Knowledge, awareness, attitudes and sources of vitamin D deficiency and sufficiency in Saudi children

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.

Maternal Awareness of Vitamin D Deficiency in Infants and Children Up to the Age of 6 Years: A Cross-sectional Study in Jordan

Vitamin D deficiency is a worldwide health problem. The current study aims to evaluate mothers' habits and knowledge regarding vitamin D deficiency in kids up to the age of 6. A questionnaire was made available online among mothers of children between 0 and 6 years. Most mothers (65.7%) were aged between 30 and 40 years. Sunlight was identified as the main source of vitamin D by most participants (89.1%), while fish and eggs were reported to be the main dietary sources of vitamin D by most participants (63.7% and 65.2%, respectively). Most participants identified the benefits of vitamin D, risk factors, and complications of vitamin D deficiency. The majority (86.4%) think they need more information on vitamin D deficiency in children. A moderate knowledge level was reported among more than half of the participants although there was inadequate knowledge in certain domains of vitamin D knowledge. More education is required for mothers about vitamin D deficiency.

Seasonal Variations in 25-Hydroxyvitamin D Levels among Pediatric Patients Attending the Healthcare Centre

Vitamin D plays an essential role in maintaining bone density, building the immune system, and regulating cell growth alongside other key biological functions. Limited data are available about the seasonal variation in vitamin D levels in the pediatric population in Saudi Arabia. This study aimed to investigate the seasonal influence on the pediatric circulating levels of 25(OH)D. A total of 1790 pediatric outpatients who visited the University healthcare centre were included in this study. Overall, there was a noticeably high prevalence (69%) of both combined 25(OH)D deficiency and insufficiency. The highest mean serum concentration of 25(OH)D was recorded in summer (29 ng/mL) and autumn (27 ng/mL). The deficient and insufficient categories were predominant, accounting for 33% and 36%, respectively. Comparable patterns were recorded during autumn, winter, and spring. Interestingly, the 25(OH)D level was significantly associated with the four seasons (p = 0.001), with females having a higher prevalence of 25(OH)D deficiency in the spring and summer than males. Furthermore, only in autumn and winter, we found a significant association between gender and 25(OH)D status (p < 0.001 for both). Another association between nationality and the circulating levels 25(OH)D was found during autumn and winter (p < 0.001 and p = 0.01), respectively. In all seasons, age had a negative impact on serum (OH)D levels. However, this relationship was statistically significant (p < 0.05) only in summer, autumn, and winter. Gender was a significant predictor, with 25(OH)D levels in autumn and winter and an odds ratio of 1.67 in autumn and 2 in winter, indicating that being men had a positive influence on circulating 25(OH)D levels. There were highly significant differences in 25(OH)D concentrations among different age categories. The Saudi population experiences low levels of vitamin D, particularly in autumn and winter periods. This study showed that seasonality, age category, nationality, and gender influence vitamin D status, suggesting the need for tailored intervention and monitoring of 25(OH)D status to reach adequate levels of vitamin D. Healthcare practitioners and policymakers may consider the interplay between age, nationality, gender, and seasonal variations when addressing vitamin D status and a targeted supplementation approach for high-risk groups that may develop health issues.

Vitamin D Knowledge, Awareness, and Attitudes of Adolescents and Adults: A Systematic Review

INTRODUCTION

The aims of this systematic review were 2-fold: (1) evaluate the effect of vitamin D educational interventions on serum 25-hydroxyvitamin D (25-OHD) concentration in adolescents (aged 10-19 years) and adults, and (2) assess the association between serum 25-OHD concentration and vitamin D knowledge, awareness of vitamin D deficiency risk, and attitudes toward behaviors associated with acquiring vitamin D.

METHODS

Medline, CINAHL, Embase, and SPORTDiscus were systematically searched for studies reporting associations between serum 25-OHD concentration and vitamin D knowledge, awareness, and attitudes. Results were summarized narratively. Effect sizes were calculated when data were available.

RESULTS

Eight studies reported experimental effects (2 randomized controlled trials, 1 cluster randomized trial, 4 quasi-experiments, 1 clinical audit), and 14 reported cross-sectional associations. Seven of 8 interventions reported no effect of educational interventions on serum 25-OHD concentration. A slight majority (53%; κ = 19) of studies reported statistically significant associations between serum 25-OHD concentration and vitamin D knowledge and attitudes.

