Vitamin D levels in healthy men in eastern Saudi Arabia

Relationship of Vitamin-D Deficiency with Kidney Disease in Patients with Type-2 Diabetes Mellitus (T2DM) in the Makkah Region: A Cross-Sectional Study

Aim

Vitamin D deficiency is linked with type 2 diabetes mellitus (T2DM) and the occurrence of complications in patients with type 2 diabetes mellitus. None of the studies have focused on the association between vitamin D levels in patients with type 2 diabetes mellitus and diabetic nephropathy (DN) in the Makkah region, Saudi Arabia. Hence, the purpose of this study is to investigate the relationship of vitamin D with kidney disease in patients with T2DM in the Makkah region, of Saudi Arabia.

Materials and Methods

This descriptive cross-sectional study was conducted at different hospitals in the Makkah region on T2DM patients from 2021 to 2022. In total, 328 patients with confirmed diabetes were enrolled in this study. T2DM patients over the aged>18 to 92 years were included in the study. General laboratory characteristics of the study population were measured, including fasting blood sugar, HbA1C (Glycated hemoglobin), vitamin D, kidney function (BUN-Blood urea nitrogen and creatinine), and lipid profiles (cholesterol, triglycerides, LDL-Low density lipoprotein, and HDL-High density lipoprotein).

Results

46.6% (n=153) of participants had normal serum vitamin D levels. Insufficient and deficient serum vitamin D level were observed in 43.9% (n=144) and 9.5% (n=31) of participants, respectively. Of the participants, 25.9% (n=85) had good glycemic control (<7.0%). Moderate and poor glycemic control were observed in 39.9% (n=131) and 34.1% (n=112) of the participants, respectively. A significant negative correlation (p<0.5) was found between vitamin D levels and kidney function test results (blood urea nitrogen and serum creatinine levels). An inverse relationship was observed between HbA1c levels and vitamin D deficiency.

Conclusion

Nephropathy is more likely to develop in people with type 2 diabetes mellitus and vitamin D deficiency.

Osteoporosis: Is the prevalence increasing in Saudi Arabia

Background and Objective:

The objective of this analysis is to report from a teaching hospital in eastern Saudi Arabia hospital based prevalence of osteopenia and osteoporosis.

Methods:

This is a retrospective study of all patients who underwent dual-energy X-ray absorptiometry (DXA) scan between January 1, and December 31, 2018, at King Fahd Hospital of the University at Alkhobar, Saudi Arabia. Demographic data of patients, which included age, sex, diabetes mellitus status based on fasting blood sugar, hemoglobin A1C, Vitamin D level, parathormone level, and T score of the neck of femur and lumbar spine was extracted from the Quadrumed patient care system. The data was entered into database and analyzed.

Results:

Three hundred and one patients had a DXA scan for the year 2018, a jump of 27.2% of requests to diagnose osteoporosis. There were 55 (18.27%) were male and rest females (246). The average age for males was 65.2 ± 10.5 and females 62.9 ± 9.4 years. Using T score of the lumbar spine, 63.6% were osteoporotic in males and 52.8% in females.

Conclusions:

The hospital-based study shows that the prevalence of osteoporosis has significantly increased in men to 63.6%, while in postmenopausal women to 58.4%, this is high compared to the earlier reports.

Decreasing prevalence of vitamin D deficiency in the central region of Saudi Arabia (2008-2017)

OBJECTIVE

Widespread vitamin D deficiency (serum 25-hydroxyvitamin D < 50 nmol/L) in Saudi Arabia (SA) has been documented, yet a time trend is needed to establish where the prevalence is headed. This study aims to fill this gap.

STUDY DESIGN AND SETTING

This cross-sectional series (N = 7360) were conducted in the central region of SA from 2008 to 2017. Participants of all ages were taken from multiple cohorts that included the Biomarker Screening in Riyadh (2008-2010; N = 1460), the Osteoporosis Registry (2014-2017; N = 1225), Gestational Diabetes Mellitus cohort (2014-2017, N = 281), Vitamin D School Project (2011-2017; N = 3039) and Prediabetes cohort (2012-2017; N = 1355) master databases.

RESULTS

Vitamin D deficiency in SA has a 10-year prevalence of 73.2 %. Between 2008-2017, the prevalence of vitamin D deficiency decreased from 87.1% to 64.7% for participants aged 18-40 years (p-trend<0.001), and from 86.2% to 45.7% in participants aged > 40 years (p-trend<0.001). During this period, vitamin D deficiency in females decreased from 80.1% to 69.6% (p-trend<0.001), whereas in males, it decreased from 93.2% to 49.3% (p-trend<0.001). Serum 25(OH)D was observed to have an overall increase of 2.2 ± 0.1 nmol/l (p < 0.001) along with the seasonally adjusted annual increase of 1.3 ± 0.2 nmol/l from 2008 to 2017 (p < 0.001).

CONCLUSION

The decreasing trend in vitamin D deficiency in SA across all demographics suggests successful public health campaigns over time. It will be interesting to investigate further whether the general improvement in the vitamin D status at the community level also translated in lesser incidences of vitamin d-related diseases over time.

Association of two types of dietary pattern scores with cardiovascular disease risk factors and serum 25 hydroxy vitamin D levels in Saudi Arabia

Background

Cardiovascular disease (CVD) is a main cause of mortality and disability worldwide. One of the key factors in the soaring prevalence of CVD globally has been nutrition transitions and changes in dietary patterns.

Objective

This study investigated the association between two diet scores, namely, a high-fat dietary (HFD) pattern score and a Mediterranean diet (MedDiet) score, and CVD risk factors (obesity, hypertension, total cholesterol, and blood glucose) and serum 25 hydroxy vitamin D (25[OH]D) levels.

Methods

Three hundred twenty-one participants were included in this study. Fasting blood tests were collected from all participants for biochemical measurements. Blood pressure and anthropometric measurements were also taken. A validated, semi-quantitative food frequency questionnaire was used to collect data on participants’ dietary intake. Dietary scores for the HFD pattern were calculated based on recommended food groups. MedDiet scores were calculated based on a previously validated method that contains 14 questions related to MedDiet. Both diet scores were classified into tertiles. Linear regression analyses were performed to assess the statistical significance of the tertile groups.

Result

A significant association was found between HFD score and obesity when comparing the lowest tertile (27.3±4.6 kg/m²) of HFD scores with the medium tertile (29.2±5.7 kg/m2; P = 0.02). A higher HFD score was significantly associated with lower 25(OH)D levels (P = 0.02). In addition, a significant association was observed between MedDiet scores and 25(OH)D levels, with an increase in MedDiet score resulting in an increase in 25(OH)D levels (P = 0.01). Furthermore, a significant negative association between MedDiet scores and low-density lipoprotein levels was reported only in participants with CVD (P = 0.03).

Conclusion

The results of this study revealed that HFD and MedDiet scores might have a role in the development of CVD and vitamin D deficiency among the Saudi Arabian population. Further studies are required using diet scores to assess the quality of dietary patterns and their association with an increased risk of diseases in Saudi Arabians.

Vitamin D status and CYP27B1-1260 promoter polymorphism in Tunisian patients with systemic lupus erythematosus

Aim

An association between serum vitamin D (Vit D) levels and systemic lupus erythematosus (SLE) has been reported by several studies that suggested the involvement of genetically determined characteristics of enzymes of vitamin D metabolism. Our study aimed to evaluate the relationship between 25 hydroxyvitamin D (25[OH]D) level, the most representative metabolite of VitD status, and polymorphism of the cytochrome P450, CYP27B1 gene, which influence vitamin D metabolism, and serum levels, in SLE Tunisian patients.

Material and Methods

A cross‐sectional study has been conducted in SLE patients (supplemented and not supplemented patients), matched to healthy controls by age and gender. The 25[OH]D serum level was measured by chemiluminescence assay and CYP27B1‐1260 genetic polymorphism was carried out using PCR‐RFLP methods. Statistical analysis was made using Shesis and SPSS.20 Software.

