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

Wahab N. Evaluating the Role of Vitamin D in Prediabetes Management, Insights from RCTs in the MENA Region: A Comprehensive Systematic Review

Background/Objectives: The association between vitamin D deficiency and prediabetes has been extensively investigated, yet the findings remain inconsistent, with limited data available on the MENA region. This systematic review aims to assess the relationship between vitamin D deficiency and prediabetes in the Middle East and North Africa (MENA) region, focusing specifically on randomized controlled trials (RCTs). Methods: A comprehensive literature search was performed across four databases, which were Ovid MEDLINE, Cochrane, Scopus, and PubMed. RCTs studies conducted on people with prediabetes aged 15 years and older who live in the MENA region, and receiving vitamin D supplementation were included in the study. Results: From 2194 studies identified from the literature search, only 51 studies were considered eligible for full-text review. Ultimately, seven articles were finalized for inclusion. The findings from these studies showed mixed results, where some studies indicated that vitamin D supplementation had no significant effect on these outcomes. The remaining reported improvements in insulin sensitivity and a reduced risk of progression to type 2 diabetes with vitamin D supplementation. Conclusions: This systematic review examines the complex and contradictory relationship between vitamin D deficiency and prediabetes in the MENA region. Due to the mixed pattern seen in the intervention of vitamin D to prevent the development of type 2 diabetes, further research is necessary to elucidate the underlying mechanisms and potential confounding factors specifically in population of the MENA region.

The Impact and Efficacy of Vitamin D Fortification

Vitamin D deficiency is a global health issue linked to various chronic diseases and overall mortality. It primarily arises from insufficient sunlight exposure, compounded by dietary limitations. Vitamin D fortification of commonly consumed foods has emerged as a viable public health intervention to address this deficiency. This review evaluates the impact of vitamin D food fortification on serum levels, intake, and health outcomes and explores the stability, bio-accessibility, bioavailability, and cost-effectiveness of such interventions. A comprehensive literature search was conducted in PubMed and Google Scholar, focusing on studies from 2015 to 2024. The criteria included primary research on healthy adults that addressed the effects of vitamin D fortification on health, intake, and serum levels, as well as the fortification's stability, bio-accessibility, bioavailability, and cost-effectiveness. Studies were extracted and analyzed according to PRISMA guidelines. The review included 31 studies from diverse geographic locations, revealing that fortifying dairy products, cereals, fats, oils, and other food items effectively increased serum 25-hydroxyvitamin D levels. The fortification methods varied, with vitamin D3 showing superior efficacy over vitamin D2. Encapsulation techniques improved stability and bioavailability. Fortifying staple foods like milk and eggs proved cost-effective compared with pharmaceutical interventions. Vitamin D food fortification significantly enhances serum levels and intake, with dairy and cereals being the most frequently fortified. Standardized fortification guidelines are essential to ensure safety and efficacy. Ongoing evaluation and region-specific policies are crucial for effectively optimizing fortification strategies and addressing vitamin D deficiency.

The dietary fiber and micronutrient composition of traditional foods from Lebanon and their contribution to dietary adequacy: A call for action

Traditional Lebanese cuisine is based on traditional dishes, where Arabic sweets play an important role in daily consumption. This study focuses on the evaluation of total fibers and trace elements, especially vitamins A, D, E, and C of traditional foods and Arabic sweets commonly consumed in Lebanon by chemical analysis. A total of thirty types of Arabic sweets were chosen from reputable confectionery establishments, while thirty varieties of traditional Lebanese dishes were collected from central kitchens in the main Lebanese governorates. It was discovered that 23% percent of Arabic sweets and 30% of traditional dishes were rich in total dietary fiber. Moreover, Arabic sweets had trace amounts of vitamin A, vitamin E, and vitamin C. In specific sweets, vitamin A content showed variability, with values ranging from 8ug to 15 ug per 100 g of edible portions. Most of the traditional dishes contained traces of vitamin C. However, Tabboula stood out as the only dish that contributed to over 23% of the recommended daily value for vitamin C. Trace amounts of vitamins A, D, E, and C were present in almost all traditional Lebanese foods and Arabic sweets. This study revealed that these foods lack essential micronutrients and total dietary fibers.

Vitamin D Deficiency-A Public Health Issue in Children

BACKGROUND

25-hydroxyvitamin D [25(OH)D] deficiency is a global health concern, particularly in pediatric populations, with implications for musculoskeletal health and overall well-being. This study aimed to evaluate serum 25(OH)D levels in a pediatric population and assess the prevalence of deficiency and insufficiency.

METHODS

A retrospective analysis was conducted on data from 741 pediatric patients (2-17 years old) who visited an urban hospital for children for acute respiratory and gastrointestinal conditions in the span of 2 years. Serum 25(OH)D levels were measured using chemiluminescent microparticle immunoassay. Statistical analyses were performed to assess the prevalence of deficiency and insufficiency, seasonal variations, and correlations with age and daylight exposure.

RESULTS

Of the 739 pediatric patients analyzed, a substantial proportion exhibited insufficient (31.80%) or deficient (36.54%) serum 25(OH)D levels. While younger age groups generally had higher mean 25(OH)D levels, a negative correlation was observed between 25(OH)D levels and age. Sunlight exposure variations did not significantly impact serum 25(OH)D levels. Despite diverse daylight exposure patterns, there were no significant differences between longer and shorter daylight periods.

CONCLUSIONS

This study highlights the high prevalence of 25(OH)D deficiency and insufficiency in the pediatric population, emphasizing the need for public health monitoring and targeted supplementation strategies. Findings underscore the importance of regular consultations with healthcare providers to ensure optimal 25(OH)D levels in children, with potential implications for revising current sufficiency thresholds. Addressing 25(OH)D deficiency is crucial for promoting musculoskeletal health and overall well-being in children.

Association of Vitamin D with Perfluorinated Alkyl Acids in Women with and without Non-Obese Polycystic Ovary Syndrome

BACKGROUND

Perfluorinated alkyl acids (PFAAs) are persistent organic pollutants affected by BMI and ethnicity, with contradictory reports of association with vitamin D deficiency.

METHODS

Twenty-nine Caucasian women with non-obese polycystic ovary syndrome (PCOS) and age- and BMI-matched Caucasian control women (n = 30) were recruited. Paired serum samples were analyzed for PFAAs (n = 13) using high-performance liquid chromatography-tandem mass spectrometry. Tandem mass spectrometry determined levels of 25(OH)D3 and the active 1,25(OH)2D3.

RESULTS

Women with and without PCOS did not differ in age, weight, insulin resistance, or systemic inflammation (C-reactive protein did not differ), but the free androgen index was increased. Four PFAAs were detected in all serum samples: perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS). Serum PFOS was higher in PCOS versus controls (geometric mean [GM] 3.9 vs. 3.1 ng/mL, p < 0.05). Linear regression modeling showed that elevated PFHxS had higher odds of a lower 25(OH)D3 (OR: 2.919, 95% CI 0.82-5.75, p = 0.04). Vitamin D did not differ between cohorts and did not correlate with any PFAAs, either alone or when the groups were combined. When vitamin D was stratified into sufficiency (>20 ng/mL) and deficiency (<20 ng/mL), no correlation with any PFAAs was seen.

CONCLUSIONS

While the analyses and findings here are exploratory in light of relatively small recruitment numbers, when age, BMI, and insulin resistance are accounted for, the PFAAs do not appear to be related to 25(OH)D3 or the active 1,25(OH)2D3 in this Caucasian population, nor do they appear to be associated with vitamin D deficiency, suggesting that future studies must account for these factors in the analysis.

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

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

Prospective cohort study of vitamin D deficiency in pregnancy: Prevalence and limited effectiveness of 1000 IU vitamin D supplementation

BACKGROUND

Vitamin D deficiency is highly prevalent worldwide among pregnant women. Although vitamin D supplementation is effective in improving vitamin D status, the safety and optimal dosing of vitamin D supplementation during pregnancy remain less well understood.

OBJECTIVE

This study aimed to investigate the prevalence of vitamin D deficiency among pregnant women and evaluate the effectiveness of vitamin D supplementation in improving vitamin D status during pregnancy.

DESIGN

This prospective cohort study assessed the impact of a 16-week daily vitamin D supplementation 1000 IU regimen on vitamin D status among pregnant women.

METHODS

A total of 365 pregnant women were recruited, and their baseline total circulating 25-hydroxy vitamin D concentrations were measured. Of these, 249 participants completed the study, which involved oral daily supplementation with 1000 IU of vitamin D and a repeat of total circulating 25-hydroxy vitamin D concentrations after 16 weeks.

RESULTS

The study found that 57.7% of the participants had vitamin D deficiency, consistent with the rates reported in other studies. However, vitamin D supplementation at a dose of 1000 IU had a small effect size and was not clinically significant. However, 67% of participants with vitamin D deficiency remained deficient; among participants initially with vitamin D insufficiency, 30% became deficient. Moreover, 26.5% of individuals with sufficient vitamin D status at 12 weeks showed insufficient levels by 28 weeks.

