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    Epidemiology of vitamin D insufficiency and deficiency in a population in a sunny country: Geospatial meta-analysis in Brazil. Pereira-Santos Marcos,Santos José Yure Gomes Dos,Carvalho Gisele Queiroz,Santos Djanilson Barbosa Dos,Oliveira Ana Marlúcia Critical reviews in food science and nutrition Studies conducted among populations of tropical countries have reported high prevalences of vitamin D deficiency and insufficiency. Information resulting from meta-analyses on the spatial distribution of vitamin D deficiency and insufficiency in tropical countries is still rare. The aim of this review was investigated the prevalence of vitamin D deficiency and insufficiency among the Brazilian population. Observational studies were searched in eight electronically databases. Additionally, theses and dissertations and abstracts were screened. Details on study design, methods, population, mean and data on serum concentrations of vitamin D in different age groups in Brazil were extracted. Data were pooled using a random-effects model and choropleth maps were created based on the geopolitical regions of the country. 72 published paper met the inclusion criteria. The mean vitamin D concentration among the Brazilian population between 2000 and 2017 of 67.65 nmol/L (95% CI: 65.91, 69.38 nmol/L).The prevalences of vitamin D deficiency and insufficiency were 28.16% (95% CI: 23.90, 32.40) and 45.26% (95% CI: 35.82, 54.71), respectively, for the Brazilian population. The highest prevalence of deficiency were observed in the southern and southeastern regions and the highest occurrence of vitamin D insufficiency was among the populations of the southeastern and northeastern regions. Finally, there are high prevalence of inadequate vitamin D concentrations among the population, regardless of age group in Brazil. The development of vitamin D food fortification policies in needs to be cautious and carefully planned. 10.1080/10408398.2018.1437711
    Highly prevalence of vitamin D deficiency among Brazilian women of reproductive age. Lopes Vinicius Medina,Lopes Joaquim Roberto Costa,Brasileiro Jean Pierre Barguil,Oliveira Ingrid de,Lacerda Ricardo Peclat,Andrade Marcos Renato Dib,Tierno Natália Ivet Zavattiero,Souza Roberto Costa Cavalcante de,Motta Luiz Augusto Casulari Roxo da Archives of endocrinology and metabolism Objective:Vitamin D has several metabolic functions and possible reproductive functions. This study aimed to determine the prevalence of vitamin D deficiency among Brazilian women of reproductive age, and to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and infertility causes. Subjects and methods:This retrospective cross-sectional study evaluated data from a private Brazilian assisted reproduction center that were collected between January 1 and May 5, 2012. Serum 25(OH)D concentrations were measured and compared for infertile and fertile women. Concentrations of 25(OH)D that were < 20 ng/mL were defined as deficiency and concentrations of 21-30 ng/mL were defined as hypovitaminosis D. Results:Among the 369 evaluated women, 81.1% exhibited hypovitaminosis D and 32.0% exhibited deficiency. The infertile and control patients did not exhibit any significant differences in the prevalence of vitamin D deficiency (30.2% vs. 35%, respectively; p = 0.33) or in the mean 25(OH)D concentrations (24.3 ± 7.9 ng/mL vs. 23.8 ± 8.7 ng/mL, respectively; p = 0.51). Furthermore, there were no significant differences in the mean 25(OH)D concentrations among subgroups of patients with single infertility factors, or between these subgroups and the control group. Conclusions:A high proportion of Brazilian women of reproductive age exhibited vitamin D deficiency, regardless of their fertility status. Thus, it may be useful to evaluate this population for vitamin D deficiency, although future studies are needed to determine whether this deficiency might affect the outcomes of treatments for infertility. 10.1590/2359-3997000000216