Results

Controls and Vit D not supplemented patients’ groups presented the highest percentage of hypovitaminosis D. A significant difference in the mean level of circulating 25[OH]D between Vit D supplemented SLE patients and controls was observed (23.91 ng/ml and 7.18 ng/ml, respectively p = 3.4 10⁵). Our results showed a correlation of high 25[OH]D level with complement component 3 levels and prednisolone drug. Moreover, the analysis of CYP27B1‐1260 polymorphism in SLE patients and controls revealed a nonsignificant allelic or genotypic association.

Conclusion

Despite the sunny climate, the high prevalence of Vit D deficiency is common in Tunisia. This hypovitaminosis D feature may affect the Vit D levels in our SLE patients but a direct association with the disease or with the genetically determined features remains unclear. More studies are needed to establish thresholds and susceptibility genes according to the characteristics of each population.

Seasonal variations in serum levels of vitamin D and other biochemical markers among KSA patients prior to thyroid surgery

Objectives

Serum levels of vitamin D can vary between seasons, which may affect serum calcium levels in post-thyroidectomy patients. This study aimed to determine seasonal variations in serum levels of vitamin D and other biochemical markers in patients prior to thyroid surgery in a KSA hospital.

Methods

In this study, we analysed the data of 685 post-thyroidectomy patients. The preoperative laboratory values of all patients were collected, and the patients were categorized into groups based on the month when the surgical procedure was performed as follows: cold (November–February) and warm/hot groups (March–October).

Results

Serum vitamin D levels were deficient in 70% of the patients, insufficient in 18%, and optimal in 12%. The mean age of patients in the deficient group was significantly lower than that in the optimal group. There were significantly more patients who had vitamin D deficiency during the cold season than during the warm/hot season (p = 0.024). Serum vitamin D levels did not vary between seasons (p = 0.836); however, the preoperative magnesium and thyroid stimulating hormone (TSH) levels were significantly higher during the warm/hot season than during the cold season (p = 0.039 and p < 0.001, respectively). Preoperative calcium level was not significantly different between the cold and warm/hot months (p = 0.282).

Conclusion

This study suggests a non-significant seasonal fluctuation in serum levels of vitamin D with insignificant variation in serum calcium levels during cold and warm/hot seasons. The findings necessitate a careful review of the patients’ biochemical status prior to surgery. Future prospective longitudinal studies are needed to confirm this variability.

The Association Between Serum 25-Hydroxyvitamin D Levels and Patients With Allergic Rhinitis

Introduction Many studies have suggested a link between vitamin D deficiency and the development of other atopic diseases like allergic rhinitis (AR). AR can lead to sleep disturbance, fatigue, depressed mood, and compromised cognitive function, which can impair the quality of life and productivity in many people. Objective We aimed to determine the association between vitamin D levels and AR and the effect of vitamin D on atopy markers. Methods All patients with AR who were diagnosed, treated, and followed up at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia from January 2012 to January 2020 were included in the study. Our exclusion criteria were as follows: pediatric patients, patients with insufficient follow-up data, patients with no atopy markers, patients with comorbid conditions affecting their serum vitamin D levels, and patients with a history of taking medications that affect serum vitamin D levels. Results Fifty-five adult patients with AR were included in the study. Patients with vitamin D deficiency were more likely to have uncontrolled AR. Regarding the effect of vitamin D deficiency on atopy markers, there was no statistically significant relationship between vitamin D deficiency and serum immunoglobulin E (IgE) levels. However, serum eosinophil levels were significantly higher in patients with vitamin D deficiency. Conclusion Our results showed that vitamin D deficiency is strongly associated with uncontrolled AR; there was a statistically significant relationship between vitamin D deficiency and eosinophil levels, but no significant relationship between vitamin D deficiency and serum IgE was found.

Vitamin D status and its correlates in Saudi male population

Background

Vitamin-D deficiency is a universal health problem caused primarily by inadequate exposure to sunlight. This study aimed to assess the vitamin D status and investigate the factors affecting vitamin D distribution among Saudi males.

Methods

A cross-sectional study was conducted at the King Saud University Medical City from December 2015 to August 2016. Saudi males attending the outpatient primary health care clinics were invited to participate in the study. Data were collected on the current and past health status along with biochemical investigations for total 25-hydroxyvitamin D (25OHD), blood sugar, and cholesterol.

Results

Majority of the participants (76.1%) had vitamin D deficiency. Blood sugar level, age, and cholesterol level were the most significant factors associated with vitamin D status. The highest percentage of deficiency was observed in the youngest age group (30-40 years). With increasing age, the percentage of deficiency decreased significantly. Those with normal blood sugar and cholesterol level had higher serum vitamin D levels compared to those with diabetes and hypercholesterolemia.

Conclusions

Vitamin D deficiency is still endemic in Saudi Arabia, particularly among younger males and those with diabetes and hypercholesterolemia. Vitamin D screening, supplementations, and vitamin D-fortified foods should be provided especially for these groups.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6527-5) contains supplementary material, which is available to authorized users.

Determinants of Vitamin D deficiency in asymptomatic healthy young medical students

Objective:

The study aimed to determine vitamin D status and frequency of its determinants related to diet, clothing, lifestyle and exposure to sunlight among young healthy medical students living in Karachi, Pakistan.

Methods:

This cross sectional study included responses gathered on questionnaire from medical students of Karachi Medical &Dental College from 4^th of August 2017 till 30^th April 2018. All the participants were healthy young adult’s year of age who gave written informed consent to participate in the study. Questions regarding demographics, sun exposure, diet, clothing, living patterns and any symptoms like pain or body aches were recorded. Serum 25 (OH) vitamin D3, calcium and phosphorus levels were measured through laboratory examination. For serum 25OHD, the cutoff values ≤ 20ng /ml, ≥ 21-29ng /ml, and ≥ 30ng/ml were defined as deficiency, insufficiency, and sufficiency respectively.

Results:

Total number of medical students enrolled in the study was 221.Among total participants 191 (86.43%) were females and 30 (13.57%) were males. Mean ± SD age was almost similar (23.00 ± 2.56 vs. 23.03 ± 2.05). Majority of the females 115 (60.2%) had BMI within normal range, and were predominantly single 164 (85.9%). Vitamin D deficiency was found in 197 (89.14%), insufficiency in 16 (7.24%), and only 8 (3.62%) had sufficient levels. Determinant factors reported by deficient group (n=197); fabric color (dark mix) 87.3%, fabric material (synthetic + mix) 48.7%, full length of sleeves by 45.7%, exposure to sun only on hands and face during outdoors was reported by 64.5%, milk up to 250 cc was consumed by 77.2%, one egg per day in diet was taken by 56.9% and intake of cod liver oil was less common in only 27.4%.

Conclusion:

Deficiency of vitamin D is common among healthy young adults particularly females which emphasize need to add vitamin D supplements in their routine diet.

Effect of Vitamin D and Calcium Supplementation in Patients with Systemic Lupus Erythematosus

Background:

Systemic lupus erythematosus is a chronic autoimmune disease that increases the risk of suboptimal vitamin D levels.

Aim:

To determine the effects of vitamin D and calcium supplementation on disease activity, related immune markers and bone mineral density in patients with systemic lupus erythematosus.

Subjects and Methods:

Eighty-one patients with systemic lupus erythematosus aged 20–70 years were recruited for this interventional study. Participants were enrolled into the following groups: no corticosteroid treatment (n = 21), corticosteroid treatment but without supplementation (n = 30) and corticosteroid treatment along with oral vitamin D and calcium supplementation (n = 30). Disease activity and laboratory parameters of all participants were measured at baseline and at 6 months. Bone mineral density was assessed using standardized dual-energy X-ray absorptiometry.

