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Bakkar NAALH, Bakr AY, Alhusseini AH, Alourfi ZH. The relationship between serum 25-hydroxy vitamin D status and hypertension in Syrian population: retrospective cohort study. Ann Med Surg (Lond) 2024; 86:3222-3226. [PMID: 38846846 PMCID: PMC11152839 DOI: 10.1097/ms9.0000000000001989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Vitamin D is a liposoluble steroid hormone that plays a crucial role in the maintenance of bone metabolism and calcium homoeostasis. Many studies on the effects of vitamin D on general health have been significantly increased, driven by new findings concerning the systemic and extraskeletal effects of this hormone. This study was performed to determine whether low levels of vitamin D were associated with hypertension in Syrian people. Materials and methods This retrospective cohort study consisted of 207 subjects, including 83 (40.1%) patients suffering from essential hypertension and 124 (59.9%) patients with normal blood pressure. Aged older than 18 years, who was referred to the endocrinology clinic from September 2022 to September 2023. The data were analysed by using SPSS (version 25). Logistic regression analyses were performed with adjustments for age, sex, and waist circumference. Results Hypertension rates were 73%, 20%, and 5% in 25-hydroxyvitamin D groups less than 12 ng/ml, 12-20 ng/mL, and greater than or equal to 20 ng/ml, respectively. Odds ratios (95% CIs) for hypertension adjusting for age, sex, and waist circumference were 178.6 (30.5_1045.6), 5.13 (0.9_26.5) for 25-hydroxyvitamin D levels less than 12 ng/ml, and 12-20 ng/ml, respectively, compared with the greater than or equal to 20 ng/ml group. Conclusions This study has shown a high prevalence of low vitamin D levels (25OHVD/20 ng/ml) among a sample of Syrian people (78.3%). The lowest 25OHVD group was associated with a higher prevalence of hypertension, which refers to an adverse association between vitamin D level and essential hypertension. Further research is needed to confirm this relationship.
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Bahlous A, Krir A, Mrad M, Bouksila M, Kalai S, Kilani O, El KEC, Sahli H, Laadhari N. VITAMIN D STATUS IN A HEALTHY TUNISIAN POPULATION. J Med Biochem 2022; 41:168-175. [PMID: 35510205 PMCID: PMC9010047 DOI: 10.5937/jomb0-30247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Afef Bahlous
- University of Tunis-El Manar, Pasteur Institute of Tunis, Laboratory of Clinical Biochemistry and Hormonology, Tunisia
| | - Asma Krir
- University of Tunis-El Manar, Pasteur Institute of Tunis, Laboratory of Clinical Biochemistry and Hormonology, Tunisia
| | - Mehdi Mrad
- University of Tunis-El Manar, La Rabta Hospital, Rheumatology Department, Immuno-Rheumatology Research Laboratory, Tunisia
| | - Mouna Bouksila
- University of Tunis-El Manar, La Rabta Hospital, Rheumatology Department, Immuno-Rheumatology Research Laboratory, Tunisia
| | - Safa Kalai
- University of Tunis-El Manar, Pasteur Institute of Tunis, Laboratory of Clinical Biochemistry and Hormonology, Tunisia
| | - Osman Kilani
- University of Tunis-El Manar, Pasteur Institute of Tunis, Laboratory of Clinical Biochemistry and Hormonology, Tunisia
| | - Kateb Elhem Cheour El
- University of Tunis-El Manar, La Rabta Hospital, Medicine School of Tunis, Rheumatology Department, Tunisia
| | - Hela Sahli
- University of Tunis-El Manar, La Rabta Hospital, Rheumatology Department, Immuno-Rheumatology Research Laboratory, Tunisia
| | - Nizar Laadhari
- University of Tunis-El Manar, Charles Nicolle Hospital, Occupational Pathology and Fitness for Work Service, Tunis, Tunisia
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Al-Awwad NJ, Ayoub J, Barham R, Sarhan W, Al-Holy M, Abughoush M, Al-Hourani H, Olaimat A, Al-Jawaldeh A. Review of the Nutrition Situation in Jordan: Trends and Way Forward. Nutrients 2021; 14:135. [PMID: 35011008 PMCID: PMC8746685 DOI: 10.3390/nu14010135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 01/22/2023] Open
Abstract
Jordan is witnessing an escalating pace of nutrition transition, which may be associated with an increased burden of malnutrition and related non-communicable diseases. This review analyzes the nutrition situation in Jordan by exploring specific nutrition indicators, namely infant and young child feeding, low birthweight, micronutrient deficiencies, anthropometric indicators, and food consumption patterns. Results showed that although most children were ever breastfed and early initiation of breastfeeding had a two-fold increasing trend, rates of exclusive breastfeeding below 6 months of age and continued breastfeeding until two years of age were low. Complementary feeding indicators, particularly minimum diet diversity and minimum acceptable diet standards, were suboptimal. An overall low burden of stunting, wasting, and underweight among children under 5 years and remarkable progress in optimizing iodine status among school-aged children were reported. Conversely, the burden of low birthweight and overweight/obesity exacerbated, coexisting with anemia, vitamin A deficiency, and vitamin D deficiency. Overall, fruit and vegetable consumption were inadequate. The consumption of soft drinks and salt on the other hand was higher than recommended. This review acknowledges the double burden of malnutrition in Jordan and recommends the prioritization and evaluation of interventions towards improving the population's nutritional status and achieving nutrition targets.
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Affiliation(s)
- Narmeen Jamal Al-Awwad
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Jennifer Ayoub
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Rawhieh Barham
- Nutrition Department, Ministry of Health, Amman 11118, Jordan;
| | - Wafaa Sarhan
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Murad Al-Holy
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Mahmoud Abughoush
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
- Science of Nutrition and Dietetics Program, College of Pharmacy, Al Ain University, Abu Dhabi 64141, United Arab Emirates
| | - Huda Al-Hourani
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Amin Olaimat
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan; (N.J.A.-A.); (M.A.-H.); (M.A.); (H.A.-H.); (A.O.)