CONCLUSION

Vitamin D deficiency is widespread among pregnant women, and vitamin D supplementation at a daily dose of 1000 IU may not adequately address this problem. Although the study has limitations, its results align with previous research and may apply to other populations with a high prevalence of vitamin D deficiency during pregnancy. Further research is necessary to determine the most effective approach for addressing prenatal vitamin D deficiency.

Evaluation of the deficiency status of 25-hydroxyvitamin D and associated factors in Southwest China: A hospital-based retrospective cross-sectional analysis of a low-latitude, high-altitude, multiracial region

Vitamin D deficiency is widespread in different populations and regions worldwide and has become a global health issue. The vitamin D status of the population in the Yunnan Province of Southwest China has not been evaluated to date. Therefore, in this study, we evaluated the vitamin D status according to the serum concentrations of 25-hydroxyvitamin D (25(OH)D) in individuals of Yunnan Province, a low-latitude, high-altitude and multiracial region in China. The data on 25(OH)D concentrations from October 2012 to December 2017 were retrospectively collected and assessed using the laboratory information system from 52 950 hospital-based participants (age, 1 day-96 years; females, 73.74%). The serum concentration of 25(OH)D was evaluated using a chemiluminescent immunoassay. The analysis was stratified by sex, age, sampling season, testing year, minority, residential district, latitude, altitude and meteorological factors. Vitamin D status was classified as follows: severe deficiency: <10 ng/mL; deficiency: <20 ng/mL; insufficiency: <30 ng/mL; and sufficiency: ≥30 ng/mL. The results showed that vitamin D deficiency is highly prevalent in Yunnan Province in a hospital-based cohort, with a deficiency and severe deficiency rate of 65.1% and a sufficiency rate of 5.30%. Significantly lower vitamin D levels and sufficiency rates were observed in females than in males (20.13 ± 7.22 ng/mL vs. 17.56 ± 6.66 ng/mL and 8.20% vs. 4.20%; p < 0.01, respectively); in spring and winter (16.93 ± 6.24 ng/mL; 2.97% and 16.38 ± 6.43 ng/mL; 3.06%, respectively) than in summer and autumn (20.23 ± 7.14 ng/mL; 8.02% and 19.10 ± 6.97 ng/mL; 6.61% [p < 0.01], respectively); and in older individuals (0-6 years: 28.29 ± 13.13 ng/mL vs. >60 years: 14.88 ± 8.39 ng/mL; p < 0.01). Relatively higher vitamin D levels were observed in individuals of Yi, Zhuang, Hani, Dai, Miao and Lisu minorities and lower levels in individuals of Hui and Zang minorities compared with those of the Han nationality (p < 0.01). The mean sunlight duration, mean air temperature, maximum ultraviolet value and latitude were significantly correlated with vitamin D levels (r = -0.53, 0.60, 0.31, -0.68, respectively; p < 0.05). These results suggest that vitamin D status is influenced by sex, age, minority, latitude and some meteorological factors in areas with high and low altitudes. Hence, new public health policies, such as advice on sunshine exposure, food fortification and nutrition education, as well as the implementation of vitamin D supplementation programmes must be considered to alleviate vitamin D deficiency in Yunnan province, Southwest China.

Prevalence and predictors of vitamin D deficiency in Lebanon: 2016-2022, before and during the COVID-19 outbreak

BACKGROUND

Vitamin D deficiency is very common worldwide, particularly in Middle-Eastern countries. Recent Lebanese studies demonstrated an improvement in vitamin D status over time. However, the comparison between the years before and during the COVID-19 outbreak has never been analyzed in the Middle-East area. This study aimed to determine the prevalence and the predictors of 25-hydroxyvitamin D (25(OH)D) levels during the last 7 years.

METHODS

Serum 25(OH)D levels from a large laboratory database were retrospectively collected from Hôtel-Dieu de France Hospital between January 2016 and June 2022 (N = 66,127). Data related to age, gender, season and year of sampling were also retrieved.

RESULTS

Mean age of the population was 50.6 ± 19 years, 62.7% were women, 5.3% were children and adolescents, 67.6% adults and 27% elderly. Mean serum 25(OH)D level was 25.7 ± 11.9 ng/mL. The overall population with vitamin D sufficiency (>30 ng/mL) was 31.9%. The increase in mean serum 25(OH)D observed between 2016 and 2022 was 6.36 ng/mL (p < 0.0001). The prevalence of 25(OH)D deficiency (<30 ng/mL) decreased from 76.2% in 2016 to 56.5% in 2022 (p < 0.0001) with a significant difference between the period before and during the COVID-19 outbreak (72.3% vs.42.5%, p < 0.0001). In a multivariate logistic regression, older age, female sex, summer season, years of the COVID-19 outbreak and outpatient samples were protective factors against the risk of hypovitaminosis D (p < 0.0001 for all variables).

CONCLUSION

Our study showed a continuous positive change in vitamin D status time, most notably after the COVID-19 outbreak. Further studies are needed to assess the clinical impact of the pandemic on vitamin D status in our population.

Impact of Vitamin D Deficiency on Mental Health in University Students: A Cross-Sectional Study

Students pursuing a university education are vulnerable to psychological burdens such as depression, anxiety, and stress. The frequency of vitamin D deficiency, on the other hand, is extensively recognized worldwide, and vitamin D regulates various neurological pathways in the brain that control psychological function. Therefore, the goal of this cross-sectional study was to determine the relationship between vitamin D deficiency and psychological burden among university students in Riyadh, Saudi Arabia. During March-May 2021 in Riyadh, a cross-sectional comparative study survey was delivered to university students. The DASS-21 scale was used to determine the severity of the psychological burden. Both univariate and binomial regression analyses were conducted to analyze the level of significance and influence of several factors on the development of psychological burden. The data were analyzed with SPSS-IBM, and a p value of <0.05 was considered significant. Of the 480 students recruited for the study, 287 (59.79%) had a vitamin D deficiency. Significantly (p = 0.048), a high proportion of the vitamin D-deficient students attained a low or moderate GPA compared to the control cohort. The prevalence of depression, anxiety, and stress among the vitamin D-deficient students was 60.35%, 6.31%, and 75.08%, respectively, which was significantly (p < 0.05) different from the control group. The odds of developing depression (OR = 4.96; CI 2.22-6.78; p < 0.001), anxiety (OR = 3.87; CI 2.55-6.59; p < 0.001), and stress (OR = 4.77; CI 3.21-9.33; p < 0.001) were significantly higher in the vitamin D-deficient group. The research shows a strong association between psychological stress and vitamin D deficiency. To promote the mental health and psychological wellbeing of university students, it is critical to create awareness about the adequate consumption of vitamin D. Additionally, university students should be made aware of the likelihood of a loss in academic achievement owing to vitamin D deficiency, as well as the cascade effect of psychological burden.

Ethnic determinants of skeletal health in female patients with fragility fracture in a culturally diverse population

Background

Low bone density leads to fragility fracture, with significant impact on morbidity and mortality. While ethnic differences in bone density have been observed in healthy subjects, this has not yet been explored in fragility fracture patients.

Aims

To assess if ethnicity is associated with bone mineral density and serum markers of bone health in female patients who experience fragility fractures.

Methods

219 female patients presenting with at least one fragility fracture at a major tertiary hospital in Western Sydney Australia were studied. Western Sydney is a region with great cultural diversity, comprising people from over 170 ethnicities. Within this cohort, the three largest broad ethnic groups were Caucasians (62.1 %), Asians (22.8 %), and Middle Eastern patients (15.1 %). Location and nature of the presenting fracture and other relevant past medical history were obtained. Bone mineral density, measured by dual-energy X-ray absorptiometry, and bone-related serum markers were compared between ethnicities. Covariates (age, height, weight, diabetes, smoking, and at-risk drinking) were adjusted in multiple linear regression model.

Results

Although Asian ethnicity was associated with lower bone mineral density at the lumbar spine in fragility fracture patients, this association was no longer significant after adjustment for weight. Ethnicity (Asian or Middle Eastern) was not a determinant of bone mineral density at any other skeletal site. Caucasians had lower estimated glomerular filtration rate compared to Asian and Middle Eastern subjects. Serum parathyroid hormone concentrations were significantly lower in Asians compared to other ethnicities.

Conclusion

Asian ethnicity and Middle Eastern ethnicity were not major determinants of bone mineral density at the lumbar spine, femoral neck, or total hip.

The Association Between Vitamin D Level and Chest Pain, Anxiety, and Fatigue in Patients With Coronary Artery Disease

This study sought to assess the association between vitamin D deficiency (VDD) and chest pain, anxiety, and fatigue in patients with coronary artery disease (CAD). A cross-sectional study was conducted to collect data from a sample of 90 participants with CAD. Serum 25OHD3 was measured using a radioimmunoassay procedure. Chest pain was assessed using the Numeric Pain Rating Scale, anxiety using the Anxiety Subscale, and fatigue by the General Fatigue subscale. The majority of participants (80%) had VDD. Results showed that the level of vitamin D was significantly negatively associated with chest pain (r = -.43, p = .00); anxiety (r = -.466, p = .00); and fatigue (r = -.25, p = .018). Findings suggest the role of VDD in heightened central sensitivity in cardiac-related symptoms such as chest pain, anxiety, and fatigue. Patients with CAD should be monitored for VDD so that the condition can be corrected.