Results:

At baseline, none of the patients had a normal vitamin D status. There were no significant correlations between vitamin D status and the studied immune markers or disease activity values before and after supplementation. After 6 months, patients who received supplementation showed significant (P = 0.002) improvements in bone mineral density. In addition, frequency of osteopenia decreased from 40% to 16.7% and that of osteoporosis decreased from 26.7% to 13.3%.

Conclusion:

Vitamin D and calcium supplementation significantly improved the bone mineral density in vitamin D-deficient patients with systemic lupus erythematosus but did not significantly attenuate immune markers or disease activity. Further investigations are recommended with higher doses of vitamin D and longer durations to normalize the vitamin level and, possibly, achieve better disease control.

Topical vitamin D3: A randomized controlled trial (RCT)

OBJECTIVE

The intent of this study was to test the effect of Top-D, a topical Vitamin D preparation, in delivering vitamin D.

METHODS

Five hundred and fifty healthy patients, with vitamin D insufficiency and deficiency were recruited after written informed consent. Demographic data was recorded, adequate history and clinical examination was done to rule out any metabolic diseases. Complete blood picture, serum calcium, phosphorous, Parathormone and 25 Hydroxy-vitamin D3 (25OHD) was carried out before enrollment of the patients. Patients were divided randomly into two groups 350 in study group and 200 in the control group. Patients in the study group were given Top-D (Vitamin D3 gel made from proniosomal technology) to apply daily on the skin. Top-D 1 g contained 5000 IU of vitamin D3. The control group was given 1 g of Aloe vera gel to be applied every day. The two groups had no knowledge to which group they belong. After 4 months serum 25OHD was tested again.

RESULTS

Three hundred and forty five patients in study group and 192 in control group completed the study. The mean age of the patients in the both the groups was 42 years (18-80 years). The pretreatment 25OHD level in the study group was 11.03 ± 4.57 (2-12) ng/l compared to the control group 10.36 ± 4.09 (2-21) and post treatment the levels were 37.17 ± 6.04 (12-54) ng/ml and 10.51 ± 3.5 (2-19) ng/ml (p < 0.001).

CONCLUSION

The results of this study indicate that transdermal route of vitamin D is potentially, safe and can give desired results to raise the vitamin D levels. This route is an alternate route for supplementation of vitamin D which should be utilized.

Vitamin D deficiency in sickle cell disease patients in the Eastern Province of Saudi Arabia

BACKGROUND

Vitamin D deficiency (VDD) is a major global health problem. In sickle cell disease (SCD), VDD is highly prevalent, reaching up to 96% of populations. VDD may contribute to many of the complications of SCD.

OBJECTIVE

Estimate the 25-hydroxyvitamin D [25(OH)D] level and the frequency of VDD and insufficiency among among SCD patients by age group and disease status.

DESIGN

Analytical cross-sectional.

SETTING

Ministry of Health (MOH) secondary care hospital.

PATIENTS AND METHODS

Non-probability purposive sampling was used to select SCD patients, aged 12 years and older, of both sexes, who had visited the hospital during a period of 5 years (2010-2014). Blood samples were processed by electrochemiluminescence technology.

MAIN OUTCOME MEASURE(S)

25(OH)D levels by demographic data, and disease activity.

SAMPLE SIZE

640 patients.

RESULTS

Of those, 82% (n=523) had suboptimal 25(OH)D (0-<30 ng/ mL), and 67% were deficient (0-<20 ng/mL). Patients with any SCD crisis (20.7%, 144/694) had lower 25(OH)D (median, IQR: 10.1 ng/mL [8.6] ng/mL) compared to patients without crisis (71.0%, 493/694) (15.7 ng/ mL [18.2] ng/mL) (P<.001). Deficiency was more common in the young.er age groups and in sickle cell anemia patients with crisis.

CONCLUSIONS

VDD is highly prevalent in this population. Established vitamin D screening is a necessity, so that affected patients can be treated.

LIMITATIONS

Presence of residual confounders such as nutritional status, physical activity, lack of sun exposure, medications that alleviate SCD crises (such as hydroxyurea), and comorbid illnesses. The relationship between sickle cell disease genotype and vitamin D level was not analyzed.

CONFLICT OF INTEREST

None.

Prevalence of vitamin D deficiency and its associated factors in three regions of Saudi Arabia

Objectives:

To measure prevalence of vitamin D deficiency in Saudi Arabia, unveil the life style, nutritional habits and status, as well as identify the potential risk factors.

Method:

A school-based survey targeting Saudi school students and employees was conducted during the period from 2013 to 2014 using multistage cluster random sample in Central, Western and Eastern regions. The prevalence of vitamin D deficiency and difference between various population subgroups were calculated. Logistic regression analysis was used to determine the predictors of potential risk factors.

Results:

Prevalence of vitamin D deficiency was 49.5% in students and 44% in employees. Life style was not adequate to protect against vitamin D depletion. Unhealthy nutritional habits were widespread, some manifested in childhood while others manifested later in life. Living in the Eastern region, females, 16-19 years of age, low economic class, obese and lack of omega 3 supplements were risk factors in students. Employees living in the Eastern region, females, middle-income class, carbonated soft drink consumers, and lack of multivitamin supplements were at higher risk.

Conclusion:

There is a need for a health awareness program using evidence-based recommendations. Screening for early detection and correction of the condition should be proposed to be part of the national health strategy. There is need for identifying the burden of vitamin D deficiency on other diseases to control and improve the prognosis of these conditions.

Intermediate and low abundant protein analysis of vitamin D deficient obese and non-obese subjects by MALDI-profiling

Obesity is a pathological condition caused by genetic and environmental factors, including vitamin D deficiency, which increases the risk of developing cardiovascular disorders and diabetes. This case-control study was designed to verify whether serum profiles could be identified differentiating obese and non-obese Saudis characterized by vitamin D deficiency and pathological levels of triglycerides, high-density lipoprotein cholesterol and high total cholesterol levels. The serum protein profiles of 64 vitamin D deficient (serum 25(OH)D < 50nmol/L) individuals with metabolic syndrome and with (n = 31; BMI ≥ 30) or without (n = 33; BMI < 30) obesity were analyzed by a quantitative label-free mass spectrometry approach (MALDI-profiling), combined with different serum immunodepletion strategies (Human7 and Human14 immuno-chromatographies), to analyze the intermediate- and low-abundant protein components. The analysis of intermediate-abundant proteins (Human7) in obese vs. non-obese subjects identified 14 changed peaks (p < 0.05) in the m/z range 1500–35000. Furthermore, the Human14 depletion provided new profiles related to obesity (121 changed peaks). Among changed peaks, 11 were identified in the m/z range 1500–4000 Da by high-resolution tandem mass spectrometry, belonging to apolipoprotein CIII, apolipoprotein B100, alpha-1-antichymotrypsin and complement C3. Data herein show that distinct protein profiles identify specific peptides belonging to lipid metabolism and inflammation processes that are associated with obesity and vitamin D deficiency.

No Association between 25 (OH) Vitamin D Level And Hypothyroidism among Females

AIM:

The aim was to investigate serum vitamin D (25-OH) level among females with hypothyroidism.

MATERIALS AND METHODS:

A case-control study (58 in each arm) was conducted in Arar Central Hospital, Kingdom Saudi Arabia. The cases were females with hypothyroidism, and healthy females were controls. TSH, thyroid hormones: Free T3 (FT3) and Free T4 (FT4) and haemoglobin levels were measured in all participants. Serum vitamin D (25-OH) level was measured using the spectrophotometry.

RESULTS:

While there was no significant difference in the age and haemoglobin level, body mass index (BMI) was significantly higher in the cases. Compared with the controls, cases had significantly higher TSH, had significantly lower T4, and there was no significant difference in FT3 and 25 (OH) vitamin D, [16.1 (8.8-26.7) vs. 14.0 (9.5-20.3 ng/ml; P = 0.577]. Linear regression showed no association between, age, BMI, haemoglobin, TSH, FT3, FT4 and the log of 25 (OH) vitamin D levels.

CONCLUSION:

There was no significant difference in vitamin D level among females with hypothyroidism and healthy controls.

