High Prevalence of Hypovitaminosis D in Morocco: Relationship to Lifestyle, Physical Performance, Bone Markers, and Bone Mineral Density

Prevalence of postmenopausal osteoporosis in Morocco: a systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis was conducted as part of the update of Moroccan recommendations for the management of postmenopausal osteoporosis. Its aim was to estimate the prevalence of postmenopausal osteoporosis in Morocco, based on available bibliographic data.

METHODS

We conducted a systematic search of the Medline/PubMed, Scopus, and Embase databases to identify articles published between January 2000 and January 2024. We included all observational studies reporting the prevalence of osteoporosis in postmenopausal women in Morocco. Two reviewers independently contributed to the study selection and data extraction. We assessed the risk of bias in the included studies using the Joanna Briggs Institute tool. Statistical analyses were performed using Stata with the Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I2 test statistic. Meta-regression analysis was used to investigate the effect of the date on the prevalence. Publication bias was assessed by DOI plots and the LFK index.

RESULTS

An electronic search found a total of 161 citations from the databases. After excluding the irrelevant articles, 17 eligible studies were included. This meta-analysis included 5097 postmenopausal women. The pooled prevalence of postmenopausal osteoporosis was 32% (95% CI 28-36). Heterogeneity was statistically significant (I2 = 89.67%). There was no significant difference between subgroup analyses performed by risk of bias and sample size. The prevalence rate was significantly higher in 2006-2012 (36%; 95% CI 31-42; I2 = 88.7%; p < 0.001) than in 2013-2019 (27%; 95% CI 22-32; I2 = 85.9%; p < 0.001). Meta-regression showed that the prevalence of osteoporosis decreases very slightly (0.016% per year). This decrease becomes nonsignificant if only studies with a low risk of bias are included in the meta-regression (coefficient - 7.77, p = 0.667, I2 0%). No publication bias was detected in this meta-analysis.

CONCLUSION

Our results indicate that postmenopausal osteoporosis is prevalent in Morocco, which is a developing country; however, the prevalence of this disease is aligned with that of industrialized countries.

Assessment of Vitamin D Status in the Drâa-Tafilalet Population (Morocco) Based on Sociodemographic, Health, and Nutritional Factors

The purpose of this study was to evaluate the vitamin D status and determine the factors influencing it in the Drâa-Tafilalet community (southeastern Morocco). Sociodemographic factors, health, cognitive status, sun exposure, and nutritional conditions were examined to help us understand their association with vitamin D status. Vitamin D data were gathered through laboratory testing, while demographic and health information was collected through interviews with participants in 2023. The study involved 100 participants aged 60 and above, most of whom were women (85%) rather than men (15%). The majority of participants were Arabs (90%), with a minority being Amazigh (10%). The average vitamin D level was 31.83 ± 10.55 ng/mL, varying based on participants' age, education, and gender. Sun-exposed individuals exhibited significantly higher mean vitamin D levels (33.56 ± 11.99 ng/mL) compared to those with limited sun exposure (28.97 ± 9.28 ng/mL). Moreover, the time spent outdoors, seasonal changes, and the duration of sun exposure affected the levels of vitamin D. These findings depict the vitamin D status of the elderly population of Drâa-Tafilalet, recognized as one of Morocco's poorest regions, shedding light on the significant influencers. Nonetheless, additional research is necessary to explore the correlation between dietary habits, sunlight exposure, and vitamin D levels in both young and elderly populations.

Vitamin D status and its associations with bone mineral density, bone turnover markers, and parathyroid hormone in Chinese postmenopausal women with osteopenia and osteoporosis

Background

Vitamin D is a key factor in bone metabolism, yet vitamin D insufficiency and deficiency are prevalent among postmenopausal women, with potential repercussions on bone mineral density (BMD), bone turnover markers (BTMs), and parathyroid hormone (PTH). Nonetheless, the findings from existing studies exhibit inconsistency, and a notable gap exists in the availability of large-scale investigations.

Methods

In this real-world study, 8,532 postmenopausal women over 50 years old with a diagnosis of osteopenia (50.9%) and osteoporosis (49.1%) at the first visit were enrolled in this study. Serum 25(OH)D level, PTH, osteocalcin (OC) and Beta-CrossLaps of type 1 collagen containing cross-linked C-telopeptide (β-CTX), were measured. BMD at all sites, including the lumbar spine, femoral neck, and total hip were obtained by dual-energy X-ray absorptiometry (DXA). The associations of serum 25(OH)D level with BMDs and BTMs were investigated using spearman correlation analysis and analysis of general linear model adjusted by age and body mass index.

Results

The serum 25(OH)D level was 22.17 ± 9.75 ng/mL among all patients included in this study. For the osteopenia group, the serum 25(OH)D level was 22.40 ± 9.41 ng/mL, while for the osteoporosis group, it measured 21.93 ± 10.08 ng/mL. In the osteopenia group, the prevalence of vitamin D deficiency, insufficiency and sufficiency was 45.8, 34.6, and 19.6%, respectively, which was close to that of the osteoporosis group (47.4, 34.3, and 18.3%) (p = 0.202). Spearman correlation analysis unveiled negative associations between serum 25(OH)D concentrations and both BTMs and PTH within both the osteopenia and osteoporosis group. In the osteoporosis group, there were positive correlations between 25(OH)D levels and femoral neck BMD (r = 0.040, p = 0.010) and total hip BMD (r = 0.053, p = 0.001). Furthermore, we found that for the osteopenia group, greater vitamin D levels were associated with greater femoral neck BMD (p = 0.020) and total hip BMD (p = 0.008) and lower β-CTX (p < 0.001), OC (p < 0.001), and PTH (p < 0.001). The same trends were seen in osteoporosis patients (p < 0.05), and with greater lumbar spine BMD with higher levels of 25(OH)D (p = 0.009).

Conclusion

This study showed high prevalence of vitamin D deficiency and insufficiency in Chinese postmenopausal women with osteopenia and osteoporosis and the relationships between vitamin D and BMD, BTMs and PTH. The results contribute to a more comprehensive understanding of how vitamin D may impact bone health.

Vitamin D status and its relationship with obesity indicators in Moroccan adult women

Background: Although vitamin D deficiency has been studied in various populations, there are few data on its prevalence and associated factors among Moroccan women. Aim: To determine the prevalence of vitamin D deficiency and investigate its association with body mass index (BMI), waist circumference, and serum concentrations of parathyroid hormone, calcium, and phosphorus in a sample of Moroccan adult women. Methods: This is a cross-sectional study conducted at Mohammed V Military Hospital of Instruction, Rabat. Anthropometric measurements and biochemical analyses were performed using standard procedures Results: A total of 714 women aged 18-65 years participated in this study. The overall prevalence of vitamin D deficiency was 74.4%. Approximately 24% and 51% of women had severe and moderate vitamin D deficiency, respectively. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were inversely correlated with BMI in vitamin D-deficient subjects (P = 0.036) and with parathyroid hormone 1-84 (PTH1-84) levels in the study sample (P = 0.010). PTH1-84 concentrations were greater among overweight/obese individuals compared to their non-overweight peers (P = 0.001) and tended to be higher among vitamin D-deficient women than vitamin D-sufficient women (P = 0.053). Conclusion: This study showed a very high prevalence of vitamin D deficiency in this sample of Moroccan women. Lower serum 25(OH)D levels were associated with increased BMI in vitamin D-deficient women and with elevated PTH1-84 levels among the study sample. Although these findings come from a convenience sample of women that attended a nutrition clinic, they underscore the urgent need to develop public health interventions to improve women's vitamin D status.

Impact of Vitamin D Deficiency on Mental Health in University Students: A Cross-Sectional Study

Students pursuing a university education are vulnerable to psychological burdens such as depression, anxiety, and stress. The frequency of vitamin D deficiency, on the other hand, is extensively recognized worldwide, and vitamin D regulates various neurological pathways in the brain that control psychological function. Therefore, the goal of this cross-sectional study was to determine the relationship between vitamin D deficiency and psychological burden among university students in Riyadh, Saudi Arabia. During March-May 2021 in Riyadh, a cross-sectional comparative study survey was delivered to university students. The DASS-21 scale was used to determine the severity of the psychological burden. Both univariate and binomial regression analyses were conducted to analyze the level of significance and influence of several factors on the development of psychological burden. The data were analyzed with SPSS-IBM, and a p value of <0.05 was considered significant. Of the 480 students recruited for the study, 287 (59.79%) had a vitamin D deficiency. Significantly (p = 0.048), a high proportion of the vitamin D-deficient students attained a low or moderate GPA compared to the control cohort. The prevalence of depression, anxiety, and stress among the vitamin D-deficient students was 60.35%, 6.31%, and 75.08%, respectively, which was significantly (p < 0.05) different from the control group. The odds of developing depression (OR = 4.96; CI 2.22-6.78; p < 0.001), anxiety (OR = 3.87; CI 2.55-6.59; p < 0.001), and stress (OR = 4.77; CI 3.21-9.33; p < 0.001) were significantly higher in the vitamin D-deficient group. The research shows a strong association between psychological stress and vitamin D deficiency. To promote the mental health and psychological wellbeing of university students, it is critical to create awareness about the adequate consumption of vitamin D. Additionally, university students should be made aware of the likelihood of a loss in academic achievement owing to vitamin D deficiency, as well as the cascade effect of psychological burden.