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo 7608, Egypt
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Seetan K, Albashir S, Jarrar B, Aldebei A, Shatanawi M, Abu Serhan H, Irshedat S. Assessment of Serum Vitamin D Levels in the serum of Patients with Postherpetic neuralgia and its correlation to pain severity: A cross-sectional comparative study. Int J Clin Pract 2021; 75:e14750. [PMID: 34431183 DOI: 10.1111/ijcp.14750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Vitamin D is an essential micronutrient for the maintenance of many functions in the human body. Postherpetic neuralgia (PHN) is caused by the reactivation of the latent varicella-zoster virus (VZV) in the neurons. This study aims to assess the serum vitamin D level in patients with PHN and to correlate the level of vitamin D with pain severity. METHODS AND MATERIALS A hospital-based cross-sectional comparative study was conducted in the period from April 2019 to January 2021. One hundred and sixty-two individuals, matched for age and gender, divided into cases and controls (81 for each). Serum levels of 25(OH)D were measured for cases and controls. Demographic data were taken, and then the diagnosis of neuropathic pain in cases was established using the Douleur Neuropathique 4 (DN4) questionnaire. RESULTS We included 39 (52%) males in the PHN group and 36 (48%) in the control group. There was no significant difference between groups regarding age, marital status, smoking and BMI. The duration of pain in our study had a mean of 7.6 ± 3.6 months. We found the DN4 score for the pain to be negatively associated with vitamin D levels (Pearson's correlation coefficient: -0.511, P = .000). The levels of vitamin D were moderately associated with pain duration (Pearson's correlation: -0.466, P = .000). CONCLUSION PHN patients had a high prevalence of vitamin D deficiency and those who had vitamin D deficiency were older and had higher degrees of pain for a longer duration. In PHN patients, vitamin D deficiency was moderately associated with increased severity and duration of pain.
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Affiliation(s)
- Khaled Seetan
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Sharaf Albashir
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Bashar Jarrar
- Department of Clinical Dermatology, Jordanian Royal Medical Services, Amman, Jordan
| | - Asem Aldebei
- Department of Clinical Dermatology, Jordanian Royal Medical Services, Amman, Jordan
| | - Murad Shatanawi
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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Gerges MES, Amin GEA, Andraous F, Abdel Hamid DM, Allam MF. Vitamin D level in a sample of Egyptian females of childbearing age attending a family medicine center. Int J Clin Pract 2021; 75:e13738. [PMID: 32991001 DOI: 10.1111/ijcp.13738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is now recognised as a pandemic. The normal range of Vitamin D in the Arab countries is much lower than the international standards. Several Arab countries have published studies assessing serum Vitamin D levels among women--to date there is no national study assessing Vitamin D levels among Egyptian women. OBJECTIVE The aim of the study is to measure Vitamin D level among Egyptian women of childbearing age. PATIENTS AND METHODS We included 100 healthy adult females of childbearing age, who were attending a family medicine center in Cairo, Egypt. A validated interview questionnaire was conducted with participants, thereafter BMI and serum 25 (OH) Vitamin D levels were measured. RESULTS The age of the included women ranged from 19 to 49 years old with a mean age of 34 ± 8.47 years. Only 39% of participants were employed and 61% were housewives. About 76% of participants were married, 20% unmarried and 4% divorced. Most of participants (82%) wore hijab; only 9% wore niqab and 9% wore no scarf. Only 44% of participants had normal levels of Vitamin D (˃20-150 ng/mL). About 43% of the participants were Vitamin D deficient and 13% were Vitamin D insufficiency. CONCLUSION Vitamin D deficiency and insufficiency are prevalent among Egyptian women of childbearing age. A routine monitoring screening for Vitamin D deficiency and Vitamin D health education are required to minimise risk factors among women of childbearing age.
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Affiliation(s)
| | | | - Fady Andraous
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Farouk Allam
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Arabi A, Chamoun N, Nasrallah MP, Tamim HM. Vitamin D Deficiency in Lebanese Adults: Prevalence and Predictors from a Cross-Sectional Community-Based Study. Int J Endocrinol 2021; 2021:3170129. [PMID: 34462634 PMCID: PMC8403038 DOI: 10.1155/2021/3170129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/19/2021] [Accepted: 08/13/2021] [Indexed: 01/03/2023] Open
Abstract
METHODS A random sample of Lebanese adults residing in the Greater Beirut area was selected based on area probability and multistage cluster sampling. Data from 446 participants (68% females) with mean age 45.3 ± 15 years were used for the analyses. Participants were recruited between March and May. Serum 25-hydroxyvitamin D levels were measured using electrochemiluminescent immunoassay. RESULTS Vitamin D deficiency was highly prevalent whether using the cutoff of 50 nmol/L or using the more conservative cutoff of 30 nmol/L; more specifically, 71.9% and 39.1% of the study population were deficient using the above cutoffs, respectively In the bivariate analyses, gender, BMI and body fat mass, socioeconomic factors (income and education level), alcohol consumption, dietary intake of fat and of vitamin D, serum LDL-cholesterol, and serum creatinine were all associated with vitamin D status. After adjustment for multiple covariates, age, income, alcohol consumption, and serum creatinine were independent predictors of vitamin D deficiency. CONCLUSION Vitamin D deficiency is highly prevalent in Lebanon. Preventive measures should target the modifiable risk factors.
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Affiliation(s)
- Asma Arabi
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon
| | - Nariman Chamoun
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon
| | - Mona P. Nasrallah
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon
| | - Hani M. Tamim
- Department of Internal Medicine, Biostatistics Unit, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
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Al-Bayyari N, Al-Domi H, Zayed F, Hailat R, Eaton A. Androgens and hirsutism score of overweight women with polycystic ovary syndrome improved after vitamin D treatment: A randomized placebo controlled clinical trial. Clin Nutr 2020; 40:870-878. [PMID: 33010974 DOI: 10.1016/j.clnu.2020.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/19/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIM The objective of this study was to investigate the effect of vitamin D treatment on androgen levels and hirsutism scores in overweight women with PCOS. METHODS A prospective, randomized, double-blind, placebo-controlled clinical study was conducted at King Abdullah University Hospital in Irbid, Jordan. Overweight Jordanian females aged 18-49 years with vitamin D deficiency and PCOS (n = 60) were assigned to two groups: the treatment group (n = 30) who received 50,000 IU per week of vitamin D3 and the control group (n = 30) who received a placebo. RESULTS After receiving the treatment for 12 consecutive weeks, the levels of total testosterone, parathyroid hormone, free androgen index, and hirsutism score were significantly decreased (P < 0.001), and the levels of 25-hydroxyvitamin D (25(OH)D), sex hormone binding globulin, and phosphorus were significantly increased (P < 0.05). Furthermore, significant changes were observed in ovarian volume and follicle numbers and size ultrasonography, and in the regularity of the menstrual cycle (P < 0.001). In the placebo group, no significant changes were observed in either androgen levels, hirsutism score, or menstrual regularity. CONCLUSION Vitamin D3 at a treatment dose of 50,000 IU per week improved 25(OH)D levels and decreased the hirsutism scores and androgen levels of overweight women with PCOS. These results could mean increased fertility and better reproductive health for overweight women with PCOS; the use of vitamin D3 as a treatment for these patients should be further investigated. CLINICALTRIALS. GOV REGESTRATION NUMBER NCT02328404.