    Vitamin D deficiency in India: prevalence, causalities and interventions. G Ritu,Gupta Ajay Nutrients Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%-100% in the general population. In India, widely consumed food items such as dairy products are rarely fortified with vitamin D. Indian socioreligious and cultural practices do not facilitate adequate sun exposure, thereby negating potential benefits of plentiful sunshine. Consequently, subclinical vitamin D deficiency is highly prevalent in both urban and rural settings, and across all socioeconomic and geographic strata. Vitamin D deficiency is likely to play an important role in the very high prevalence of rickets, osteoporosis, cardiovascular diseases, diabetes, cancer and infections such as tuberculosis in India. Fortification of staple foods with vitamin D is the most viable population based strategy to achieve vitamin D sufficiency. Unfortunately, even in advanced countries like USA and Canada, food fortification strategies with vitamin D have been only partially effective and have largely failed to attain vitamin D sufficiency. This article reviews the status of vitamin D nutrition in the Indian subcontinent and also the underlying causes for this epidemic. Implementation of population based educational and interventional strategies to combat this scourge require recognition of vitamin D deficiency as a public health problem by the governing bodies so that healthcare funds can be allocated appropriately. 10.3390/nu6020729
    Vitamin D Deficiency among Adults with History of Pulmonary Tuberculosis in Korea Based on a Nationwide Survey. Joo Mi Hyun,Han Mi Ah,Park Sun Mi,Shin Hwan Ho International journal of environmental research and public health We investigated the prevalence of vitamin D deficiency among individuals who have a history of tuberculosis (TB) diagnosis in Korea. Using the 5th Korean National Health and Nutrition Examination Survey, we selected 805 individuals with a history of TB diagnosis and 16,049 controls without a history of TB. Vitamin D deficiency was defined as a 25(OH)D level less than 20 ng/mL. Vitamin D deficiency was revealed in 71.7% of the individuals with a history of TB diagnosis and in 72.1% of the controls. Vitamin D deficiency was more likely in women than in men, in people who engaged in other jobs or were unemployed than in people who engaged in skilled agricultural, forestry, and fishery jobs, and in people who walked 3-5 days per week than in people who walked 6-7 days per week. Vitamin D deficiency was highly prevalent in the TB group. Regular examination and strategies to increase vitamin D levels in individuals with a history of TB are needed, as vitamin D is associated with TB conditions and bone disease. 10.3390/ijerph14040399
    Prevalence of Vitamin D Deficiency in Singapore: Its Implications to Cardiovascular Risk Factors. Bi Xinyan,Tey Siew Ling,Leong Claudia,Quek Rina,Henry Christiani Jeyakumar PloS one OBJECTIVE:Vitamin D deficiency is a global health challenge and has been linked to type 2 diabetes and other chronic diseases. However, the relationship between vitamin D status, body composition, and cardiovascular risks has not been well characterized in Asian populations. The objectives of this study were to examine the factors associated with the low vitamin D levels in a sunny tropical region and to assess the role of vitamin D status in cardiovascular risk factors. DESIGN AND METHODS:This was a cross-sectional study. One hundred and fourteen healthy participants (59 males and 55 females) residing in Singapore took part in this study. Plasma 25OH-D3 concentration was measured by using LC-MS/MS. Body fat (%) was measured by using three different techniques including bioelectrical impedance analysis (BIA), BOD POD, and dual-energy X-ray absorptiometry (DEXA). Basic anthropometric measurements, fasting blood glucose (FBG), fasting serum insulin (FSI), and lipid profiles were obtained using standard protocols. RESULTS:Approximately 42% of the participants were vitamin D deficient (< 20 ng/mL). Vitamin D status was inversely associated