Improved HDL Cholesterol through Vitamin D Status Correction Substantially Lowers 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Vitamin D-Deficient Arab Adults

This interventional study aimed to determine whether correcting vitamin D status in deficient Arab adults [25(OH)D <50 nmol/L] improves their 10-year risk of Atherosclerotic Cardiovascular Disease (ASCVD) risk scores. Saudi adults (58 males 62 females) with baseline vitamin D deficiency (<50 nmol/L) were given 50,000 IU cholecalciferol weekly for 2 months, then twice a month, followed by daily 1000 IU until month 6. Fasting blood samples were collected pre- and post-intervention and assessed for glucose, lipids, and 25(OH)D levels. The predicted 10-year ASCVD risk scores were calculated at baseline and after intervention. At baseline, significantly higher 10-year ASCDV risk scores were observed in males than females (9% vs. 3%, p < 0.001). After 6 months, only 21% (25 out of 120) achieved 25(OH)D levels above optimal level (≥75 nmol/L). While modest improvements were seen in glucose and lipid profiles, only HDL cholesterol showed favorable significant changes in all participants, which translated to significantly improved 10-year ASCVD risk scores independent of whether they achieved optimum vitamin D status. Still, those who achieved optimal vitamin D levels had a modestly larger decrease in ASCVD risk scores than those with less optimal 25(OH)D levels (-23% versus -18%) and this improvement was slightly more pronounced in males (-26% versus -10%, or 16% improvement) than females (-47% versus -32%, or 15% improvement). In conclusion, vitamin D status correction significantly enhances HDL cholesterol which prospectively reduces 10-year ASCVD risk as vitamin D levels approach optimum status among adult Arabs with baseline vitamin D deficiency. This improvement appears to be slightly more apparent in males than females.

Knowledge about Vitamin D among Women in the United Arab Emirates

Vitamin D deficiency is a significant public health issue as it affects almost 90% of the United Arab Emirates (UAE) population. A bigger portion of this percentage is women due to the physiological changes throughout their life cycle. This study aims to assess the knowledge about vitamin D among women in the UAE. This is a quantitative cross-sectional study. Using snowball sampling, an electronic questionnaire was sent to women aged 18 years and above. Overall, 1537 women completed the questionnaire. The participants had mean scores of 49.4 ± 10.7 and 59.6 ± 14.6 for general and nutritional knowledge, respectively. Factors associated with higher scores included older age, marriage, higher educational level, and having tested their vitamin D levels. Factors associated with lower scores included the history of a chronic illness and being employed. Findings indicate that women in this study showed a low level of vitamin D knowledge specifically regarding the non-skeletal benefits of vitamin D and factors that affect vitamin D synthesis. Therefore, health education and promotion programs must be implemented across the UAE to improve overall awareness about vitamin D.

Vitamin D status of the Russian adult population from 2013 to 2018

Vitamin D deficiency is widespread globally, however available data for the Russian adult population is fragmented. This cross-sectional study used secondary data for individuals undergoing testing for vitamin D concentrations from 2013 to 2018 by InVitro laboratory. 25(OH)D serum concentration was determined using chemiluminescent microparticle immunoassay. The mean, median, and proportion with severe, deficient, insufficient and sufficient 25-hydroxyvitamin D (25(OH)D) concentrations were estimated. Splines examined the effect of latitude on 25(OH)D concentrations. Data were available for 30,040 subjects age ≥ 18 years. 24.2% of the sampled population had sufficient (30-< 150 25(OH)D ng/mL), 34% deficient (10-19.9 ng/mL) and 5.6% severely deficient (< 10 ng/mL) status. Average 25(OH)D concentrations were highest among 30-44 years and lowest amongst older adults; females had modestly higher values. Concentrations were 15% higher in fall/summer vs. winter/spring. A non-linear relationship was observed by latitude; the highest 25(OH)D concentrations were observed near 54°N, decreasing at more southern latitudes for women and more northern latitudes for both sexes. These results are comparable to other Northern European publications and limited Russian samples demonstrating low concentrations. Acknowledging that nationally-representative and randomly sampled data are needed, the present data suggest the burden may be high and identifies some population sub-groups and geographic areas with a higher potential deficiency of vitamin D.

Vitamin D and musculoskeletal health: outstanding aspects to be considered in the light of current evidence

Vitamin D enhances calcium absorption and bone mineralisation, promotes maintenance of muscle function, and is crucial for musculoskeletal health. Low vitamin D status triggers secondary hyperparathyroidism, increases bone loss, and leads to muscle weakness. The primary physiologic function of vitamin D and its metabolites is maintaining calcium homeostasis for metabolic functioning, signal transduction, and neuromuscular activity. A considerable amount of human evidence supports the well-recognised contribution of adequate serum 25-hydroxyvitamin D concentrations for bone homeostasis maintenance and prevention and treatment strategies for osteoporosis when combined with adequate calcium intake. This paper aimed to review the literature published, mainly in the last 20 years, on the effect of vitamin D and its supplementation for musculoskeletal health in order to identify the aspects that remain unclear or controversial and therefore require further investigation and debate. There is a clear need for consistent data to establish realistic and meaningful recommendations of vitamin D status that consider different population groups and locations. Moreover, there is still a lack of consensus on thresholds for vitamin D deficiency and optimal status as well as toxicity, optimal intake of vitamin D, vitamin D supplement alone as a strategy to prevent fractures and falls, recommended sun exposure at different latitudes and for different skin pigmentations, and the extra skeletal effects of vitamin D.

Factors Associated with Low Vitamin D Status among Older Adults in Kuwait

Low vitamin D levels among older people represent a significant health problem worldwide. This study aimed to examine the factors associated with vitamin D deficiency in older people (aged ≥ 65) in the Kuwaiti population. A cross-sectional study was conducted in seven primary healthcare centers across Kuwait (November 2020 to June 2021). The participants (n = 237) had their serum vitamin D (25(OH)D) concentrations (analyzed using LC-MS) classified as sufficiency 75 nmol/L (30 ng/mL) or deficiency < 75 nmol/L (below 30 ng/mL). The data were collected using self-administered questionnaires and face-to-face interviews with participants in geriatric clinics. Binomial logistic regression analysis was applied to assess factors associated with vitamin D deficiency. Vitamin D deficiency was found to be present in two thirds of the participants (n = 150, 63%), with a higher prevalence of deficiency in participants who did not receive vitamin D supplements, compared to those who did (84% vs. 16%, p = 0.001). The results from the binary logistic regression showed that a low duration of sun exposure (OR = 0.24, 95% C.I. [0.08−0.7], p = 0.011), dark skin pigmentation (OR = 4.46, 95% [1.35−20.49], p = 0.026), and lower caloric intake (OR = 0.9, 95% C.I. [0.85−0.96], p = 0.001) were risk factors for vitamin D deficiency. Furthermore, a significant inverse relationship was found between vitamin D levels and parathyroid hormone (PTH) levels (OR = 1.16, 95% C.I. [1.04−1.31], p = 0.016). These findings support the recommendation that vitamin D supplementation and adequate sunlight exposure are necessary for raising low vitamin D levels in older people in Kuwait.

Prevalence and Correlates of Vitamin D Deficiency in Children Aged Less than Two Years: A Cross-Sectional Study from Aseer Region, Southwestern Saudi Arabia

Background: Vitamin D is an essential nutrient for bone growth, mineralization, and other metabolic processes in the human body. Hence, insufficiency or deficiency of this vitamin can have long-term effects, particularly for children. Objectives: The aims of this study were to determine the prevalence of vitamin D deficiency in children up to 2 years of age and investigate the independent predictors of vitamin D deficiency. Methodology: This cross-sectional study was conducted among 484 children aged up to two years who were admitted to the hospital for the treatment of any acute condition from January to November 2021. Serum 25(OH)D was used to determine the level of vitamin D. The serum 25(OH)D was categorized into 3 groups: Sufficiency (>30 ng/mL), insufficiency (20−30 ng/mL), and the deficiency (<20 ng/mL). Results: Overall, vitamin D deficiency was observed in 70.5% of the children, of whom 45.9% had insufficient levels, and one-fourth (24.6%) showed deficiency. The children aged 2−12 months (infants) were more likely to be vitamin deficient compared to children aged 12 months and above. The children who lived in urban areas had a threefold increased risk of vitamin D deficiency (aOR = 3.0, 95% CI 1.78−5.08). The children who were exposed to sunlight for less than 3 days per week experienced a higher risk of developing vitamin D deficiency (aOR = 4.17, 95% CI 2.04−10.88). Children who had received only breast milk were more than two times more likely to experience vitamin D deficiency (aOR = 2.42, 95% CI 1.12−5.23) compared to their counterparts. Conclusion: Our study reveals a high prevalence of vitamin D deficiency among children aged up to two years. Infants, urban dwellers, only breastfed, and exposure to sunlight for less than three days per week were identified to be the independent risk factors for vitamin D deficiency. The results of this work call for enhancing awareness to ensure adequate levels of vitamin D for better health of the children in this region of Saudi Arabia.

Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness

Objective

Studies have demonstrated a potential correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This retrospective study examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2.

Participants

The records of individuals admitted between April 7^th, 2020 and February 4^th, 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel, with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) were searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test.

Design

Patients admitted to GMC with COVID-19 were categorized according to disease severity and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity was ascertained utilizing a multivariable regression analysis. To isolate the possible influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a cosinor model was used.

Results

Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection. A lower vitamin D status was more common in patients with the severe or critical disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 ng/mL [34.3%] p < 0.001). Patients with vitamin D deficiency (<20 ng/mL) were 14 times more likely to have severe or critical disease than patients with 25(OH)D ≥40 ng/mL (odds ratio [OR], 14; 95% confidence interval [CI], 4 to 51; p < 0.001).

Conclusions

Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.

Impact evaluation of the efficacy of different doses of vitamin D supplementation during pregnancy on pregnancy and birth outcomes: a randomised, controlled, dose comparison trial in Pakistan

Background

Vitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn.

Methods

We conducted a double-blinded, randomised controlled trial in Karachi, Pakistan to evaluate the effect of different doses of vitamin D supplementation during pregnancy on biochemical markers (serum 25(OH)D, calcium, phosphorus and alkaline phosphatase) in women and neonates, and on pregnancy and birth outcomes (gestational diabetes, pre-eclampsia, low birth weight, preterm births and stillbirths).

Results

Pregnant women (N=350) in their first trimester were recruited and randomised to three treatment groups of vitamin D supplementation: 4000 IU/day (group A, n=120), 2000 IU/day (group B, n=115) or 400 IU/day (group C, n=115). Women and their newborn in group A had the lowest vitamin D deficiency at endline (endline: 75.9%; neonatal: 64.9%), followed by group B (endline: 84.9%; neonatal: 73.7%) and then the control group (endline: 90.2%; neonatal: 91.8%). Vitamin D deficiency was significantly lower in group A than in group C (p=0.006) among women at endline and lower in both groups A and B than in the control group (p=0.001) in neonates. Within groups, serum 25(OH)D was significantly higher between baseline and endline in group A and between maternal baseline and neonatal levels in groups A and B. Participant serum 25(OH)D levels at the end of the trial were positively correlated with those in intervention group A (4000 IU/day) (β=4.16, 95% CI 1.6 to 6.7, p=0.002), with food group consumption (β=0.95, 95% CI 0.01 to 1.89, p=0.047) and with baseline levels of serum 25(OH)D (β=0.43, 95% CI 0.29 to 0.58, p<0.0001).

Conclusion

The evidence provided in our study indicates that vitamin D supplementation of 4000 IU/day was more effective in reducing vitamin D deficiency among pregnant women and in improving serum 25(OH)D levels in mothers and their neonates compared with 2000 IU/day and 400 IU/day.

Trial registration number NCT02215213.

Circulating MicroRNA Expression, Vitamin D, and Hypercortisolism as Predictors of Osteoporosis in Elderly Postmenopausal Women

BACKGROUND

MicroRNAs (miRNA) identified as critical molecular regulators for bone development, function, and modeling/remodeling process and could be predictable for osteoporotic fractures in postmenopausal elderly women.

AIM

The potential diagnostic role of circulating miRNAs, miR-148a and miR-122-5p, in the pathogenesis of osteoporosis and its association with bone markers, hypercortisolism, and vitamin D deficiency were explored in postmenopausal elderly women with osteoporosis.

METHODS

A total of 120 elderly women aged 50-80 years old were recruited in this study, of which only 100 eligible women with amenorrhea of at least 12 consecutive months or surgical menopause participated in this study. Based upon bone mineral density (BMD) measurements, the participants were classified according into two groups: normal (n = 45; T score of ≥-1.0) and osteoporosis (n = 55; T score: ≤-2.5). Circulating miRNAs, miR-148a and miR-122-5p, were estimated by real-time RT-PCR analysis. In addition, bone markers, hypercortisolism, and vitamin D deficiency were colorimetrically and ELISA immune assay estimated. The potential role of miR-148a, miR-122-5p, cortisol, and vitamin D in the diagnosis of osteoporosis was predicted using the analysis of the respective area under the receiver operating characteristic curve (AUC-ROC).

RESULTS

The expressed level of miR-148a significantly increased and miR-122-5p significantly decreased in the serum of osteoporotic patients compared to healthy controls. In addition, a significant increase in the levels of cortisol, s-BAP, and CTx and significant decrease in the levels of T-BMD, the levels of OC, and s-Ca were also identified. All parameters significantly correlated with fracture risk parameters; BMD, and T score lumbar spine (L2-L4). Thus, the data showed AUC cut off values (miR-148a; 0.876, miR-122-5p; 0.761) were best evaluated for clinical diagnosis of patients with osteoporosis and that AUC cut off values of 0.748 for cortisol and 0.635 for vitamin D were the best cut off values, respectively, reported for the prediction of osteoporosis clinical diagnosis.

CONCLUSION

In this study, expressed miRNAs miR-148a and miR-122-5p and changes in the levels of both cortisol and vitamin D status are significantly associated with bone loss or osteoporosis. Thus, circulation miRNAs alone or in combination with cortisol and vitamin D status might be considered predictable biomarkers in the diagnosis or the pathogenesis of osteoporosis in elderly postmenopausal women; however, more studies are recommended.

Association of Vitamin D deficiency with primary glaucoma among Saudi population - A pilot study

PURPOSE

Glaucoma is a complex multifactorial disorder that is influenced by various systemic conditions. Several studies investigated the association between systemic factors such as Vitamin D deficiency for glaucoma development and reported contradicted findings. The aim of this study was to assess Vitamin D levels in glaucomatous Saudi subjects and its association with cup/disc ratio in primary open- and closed-angle glaucoma.

METHODS

This was a pilot study that included subjects aged 41-78 years from both genders recruited from a tertiary hospital, Riyadh city, Kingdom of Saudi Arabia. Subjects were divided into three groups: Group 1: subjects with primary open-angle glaucoma (POAG), Group 2: subjects with primary angle-closure glaucoma (PACG), and Group 3: control subjects. All participants underwent detailed ophthalmic examinations including visual acuity, intraocular pressure measurement (IOP), gonioscopy, and fundus examinations. In addition, blood samples were collected from glaucoma patients and controls to measure the serum 25-hydroxyvitamin D levels.

RESULTS

A total of 75 subjects were included in this study. Measurement of IOP was within the range of 9-27 for all subjects. Mean serum 25-hydroxyvitamin D levels were 72.58 ± 31.79, 69.20 ± 24.24, and 67.14 ± 29.02 in Groups 1, 2, and 3, respectively. There were insignificant differences in Vitamin D levels among the three groups (P > 0.05). Moreover, no significant correlation was noted between Vitamin D levels and cup/disc ratio in Groups 1 and 2.

CONCLUSION

No association was found between Vitamin D deficiency and both POAG and PACG among Saudi population despite low serum level of Vitamin D in glaucomatous and control subjects. This study suggested that Vitamin D level may not contribute in augmenting the severity and progression of glaucoma.

Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX survey

Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment.

PURPOSE

We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels.

METHODS

An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL.

RESULTS

A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH)D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)].

CONCLUSIONS

High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.

Assessment of serum vitamin D levels in Egyptian children with beta-thalassemia major

Background

Beta-thalassemia major patients are at increased risk of complications including endocrinopathies and bone disease due to iron overload. So, this study aimed to assess the growth parameters, serum levels of 25-OH-vitamin D, calcium, and phosphorous in children with beta-thalassemia major. This was a case-control study that included 55 children with beta-thalassemia major compared with 30 sex- and age-matched healthy children that served as a control group. All enrolled children were subjected to full history taking, clinical examination including anthropometric measurements, and laboratory investigations including complete blood count, serum ferritin, levels of serum calcium, phosphorus, and 25-OH-vitamin D.

Results

Body mass index was statistically significantly lower in the thalassemic group (P < 0.001). It was observed that vitamin D levels were significantly lower in thalassemic patients than in controls (P value < .0001). The mean serum 25-OH-vitamin D levels were 19.84 ± 5.79 ng/ml and 44.98 ± 5.77 ng/ml, respectively; 22 cases (40%) had insufficient vitamin D, and 5 cases (9%) had deficient vitamin D. Regarding serum calcium and phosphorous, there was no significant difference between the thalassemic and control groups.

Conclusion

Children with beta-thalassemia major had low body mass index and metabolic abnormality in the form of lower serum levels of vitamin D that signify the importance of therapeutic interventions.

Vitamin D3 Dose Requirement That Raises 25-Hydroxyvitamin D to Desirable Level in Overweight and Obese Elderly

CONTEXT

Guidelines for the dosage of vitamin D supplementation vary widely globally.

OBJECTIVE

To investigate the impact of 2 vitamin D doses, bracketed between the IOM recommended dietary allowance (RDA) and the upper tolerable limit, on vitamin D nutritional status in elderly individuals.

