Awareness of Vitamin D Deficiency among the General Population in Jeddah, Saudi Arabia

Assessment the awareness of vitamin D deficiency among the general population in Syria: an online cross-sectional study

BACKGROUND

Vitamin D deficiency is an importance preventable problem in the global and associates with lack levels of awareness about vitamin D. According to prior studies, in the Arab world, there is low of knowledge and awareness toward vitamin D deficiency. The target of our study is evaluating the knowledge level about vitamin D deficiency and determining the associated factors with levels of awareness of its.

METHOD

This online cross-sectional study was performed in Syria between 25 February to 29 March 2023 to assess the levels of knowledge about vitamin D deficiency among general Syrian population. The study's survey was obtained from previously published research and we conducted a pilot study to assure the validity and clarity questionnaire. All Syrian individuals aged 18 or older who were able to read and write and willing to participate were included, while, non-Syrian nationality individuals and all medical staff (doctors, nurses, and medical students…), as well, those under 18 age were excluded. The questionnaire consisted of 23 questions separated into four categories. The first section was sociodemographic information of the study population. The second section measured the level awareness of the study population regarding the benefits of vitamin D. In addition, the third and fourth part evaluated knowing of the respondents about sources of and toxicity consequences of vitamin D. The data were analyzed by utilizing multivariate logistic regression in IBM, SPSS V.28 version.

RESULTS

Overall, 3172 of the study population accepted to participate in this research and 57.9% the majority of them were aged in the range among 18 and 28. While, the average age of the respondents were 30.80 ± 11.957. Regarding with the awareness toward knowledge of advantages and source of vitamin D and outcomes of vitamin D toxicity. Most of the participants mentioned that vitamin D is used to treat bone disease and rickets and contributes in maintaining calcium and phosphates (91.4% and 84.6%, respectively). Whereas, more than half of them reported that sun exposure does not cause vitamin D poisoning and that vegetarians are more likelihood to have vitamin D than non-vegetarians, (54.1% and 54.9%, respectively). Only, age and occupation out of nine predictors variables were significantly correlated with adequate knowledge of Vitamin D (p-value < 0.05). The respondents aged more than 60 years were high probability to have good recognition of Vitamin D than participants aged between 18 and 28 years. (OR = 7.95). Retired participants have shown lower aware of Vitamin D 0.38 times than students.

CONCLUSION

Our research revealed that most of the participated individuals have sufficient comprehension about vitamin D, despite, there were significant gap. Health education via programs by government health-care agencies, NGOs and social workers is necessary to increase the awareness and knowledge toward benefits, source, deficiency and toxicity of vitamin D to avoid injury several diseases such as rickets.

Vitamin D knowledge, awareness and practices of female students in the Southwest of Saudi Arabia: A cross-sectional study

Vitamin D deficiency is a common health problem among adults in Saudi Arabia, particularly females. Vitamin D deficiency is associated with many diseases, including cardiovascular diseases, diabetes, autoimmune diseases, neurological disorders, and cognitive decline. This study aimed to assess the knowledge, awareness and practice of vitamin D deficiency among female students in Jazan University as well as to determine the sociodemographic related factors. A cross-sectional study was conducted among 204 female undergraduate and postgraduate students (18 years of age and older) in March 2022 from Saudi Arabia. Students completed a web-based survey about vitamin D and their demographic characteristics. Statistical analyses were conducted using Statistical Package for the Social Sciences software. Descriptive statistics, the Chi-squared test of homogeneity, and univariate and multivariate logistic regression were used. The results revealed that the participants had limited knowledge related to vitamin D normal level (49.5%), and the recommended daily amount of vitamin D (26.5%). Most of the participants were unaware of its benefits for vision, muscle integrity, weakness, and fatigue. Most of them recognized the importance of sunlight for maintaining suitable levels of vitamin D (94.1%). However, only 43.1% identified that decreased intake of foods rich in vitamin D is a cause of vitamin D deficiency. Participants (33.7%) preferred exposure to sunlight to improve their vita-min D levels, and 32.4% used vitamin D supplements. However, only 39.2% had ever examined their vitamin D status. Univariate and multivariate logistic regression models demonstrated a significant association between knowledge, and residence, and source of information (odds ratios = 3.48 and 2.79, respectively, P < .05). Most respondents had a basic understanding of vitamin D, vitamin D insufficiency, and the environmental and dietary factors contributing to it. Given the findings obtained, cognitive interventions need to be carried out.

