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Mirza AA, Rathi H, Dakshinamurthy S, Goyal B, Saha S, Saxena V, Kalyani V, Kumar R, Naithani M. Assessment of Vitamin D Levels and Other Bone Related Biochemical Markers in Healthy Adults in Rural Population of Uttarakhand, India. Indian J Clin Biochem 2023; 38:316-323. [PMID: 37234188 PMCID: PMC10205961 DOI: 10.1007/s12291-022-01048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
Abstract
Despite being close to equator and receiving sufficient sun rays, evidences revealed that Indians have severe deficiency of vitamin D (vit D) ranging from 41 to 100% in different geographical locations. Therefore, in this study levels of 25(OH)D (physiologically measurable form) along with other bone metabolism associated biochemical markers were determined in serum sample of 300 apparently healthy study subjects (rural) from Doiwala block of Dehradun district in the state of Uttarakhand. Demographic data was also obtained based on a structured questionnaire to establish an association between 25(OH)D levels and various dietary and socio-cultural factors. Results demonstrated that of all study subjects, 197 (65%) had 25(OH)D levels below < 12 ng/mL (deficient) and 65 (21%) had 25(OH)D levels between 12 and 20 ng/mL (insufficient) with all other markers falling within respectively established reference ranges. Further, in univariate analysis, gender, occupation (indoor and outdoor), education were independently associated with vitamin D status. Additionally, parathyroid hormone associated significantly with gender and occupation, while calcium associated significantly with gender, occupation and education. Lastly, regression analysis revealed that gender and occupation independently associated with vitamin D status of subjects. In conclusion, apparently healthy subjects showed considerable vitamin D deficiency thereby generating an urgent need for formulating and implementing better government policies for enrichment of vitamin D levels among rural adults of Uttarakhand in future. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-022-01048-6.
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Affiliation(s)
- Anissa Atif Mirza
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249201 India
| | - Himani Rathi
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249201 India
| | | | - Bela Goyal
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249201 India
| | - Sarama Saha
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249201 India
| | - Vartika Saxena
- Department of Community Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Vasantha Kalyani
- Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Raman Kumar
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249201 India
| | - Manisha Naithani
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249201 India
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Jalili C, Kazemi M, Taheri E, Mohammadi H, Boozari B, Hadi A, Moradi S. Exposure to heavy metals and the risk of osteopenia or osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2020; 31:1671-1682. [PMID: 32361950 DOI: 10.1007/s00198-020-05429-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 01/21/2023]
Abstract
The relationship between heavy metal exposure and risk of osteopenia or osteoporosis has biological plausibility, yet it remains inconclusive; therefore, we conducted a systematic review and meta-analysis to evaluate the associations between exposure to heavy metals (i.e., cadmium, lead, and mercury) and the risk of osteopenia or osteoporosis. Databases of MEDLINE, Embase, Scopus, and Web of Science were searched through November 2019, to identify studies that evaluated the relationship between exposure to cadmium, lead, and mercury and risk of osteopenia or osteoporosis in adults. Fourteen eligible studies were included. Effect sizes expressed as pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using weighted random-effect models. Exposure to cadmium (OR = 1.35; 95% CI: 1.17 to 1.56; P ≤ 0.001) and lead (OR = 1.15; 95% CI: 1.00 to 1.32; P = 0.05) was associated with an increased risk of osteopenia or osteoporosis, unlike mercury. Subgroup analyses showed cadmium exposure increased the risk of osteopenia or osteoporosis in older (> 65 yrs.; OR = 1.43; 95%CI: 1.08 to 1.88, P = 0.01) compared with younger (18-65 yrs.; OR = 1.24; 95% CI: 1.02 to 1.52, P = 0.03) adults. Also, lead exposure increased the risk in men (OR = 1.55; 95% CI: 1.15 to 2.09, P = 0.007) unlike in women. By contrast to urinary levels, blood (OR = 1.26; 95% CI: 1.08 to 1.47, P = 0.003) and dietary (OR = 1.46; 95% CI: 1.28 to 1.67, P < 0.001) levels of cadmium were associated with an increased risk of osteopenia or osteoporosis. Exposure to cadmium and lead may be associated with an increased risk of osteopenia or osteoporosis, although high heterogeneity was detected.