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Affiliation(s)
- Nahla Al-Bayyari
- Department of Nutrition and Food Technology, Faculty of Al-Huson University College, Al-Balqa Applied University, Al-Salt, Jordan.
| | - Hayder Al-Domi
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University, Amman, Jordan
| | - Faheem Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ra'ed Hailat
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Arieanna Eaton
- Department of Integrated Physiology and Health Sciences, Alma College, Alma, MI, USA
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Petry N, Al-Maamary SA, Woodruff BA, Alghannami S, Al-Shammakhi SM, Al-Ghammari IK, Tyler V, Rohner F, Wirth JP. National Prevalence of Micronutrient Deficiencies, Anaemia, Genetic Blood Disorders and Over- and Undernutrition in Omani Women of Reproductive Age and Preschool Children. Sultan Qaboos Univ Med J 2020; 20:e151-e164. [PMID: 32655907 PMCID: PMC7328830 DOI: 10.18295/squmj.2020.20.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/04/2019] [Accepted: 12/05/2019] [Indexed: 01/18/2023] Open
Abstract
A national cross-sectional survey was conducted to estimate the prevalence of anaemia, micronutrient deficiencies, haemoglobin disorders and over- and undernutrition in children and women of reproductive age in Oman. Wasting and stunting were found in 9.3% and 11.4% of children aged 0-59 months, respectively, while 4.2% were overweight or obese. In addition, 23.8% were anaemic and 10.2%, 9.5% and 10.6% had iron, vitamin A and vitamin D deficiencies, respectively. Sickle cell and β-thalassaemia genetic traits were present in 5.3% and 4.2% of children and 4.7% and 2.8% of women, respectively. Overall, 9.1% of Omani women were underweight and 59.2% were overweight or obese. The prevalence of anaemia was 27.8%, while iron, folate, vitamin B12 and vitamin D deficiencies affected 24.8%, 11.6%, 8.9% and 16.2%, respectively. Anaemia among both children and women and the prevalence of overweight and obesity in women are the most concerning nutritional problems in Oman.
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Affiliation(s)
- Nicolai Petry
- Department of Nutrition & Health, GroundWork LLC, Zurich, Switzerland
| | - Salima A Al-Maamary
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | | | - Samia Alghannami
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | - Saleh M Al-Shammakhi
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | - Ibtesam K Al-Ghammari
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | - Vilma Tyler
- Department of Health & Nutrition, United Nations International Children's Emergency Fund, Amman, Jordan
| | - Fabian Rohner
- Department of Nutrition & Health, GroundWork LLC, Zurich, Switzerland
| | - James P Wirth
- Department of Nutrition & Health, GroundWork LLC, Zurich, Switzerland
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El-Khateeb M, Khader Y, Batieha A, Jaddou H, Hyassat D, Khawaja N, Abujbara M, Ajlouni K. Vitamin D deficiency and associated factors in Jordan. SAGE Open Med 2019; 7:2050312119876151. [PMID: 35154754 PMCID: PMC8826271 DOI: 10.1177/2050312119876151] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Mohammed El-Khateeb
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Yousef Khader
- Jordan University for Science and Technology, Irbid, Jordan
| | - Anwer Batieha
- Jordan University for Science and Technology, Irbid, Jordan
| | - Hashem Jaddou
- Jordan University for Science and Technology, Irbid, Jordan
| | - Dana Hyassat
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Nahla Khawaja
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Mousa Abujbara
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
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Zainel AJAL, Qotba H, Al Nuaimi A, Syed M. 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. BMJ Open 2019; 9:e029334. [PMID: 31427331 PMCID: PMC6701579 DOI: 10.1136/bmjopen-2019-029334] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
| | - Hamda Qotba
- Research Department, Clinical Affairs Directorate, Primary Health Care Corporation, Doha, Qatar
| | - Ahmed Al Nuaimi
- Research Department, Clinical Affairs Directorate, Primary Health Care Corporation, Doha, Qatar
| | - Mohamed Syed
- Research Department, Clinical Affairs Directorate, Primary Health Care Corporation, Doha, Qatar
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Judistiani RTD, Nirmala SA, Rahmawati M, Ghrahani R, Natalia YA, Sugianli AK, Indrati AR, Suwarsa O, Setiabudiawan B. Optimizing ultraviolet B radiation exposure to prevent vitamin D deficiency among pregnant women in the tropical zone: report from cohort study on vitamin D status and its impact during pregnancy in Indonesia. BMC Pregnancy Childbirth 2019; 19:209. [PMID: 31226954 PMCID: PMC6588851 DOI: 10.1186/s12884-019-2306-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 04/18/2019] [Indexed: 12/13/2022] Open
Abstract
Background Vitamin D deficiency during pregnancy carries potential threat to fetal well being. Natural conversion of vitamin D in the skin can be facilitated by direct ultra violet B (UVB) radiation, but the effect is reduced by wearing umbrellas, clothes, or sunblock cream. Muslim women wear hijab that allows only face and hands to be seen. With increasing proportion of muslim women wearing hijab and the lack of vitamin D fortification and fish consumption in Indonesia, it poses a problem for vitamin D deficiency among pregnant women. This study aimed at finding the best timing of UVB exposure and the duration of exposure which can be suggested to prevent vitamin D deficiency among pregnant women, for those wearing hijab or not. Methods This study recruited 304 pregnant women in the first trimester, 75–76 women from 4 cities of the most populated province, West Java, Indonesia which represented 70–80% percent of pregnancy per year. A 3-day notes on duration, time and type of outdoor activity and the clothing