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Abstract
Vitamin D has important benefits in reducing the risk of many conditions and diseases. Those diseases for which the benefits are well supported and that have large economic effects include many types of cancer, cardiovascular diseases, diabetes mellitus, several bacterial and viral infections, and autoimmune diseases such as multiple sclerosis. Europeans generally have low serum 25-hydroxyvitamin D [25(OH)D] levels owing to the high latitudes, largely indoor living, low natural dietary sources of vitamin D such as cold water ocean fish, and lack of effective vitamin D fortification of food in most countries. Vitamin D dose-disease response relations were estimated from observational studies and randomized controlled trials. The reduction in direct plus indirect economic burden of disease was based on increasing the mean serum 25(OH)D level to 40 ng/mL, which could be achieved by a daily intake of 2000–3000 IU of vitamin D. For 2007, the reduction is estimated at €187,000 million/year. The estimated cost of 2000–3000 IU of vitamin D3/day along with ancillary costs such as education and testing might be about €10,000 million/year. Sources of vitamin D could include a combination of food fortification, supplements, and natural and artificial UVB irradiation, if properly acquired. Additional randomized controlled trials are warranted to evaluate the benefits and risks of vitamin D supplementation. However, steps to increase serum 25(OH)D levels can be implemented now based on what is already known.  

Introduction
The health benefits of UVB and vitamin D include reduced risk for fractures, cancer, infectious diseases, autoimmune diseases, cardiovascular diseases, metabolic diseases, congestive heart failure, periodontal disease, etc. The scientific consensus is that about 4000 International Units (IU) of vitamin D3/day are required for optimal health. Skin production of vitamin D3, stimulated by solar ultraviolet-B (UVB) provides most of the vitamin D for the majority of Americans. For young, lightly-pigmented individuals, a few minutes of mid-day solar UVB in summer can produce about 1000 IU for each 10% of the body exposed. Wearing sunscreen blocks vitamin D production, and going out when the sun is low in the horizon, such as morning and afternoon and winter, is not conducive to vitamin D production. The average American obtains 250-300 IU/day from fortified food and fish. Thus, most Americans do not get enough vitamin D.

For those who would like to learn more about the health effects of vitamin D, I’ve assembled comprehensive information, including the following: web sites, presentations, books, journal papers, practical matters, the Vitamin D Scientists’ Call to Action Statement, and the abstract of my latest vitamin D manuscript. I would be happy to provide more information upon request.

Abstract Alzheimer's disease (AD), first described in 1906 by German psychiatrist Alois Alzheimer, is a progressive brain disorder that causes a gradual and irreversible decline in memory, language skills, perception of time and space, emotional stability, pattern recognition, coordination, and, eventually, the ability to care for oneself. AD is associated with abnormal changes in the brain involving plaques, tangles, beta-amyloid protein, and free radicals.

The risk factors for AD include both genetic and environmental factors. The primary genetic risk factor is the presence of the apolipoprotein E epsilon4 (APOE e4) allele, which is more common among Africans, Inuits, AmerIndians, and northern Europeans than southern Europeans and Asians. This allele can be considered a "thrifty gene," one that helps store excess energy as fat, which is a survival factor for hunter-gatherer peoples. The primary dietary risk factors are total energy and some types of fat, while the primary risk reduction factors are cereals or grains and fish and some types of fat. Among fats, the good ones are linoleic acid (found in safflower, sunflower, hemp, soybean, walnut, pumpkin, sesame, and flax seed oil), alpha-linolenic acid (found in fish, canola, flax, hemp seed, soy bean, and walnut oil and dark green leaves), and olive oil, while the bad ones are saturated fats (found in solid fats such as butter and cheese) and trans-fatty acids (found in many processed foods and labeled as partially-hydrogenated vegetable oils). Also, extra virgin olive oil, with its strong antioxidant properties, is a good choice. Antioxidant vitamins C and E, as well as flavonoids, found in fruits and vegetables, and resveratrol, found in red wine, play a protective role. Obesity, smoking, cholesterol, and homocysteine are also risk factors, while exercise reduces the risk. Thus, even if one has a genetic predisposition for AD, there are many ways that one can reduce the risk.

For those who want to reduce their risk of AD, the most important thing appears to be to maintain a low body mass index by eating a diet low in total energy, low in bad fats, adequate in good fats, high in fruits, vegetables, and antioxidants, and moderate-to-high in cereals and grains, with whole grains preferred. Added sugars should also be avoided since they lead to obesity. The traditional diets in Southeast Asia and the Mediterranean provide examples of good diets. Adequate folate consumption, perhaps via supplements, should also be included. In addition, antioxidant and folate supplements would be beneficial. Finally, keeping both the mind and body active, are very helpful.