Vitamin D deficiency prevention policies in Iran: a retrospective policy analysis

Aim

Iran has a higher prevalence of vitamin D deficiency (VDD) than the global level. This study aimed to assess VDD prevention policies in Iran through a policy analysis of agenda setting using the multiple streams framework (MSF).

Methods

Using Kingdon's MSF model, this qualitative analytical study performed a policy analysis on vitamin D-related policies in Iran. The policy documents were reviewed, and in-depth interviews were conducted with stakeholders (n = 27) using the framework analysis method. To categorize data and extract the related themes, MAXQDA version 10 was used.

Results

According to Kingdon's MSF theory, the problem stream included the high prevalence of VDD among Iranian infants (23.3%), adolescents (76%), and adults (59.1%). The policy stream was identified to focus on preventing programs for non-communicable diseases in the health sector. The political stream indicated that national and international support could provide a political climate for this issue.

Conclusion

According to our results, a window of opportunity for policymaking on VDD prevention has opened. However, there are some challenges related to the implementation of these policies. These include the dominance of a treatment-based view rather than a prevention-based approach in the health sector, economic problems, and restricted access to health services due to the outbreak of coronavirus disease 2019 (COVID-19). To strengthen and implement VDD prevention policies, the stakeholders need support from high-level policymakers.

Nutritional rickets and vitamin D deficiency: consequences and strategies for treatment and prevention

INTRODUCTION

Rickets is typically characterized by bone deformities due to defective bone mineralization and chondrocyte maturation in growing bones. However, infantile rickets often goes unrecognized, because the skeletal abnormalities are more subtle and often can only be detected radiologically. Nutritional rickets is a major public health concern in several regions worldwide. It is most commonly caused by vitamin D and/or calcium deficiency.

AREA COVERED

We provide an overview of historical perspective, epidemiology, and pathophysiology of nutritional rickets. Additionally, we outline diagnostic approaches and highlight challenges in radiographic diagnosis of rickets. Finally, we present strategies for prevention and treatment of rickets.

EXPERT OPINION

Despite the evidence from clinical databases that rickets is a rare disease, it is likely that rickets is clinically underdiagnosed as studies designed to screen healthy children for radiographic evidence of rickets reported surprisingly much higher prevalence. It has been reported that some of the radiologic features of rickets can be misinterpreted as fractures. To prevent nutritional rickets, most if not all infants and young children, should receive vitamin D from formulas and foods that are fortified with vitamin D or supplementation to achieve a serum 25-hydroxyvitamin D of at least 20 ng/mL as recommended by the Institute of Medicine. It has been recommended by the Endocrine Society that to achieve maximum bone health for children and adults, a serum concentration of 25-hydroxyvitamin D should be at least 30 ng/mL and preferably 40-60 ng/mL. Pregnant women who are unable to obtain an adequate amount of vitamin D from sunlight exposure and natural and fortified diets should take a vitamin D supplement of 1500-2000 IUs daily as recommended by the Endocrine Society since it has been demonstrated that 600 IUs daily will not maintain a circulating 25-hydroxyvitamin D of at least 20 ng/mL and most pregnant women. If lactating women take approximately 6400 IUs of vitamin D daily, they provide enough vitamin D in their milk to satisfy their infant's requirement thereby preventing rickets.