Association between Vitamin D Status and Health Status of Adults in Western Libya

Vitamin D (VitD) is essential for health and preventing diseases. This study aimed to investigate the possible association between VitD status and health status in 306 Libyan male and female young adults (18–25 Y) and adults (26–65 Y). There were 89.54% of subjects that had VitD levels below normal (<30 ng/mL), of which 45.42% were VitD deficient (<10 ng/mL) and 44.12% were VitD insufficient (10–29.9 ng/mL). VitD deficiency was associated with higher fasting blood sugar (FBS), low-density lipoprotein (LDL), and triacylglycerol (TAG) levels. Young adults had lower VitD levels than adults, which was associated with some health conditions. VitD insufficiency was associated with higher body mass index (BMI) values in adults, especially females, with higher FBS levels in adult males and higher hemoglobin A1c (HbA1c) levels in adult females. VitD deficiency in young adults was associated with higher TAG levels (more likely in adults) and lower high-density lipoprotein (HDL) values. Furthermore, VitD deficient adult females appeared to have a higher risk of sleeping problems, psychological disorders, headache, and osteoporosis, whereas their male counterparts appeared to be at a higher risk of developing obesity and diabetes mellitus (DM). Findings showed a serious prevalence of VitD inadequacy in the Libyan population, which appears to negatively affect health status and be associated with some disease conditions.

Concentrations of total, bioavailable, and free 25OHD in individuals with and without primary hyperparathyroidism and their correlations to DXA and trabecular bone score

Objective

This study aimed to investigate the association between 25OHD (total, bioavailable and free) with bone mass and microarchitecture among primary hyperparathyroidism (PHPT) patients and controls.

Subjects and methods

Sixty-four patients in the preoperative period of PHPT and 63 matched controls, who had not taken vitamin D in the last three months. To calculate the bioavailable and free 25OHD, the genetic variants of the vitamin D-binding protein (DBP) were determined. Bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry (DXA). The distributions of total, bioavailable and free 25OHD and their correlation with TBS and DXA were evaluated.

Results

PHPT showed BMD and TBS values lower than CTRL in all locations (p < 0.05). There were no statistical differences in the levels of free, bioavailable and total 25OHD between the PHPT and CTRL groups [mean, min-max: 3.4 (1.4-8.6) vs. 3.1 (1.0- 9.8) pg/mL, 1.51 (0.43-3.58) vs. 1.41 (0.38-3.48) ng/mL, 22.6 (11.0-39.9) vs. 20.6 (8.9-35.3) ng/dL, respectively; (p > 0.05). The distribution of DBP haplotypes was similar between groups. DXA showed no correlation with any form of 25OHD in both groups. TBS presented a weak correlation with the total 25OHD in PHPT (r = 0.28; p = 0.02) and a moderate correlation with the total, free and bioavailable 25OHD in CTRL (r = 0.42; r = 0.42; r = 0.43; respectively, p < 0.01).

Conclusion

The concentrations of total, free and bioavailable 25OHD were similar in both the PHPT and control groups. 25OHD concentrations correlated positively with TBS and not with DXA, especially in controls, suggesting that this method may be more sensitive to assessing the consequences of vitamin D deficiency on bone quality in individuals without PHPT.

Development and Validation of Vitamin D- Food Frequency Questionnaire for Moroccan Women of Reproductive Age: Use of the Sun Exposure Score and the Method of Triad's Model

This cross-sectional study aimed to develop and validate a vitamin D food frequency questionnaire (VitD-FFQ) to assess vitamin D intake in Moroccan women of reproductive age. Using the method of triads, the VitD-FFQ was validated against seven-day dietary records (7d-FR) and 25-hydroxyvitamin D (25(OH)D) as a biomarker of vitamin D status in 152 women (aged 18-45 years). Participants' sun exposure scores (SES) were assessed using a specific questionnaire (SEQ). Predictors of vitamin D status were identified via linear regression models. Several statistical tests were applied to evaluate the criterion validity of the FFQ against two references methods (7d-FR and the biomarker-serum 25(OH)D). Median (Interquartile range) intakes were 7.10 ± 6.95 µg /day and 6.33 ± 5.02 µg/ day, respectively, for VitD-FFQ and 7d-FR. Vitamin D status was mainly determined by SES (R = 0.47) and vitamin D absolute food intakes derived by the VitD-FFQ (R = 0.56), which demonstrated a more significant prediction ability compared to 7d-FR (R = 0.36). An agreement was observed between the VitD-FFQ and 7d-FR (BA index of 3.29%) with no proportional bias (R² = 0.002, p = 0.54). <10% of participants were incorrectly classified, and weighted kappa statistics showed that VitD-FFQ had an acceptable ranking ability compared to the 7d-FR and the biomarker. The validity coefficient for the VitD-FFQ was high: ρQR = 0.90 (95%CI: 0.89-0.92), and a range from 0.46 to 0.90. Adjustment for the participants' SES and BMI (body mass index) improved the biomarker's validity coefficient (ρRB 0.63 (95% CI 0.39-0.82). Our results indicate that the VitD-FFQ is valid for estimating absolute vitamin D intake in Moroccan women of reproductive age.

Sun Exposure Score and Vitamin D Levels in Moroccan Women of Childbearing Age

Sunlight exposure is an essential source of vitamin D for many humans. However, hypovitaminosis D is a global public health problem. This study aimed to develop and validate a sun exposure score (SES) and correlate it with serum 25-hydroxyvitamin D levels in women of childbearing age. One hundred and sixty women aged 18 to 45 years residing in Meknes, Morocco, were included. A questionnaire estimating the sun exposure score and blood analysis of serum 25-OHD concentration were performed. The questionnaire's reliability and construct validity were evaluated using Cronbach's alpha and factor analysis. Spearman's test was used to assess the correlation between SES and 25-OHD levels. The score's reliability and construct validity were good, with Cronbach's alpha values >0.70 and factorial saturation ranging from 0.696 to 0.948. Serum 25-OHD levels were significantly associated with the total sun exposure score, and all SES domains (Rho was 0.615 (p < 0.0001), 0.307 (p < 0.0001), 0.605 (p < 0.0001), and 0.424 (p < 0.0001) for total SES, indoor exposure domain, outdoor exposure domain, and sun protection practice domain, respectively). In addition, median 25-OHD levels increased significantly when sun exposure was changed from insufficient to sufficient (p < 0.0001). The results suggest that the sun exposure score could be used as a clinical tool to assess vitamin D levels in women of childbearing age.

Multifactorial hypovitaminosis D among women in the South-East Oases of Morocco

This study assessed the vitamin D status among women in South-East Oases of Morocco. Two hundred thirty-three healthy volunteer women were recruited at five urban and rural health centers. Hypovitaminosis D is very common in this region and correlated to age, monthly income, skin color, daily sun exposure, BMI, and body fat percentage.

PURPOSE

This study assessed the vitamin D status among women in the Draa-Tafilalet region and its relationship with clinical, anthropometric, and behavioral parameters.

METHODS

The study was carried out with 233 women in consultation at five urban and rural health centers in the South-East region of Morocco. The data collected relate to age, monthly income, educational level, BMI, body fat percentage, daily sun exposure, physical activity level, veil wear, and skin color. The plasma determination of vitamin D was measured by immunofluorescence. Statistical analyses were performed using Python and Jamovi.

RESULTS

The median 25(OH)D plasma concentration was 9.95 ng/mL (IQR: 8-13.18). A total of 50.64% of women had 25(OH)D levels below 10 ng/ml and 47.21% had levels between 10 and 30 ng/mL. Statistical tests showed an association between hydroxyvitamin D plasma levels and age (r =  - 0.139; p = 0.034), monthly income (p = 0.001), BMI (r =  - 0.200; p = 0.002), body fat percentage (r =  - 0.131; p = 0.049), daily sun exposure (r = 0.165; p = 0.012), and skin color (p < 0.001). Binomial logistic regression showed that darker skin was associated with vitamin D deficiency (< 10 ng/mL). It also showed that high income and longer sun exposure could be protecting factors against vitamin D deficiency.

CONCLUSION

The plasma concentrations of vitamin D in women in the Draa-Tafilalet region were low compared to expected results for a high sunshine time area.

VITAMIN D STATUS IN A HEALTHY TUNISIAN POPULATION

Background

Vitamin D deficiency is one of the most common medical conditions worldwide. In Tunisia, several studies evaluated Vitamin D status, but this was concerning specific populations (pregnant women, obese or diabetic patients and children with asthma). The only study that evaluated Vitamin D status in a healthy Tunisian population was conducted by Meddeb and associeties in 2002. The update of data available, based on the currently recommended limits, is necessary. This study aimed to estimate the prevalence of hypovitaminosis D in a healthy Tunisian population, and correlate the values with potential risk factors.