IMPLICATIONS FOR RESEARCH AND PRACTICE

The few educational interventions employed to increase serum 25-OHD concentration lack effectiveness. Future studies may use randomized controlled trial designs, enroll those at risk for vitamin D insufficiency and underrepresented in the literature, increase the salience of the information to the target population, and include safe sun exposure recommendations.

Public Knowledge, Attitude, and Practice Toward Vitamin D Deficiency in Al-Qunfudhah Governorate, Saudi Arabia

BACKGROUND

Vitamin D is a very important component of all vital functions in the human body. Its deficiency is a major public health issue worldwide and is associated with a broad spectrum of diseases. This study assessed knowledge, attitude, and practices regarding vitamin D deficiency among the general population in the Al-Qunfudhah governorate, Saudi Arabia.

METHODS

An analytical cross-sectional study was carried out among the population in Al-Qunfudhah governorate, Saudi Arabia. A self-administrated online questionnaire was utilized to collect the research data during a period of four months from November 2021 to February 2022.

RESULTS

A sample of 466 participants was recruited in this study, about two-thirds of them were females (64.4%) and had a university education (67.8%). Despite 91% of them having previously heard about vitamin D, only (17.4%) were able to recognize sunlight exposure as a main source of vitamin D. Poor knowledge and positive attitude regarding vitamin D were obviously seen among 72.3% and 95.7%. Although 89% of the participants' family members had been diagnosed with hypovitaminosis D. Only 45% of the sample were willing to be compliant with vitamin D supplement whenever it is needed. The most reported source of information regarding vitamin D among the respondents was mass media (62.2%). The associated variables of good knowledge were female gender (P 0.001), young (P 0.001), unmarried (P 0.006), highly educated (P 0.048), and receiving medical information from physicians (P 0.018).  Conclusion: This study reveals the poor level of knowledge about vitamin D deficiency among the Al-Qunfudhah population, and this negatively affected their compliance for vitamin D supplementation when having hypovitaminosis D. Positive attitude toward vitamin D deficiency among the majority of the participants was obvious and may direct them to change their behavior toward vitamin D. Therefore, this study highlights the necessity of educating and sensitizing population about vitamin D and prevention of its deficiency.

Knowledge and Attitudes towards Vitamin D among Health Educators in Public Schools in Jeddah, Saudi Arabia: A Cross-Sectional Study

Health educators in schools are a very important part of the education system. Considering the significant prevalence of vitamin D deficiency in the Kingdom of Saudi Arabia, it is important to investigate the knowledge of and attitude towards vitamin D among health educators. This study aims to examine the knowledge of and attitude towards vitamin D among health educators in public schools in Jeddah as well as to identify the associated sociodemographic factors. A cross-sectional study was conducted between May and December 2021 among 231 health educators. Data were collected via a self-administered online questionnaire. The results revealed that only 45% of health educators had good knowledge of vitamin D, and approximately 43% had a positive attitude towards vitamin D. Additionally, those who had good knowledge of vitamin D were males (58.7%) (p = 0.005) and had a bachelor's degree (74%) (p = 0.01). Moreover, male health educators aged 45-54 years had a positive attitude towards vitamin D (3.8 ± 0.7) (p = 0.007). In addition, female health educators who were divorced (3.8 ± 0.7) and widowed (3.6 ± 0.5) (p = 0.04) and those who were administrators (3.3 ± 0.7) (p = 0.01) had a positive attitude towards vitamin D. The Ministry of Education (MOE) in the Kingdom must educate health educators through educational programmes that aim to increase the knowledge of and develop a positive attitude towards vitamin D intake.