with body fat (%), homeostasis model assessment of insulin resistance (HOMA-IR), and total cholesterol/high density lipoprotein (TC/HDL) ratio, while positively associated with lean body mass (LBM) and hand grip strength (HGS). CONCLUSIONS:The high prevalence of vitamin D deficiency in a sunny tropical region reinforces the need to recognize that sunlight alone is not the precursor for optimal vitamin D status. This raises the need to investigate public health measures that will encourage exposure to sunlight without overexposure that is harmful to skin. More importantly, vitamin D deficiency is associated with increased cardiovascular risks, i.e. HOMA-IR, TC/HDL, and LDL/HDL. Future studies should attempt to elucidate the potential mechanisms. 10.1371/journal.pone.0147616
    The high prevalence of vitamin D deficiency and its related maternal factors in pregnant women in Beijing. Song Shu Jun,Zhou Ling,Si Shaoyan,Liu Junli,Zhou Jinlian,Feng Kai,Wu Jie,Zhang Wenying PloS one Maternal vitamin D deficiency has been suggested to influence fetal and neonatal health. Little is known about vitamin D status in Chinese pregnant women. The purpose of this study was to assess the vitamin D status of pregnant women residing in Beijing in winter and evaluate the impact of maternal factors on serum 25-hydroxyvitamin D [25(OH)D] levels. The study was conducted on 125 healthy pregnant women. For each individual, data concerning pre-pregnancy weight, educational status, use of multivitamins and behavioral factors such as daily duration of computer use, walking and sun exposure were obtained. Serum concentrations of 25(OH)D were measured by enzyme-linked immunosorbent assay. The prevalence of vitamin D deficiency (25(OH)D < 50 nmol/L) was 96.8% and almost half (44.8%) of women were severely vitamin D deficiency (25(OH)D < 25 nmol/L). The concentration of 25(OH)D was lower in women with shorter duration of sun exposure (≤ 0.5 h/day, 25.3 ± 8.9 nmol/L) than that in women with longer duration of sun exposure (> 0.5 h/day; 30.3 ± 9.5 nmol/L; P = 0.003). Thirty six women (28.8%) had sun exposure duration ≥ 1.5h/day. The 25(OH)D concentration in these women was 31.5 ± 9.4 nmol/L which was also much lower than the normal level. Women who reported taking a multivitamin supplement had significantly higher 25(OH)D concentrations (32.3 ± 9.5 nmol/L) when compared with non-users (24.9 ± 8.2 nmol/L; P < 0.001). Pregnant women in Beijing are at very high risk of vitamin D deficiency in winter. Duration of Sun exposure and the use of multivitamin were the most important determinants for vitamin D status. However, neither prolonging the time of sunlight exposure nor multivitamin supplements can effectively prevent pregnant women from vitamin D deficiency. Other measures might have to be taken for pregnant women to improve their vitamin D status in winter. 10.1371/journal.pone.0085081
    Prevalence and determinants of vitamin D deficiency in healthy French adults: the VARIETE study. Souberbielle Jean-Claude,Massart Catherine,Brailly-Tabard Sylvie,Cavalier Etienne,Chanson Philippe Endocrine The U.S. Institute of Medicine considers that a serum 25-hydroxyvitamin D (25OHD) concentration >20 ng/mL corresponds to optimal vitamin D status in the general population. Old studies of vitamin D status in the French general population have demonstrated high prevalence of insufficiency. We measured serum 25OHD, 1,25(OH)2D, PTH, calcium, phosphorus, and creatinine levels in 892 French Caucasian healthy subjects (463 men, 429 women) aged from 18 to 89 years. The 25OHD concentration was similar in men (24.1 ± 8.2 ng/mL) and women (23.4 ± 8.0 ng/mL). 25OHD concentrations of <10, <12, <20, and <30 ng/mL were found in respectively 6.3, 9.9, 34.6, and 80.3 % of subjects. Residence in northern France (odds ratio [OR] 1.91), blood sampling between January and March (OR 7.74), BMI ≥24 kg/m(2) (OR 1.81), and age 60 years or more (OR 1.99) were significant determinants of hypovitaminosis D (25OHD <20 ng/mL). The serum 25OHD level correlated positively with 1,25(OH)2D and negatively with PTH. 25OHD values below 20 ng/mL were associated with lower 1,25(OH)2D levels, and 25OHD values below 27 ng/mL were associated with higher PTH levels. Many French healthy adults have a 25OHD concentration <20 ng/mL, especially during winter months. Actions to improve the vitamin D status of the French general population are urgently needed. 10.1007/s12020-016-0960-3