wore by the women were collected. UVB intensity radiation were obtained. Calculation on body surface area exposed to direct UVB radiation and UVB radiation intensity were done. Measurement of vitamin D level in sera were done on the same week. Results The median of maternal sera vitamin D level was 13.6 ng/mL and the mean exposed area was around 0.48 m2 or 18.59% of total body surface area. Radiation intensity reached its peak around 10.00 and 13.00, but the mean duration of exposure to UVB during this window was lower than expected. Significant correlation was found between maternal sera vitamin D level and exposed body surface area (r = 0.36, p < 0.002) or percentage of exposed body surface (r = 0.39, p < 0.001) and radiation intensity (r = 0.15, p = 0.029). Further analysis showed that duration of exposure to UVB should be longer for pregnant women wearing hijab as compared to women without hijab. Conclusion This study suggested that the best timing to get UVB exposure was between 10.00–13.00, with longer duration for women wearing hijab (64.5 vs 37.5 min) of continuous exposure per day. Electronic supplementary material The online version of this article (10.1186/s12884-019-2306-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raden Tina Dewi Judistiani
- Public Health Department, Faculty of Medicine Universitas Padjadjaran, Jalan Eijkman 38, Bandung, Jawa Barat, 40161, Indonesia. .,Centre of Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Sefita Aryuti Nirmala
- Public Health Department, Faculty of Medicine Universitas Padjadjaran, Jalan Eijkman 38, Bandung, Jawa Barat, 40161, Indonesia.,Centre of Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Meilia Rahmawati
- Master in Midwifery Program, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Reni Ghrahani
- Centre of Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yessika Adelwin Natalia
- Public Health Department, Faculty of Medicine Universitas Padjadjaran, Jalan Eijkman 38, Bandung, Jawa Barat, 40161, Indonesia
| | - Adhi Kristianto Sugianli
- dr Hasan Sadikin Hospital, Bandung, Indonesia.,Clinical Pathology Department, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Agnes Rengga Indrati
- Centre of Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,dr Hasan Sadikin Hospital, Bandung, Indonesia.,Clinical Pathology Department, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Oki Suwarsa
- Centre of Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,dr Hasan Sadikin Hospital, Bandung, Indonesia.,Department of Dermatovenereology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Budi Setiabudiawan
- Centre of Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,dr Hasan Sadikin Hospital, Bandung, Indonesia
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12
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Lips P, Cashman KD, Lamberg-Allardt C, Bischoff-Ferrari HA, Obermayer-Pietsch B, Bianchi ML, Stepan J, El-Hajj Fuleihan G, Bouillon R. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol 2019; 180:P23-P54. [PMID: 30721133 DOI: 10.1530/eje-18-0736] [Citation(s) in RCA: 369] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L or 20 ng/mL) is common in Europe and the Middle East. It occurs in <20% of the population in Northern Europe, in 30-60% in Western, Southern and Eastern Europe and up to 80% in Middle East countries. Severe deficiency (serum 25(OH)D <30 nmol/L or 12 ng/mL) is found in >10% of Europeans. The European Calcified Tissue Society (ECTS) advises that the measurement of serum 25(OH)D be standardized, for example, by the Vitamin D Standardization Program. Risk groups include young children, adolescents, pregnant women, older people (especially the institutionalized) and non-Western immigrants. Consequences of vitamin D deficiency include mineralization defects and lower bone mineral density causing fractures. Extra-skeletal consequences may be muscle weakness, falls and acute respiratory infection, and are the subject of large ongoing clinical trials. The ECTS advises to improve vitamin D status by food fortification and the use of vitamin D supplements in risk groups. Fortification of foods by adding vitamin D to dairy products, bread and cereals can improve the vitamin D status of the whole population, but quality assurance monitoring is needed to prevent intoxication. Specific risk groups such as infants and children up to 3 years, pregnant women, older persons and non-Western immigrants should routinely receive vitamin D supplements. Future research should include genetic studies to better define individual vulnerability for vitamin D deficiency, and Mendelian randomization studies to address the effect of vitamin D deficiency on long-term non-skeletal outcomes such as cancer.
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Affiliation(s)
- Paul Lips
- Endocrine Section, Department of Internal Medicine, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, Department of Medicine, University College Cork, Cork, Ireland
| | - Christel Lamberg-Allardt
- Calcium Research Unit, Department of Food and Nutritional Sciences, University of Helsinki, Helsinki, Finland
| | | | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Jan Stepan
- Institute of Rheumatology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roger Bouillon
- Clinic and Laboratory of Endocrinology, Gasthuisberg, KU Leuven, Leuven, Belgium
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13
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Altowijri A, Alloubani A, Abdulhafiz I, Saleh A. Impact of Nutritional and Environmental Factors on Vitamin D Deficiency. Asian Pac J Cancer Prev 2018; 19:2569-2574. [PMID: 30256062 PMCID: PMC6249461 DOI: 10.22034/apjcp.2018.19.9.2569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/29/2018] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Albaraa Altowijri
- Department of Hematology- Oncology, Vontz Center for molecular studies, University of Cincinnati, OH,USA.