Association of Vitamin D Knowledge, Behavior and Attitude with BMI Status among Arab Adults

This study aims to investigate the association of vitamin D (VD) knowledge, behavior, and attitude with BMI status among Saudi adults. This cross-sectional online survey included a total of 774 participants (M/F: 239/535). Knowledge about the overall sources of VD was highest in OB participants in correctly identifying sunlight (95.1%; p < 0.001) while significantly more OW participants answered food (83.1%; p = 0.04) and fortified food (66.5%; p = 0.02). However, 18.9% of OB participants also wrongly identified air as a VD source and this was significantly higher than in other groups (p = 0.03). OW participants were 50% less likely to identify salmon and fish oil (odds ratio, OR 0.5 (95% Confidence interval, CI 0.4-0.7); p < 0.01) and 40% more likely to identify chicken (OR 1.4 (1.0-1.9); p < 0.05) as dietary sources of VD than controls. On the other hand, OB participants were almost three times more likely to know that sunlight exposure is the main source of VD than controls (OR 2.65 (1.2-6.0); p < 0.05). In conclusion, while VD knowledge overall was apparently high in Saudi adults regardless of BMI status, the quality of knowledge among OB and OW individuals appear inconsistent, particularly in terms of identifying the right VD sources. Public health awareness campaigns should include the correction of VD misconceptions so that high-risk populations are able to make well-informed decisions in achieving optimal VD levels.

Evaluation of Knowledge, Attitudes, and Practices Related to Osteoporosis and Correlates of Perceived High Risk among People Living in Two Main Districts of Lebanon

BACKGROUND

The prevalence of osteoporosis is increasing in Lebanon.

AIM

We evaluated the knowledge, attitudes, and practices related to osteoporosis and correlates of its perceived high risk among people living in Beirut and Mount Lebanon districts of Lebanon.

METHODS

This study is a cross-sectional study which consisted of 376 participants that were selected from the two districts within two or three households after two geographical areas were randomly selected from each stratum classified by education and altitude. They were then asked to fill a KAP survey on osteoporosis and provide information on factors likely related to its perceived high risk.

RESULTS

The majority of participants had a low (20.2%) and moderate (65.4%) knowledge of osteoporosis, with a higher knowledge in females than in males. A higher percentage of young people perceived it as a serious health risk than that of older people. In contrast, 85.9% participants reported drinking caffeinated beverages and 51.6% participants reported that they do not exercise. Glucose intolerance due to epigenetic and genetic factors, female sex, and older age were risk factors of a perceived high risk of osteoporosis, while any physical exercise, abstention from caffeine for 48 to 72 hours, and higher education were protective factors.

CONCLUSION

A nationwide KAP study should be conducted; likewise, awareness campaigns should be adopted.

Knowledge and Practice of Infants Exposure to Sunlight Among Lactating Mothers Attending at Yirgalem Hospital, Sidama Regional State

Background:

Exposure to sunlight is vital for the synthesis of vitamin-D and vitamin D plays an important role in growth and bones strength. Therefore, this study aimed to assess the knowledge and practice of infants exposure to sunlight among lactating women.

Methods:

A cross-sectional study was conducted from May 01 to 30, 2019 among 327 infant coupled lactating mothers attended at Yirgalem General Hospital. An interviewer-administered questionnaire was used to collect relevant data through a convenient sampling technique.

Results:

A total of 84.7% of respondents exposed infants to sunlight. More than 94% knew the benefit of exposing infants to sunlight. About 20.9%, 25.6%, and 19.9% of mothers exposed infants to sunlight within 15, 16 to 30, and 31 to 45 days of birth, respectively. In addition, 59.9% of respondents exposed infants to sunshine daily and 72.2% exposed without clothing the infants’ body. Moreover, 63.5% of mothers have applied lubricants and overall 54.5% of mothers exposed infants to sunlight in good practice. Unemployed women were 4.7 times more likely (aOR; 95%CI: 4.7; 2.0-11.4) to expose infants to sunlight when compared to those employed, while women whose husbands have at least secondary education level were 5.1 times more likely (aOR; 95%CI: 5.1; 1.6-16.1) to expose infants to sunlight when compared to those unable to read and write.

Conclusion:

More than 45% and more than one-third of lactating mothers had poor practice and exposed infants to sunlight for inadequate time, respectively. Therefore, the finding indicates a need for awareness creation to increase women’s knowledge and practice toward the exposure of infants to sunlight.

Knowledge of Vitamin D among First-year Medical Undergraduate Students of a Medical College: A Descriptive Cross-sectional Study

Introduction:

Vitamin D also known as the sunshine vitamin, helps in bone metabolism and calcium homeostasis. It is estimated that one billion people in the world have vitamin D deficiency making it a public health problem. The objective of this study is to find out the knowledge regarding vitamin D among first-year medical undergraduate students of a medical college.