METHODS

This post hoc analysis of data collected from a 12-month, double-blind, randomized control trial included 221 ambulatory participants (≥ 65 years) with a mean BMI of 30.2 kg/m2 and a mean baseline serum 25-hydroxyvitamin D [25(OH)D] level of 20.4 ± 7.4 ng/mL, who were recruited from 3 outpatient centers in Lebanon. All participants received 1000 mg of elemental calcium daily from calcium citrate plus the daily equivalent of either 600 IU or 3750 IU of vitamin D3.

RESULTS

Mean 25(OH)D level at 12 months was 26.0 ng/mL with low dose and 36.0 ng/mL with high dose vitamin D3. The proportion of participants reaching a value ≥ 20 ng/mL was 86% in the low dose, and 99% in the high dose arms, with no gender differences. The increment of 25(OH)D per 100 IU/day was 1 ng/mL with the low dose, and 0.41 ng/mL with the high dose. Serum 25(OH)D levels at 1 year were highly variable in both treatment arms. Baseline 25(OH)D level and vitamin D dose-but not age, BMI, gender, or season-were significant predictors of serum 25(OH)D level post-intervention.

CONCLUSION

The IOM Recommended Dietary Allowance (RDA) of 600 IU/day does not bring 97.5% of ambulatory elderly individuals above the desirable threshold of 20 ng/mL. Country-specific RDAs are best derived taking into account the observed variability and predictors of achieved 25(OH)D levels.

Vitamin D Regulates the Expression of Glucocorticoid Receptors in Blood of Severe Asthmatic Patients

Purpose

Vitamin D (VitD) deficiency is a significant public health concern in many areas around the globe and has been associated with many immune-mediated diseases, including asthma. Severe asthma has been linked to a decreased glucocorticoid receptor (GR) ratio (GR-α/GR-β ratio), indicating steroid hyporesponsiveness. Using a combination of in silico and in vivo approaches, we aimed to explore the immunomodulatory effect of VitD on asthmatic patients diagnosed with hypovitaminosis D.

Methods

In silico tools were used to identify the regulatory effect of VitD supplementation on GR genes. We measured the expression levels of GR-α and the inactive isoform, GR-β, in the blood of adult asthmatics diagnosed with hypovitaminosis D before and after VitD supplementation. Moreover, the blood levels of inflammatory cytokines associated with asthma severity were determined.

Results

Using an in silico approach, we identified specific genes commonly targeted by VitD as well as corticosteroids, the mainstay of asthma therapy. NR3C1 gene encoding GR was found to be significantly upregulated on Th2 CD4 cells and NK cells. Interestingly, blood expression level of NR3C1 was lower in severe asthmatics compared to nonsevere asthmatics and healthy controls, while the blood level of VitD receptor (VDR) was higher. Upon VitD supplementation of severe asthmatic patients, there was a significant increase in the blood levels of GR-α with no change in GR-β mRNA expression. VitD supplementation also suppressed the blood levels of IL-17F and IL-4.

Conclusion

VitD may enhance steroid responsiveness by upregulating the expression of steroid receptor GR-α.

Vitamin D deficiency effects on cardiovascular parameters in women with polycystic ovary syndrome: A retrospective, cross-sectional study

PURPOSE

Polycystic ovary syndrome (PCOS) is associated with vitamin D deficiency (25-hydroxyvitamin D (25(OH)D), and both are associated with increased cardiovascular risk; therefore, the combination of PCOS and moderate vitamin D deficiency may exacerbate the cardiovascular and metabolic characteristics in women with PCOS. This study sought to address this question.

METHODS

In this retrospective, cross-sectional study, demographic and metabolic data from women aged 18-40 years from the Qatar Biobank (QBB) (78 diagnosed with PCOS, 641 controls) was analyzed.

RESULTS

Moderate vitamin D deficiency was seen in both normal and PCOS cohorts irrespective of body mass index (BMI) stratification into normal, overweight and obese. Significant differences in free androgen index (FAI) and high density lipoproteins (HDL) (p < 0.05) were seen in PCOS irrespective of BMI, though insulin resistance and increased C-reactive protein (CRP) (p < 0.05) were seen only in obese PCOS subjects; however, there was no correlation (Pearson coefficient) of any these parameters with vitamin D for women with or without PCOS, nor when vitamin D deficiency was compared to vitamin D insufficiency (above and below 20 ng/mL, respectively) between the normal and PCOS groups.

CONCLUSION

Moderate vitamin D deficiency did not associate with nor exacerbate insulin resistance, androgen levels, inflammation or cardiovascular risk indices in women with PCOS, suggesting that a prospective study on vitamin D deficiency to confirm non-causality is required.

Risk of hypercalcemia in patients with very high serum 25-OH vitamin D levels

OBJECTIVE

We aimed to evaluate the risk of hypercalcemia in patients with very high levels of 25-hydroxy vitamin D (25(OH)D).

METHODS

The distribution of patients who were screened for 25(OH)D in our hospital between January 2014 and December 2018 was evaluated and patients with serum concentrations of 25(OH)D >88 ng/mL were selected. Then, biochemical parameters of the cases with 25(OH)D >88 ng/mL were compared according to calcium status, vitamin D level (group 1, 88-100 ng/mL; group 2, 100-150 ng/mL, and group 3, >150 ng/mL), and gender.

RESULTS

A total of 282 932 patients who underwent 25(OH)D tests in our hospital were evaluated. A total of 1311 (0.5%) patients had very high 25(OH)D levels (>88 ng/mL). Four hundred and ninety-five patients who met our inclusion criteria and had complete data participated in the study. The median age was 58 years (interquartile range [IQR] = 41-71 years) and the median level of 25(OH)D was 104.6 mg/mL (IQR = 94.9-124.9 ng/mL). Most of the subjects (83.7%) with very high 25(OH)D levels were normocalcemic. A weak inverse correlation was observed between 25(OH)D level and intact parathyroid hormone (iPTH) level (r = -0.118, P = .01), but no correlation between 25(OH)D and calcium levels was observed. Alkaline phosphatase (ALP) levels were significantly higher in males (P = .032), and age and iPTH levels were higher in females (P < .001 and P = .004). ALP, phosphorus levels, and iPTH suppression rates were higher in hypercalcemic patients (P < .001, P < .001, and P < .001, respectively), while the iPTH level was significantly lower in hypercalcemic patients (P < .001) than in normocalcemic patients. Amongst the three groups with different 25(OH)D levels, no difference was found in levels of iPTH, calcium, phosphorus, ALP, or age.

CONCLUSION

Most patients with very high vitamin D levels were normocalcemic, but severe hypercalcemia was also observed. Vitamin D replacement therapy and follow-up should be performed according to clinical guideline recommendations.

Association of vitamin D deficiency and insulin resistance with breast cancer in premenopausal Algerian women: A cross-sectional study

BACKGROUND

Low 25(OH)D levels are mainly related to breast cancer (BC) risk in postmenopausal women, while the impact of insulin resistance (IR) on BC prognosis is controversial.

OBJECTIVE

Considering the high prevalence of BC in younger Algerian women, this cross-sectional study analyzed whether vitamin D status and IR are biomarkers for breast tumor status in premenopausal women.

METHODS

In 96 women (mean age, 40.96±0.65years) newly diagnosed with BC, tumor status was determined immunohistochemically, classified by molecular subtype, then correlated with body-mass index, total plasma 25(OH)D, insulin and glucose levels and HOMA-IR, using chi², Student t, Spearman and ANOVA tests and multivariate logistic regression.

RESULTS

66 of the 98 patients (68.75%) showed vitamin D deficiency (9.74ng/mL). Overweight and obese patients with HOMA-IR >2.5, positive for HER2 and with high Ki-67 index had the most severe vitamin D deficiency. There was a significant association between vitamin D deficiency, high Ki-67 index (OR, 14.55; 95% CI, 3.43-82.59; p=0.00078) and IR (OR, 4.99; 95% CI, 1.27-24.47; p=0.03), and between IR and HER2-positivity (OR, 3.23; 95% CI, 1.05-10.56; p=0.04).

CONCLUSIONS

Vitamin D deficiency and IR are potential biomarkers for poorer prognosis in BC patients, independently of and/or synergically with high Ki-67 index and HER2-positivity in premenopausal overweight or obese women. The potential relationship of vitamin D receptor gene expression with breast cancer survival in Algerian patients will be investigated in a large cohort.

Vitamin D deficiency in children with bronchial asthma in southern Jordan: a cross-sectional study

Objectives

To assess serum 25-hydroxycholecalciferol (25-OH vitamin D) levels in Jordanian children with bronchial asthma, and to examine correlations between 25-OH vitamin D levels and asthma severity and control.

Methods

A cross-sectional study was conducted at the Paediatric Chest Clinic, Al-Karak Governmental Hospital, Southern Jordan, between May 2015 and February 2016. Serum 25-hydroxyvitamin D level was determined in children aged 1–14 years diagnosed with bronchial asthma (6–14 years) or recurrent wheezing episodes (<6 years). Asthma severity was determined based on the Global Initiative for Asthma assessment, the Asthma Control Test, and the Childhood Asthma Control Test. Demographic and clinical characteristics were compared between patients with low and normal 25-OH vitamin D levels, and correlations between asthma severity and 25-OH vitamin D level were assessed.