Knowledge and attitudes about vitamin D, and behaviors related to vitamin D in adults with and without coronary heart disease in Saudi Arabia

Background

Vitamin D deficiency is prevailing in Saudi Arabia. Recent national data indicated an inverse association between vitamin D status and coronary heart disease (CHD), which increases concerns about vitamin D deficiency as a serious public health problem. Therefore, the current study aimed to investigate whether knowledge, attitudes and behaviors related to vitamin D contribute to the prevalence of vitamin D deficiency among adults with and without CHD in Saudi Arabia.

Methods

This case-control study consisted of 130 CHD cases and 195 matched controls. The study subjects were recruited from three hospitals in Saudi Arabia. Structured interviews were completed to collect data on participants’ socio-demographics, knowledge about vitamin D, attitudes toward sun exposure, and behaviors related to vitamin D. Also, serum vitamin D levels were measured.

Results

Severe vitamin D deficiency [serum 25(OH)D < 10 ng/mL] was more prevalent in the CHD cases than in the controls (46% and 3%, respectively). The total knowledge score was higher in the controls than in the cases [2.5 (±1.8) and 1.6 (±2.2), respectively]. The cases had better attitudes toward sun exposure compared to the controls (p = 0.001); however, the controls had better attitudes toward vitamin D compared to the cases (p = 0.001). The controls had a higher consumption of multivitamin supplements than the cases (6.7% and 0.8%, respectively; p = 0.010). Similarly, the controls had a higher consumption of butter (p = 0.001), oily fish (p = 0.004), and liver (p = 0.003) than the cases; however, the cases had a significantly higher intake of milk (p = 0.001). A multivariate logistic regression showed that vitamin D deficiency [25(OH)D < 20 ng/mL] was associated with low levels of knowledge about vitamin D, with an odds ratio of 1.82 (95% CI: 1.08–3.06, P = 0.024). Vitamin D deficiency was also associated with low intake of vitamin supplements, with an odds ratio of 4.35 (95% CI: 2.12–8.92, P < 0.001).

Conclusion

The present study revealed that low levels of knowledge about vitamin D and low consumption of vitamin supplementation, including vitamin D, calcium, multivitamin, and calcium supplements with vitamin D, may have contributed to the higher prevalence of vitamin D deficiency among the CHD cases than among the controls. Further studies using a qualitative approach are crucial to explore the underlying reasons for low knowledge about vitamin D and behaviors related to vitamin D including the intake of vitamin supplementation  that may contribute to the high burden of vitamin D deficiency in the country.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4183-1) contains supplementary material, which is available to authorized users.

The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions

Micronutrient deficiencies and inadequacies constitute a global health issue, particularly among countries in the Middle East. The objective of this review is to identify micronutrient deficits in the Middle East and to consider current and new approaches to address this problem. Based on the availability of more recent data, this review is primarily focused on countries that are in advanced nutrition transition. Prominent deficits in folate, iron, and vitamin D are noted among children/adolescents, women of childbearing age, pregnant women, and the elderly. Reports indicate that food fortification in the region is sporadic and ineffective, and the use of dietary supplements is low. Nutrition monitoring in the region is limited, and gaps in relevant information present challenges for implementing new policies and approaches to address the problem. Government-sponsored initiatives are necessary to assess current dietary intakes/patterns, support nutrition education, and to reduce food insecurity, especially among vulnerable population groups. Public-private partnerships should be considered in targeting micronutrient fortification programs and supplementation recommendations as approaches to help alleviate the burden of micronutrient deficiencies and inadequacies in the Middle East.

Low levels of Vitamin D an emerging risk for cardiovascular diseases: A review

Sunlight is regarded among greatest gifts that are presented in abundance to the human beings from the God. Sunlight is also a rich source of Vitamin D (Vit D) that prevents us from numerous ailments such as autoimmune disorders, various types of cancer, and the above all cardiovascular diseases (CVD). Evident from recent research that Vit D deficiency may be the cause for hypertension, cardiac autonomic imbalance, vascular endothelial dysfunction, metabolic syndrome, and even diabetes. Concurrently, many studies present research outcomes that are contradictory to earlier results and also raised a concern not for general public but also among their treating physicians. The sole focus of this review is to systematically present the available research data and critically evaluate the link between Vit D deficiency and development of risk factors for CVD.

Association between Vitamin D Status and Coronary Heart Disease among Adults in Saudi Arabia: A Case-Control Study

Recent evidence has pointed out an association between vitamin D deficiency and coronary heart disease (CHD). Due to the growing epidemic of CHD and vitamin D deficiency in Saudi Arabia, exploring the role of vitamin D in the prevention of CHD is crucial. The aim of this study was to examine the association between vitamin D status and CHD in Saudi Arabian adults. This case-control study included 130 CHD cases and 195 age-sex matched controls. Study subjects were recruited from three hospitals in the western region of Saudi Arabia. Study participants were interviewed face-to-face to collect data on their socio-demographic characteristics and family history of CHD. Fasting blood samples were collected, and serum levels of vitamin D, glucose, and total cholesterol were measured. Body weight, height, and blood pressure measurements were also recorded. Severe vitamin D deficiency (25(OH)D < 10 ng/mL) was much more prevalent in CHD cases than in controls (46% and 3%, respectively). The results of multivariate logistic regression showed that vitamin D deficiency (25(OH)D < 20 ng/mL) was associated with CHD, with an odds ratio of 6.5 (95% CI: 2.7-15, p < 0.001). The current study revealed that vitamin D deficiency is independently associated with CHD, suggesting an important predictor of CHD among Saudi adults.

Deficiencies Under Plenty of Sun: Vitamin D Status among Adults in the Kingdom of Saudi Arabia, 2013

BACKGROUND

Vitamin D deficiency has been correlated with several diseases and injuries including diabetes, osteoporosis, fractures, and falls. In the Kingdom of Saudi Arabia (KSA), current data on vitamin D status are lacking.

AIMS

To inform Saudi public health authorities on the current status of blood levels vitamin D deficiency, we analyzed data from the Saudi Health Interview Survey.

MATERIALS AND METHODS

The Saudi Health Interview Survey (SHIS) is a cross-sectional national multistage survey of individuals aged 15 years and above on sociodemographic characteristics, tobacco consumption, diet, physical activity, health care utilization, different health-related behaviors, and self-reported chronic conditions. A total of 10,735 participants completed a health questionnaire and were invited to the local health clinics for biomedical exams.

RESULTS

62.65% of female Saudis and 40.6% of male Saudis aged 15 years and above are deficient in vitamin D. Out of them, less than 1% males and less than 2% females consume vitamin D supplements. Women who have never married and obese individuals are more likely to be deficient in vitamin D, compared to men who were currently married and nonobese individuals. Those consuming vitamin D supplements are less likely to be deficient in vitamin D.

CONCLUSIONS

Our study showed a high prevalence of vitamin D deficiency among Saudi men and women, and the results call for an increased awareness to ensure adequate levels of vitamin D for better health in Saudi Arabia. Moreover, our findings are certainly relevant for other countries in the Gulf region or countries with similar cultures, clothing, and religions.

Knowledge, attitude, and practice of general practitioners in Dammam, Saudi Arabia towards Vitamin D supplementation to infants

Background:

With the report of high prevalence rate of Vitamin D deficiency in the literature since the 1980s, the condition can be considered an epidemic in Saudi Arabia. However, no specific steps have been taken by the Ministry of Health to tackle the problem. Moreover, little is known about general practitioners’ (GPs) knowledge, attitude, and practice (KAP) of Vitamin D supplementation for infants.

Objectives:

To measure the KAP of GPs, of Vitamin D supplementation for infants in Dammam, Saudi Arabia.