Vitamin D Sources, Metabolism, and Deficiency: Available Compounds and Guidelines for Its Treatment

Studies on vitamin/hormone D deficiency have received a vast amount of attention in recent years, particularly concerning recommendations, guidelines, and treatments. Moreover, vitamin D’s role as a hormone has been confirmed in various enzymatic, metabolic, physiological, and pathophysiological processes related to many organs and systems in the human body. This growing interest is mostly due to the evidence that modest-to-severe vitamin D deficiency is widely prevalent around the world. There is broad agreement that optimal vitamin D status is necessary for bones, muscles, and one’s general health, as well as for the efficacy of antiresorptive and anabolic bone-forming treatments. Food supplementation with vitamin D, or the use of vitamin D supplements, are current strategies to improve vitamin D levels and treat deficiency. This article reviews consolidated and emerging concepts about vitamin D/hormone D metabolism, food sources, deficiency, as well as the different vitamin D supplements available, and current recommendations on the proper use of these compounds.

Low Vitamin D Level in Saudi Women With Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. In this study, serum 25-hydroxyvitamin D levels were compared between women with and without PCOS and with regard to anthropometric indices and lipid and glucose biomarkers. Thirty-one women with PCOS and 75 controls answered a questionnaire on vitamin D, in addition to general health and lifestyle. The patients with PCOS had lower vitamin D levels (p < 0.05), a significantly higher rate of obesity (p < 0.05), and significantly higher serum triglyceride levels than did controls. The number of patients with PCOS consumed milk and dairy products (p < 0.05) and exposed to sun (p < 0.006) were lower compared to controls. Triglyceride levels were significantly correlated with body mass index (BMI); vitamin D level was not significantly correlated with anthropometrical or biochemical variables. These results affirm that vitamin D levels are lower in women with PCOS; however, despite the significantly higher proportion of obesity among patients with PCOS, hypovitaminosis was not associated with BMI. The relationship between body composition and vitamin D in PCOS and the effect of vitamin D correction on metabolic and hormonal parameters associated with PCOS must be assessed in future trials.

Response regarding the importance of vitamin D and calcium among undergraduate health sciences students in Al Kharj, Saudi Arabia

BACKGROUND

Vitamin D and calcium are essential dietary components for human body, and their deficiency is linked to poor bone health and osteoporosis. Adequate knowledge of health staff regarding vitamin D and calcium is critical for general population awareness. The current work was to evaluate the awareness regarding the importance of vitamin D and calcium among undergraduate health science students in Al Kharj.

METHODS

A self-distributed validated questionnaire-based cross-sectional study was conducted. Undergraduate health science students in Prince Sattam bin Abdulaziz University from the College of Medicine, College of Pharmacy, College of Dentistry, and College of Applied Medical Science were included in the study. Students between the age of 18 and 25 years have participated in the study.

RESULTS

Four hundred fifty-seven undergraduate health science students participated in the study. The vast majority of students knew about the importance of calcium (96.7%) and vitamin D (95.4%), whereas only 89.4% knew about osteoporosis. The participant students reported in their answers that the sources of knowledge were the Internet (42.8%), physicians (41.5%), textbooks (21.2%), teachers (19.1%), family and relatives (18.3%), and/or other sources (6.1%). The overall attitude was poor in about (54%) of the participants showing gender differences regarding sun-exposure duration and supplementation of calcium and vitamin D.

CONCLUSION

The study revealed that both male and female undergraduate health science students in Al Kharj were familiar with the importance of vitamin D and calcium; however they reported improper attitude that warrants further health guidance and educational programs.

Evaluation of Self-Assessed State of Health and Vitamin D Knowledge in Emirati and International Female Students in United Arab Emirates (UAE)

INTRODUCTION

Globally, vitamin D deficiency is one of the most common deficiencies, affecting nearly half the world's population. The objective of this survey was to assess and compare the knowledge about vitamin D and the perceived state of health in Emirati and international tourist female students in Dubai, United Arab Emirates (UAE).