Results

Out of 98 included children, 25-OH vitamin D levels were deficient and insufficient in 41 (41.8%) and 34 (34.7%) children, respectively. Only 23 (23.5%) had sufficient 25-OH vitamin D levels. A significant correlation was found between severity of asthma symptoms and 25-OH vitamin D deficiency.

Conclusion

25-OH vitamin D deficiency is highly prevalent in Jordanian children with bronchial asthma and correlates significantly with asthma severity.

Vitamin D Metabolic Profiles in Premenopausal Women Wearing Niqab and Hijab in Sunny Basrah

Background Conservative clothing like niqab and hijab may affect the wearer's vitamin D metabolic parameters even in predominantly sunny areas of the world (i.e., areas with adequate sunlight exposure throughout the year). Our objective was to evaluate the effect of wearing the niqab or hijab on different vitamin D3 metabolic parameters in a sample of premenopausal women from Basrah. Methodology This was a cross-sectional observational study on premenopausal women who wore a niqab (n = 64), with a comparable age-matched group of women who wore the hijab (n = 60). Biochemical evaluation of the vitamin D3 metabolic profile involved 25-hydroxycholecalciferol (25-OH)-vitamin D, corrected serum calcium, parathyroid hormone (PTH), phosphorus, and alkaline phosphatase estimation. Statistical comparison of these parameters was made using the independent sample t-test and Mann-Whitney-U test. Results The two groups of women were age- and weight-matched, with a median age of 39 and median body mass index (BMI) of 31.8 kg/m2. Overall, age, marital status, and BMI of women in both groups had no significant relationship with the vitamin D3 metabolic parameters (low 25-OH-vitamin D, low corrected calcium, and high PTH). The subgroup analysis for women wearing the niqab showed the same results. Conclusions Wearing niqab or hijab in premenopausal women was not associated with any significant statistical relationship or difference in vitamin D3 metabolic parameters. Conservative dress styles like niqab and hijab are practical barriers to sun exposure and contribute to suboptimal vitamin D levels, affecting subsequent metabolic pathways. Healthcare professionals should advise women who wear niqab or hijab to increase their vitamin D3 levels through culturally appropriate alternative mechanisms.

Vitamin D level in a sample of Egyptian females of childbearing age attending a family medicine center

BACKGROUND

Vitamin D deficiency is now recognised as a pandemic. The normal range of Vitamin D in the Arab countries is much lower than the international standards. Several Arab countries have published studies assessing serum Vitamin D levels among women--to date there is no national study assessing Vitamin D levels among Egyptian women.

OBJECTIVE

The aim of the study is to measure Vitamin D level among Egyptian women of childbearing age.

PATIENTS AND METHODS

We included 100 healthy adult females of childbearing age, who were attending a family medicine center in Cairo, Egypt. A validated interview questionnaire was conducted with participants, thereafter BMI and serum 25 (OH) Vitamin D levels were measured.

RESULTS

The age of the included women ranged from 19 to 49 years old with a mean age of 34 ± 8.47 years. Only 39% of participants were employed and 61% were housewives. About 76% of participants were married, 20% unmarried and 4% divorced. Most of participants (82%) wore hijab; only 9% wore niqab and 9% wore no scarf. Only 44% of participants had normal levels of Vitamin D (˃20-150 ng/mL). About 43% of the participants were Vitamin D deficient and 13% were Vitamin D insufficiency.

CONCLUSION

Vitamin D deficiency and insufficiency are prevalent among Egyptian women of childbearing age. A routine monitoring screening for Vitamin D deficiency and Vitamin D health education are required to minimise risk factors among women of childbearing age.

Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence

Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.

The microclimatic impacts of urban spaces on the behaviour of pandemics between propagation and containment: Case study historic Cairo

Although previous researches proved that frequent visits to urban spaces enhance the physical and mental health of people, most governments adopted lockdown policies after the outbreak of COVID-19. This decision has negatively impacted the wellbeing of communities and the livability of urban spaces. In this context the research questions how far the microclimatic conditions of urban space would influence its performance during respiratory pandemics? The study investigated this question through a dense literature survey including 47 scientific journal articles and governmental reports. The outputs were synthesized through a quantitative assessment framework. It detected the spatio-environmental parameters influencing the behaviour of respiratory pandemics in urban settings. To validate the framework's outputs, the research applied case study sampling for 3 urban spaces in historic Cairo. It generated digital simulations and computations addressing solar radiation, natural ventilation, air temperature, and humidity, besides space dimension and number of users. The results illustrated the areas of adequate and poor microclimatic performance during pandemics. They are demonstrated through numerical tables, digital simulations, and graphs. Eventually, a concluding assessment framework selected the optimum urban space performance to be engaged in the public life of historic Cairo during lockdown periods.

Serum 25-Hydroxyvitamin D Concentrations and Cardiometabolic Biomarkers in Chinese Rural Population

There is a paucity of data on the relation between serum 25-hydroxyvitamin D [25(OH)D] concentration and cardiometabolic biomarkers in the Chinese population. To comprehensively and quantitatively examine the association of 25(OH)D and cardiometabolic traits, we conducted a cross-sectional study in the Chinese rural population. Serum 25(OH)D and eight cardiometabolic biomarkers were measured in 1714 individuals from Henan province, China. Scatter plot was used to visualize the distribution and correlation of 25(OH)D and cardiometabolic indicators. Moreover, multivariate linear regressions and restricted cubic spline (RCS) functions were performed to examine the quantitative association between the serum 25(OH)D and cardiometabolic parameters. The median serum 25(OH)D level was 19.94 ng/ml in all participants, with an estimated 50.12% presenting vitamin D deficiency. Serum 25(OH)D level showed significantly modest association with cardiometabolic parameters (p<0.05) except for diastolic blood pressure (r=0.03, p=0.22). Multiple linear regression models showed that 25(OH)D concentration was positively associated with high-density lipoprotein cholesterol (HDL-C) and negatively associated with low-density lipoprotein cholesterol (LDL-C) and fasting serum glucose (GLU). The results of restricted cubic spline models indicated a positively linear association of 25(OH)D with HDL-C (p for overall<0.001, p for nonlinearity=0.191) and a negatively linear association with GLU (p for overall=0.024, p for nonlinearity=0.095). Overall, vitamin D deficiency was very common among Chinese rural population living near the 34 degrees north latitude. Besides, there were significant association between 25(OH)D concentrations and cardiometabolic biomarkers including HDL-C and GLU levels. Future longitudinal studies and randomized trials are warranted to clarify the causal relationship.

Daily vitamin D3 in overweight and obese children and adolescents: a randomized controlled trial

PURPOSE

To assess the efficacy of different doses of vitamin D₃ on serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone(iPTH), calcium, phosphorus, and alkaline phosphatase concentrations in overweight and obese school-children.

METHODS

A total of 378 children and adolescents, 6-13 years of age, with age- and sex-specific body mass index(BMI) Z-score ≥ 1(according to the World Health Organization criteria) were allocated to receive 600, 1000, and 2000 IU vitamin D₃/days. 25(OH)D, iPTH, calcium, phosphorus, and alkaline phosphatase concentrations were measured at baseline, 6, and 12 months. In this intention-to-treat analysis, we fitted a linear mixed effect model involving a random effect of participants within treatment groups and fixed effects of dose, time, and their interactions.

RESULTS

Mean(SD) of age and BMI Z-score were 9.3 (1.7) years and 2.55 (0.73), respectively. The median (IQR) for 25(OH)D was 11.5 (8.9), 11.7 (10.5), 12.2 (10.2) ng/mL (28.75, 29.25, and 30.50 nmol/L) at baseline and 23.1 (8.0), 25.6 (8.3), 28.6 (10.4) ng/mL (57.75, 64.00, and 71.50 nmol/L) at the end of 12 months in 600, 1000, and 2000 IU, respectively (p values for dose, time, and the interaction being < 0.0001, < 0.0001,and 0.082, respectively). Prevalence of vitamin D deficiency (< 20 ng/mL) was 80.2, 77.5, and 75.5% in 600, 1000, and 2000 IU groups at baseline, respectively, which decreased to 34, 18.4, and 7.5%, respectively, at 12 months. Patterns of iPTH, calcium, phosphorus, and alkaline phosphatase response over time did not differ significantly among groups (p values = 0.452, 0.670, 0.377, 0.895, respectively).

CONCLUSIONS

Increases in 25(OH)D concentration were found with supplementation of 1000 and 2000 IU, compared with 600 IU/days, whereas there was no evidence of iPTH suppression or change in serum calcium, phosphorus, and alkaline phosphatase among children with excess weight.

Vitamin D Deficiency in Lebanese Adults: Prevalence and Predictors from a Cross-Sectional Community-Based Study

METHODS

A random sample of Lebanese adults residing in the Greater Beirut area was selected based on area probability and multistage cluster sampling. Data from 446 participants (68% females) with mean age 45.3 ± 15 years were used for the analyses. Participants were recruited between March and May. Serum 25-hydroxyvitamin D levels were measured using electrochemiluminescent immunoassay.