Methods:

This is a descriptive cross-sectional study carried out from 2nd February 2020 to 15th February 2020 at Kathmandu Medical College Teaching Hospital, Duwakot among medical undergraduate students of a medical college. Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College Teaching Hospital (Reference Number: 2812201809). A structured self-designed multiple-choice questionnaire on vitamin D knowledge was used. Convenient sampling method was applied and statistical analysis was done with Statistical Package for the Social Sciences 20 version.

Results:

Out of total 157 undergraduate medical students, 21 (13.3%) exhibited good knowledge, 116 (73.9.8%) had average, and 20 (12.8%) had poor knowledge. There were 83 (52.9%) Bachelor of Medicine and Bachelor of Surgery students, 39 (24.8%) were Bachelor of Dental Surgery and 35 (22.3%) were Nursing students.

Conclusions:

We found a satisfactory level of knowledge of vitamin D among first-year undergraduate medical students of a medical college when compared to similar studies. The majority of students from all three disciplines had average knowledge of vitamin D.

Assessment of knowledge, attitudes and practice towards Vitamin D among university students in Pakistan

Background

Pakistan has one of the highest reported incidence of vitamin D deficiency in studies conducted worldwide. However, there has been very limited exploration of vitamin D related knowledge, attitudes and practices among healthy youth in Pakistan.

Methods

A cross-sectional survey was conducted among youth (aged > 16 years) from two engineering universities in Pakistan. Participants were asked questions on their concern about vitamin D levels, testing, and supplementation practices. Knowledge was examined using questions about food sources, health benefits and factors affecting vitamin D production within the human body. Of the 900 eligible students invited to participate, 505 (56%) completed the questionnaire and were included in the analysis.

Results

Only 9% participants were able to identify the correct food sources of vitamin D, 33% were aware of the bone health benefits (bone health and calcium absorption) of vitamin D and 36% identified sunlight exposure as a factor influencing vitamin D production. Knowledge about food sources and health benefits of vitamin D was not associated with gender and individuals concern about their levels. Those tested and taking supplements were more likely to identify bone related health benefits and factors affecting vitamin D production. Forty percent male and 52% female students expressed concern that their vitamin D levels were too low. However, 72% participants reported that they had never been tested for vitamin D levels. Use of supplements was significantly higher among female students (F = 52% vs M = 37%; P = 0.003). Those who had been tested for vitamin D deficiency were more likely to take supplements.

Conclusion

Despite being identified as a high-risk population, knowledge about vitamin D was limited among university students. Interventions are needed to increase awareness about the importance of vitamin D for health, including the need for exposure to sunlight and adequate dietary intake of vitamin D. Our study provides much needed baseline evidence for making health-policy recommendations for this vulnerable population group.

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

Background

During the last decade, vitamin D status was a major concern in the health and biomedical fields. This study assessed the level of awareness and knowledge regarding vitamin D and investigated the factors associated with the level of awareness such as knowing general facts about vitamin D, sources, benefit, and consequences of its deficiency.

Methods

This cross-sectional study was conducted among the general population in Jeddah, Saudi Arabia, above the age of 18 years who were in 3 malls during the period of August and September 2017. A self-administrated questionnaire in paper forms was utilized and was divided into two parts to collect data. It was designed by the authors after revising the previous studies and validated by three pediatric consultants. An ethical approval was obtained from the ethical committee in King Abdulaziz University. We did an initial sample and tested it with the Cronbach test. The questionnaire had 2 parts with 19 questions. The first part was demographic information, and the second part was general information about vitamin D. An ethical approval was obtained from the ethical committee in King Abdulaziz University. Each participant received explanations about the aim of the study, and a verbal consent was taken from participants. The scoring system was as follows: for each right answer, 1 score was given and for wrong answer, 0 score was given, and the overall score was 14. The collected data were statistically analyzed using descriptive statistics using IBM SPSS statistics for windows version 20.0 (SPSS Inc., Chicago, IL).