Irina P. Terenetskaya
Institute of Physics, National Academy of Sciences of Ukraine
252022 Kiev-22, Ukraine
e-mail: teren@iop.kiev.ua

Abstract. A new method of biological dosimetry of UVB radiation based on an in vitro model of previtamin D photosynthesis is presented. The important role of vitamin D synthesis upon UV solar radiation is briefly reviewed. Distinctive features and extended capabilities of the method are discussed in detail with reference to the results of laboratory and field tests.

Martin Lipkin, MD and Harold L. Newmark, DSc
Weill Medical College of Cornell University, Strang Cancer Research Laboratory at The Rockefeller University, New York (M.L.)
Rutgers University, New Jersey (H.L.N.)

Abstract: Several recent epidemiologic and experimental studies have suggested that decreased calcium and vitamin D intake and high dietary fat are associated with mammary gland carcinogenesis. Complete reduction or elimination of human exposure to environmental factors such as high-fat diets is inherently difficult to implement. Recent studies have begun to evaluate a possible role for increased dietary calcium and vitamin D in reducing the risk of colonic and mammary cancers, even in the presence of a high-fat diet. Studies from our laboratory recently found that decreased dietary calcium and vitamin D in a high-fat diet induced adverse changes in the mammary gland and several other organs, which were reversed by increasing dietary calcium and vitamin D; the findings further suggest a possible role for increased dietary calcium and vitamin D in the chemoprevention of these cancers.

1. reservelæge Henning Glerup & overlæge Erik Fink Eriksen
Århus Universitetshospital, Århus Kommunehospital,
Medicinsk-gastroenterologisk Afdeling V, og
Århus Universitetshospital, Århus Amtssygehus, Medicinsk
Endokrinologisk Afdeling C

Resumé: D-vitamin spiller en central rolle i sikring af normalt niveau af serumcalcium. Den centrale regulering sker ved nyrernes hydroxylering af 25(OH)D 3 til calcitriol (1,25(OH) 2 D 3 ). 1,25(OH) 2 D 3 har i en årrække været anset for at være den eneste betydende mediator af D-vitamins regulering af calciumhomøostasen. Kliniske mål for hypovitaminosis D har dog altid vist sig at korrelere til 25(OH)D 3 og ikke til 1,25(OH) 2 D 3 . Dette paradoks har hidtil været uforklaret. Nye forskningsresultater har vist, at forskellige celletyper har kapacitet for intracellulær 1,25(OH) 2 D 3 -syntese ud fra 25(OH)D 3 . Den lokale intracellulære 1,25(OH) 2 D 3 -syntese er substratafhængig af 25(OH)D 3 , hvilket giver en plausibel forklaring på paradokset. Den lokale 1,25(OH) 2 D 3 -syntese synes at have betydning for risikoen for udvikling af en række cancerformer (f.eks. prostata-, colon- og mammacancer). Ud fra hidtidige forskningsresultater argumenteres der for, at S-25(OH)D 3 i cancerprofylaktisk øjemed bør holdes over 50 nmol/l.

Summary

Vitamin D sufficiency is required for optimal health. The conditions with strong evidence for a protective effect of vitamin D include several bone diseases, muscle weakness, more than a dozen types of internal cancers, multiple sclerosis, and type 1 diabetes mellitus. There is also weaker evidence for several other diseases and conditions. There are good reasons that vitamin D sufficiency be maintained during all stages of life, from fetal development to old age. Adequate calcium intake is also recommended. The current vitamin D requirements in the United States are based on protection against bone diseases. These guidelines are being revised upward in light of new findings, especially for soft-tissue health. The consensus of scientific understanding appears to be that vitamin D deficiency is reached for serum 25-hydroxyvitamin D (25(OH)D) levels less than 20 ng/mL (50 nmol/L), insufficiency in the range from 20-32 ng/mL, and sufficiency in the range from 33-80 ng/mL, with normal in sunny countries 54-90 ng/mL, and excess greater than 100 ng/mL. Solar ultraviolet-B (UVB) irradiation is the primary source of vitamin D for most people. In general, the health benefits accruing from moderate UV irradiation, without erythema or excess tanning, greatly outweigh the health risks, with skin pigmentation (melanin) providing much of the protection. In the absence of adequate solar UVB irradiation due to season, latitude, or lifestyle, vitamin D can be obtained from fortified food, oily fish, vitamin D supplements, and artificial sources of UVB radiation.