Skip to main content Skip to main navigation menu Skip to site footer

Primary source of Vitamin D: sunlight or nutrition?

  • Bahrul Fikri ,
  • Aidah Juliaty ,
  • Sam Engels ,
  • Azwin Mengindera Putera ,
  • Zahrah Hikmah ,
  • Andi Dwi Bahagia Febriani ,
  • Sri Hardiayanti Putri ,
  • Nadirah Rasyid Ridha ,
  • Ema Alasiry ,
  • Anang Endaryanto ,
  • Nasrum Massi ,
  • Yusrawati ,
  • Deasy Irawati ,
  • Hamsu Kadrian ,


Link of Video Abstract: 


This study reviews the existing literature on whether sunlight or nutrition is the main source of vitamin D and explores the factors contributing to vitamin D deficiency in tropical regions. The key findings include urbanization, ethnicity, sun-avoidance, religion, and nutrition as causes for the high prevalence of vitamin D deficiency in tropical areas. While sunlight is considered the main source of vitamin D, factors such as air pollution, sun-avoidance behaviors, and the clothing style of certain religions can limit sunlight absorption. Moreover, limited access to vitamin D-rich foods and low consumption of fortified foods contribute to the deficiency. The study suggests further research on the role of nutrition as a potential main contributor to vitamin D deficiency in tropical areas.


  1. Umar M, Sastry KS, Chouchane AI. Role of vitamin D beyond the skeletal function: A review of the molecular and clinical studies. Int J Mol Sci. 2018;19(6):1618.
  2. Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19(2):73–8.
  3. Jukic AMZ, Hoofnagle AN, Lutsey PL. Measurement of vitamin D for epidemiologic and clinical research: Shining light on a complex decision. Am J Epidemiol. 2018;187(4):879–90.
  4. Zhang R, Naughton DP. Vitamin D in health and disease: current perspectives. Nutr J. 2010;9:65.
  5. Roth DE, Morris SK, Zlotkin S, Gernand AD, Ahmed T, Shanta SS, et al. Vitamin D supplementation in pregnancy and lactation and infant growth. N Engl J Med. 2018;379(6):535–46.
  6. Bikle DD. Vitamin D: Newer concepts of its metabolism and function at the basic and clinical level. J Endocr Soc. 2020;4(2):bvz038.
  7. Levine MA. Diagnosis and management of Vitamin D dependent rickets. Front Pediatr. 2020;8:315.
  8. Marshall I, Mehta R, Ayers C, Dhumal S, Petrova A. Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome. BMC Pediatr. 2016;16(1):208.
  9. Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020;74(11):1498–513.
  10. Nimitphong H, Holick MF. Vitamin D status and sun exposure in southeast Asia. Dermatoendocrinol. 2013;5(1):34–7.
  11. Siddiqee MH, Bhattacharjee B, Siddiqi UR, MeshbahurRahman M. High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis. BMC Public Health. 2021;21(1):1823.
  12. Cribb VL, Northstone K, Hopkins D, Emmett PM. Sources of vitamin D and calcium in the diets of preschool children in the UK and the theoretical effect of food fortification. J Hum Nutr Diet. 2015;28(6):583–92.
  13. Mendes MM, Hart KH, Botelho PB, Lanham-New SA. Vitamin D status in the tropics: Is sunlight exposure the main determinant? Nutr Bull. 2018;43(4):428–34.
  14. Dominguez LJ, Farruggia M, Veronese N, Barbagallo M. Vitamin D sources, metabolism, and deficiency: Available compounds and guidelines for its treatment. Metabolites. 2021;11(4):255.
  15. Divakar U, Sathish T, Soljak M, Bajpai R, Dunleavy G, Visvalingam N, et al. Prevalence of vitamin D deficiency and its associated work-related factors among indoor workers in a multi-ethnic Southeast Asian country. Int J Environ Res Public Health. 2019;17(1):164.
  16. Holick MF. Vitamin D: a D-Lightful health perspective. Nutr Rev. 2008;66(10 Suppl 2):S182-94.
  17. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S-6S.
  18. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.
  19. Moan J, Porojnicu AC, Dahlback A, Setlow RB. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci U S A. 2008;105(2):668–73.
  20. Webb AR, Kift R, Durkin MT, O’Brien SJ, Vail A, Berry JL, et al. The role of sunlight exposure in determining the vitamin D status of the U.K. white adult population. Br J Dermatol. 2010;163(5):1050–5.
  21. Lips P, van Schoor NM, de Jongh RT. Diet, sun, and lifestyle as determinants of vitamin D status. Ann N Y Acad Sci. 2014;1317:92–8.
  22. Wakayo T, Belachew T, Vatanparast H, Whiting SJ. Vitamin D deficiency and its predictors in a country with thirteen months of sunshine: The case of school children in Central Ethiopia. PLoS One. 2015;10(3):e0120963.
  23. Chailurkit L or, Aekplakorn W, Ongphiphadhanakul B. Regional variation and determinants of vitamin D status in sunshine-abundant Thailand. BMC Public Health. 2011;11:853.
  24. Beer RJ, Herrán OF, Villamor E. Prevalence and correlates of vitamin D deficiency in a tropical setting: results from a nationally representative survey. Am J Clin Nutr. 2020;112(4):1088–98.
  25. Lin L, Ou Q, Lin L, Zhang H, Chen K, Chen D, et al. Low prevalence of vitamin D deficiency in adult residents in Hainan, the tropical island province of China. Ann Palliat Med. 2021;10(5):5580–9.
  26. Md Isa Z, Mohd Nordin NR, Mahmud MH, Hashim S. An update on vitamin D deficiency status in Malaysia. Nutrients. 2022;14(3):567.
  27. Maeda SS, Borba VZC, Camargo MBR, Silva DMW, Borges JLC, Bandeira F, et al. Recommendations of the Brazilian Society of Endocrinology and Metabology (SBEM) for the diagnosis and treatment of hypovitaminosis D. Arq Bras Endocrinol Metabol. 2014;58(5):411–33.
  28. Maeda SS, Saraiva GL, Kunii IS, Hayashi LF, Cendoroglo MS, Ramos LR, et al. Factors affecting vitamin D status in different populations in the city of São Paulo, Brazil: the São PAulo vitamin D Evaluation Study (SPADES). BMC Endocr Disord. 2013;13:14.
  29. Setiati S. Vitamin D status among Indonesian elderly women living in institutionalized care units. Acta Med Indones. 2008;40(2):78–83.

How to Cite

Fikri, B., Juliaty, A., Engels, S., Putera, A. M., Hikmah, Z., Febriani, A. D. B., Putri, S. H., Ridha, N. R., Alasiry, E., Endaryanto, A., Massi, N., Yusrawati, Irawati, D., & Kadrian, H. (2024). Primary source of Vitamin D: sunlight or nutrition?. Bali Medical Journal, 13(1), 458–462.