Materials and Methods:

This was a cross-sectional study of GPs practicing in primary healthcare centers in the Dammam area of Saudi Arabia. All the 110 GPs working in primary health centers (PHCs) in Dammam were invited to participate in the study. Data was collected with the help of a self-administered questionnaire. Data was analyzed using SPSS 20.0. Statistical analysis included descriptive analysis of all the variables, expressed as the mean (standard deviation [SD]) or the median if not normally distributed.

Results:

Ninety-three GPs working in the Dammam area participated in the study. Thirty percent had excellent knowledge of Vitamin D. Ninety two percent had a positive attitude toward Vitamin D supplementation and sixty percent regularly prescribed Vitamin D supplementation for infants.

Conclusion:

The majority of GPs had a positive attitude toward Vitamin D supplementation for infants. However, their knowledge and practice need improvement.

Association of rs7041 and rs4588 Polymorphisms of the Vitamin D Binding Protein and the rs10741657 Polymorphism of CYP2R1 with Vitamin D Status Among Jordanian Patients

AIM

Previous studies have shown a high prevalence of vitamin D deficiency among Jordanians despite adequate exposure to sunlight, suggesting the presence of other causes for this deficiency. The aim of this study was to identify the relationship between 25-hydroxyvitamin D [25-(OH) VD] status and the nonsynonymous single-nucleotide polymorphisms (SNPs) (rs7041 and rs4588) of the GC gene, which encodes the vitamin D binding protein, and one SNP (rs10741657) near the CYP2R1 gene.

METHODS

Blood samples from 381 subjects (74 males and 307 females, 18-60 years of age) were obtained from the "National Center for Diabetes, Endocrinology and Genetics" (Amman, Jordan). The subjects were classified as "apparently healthy" if they did not suffer from chronic diseases and as "unhealthy" if they suffered from certain chronic diseases. Subjects' genotypes for GC; rs7041 and rs4588; CYP2R1; rs10741657 were determined by the polymerase chain reaction-restriction fragment length polymorphism assay method.

RESULTS

Apparently, healthy subjects had significantly higher 25-(OH) VD levels than unhealthy patients. In apparently healthy subjects, the rs10743657 genotypes containing the variant allele A (AA, GA) were associated with higher 25-(OH) VD levels than the homozygous wild-type genotype (GG). The genotypes containing the variant allele of rs7041 (TT, TG) and rs4588 (AA, AC) were associated with lower 25-(OH) VD levels than the wild-type genotypes (GG and CC, respectively). Haplotype analysis of rs7041 and rs4588 revealed that the haplotypes GC1S and GC1S/S were associated with 25-(OH) VD sufficiency, whereas haplotypes GC1F/S, GC1F/2, GC1S/2, GC2, and GC2/2 were associated with 25-(OH) VD deficiency. In unhealthy patients, only the homozygous genotype of the variant allele of rs7041 (TT) was associated with higher 25-(OH) VD levels, which is the reverse of what had been observed in apparently healthy subjects.

CONCLUSIONS

The rs70141657G/A of CYP2R1 and rs7041T/G and rs4588C/A of vitamin D binding protein genetic polymorphisms were associated with increased risk of vitamin D deficiency among apparently healthy Jordanians.

Dairy products consumption and serum 25-hydroxyvitamin D level in Saudi children and adults

Vitamin D deficiency is implicated in several calcium deficiency-related disease conditions. We aimed to investigate vitamin D status and its association with consumption frequencies of various dairy products in Saudi population. Subjects consisted of 820 children (327 boys; mean age 14.9 yrs and 493 girls; 14.8 yrs) and 565 adults (249 men, 27.9 yrs and 316 women 32.2 yrs). We estimated the consumption frequencies of various dairy food products (fresh milk, powdered milk, laban, yoghurt and cheese) using a qualitative food frequency questionnaire and serum level of 25-hydroxyvitamin D (25 (OH) D). Associations between variables of interest were assessed by Pearson correlation analysis. Among the study subjects, 80% boys, 90% girls, 64% men and 50% women had deficient/insufficient levels of vitamin D. Modest associations were found between mean serum 25 (OH) D concentration and fresh milk consumption in children (r=0.11) (especially in girls (r=0.12)), and overall dairy products consumption in women (r=0.12).

CONCLUSION

Results indicated widespread vitamin D deficiency in Saudi Arabian children and adults. High level of vitamin D deficiency and a lack of strong correlation between dairy product consumption and serum level of vitamin D imply a need for adequate fortification of milk and other dairy products with vitamin D.

Dietary products consumption in relation to serum 25-hydroxyvitamin D and selenium level in Saudi children and adults

Vitamin D deficiency is a global health threat that has been associated with several chronic diseases. Selenium is an essential trace element because of role in major metabolic processes, immune function, thyroid hormone metabolism, male infertility, neoplasms and cardiovascular disease. We aimed to investigate for the first time in the Saudi population the association between vitamin D and selenium status with various dietary products consumption. A total of 259 children and 95 adults were included in this cross-sectional study. We estimated the consumption frequencies of various dietary food products using a qualitative food frequency questionnaire (FFQ) and also measured serum levels of 25-hydroxyvitamin D and selenium. Associations between variables of interest were assessed. Vitamin D deficiency and insufficiency were observed in 80% of the boys, 90% of the girls, 64% of men and 50% of women. Modest associations were found between mean serum 25 (OH) D concentration and consumption frequencies of fresh milk in children (r=0.11; P<0.05), more specifically in girls (r=0.12; P<0.05), and to the overall consumption of dairy products in women (r=0.12; P<0.05). Vitamin D status was also inversely associated with selenium in adults (r=-0.43; P<0.05). There was a significant correlation between delta changes of serum selenium, triglycerides and HDL levels (P-values <0.05). Vitamin D and selenium levels are modestly associated with dietary products consumption. Changes in selenium levels were associated with increased serum triglyceride levels, indicating a potential biomarker for cardiovascular risk and dyslipidemia. The widespread vitamin D deficiency observed in the present study highlight the need for adequate fortification of dairy products.

Increasing trends and significance of hypovitaminosis D: a population-based study in the Kingdom of Saudi Arabia

Vitamin D deficiency is highly prevalent in Saudi Arabia, particularly among young women and is emerging as public health threat of epidemic proportions. Prevalence of severe hypovitaminosis D is expected to rise exponentially without primary intervention. This largest study encompasses extent of vitamin D deficiency and recommendations to reduce significant health care burden.

INTRODUCTION

The aim of the study was to determine the prevalence and significance of vitamin D deficiency in Saudi population and to help develop national consensus for its prevention, screening, and management.

METHODS

This was a retrospective observational study which involved 10,709 patients, recruited from the Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center (KFSH&RC), Saudi Arabia, over a period of 5 years. The endpoints included overall status of vitamin D level and severity of vitamin D deficiency. Serum measurements included 25 hydroxyvitamin D (25(OH)D), parathormone, calcium, phosphate, alkaline phosphatase, albumin levels, eGFR levels, bone mineral density.

RESULTS

A total of 10,709 patients were analyzed; 31.4 % were males and 68.6 % were females, with a preponderance of Saudis (68.5 %) compared to non-Saudis (31.5 %). The prevalence of vitamin D deficiency was 83.6 % (31.9 % severe, 32.0 % moderate, and 19.7 % mild), when cut points of less than 25, 50, and 75 nmol/l, respectively, were used. Mean serum 25(OH)D was 44.58 ± 34.80 standard deviation (SD) nmol/l. There was significant difference in severity of vitamin D deficiency stratified by age, gender, and nationality. More females had severe 25(OH)D deficiency compared to males (35.6 vs. 23.7 %, p < 0.000). Severe 25(OH)D deficiency was markedly high among adolescents as compared to other age groups (49.2 vs. 30.9 %, p < 0.000). More Saudis were found to be vitamin D deficient compared to non-Saudis (37.2 vs. 20.3 %, p < 0.000).

CONCLUSION

The prevalence of hypovitaminosis D is significantly high among Saudi population, especially among women, despite abundant sunshine. It is a major public health concern and requires a robust health policy for vitamin D supplementation and implementation of dietary public health measures. Vitamin D screening is strongly recommended at an earlier age especially among women and children.

