Contents - IARC

Vitamin D and Cancer
Chapter 6 – Current recommendations for vitamin D intakes
Internationally, the recommendations for vitamin D intake have been based upon levels
presumed necessary for the prevention of vitamin D deficiency diseases, mainly rickets and
osteomalacia that affect children and women in childbearing age. The vitamin D requirements for
healthy adults have never been precisely defined (SCF, 2002). In addition, the lack of a standard
approach for deriving nutrient recommendations has resulted in wide between country heterogeneity
in terms of recommended intake levels (Doets et al.,2008). The potential confusion is compounded by
the use of different terminologies, such as estimated average requirement (EAR), recommended
dietary allowance (RDA), adequate intake level (AI), and tolerable upper intake level (UL), with many
local variants, which are used to express requirement levels. Below, vitamin D intake
recommendations from major health agencies and different world regions are briefly reviewed.
6.1 WHO/FAO
A joint WHO/FAO report entitled Expert Consultation on Diet, Nutrition and Prevention of Chronic
Diseases (2003) 4 makes recommendations based on the latest scientific evidence available at the
time of publication pertaining to relevant interventions for chronic disease risk reduction and with the
overall aim of implementing more effective and sustainable policies and strategies to deal with the
increasing public health challenges related to diet and health. The report lists vitamin D as having
“insufficient” evidence to merit a recommendation for cancer risk reduction. However, the report does
recommend intakes of vitamin D and calcium for fracture risk reduction in osteoporosis.
Another joint report from the WHO/FAO expert consultation on Vitamin and Mineral
Requirements in Human Nutrition (2004) 5 took one of the recommendation made by MF Holick
(1994) saying that the most efficient and physiologically relevant way of acquiring vitamin D is via sun
exposure for approximately 30 minutes per day on the hands and face. The report does not at all
discuss issues related to skin complexion and variable ability to synthesise vitamin D. Following Holick
(1994), in situations where the skin synthesis of vitamin D is negatively influenced (high latitude, winter
season, dark skin pigmentation, older age, clothing, sunscreen use), the report provides
recommendations for dietary intake ranging from 5 μg/day (infants, children, adolescents, adults up to
50 years old, pregnant women, lactating women) to 10 μg/day (adults 51-65years old) to 15 μg/day
(adults >65years and over).
6.2 Europe
Most European countries provide recommendations for vitamin D intake specific to their own
populations (Doets et al.,2008). In most countries, specific recommendations are provided for different
age ranges and at-risk population groups (infants, pregnant and lactating women). Overall, the
recommendations vary greatly from country to country. For adults aged 25 to 50 years old, the
recommendations range from no supplementation in the United Kingdom, 2.5 μg/day in the
Netherlands and Russian Federation to 10 μg/day in Albania and Iceland, with the majority of
countries recommending an intake of 5 μg/day (Doets et al.,2008). In most countries, dietary vitamin D
recommendations are higher for infants, children, adolescents, and adults aged 70 years or more with
the maximum being 22.5 μg/day for infants in France. In the United Kingdom, a report of the
Department of Health Committee on Medical Aspects of Food and Nutrition Policy has not established
an RNI for children older than 3 years, or for adults younger than 65 years (Department of Health,
1998). For Finland, Germany, Switzerland and Austria the recommended daily intake of vitamin D is
5-10 µg/day for most of the population (National Nutrition Council, 1999; Deutsche Gesellschaft für
Ernährung et al.,2000). In Norway, the National Council on Nutrition and Physical Activity has
recommended daily consumption of cod-liver oil supplements, which contains other nutrients in
addition to vitamin D (Brustad et al.,2004; Rimestad et al.,2001). The European Union’s Scientific
Committee on Food (SCF) has provided Population Reference Intakes (PRI) for vitamin D as follows:
6-11 month 10-25 µg; 1-3 years 10 µg; 4-10 years 0-10 µg; 11-17 years 0-15 µg; 18-64 years 0-10 µg;
≥ 65 years 10 µg; pregnancy 10 µg; lactation 10 µg (SCF, 1993). The European Union has supported
a project towards a strategy for optimal vitamin D fortification named OPTIFORD (Andersen et
al.,2001) as well as the EURRECA (EURopean micronutrient RECommendations Aligned) project
aiming at identifying and addressing the problem of differences between countries in micronutrient
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