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14
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Chakhtoura M, Rahme M, Chamoun N, El-Hajj Fuleihan G. Vitamin D in the Middle East and North Africa. Bone Rep 2018; 8:135-146. [PMID: 29955632 PMCID: PMC6020111 DOI: 10.1016/j.bonr.2018.03.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The Middle East and North Africa (MENA) region registers some of the lowest serum 25‑hydroxyvitamin D [25(OH)D] concentrations, worldwide. We describe the prevalence and the risk factors for hypovitaminosis D, completed and ongoing clinical trials, and available guidelines for vitamin D supplementation in this region. METHODS This review is an update of previous reviews published by our group in 2013 for observational studies, and in 2015 for randomized controlled trials (RCTs) from the region. We conducted a comprehensive search in Medline, PubMed, and Embase, and the Cochrane Library, using MeSH terms and keywords relevant to vitamin D, vitamin D deficiency, and the MENA region, for the period 2012-2017 for observational studies, and 2015-2017 for RCTs. We included large cross-sectional studies with at least 100 subjects/study, and RCTs with at least 50 participants per arm. RESULTS We identified 41 observational studies. The prevalence of hypovitaminosis D, defined as a 25‑hydroxyvitamin D [25(OH)D] level below the desirable level of 20 ng/ml, ranged between 12-96% in children and adolescents, and 54-90% in pregnant women. In adults, it ranged between 44 and 96%, and the mean 25(OH)D varied between 11 and 20 ng/ml. In general, significant predictors of low 25(OH)D levels were female gender, increasing age and body mass index, veiling, winter season, use of sun screens, lower socioeconomic status, and higher latitude.We retrieved 14 RCTs comparing supplementation to control or placebo, published during the period 2015-2017: 2 in children, 8 in adults, and 4 in pregnant women. In children and adolescents, a vitamin D dose of 1000-2000 IU/d was needed to maintain serum 25(OH)D level at target. In adults and pregnant women, the increment in 25(OH)D level was inversely proportional to the dose, ranging between 0.9 and 3 ng/ml per 100 IU/d for doses ≤2000 IU/d, and between 0.1 and 0.6 ng/ml per 100 IU/d for doses ≥3000 IU/d. While the effect of vitamin D supplementation on glycemic indices is still controversial in adults, vitamin D supplementation may be protective against gestational diabetes mellitus in pregnant women. In the only identified study in the elderly, there was no significant difference between 600 IU/day and 3750 IU/day doses on bone mineral density. We did not identify any fracture studies.The available vitamin D guidelines in the region are based on expert opinion, with recommended doses between 400 and 2000 IU/d, depending on the age category, and country. CONCLUSION Hypovitaminosis D is prevalent in the MENA region, and doses of 1000-2000 IU/d may be necessary to reach a desirable 25(OH)D level of 20 ng/ml. Studies assessing the effect of such doses of vitamin D on major outcomes, and confirming their long term safety, are needed.
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Key Words
- 25(OH)D, 25‑hydroxyvitamin D
- ALKP, alkaline phosphatase
- BMC, bone mineral content
- BMD, bone mineral density
- BMI, body mass index
- CARS, Childhood Autism Rating Scale
- CDC, Centers for Disease Control
- Ca, Calcium
- DEQAS, Vitamin D External Quality Assessment Scheme
- DXA, dual-energy X-ray absorptiometry
- ESCEO, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis
- GDM, Gestational Diabetes Mellitus
- HOMA-IR, homeostatic model assessment of insulin resistance
- HbA1c, glycated hemoglobin
- Hypovitaminosis D
- ID LC-MS/MS, isotope dilution liquid chromatography - tandem mass spectrometry
- IOM, Institute of Medicine
- KSA, Kingdom of Saudi Arabia
- LCMS/MS, liquid chromatography-tandem mass spectrometry
- MENA, Middle East North Africa
- Middle East and North Africa
- OSTEOS, Lebanese Society for Osteoporosis and Metabolic Bone Disorders
- PO4, phosphorus
- PTH, parathyroid hormone
- Predictors
- RCT, randomized controlled trials
- ROB, risk of bias
- RR, relative risk
- SDp, pooled standard deviation
- T2D, type 2 diabetes
- UAE, United Arab Emirates
- UVB, ultraviolet B
- VDDR2, vitamin d dependent rickets type 2
- VDR, vitamin d receptor
- VDSP, Vitamin D Standardization Program
- Vitamin D assays
- Vitamin D guidelines
- WM, weighted mean
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Affiliation(s)
- Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, P.O. Box: 113-6044/C8, Lebanon
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15
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Alzaheb RA. The Prevalence of Hypovitaminosis D and Its Associated Risk Factors Among Women of Reproductive Age in Saudi Arabia: A Systematic Review and Meta-Analysis. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2018; 11:1179562X18767884. [PMID: 29662333 PMCID: PMC5896848 DOI: 10.1177/1179562x18767884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 03/01/2018] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Riyadh A Alzaheb
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
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16
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Oussedik-Lehtihet S, Haouichat C, Hammoumraoui N, Ducros E, Gouhier-Kodas C, Lancrenon S, Djoudi H. Hypovitaminosis D and Its Associated Factors in North Algerian Postmenopausal Women: Results of a Cross-Sectional Study. J Nutr Metab 2017; 2017:9032141. [PMID: 29391950 PMCID: PMC5748113 DOI: 10.1155/2017/9032141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/06/2017] [Accepted: 10/29/2017] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- S. Oussedik-Lehtihet
- Centre Hospitalier Universitaire de Douera, Rue des Frères Halim, Douera 16000, Alger, Algeria
| | - C. Haouichat
- Centre Hospitalier Universitaire de Douera, Rue des Frères Halim, Douera 16000, Alger, Algeria
| | - N. Hammoumraoui
- Centre Hospitalier Universitaire de Douera, Rue des Frères Halim, Douera 16000, Alger, Algeria
| | - E. Ducros
- Laboratoire Innotech International, 22 Avenue Aristide Briand, 94110 Arcueil, France
| | - C. Gouhier-Kodas
- Laboratoire Innotech International, 22 Avenue Aristide Briand, 94110 Arcueil, France
| | - S. Lancrenon
- Sylia-Stat, 10 Boulevard du Maréchal Joffre, 92340 Bourg-la-Reine, France
| | - H. Djoudi
- Centre Hospitalier Universitaire de Douera, Rue des Frères Halim, Douera 16000, Alger, Algeria
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Abstract
Vitamin D deficiency occurs all over the world, mainly in the Middle East, China, Mongolia, and India. This article focuses on the vitamin D status in adults. Risk groups include older persons, pregnant women, and non-Western immigrants. Adequate vitamin D status, defined as serum 25-hydroxyvitamin D greater than 50 nmol/L, is present in less than 50% of the world population, at least in winter. Preventative strategies, such as increasing fish consumption, fortification of foods, use of vitamin D supplements, and advice for moderate sunlight exposure, are warranted.
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Affiliation(s)
- Natasja van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands.