RESULTS

Vitamin D deficiency was highly prevalent whether using the cutoff of 50 nmol/L or using the more conservative cutoff of 30 nmol/L; more specifically, 71.9% and 39.1% of the study population were deficient using the above cutoffs, respectively In the bivariate analyses, gender, BMI and body fat mass, socioeconomic factors (income and education level), alcohol consumption, dietary intake of fat and of vitamin D, serum LDL-cholesterol, and serum creatinine were all associated with vitamin D status. After adjustment for multiple covariates, age, income, alcohol consumption, and serum creatinine were independent predictors of vitamin D deficiency.

CONCLUSION

Vitamin D deficiency is highly prevalent in Lebanon. Preventive measures should target the modifiable risk factors.

X-linked Hypophosphatemic Rickets: Awareness, Knowledge, and Practice of Pediatric Endocrinologists in Arab Countries

X-linked hypophosphatemic rickets (XLHR) is a genetic disease caused by inactivating pathogenic variants in PHEX, which results in reduced mineralization of bone, teeth, and renal phosphate wasting. XLHR is traditionally treated by phosphate and vitamin D analogs. Recently, burosumab, a recombinant anti-fibroblast growth factor-23 (FGF-23) monoclonal antibody was approved as specific XLHR therapy. We aimed to assess the awareness, knowledge, and management of XLHR among members of the Arab Society for Pediatric Endocrinology and Diabetes (ASPED). Of the 97 physicians who answered the online questionnaire, 97% were aware of XLHR, and while 90% screen family members of the index case, only 29% manage children with XLHR. In children with rickets, 40% of participants measure serum/urine phosphate routinely, and 31% request serum FGF-23 in suspected XLHR cases. Almost all responders use conventional XLHR therapy, and 4% used Burosomab. Only 14% were satisfied with the conventional treatment, and 69% reported therapeutic complications in up to 25% of their patients. Multidisciplinary care for XLHR is practiced by 94%, but 82% of providers did not have transition clinics. Pediatric endocrinologists in ASPED countries are aware of XLHR but have variable practice and are unsatisfied with its conventional treatment. Raising awareness of the recognition and modern management of XLHR is needed.

Assessment of vitamin D-binding protein (DBP) gene polymorphisms and their correlation with multiple sclerosis: a case-control study in a sample of the Syrian population

Background

Vitamin D deficiency is a major health concern as it increases the risk of developing many serious diseases. Recently, the correlation between vitamin D deficiency and multiple sclerosis (MS) is a matter of serious debate. In this case-control study, we aimed to assess the correlation between genetic changes in the vitamin D-binding protein (DBP) gene and their consequence on MS patients. Our sample study consisted of 110 individuals; 40 patients with MS as cases and 70 healthy controls. Vitamin D levels were determined by immunofluorescence assay, and polymorphisms at rs7041 (c.1296 T > G p.Asp416Glu) and rs4588 (c.1307C > A p.Thr420Lys) of the DBP gene were genotyped using PCR/RFLP method for all cases and controls.

Results

Our results showed that genotype frequencies were consistent with Hardy-Weinberg equilibrium. A significant association was found in rs7041 (c.1296TT) homozygous wild-type, and the odds ratio was < 1 suggesting a protective role against developing MS (OR; 0.03, p = 0.0002) whereas the c.1296GG genotype was significantly correlated with an increased risk for MS by 6 folds (OR: 6.0000, p < 0.0001). No significant association was noted at rs4588 and MS occurrence. In addition, our compound genotyping results revealed that haplotypes 1S-1S are 6 times more likely to develop MS, whereas haplotypes 1F-1F had a more protective role in MS patients (OR: 0.063, p = 0.06.), respectively. The risk of vitamin D insufficiency in patients was greater by 14 folds compared to controls (OR: 14.05, p = 0.0128). Furthermore, the c.1296GG genotype was associated significantly by more than 4 times with insufficient levels of vitamin D and by 7 folds with vitamin deficiency.

Conclusions

We conclude that polymorphisms in the DBP gene could have independent effects on the risk of developing multiple sclerosis. The homozygous recessive genotype at rs7041 was associated with insufficient levels of vitamin D and with the risk of MS emergence.

Vitamin D3 metabolite ratio as an indicator of vitamin D status and its association with diabetes complications

BACKGROUND

Vitamin D deficiency is diagnosed by total serum 25-hydroxyvitamin D (25(OH)D) concentration and is associated with poor health and increased mortality; however, some populations have low 25(OH) D concentrations without manifestations of vitamin D deficiency. The Vitamin D Metabolite Ratio (VMR) has been suggested as a superior indicator of vitamin D status. Therefore, VMR was determined in a population with type 2 diabetes at high risk for vitamin D deficiency and correlated with diabetic complications.

RESEARCH DESIGN AND METHODS

Four hundred sisty patients with type 2 diabetes (T2D) were recruited, all were vitamin D₃ supplement naive. Plasma concentration of 25-hydroxyvitamin D₃ (25(OH)D₃) and its metabolites 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) and 24,25-dihydroxyvitamin D₃ (24,25(OH)₂D₃) and its epimer, 3-epi-25-hydroxyvitamin D₃ (3-epi-25(OH)D₃), were measured by LC-MS/MS analysis. VMR-1 was calculated as a ratio of 24,25(OH)₂D₃:25(OH)D₃; VMR-2 as a ratio of 1,25(OH)₂D₃:25(OH)D₃; VMR-3 was calculated as a ratio of 3-epi-25(OH)D₃: 25(OH)D_3. RESULTS: An association means that there were significant differences between the ratios found for those with versus those without the various diabetic complications studied. VMR-1 was associated with diabetic retinopathy (p = 0.001) and peripheral artery disease (p = 0.012); VMR-2 associated with hypertension (p < 0.001), dyslipidemia (p < 0.001), diabetic retinopathy (p < 0.001), diabetic neuropathy (p < 0.001), coronary artery disease (p = 0.001) and stroke (p < 0.05). VMR-3 associated with hypertension (p < 0.05), dyslipidemia (p < 0.001) and coronary artery disease (p < 0.05).

CONCLUSIONS

In this cross sectional study, whilst not causal, VMR-2 was shown to be the superior predictor of diabetic and cardiovascular complications though not demonstrative of causality in this cross-sectional study population over VMR-1, VMR-3 and the individual vitamin D concentration measurements; VMR-2 associated with both microvascular and cardiovascular indices and therefore may have utility in predicting the development of diabetic complications.

Influence of Physical Activity Level on Composite Indices of Femoral Neck Strength in a Group of Young Overweight Men

The aim of the present study was to explore the influence of physical activity level on composite indices of femoral neck strength (compression strength index [CSI], bending strength index, and impact strength index) in a group of young overweight men. To do so, we compared composite indices of femoral neck strength in active overweight men and insufficiently active overweight men. They were divided into 2 groups based on their physical activity level: 70 active overweight men (engaging in more than 150 minutes of physical activity per week; 8.7 ± 4.8 h/wk) and 26 insufficiently active overweight men (engaging in less than 150 minutes of physical activity per week; 1.2 ± 0.7 h/wk). Height (m) and weight (kg) were measured, and body mass index (kg/m²) was calculated. Bone mineral density was measured by dual-energy X-ray absorptiometry at whole body, lumbar spine, total hip, and femoral neck. Body weight, lean mass, fat mass, and body mass index were not significantly different between the 2 groups. CSI, bending strength index, and impact strength index were significantly higher in active overweight men compared to insufficiently active overweight men. After adjustment for age, physical activity (h/wk) and lean mass, only CSI remained higher in active overweight men compared to insufficiently active overweight men. This study suggests that, in young overweight men, being active (engaging in more than 150 minutes of physical activity per week) is associated with greater composite indices of femoral neck strength. To our knowledge, this is the first study that finds a significant difference regarding composite indices of femoral neck strength between 2 groups of young overweight men with different levels of physical activity.

The Role of Polymorphisms in Vitamin D-Related Genes in Response to Vitamin D Supplementation

Background. Vitamin D deficiency represents a major healthcare problem. Vitamin D status is influenced by genetic and environmental determinants. Several observational studies have evaluated the association of single-nucleotide polymorphisms (SNPs) in vitamin D-related genes and vitamin D levels. Nevertheless, little is known about the role of these SNPs in the response to vitamin D supplementation. We conducted an interventional study to define the association between SNPs in vitamin D-related genes and the response to vitamin D supplementation in 100 self-reported healthy women of Arab ancestry for the majority. Methods. A total of 100 healthy female subjects received a weekly oral dose of 50,000 IU vitamin D for 12 weeks. Serum vitamin D concentration and metabolic profiles were measured at baseline and 12 weeks post-vitamin D supplementation. The genotypes of 37 SNPs selected from previously reported vitamin D-related genes have been assessed by Fluidigm genotyping assay. Results. Rs731236 (VDR gene) and rs7116978 (CYP2R1 gene) showed a significant association with vitamin D status. The rs731236 GG genotype and the rs7116978 CC genotype were associated with a “vitamin D sufficiency” state. Rs731236 GG and rs7116978 CC genotypes showed a higher response to vitamin D supplementation. Transcription factor binding site prediction analysis showed altered binding sites for transcription factors according to the different rs7116978 alleles. Interestingly, the 37 SNPs previously established to play a role in vitamin D-related pathways explained very little of the response to vitamin D supplementation in our cohort, suggesting the existence of alternative loci whose number and effect size need to be investigated in future studies. Conclusion. In this paper, we present novel data on vitamin D-related SNPs and response to vitamin D supplementation demonstrating the feasibility of applying functional genomic approaches in interventional studies to assess individual-level responses to vitamin D supplementation.