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Affiliation(s)
- C Jalili
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - M Kazemi
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, Ithaca, NY, USA
| | - E Taheri
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - B Boozari
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Hadi
- Halal Research Center of IRI, FDA, Tehran, Iran
| | - S Moradi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Lavado-García JM, Puerto-Parejo LM, Roncero-Martín R, Moran JM, Pedrera-Zamorano JD, Aliaga IJ, Leal-Hernández O, Canal-Macias ML. Dietary Intake of Cadmium, Lead and Mercury and Its Association with Bone Health in Healthy Premenopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121437. [PMID: 29168740 PMCID: PMC5750856 DOI: 10.3390/ijerph14121437] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 01/23/2023]
Abstract
The bone is one of the relevant target organs of heavy metals, and heavy metal toxicity is associated with several degenerative processes, such osteoporosis and bone mineral alterations, that could lead to fractures. We aimed to study a presumed relationship between bone density, evaluated by quantitative bone ultrasound (QUS), dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) and the dietary intake of cadmium, lead and mercury in healthy premenopausal women. A total of 158 healthy, non-smoking, premenopausal women were incorporated into the study. A validated food frequency questionnaire (FFQ) was administered to assess intake during the preceding seven days. The median predicted dietary cadmium intake among the 158 women studied was 25.29 μg/day (18.62–35.00) and 2.74 μg/kg body weight/week (b.w./w) (1.92–3.83). Dietary lead intake was 43.85 μg/day (35.09–51.45) and 4.82 μg/kg b.w./w (3.67–6.13). The observed dietary mercury intake was 9.55 μg/day (7.18–13.57) and 1.02 μg/kg b.w./w (0.71–1.48). Comparisons, in terms of heavy metal intake, showed no significant results after further adjusting for energy intake. No statistically significant correlations between heavy metal intake and the QUS, DXA and pQCT parameters were observed. Levels of dietary exposure of cadmium, lead and mercury were mostly within the recommendations. We did not find associations between the QUS, DXA and pQCT parameters and the dietary intake of the studied heavy metals in healthy premenopausal women.
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Affiliation(s)
- Jesus M Lavado-García
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
| | - Luis M Puerto-Parejo
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
| | - Raul Roncero-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
| | - Jose M Moran
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
| | - Juan D Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
| | - Ignacio J Aliaga
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
| | - Olga Leal-Hernández
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
| | - Maria L Canal-Macias
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain.
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Puerto-Parejo LM, Aliaga I, Canal-Macias ML, Leal-Hernandez O, Roncero-Martín R, Rico-Martín S, Moran JM. Evaluation of the Dietary Intake of Cadmium, Lead and Mercury and Its Relationship with Bone Health among Postmenopausal Women in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E564. [PMID: 28587146 PMCID: PMC5486250 DOI: 10.3390/ijerph14060564] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/18/2017] [Accepted: 05/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heavy metals, such as lead, cadmium, and mercury, are absorbed through contaminated food sources and water. Few studies have investigated the extent to which dietary heavy metals are associated with low bone mineral density. AIMS We aimed to characterize the dietary intake of the heavy metals lead, cadmium and mercury among healthy, non-smoking postmenopausal women in Spain. Furthermore, we sought to establish a putative relationship between bone health and the intake of these heavy metals in this population. STUDY DESIGN The daily intake of the heavy metals considered for the different food groups was calculated by accounting for food content and consumption in 281 postmenopausal women. Bone measurements were performed using a Quantitative Bone Ultrasound (QUS), a Dual-Energy X-ray Absorptiometry (DXA) and a Peripheral Quantitative Computed Tomography (pQCT). RESULTS The average estimated dietary cadmium exposure among the 281 women studied was 29.87 μg/day (20.41-41.04) and 3.03 μg/kg body weight (b.w.; 2.17-4.40). Dietary lead exposure was 46.24 μg/day (38.11-54.77) and 4.87 μg/kg b.w. (4.00-6.14). The estimated dietary mercury exposure was 11.64 μg/day and 1.19 μg/kg b.w. (0.82-1.76). Participants were classified according to their heavy metal intake (above or below the respective medians). After further adjustment for potential confounding factors, no significant differences were found in all the measured parameters (p > 0.05). CONCLUSIONS We did not find associations between bone health and the dietary intake of three heavy metals in postmenopausal women. Dietary intake of the measured heavy metals were within the recommended values.
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Affiliation(s)
- Luis M Puerto-Parejo
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Caceres, Spain.
| | - Ignacio Aliaga
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Caceres, Spain.
| | - María L Canal-Macias
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Caceres, Spain.
| | - Olga Leal-Hernandez
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Caceres, Spain.
| | - Raul Roncero-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Caceres, Spain.
| | - Sergio Rico-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Caceres, Spain.
| | - Jose M Moran
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Caceres, Spain.