Methods

It was conducted on 209 Tunisian healthy subjects. Data collected included clinical characteristics and dietary intakes. We measured 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), glycemia, creatinine, calcium, phosphorus, and alkaline phosphatase concentrations. Hypovitaminosis D was retained for 25(OH)D concentrations <75 nmol/L. Vitamin D deficiency was defined by 25(OH)D concentrations <25 nmol/L.

Results

The prevalence of hypovitaminosis D and vitamin D deficiency were respectively 92.3% and 47.6%. The main factors that were significantly associated with low vitamin D levels in our multivariate analysis were veiling, living in rural areas and sunscreen use. However, sex, age, socioeconomic level, phototype, solar exposure score, smoking and bone mass index, were not statistically associated with hypovitaminosis D. The study of relationship between vitamin D status and serum PTH levels showed a significative and negative correlation (P < 0.005).

Conclusions

Given the high prevalence of vitamin D, an adapted health policy is essential. A widespread vitamin D supplementation and food fortification seems to be necessary in Tunisia.

Vitamin D and associated factors, among pregnant women in southeastern Nigeria

In this prospective study on vitamin D and its associated factors conducted on 256 pregnant women from Anambra state of southeastern Nigeria, Vitamin D deficiency (VDD) occurred in 36 (14.1%). Vitamin D levels were significantly associated with parity, gestational age, social class, place of abode, skin colour, workplace location, and compliance to ANC drugs. Pregnant women with these features are considered to be at risk for vitamin D deficiency. The study however did not show any association between vitamin D and maternal age, social class of the pregnant women, and the season of the year. It is recommended that vitamin D supplementation be considered routinely for women with the risk factors - especially for the grandmultipara, women at term gestational age, women of dark complexion, those with indoor work location, and of urban habitat.Impact statementWhat is already known on this subject? Vitamin D is a fat-soluble vitamin primarily responsible for calcium and phosphorous homeostasis in the human body. it is derived in the human body both from endogenous sources through cutaneous synthesis following exposure to sunlight, and from endogenous conversion from pre-vitamin D to 25-hdroxycholecalciferol (25 (OH)D. Vitamin D is essential in pregnancy for maternal health, foetal skeletal growth and bone development. Vitamin D deficiency (VDD) in pregnancy occurs globally with a prevalence of 4.7% to as high as 80%.What do the results of this study add? This study shows that parity, gestational age, social class, place of domicile, skin colour, workplace location, and compliance to ANC drugs constitutes associated factors to vitamin D levels.What are the implications of these findings for clinical practice and/or further research? These findings imply that grandmultiparous pregnant women, women at term gestational age, of dark complexion, with indoor work location, and of urban habitat, by virtue of their relatively lower levels of vitamin D, should be considered for routine vitamin D supplementation.

Identifying consistent biomechanical parameters across rising-to-walk subtasks to inform rehabilitation in practice: A systematic literature review

BACKGROUND

The best approach to rehabilitate the control of everyday whole-body movement (e.g. rise-to-walk) after pathology remains unclear in part because the associated controlled performance variables are not known. Rise-to-walk can be performed fluidly (sit-to-walk) or non-fluidly (sit-to-stand, proceeded by gait-initiation). Biomechanical variables that remain consistent in health regardless of how rise-to walk is performed represent controlled performance variable candidates which could monitor rehabilitative change.

RESEARCH QUESTION

To determine if any biomechanical parameters remain consistent across rising-to-walk (RTW) subtasks (sit-to-stand, gait-initiation, and sit-to-walk) in healthy adults for purposes of movement control assessment in clinical practice.

METHODS

Data sources included Medline, Cinahl, and Scopus databases, and the grey literature. Study selection was based on eligibility criteria and must have reported spatiotemporal, kinematic and/or kinetic biomechanical parameters featuring >1 RTW subtask. Data extraction and synthesis; standardised-mean-differences (SMDs) were calculated (pooled if replicated in >1 study) for each parameter. Consistency was determined if SMD95 %CIs included the zero-effect line.

RESULTS

Nine studies (n = 99) were included (40 ± 7.5yrs). Seven parameters were replicated in >1 study and subjected to meta-analysis (fixed-effect model). Two were consistent between sit-to-stand and sit-to-walk: flexion-momentum time (M(95 %CI) = 0.055(-0.423 to 0.533); p = 0.823) and peak whole-body-centre-of-mass vertical velocity (M(95 %CI)= -0.415(-0.898 to 0.069); p = 0.093); and centre-of-pressure to whole-body-centre-of-mass distance at toe-off (M(95 %CI)= -0.137(-0.712 to 0.439); p = 0.642) between gait-initiation and sit-to-walk. Another 20 parameters were consistent based on single-study SMDs.

SIGNIFICANCE

Consistent parameters might exist across RTW subtasks. However, the evidence is based on few studies with small samples and variable RTW protocols. Future studies designed to confirm consistency using a standardised RTW protocol are needed.

Association between variants in vitamin D-binding protein gene and vitamin D deficiency among pregnant women in china

BACKGROUND

The prevalence of vitamin D deficiency and insufficiency is extremely high in pregnant women worldwide. However, the association between single nucleotide polymorphisms (SNPs) in vitamin D metabolic pathway genes and 25-hydroxyvitamin D (25(OH)D) concentration among Chinese pregnant women is seldom reported. The risk of adverse neonatal outcomes due to maternal vitamin D deficiency has not been well investigated.

METHODS

A total of 815 pregnant women and 407 infants were enrolled in this study. Serum 25(OH)D concentration was detected. DNA was extracted from the maternal blood for genotyping genetic SNPs in vitamin D pathway. An XGBoost model was established based on SNPs combined with external variables.

RESULTS

Mean serum 25(OH)D level was 15.67 ± 7.98 ng/mL among the pregnant women. Seventy-five percent of pregnant women had 25(OH)D deficiency in China. SNPs of GC (rs17467825, rs4588, rs2282679, rs2298850, and rs1155563) were significantly associated with maternal 25(OH)D concentration. The influence of variants of rs17467825, rs4588, rs2282679, and rs2298850 on maternal 25(OH)D might be modified by vitamin D supplementation and sunshine exposure. An XGBoost model was established for monitoring 25(OH)D status in pregnant women and provided clinical advice to reduce the risk of 25(OH)D deficiency. Mothers with 25(OH)D deficiency hinted a risk for macrosomia.

CONCLUSION

A high prevalence of vitamin D deficiency in China has been confirmed. A clinical model was established to guide pregnant women to supplement vitamin D according to genotype. Furthermore, we suggest the effect of maternal vitamin D status on the risk of macrosomia.

Validity of the Korebalance® Balance System in Patients with Postmenopausal Osteoporosis

Objective

Balance is impaired in postmenopausal osteoporosis. Balance can be assessed with several tests and balance assessment systems. In our study, we investigated validity of Korebalance Balance System (KBS).

Method

52 postmenopausal osteoporotic patient evaluated with balance tests (Berg Balance Scale (BBS) and Time Up&Go Test (TUG)) and Korebalance Balance System. KBS is a balance evaluation and exercise system. The higher the score, the greater the deterioration in the balance. Static and dynamic balance evaluation results are recorded as score values. KBS, BBS and TUG compared with demographic and clinic parameters (age, 25OHvitD, menopausal age, fall history in last year, fracture history).

Results

According to Pearson r correlation analysis, Korebalance Dynamic Test (KDT) and BBS had moderately negative correlation (r=-.38, p<.01), KDT and TUG had moderately positive correlation (r=-.42, p<.01). According to Spearman rho correlation analysis, Korebalance Static Test (KST) and BBS had moderately negative correlation (r=-.30, p<.05). Age and KST (r=.33, p<.05), age and KDT (r=.31, p<.05) had moderately positive correlation. No significant correlation was found with other parameters. In discriminant validity, there was no correlation between other nonfunctional demographic and clinical parameters.

Conclusion

Korebalance Balance System was found to be a convenient assessment tool with moderate convergent validity compared with BBS and TUG and has an excellent intraclass correlation.

Association of vitamin d with glycemic control in Saudi patients with type 2 diabetes: A retrospective chart review study in an emerging university hospital

Background

Vitamin D (mainly 25‐hydroxyvitamin D, 25[OH]D) has stimulated increasing interest in Saudi Arabia over the current years due to its association with several different chronic diseases such as diabetes. This study aims to ascertain whether the vitamin D level has any influence on glycemic control in Saudi patients with type 2 diabetes (T2DM).

Method

This retrospective study included 200 patients with T2DM who visited Prince Sattam Bin Abdulaziz University Hospital between January 2015 and December 2015. Venous blood was collected and examined for “serum/plasma levels of 25(OH)D” and related variables using kit methods. HbA1C levels <7% and ≥7% were taken as indicators of good and poor glycemic control, respectively. An association between vitamin D deficiency and poor glycemic control was determined using multinomial logistic regression analysis.