    Vitamin D Deficiency and Insufficiency According to the Current Criteria for Children: Vitamin D Status of Elementary School Children in Turkey Hocaoğlu-Emre F. Sinem,Sarıbal Devrim,Oğuz Osman Journal of clinical research in pediatric endocrinology Objective:This study aimed to determine the ratio of seasonal vitamin D deficiency and insufficiency in elementary school children aged between 6-9 years old, living in one of the largest metropols of Europe, İstanbul. Methods:Serum 25(OH)D levels of 640 children aged 6-9 years old were scanned retrospectively from the hospital information system records between September 2017-August 2018 period. Vitamin D deficiency was defined as a serum 25(OH)D level less than 12 ng/mL (30 nmol/L) and insufficiency as levels between 12 and 20 ng/mL (30-50 nmol/L). Results:Serum 25(OH)D levels ranged from 3.90 to 64.60 ng/mL, the median value was 25.95 ng/mL for all subjects. Of all the primary school children, 485 (75.78%) had adequate levels of 25(OH)D. Vitamin D deficiency was observed in 36 of children (5.62%), whereas insufficient levels of 25(OH)D were found in 119 children (18.60%). The ratio of vitamin D insufficiency and deficiency together was highest in spring (31.87%) and lowest in summer (13.12%). Conclusion:Vitamin D deficiency is a widely observed and preventable public health problem among children of different ages. It is necessary to increase the awareness among health professionals, and providing 25(OH)D supplements will yield generations with healthy bone structure and well growth. 10.4274/jcrpe.galenos.2018.2018.0272
    Vitamin D deficiency prevalence and risk factors among pregnant Chinese women. Yun Chunfeng,Chen Jing,He Yuna,Mao Deqian,Wang Rui,Zhang Yu,Yang Chun,Piao Jianhua,Yang Xiaoguang Public health nutrition OBJECTIVE:To evaluate vitamin D deficiency prevalence and risk factors among pregnant Chinese women. DESIGN:A descriptive cross-sectional analysis. SETTING:China National Nutrition and Health Survey (CNNHS) 2010-2013. SUBJECTS:A total of 1985 healthy pregnant women participated. Possible predictors of vitamin D deficiency were evaluated via multiple logistic regression analyses. RESULTS:The median serum 25-hydroxyvitamin D level was 15·5 (interquartile range 11·9-20·0, range 3·0-51·5) ng/ml, with 74·9 (95 % CI 73·0, 76·7) % of participants being vitamin D deficient (25-hydroxyvitamin D <20 ng/ml). According to the multivariate logistic regression analyses, vitamin D deficiency was positively correlated with Hui ethnicity (P=0·016), lack of vitamin D supplement use (P=0·021) and low ambient UVB level (P<0·001). In the autumn months, vitamin D deficiency was related to Hui ethnicity (P=0·012) and low ambient UVB level (P<0·001). In the winter months, vitamin D deficiency was correlated with younger age (P=0·050), later gestational age (P=0·035), higher pre-pregnancy BMI (P=0·019), low ambient UVB level (P<0·001) and lack of vitamin D supplement use (P=0·007). CONCLUSIONS:Vitamin D deficiency is prevalent among pregnant Chinese women. Residing in areas with low ambient UVB levels increases the risk of vitamin D deficiency, especially for women experiencing advanced stages of gestation, for younger pregnant women and for women of Hui ethnicity; therefore, vitamin D supplementation and sensible sun exposure should be encouraged, especially in the winter months. Further studies must determine optimal vitamin D intake and sun exposure levels for maintaining sufficient vitamin D levels in pregnant Chinese women. 10.1017/S1368980015002980