Result

Out of 1022 participants, 472 (46.1%) were aged 18–28 years, 830 (82.1%) were of Saudi ethnicity, 702 (68.7%) had a university degree, 275 (26.9%) attended high school, more than half were married (55.6%), and 54.4% had children. The majority of the participants agreed that vitamin D is important in the maintenance of bone and tooth health (88.4%). It is important in the maintenance of calcium and phosphates (76.6%), and it strengthens immunity (69.4%). Of the total participants, 86.2% were aware that sunlight exposure encourages vitamin D production in the skin. The overall knowledge mean score was 5.9 ± 1.2 (39.3%).

Conclusion

This study highlighted a high level of inadequate knowledge of vitamin D deficiency among participants. There was a significant association between knowledge level and education level. The awareness of vitamin D deficiency is high regarding its benefits. The study revealed that participants who did not have children had the highest score for benefits. Nongovernment organizations and social workers may work together with government health-care organization to teach parents and children about the uses and benefits of vitamin D.

The Relationship Between Vitamin D Deficiency and Insulin Resistance in Pregnant Women with Gestational Diabetes

BACKGROUND

Diabetes Mellitus is one of the most common medical disorders in pregnancy. The possibility of vitamin D deficiency as a pathogenesis for impaired glucose tolerance tests show a probable role of vitamin D in insulin secretion and reduction of insulin resistance. This study was assigned to evaluate relation between serum vitamin D level and insulin resistance in Gestational Diabetes Mellitus (GDM).

METHODS

This cross sectional study was done throughout one year between 2015-2016 in GDM patients (age, 20-40 years). After history taking and physical examination, the laboratory tests including : Fasting Blood Sugar (FBS), Glucose Tolerance Test (GTT), calcium, phosphorous, parathormone, 25(OH) vitamin D, insulin, HbA1C, TG, LDL, HDL were performed for all patients. Insulin resistance was calculated according to HOMA-IR formula. Vitamin D level was compared between patients with and without insulin resistance.

RESULTS

This research was performed in 93 GDM patients with average age (30.3 ± 5.6). Thirty eight patients with insulin resistance and 55 patients without insulin resistance were detected. The prevalence of vitamin D deficiency was 91.4% in all patients. There was no significant difference in vitamin D levels between insulin resistant and non insulin resistant group (P-value=0.51). In all variable parameters, only FBS and triglyceride level in insulin resistant group were more than non insulin resistant group (P-value<0.05).

CONCLUSION

Obtained results showed not significant relationship between vitamin D deficiency and insulin resistance in GDM patients.

Histochemical examination of the effects of high-dose 1,25(OH)2D3 on bone remodeling in young growing rats

Vitamin D has an anabolic effect on bone developmental processes and is involved in maintaining skeletal integrity. In recent years, pediatric cases of vitamin D intoxication have attracted attention. Therefore, the aim of this study was to investigate the influence of long-term administration of physiologically-high-dose calcitriol (1,25(OH)2D3) on bone remodeling in young developing rats. Neonatal rats received once-daily subcutaneous injection of calcitriol (250 ng/kg body weight), or PBS only as a control, for 3 weeks. At 1, 2 and 4 weeks' post-administration, rats were sacrificed and fixed by transcardial perfusion with 4 % paraformaldehyde, following which tibiae were extracted for histochemical analysis. Compared with the control group, the number of tartrate-resistant acid phosphatase- and Cathepsin K-positive osteoclasts were significantly increased, and the expression of alkaline phosphatase in osteoblasts was decreased in trabecular bone of rats administered high-dose 1,25(OH)2D3, leading to decreased trabecular bone volume. In addition, the expression of receptor activator of nuclear factor kappa-B ligand (RANKL) was increased, while that of osteoprotegerin was weaker in osteoblasts in the experimental group compared with the control group. Moreover, there was weaker immunoreactivity for EphrinB2 in osteoclasts and EphB4 in osteoblasts of trabecular bone in the experimental group compared with the control group. These findings suggest that long-term use of physiologically-high dose calcitriol may result in bone loss through RANKL/RANK/osteoprotegerin and EphrinB2-EphB4 signaling pathways, and that these negative effects could continue after drug withdrawal. Therefore, optimal limits for vitamin D administration need to be established for children and adolescents.