Results

Among the total of 200 patients with type 2 diabetes, 118 (59%) were female and 82 (41%) were males with the mean age 42.4 ± 14.8 years. Good glycemic control (HbA1c < 7) was observed in 127 (63.5%), and poor glycemic control (HbA1c > 7) was found in 73(36.5%). The mean serum 25(OH)vit D was 20.27 ± 8.66 ng/mL, with (52% vs 82%; P ≤ .001) of subjects identified to have vitamin D deficiency in good and poor glycemic control groups, respectively.

Conclusion

Taken together, our results demonstrated an association of vitamin D level with poor glycemic control in patients with type 2 diabetes. However, additional studies with larger sample size from local population are warranted in future to confirm and extend the findings of the present study.

Vitamin D deficiency and associated factors in Jordan

Background:

In Jordan, many studies reported various rates of vitamin D deficiency and insufficiency among different groups. This study aimed to determine the prevalence of low vitamin D level among Jordanian adults and determine its association with selected variables.

Methods:

The vitamin D level was assessed in a national representative sample of 4056 subjects aged >17 years. The study involved face-to-face interviews with the subjects and measurement of serum 25(OH)D. Low vitamin D level was defined as 25(OH)D < 30 ng/mL. Deficiency was defined as 25(OH)D < 20 ng/mL, and insufficiency was defined as 25(OH)D level of 20–30 ng/mL.

Results:

The overall prevalence of low vitamin D status (25(OH)D < 30 ng/mL) was 89.7%, with higher prevalence in males (92.4%) than in females (88.6%). Vitamin D was sufficient in 7.6% of males, insufficient in 38.4% of males, and deficient in 54% of males. Among females, vitamin D was insufficient in 10.1% and deficient in 78.5%. The prevalence of vitamin D deficiency was much higher in females than in males (p = 0.001). The only variables that were significantly associated with low level of vitamin D were gender, age, obesity, and employment.

Conclusion:

The prevalence of low vitamin D level is extremely high in Jordan. Age, gender, obesity, and unemployment were associated with low levels of vitamin D. Health authorities in Jordan need to increase the level of awareness about vitamin D deficiency and its prevention, particularly among women.

Vitamin D status among adults (18-65 years old) attending primary healthcare centres in Qatar: a cross-sectional analysis of the Electronic Medical Records for the year 2017

OBJECTIVES

To investigate the prevalence of vitamin D deficiency among individuals attending primary healthcare facilities in Qatar and to assess the association between vitamin D deficiency and some medical conditions in persons aged 18-65 years old.

SETTING

The study was undertaken in publicly funded primary healthcare services in the State of Qatar.

PARTICIPANTS

A total of 102 342 participants aged between 18 and 65 years old with a valid serum vitamin D test result during the year 2017.

OUTCOME MEASURES

Serum level <10 ng/mL (<25 nmol/L) was defined as severe vitamin D deficiency, a serum level of <20 ng/mL (<50 nmol/L) was defined as vitamin D deficiency and a serum level <30 ng/mL (<75 nmol/L) defined as vitamin D insufficiency.

RESULTS

The prevalence rate of severe vitamin D deficiency was 14.1% among study participants with no history of vitamin D replacement therapy in the previous months. The prevalence rate of vitamin D deficiency was as high as 71.4% and that of vitamin D insufficiency was up to 92.7%. None of the five chronic conditions explored in the study (diabetes, hypertension, asthma, stroke and cardiovascular disease) had an obvious association with severe vitamin D deficiency status in a bivariate analysis. However, multivariate modelling showed that (adjusting for age, gender, body mass index and nationality and each of the included chronic conditions) hypertension, cardiovascular diseases and stroke placed an individual at a higher risk of having an associated severe vitamin D deficiency status.

CONCLUSION

Although not comprehensive and nationally representative, this study is suggestive of a higher prevalence of vitamin D deficiency among young adults, females, Qatari nationality and those with higher body mass index. Multivariate modelling showed that hypertension, cardiovascular diseases and stroke were associated with a higher risk of severe vitamin D deficiency status.

Prevalence of hypovitaminosis D in postmenopausal women: a systematic review

BACKGROUND

Hypovitaminosis D is considered a global public health issue. Knowledge of its true dimensions will allow us to design interventions and plan preventive measures that can have a significant impact on human health.

OBJECTIVES

The aim of this study was to evaluate the prevalence of hypovitaminosis D, defined as a serum 25-hydroxyvitamin D concentration < 30 ng/ml, in postmenopausal women around the world, as well as to identify the potential associated factors.

METHODS

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. Specific search terms were consulted in Medline, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, with no restriction for the year or language of publication.

RESULTS

Of 451 studies initially identified, 32 were selected for analysis. Collectively, those 32 studies evaluated 21,236 postmenopausal women, of whom 16,440 (77.4%) had serum 25-hydroxyvitamin D concentrations < 30 ng/ml. The reported prevalence of hypovitaminosis D ranged from 29% (in the United States) to 99.4% (in China). In six of the studies, the prevalence was above 90%.

CONCLUSIONS

If the criterion is the 30 ng/ml cut-off point, the majority of postmenopausal women in the world could be classified as having hypovitaminosis D. Among the studies evaluated, the lowest prevalence reported was nearly 30%. Neither latitude, region of the world, nor laboratory methodology were found to be associated with the prevalence of hypovitaminosis D.

Association between Vitamin D Levels and Nonalcoholic Fatty Liver Disease: Potential Confounding Variables

Nonalcoholic fatty liver disease (NAFLD), historically considered to be the hepatic component of the metabolic syndrome, is a spectrum of fat-associated liver conditions, in the absence of secondary causes, that may progress to nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. Disease progression is closely associated with body weight or fatness, dyslipidemia, insulin resistance, oxidative stress, and inflammation. Recently, vitamin D deficiency has been linked to the pathogenesis and severity of NAFLD because of vitamin D "pleiotropic" functions, with roles in immune modulation, cell differentiation and proliferation, and regulation of inflammation. Indeed, several studies have reported an association between vitamin D and NAFLD/NASH. However, other studies have failed to find an association. Therefore, we sought to critically review the current evidence on the association between vitamin D deficiency and NAFLD/NASH, and to analyze and discuss some key variables that may interfere with this evaluation, such as host-, environment-, and heritability-related factors regulating vitamin D synthesis and metabolism; definitions of deficient or optimal vitamin D status with respect to skeletal and nonskeletal outcomes including NAFLD/NASH; methods of measuring 25(OH)D; and methods of diagnosing NAFLD as well as quantifying adiposity, the cardinal link between vitamin D deficiency and NAFLD.

25-Hydroxyvitamin D levels and its relation to muscle strength, maximal oxygen consumption, and body mass index in young and middle adulthood women

Introduction

Vitamin D is a potent secosteroid hormone that provides many health benefits. The ubiquitous nature of vitamin D receptor (VDR) suggests widespread effect.

Purpose

The purpose of this study was to investigate the relationship between 25-hydroxyvitamin D (25OHD) levels and muscle strength, maximal oxygen consumption (VO₂max), and body mass index (BMI) in Iranian young and middle adulthood women.

Participants and methods

A cross-sectional descriptive study was conducted in 182 healthy Iranian women within the age range of 26–60 years. Body weight and height were measured, and BMI was calculated. VO₂max was determined by the Rockport test. Muscle strength was determined by the chest press, leg press, and hand grip test. Also, circulating levels of 25OHD were evaluated.

Results

Results showed a significant relationship between 25OHD levels and BMI, VO₂max, and muscle strength (chest press, leg press, hand grip dominant hand [HGDH], and hand grip nondominant hand [HGNDH]) in young and middle adulthood women (BMI in young and middle adulthood: r=−0.48, P<0.001 and r=−0.27, P=0.01, respectively; VO₂max in young and middle adulthood women: r=0.69, P<0.001 and r=0.57, P<0.001, respectively; chest press, leg press, HGDH, and HGNDH in young adulthood: r=0.58, r=0.59, r=0.65, and r=0.42, respectively, P<0.001; and in middle adulthood: r=0.73, r=0.34, r=0.66, and r=0.55, respectively, P≤0.001). Multiple linear regression analysis showed that higher levels of VO₂max, HGDH, and chest press predicted higher 25OHD levels in the young adulthood women (R²=0.75; β=0.39, β=0.35, and β=0.30, respectively; P<0.001). Moreover, VO₂max and HGDH were the strongest predictor of 25OHD levels in the middle adulthood women (R²=0.71; β=0.35, β=0.40, respectively; P<0.001).

Conclusion

Based on the results, it could be concluded that VO₂max and strength are useful indirect marker for 25OHD levels in the young and middle adulthood women. It also seems that VO₂max and HGDH strength had stronger associations with 25OHD levels in the young adulthood women, and chest press and HGDH had stronger associations with 25OHD levels in the middle adulthood women.