Topical delivery of vitamin d3: a randomized controlled pilot study

BACKGROUND AND OBJECTIVE

The purpose of the present study is to explore the assessment if the transdermal delivery of vitamin D is feasible.

METHODS

In 50 female Medical students, this study was conducted. Age, weight and height was taken, a detailed history and clinical examination was performed. Blood was drawn for 25 Hydroxy Vitamin D3 (25OHD) level. Two women had >30 ng/mL of 25OHD and was excluded from the study. The participants were divided into two groups of 24 in each arm. All participants equivocally agreed not to change their dietary habits and life style till the study was over. The study group of women were asked to apply; Top-D (Aloe Vera based- Vitamin D3) (Patency Pending) was developed at King Fahd Hospital of the University, AlKhobar with each gram of the Top-D cream delivering 5000 IU of vitamin D3. The second group used 1 gram of Aloe vera gel. The participants had no knowledge to which group they belong. A second blood sample was taken at the end of 3 months and the data was analyzed.

RESULTS

The data of 48 women was available for analysis. The average age was 22.58 ± 1.95 years. The mean pre-treatment 25OHD in the study group was 12.05 ng/Ml ± 6.54 and post-treatment was 37.95 ng/mL ± 6.43 (P=0.001, CI<28.582 ). In control group pre-treatment 25OHD was 11.4 ng/mL ± 3.97 and post-treatment was 10.58ng/mL ± 3.03.

CONCLUSIONS

This randomized control study shows that vitamin D3 can safely be delivered through the dermal route. This route could be exploited in treating vitamin D deficiency.

Vitamin d deficiency and its association with thyroid disease

OBJECTIVES

Vitamin D deficiency is a global health problem, its role as an immune modulator has been recently emphasized. The evidence is increasingly pointing towards vitamin D significant role in reducing the incidence of autoimmune diseases. However, at this time the research on its role in autoimmune and thyroid disease is not conclusive. We aimed to examine the relationship between hypothyroidism and vitamin D deficiency and to clarify the relation between serum calcium levels with hypothyroid disease.

SUBJECTS AND METHODS

Serum vitamin D (25-OH) levels were measured in 30 patients with hypothyroidism and 30 healthy subjects, utilizing the spectrophotometric method. Vitamin D deficiency was designated at levels lower than 20 ng/ml. Thyroid hormones (TSH, T3 and T4) and calcium levels were evaluated in all participants.

RESULTS

Serum 25(OH) vit D was significantly lower in hypothyroid patients than in controls (t=-11.128, P =0.000). Its level was insignificantly decreased in females than male patients (t=- 1.32, P >0.05). Moreover, serum calcium levels recorded a significant decrease in hypothyroid patients when compared to controls (t= -5.69, P = 0.000).

CONCLUSION

Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.

Vitamin D status among patients visiting a tertiary care center in Riyadh, Saudi Arabia: a retrospective review of 3475 cases

BACKGROUND

Vitamin D deficiency has been implicated in several chronic, non-communicable diseases independent of its conventional role in bone and calcium homeostasis. In this retrospective study, we determined the prevalence of vitamin D deficiency and its association to several cardiometabolic indices among patients visiting King Abdulaziz Medical City (KAMC), a tertiary hospital in Riyadh, Saudi Arabia.

METHODS

A total of 3475 charts of out-patient subjects who visited KAMC from September 2009 until December 2010 were reviewed and included. Variables of interest included measurements of vitamin D status, glycemic and renal profile, as well as trace elements (calcium and phosphorous).

RESULTS

The over-all prevalence of vitamin D deficiency in the cohort studied was 78.1% in females and 72.4% in males. 25(OH) vitamin D was significantly associated with increasing age and weight (p-values < 0.0001 and 0.005, respectively). It was also positively associated with albumin, calcium and phosphorous (p-values < 0.0001, < 0.0001 and 0.0007, respectively) and negatively associated with alkaline phosphatase as well as circulating levels of PTH (p-values 0.0002 and 0.0007, respectively).

CONCLUSION

In conclusion, vitamin D deficiency is overwhelmingly common among patients seen at KAMC regardless of the medical condition, and it is significantly associated with increasing age, weight and markers of calcium homeostasis. Findings of the present study further stress the spotlight on vitamin D deficiency epidemic in the country and region in general.

Assessment of low vitamin D among Saudi Arabians. Did we overshoot the runway?

OBJECTIVES

To compare the performance of 3 commonly used 25-hydroxyvitamin D (25-OHD) assays among a sample of the Saudi population.

METHODS

This cross-sectional study was carried out between January 2011 and December 2012 at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. After informed consent, blood samples for measurement of 25-OHD level was extracted from 200 adults. The vitamin D levels of each individual were determined using chemiluminescence immunoassay (CLIA), radio-immuno assay (RIA), and liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. Assays were also compared through commonly used cut-points for classification of vitamin D deficiency. Bias between assays was evaluated using Bland-Altman plots.

RESULTS

The average age of patients was 45.7+/-16.1 years. A significant difference between the assays was found. The mean 25-OHD levels were highest for the LC-MS/MS (21.65 ng/mL, 95% CI 19.74-23.56), intermediate for RIA (16.607 ng/mL, 95% CI 14.87-18.32), and lowest for CLIA method (13.864 ng/mL, 95% CI 12.109-15.618). Using 30 ng/mL as a cutoff value, only 6% was found to have normal levels of 25-OHD using CLIA, 9% using RIA, and 22% using LC-MS/MS.

CONCLUSION

Levels of 25-OHD and the prevalence of vitamin D deficiency are dependent on the assay used. The reported high prevalence of hypovitaminosis D among the Saudi population can be partially explained by the use of assays that underestimate vitamin D levels.

Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes

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.

Vitamin d deficiency in patients with type-2 diabetes mellitus in southern region of saudi arabia

INTRODUCTION

Type-2 diabetes mellitus and Vitamin D deficiency are both common in Saudi Arabian population. New roles of vitamin D have emerged recently especially in the prevention of cardiovascular disease, cancer and insulin resistance.

OBJECTIVE

To estimate 25-OH vitamin D deficiency in patients with type-2 diabetes mellitus in comparison to normal age-matched non-diabetic control population.

METHODS

A Randomized Case-Control study was done in three tertiary care hospitals in Southern Region, Saudi Arabia from June 2010 to June 2012 and 345 patients were selected; 172 in the diabetic group and 173 in the non-diabetic group. Biochemical workup and 25-OH vitamin D levels were done.

RESULTS

The mean serum 25-OH vitamin D levels in the diabetic group were 15.7 + 7.5 ng/mL as compared healthy non-diabetic group having 11.1 + 5.9 ng/mL and a total of 340 patients (98.5%) from both groups were found to be deficient in 25-OH vitamin D which is the highest reported so far in Saudi Arabia.

CONCLUSION

The population in our study was generally deficient in 25-OH vitamin D irrespective of diabetes mellitus indicating a greater need for vitamin D supplementation.

Fortification with vitamin D: Comparative study in the Saudi Arabian and US markets

BACKGROUND AND OBJECTIVE

Vitamin D deficiency is common among Saudi Arabian population. To evaluate the current status of vitamin D fortification and calcium content of commonly consumed food items by the Saudi population and to compare it to US data.

SETTING AND DESIGN

Cross-sectional market survey at markets of Eastern Province of Saudi Arabia and State of Illinois, USA.

METHODS

A dietary survey was carried out for the content of calcium and vitamin D on the most commonly consumed food products by the Saudi population which are suppose to be fortified by vitamin D. The survey included different brands of fresh milk, yoghurt, powdered milk, cheese, ready-to-eat breakfast cereals and orange juice. Vitamin D content in the products studied from the Saudi marketplace was compared with the suggested vitamin D content in the same products according to US Code of Federal Regulations recommendations.