    Vitamin D deficiency in Europe: pandemic? Cashman Kevin D,Dowling Kirsten G,Škrabáková Zuzana,Gonzalez-Gross Marcela,Valtueña Jara,De Henauw Stefaan,Moreno Luis,Damsgaard Camilla T,Michaelsen Kim F,Mølgaard Christian,Jorde Rolf,Grimnes Guri,Moschonis George,Mavrogianni Christina,Manios Yannis,Thamm Michael,Mensink Gert Bm,Rabenberg Martina,Busch Markus A,Cox Lorna,Meadows Sarah,Goldberg Gail,Prentice Ann,Dekker Jacqueline M,Nijpels Giel,Pilz Stefan,Swart Karin M,van Schoor Natasja M,Lips Paul,Eiriksdottir Gudny,Gudnason Vilmundur,Cotch Mary Frances,Koskinen Seppo,Lamberg-Allardt Christel,Durazo-Arvizu Ramon A,Sempos Christopher T,Kiely Mairead The American journal of clinical nutrition BACKGROUND:Vitamin D deficiency has been described as being pandemic, but serum 25-hydroxyvitamin D [25(OH)D] distribution data for the European Union are of very variable quality. The NIH-led international Vitamin D Standardization Program (VDSP) has developed protocols for standardizing existing 25(OH)D values from national health/nutrition surveys. OBJECTIVE:This study applied VDSP protocols to serum 25(OH)D data from representative childhood/teenage and adult/older adult European populations, representing a sizable geographical footprint, to better quantify the prevalence of vitamin D deficiency in Europe. DESIGN:The VDSP protocols were applied in 14 population studies [reanalysis of subsets of serum 25(OH)D in 11 studies and complete analysis of all samples from 3 studies that had not previously measured it] by using certified liquid chromatography-tandem mass spectrometry on biobanked sera. These data were combined with standardized serum 25(OH)D data from 4 previously standardized studies (for a total n= 55,844). Prevalence estimates of vitamin D deficiency [using various serum 25(OH)D thresholds] were generated on the basis of standardized 25(OH)D data. RESULTS:An overall pooled estimate, irrespective of age group, ethnic mix, and latitude of study populations, showed that 13.0% of the 55,844 European individuals had serum 25(OH)D concentrations <30 nmol/L on average in the year, with 17.7% and 8.3% in those sampled during the extended winter (October-March) and summer (April-November) periods, respectively. According to an alternate suggested definition of vitamin D deficiency (<50 nmol/L), the prevalence was 40.4%. Dark-skinned ethnic subgroups had much higher (3- to 71-fold) prevalence of serum 25(OH)D <30 nmol/L than did white populations. CONCLUSIONS:Vitamin D deficiency is evident throughout the European population at prevalence rates that are concerning and that require action from a public health perspective. What direction these strategies take will depend on European policy but should aim to ensure vitamin D intakes that are protective against vitamin D deficiency in the majority of the European population. 10.3945/ajcn.115.120873
    High prevalence of vitamin D deficiency and insufficiency in a low income peri-urban community in Karachi. Mehboobali Naseema,Iqbal Saleem Perwaiz,Iqbal Muhammad Perwaiz JPMA. The Journal of the Pakistan Medical Association OBJECTIVE:To determine the frequency of vitamin D deficiency and insufficiency in a low-income peri-urban population. METHODS:The cross-sectional study was conducted in a low-income, unplanned settlement in Karachi, and comprised apparently healthy adults who were recruited randomly with informed consent. Serum levels of 25-hydroxy vitamin D were measured using a kit obtained from Roche Diagnostics. One-way analysis of variance and logistic regression were used for statistical analysis. RESULTS:Of the 858 subjects, 507(59%) were females and 351(41%) males (age range: 18-60 years). Prevalence estimates of vitamin D deficiency (<20ng/ml) and insufficiency (20.0-29.9ng/ml) were found to be 501(58.4%) and 269(31.4%), respectively. Odds ratio of vitamin D deficiency was significantly higher in females compared to males after adjusting for education and smoking status (p=0.001). CONCLUSIONS:High prevalence of vitamin D deficiency among females in one of the peri-urban areas points towards a public health problem which requires attention of the medical community.