Effect of multiple micronutrient fortified milk consumption on vitamin D status among school-aged children in rural region of Morocco

Vitamin D deficiency is a health problem in both developed and developing countries. The aim of this study was to determine the effect of multi-vitamin fortified milk consumption on vitamin D status among children living in the mountainous region of Morocco. Children aged 7 to 9 years (n = 239; 49% of girls vs 51% of boys) participated in a double-blind longitudinal study, where they were divided in 2 groups: a fortified group that received daily 200 mL of fortified ultra-high-temperature (UHT) milk enriched with 3 μg of vitamin D₃ and a nonfortified group that received 200 mL of nonfortified UHT milk with a natural abundance of vitamin D₃ (about 1.5 μg). Blood samples were collected 3 times (at baseline, then at the fourth and ninth months). The average weight, height, and z score of body mass index for age of participants were 22.8 ± 2.6 kg, 121.5 ± 5.2 cm, and -0.2 ± 0.6 kg/m², respectively. At baseline, 47.5% of children had a concentration of 25-hydroxyvitamin D below 50 nmol/L. At the end of the study the prevalence of vitamin D <50 nmol/L decreased significantly by 37.6% in the fortified group. These results reveal prevalent vitamin D insufficiency (<50 nmol/L) during winter among rural Moroccan school-aged children, which seems to be better improved by consuming the fortified milk instead of the nonfortified one.

Impact of Nutritional and Environmental Factors on Vitamin D Deficiency

Background: Vitamin D can be obtained through a variety of food sources; however, ultraviolet rays in the sunlight can convert a natural substance in the skin known as ergosterol to vitamin D. Aim: This study aims to investigate the prevalence and risk factors linked to vitamin D deficiency among a group of apparently healthy young male and female Tabuk citizens in Saudi Arabia. Methods: A cross-sectional study that comprised a convenience sampling method of 350 male and female Tabuk citizens. Results: The results indicated a generalized vitamin D deficiency and severe deficiency among the participants, where 74.57% of the population had vitamin D deficiency, and 25.43% reported vitamin D sufficiency. There was a significant positive correlation among the BMI, exercise, exposure to sunlight, vitamin D intake, and calcium intake with vitamin D status (r = 0.574,** 0.525,** 0.515,** 0.466 and 0.465** at p-value < 0.001, respectively). Conclusion: The present study indicates vitamin D deficiency to be relatively common even among the population of Saudi Arabia, a country receiving adequate sunlight. Also, Vitamin D and calcium supplementation can prove to be beneficial in correcting the deficiency. Moreover, the individuals at a higher risk of vitamin insufficiency, such as women, need to be educated on the health benefits of vitamin D and calcium supplementation.

Vitamin D status and body composition: a cross-sectional study among employees at a private university in Lebanon

Background

The prevalence of low vitamin D status is increasing globally, and Lebanon is not spared. The objectives of this study are to determine the prevalence and correlates of low vitamin D status, and to assess the association between percent body fat and vitamin D status, independently of obesity.

Methods

A cross-sectional study was performed on NDU employees. Data on dietary intake, physical activity, lifestyle, health status, and demographic variables were collected during a face-to-face interview. Anthropometric measures (weight, height and waist circumference) were measured and body composition was assessed using the bioelectrical impedance analysis (BIA) machine InBody 720 (Biospace, Seoul, Korea). The Nutritionist Pro diet analysis software version 31.0 was used to estimate dietary intake of vitamin D. Serum 25 hydroxyvitamin D (25(OH)D) was measured using enzyme linked immunosorbent assay kit (ELISA) (Calbiotech, Spring Valley, California, USA). Vitamin D status was assessed according to the National Osteoporosis Foundation (sufficiency: ≥ 75 nmol/L / ≥30 ng/mL) and the Institute of Medicine cut-offs (adequacy: ≥50 nmol/L / ≥20 ng/mL). Statistical analyses were performed by SPSS version 22.

Results

A total of 344 employees (50% Male) aged between 20 and 74 years participated in the study. More than half of the participants were overweight and obese. Mean serum vitamin D concentrations were 28.2 ± 13.9 ng/mL. Among participants, 37.5% of our study population had 25(OH)D ≥ 30 ng/mL, and 68.3% had 25(OH)D ≥ 20 ng/mL. Individuals with low vitamin D status had significantly higher percent body fat (PBF) (p < 0.005), and higher waist circumference (WC) (p = 0.012) than in the sufficient group, however BMI did not differ by vitamin D status. Logistic regression analysis indicated that a 1% increase in body fat increases the odds of having 25(OH)D ≤ 30 ng/mL by 8% while controlling for BMI and other confounders (p = 0.019).

Conclusion

This study reinforces the need for regular screening for low vitamin D status in Lebanese adults, particularly individuals at risk, including those with high risk WC, high PBF, who work indoors and have low vitamin D intake, and recommending vitamin D supplementation if needed.

Vitamin D and Trabecular Bone Score in a Group of Young Lebanese Adults

The relationship between vitamin D and trabecular bone score (TBS) in young adults remains unclear. The aim of this study was to explore the relationship between 25-hydroxyvitamin D [25(OH)D] serum levels and TBS in a healthy adult population. A total of 54 men and 61 women whose ages range from 18 to 35 participated in the present study. Participants with 25(OH)D insufficiency (between 21 and 29 ng/mL) were 55.7%, and those with 25(OH)D deficiency (≤20 ng/mL) were 11.4%. TBS positively correlated with 25(OH)D in men (r = 0.393; p <0.05) and women (r = 0.324; p < 0.05). In both genders, TBS was significantly higher in 25(OH)D-sufficient participants (≥30 ng/mL). The present study provides evidence that vitamin D positively affects bone health and suggests that maintaining adequate vitamin D status may be essential for optimal TBS values.

The Prevalence of Hypovitaminosis D and Its Associated Risk Factors Among Women of Reproductive Age in Saudi Arabia: A Systematic Review and Meta-Analysis

Vitamin D deficiency is currently a worldwide epidemic. Middle Eastern countries, including Saudi Arabia, have high vitamin D deficiency prevalence, most prominently among women, despite their plentiful year-round sunshine. Previous research investigating vitamin D status among Saudi women of reproductive age (15-49 years) is scarce, and no study has used a nationally representative sample, so this review quantified overall hypovitaminosis D prevalence among women in Saudi Arabia and explored the associated risk factors. The Web of Science, Scopus, and Medline databases were searched for prior studies in Saudi Arabia exploring vitamin D status among women of reproductive age, published between January 1, 2000 and May 25, 2017. Data were extracted from the identified studies, and a random effects model meta-analysis established the overall hypovitaminosis D prevalence. The initial search yielded 223 possibly relevant articles; 13 were confirmed as eligible, with samples totaling 2877 women aged between 15 and 49 years. Meta-analysis revealed a mean serum 25-hydroxyvitamin D, 25(OH)D, level of 13.1 ng/mL (95% confidence interval [CI]: 11.6-14.6) and an overall prevalence of hypovitaminosis D, defined as 25(OH)D < 30 ng/mL, of 77.4% (95% CI: 63.2-87.3), mostly due to insufficient sunlight exposure and low dietary vitamin D intake. There is therefore a need for a national strategy to raise vitamin D levels among women in Saudi Arabia by advising them on natural vitamin D sources, and recommending the timing and duration of sun exposure, while also defining a national approach to vitamin D fortification and supplementation.

Vitamin D status and abdominal aortic calcification in postmenopausal women

Vitamin D has an important role in bone metabolism and may be involved in the process of vascular calcification. The objective of this study was to evaluate the effect of vitamin D status on the presence of abdominal aortic calcification (AAC). We enrolled, in a cross-sectional study, 429 postmenopausal women [mean age, weight, and BMI of 59.5 ± 8.3 (50-83) years, 75.8 ± 13.3 (35-165) kg, and 29.9 ± 5.2 (14.6-50.8) kg/m², respectively]. Lateral vertebral fracture assessment (VFA) images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. Vertebral fractures (VFs) were defined using the Genant semiquantitative (SQ) approach. We used the Kauppila score to assess AAC extension. Clinical risk factors of osteoporosis were collected, and 25-hydroxy vitamin D was measured using electrochemiluminescence (Roche). Prevalence of osteoporosis and hypovitaminosis D (<20 ng/ml) was 21.0% and 78.1%, respectively. VFs grade 2/3 were identified in 76 patients (17.7%). Two thirds of the evaluable participants did not have any detectable AAC. The prevalence of significant atherosclerotic burden, defined as a radiographic 24-point AAC score of 5 or higher, was 7.9%. The group of women with extended AAC were older and had a statistically significant higher menopause duration and more prevalent grade 2/3 VFs. Compared to women with normal values of vitamin D, women with vitamin D insufficiency (<20 ng/ml) and deficiency (<10 ng/ml) had a lower BMD and more prevalent VFs. No difference was noted with regard to AAC among the three groups. Multiple stepwise conditional logistic regression analysis showed that the presence of AAC was associated significantly with age and the presence of VFs. Extended aortic calcifications are independently associated with prevalent VFA-identified VFs but not with serum vitamin D levels in postmenopausal women. VFA imaging using DXA may detect at the same time prevalent VFs and AAC, an important cardiovascular disease risk factor.