METHODS

This is a cross-sectional study that took place in universities in Dubai, United Arab Emirates. This survey consisted of 17 multiple choice questions and was adapted from a study recently conducted in Poland. The first part of the survey assessed levels of supplementation, diet and UV exposure. Another section evaluated the participants' self-assessed state of health in terms of vitamin D testing, symptoms related to vitamin D deficiency and general welbeing. The collected data were statistically analyzed using SPSS statistics for windows version 26.0 (SPSS Inc., Chicago, IL, United States). Statistical significance was set at P < 0.05.

RESULTS

105 respondents were Emiratis and 65 were international students. The average age was 21, with an average BMI 23.3 kg/m2. Almost one-third of each group reported using Vitamin D supplements once weekly. The vast majority of both groups reported rarely getting tanned. Almost all participants in both groups reported regular consumption of Vitamin D rich foods. In both groups, more than half reported consuming milk and cheese regularly and up to one-third reported consuming fish in a regular manner. Although more than half of the students rated their health as good; more than two-thirds reported experiencing muscle pain; only half reported having their blood Vitamin D levels measured once; half reported experiencing problems with concentration and more than three-quarters reported experiencing bad mood in the past month. The prevalence of these symptoms was almost similar across different categories of vitamin D supplementation, tanning habits, dietary intake, or nationality. No statistically significant differences were noted between the Emirati and International tourist students regarding any of the studied variables.

CONCLUSION

Notably, more Emirati students were aware of the association between vitamin D and osteoporosis than International tourist students (40% vs. 21.9%, respectively; p < 0.05). On the other hand, both groups had lower knowledge about the relationship between vitamin D deficiency and depression, Rheumatoid Arthritis and Hypertension, and the optimal vitamin D level; however, no statistically significant differences were noted regarding this knowledge of Emiratis and international students.

Emirati Adults Have a Higher Overall Knowledge on Vitamin D Compared to Tourists

Objectives

In the last decade, vitamin D deficiency has become a major global issue. One of the main functions of vitamin D is the proper absorption of calcium in the gastrointestinal track. Optimal vitamin D levels are mandatory for adequate calcium absorption and bone health. The purpose of this study was to assess the level of knowledge of vitamin D, calcium, and physical activity among Emirati and tourist adults in Abu Dhabi.

Methods

This is a cross-sectional study that took place in three different malls in Abu Dhabi and included Emirati and tourist adults. Participants were asked to fill in a questionnaire consisting of 32 questions. These included questions on vitamin D, calcium, supplement, and physical activity knowledge. Another section of the questionnaire included general information on age, sex, education, weight, and height. The collected data were statistically analyzed using descriptive statistics using IBM SPSS statistics for Windows version 26.0 (SPSS Inc., Chicago, IL, United States). Statistical significance was set at P < 0.05.

Results

Out of 147 adults, 113 were females and 34 males. The mean age, height, and weight were 27.9 ± 8.6 years, 162.7 ± 10.4 cm, and 66.5 ± 19.5 kg, respectively. Emiratis had statistically significant higher basic knowledge on vitamin D compared to tourists (44.9 vs 27.1%), respectively. More than 66% of the whole sample was aware that vitamin D deficiency can affect muscle strength, as well as that calcium may affect osteoporosis. In a multiple regression model to analyze the possible effects of other factors to knowledge, it was found that only age (Beta: 0.045, P < 0.014) and nationality (Beta: 0.750, P < 0.018) were independently and significantly associated to vitamin D.

Conclusion

Emirati participants showed a higher overall vitamin D knowledge than their tourist counterparts. Both groups had low/medium level of knowledge when it comes to physical activity and calcium and vitamin D supplements.

The sunshine under our skin: public knowledge and practices about vitamin D deficiency in Al Ain, United Arab Emirates

This cross-sectional study among members of public showed that people generally had good knowledge and awareness about vitamin D. However, inconsistencies between awareness and attitudes were observed. Our findings reinforce the need of educating people to improve attitude and practices toward vitamin D consumption.