RESULTS

The overall calcium content in the processed dairy products is generally higher than the content in fresh dairy products. Vitamin D content in the fresh dairy products varied from 40 IU/L to 400 IU/L. None of the cereals or orange juice in Saudi Arabia contain vitamin D supplement. The vitamin D content in the food items from the Saudi marketplace is mostly lower than recommended by the US Code of Federal Regulations.

CONCLUSION

Most commonly consumed food products by Saudi population which are suppose to be fortified by vitamin D either not fortified or contain an amount less than recommended by guidelines set for US marketplace.

Vitamin D status among Adult Saudi Females visiting Primary Health Care Clinics

BACKGROUND

Vitamin D plays an important role in diverse physiological functions in addition to its role in bone health. Vitamin D deficiency is very common in elderly people, but there are few reports on its prevalence in young adults.

METHOD

A cross-sectional study was carried out on a total of 465 young adult Saudi females aged 19 to 40 years old who were selected from primary health care centers of King Abdulaziz medical city, Riyadh, KSA. A questionnaire was used to identify socio-demographic characteristics and risk factors such as sunlight exposure and dietary intake. 25-hydroxy vitamin D [25(OH)D], Parathyroid hormone (PTH) and bone biochemical parameter were measured. The cutoff values for Vitamin D were defined as follows: deficient (<25nmol/L), insufficient (25-75 nmol/L) and normal (≥ 75 nmol/L).

RESULT

Overall, hypovitaminosis D were identified in all participants, with a mean level of 18.34 ±8.2 nmol/L. Of all the participants, 79.1% exhibited severe vitamin D deficiency (serum 25(OH) D < 25 nmol/L), while 20.9% exhibited vitamin D insufficiency (serum 25(OH) D between 25-50 nmol/L). There was a significant inverse correlation between serum 25 (OH) D concentrations and PTH, where secondary hyperparathyroidism was evident in 61.4% of participants with deficient vitamin D compared to 39.2% of participants with insufficient vitamin D.

CONCLUSION

Despite the abundant sunlight in Saudi Arabia, the prevalence of hypovitaminosis D among young healthy Saudi females is 100%. This finding should be considered a public health problem. Case identification, health education and prevention should be encouraged.

Prevalence of vitamin d insufficiency in qatar: a systematic review

Qatar has a high burden of chronic diseases including obesity, cardiovascular disease and type 2 diabetes mellitus. Low serum vitamin D levels have been implicated in the development and progression of a range of these chronic conditions. The prevalence of vitamin D insufficiency or deficiency in the general population of Qatar has still not been investigated. The aim of this study was to carry out a systematic review of published studies documenting the prevalence of vitamin D insufficiency or deficiency in the Qatari population. A search strategy was developed for online databases (PubMed, Ovid MEDLINE, Embase and Embase Classic) between 1980 to the last week of August 2012, and bibliographies of the included studies were further searched for additional reports. Search terms used were QATAR and VITAMIN D. Studies reporting the serum levels of vitamin D in several Qatari sub-populations were identified. Weighted-average vitamin D serum levels and prevalence of low vitamin D status (<75 nmol/L) were calculated. Subgroup analysis was carried out by age. The quality of each study was evaluated according to four criteria: national representativeness, representation of males and females, the sample size, and the sampling protocol. A total of 16 relevant publications were identified, and 8 of these (reporting from 7 unique studies) met our inclusion and exclusion criteria with a total number of 1,699 Qatari subjects. The pooled sample size weighted-average vitamin D concentration (±SD) was 45.3±14.3 nmol/L (95% CI: 44.6-46.0; range 29.2-66.9 nmol/L). The weighted-average prevalence of low vitamin D status was 90.4% (95% CI: 90.1-91.0; range 83%-91%). Age was inversely correlated with vitamin D levels and directly with its insufficiency/deficiency prevalence. There have only been a few studies on the prevalence of low vitamin D in Qatar a very high prevalence of vitamin D insufficiency/deficiency in Qatar that increases with age has been suggested. The present report underlines the need to develop a nationally representative study to further evaluate vitamin D status in Qatar. Given the growing evidence of the role of vitamin D in chronic disease, this study could help develop public health strategies for disease prevention in Qatar.

Evidence for nutrition transition in Kuwait: over-consumption of macronutrients and obesity

OBJECTIVES

To describe nutrient intakes and prevalence of overweight and obesity in a nationally representative sample of Kuwaitis and to compare intakes with reference values.

DESIGN

Cross-sectional, multistage stratified, cluster sample. Settings National nutrition survey covering all geographical areas of the country.

SUBJECTS

Kuwaitis (n 1704) between 3 and 86 years of age.

RESULTS

Obesity was more prevalent among women than men (50 % and 70 % for females aged 19-50 years and ≥51 years, respectively, v. 29 % and 42 % for their male counterparts). Boys were more obese than girls, with the highest obesity rate among those aged 9-13 years (37 % and 24 % of males and females, respectively). Energy intake was higher than the estimated energy requirements for almost half of Kuwaiti children and one-third of adults. The Estimated Average Requirement was exceeded by 78-100 % of the recommendation for protein and carbohydrates. More than two-thirds of males aged ≥4 years exceeded the Tolerable Upper Intake Level for Na. Conversely, less than 20 % of Kuwaitis, regardless of age, consumed 100 % or more of the Estimated Average Requirement for vitamin D, vitamin E, Ca, n-3 and n-6 fatty acids. Less than 20 % of children met the recommended level for fibre.

CONCLUSIONS

Nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients and decreased intakes of fibre and micronutrients. Interventions to increase awareness about healthy foods combined with modifications in subsidy policies are clearly warranted to increase consumption of low-energy, nutrient-dense foods.

The status of Vitamin D in medical students in the preclerkship years of a Saudi medical school

Background:

The prevalence of vitamin D deficiency has recently been recognized in different parts of the world, even affecting healthy populations. The deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. Few studies have been done to evaluate the status of vitamin D in the medical community. The objective of this study was to evaluate the prevalence of low levels of vitamin D in healthy Saudi medical students.

Materials and Methods:

A cross-sectional study was carried out in November 2009 on male and female students in the preclerkship years of medical school at the King Faisal University, Dammam. Data on age, consumption of dairy products and seafood, and exposure to sunlight were collected. The body mass index was calculated. Approximately, 15 ml of blood was extracted for the measurement of serum calcium, serum albumin, serum phosphorus, alkaline phosphatase, fasting parathyroid hormone, and vitamin D levels. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D < 50 nmol/l. Comparison between groups was done for statistical significance using an unpaired t-test. Significance was set at P < 0.05 using 95% CI for all comparisons.

Results:

The data from 95 male and 103 female students were analyzed. The mean age for all students was 19.54 years. In 100% of the students, the vitamin D level was low. The prevalence of vitamin D deficiency in all students was 96.0% (92.64% in males and 99.03% in females), while the remaining 4% had vitamin D insufficiency. The mean 25-hydroxy vitamin D level was 26.83 ± 12.60 nmol/l in males and 16.03 ± 8.28 nmol/l in females (P-value = 0.0001). Males had a statistically significant higher body mass index as well as consumption of dairy products, while the consumption of seafood was significantly higher in females. There was no difference between the two groups in terms of exposure to the sun.

Conclusion:

Vitamin D deficiency was highly prevalent among medical students included in this study. An urgent action has to be taken in order to prevent adverse consequences of low vitamin D in the young, otherwise healthy populations.

Stone formation in the Middle Eastern Gulf States: A review

Objectives

To review the possible causes of the high incidence of urolithiasis in the oil-rich Gulf States.

Methods

Data were extracted from published reports on the incidence of urolithiasis, affluence and diet in the Gulf States, various Western countries and China.