Hypovitaminosis D and Its Associated Factors in North Algerian Postmenopausal Women: Results of a Cross-Sectional Study

PURPOSE

As the vitamin D status of Algerian postmenopausal women was poorly described, this cross-sectional study investigated the prevalence of low vitamin D status in a sample population. Secondarily, predictive factors of this hypovitaminosis D were explored.

METHODS

All the 336 selected women ≥ 45 years from Douera were interviewed to get anthropometric and lifestyle data, reproductive and medical history, medications, and calcium/vitamin D intakes. A blood sample was collected to measure 25-hydroxyvitamin D (25(OH)D) concentrations.

RESULTS

Approximately 86% of subjects had low vitamin D status (<20 ng/mL). Mean 25(OH)D level was 14.4 ± 5.3 ng/mL with a clear seasonal dynamic and a significant negative correlation with PTH levels (r  = -0.15, p=0.006). A multiple regression analysis using the 25(OH)D cutoff value of 17 ng/mL instead of the generally admitted level of 20 ng/mL was performed to increase statistical power. Other seasons than summer (OR 4.159 and 95% CI 2.456-7.043), obesity (≥30 kg/m2, OR 1.826, 95% CI 1.081-3.083), and veiling (OR 3.526, 95% CI 1.090-11.400) were significantly associated with 25(OH)D concentrations <17 ng/mL.

CONCLUSIONS

In North Algeria, the abundant sunlight appears insufficient to fully offset hypovitaminosis D risk factors in postmenopausal women, especially obesity and veiling. It suggests the major need to increase vitamin D supplementation in this subpopulation.

Evaluation of Quality of life, Physical Activity and Nutritional Profile of Postmenopausal Women with and without Vitamin D Deficiency

Introduction Vitamin D deficiency is associated with various diseases. Prevalent in Brazil, it can result from inadequate lifestyle habits. Objective To demonstrate that postmenopausal women with vitamin D deficiency have worse quality of health, expressed as worse quality of life, lower levels of physical activity, and worse nutritional profile. Methods Postmenopausal women answered questionnaires about physical activity and quality of life, provided a 24-hour food record, and had serum vitamin D levels measured. Results Among the more active women, those who perform a daily average of one hour of physical activity had vitamin D levels above 20 ng/mL (76.9%), and those, which expose themselves to sunlight, had vitamin D levels above 30 ng/mL (34.6%). Meanwhile the percentages for the women who are less physically active and less exposed to sunlight were 42.2% and 8.9% respectively. Being more active and more exposed to sunlight resulted in a lower fat percentage. Serum vitamin D levels were not correlated with quality of life. Conclusion Walking and gardening increased serum vitamin D levels and decreased the percentage of body fat. The limitations of the study prevented the impact of 25-hidroxyvitamin D on the quality of life and nutritional aspects of the women from being evaluated.

Evaluation of Vitamin D Status in Rheumatoid Arthritis and Its Association with Disease Activity across 15 Countries: "The COMORA Study"

The aims of this study are to evaluate vitamin D status in 1413 RA patients of COMORA study from 15 countries and to analyze relationship between patients' RA characteristics and low levels of vitamin D. All demographic, clinical, and biological data and RA comorbidities were completed. The results showed that the average of vitamin D serum dosage was 27.3 ng/mL ± 15.1 [0.1–151]. Status of vitamin D was insufficient in 54.6% and deficient in 8.5% of patients. 43% of RA patients were supplemented with vitamin D and absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency (p < 0.001). Finally, our study shows that the status of low levels of vitamin D is common in RA in different countries and under different latitudes. Absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency. Low levels of vitamin D were associated with patients characteristics (age, BMI, and educational level), RA (disease activity and corticosteroid dosage), and comorbidities (lung disease and osteoporosis therapy). This suggests the need for a particular therapeutic strategy to improve vitamin D status in RA patients.

Mechanical factors and vitamin D deficiency in schoolchildren with low back pain: biochemical and cross-sectional survey analysis

OBJECTIVE

This study was designed to evaluate the role of vitamin D, muscle fatigue biomarkers, and mechanical factors in the progression of low back pain (LBP) in schoolchildren.

BACKGROUND

Children and adolescents frequently suffer from LBP with no clear clinical causes, and >71% of schoolchildren aged 12-17 years will show at least one episode of LBP.

MATERIALS AND METHODS

A total of 250 schoolchildren aged 12-16 years were randomly enrolled in this study. For all schoolchildren height, weight, percentage of daily sun exposure and and areas of skin exposed to sun, method of carrying the bag, and bag weight and type were recorded over a typical school week. Pain scores, physical activity (PA), LBP, serum vitamin 25(OH)D level, serum bone-specific alkaline phosphatase, creatine kinase (CK), and lactate dehydrogenase (LDH) activities and calcium (Ca) concentrations were estimated using prevalidated Pain Rating Scale, modified Oswestry Low Back Pain Disability Questionnaire, short-form PA questionnaire, and colorimetric and immunoassay techniques.

RESULTS

During the period of October 2013-May 2014, LBP was estimated in 52.2% of the schoolchildren. It was classified into moderate (34%) and severe (18%). Girls showed a higher LBP (36%) compared with boys (24%). In schoolchildren with moderate and severe LBP significantly higher (P=0.01) body mass index, waist, hip, and waist-to-hip ratio measurements were observed compared with normal schoolchildren. LBP significantly correlated with less sun exposure, lower PA, sedentary activity (TV/computer use), and overloaded school bags. In addition, schoolchildren with severe LBP showed lower levels of vitamin 25(OH)D and Ca and higher levels of CK, LDH, and serum bone-specific alkaline phosphatase compared with moderate and healthy schoolchildren. Stepwise regression analysis revealed that age, gender, demographic parameters, PA, vitamin D levels, Ca, CK, and LDH associated with ~56.8%-86.7% of the incidence of LBP among schoolchildren.

CONCLUSION

In children and adolescents, LBP was shown to be linked with limited sun exposure, inadequate vitamin D diets, adiposity, lower PA, sedentary lifestyles, vitamin 25 (OH) D deficiency, and lower levels of Ca, CK, and LDH.

Prevalence and Predictors of Hypovitaminosis D Among Female University Students in Tabuk, Saudi Arabia

BACKGROUND

A high hypovitaminosis D prevalence has repeatedly been reported in Middle Eastern countries. Previous data regarding the vitamin D status of young women in Saudi Arabia and the related hypovitaminosis D risk factors are scarce, so this research assessed hypovitaminosis D prevalence and its risk factors among apparently healthy female university students in Tabuk, Saudi Arabia.

METHODS

This cross-sectional research used a convenience sample of healthy female students (n = 180) aged between 19 and 25 years in May 2016. Information was gathered on the participants' sociodemographics, health, lifestyle, dietary intakes, anthropometry, and serum 25-hydroxyvitamin D (25(OH)D), and a logistic regression analysis was performed to assess hypovitaminosis D risk factors.

RESULTS

The sample's hypovitaminosis D prevalence (25(OH)D <30 ng/mL) was 80.6%. The main determinants of hypovitaminosis D were as follows: urban residence (odds ratio [OR] = 6.54; 95% confidence interval [CI], 2.74-5.63), rare sun exposure (OR = 6.14; 95% CI, 2.15-17.55), and insufficient vitamin D intake (OR = 2.50; 95% CI, 1.07-5.81).

CONCLUSIONS

The findings emphasize that despite plentiful sunshine, Saudi Arabia and the Middle East face a vitamin D deficiency epidemic. Vitamin D status must therefore be assessed at the national level so that strategies aimed at boosting vitamin D levels can be instigated.

The Relationship between 25 (OH) D Levels (Vitamin D) and Bone Mineral Density (BMD) in a Saudi Population in a Community-Based Setting

BACKGROUND

Vitamin D deficiency has been linked to an increased risk of osteoporosis. Vitamin D deficiency has reached high levels in the Saudi population, but there is conflicting evidence both in the Saudi population, and worldwide, regarding the existence of a correlation between these low vitamin D levels and reduced BMD (bone mineral density), or osteoporosis.

OBJECTIVE

The objective of this study was primarily to determine whether there was a correlation between vitamin D deficiency and osteoporosis in the Saudi population. We aimed to investigate whether the high levels of vitamin D deficiency and insufficiency would translate to higher prevalence of osteoporosis, and whether there is a correlation between vitamin D levels and bone mineral density.

