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IntroductionVitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency.MethodsA systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations.ResultsThe updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care.ConclusionVitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies and should also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.

Little published information is available regarding epidemiological data on vitamin D status in the large geographical region of Central Europe (CE). We searched the journal literature with regard to 25(OH)D concentrations among community-dwelling or healthy people living in CE. 25(OH)D concentrations varied by age, season, study sample size, and methodological approach [i.e., 25(OH)D assay used]. Concentrations of 25(OH)D in CE appeared lower than 30 ng/mL, and the magnitude of hypovitaminosis D was similar to that reported in Western Europe. While most of the studies reviewed were cross-sectional studies, a longitudinal study was also included to obtain information on seasonal variability. The longitudinal study reported wintertime 25(OH)D values close to 21–23 ng/mL for all studied age groups, with a significant increase of 25(OH)D in August reaching 42 ng/mL for those aged 0–9 years, but only 21 ng/mL for the elderly aged 80–89 years. The decrease in 25(OH)D with respect to age was attributed to decreased time spent in the sun and decreased vitamin D production efficiency. Based on the literature review on vitamin D status in the CE populations, it can be concluded that 25(OH)vitamin D levels are on average below the 30 ng/mL level.

functions of vitamin D seem to be higher (30-50 ng/ml; 75-125 nmol/l), 25 but still are considered uncertain. Some authors, however, argue that even for proper bone mineralization, levels higher than 30 ng/ml (75 nmol/l) are necessary. 26 Indisputably, low 25(OH)D levels (below 20 ng/ml) are common and were reported worldwide, 1-7 and this is a drawback because epidemiological data underlined an association between vitamin D deficit and a higher risk for chronic conditions and multimorbidity, including musculoskeletal disorders, cancer, autoimmune diseases, cardiovascular disease, diabetes, and infectious diseases. 1,3,[27][28][29][30] One of the countries with limited data on vitamin D status is Poland (49-54°N; Central Europe). Results of studies carried out in our country indicated that the problem of vitamin D deficiency considerably affects the Polish population. In a study of 448 adult residents of urban areas INTRODUCTION Vitamin D is an important prohormone that can be synthesized by the skin exposed to sunlight (UVB) or ingested with food. However, low outdoor activity, sun protection, and low vitamin D content of staple foods reduce the significance of sun and diet as natural sources for efficacy of vitamin D metabolism and related health effects. In consequence, evidence from various populations highlighted vitamin D deficiency as a public health problem with high prevalence.1-17 The prevalence of vitamin D deficiency depends on diagnostic thresholds defining vitamin D status that is determined by total serum 25(OH)D levels, 18 and the recommended levels of 25(OH)D are still an issue of debate.19-22 Currently, it is accepted that maintaining serum 25(OH) D at a level of 20 ng/ml (50 nmol/l) or above is beneficial at least for bone health and calcium homeostasis.23,24 Levels required for noncalcemic PATIENTS AND METHODSThis cross-sectional study included a total of 5775 adult volunteers (4464 women; 1311 men; mean age, 54.0 ±15.9 years; range, 15.6-89.8 years), who were enrolled and examined through late winter and spring 2014. Serum concentrations of 25(OH)D were determined using the Liaison XL system (DiaSorin; CLIA method). Demographic and anthropometric data were also analyzed. RESULTSThe mean 25(OH)D concentration in the studied population was 18.0 ±9.6 ng/ml; 65.8% of the patients had 25(OH)D levels of less than 20 ng/ml; 24.1% had suboptimal levels of 20 to 30 ng/ml; and only 9.1% demonstrated the optimal levels of 30 to 50 ng/ml. In 89.9% of the studied population, 25(OH)D levels of less than 30 ng/ml were found. Obesity, defined as body mass index (BMI) over 30 kg/m 2 , was associated with lower 25(OH)D levels compared with normal weight (15.8 ±8.5 vs 18.5 ±9.7 ng/ml; P <0.0001). Lower 25(OH)D levels were observed in men, younger individuals, and individuals with excess body weight and higher BMI. CONCLUSIONSThe results of our study, which involved the most representative sample size of Polish adults, support the previously reported data on vitamin D status. The levels of 25(OH)D determined f...