    High prevalence of maternal vitamin D deficiency in preterm births in northeast China, Shenyang. Zhu Tong,Liu Tian-Jing,Ge Xin,Kong Juan,Zhang Li-Jun,Zhao Qun International journal of clinical and experimental pathology INTRODUCTION:Maternal vitamin D deficiency has been associated with a number of fetal and neonatal health problems. Preterm birth is one of the most detrimental, and the role of maternal vitamin D deficiency in preterm births has not been universally acknowledged. There had been limited epidemiological studies of vitamin D deficiency on the Chinese population. SUBJECTS AND METHODS:1103 women delivered in Shengjing Hospital, China Medical University from January 1(st), 2012 to January 1(st), 2013. Finally, 821 mother-newborn pairs which contained 143 mother-newborn pairs who were preterm delivery were recruited for analysis. RESULTS:There was significant difference between spring and summer (P<0.0001) as well as spring and autumn (P<0.01). Compared to those in summer and autumn, the 25 (OH) D level was significantly lower in winter (summer vs winter P<0.0001, autumn vs winter P<0.0001). Maternal vitamin D level showed obvious variation with months and seasons, with higher level in summer months and lower level in winter months. There were significant difference between the vitamin D level of the very preterm group and the mildly preterm groups (P<0.01), as well as the very preterm group and the in-term groups (P<0.001). Prevalence of Vitamin D deficiency occurred in 63.04% of pregnant women in very preterm group, compared with 36.61% in in-term group. CONCLUSION:Vitamin D nutritional status of pregnant women and their newborns in Shenyang were relatively good compared to cities in similar latitudes. Vitamin D deficiency was most severe in late spring and least in summer. Severe preterm births before 31 weeks of gestation was associated with maternal vitamin D deficiency.
    Vitamin D deficiency in northern Taiwan: a community-based cohort study. Lee Ming-Jse,Hsu Heng-Jung,Wu I-Wen,Sun Chiao-Yin,Ting Ming-Kuo,Lee Chin-Chan BMC public health BACKGROUND:Vitamin D deficiency has become an important public health problem, however few studies have been conducted in subtropical countries, and the predictors of vitamin D deficiency in people with healthy renal function are unclear. The objective of this study was to evaluate the prevalence and factors associated with vitamin D deficiency in northern Taiwan. METHODS:The cross-sectional study was performed between August 2013 and August 2017, and included 3954 participants without chronic kidney disease (CKD) aged ≥30 years in northern Taiwan. Serum 25-hydroxyvitamin D [25(OH)-D] levels, biochemistry, sociodemographic variables (age, sex, education, occupation) and lifestyle habits (tea, coffee consumption and physical activities) were recorded. Associations between vitamin D status and these variables were examined using a regression model. The definition of deficiency was defined as a serum 25(OH)-D level < 20 ng/mL (50 nmol/L). RESULTS:The mean 25(OH)-D concentration was 28.9 ng/mL, and 22.4% of the study population had vitamin D deficiency. There was a significantly higher vitamin D deficiency ratio in the women compared to the men (22.9% vs 9.9%, p < 0.001). Vitamin D deficiency was most prevalent (38.4%) in those aged 30-39 years. Those with a graduate degree had the highest rate of vitamin D deficiency (31.5%). The predictors of vitamin D deficiency included female sex, young age, high education level, living in an urban area and physical inactivity. Tea consumption was negatively associated with vitamin D deficiency. CONCLUSIONS:Vitamin D deficiency is prevalent in subtropical areas such as northern Taiwan in healthy individuals without CKD. 10.1186/s12889-019-6657-9