MATERIALS AND METHODS

This was a community based cross sectional study conducted in the Family Medicine Clinics at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. Electronic records of 1723 patients were reviewed. Laboratory and radiology results were collected, including vitamin D levels, calcium levels, and bone mineral density scan results.

RESULTS

Among the whole population, 61.5% had moderate to severe vitamin D deficiency with levels less than 50nmol/L. 9.1% of the population had osteoporosis, and 38.6% had osteopenia. Among the whole population, there was no significant correlation between spine or total femoral BMD and serum 25(OH) D.

CONCLUSION

Vitamin D deficiency is prevalent in the Saudi population. However, no correlation has been found between vitamin D deficiency and reduced bone mineral density in any age group, in males or females, Saudis or Non-Saudis, in our population in Riyadh, Saudi Arabia.

Vitamin D status in healthy Moroccan men and women aged 50 years and older: a cross-sectional study

This study aimed to compare the vitamin D status in healthy Moroccan men and women aged 50 years and older. A total of 186 Moroccan women and 68 men, who had no previous diagnosis of osteoporosis, were recruited prospectively. We found in this study a high prevalence of hypovitaminosis D with no difference between men and women.

PURPOSE

The main purpose of this study was to describe and compare the vitamin D status, parathormone, calcium, and phosphate of healthy Moroccan men and women aged 50 years and older.

METHODS

We conducted two cross-sectional studies, in postmenopausal women from October 2008 to November 2009 and in men over 50 years old, from December 2009 to August 2010. A total of 186 Moroccan women and 68 men, who had no previous diagnosis of osteoporosis, were recruited prospectively. For the definition of hypovitaminosis D, the preferred level for 25-hydroxyvitamin D (25(OH)D) insufficiency, which is now recommended by many experts, is 30 ng/mL (75 nmol/L), and the levels below 10 ng/ml (25 nmol/L) indicate deficiency.

RESULTS

The prevalence of vitamin D deficiency in men and women was 4.4 and 8.6 %, respectively, and the prevalence of vitamin D(25(OH) D) insufficiency in men and women were 85.2 and 77.4 %, respectively. In men and women, no correlations were found between intact parathormone (PTHi) and 25(OH) D (r = 0.056).

CONCLUSIONS

Despite a sunny environment, we found in this study a high prevalence of hypovitaminosis D (insufficiency + deficiency) in Moroccan men over 50 years old and postmenopausal women.

Bioavailable 25(OH)D but Not Total 25(OH)D Is an Independent Determinant for Bone Mineral Density in Chinese Postmenopausal Women

Total 25(OH)D levels were determined to assess bone health in elderly populations; however, the bioavailability of 25(OH)D is regulated by the albumin and vitamin D binding protein (DBP) levels and DBP variations. Whether bioavailable 25(OH)D level is a superior biomarker for vitamin D than total 25(OH)D level regarding the BMD and the bone metabolism were not yet fully understood. With a community based cross-sectional study of 967 postmenopausal women, we found that the variant rs7041, but not rs4588, of DBP was significantly associated with the blood DBP level, which was positively correlated with the total 25(OH)D level but negatively associated with bioavailable 25(OH)D levels. Both total and bioavailable 25(OH)D levels were significantly correlated with the BMD value in postmenopausal women; however, only the bioavailable 25(OH)D level was an independent determinant of the BMD values when adjusted for age, body mass index and bone turnover biomarkers (OST and β-CTX). The bioavailable and total 25(OH)D were negatively correlated with bone formation biomarkers (OST, PINP and ALP) and PTH levels, while they were positively correlated with osteoprotegerin (OPG) level; however, the bone resorption biomarker (β-CTX) was not correlated with the 25(OH)D levels. An increment of PTH level, along with reduced bioavailable 25(OH)D levels, was evident when the bioavailable 25(OH)D level was < 5 ng/mL, which may be the optimal cutpoint for sufficient vitamin D in Chinese elderly women. The blood calcium, magnesium, ALP, TSH, FGF23, and phosphorus levels were not correlated with the total or the bioavailable 25(OH)D levels. These results suggested that high bioavailable 25(OH)D levels were correlated with reduced bone turnover processes and were a biomarker superior to total 25(OH)D for vitamin D in assessing the risks of bone-related diseases. The results indicate that the bioavailable 25(OH)D level should be determined in assessing the bone health.

•

DBP levels and variants on DBP were associated with the total and bioavailable 25(OH)D levels in the elderly populations.

•

Both the total and bioavailable 25(OH)D levels were correlated with the BMD in postmenopausal women.

•

Multivariate analyses suggested that the bioavailable but not total 25(OH)D was an independent determinant for the BMD.

•

Higher bioavailable 25(OH)D levels were correlated with reduced bone turnover and lower PTH in postmenopausal women.

With a cross-sectional community study, we found that the variant rs7041, but not rs4588, of DBP was significantly associated with the blood DBP level, which was positively correlated with the total 25(OH)D levels but negatively associated with the bioavailable 25(OH)D levels. The bioavailable 25(OH)D level was an independent determinant for BMD but not total 25(OH)D. Higher vitamin D levels were correlated with the reduced bone turnover process and lower PTH levels, which might lead to the higher BMD value in postmenopausal women. These results suggested that bioavailable 25(OH)D was a superior biomarker than total 25(OH)D regarding the bone metabolism, and that vitamin D intervention may improve the bone health in elderly populations.

Relation of Age, Sex and Bone Mineral Density to Serum 25-Hydroxyvitamin D Levels in Chinese Women and Men

OBJECTIVE

To investigate the relation of circulating 25-hydroxyvitamin D (25[OH]D) levels to age, sex, and bone mineral density (BMD) in adults living in Guangzhou Province.

METHODS

This cross-sectional study comprised 188 women and 122 men aged 17-88 years who were randomly sampled among community-dwelling Guangzhou residents. BMD at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry, and serum concentrations of 25(OH)D, parathyroid hormone (PTH), procollagen I N-terminal peptide, and beta C-telopeptide of collagen were assayed by electrochemiluminescence immunoassay. Serum 25(OH)D concentrations were divided into four subgroups: severe deficiency (<10 ng/mL), deficiency (10-20 ng/mL), insufficiency (20-30 ng/mL), and sufficiency (≥30 ng/mL).

RESULTS

The mean age of participants was 47.39 ± 19.32 years. Serum 25(OH)D levels were significantly lower in women than men (25.35 ± 6.59 ng/mL vs 27.25 ± 7.94 ng/mL, P < 0.05). The prevalence of 25(OH)D severe deficiency (<10 ng/mL) was 1.6% in men, zero in women; 25(OH)D deficiency (10-20 ng/mL) was 22.9% in women and 20.5% in men; and 25(OH)D insufficiency (20-30 ng/mL) was 73.4% in women and 65.6% in men. An inverse relationship between serum 25(OH)D levels and age (r = -0.249, P < 0.01) was observed in men, but no correlation was found in women (r = 0.130, P > 0.05). Serum 25(OH)D levels were positively associated with lumbar spine and femoral neck BMD (r = 0.382, P < 0.01; r = 0.384, P < 0.01, respectively) in elderly women and (r = 0.332, P < 0.05; r = 0.260, P < 0.05, respectively) and in young men. When adjustments were made for age, correlations between serum 25(OH)D levels and lumbar spine and femoral neck BMD persisted (r = 0.325, P < 0.05; r = 0.323, P < 0.05, respectively) in elderly women. However, age-adjusted serum 25(OH)D levels were positively correlated with BMD at lumbar spine (r = 0.278, P < 0.05) but not at femoral neck (r = 0.165, P > 0.05) in young men. No association between unadjusted or age-adjusted serum 25(OH)D levels and lumbar spine and femoral neck BMD was found in young and middle-aged women and in middle-aged and elderly men. Neither serum PTH levels nor bone turnover markers were related to unadjusted and age-adjusted serum 25(OH)D levels in our participants.

CONCLUSION

More than two-third of participants residing in Guangzhou had vitamin D insufficiency. Serum 25(OH)D level is an important biomarker for BMD in elderly women and young men.

Association Between Vitamin D Deficiency and Outcomes Following Spinal Fusion Surgery: A Systematic Review

BACKGROUND

Vitamin D deficiency is a relatively common occurrence in patients presenting for spinal surgery; however, whether this abnormality has any effect on spinal fusion outcomes remains unclear. We performed a systematic review of the available literature relevant to the association between vitamin D deficiency and spinal fusion outcomes.

METHODS

We conducted a systematic and critical review of recent literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched: MEDLINE/PubMed, Google Scholar, Cochrane, Web of Science, and Scopus. Key search terms were "vitamin D," "spinal surgery outcomes," "spinal fusion," and "pseudarthrosis." Papers included in the review were original research articles in peer-reviewed journals. The articles were thoroughly examined and compared on the basis of study design, outcomes, and results.