Genetic Variation in Cytochrome P450 2R1 and Vitamin D Binding Protein Genes are associated with Vitamin D Deficiency in Adolescents

Background: Genome Wide Association Studies (GWAS) have evaluated several genes related to vitamin D synthesis, metabolism and transport. They have proposed a genetic basis for low levels of vitamin D in the blood. The current study aims to investigate the relationship between certain vitamin D-associated gene variants and vitamin D deficiency in Iranian adolescents. Methods: In this case-control study, the genomic DNA was extracted by Real Time PCR High Resolution Melt (HRM). All measurements were carried out with triple repetition. The following factors were assessed: single nucleotide polymorphisms (SNPs) in Vitamin D binding protein (DBP, rs2282679), 7-Dehydrocholesterol reductase (DHCR7, rs12785878) and Cytochrome P450 2R1 (CYP2R1, rs10741657). Results: the genomic DNA of blood samples obtained from 481 adolescents. Participants with hypovitaminosis D were compared with a control group. The average vitamin D level of sufficient subjects (controls) was 44.88±14.01 ng/mL, while subjects who were insufficient (cases) had an average vitamin D level of 7.03±1.24 ng/mL. No statistically significant differences were found in the allelic and genotypic distributions between genders. The SNP frequency in CYP2R1 (rs10741657) and DBP (rs2282679) in the vitamin D deficient group was significantly higher than in the control group (p-values < 0.001 and 0.01 respectively). There were no statistically significant differences in the DHCR7 SNP (rs12785878) distributions between the Vitamin D deficient group and control group. Conclusion: The present study demonstrated evidence of the ability of the SNPs under investigation to predict circulating vitamin D concentration. Further study is needed to better understand if and how genetic factors contribute to vitamin D levels, and certain skeletal-associated disorders in adolescents.

Association of vitamin D2 and D3 with type 2 diabetes complications

AIMS

Vitamin D measurement is a composite of vitamin D₂ (25(OH)D₂) and D₃ (25(OH)D₃) levels, and its deficiency is associated with the development of type 2 diabetes (T2DM) and diabetic complications; vitamin D deficiency may be treated with vitamin D₂ supplements. This study was undertaken to determine if vitamin D₂ and D₃ levels differed between those with and without T2DM in this Middle Eastern population, and the relationship between diabetic microvascular complications and vitamin D₂ and vitamin D₃ levels in subjects with T2DM_. METHODS: Four hundred ninety-six Qatari subjects, 274 with and 222 without T2DM participated in the study. Plasma levels of total vitamin D₂ and D₃ were measured by LC-MS/MS analysis.

RESULTS

All subjects were taking vitamin D₂ and none were taking D₃ supplements. Vitamin D₂ levels were higher in diabetics, particularly in females, and higher levels were associated with hypertension and dyslipidemia in the diabetic subjects (p < 0.001), but were not related to diabetic retinopathy or nephropathy. Vitamin D₃ levels measured in the same subjects were lower in diabetics, particularly in females (p < 0.001), were unrelated to dyslipidemia or hypertension, but were associated with retinopathy (p < 0.014). Neither vitamin D₂ nor vitamin D₃ were associated with neuropathy. For those subjects with hypertension, dyslipidemia, retinopathy or neuropathy, comparison of highest with lowest tertiles for vitamin D₂ and vitamin D₃ showed no difference.

CONCLUSIONS

In this Qatari cohort, vitamin D₂ was associated with hypertension and dyslipidemia, whilst vitamin D₃ levels were associated with diabetic retinopathy. Vitamin D₂ levels were higher, whilst vitamin D₃ were lower in diabetics and females, likely due to ingestion of vitamin D₂ supplements.

Poor dietary consumption and limited sun exposure are risk factors for vitamin D deficiency in premenopausal Kuwaiti women: A cross-sectional study

Background: Low serum vitamin D levels are reported constantly among females living in the Arabian Gulf countries, presumably due to their lifestyle, which limits direct sun exposure. Because Vitamin D deficiency has been implicated in a wide range of ailments, healthy females with the deficiency might be at risk for developing many health problems. Thus, the aim was to assess lifestyle risk factors for vitamin D deficiency in healthy women in Kuwait. Methods: A total of 104, disease-free, premenopausal women were recruited for assessment of their serum 25OHD and intact PTH levels. Physical examination, blood withdrawal and interviewer-administered questionnaires were used to collect the relevant data. Associations were detected statistically using nonparametric tests and logistic regression was used to identify risk factors for vitamin D deficiency. Results: Vitamin D deficiency ( < 25 nmol/L) occurred in 84.6%, and hyperparathyroidism ( ≥ 6.9 pmol/L) occurred in 25% of women, among which all were vitamin D deficient. Significant risk factors of vitamin D deficiency were nondaily milk intake (OR:25, CI%:4.2-147), no fish intake (OR:5, CI%:1-22.8), and no weekend sun exposure (OR:8.2, CI%:1.28-52.6). Having PTH ≥ 6 pmol/L was also associated with a higher likelihood of having vitamin D deficiency. Conclusion: Vitamin D deficiency is very common in disease-free, premenopausal Kuwaiti women and can be avoided by improving food consumption and obtaining more sun exposure.

Time trends and predictors of hypovitaminosis D across the life course: 2009-2016

PURPOSE

We investigated prevalence, determinants, seasonal changes, and time trends in hypovitaminosis D. We derived a desirable serum 25-hydroxy-vitamin D (25OHD) level in adults/elderly by evaluating the 25OHD-parathyroid hormone (PTH) exponential relationship.

METHODS

We analyzed serum 25OHD data from a large laboratory database (N = 151,705), from a major academic medical center in Lebanon, from 2009 to 2016. We used cross calibration formulas to convert measured 25OHD levels to LC-MS/MS equivalents based on our external quality assurance protocols.

RESULTS

6% of the population were children (mean age 11 ± 5 years, 56% girls), 68% were adults (44 ± 13 years, 71% women), and 25% were elderly (74 ± 6 years, 59% women). The prevalence of hypovitaminosis D, in the entire population, was 39%, 29% and 23% at 25OHD cutoffs of 20 ng/ml, 15 ng/ml, and 12 ng/ml, respectively, across all years. Using multivariate analysis, predictors of 25OHD levels below 12, 15 and 20 ng/ml were younger age, male sex, winter months, and inpatient status both in adults and elderly. In children, older age, female sex, winter months, and inpatient status, predicted levels below 15 ng/ml and 20 ng/ml, but only older age, female sex, and winter months predicted levels below 12 ng/ml. There was a significant steady annual increase in 25OHD levels between 2009 and 2016 of 0.9 ng/ml/year (95% CI: 0.7, 1.0) in children, 1.2 ng/ml/year (1.2, 1.3) in adults and 2.6 ng/ml/year (2.6, 2.8) in the elderly. Using best fit non-linear regression models, on a subset of adults and elderly in whom concomitant 25OHD and PTH data was available (N = 4025), PTH levels plateaued at a serum 25OHD level of 26.1 ng/ml.

CONCLUSION

Secular increase in serum 25OHD levels is observed in Lebanon, but hypovitaminosis D is still prevalent. Our data provides basis for a desirable 25OHD level above 26 ng/ml in adult and elderly Lebanese individuals.

Nutritional rickets: Historic overview and plan for worldwide eradication

Rickets was first described in great detail in the mid 17th century and was affecting a great number of children in major European cities. The disease, however, existed already in the Roman times. The etiology of this disease remained enigmatic until the 1920s when two different mechanisms, lack of exposure to sunlight and lack of a dietary factor were finally solved by the discovery of vitamin D and its dual origin. Soon thereafter, the implementation of vitamin D supplementation for all infants and small children largely eliminated nutritional rickets in Europe and North America. It took nearly a century to elucidate the complex chemistry, metabolism, mode and spectrum of activity of the vitamin D endocrine system. Nutritional rickets, whether due to simple vitamin D or calcium deficiency or both, remains widely ravaging many infants and children around the world. Asian countries and the Middle East are mainly confronted with vitamin D deficiency whereas many African and some Asian countries face calcium deficiency rickets. Immigrants and refugees or in general people with a darker skin living in moderate climate zone are also confronted with this disease. There is great consensus how this disease could be prevented or cured. In collaboration with most international professional societies, we prepare a memorandum, in line with the successful battle against iodine deficiency disorders, to convince the World Health Organization and its member states to start an implementation program to eradicate nutritional rickets by 2030.