    High prevalence of vitamin D deficiency among middle-aged and elderly individuals in northwestern China: its relationship to osteoporosis and lifestyle factors. Zhen Donghu,Liu Lijuan,Guan Conghui,Zhao Nan,Tang Xulei Bone PURPOSE:Vitamin D deficiency has reached epidemic proportions; this deficiency has been associated with osteoporosis and certain lifestyle factors in adults. This relationship is not well documented among the Lanzhou population in northwest China. This study sought to determine the prevalence of vitamin D deficiency and its risk factors in addition to its relationship with osteoporosis in a Chinese population living in Lanzhou. METHODS:This cross-sectional study involved 2942 men and 7158 women aged 40-75years who were randomly selected from 3 communities in the Lanzhou urban district and examined medically. Levels of 25-hydroxy-vitamin D [25(OH)D] and other parameters were measured according to detailed inclusion criteria. Vitamin D deficiency was defined as serum 25(OH)D levels below 20ng/mL. Calcaneus bone mineral density (BMD) was measured by quantitative ultrasound (QUS). RESULTS:The prevalence of vitamin D deficiency (25(OH)D levels <20ng/mL) was present in 75.2% of the entire study population. Vitamin D deficiency was more prevalent in women (79.7%) than in men (64%; P<0.001). Multiple logistic regression analysis revealed that the significant predictors of vitamin D deficiency included coronary heart disease (CHD), obesity, dyslipidemia, older age, female sex, and smoking (all P<0.05), whereas tea intake, moderate physical activity, milk intake, vitamin D supplementation and sun exposure were protective (all P<0.05). No significant difference in calcaneus BMD measured by QUS was noted between subjects with <20ng/mL and ≥20ng/mL vitamin D levels (0.53±0.13 vs. 0.54±0.13; P=0.089). The risk of having osteoporosis did not increase when vitamin D levels decreased from ≥20ng/mL to <20ng/mL after multiple adjustments (OR=1.00; 95% CI 0.85-1.16; P=0.357). CONCLUSIONS:Vitamin D deficiency is prevalent in the middle-aged and elderly northwestern Chinese population and is largely attributed to CHD, obesity, dyslipidemia, older age, female sex, and smoking. Reduced 25(OH)D levels are not associated with an increased osteoporosis risk. 10.1016/j.bone.2014.09.024
    Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes. Hemmingway Andrea,Kenny Louise C,Malvisi Lucio,Kiely Mairead E The American journal of clinical nutrition Background:Associations of vitamin D with perinatal outcomes are inconsistent and few studies have considered the wider calcium metabolic system. Objectives:We aimed to explore functional vitamin D deficiency in pregnancy by investigating associations between vitamin D status, parathyroid hormone (PTH), and perinatal outcomes. Design:SCOPE (Screening for Pregnancy Endpoints) Ireland is a prospective cohort study of low-risk, nulliparous pregnant women. We measured serum 25-hydroxyvitamin D [25(OH)D] and PTH at 15 wk of gestation in 1754 participants. Results:Mean ± SD 25(OH)D was 56.6 ± 25.8 nmol/L (22.7 ± 10.3 ng/mL) and geometric mean (95% CI) PTH was 7.84 pg/mL (7.7, 8.0 pg/mL) [0.86 pmol/L (0.85, 0.88 pmol/L)]. PTH was elevated in 34.3% of women who had 25(OH)D <30 nmol/L and in 13.9% of those with 25(OH)D ≥75 nmol/L. Whereas 17% had 25(OH)D <30 nmol/L, 5.5% had functional vitamin D deficiency, defined as 25(OH)D <30 nmol/L with elevated PTH. Elevated mean arterial pressure (MAP), gestational hypertension, pre-eclampsia, and small-for-gestational-age (SGA) birth were confirmed in 9.2%, 11.9%, 3.8%, and 10.6% of participants, respectively. In fully adjusted regression models, neither low 25(OH)D nor elevated PTH alone increased the risk of any individual outcome. The prevalence of elevated MAP (19.1% compared with 9.7%) and SGA (16.0% compared with 6.7%) were highest (P < 0.05) in those with functional vitamin D deficiency compared with the reference group [25(OH)D ≥75 nmol/L and normal PTH]. The adjusted prevalence ratio (PR) and RR (95% CIs) for elevated MAP and SGA were 1.83 (1.02, 3.27) and 1.53 (0.80, 2.93), respectively. There was no effect of functional vitamin D deficiency on the risk of gestational hypertension (adjusted RR: 1.00; 95% CI: 0.60, 1.67) or pre-eclampsia (adjusted RR: 1.17; 95% CI: 0.32, 4.20). Conclusion:The concept of functional vitamin D deficiency, reflecting calcium metabolic stress, should be considered in studies of vitamin D in pregnancy. The SCOPE pregnancy cohort is registered at http://www.anzctr.org.au as ACTRN12607000551493. 10.1093/ajcn/nqy150