RESULTS

A total of 5 studies were included in the qualitative analysis. In these studies, patients presenting with vitamin D deficiency achieved lower fusion rates and suffered higher rates of recurrent-persistent low back pain compared with patients with normal vitamin D levels. Studies examining the effect of postoperative vitamin D supplementation in deficient patients reported significant improvements in low back pain intensity, patient-reported outcomes scores, and fusion rates compared with baseline as well as with control groups.

CONCLUSIONS

The literature suggests that patients presenting for spinal fusion may benefit from correction of vitamin D deficiency to maximize the chance of a successful arthrodesis and to achieve optimal surgical outcomes. Future prospective studies are needed to determine whether routine preoperative treatment of this metabolic derangement is warranted.

Vitamin D status and parathyroid hormone levels in relation to bone mineral density in apparently healthy Syrian adults

Vitamin D deficiency was highly prevalent in this study. More than half of the participants with vitamin D level less than 5 ng/mL had secondary hyperparathyroidism, which implicated a major bone health concern. After adjustment for potential predictors, parathyroid hormone (PTH) explained about 3 % of the variance in total hip bone mineral density (BMD).

PURPOSE

Bone mineral density (BMD) is known to be influenced by serum 25-hydroxyvitamin D (25OHD) and intact parathyroid hormone (PTH) levels. The relationship between 25OHD and PTH with BMD has not been well documented in Syrian adults. We aimed to determine how differences in serum 25OHD and PTH levels impacted hip and lumbar spine BMD among apparently healthy Syrian adults.

METHODS

25OHD and PTH were measured in 156 participants aged 18-53 years from Damascus and its surroundings. Lumbar spine and hip BMD measurements were measured by dual-energy X-ray absorptiometry using Hologic Discovery Wi densitometer. Multivariate regression models were used to investigate the relationships between 25OHD, PTH, and BMD.

RESULTS

All participants, except one male, had 25OHD <30 ng/mL (<75 nmol/L), and 89.1 % of them had 25OHD levels less than 20 ng/mL (50 nmol/L). Secondary hyperparathyroidism was significantly more prevalent in the lowest 25OHD quartile compared to that in the highest quartile (59 vs. 10.3 %, p < 0.0001). Mean bone mineral density at all sites in our participants was lower when compared to that of their Caucasian counterparts in Europe and North America. No significant correlation was found between 25OHD and BMD either at hip or at lumbar spine. In the multivariate analyses, after adjustment for potential predictors, PTH explained about 3 % of the variation in total hip BMD.

CONCLUSIONS

Low BMD was relatively frequent at all measured sites. PTH, but not 25OHD, was a predictor for total hip BMD in a young population.

Vitamin D deficiency: knowledge and practices among the adult population in Sharjah, United Arab Emirates

Research demonstrate that vitamin D deficiency is significantly associated with bone diseases (e.g., osteoporosis), muscle cramps, back pain, heart diseases, diabetes mellitus, etc. The lack of knowledge and poor practice of study subjects regarding vitamin D deficiency became evident in this study.

PURPOSE

Vitamin D is vital for the growth and development of the body throughout the life span. The aim of this study is to investigate the knowledge and the practices related to vitamin D deficiency among the adult population in Sharjah, UAE.

METHODS

A cross-sectional study was conducted among adults aged 20-40 years in Sharjah, UAE. Participants were selected from public places using convenience sampling method. They were subjected to a self-administered questionnaire. Data was analyzed using SPSS 20 software. All knowledge-related questions were summed up, where a correct answer was given 1 point and incorrect one a 0, yielding a score out of 43. Subjects' scores were then transformed to a percentage.

RESULTS

A total of 503 adults were included in the study. They had a mean age of 30 years (±5.47) with a relatively homogenous gender distribution (51 % females). The mean knowledge score on vitamin D deficiency was 16.7 out of 43 (39 %). Less than half of the respondents (43 %) knew that sunlight is the main source of vitamin D. The mean score for participants' practice was 2.34 out of 6 (39 %); 77 % of them reported that they tried to avoid sun exposure, and 97 % had not tested vitamin D levels in their blood before.

CONCLUSION

The majority of the adults demonstrated significant lack of knowledge and poor practices towards vitamin D and its deficiency. Therefore, attempts to increase the awareness about this issue are required through establishing educational campaigns targeting the general public in Sharjah, UAE.

Relation of serum 25 hydroxyvitamin D levels to bone mineral density in southern Chinese postmenopausal women: A preliminary study

BACKGROUND & OBJECTIVES

Vitamin D insufficiency is prevalent in postmenopausal women and has been related to low bone mineral density (BMD). However, controversial results have been reported for the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and BMD. This study was done to investigate whether serum 25(OH)D levels were associated with BMD in postmenopausal women living in Guangzhou in southern China.

METHODS

This cross-sectional study involved 119 asymptomatic postmenopausal women, aged 48-85 yr, who were consecutively selected from Guangzhou city. BMD was measured at the lumbar spine and femoral neck. The correlation between serum 25(OH)D levels and BMD wes investigated.

RESULTS

With increasing serum 25(OH)D levels categorized as <20, 20-30, and ≥ 30ng/ml, the PTH levels decreased gradually ( P=0.031). Bivariate correlation analyses showed an inverse relationship between serum 25(OH)D and PTH levels after controlling for age and BMI (r=-0.209, P=0.023). Although subjects with vitamin D<30 ng/ml had significantly lower BMD, age- and BMI-adjusted serum 25(OH)D was weakly correlated with BMD at femoral neck (r=0.185, P0.045), and not at lumbar spine (r=0.172, p =0 0.063). In multiple regression analyses, serum 25(OH)D was a predictor for BMD at femoral neck (R 2= 0.424). However, serum β-CTX was a determinant for BMD at lumbar spine (R 2= 0.361).

INTERPRETATION & CONCLUSIONS

Serum 25(OH)D levels showed a positive correlation with BMD at femoral neck and serum β-CTX levels were inversely correlated with BMD at lumbar spine in postmenopausal women. Further studies are needed to elucidate the clinical impact of these findings.

Does vitamin D status track through adolescence?

BACKGROUND

To our knowledge, no studies have reported on the long-term variability of vitamin D status in adolescents.

OBJECTIVE

To determine whether tracking of vitamin D status occurs in healthy adolescents, we assessed the variability of 25-hydroxyvitamin D [25(OH)D] every 2 y over a 10-y period in a longitudinal cohort of adolescents living in Johannesburg, South Africa (latitude 26°S).

DESIGN

Healthy adolescents who had blood samples available on ≥3 occasions between 11 and 20 y of age were included in the study. Of the cohort of 504 children, 99 met the criteria. The mean 25(OH)D concentration at each time point was measured, and the individual 25(OH)D z scores based on year 11 values were used as the reference. All 25(OH)D concentrations for a subject were measured in a single assay.

RESULTS

No significant correlation was found between 25(OH)D in the earlier and later years of adolescence, although significant correlations were found between year 11 and year 13 (r = 0.71, P < 0.0001) and between years 15, 17, and 20 (r ≥ 0.65, P < 0.0001). The percentage of adolescents whose 25(OH)D concentration changed by >20 nmol/L from year 11 was calculated for all age groups: 12% of the cohort had a change of >20 nmol/L at 13 y of age compared with 46% at 20 y of age. Just more than one-half (53%) of the cohort changed their category of vitamin D status between the ages of 11 and 20 y, and one-third of adolescents changed from being replete to insufficient over the same period.

CONCLUSIONS

The data suggest that the measurement of 25(OH)D at a single time point does not reflect the long-term vitamin D status of an adolescent. These findings may cast doubt on the veracity of those studies that suggest an association of vitamin D status with various disease states in which vitamin D status was measured only once.

Prevalence of Vitamin D Deficiency and Its Association With Metabolic Disease in Korean Orthopedic Patients

Vitamin D is considered essential for bone and muscle health, and some studies have demonstrated the positive effects of vitamin D on metabolic diseases and cancer. Nevertheless, a high prevalence of vitamin D deficiency has been reported in various populations, regardless of country or race. However, no studies regarding the prevalence of vitamin D deficiency in Korean orthopedic patients currently exist. This cross-sectional study included 272 male and 937 female patients aged 50 years and older who were consecutively admitted to the authors' orthopedic department. Vitamin D (25-hydroxy vitamin D), bone turnover markers (osteocalcin, c-telopeptide), and bone mineral density were measured. The prevalence of vitamin D deficiency and its association with other factors were evaluated. Mean patient age was 67.2 ± 8.9 years, and mean level of vitamin D was 16.1 ± 9.1 ng/mL. Overall, 91.2% of patients had deficient (<20 ng/mL; 70.6%) or insufficient (20-30 ng/mL; 20.6%) levels of vitamin D. Vitamin D level did not vary by age group or sex. The level of vitamin D was significantly associated with osteocalcin, c-telopeptide, calcium, alkaline phosphatase, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and glucose (P<.01). Vitamin D level in Korean orthopedic patients of this region was extremely low, regardless of sex and age. Although vitamin D was not directly associated with bone mineral density, there were significant associations between vitamin D and other factors related to bone health and metabolic diseases.