24.1	Jun: 9.1%	Jun: 43.4%	C1
Mujezinović et al.		Mar: 29.6±4.6 years	401	Neonates:	Mothers: 25–50	Mothers >80
2017 (33-38)		Jun: 30.3±4.9 years	Neonates:	55.2±30.9	nmol/L: 41.5%	nmol/L: 7%
			Sept 100	Sep: 72.9±31.7	Sept: 38.0%	Sept: 12.0%
			Dec 100	Dec: 52.5±27.3	Dec: 40.4%	Dec: 2.0%
			Mar 101	Mar: 36.4±22.6	Mar: 53.0%	Mar: 13.0%
			Jun 100	Jun: 59.5±24.9	Jun: 34.3%	Jun: 13.1%
					Neonates:	Neonates:
					<50 nmol/L:	50–75 nmol/L:
					47.6%	27.4%
						>75 nmol/L:
						24.9%

Ekart, Vodošek Hojs		Outpatients	72	55.75±27.59			B
et al. 2013 (45)		with chronic
		kidney disease in
		predialysis clinic
		Age: 60.72±12.7 years

Ferant and Kozar	Mar 2011 -	Pediatrics patients	CD: 35	CD: 32.5			A,
2012, Šikić Pogačar,	Apr 2012	with celiac					B,
Dolinšek et al. 2013,		disease (CD) and	IBD: 35	IBD: 32.6			C4,
Ferant, Kozar et		inflammatory bowel	K: 34	K: 49.9
al. 2014 (40-42)		disease (IBD)
		Age: 10-18 years

Gradišnik 2017,	Feb - Mar 2016	Institutionalized	80	33.0±27.0	IR: <7.5		A,
Velnar, Gradišnik et		residents (IR),			nmol: 14%		C3
al. 2018 (28, 29)		controls living
		(K) at home	IR: 42	IR: 27.0	K: <7.5 nmol: 13%
		Age: 51-93 years	K: 38	K: 39.5

Gros 2008 (55)	2006	Participants in	Jan	Jan			C3
		the laboratory for	M: 54	M: 31.9±16.2
	Jan, Feb, Mar,	analysis of hormones	F: 120	F: 40.3±39.0
	Aug, Sept, Oct	and tumour markers
			Feb	Feb
			M:48	M: 32.2±27.3
			F: 82	F: 29.5±21.7
			Mar	Mar
			M: 67	M: 27.6±21.8
			F: 140	F: 28.7±19.9
			Aug	Aug
			F: 34	F: 59.6±35.4
			Sept	Sept
			M: 54	M: 52.2±33.8
			F: 81	F: 55.9±26.3
			Oct	Oct
			M: 42	M: 55.8±23.9
			F: 118	F: 56.0±27.6

Hribar, Hristov et	2017 - 2018	A nationally	Adults: 125	Adults: 50.7	<30 nmol/L	<75 nmol/L	A
al. 2020 (20)		representative sample		(45.4–56.0)
	Summer:	of adults and elderly	Summer: 52		Adults: 24.9%	Adults: 83.3%
	May-Oct,			Summer: 70.4
	Winter:	Age adults:	Winter: 73	(62.2–78.5)	Adults winter: 40.8%	Adults winter: 98.0%
	Nov-Apr	18-64 years;		Winter: 36.7
					Adults summer:	Adults summer:
		mean 46.5±13.2	Elderly: 155	(32.5–40.9)	2.6%	62.6%
		Age elderly:	Summer: 64		Elderly: 23.5%	Elderly: 84.4%
		65-75 years; mean 68.6±2.8	Winter: 91	Elderly: 47.7 (43.9–51.5)	Elderly	Elderly winter:
					winter: 7.8%	92.2%
				Summer: 60.1
				(54.0–66.2)	Elderly summer:	Elderly summer:
					34.6%	73.4%
				Winter: 39.0
				(35.0–43.0)
					<50 nmol/L
					Adults: 58.2%
					Adults winter:
					81.6%
					Adults summer:
					25.3%
					Elderly: 62.9%
					Elderly winter:
					78.8%
					Elderly summer:
					40.2%