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Guarnotta V, Riela S, Massaro M, Bonventre S, Inviati A, Ciresi A, Pizzolanti G, Benvenga S, Giordano C. The Daily Consumption of Cola Can Determine Hypocalcemia: A Case Report of Postsurgical Hypoparathyroidism-Related Hypocalcemia Refractory to Supplemental Therapy with High Doses of Oral Calcium. Front Endocrinol (Lausanne) 2017; 8:7. [PMID: 28184212 PMCID: PMC5266683 DOI: 10.3389/fendo.2017.00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 11/13/2022] Open
Abstract
The consumption of soft drinks is a crucial factor in determining persistent hypocalcemia. The aim of the study is to evaluate the biochemical mechanisms inducing hypocalcemia in a female patient with usual high consumption of cola drink and persistent hypocalcemia, who failed to respond to high doses of calcium and calcitriol supplementation. At baseline and after pentagastrin injection, gastric secretion (Gs) and duodenal secretion (Ds) samples were collected and calcium and total phosphorus (Ptot) concentrations were evaluated. At the same time, blood calcium, Ptot, sodium, potassium, chloride, magnesium concentrations, and vitamin D were sampled. After intake of cola (1 L) over 180 min, Gs and Ds and blood were collected and characterized in order to analyze the amount of calcium and Ptot or sodium, potassium, magnesium, and chloride ions, respectively. A strong pH decrease was observed after cola intake with an increase in phosphorus concentration. Consequently, a decrease in calcium concentration in Gs and Ds was observed. A decrease in calcium concentration was also observed in blood. In conclusion, we confirm that in patients with postsurgical hypoparathyroidism, the intake of large amounts of cola containing high amounts of phosphoric acid reduces calcium absorption efficiency despite the high doses of calcium therapy.
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Affiliation(s)
- Valentina Guarnotta
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), Section of Endocrine-Metabolic Diseases, University of Palermo, Palermo, Italy
| | - Serena Riela
- Department of Science and Technologies Biological Chemical and Pharmaceutical (STEBICEF), Section of Chemistry, University of Palermo, Palermo, Italy
| | - Marina Massaro
- Department of Science and Technologies Biological Chemical and Pharmaceutical (STEBICEF), Section of Chemistry, University of Palermo, Palermo, Italy
| | - Sebastiano Bonventre
- Department of General, Emergency and Transplant Surgery, Unit of General and Emergency Surgery, P. Giaccone Policlinico, Palermo, Italy
| | - Angela Inviati
- Department of General, Emergency and Transplant Surgery, Unit of General and Emergency Surgery, P. Giaccone Policlinico, Palermo, Italy
| | - Alessandro Ciresi
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), Section of Endocrine-Metabolic Diseases, University of Palermo, Palermo, Italy
| | - Giuseppe Pizzolanti
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), Section of Endocrine-Metabolic Diseases, University of Palermo, Palermo, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, Endocrinology, University of Messina, Messina, Italy
| | - Carla Giordano
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), Section of Endocrine-Metabolic Diseases, University of Palermo, Palermo, Italy
- *Correspondence: Carla Giordano,
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Vera V, Moran JM, Barros P, Canal-Macias ML, Guerrero-Bonmatty R, Costa-Fernandez C, Lavado-Garcia JM, Roncero-Martin R, Pedrera-Zamorano JD. Greater Calcium Intake is Associated with Better Bone Health Measured by Quantitative Ultrasound of the Phalanges in Pediatric Patients Treated with Anticonvulsant Drugs. Nutrients 2015; 7:9908-17. [PMID: 26633479 PMCID: PMC4690069 DOI: 10.3390/nu7125517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate and compare the effects of chronic antiepileptic therapy on bone health in pediatric patients using quantitative ultrasound of the phalanges (QUS) and controlling for potential confounding factors, particularly nutrient intake. The amplitude-dependent speed of sound (Ad-SoS) was measured in 33 epileptic children and 32 healthy children aged 6.5 ± 3.1 and 6.3 ± 1.1 (mean ± SD) years, respectively. There were no significant differences in the demographics such as age, weight and height between epileptic children and the control group children. None of the children in the epileptic or the treatment group were found to have a vitamin D deficiency. There were no significant differences in laboratory tests between groups. Lower QUS figures were found in the epileptic children (p = 0.001). After further adjustment for potential confounders such age, height, weight, calcium intake, vitamin D intake, physical activity and sex, the differences remained significant (p < 0.001). After further classification of the participants based on the tertile of calcium intake, no significant differences were found between patients and healthy controls in the greatest tertile of calcium intake (p = 0.217). We conclude that anticonvulsant therapy using valproate may lead to low bone mass in children and that an adequate intake of calcium might counteract such deleterious effects.
