Influence of external, intrinsic and individual behaviour variables on serum 25(OH)D in a German survey

• Ambient UV exposure combined with behavioural factors mainly influence serum 25(OH)D concentrations in a German survey.
• The factor most significantly associated with hypovitaminosis D in Germany, defined here as 25(OH)D < 25 nmol L−1, is winter season.
• In winter 43% of survey participants were vitamin D deficient and 42% insufficient.
• In summer over half the population has insufficient 25(OH)D status with 8% deficient and 47% insufficient.

The objective of the present study was to identify external, intrinsic or behavioural factors that significantly influenced serum 25-hydroxyvitamin D (25(OH)D) concentrations in a German survey. Data from 3061 participants in the Cooperative Health Research in the Region of Augsburg, Germany (KORA) F4 survey were used to relate potential determinants to measured mean serum 25(OH)D concentrations using multivariable regression models.The factors significantly associated with hypovitaminosis D (defined as 25(OH)D < 25 nmol L−1) were season (winter, spring and autumn), urban environment and high body mass index. In contrast, times spent in sunny regions, hours per day spent outdoors in the summer as well as additional oral intake were associated with higher 25(OH)D concentrations. These results suggest that mainly ambient UV exposure but also individual behaviour are the most important determinants for personal 25(OH)D concentrations. The analyses further showed that in winter 43% of subjects were vitamin D deficient and 42% insufficient. Even in summer over half the population has insufficient vitamin D status with 8% deficient and 47% insufficient. Therefore measures to mitigate widespread vitamin D insufficiency such as regular short-term sun exposure and/or improved dietary intake/supplementation recommendations by public health bodies need to be considered.