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands
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18
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Clinical significance of vitamin D deficiency and receptor gene polymorphism in systemic lupus erythematosus patients. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Puthuraya S, Karnati S, Kazzi SNJ, Qureshi F, Jacques SM, Thomas R. Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants? J Matern Fetal Neonatal Med 2017; 31:1906-1912. [DOI: 10.1080/14767058.2017.1332034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Subhash Puthuraya
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Sreenivas Karnati
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | | | - Faisal Qureshi
- Department of Pathology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Suzanne M. Jacques
- Department of Pathology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Ronald Thomas
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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Creo AL, Thacher TD, Pettifor JM, Strand MA, Fischer PR. Nutritional rickets around the world: an update. Paediatr Int Child Health 2017; 37:84-98. [PMID: 27922335 DOI: 10.1080/20469047.2016.1248170] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Worldwide, nutritional rickets continues to be an evolving problem with several causes. This paper provides an updated literature review characterising the prevalence, aetiology, pathophysiology and treatment of nutritional rickets worldwide. A systematic review of articles on nutritional rickets from various geographical regions was undertaken. For each region, key information was extracted, including prevalence, cause of rickets specific to the region, methods of confirming the diagnosis and current treatment and preventive measures. Calcium deficiency continues to be a major cause of rickets in Africa and Asia. Vitamin D deficiency rickets is perhaps increasing in the Americas, Europe and parts of the Middle East. There continues to be a distinct presentation of calcium-predominant versus vitamin D predominant rickets, although there are overlapping features. More careful diagnosis of rickets and reporting of 25-OHD concentrations has improved accurate knowledge of rickets prevalence and better delineated the cause. Nutritional rickets continues to be an evolving and multi-factorial problem worldwide. It is on a spectrum, ranging from isolated vitamin D deficiency to isolated calcium deficiency. Specific areas which require emphasis include a consistent community approach to screening and diagnosis, vitamin D supplementation of infants and at-risk children, prevention of maternal vitamin D deficiency and the provision of calcium in areas with low calcium diets.
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Affiliation(s)
- Ana L Creo
- a Department of Pediatric and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
| | - Tom D Thacher
- b Department of Family Medicine , Mayo Clinic , Rochester , MN , USA
| | - John M Pettifor
- c Wits/SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics , University of the Witwatersrand , Johannesburg , South Africa
| | - Mark A Strand
- d Pharmacy Practice, Department of Public Health , North Dakota State University , Fargo , ND , USA
| | - Philip R Fischer
- a Department of Pediatric and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
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Alzaheb RA, Al-Amer O. Prevalence and Predictors of Hypovitaminosis D Among Female University Students in Tabuk, Saudi Arabia. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2017; 10:1179562X17702391. [PMID: 28579866 PMCID: PMC5428152 DOI: 10.1177/1179562x17702391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/22/2017] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Riyadh A Alzaheb
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Osama Al-Amer
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
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Mohammad KI, Kassab M, Shaban I, Creedy DK, Gamble J. Postpartum evaluation of vitamin D among a sample of Jordanian women. J OBSTET GYNAECOL 2016; 37:200-204. [DOI: 10.1080/01443615.2016.1234443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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23
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Khawaja N, Liswi M, El-Khateeb M, Hyassat D, Bajawi D, Elmohtaseb M, Alkhateeb H, Ajlouni K. Vitamin D Dosing Strategies Among Jordanians With Hypovitaminosis D. J Pharm Pract 2016; 30:172-179. [PMID: 26787629 DOI: 10.1177/0897190015626334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare between weekly and daily cholecalciferol in patients with hypovitaminosis D and to determine the optimal maintenance dose. METHODS Seventy-one volunteers with hypovitaminosis D were randomly assigned to 2 dose regimens: cholecalciferol 50 000 IU weekly for 8 weeks, then 50 000 IU monthly for 2 months (group A) and 7000 IU daily for 8 weeks, then 12 500 IU weekly for 2 months (group B). Cholecalciferol was stopped for 2 months and reintroduced as 50 000 IU bimonthly for group A and 50 000 IU monthly for group B. RESULTS Two months after therapy, the mean serum 25-hydroxyvitamin D (25(OH)D) level increased from 11.4 to 51.2 ng/mL and from 11.7 to 44.9 ng/mL in groups A and B, respectively ( P = .065). The levels of 25(OH)D declined similarly in both groups during maintenance and after holding therapy. After resuming cholecalciferol, 25(OH)D levels increased to 33.8 and 28.8 ng/mL in groups A and B, respectively ( P = .027). There was a negative correlation between serum 25(OH)D levels and body mass index (BMI; P = .040). CONCLUSION Timing and frequency of the dosing (daily vs weekly) have no effect on the rise in serum 25(OH)D levels as long as the accumulative dose of cholecalciferol is similar. Cholecalciferol 50 000 IU bimonthly is required to maintain sufficient 25(OH)D levels.
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Affiliation(s)
- Nahla Khawaja
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Mohammed Liswi
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Mohammed El-Khateeb
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan.,2 Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| | - Dana Hyassat
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Dalila Bajawi
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Mayada Elmohtaseb
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Hussein Alkhateeb
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- 1 The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
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Dawoud NM, Bakry OA, Shoeib MA, Ismael HN. Serum Vitamin D and Facial Aging: Is There a Link? Skin Pharmacol Physiol 2016; 29:76-82. [PMID: 27035720 DOI: 10.1159/000443839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The vitamin D endocrine system, besides multiple other functions, regulates aging in many tissues, including the skin. It protects the skin against the hazardous effects of many skin age-inducing agents, including ultraviolet radiation. Thus, in the present study we aimed to investigate the relationship between facial skin aging and 25-hydroxyvitamin D [25(OH)D] serum levels in healthy Egyptian adults. METHODS Sixty-one healthy adult subjects were included. Photodamage scores (erythema/telangiectasias, lentigines, hyperpigmentation and coarse wrinkling) were assessed and graded. Serum vitamin D was measured using enzyme immunoassay and subjects were classified as sufficient, insufficient or deficient according to the vitamin level. RESULTS The mean 25(OH)D serum level was 43.90 nmol/l. A high prevalence of vitamin D deficiency was detected in the studied subjects regardless of their age or gender. Also, vitamin D levels were not correlated with photodamage scores and were not affected by the Fitzpatrick skin phototype, duration of sun exposure per day or the use of sunscreens (p > 0.05 for all). CONCLUSIONS Aging is a complex process that is influenced by many genetic and environmental factors. Facial aging is not correlated with serum vitamin D level, and clinical trials using oral or topical vitamin D to combat aging are better predictors of its effects rather than in vivo studies.