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Affiliation(s)
- Vicente Vera
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Jose M Moran
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Patricia Barros
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Maria L Canal-Macias
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Rafael Guerrero-Bonmatty
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Carmen Costa-Fernandez
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Jesus M Lavado-Garcia
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Raul Roncero-Martin
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
| | - Juan D Pedrera-Zamorano
- Metabolic Bone Disease Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Cáceres 10003, Spain.
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Moran JM, Pedrera-Canal M, Rodriguez-Velasco FJ, Vera V, Lavado-Garcia JM, Fernandez P, Pedrera-Zamorano JD. Lack of association of vitamin D receptor BsmI gene polymorphism with bone mineral density in Spanish postmenopausal women. PeerJ 2015; 3:e953. [PMID: 26157644 PMCID: PMC4493697 DOI: 10.7717/peerj.953] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/22/2015] [Indexed: 12/03/2022] Open
Abstract
Osteoporosis is a polygenic disorder that is determined by the effects of several genes, each with relatively modest effects on bone mass. The aim of this study was to determine whether the vitamin D receptor single nucleotide polymorphism BsmI is associated with bone mineral density (BMD) in Spanish postmenopausal women. A total of 210 unrelated healthy postmenopausal women aged 60 ± 8 years were genotyped using TaqMan® SNP Genotyping Assays. Lumbar and femoral BMD were determined by dual-energy X-ray absorptiometry (DEXA). Daily calcium and vitamin D intake were determined by a food questionnaire. No differences were found in the femoral neck, trochanter, Ward’s Triangle, L2, L3, L4, L2-L4, or between the femoral neck and total hip BMD after further adjustment for potential confounding factors (P > 0.05) (age, BMI, years since menopause and daily calcium intake). The BsmI polymorphism in the VDR gene was not associated with BMD in Spanish postmenopausal women.
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Affiliation(s)
- Jose M Moran
- Metabolic Bone Diseases Research Group, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain
| | - Maria Pedrera-Canal
- Metabolic Bone Diseases Research Group, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain
| | - Francisco J Rodriguez-Velasco
- Metabolic Bone Diseases Research Group, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain
| | - Vicente Vera
- Metabolic Bone Diseases Research Group, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain
| | - Jesus M Lavado-Garcia
- Metabolic Bone Diseases Research Group, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain
| | - Pilar Fernandez
- Metabolic Bone Diseases Research Group, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain
| | - Juan D Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, Spain
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Determinants of vitamin D deficiency among undergraduate medical students in Saudi Arabia. Eur J Clin Nutr 2015; 69:1151-5. [PMID: 25690868 DOI: 10.1038/ejcn.2014.286] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND/OBJECTIVES The objectives of our study were to determine possible factors associated with low vitamin D levels in medical students. SUBJECTS/METHODS A cross-sectional study was performed among 255 first- to fifth-year male undergraduate medical students of one of the major universities in Saudi Arabia. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using electrochemiluminiscence. Multiple logistic regression analysis was performed. RESULTS Majority of Saudi medical students (75.2%) had 25(OH)D levels <30 nmol/l, defined as risk for deficiency by the Institute of Medicine. Multivariate analysis showed that the odds of having 25(OH)D serum levels of ⩾ 30 nmol/l were seven times higher both in students who took vitamin D (odds ratio (OR)=7.2, 95% confidence interval (CI)=1.8-29.9, P=0.006) or multivitamin supplements (OR=6.9, 95% CI=1.7-27.3, P=0.006) within 1 year. Students with a history of vitamin D testing >1 year before the study or moderate/vigorous physical activity (PA) had 4.4 (OR=4.4, 95% CI=1.7-11.4, P=0.003) and 2.7-fold (OR=2.7, 95% CI=1.3-5.3, P=0.006) higher odds of having 25(OH)D levels ⩾ 30 nmol/l, respectively. There was no significant association between 25(OH)D serum levels and average time spent outdoors per day (P=0.369) and type of clothing (long-sleeved vs short-sleeved; P=0.800). CONCLUSIONS Vitamin D deficiency was highly prevalent in Saudi medical students. Modifiable factors such as vitamin D intake and PA could be targeted for intervention. Further studies with standardized laboratory measurements of 25(OH)D are needed to explore the role of vitamin D testing in behavioral change, which may lead to increased serum 25(OH)D levels.
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