INTRODUCTION

Owing to its hot and dry climate, United Arab Emirates (UAE) is one of the top ranked vitamin D deficient countries. However, little is known about people's awareness surrounding this topic.

METHODS

A descriptive cross-sectional survey to assess people's knowledge, awareness, and attitude toward vitamin D deficiency was conducted in Al Ain city of UAE. A 25-item validated self-administered questionnaire was used for data collection. Differences among demographic groups were analyzed using chi-square test, and simple binary logistic regressions were used to investigate the association between vitamin D awareness and other significant risk factors.

RESULTS

More than 90% of the total 346 participants showed awareness toward vitamin D and its deficiency. Doctors were reported as the most common source of information. More than one-third of the participants claimed to have vitamin D deficiency with significantly more females than males. More than 70% of the sample considered sunlight as the best source of vitamin D and avoiding going out in sun as the major risk for vitamin D deficiency. Nearly half (43%) of the participants did not consume milk and only 24% claimed to be using vitamin D supplements. Females were found to be applying sunscreen and consuming vitamin supplements significantly more than their male counterparts. Participants aged 24-35 years, having bachelor degree and those who were tested for vitamin D, were found to score better for awareness questions.

CONCLUSIONS

Our findings demonstrate a mismatch between knowledge and awareness, and attitude implying the need of educating people to improve their attitude toward consuming vitamin D rich food and supplements.

Vitamin D for skeletal and non-skeletal health: What we should know

Vitamin D plays an essential role in regulating calcium and phosphate metabolism and maintaining a healthy mineralized skeleton. Humans obtain vitamin D from sunlight exposure, dietary foods and supplements. There are two forms of vitamin D: vitamin D₃ and vitamin D₂. Vitamin D₃ is synthesized endogenously in the skin and found naturally in oily fish and cod liver oil. Vitamin D₂ is synthesized from ergosterol and found in yeast and mushrooms. Once vitamin D enters the circulation it is converted by 25-hydroxylase in the liver to 25-hydroxyvitamin D [25(OH)D], which is further converted by the 25-hydroxyvitamin D-1α-hydroxylase in the kidneys to the active form, 1,25-dihydroxyvitamin D [1,25(OH)₂D]. 1,25(OH)₂D binds to its nuclear vitamin D receptor to exert its physiologic functions. These functions include: promotion of intestinal calcium and phosphate absorption, renal tubular calcium reabsorption, and calcium mobilization from bone. The Endocrine Society's Clinical Practice Guideline defines vitamin D deficiency, insufficiency, and sufficiency as serum concentrations of 25(OH)D of <20 ng/mL, 21-29 ng/mL, and 30-100 ng/mL, respectively. Vitamin D deficiency is a major global public health problem in all age groups. It is estimated that 1 billion people worldwide have vitamin D deficiency or insufficiency. This pandemic of vitamin D deficiency and insufficiency is attributed to a modern lifestyle and environmental factors that restrict sunlight exposure, which is essential for endogenous synthesis of vitamin D in the skin. Vitamin D deficiency is the most common cause of rickets and osteomalacia, and can exacerbate osteoporosis. It is also associated with chronic musculoskeletal pain, muscle weakness, and an increased risk of falling. In addition, several observational studies observed the association between robust levels of serum 25(OH)D in the range of 40-60 ng/mL with decreased mortality and risk of development of several types of chronic diseases. Therefore, vitamin D-deficient patients should be treated with vitamin D₂ or vitamin D₃ supplementation to achieve an optimal level of serum 25(OH)D. Screening of vitamin D deficiency by measuring serum 25(OH)D is recommended in individuals at risk such as patients with diseases affecting vitamin D metabolism and absorption, osteoporosis, and older adults with a history of falls or nontraumatic fracture. It is important to know if a laboratory assay measures total 25(OH)D or only 25(OH)D₃. Using assays that measure only 25(OH)D₃ could underestimate total levels of 25(OH)D and may mislead physicians who treat patients with vitamin D₂ supplementation.