Humar 2015,	2000 - 2010	Patients with	18	Before			B,
Osredkar, Humar et		IgA nephropathy		supplementation:			C3
al. 2015 (49, 50)		before and after		40.5±17.6
		cholecalciferol
		supplementation		After
				supplementation:
		Age: 47.1±10.1 years		65.0±27.3

Jakopin, Pečovnik-	May 2008 -	Haemodialysis	101	28.6±16.7	<12 nmol/L:	40 – 75 nmol/L:	A,
Balon et al. 2011,	May 2010	patients			16.8%	28.7%	C1
Jakopin 2013 (46, 47)
		Age: 63.3±13.5 years			12 – 37 nmol/L:	>75nmol/L: 3%
					51.5%
					40 – 75 nmol/L:
					28.7%

Jakše, Sekulič 2020 (39	) Apr (year not	Indoor female	AG: 17	67.6±36.2	<50 nmol/L:	51–75 nmol/L:	A
	provided)	athletes:	S: 14		35.5%	32.3%
		athletes engaged			S: 35.7%	S: 21.4%
		in weight-bearing		AG: 65.1±36.0
		(artistic gymnastic		S: 70.6±37.5	AG: 35.3%	AG: 41.2%
		(AG)) and non-				>75 nmol/L:
		weight-bearing				32.3%
		(swimming (S)) sport
						S: 42.9%
		Age: 16.9±4.4 years
						AG: 23.5%

Krajnc, Čokolič et	2014 - 2017	Hospitalised and	2082	Median: 62.9		Most individuals	B
al. 2018 (54)		outpatient patients				lower than
		mostly with				75 nmol/L
		osteoporosis and
		vitamin D risk factors
		for insufficiency

Krajnc, Čokolič et	(year not	Outpatient type	45	58.0±35.1			B
al. 2013 (51)	provided)	II diabetics
		Age: 59±8 years,
		mean: 10±8

Kšela and Zavratnik	Apr 2011	Ambulatory	47	33.8±17.1		2 patients above	B
2013 (52)		patients with type				75 nmol/L
		II diabetes mellitus
		Age: 65±8.7 years

Marc 1993 (18)	(year not	Haemodialysis	85	29.2±22.8			C2
	provided)	patients (DP)
		and continuous	DP: 51	DP: 39.5
		peritoneal dialysis	CAPD: 34	CAPD: 13.8
		patients (CAPD)

Osredkar, Marc	1994 - 1995	Individuals from	240	Feb: 61.3			A
1996 (22)		general population		Apr: 71.5
		included on periodic		Jun: 92.8
		medical examinations		Aug: 81.8
				Oct: 74.5
				Dec: 70.3

Pajek, Čuk et al. 2017,	2014 - 2015	Dialysis patients	DP: 54	68.0±28.4			A,
Šturm 2017 (24, 25)		(DP) from nine					C2
		Haemodialysis	K: 81	DP: 73.1±35.4
		outpatient centres		K: 64.6±22
		and controls (K)
		Age: 56.1±15.2 years

Pajk 2011 (30)	Jan 2009 -	Postmenopausal	457	48.2±27.4	<25 nmol/L:	25-75 nmol/L:	C3
	Dec 2010	women from			25.8%	56.7%
		endocrinology	55-69	55-69 years:
		and nephrology	years: 170	51.6±27.0	25-75 nmol/L:	>75 nmol/L:
		outpatients centres	70-79	70-79 years:	56.7%	17.5%
		Age: 55 - 90 years,	years: 166	48.8±26.8
		mean: 72.7	80-90	80-90 years:
			years: 121	42.7±28.3

Pečovnik-Balon, Jakopin	Sept 2005 –	Haemodialysis	102	58±35.6	10.5–50	>50 nmol/L: 52%	A
et al. 2009 (48)	Sept 2007	patients treated			nmol/L: 48%
		at the Department
		of Haemodialysis
		Age: 60.5±13.1 years