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Affiliation(s)
- Noha M Dawoud
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufiya University, Shebin Elkoom, Egypt
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Chailurkit L, Aekplakorn W, Ongphiphadhanakul B. Serum C3 epimer of 25-hydroxyvitamin D and its determinants in adults: a national health examination survey in Thais. Osteoporos Int 2015; 26:2339-44. [PMID: 25868511 DOI: 10.1007/s00198-015-3125-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED A high percentage have detectable C3 epimer of 25-hydroxyvitamin D3 (3-epi-25(OH)D3) in the population of Thai National Health Examination Survey IV. INTRODUCTION C3 epimers of vitamin D have recently been shown to contribute significantly to 25-hydroxyvitamin D (25(OH)D) levels in an infant population. However, the findings in the general adult population are unclear. Therefore, the purpose of the present study is to determine the percentage of the C3 epimer of 25(OH)D (3-epi-25(OH)D) and its determinants in an adult population. METHODS A subsample of 1148 sera randomly selected from the Thai National Health Examination Survey IV (2009) samples were measured for serum 25(OH)D2, 25(OH)D3, 3-epi-25(OH)D2, and 3-epi-25(OH)D3 by LC-MS/MS method. The relative 3-epimer contribution (%) was used to express the amount of 3-epimer-25(OH)D3 as a percentage of total 25(OH)D3 (the sum of 25(OH)D3, and 3-epi-25(OH)D3). RESULTS A high proportion of subjects had detectable 3-epi-25(OH)D3 that was <10 % of the total 25(OH)D levels. Since the level of total 25(OH)D2 is low, only a minority of subjects had detectable 3-epi-25(OH)D2. Multivariate analysis suggested that age, male gender, and rural residence were independently related to the 3-epi-25(OH)D3/total 25(OH)D3 ratio. CONCLUSIONS A high percentage of Thai adults had detectable 3-epi-25(OH)D3 that was <10 % of the total 25(OH)D levels. Age, gender, and living in a rural area were associated with the relative amount of 3-epi-25(OH)D3 to total 25(OH)D3.
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Affiliation(s)
- L Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand,
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Nichols EK, Khatib IMD, Aburto NJ, Serdula MK, Scanlon KS, Wirth JP, Sullivan KM. Vitamin D status and associated factors of deficiency among Jordanian children of preschool age. Eur J Clin Nutr 2014; 69:90-5. [PMID: 25117992 DOI: 10.1038/ejcn.2014.142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVES Vitamin D deficiency in children remains a global concern. Although literature exists on the vitamin D status and its risk factors among children in the Middle East, findings have yielded mixed results, and large, representative community studies are lacking. SUBJECTS/METHODS In a nationally representative survey of 1077 Jordanian children of preschool age (12-59 months) in Spring 2010, we measured 25(OH)D3 concentrations by liquid chromatography-tandem mass spectrometry and calculated prevalence ratios for deficiency associated with various factors. RESULTS RESULTS showed 19.8% (95% confidence interval (CI): 16.4-23.3%) deficiency (<12 ng/ml) and 56.5% (95% CI: 52.0-61.0%) insufficiency (<20 ng/ml). In adjusted models, prevalence of deficiency was higher for females compared with males (prevalence ratio (PR)=1.74, 95% CI: 1.22-2.47, P=0.002) and lower for children 24-35 months of age (PR=0.64, 95% CI: 0.44-0.92, P=0.018) compared with children 12-23 months of age. In rural areas, there was no difference in prevalence of vitamin D deficiency between those whose mothers had/did not have vitamin D deficiency (P=0.312); however, in urban areas, prevalence of vitamin D deficiency was 3.18 times greater among those whose mothers were vitamin D deficient compared with those whose mothers were not deficient (P=0.000). CONCLUSIONS Vitamin D deficiency and insufficiency pose significant public health problems in Jordanian children with female children disproportionately affected. Strong associations between vitamin D status in children and urban residency and maternal vitamin D status suggest that the behaviors related to sun exposure in urban mothers likely also affect the sun exposure and thus vitamin D status of their children.
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Affiliation(s)
- E K Nichols
- Epidemic Intelligence Service assigned to the Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, U.S. Public Health Service, Atlanta, GA, USA
| | - I M D Khatib
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - N J Aburto
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M K Serdula
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K S Scanlon
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J P Wirth
- 1] GroundWork LLC, 1299 Crans-près-Céligny, Nyon, Switzerland [2] Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - K M Sullivan
- 1] Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA [2] Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Samrah S, Khatib I, Omari M, Khassawneh B, Momany S, Daoud A, Malkawi M, Khader Y. Vitamin D deficiency and level of asthma control in women from North of Jordan: a case-control study. J Asthma 2014; 51:832-8. [PMID: 24779968 DOI: 10.3109/02770903.2014.919316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Reduced vitamin-D levels in patients with asthma have been associated with impaired lung function, increased airway hyper-responsiveness, and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. OBJECTIVE A case-control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. METHODS Sixty-eight asthmatics, age range between 14 and 65 years and 77 healthy women, age range between 19 and 51 years, were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. RESULTS The prevalence of VDD (<15 ng/ml) was higher but not statistically significant for women with asthma compared with controls (95.6% vs. 87.0%; p = 0.070). The severity of VDD correlated with the number of asthma medications (p = 0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p = 0.012) and GINA classification (p = 0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p = 0.214) and none had vitamin-A deficiency (<200 µg/dl). CONCLUSIONS VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and a need for more medications to control asthma. There was no association between vitamin-A and asthma.
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Sayed-Hassan R, Abazid N, Alourfi Z. Relationship between 25-hydroxyvitamin D concentrations, serum calcium, and parathyroid hormone in apparently healthy Syrian people. Arch Osteoporos 2014; 9:176. [PMID: 24715441 DOI: 10.1007/s11657-014-0176-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/24/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Vitamin D deficiency (25-hydroxyvitamin D (25OHD) <25 nmol/L) was common in a convenience sample of apparently healthy Syrian adults. Female gender, season, and concealing clothing were independent predictors of vitamin D deficiency. Community-based research is needed to identify vulnerable subgroups and inform public health actions. PURPOSE Optimal vitamin D status for bone health has been inferred from the determination of serum 25OHD levels below which there is an increase in serum parathyroid hormone (PTH). Studies worldwide showed high prevalence of hypovitaminosis D even in sunny countries. There is little evidence about its prevalence among Syrian adult population. We aimed to assess the serum levels of 25OHD and factors related to vitamin D inadequacy and its relation to serum PTH and calcium among apparently healthy adults. METHODS Serum 25OHD and PTH measurements were obtained from 372 subjects aged 18-62 years living in Damascus and its surroundings, between April 2011 and March 2013. Binary logistic regression was used to assess risk factors for hypovitaminosis D. RESULTS The mean (standard deviation (SD)) 25OHD level was 24.7 (16.9) nmol/L [9.8 (6.7) ng/mL] and was higher in men than women (p < 0.001). Levels <25, <50, and <75 nmol/L were detected in 61, 90.1, and 99.2 % of the participants, respectively. Season influenced vitamin D status in men but not in women (p < 0.001). Female gender and wearing the veil (hijab) were independent predictors of vitamin D deficiency (25OHD <25 nmol/L). PTH was significantly higher below this threshold (p < 0.001). Serum 25OHD <25 nmol/L, sex, and age ≥ 35 years were statistically significant factors for PTH elevation. CONCLUSIONS Vitamin D deficiency was highly prevalent in our sample. Further research is needed to identify population groups vulnerable for hypovitaminosis D and specify its predictors and inform the necessary public health measures.
