The burden of vitamin D deficiency in a mediterranean country without a policy of food fortification Giuseppe Lippi 1 , Antonio Nouvenne 2 , Andrea Ticinesi 2 , Patrizia Bonelli 1 , Gian Luca Salvagno 3 , Gianfranco Cervellin 4 , Gian Cesare Guidi 3 1 Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy; 2 Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy; Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; 3 Laboratory of Clinical Chemistry and Hematology, University of Verona, Verona, Italy; 4 Emergency Department, Academic Hospital of Parma, Parma, Italy Summary. Background: Vitamin D deiciency is a public healthcare issue and its correction is increasingly regarded as a cornerstone of preventive medicine. Methods: We designed a retrospective observational study to clearly deine the burden of total vitamin D (25-hydroxyvitamin D) deiciency in a supposedly healthy population of outpatients residing in two regions (Emilia Romagna and Veneto) of Northern Italy. Results: 25-hydroxyvitamin D results were available for a total number of 5,096 outpatients in the two centers. he median value of 25-hydroxyvitamin D was 60 nmol/L, and was higher in women than in men (62 nmol/L versus 56 nmol/L; p<0.001). he rate of 25-hydroxyvitamin D deiciency was 36%, and was marginally but signiicantly higher in men than in women (40% versus 35%; p=0.003). A signiicant variation in the rate of 25-hydroxyvitamin D deiciency was found throughout diferent age ranges, exhibiting a signiicant increase in the elderly. Conclusions: he results of this large observational study show that the burden of 25-hydroxyvi- tamin D deiciency in two regions of a Mediterranean country without a policy of food fortiication is as high as 36%, and this evidence represents a background for healthcare preventive measures aimed at reducing the prevalence of this condition in the general population. (www.actabiomedica.it) Key words: vitamin D, deiciency, deicit, prevention Acta Biomed 2015; Vol. 86, N. 1: 59-62 © Mattioli 1885 Original article Introduction Vitamin D is a fat-soluble compound which regu- lates calcium homeostasis and is also of vital importance for muscle development, function and preservation (1). Recent evidence also indicates that vitamin D status may strongly inluence the risk of a number of severe human disorders such as cancer, diabetes and cardiovas- cular disease (1,2). In humans, the active pool of vitamin D is strongly regulated by diet and dermal synthesis, so that environmental changes may exert a substantial im- pact on its concentration and bioavailability. Although epidemiological data about the burden of total vitamin D (25-hydroxyvitamin D) deiciency are considerably heterogeneous around the globe, sev- eral lines of evidence seemingly attest that this condi- tion may be more frequent than expected (3). Moreo- ver, its prevalence is continuously increasing due to considerable lifestyle changes that have occurred over the past decades, and which are basically attributable to lower exposure to sun irradiation and changes of dietary habits (3). To overcome the increasing burden of 25-hydroxyvitamin D deiciency, several countries such as the US and Canada have developed speciic policies of vitamin D food fortiication (4). Neverthe- less, the usage of supplements as well as the vitamin D content of available supplements in many of these countries remained low, so that even food fortiication