Rakuša, Vrtovec	2009 - 2018	Heart transplantation	123	73.5 (54.7–89.6)	<24.9 nmol/L:	50.0–74.9	A
et al. 2020 (57)		recipients			5.1%	nmol/L: 33.4%
		Median age: 57 years			25.0–49.9	>75.0 nmol/L:
					nmol/L: 16.2%	45.3%

Rondaij, Rotovnik Kozjek et al. 2021 (59)	Jan 2017 - Dec 2018	Chronic intestinal failure patients on	63	41.3	<30 nmol/L: 24%	50-75 nmol/L: 26%
		long-term home			30-50 nmol/L:
		parenteral nutrition			48%
		Median age: 65 years

Salkić 2016 (56)	Summer: Sept	Outpatient clinic	Summer:	Summer: 58.6			C3
	- Nov 2015	laboratory	776
				Winter: 52.3
	Winter: Jan	Age: 64.5 years	Winter: 434
	- Mar 2015

Soltirovska Salamon,	Dec 2010 -	Pregnant Women	132	74.7±27.5	<50 nmol/L: 14%	50-75 nmol/L:	A
Benedik et al. 2015 (17)	Oct 2012	in 3. trimester				41%
Smaller subsamples		Age: 30.6±4.4 years
of same population
(31, 32)

Tesovnik, Kovac	(year not	Juvenile population
et al. 2015 (44)	provided)	with type I diabetes
		Age: 4-14 years,
		median: 8.7

Tomažič, Ul et	Jan - Feb 2006	HIV-infected male	96	T1: 35.8	<50 nmol/L: 82%		A
al. 2007 (58)		population, different treatments: on three	T1: 24	T2: 26.5	T1: 75%
		T1: antiretroviral	T2: 37	T3: 36.5	T2: 89%
		treatment naïve; T2:
		treated with non-	T3: 35		T3: 82%
		protease-inhibitor
		antiretroviral
		treatment; T3:
		treated with
		protease-inhibitor
		containing
		antiretroviral
		treatment
		Age: 43 years

Trdan 2016 (26)	2014 - 2015	DM and controls	818	DM: 31.6±17.4			C3
		age: 67.6 years	DM: 266	K: 49.2±29.6
		K age: 55.4 years	K: 552

Troskot and Duhovnik	Autumn 2011	Patients treated with	P: 32	P: 55.6±25.2	P:	P:	C4
2013 (27)	- spring 2013	antiepileptic drugs			<50 nmol/L:	50-70 nmol/L:
		carbamazepine and			46.9%	31.3%
		oxcarbazepine healthy controls (P) and (K)				>75 nmol/L: 21%
		P age: 28-59 years			K:	K:
			K: 22	K: 50.6±20	<50 nmol/L:	50-70 nmol/L:
		K age: 29-60 years			59.1%	31.8%
						>75 nmol/L: 9.1%

Vindišar, Goličnik	(year not	Patients with	38	39.6±11.9	20-50 nmol/L:	>50 nmol/L:	B
et al. 2009 (53)	provided)	hip fracture			85.8%	13.2%
		Age: 58- 95 years,
		mean 79 years

Vujasinović, Kunst	(year not	Patients 1 year after	22			<65 nmol/L:	A
et al. 2016 (104)	provided)	bariatric surgery				95.4%
		Age: 42.0±9.2 years

Žmitek, Hribar et	Jan - Mar 2019	Healthy adults, mostly	238	44.0±17.0	<30 nmol/L: 21%	50 -75 nmol/L:	A
al. 2020 (21)		from Central Slovenia		M: 44.3±16.0	30 -50 nmol/L:	31%
		Age: 18–65 years;			45%	>75 nmol/L: 3%
		mean 37.7±11.4		F: 43.8±18.0

A systematic review of vitamin D status and dietary intake in various Slovenian populations

Figures & Tables

Figure 1

Figure 2

Figure 3

Figure 4

Review of reports for vitamin D intake in the Slovenian population_

Review of reports for vitamin D status in the Slovenian population_

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