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Affiliation(s)
- Rima Sayed-Hassan
- Department of Internal Medicine, Faculty of Medicine, Damascus University, P.O. Box 9241, Damascus, Syria,
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Bassil D, Rahme M, Hoteit M, Fuleihan GEH. Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes. DERMATO-ENDOCRINOLOGY 2013; 5:274-98. [PMID: 24194968 PMCID: PMC3772916 DOI: 10.4161/derm.25111] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/10/2013] [Accepted: 05/21/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide. AIM We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region. METHODS Medline, Pubmed and Embase search engines, entering keywords and concepts, combined with individual countries of interest, were used. Search was limited years 2000-2012; and review articles were used for the period preceding year 2000. RESULTS Rickets and osteomalacia still occur in this sunny region. Hypovitaminosis D prevails, with rates varying 30-90%, considering a desirable serum 25 hydroxy-vitamin D [25(OH)D] of 20 ng/ml. Advancing age, female gender, multi-parity, clothing style, season, socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults. Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children.. Associations with pain score and disease activity in rheumatologic disorders, viral load and interleukins in hepatitis C, BMI, lipids and insulin sensitivity, blood pressure, heart failure and mortality are described. Sun exposure in adults decreased prevalence of metabolic syndrome in one study. Few randomized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level, even with doses by far exceeding current recommendations. A trial in adolescent girls reveals substantial bone and lean mass increments. CONCLUSION Hypovitaminosis D is prevalent in MENA. The lack of populations based studies, gaps in studies in infants, pre-pubertal children and pregnant women, hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often subclinical disease.
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Affiliation(s)
- Darina Bassil
- Calcium Metabolism and Osteoporosis Program; WHO Collaborating Center for Metabolic Bone Disorder; Faculty of Medicine; American University of Beirut Medical Center; Beirut, Lebanon
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Abstract
Inflammatory bowel disease is associated with industrialization, and its incidence has increased markedly over time. The prospect of reversing these trends motivates the search for the agent(s) involved. Modernity entails several physical and behavioral modifications that compromise both the photosynthesis of cholecalciferol in the skin and of its bioavailability. Although deficiency in this "vitamin" has therefore emerged as a leading candidate, and despite the publication of a randomized control trial that showed a trend toward statistically significant benefit in Crohn's disease, its causal agency has yet to be demonstrated by an adequately powered study. We discuss the strengths and weaknesses of the case being made by epidemiologists, geneticists, clinicians, and basic researchers, and consolidate their findings into a model that provides mechanistic plausibility to the claim. Specifically, converging data sets suggest that local activation of vitamin D coordinates the activity of the innate and adaptive arms of immunity, and of the intestinal epithelium, in a manner that promotes barrier integrity, facilitates the clearance of translocated flora, and diverts CD4 T cell development away from inflammatory phenotypes. Because smoking is an important risk-altering exposure, we also discuss its newly established melanizing effect and other emerging evidence linking tobacco use to immune function through vitamin D pathways.
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Saki F, Karamizadeh Z, Nasirabadi S, Mumm S, McAlister WH, Whyte MP. Juvenile paget's disease in an Iranian kindred with vitamin D deficiency and novel homozygous TNFRSF11B mutation. J Bone Miner Res 2013; 28:1501-8. [PMID: 23322328 PMCID: PMC3663917 DOI: 10.1002/jbmr.1868] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 11/29/2012] [Accepted: 12/26/2012] [Indexed: 12/17/2022]
Abstract
Juvenile Paget's disease (JPD) is a rare heritable osteopathy characterized biochemically by markedly increased serum alkaline phosphatase (ALP) activity emanating from generalized acceleration of skeletal turnover. Affected infants and children typically suffer bone pain and fractures and deformities, become deaf, and have macrocranium. Some who survive to young adult life develop blindness from retinopathy engendered by vascular microcalcification. Most cases of JPD are caused by osteoprotegerin (OPG) deficiency due to homozygous loss-of-function mutations within the TNFRSF11B gene that encodes OPG. We report a 3-year-old Iranian girl with JPD and craniosynostosis who had vitamin D deficiency in infancy. She presented with fractures during the first year-of-life followed by bone deformities, delayed development, failure-to-thrive, and pneumonias. At 1 year-of-age, biochemical studies of serum revealed marked hyperphosphatasemia together with low-normal calcium and low inorganic phosphate and 25-hydroxyvitamin D levels. Several family members in previous generations of this consanguineous kindred may also have had JPD and vitamin D deficiency. Mutation analysis showed homozygosity for a unique missense change (c.130T>C, p.Cys44Arg) in TNFRSF11B that would compromise the cysteine-rich domain of OPG that binds receptor activator of NF-κB ligand (RANKL). Both parents were heterozygous for this mutation. The patient's serum OPG level was extremely low and RANKL level markedly elevated. She responded well to rapid oral vitamin D repletion followed by pamidronate treatment given intravenously. Our patient is the first Iranian reported with JPD. Her novel mutation in TNFRSF11B plus vitamin D deficiency in infancy was associated with severe JPD uniquely complicated by craniosynostosis. Pamidronate treatment with vitamin D sufficiency can be effective therapy for the skeletal disease caused by the OPG deficiency form of JPD.
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Affiliation(s)
- Forough Saki
- Department of Pediatric Endocrinology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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