Results

There are strong relationships: (a) between the life-expectancy of stones in men and the Gross National Income (GNI) per capita of these countries; and (b) between the daily consumption of animal protein and GNI per capita. Together these data suggest that the occurrence of stones is proportional to the intake of animal protein, although they also indicate that there are additional factors that further increase the risk of urolithiasis in the populations of the Gulf. The consumption of oxalate in the Gulf is three times higher and that of calcium a half of what it is in Western countries. Thus, the average oxalate/calcium ratio in the intestines of the Gulf populations is five to six times higher than that in Western populations, leading to enteric hyperoxaluria and an increased risk of calcium-oxalate stone formation. The risk is further accentuated by the lower urine volumes, due to the hot, dry climate of the region, and lower excretions of citrate, from the highly acidic urine resulting from the high intake of animal protein. There is a high incidence of uric acid-containing stones from the acidic urine and the hyperuricosuria caused by the high intake of purine.

Conclusions

The high incidence of urolithiasis in the Gulf is due to an adverse combination of dietary and environmental factors.

Vitamin D Deficiency: This clandestine endemic disease is veiled no more

Recently, scientists have generated a strong body of evidence providing new information about the preventive effect of vitamin D on a broad range of disorders. This evidence suggests that vitamin D is much more than a nutrient needed for bone health; it is an essential hormone required for regulation of a large number of physiological functions. Sufficient concentration of serum 25-hydroxyvitamin D is essential for optimising human health. This article reviews the present state-of-the-art knowledge about vitamin D's status worldwide and refers to recent articles discussing some of the general background of vitamin D, including sources, benefits, deficiencies, and dietary requirements, especially in pregnancy. They offer evidence that vitamin D deficiency could be a major public health burden in many parts of the world, mostly because of sun deprivation. The article also discusses the debate about optimal concentration of circulating serum 25-hydroxyvitamin D, and explores different views on the amount of vitamin D supplementation required to achieve and maintain this concentration.

Fibroblast Growth Factor-23 and Hypophosphatemia in Chronic Obstructive Pulmonary Disease Patients

Impaired serum phosphate levels may contribute to respiratory muscle weakness that further negatively impacts Chronic Obstructive Pulmonary Disease (COPD) patients. Recently, Fibroblast Growth Factor 23 (FGF-23) has been shown to play an important role in the regulation of body phosphate. The current study includes 2 groups: 70 COPD patients and 34 control subjects. Blood samples were taken for a panel of routine lab tests. FGF-23 was measured using a commercially available ELISA kit. Plasma FGF-23 levels were significantly higher in the patient group compared to the control group (P=0.000). Tubular maximum absorption of phosphate was significantly reduced in COPD patients compared to the control group (P=0.04). Plasma FGF-23 negatively correlated with FEV1 and serum albumin. Elevated plasma FGF-23 levels found in COPD patients correlated with disease severity and may represent an additional factor causing low serum phosphate.

Vitamin D in the Persian Gulf: integrative physiology and socioeconomic factors

Countries of the Persian Gulf region--Bahrain, Iran, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates--have become increasingly modernized, resulting in a transformation of lifestyle based on technology, sedentary activity, lack of sunlight, and unhealthy dietary patterns. These factors have led to a higher prevalence not only of vitamin D undernutrition, but also chronic obesity, insulin resistance, prediabetes, and type 2 diabetes. This review explores the integrative physiologic effects of vitamin D with socioeconomic factors and propose a hypothesis-driven model for their contributions to obesity and diabetes in the Persian Gulf. Further research into these interactions may ultimately lead to novel preventive strategies and therapies for metabolic disorders in this geographic region.

Effect of diet and lifestyle factors on bone health in postmenopausal women

Our objective was to examine the effect of nutritional intake and lifestyle factors on bone mass in postmenopausal Saudi women. A total of 122 apparently healthy postmenopausal Saudi women were recruited from the Center of Excellence for Osteoporosis Research in Jeddah. A questionnaire on lifestyle habits and dietary intake was administered to all participants. Anthropometric and bone mineral density (BMD) values were measured. Fasting blood samples were taken to measure concentrations of bone-related parameters and hormones. Most of the sample population was found to be vitamin D deficient with a serum vitamin D level below 50 nmol/l. Those participants with normal BMD values had significantly lower serum vitamin D levels than osteopenic individuals (P < 0.05). Overall, mean total caloric, total fat, and saturated fat intakes were above recommended levels. Almost 60% of the total study population had lower calcium intake than the estimated average requirements whereas the whole population had vitamin D intake level below the estimated average requirements. Only BMD of the femoral neck showed significant correlations with serum vitamin D level and dietary cholesterol intake. After adjustment for confounding variables; serum vitamin D levels were significantly correlated with cholesterol intake. Dietary calcium intake was significantly correlated with intake of protein and fiber whereas dietary vitamin D intake was significantly correlated with intake level of total fat, all fatty acids, cholesterol, and fiber. Our findings reveal the important role of dietary vitamin D and calcium in osteopenic patients and the likely requirement for supplementation of these nutrients in the Saudi population.

Influence of vitamin D levels on bone mineral density and osteoporosis

BACKGROUND AND OBJECTIVES

The effects of vitamin D on bone mass remain to be understood. This study was conducted with the objective of evaluating the influence of 25-hydroxyvitamin D (25OHD) levels on bone mineral density (BMD) among Saudi nationals.

DESIGN AND SETTING

Cross-sectional study carried out at university hospital from 1 February 2008 to 31 May 2008.

SUBJECTS AND METHODS

Healthy Saudi men and women in the peak bone mass (PBM) age group and those aged ≥ 50 years were recruited from the outpatient department of King Fahd University Hospital, Al Khobar, Saudi Arabia, between February 1, 2008, and May 31, 2008. Patient age and sex were documented, and body mass index was calculated. Hematological, biochemical, and serum 25OHD tests were performed. BMD was determined by dual-energy x-ray absorptiometry of the upper femur and lumbar spine. Patients were divided into three groups, based on their 25OHD level.

RESULTS

Data from 400 patients were analyzed. Among individuals with a normal 25OHD level, 50% of women and 7% of men in the PBM age group and 26.4% of women and 49.2% of men aged ≥ 50 years had low bone mass. In patients with 25OHD insufficiency, 84.2% of women and 88.9% of men in the PBM age group and 83.3% of women and 80% of men aged ≥ 50 years had low bone mass. Results for patients with 25OHD deficiency revealed that none of the men and women in the PBM age group or ≥ 50 years old had normal BMD. Significant positive correlations between 25OHD level and BMD and significant negative correlations with parathyroid hormone were shown in most of the groups.

CONCLUSIONS

This study showed that the vitamin D level significantly influences BMD reading among Saudi individuals. Evaluation and treatment of hypovitaminosis D should be considered during management of low bone mass.

Vitamin D deficiency and sun avoidance among university students at Abu Dhabi, United Arab Emirates

This study offers evidence that vitamin D deficiency could be a major public health burden among young Emirati adults, mostly because of sun deprivation in a sun-blessed country. This study included a random sample of 138 females and 70 males tested for serum 25-hydroxyvitamin D [25(OH)D] status. To further evaluate the predictors of vitamin D status in this population, the study examined diet, obesity and sun exposure. In summer, the mean serum 25(OH)D concentration for females was 20.9 ± 14.9 nmol/L, whereas that for males was 27.3 ± 15.7 nmol/L. Females scored significantly higher than males on the sun avoidance inventory (SAI), indicating that females avoid sun exposure to a greater extent than males, possibly explaining the lower vitamin D status. A significant negative correlation also existed between SAI and vitamin D status (Pearson's r = -0.33; p < 0.01), but no significant association was evident between vitamin D status and body mass index (Pearson's r = 0.03; p = 0.33) or low dietary intake of vitamin D-fortified foods (Pearson's r = 0.08; p = 0.13). The mean serum 25(OH)D concentration for females tested in winter was 31.3 ± 12.3 nmol/L while in the summer, it was 20.9 ± 14.9 nmol/L. This difference was statistically significant, suggesting that seasonal variation plays an important role in vitamin D status in the United Arab Emirates. Fortification of foods and drinks with vitamin D, supplementation and sensible sun exposure are important steps toward minimizing vitamin D deficiency.