    Prevalence of vitamin D deficiency and its association with nutrition, travelling and clothing habits in an immigrant population in Northern Sweden. Granlund L,Ramnemark A,Andersson C,Lindkvist M,Fhärm E,Norberg M European journal of clinical nutrition OBJECTIVES:To study prevalence and determinants of vitamin D deficiency in immigrants from Africa and the Middle East living in Umeå, Sweden. DESIGN:Cross-sectional population based. SETTING:Umeå, Sweden (63° N). SUBJECTS/METHODS:Immigrants aged 25-65 years from nine countries in Africa or the Middle East (n=1306) were invited. A total of 111 men and 106 women (16.5%) completed the study. S-25-hydroxyvitamin D3 was measured with HPLC. Anthropometry, medical, socioeconomic and lifestyle data were registered. RESULTS:Vitamin D status was insufficient or deficient in 73% of the participants. Specifically, 12% had vitamin D deficiency (25(OH)D3<25 nmol/l), and only 3.7% had optimal vitamin D status (25(OH)D3 75-125 nmol/l). Mean 25(OH)D3 level was 41.0 nmol/l (± 16.6) with no difference between sexes. Levels of 25(OH)D3 were lower (P=0.030) and vitamin D deficiency was twice as common in immigrants from Africa compared with those from the Middle East. In the multiple regression analysis, vitamin D deficiency was significantly associated with low fatty fish intake (OR 4.31, 95% CI 1.61-11.55), not travelling abroad (OR 3.76, 95% CI 1.18-11.96) and wearing long-sleeved clothes in summer (OR 3.15, 95% CI 1.09-9.12). CONCLUSIONS:The majority of immigrants from Africa and the Middle East who live in northern Sweden have vitamin D deficiency or insufficiency. Our results are consistent with sun exposure and a diet with high intake of fatty fish being most important in avoiding vitamin D deficiency. 10.1038/ejcn.2015.176
    High prevalence of vitamin D deficiency among pregnant women in a Turkish population and impact on perinatal outcomes. Aydogmus Serpil,Kelekci Sefa,Aydogmus Huseyin,Eriş Serenat,Desdicioğlu Raziye,Yilmaz Bulent,Sağlam Gülcan The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians OBJECTIVE:Maternal vitamin D deficiency is a major public health problem. The aim of this study is to investigate the influence of vitamin D deficiency on perinatal results in primigravida. METHODS:One-hundred fifty-two healthy nullipar women were included in the study. Pregnant women with serum vitamin D levels <15ng/ml were defined as Group I and ≥15 ng/dl were defined as Group II; data were evaluated retrospectively. Type of delivery, gestational age at birth, birth weight, intensive care of the newborn, peri-and postpartum complications were recorded. Statistical analyses were performed with SPSS for Windows (version 16.0 ). Categorical variables were assessed using chi-squared test. The numeric variables were analyzed using Student's t-test and one-way ANOVA. RESULTS:44.6% of pregnant women were found to have vitamin D deficiency. The mean serum vitamin D levels for Groups I and II were 10.8 ± 3.8 and 23.8 ± 13.3 ng/ml, respectively. SGA deliveries were detected in 16.66% and 4.87% of the primigravidas with and without vitamin D deficiency, respectively. CONCLUSIONS:This study has shown that maternal vitamin D deficiency is related with an increased risk of SGA delivery. Further studies are needed to explain the relationship with vitamin D deficiency and poor perinatal outcomes. 10.3109/14767058.2014.969235
    High Prevalence of Vitamin D Deficiency among Pregnant Saudi Women. Al-Faris Nora A Nutrients Vitamin D deficiency has emerged as a public health problem worldwide due to its important role in health and disease. The present work is intended to examine prevalence of vitamin D deficiency among pregnant Saudi women and related risk factors. A cross-sectional study was carried out at King Fahad Medical City in Riyadh, Saudi Arabia. Serum 25-hydroxy vitamin D (25(OH)D) was measured by enzyme-linked immunosorbent assay in 160 pregnant women during the first trimester of pregnancy. Socio-demographic, lifestyle and maternal characteristics were collected and vitamin D intake was assessed using a 24-h dietary recall. Weight and height were measured using standardized methods. Vitamin D deficiency (25(OH)D < 50 nmol/L) and insufficiency (25(OH)D = 50-74 nmol/L) were reported in 50% and 43.8% of the study sample, respectively. Median serum 25(OH)D concentration was 49.9 nmol/L. Adequate vitamin D intake (≥600 IU/day) was reported among only 8.1% of pregnant women. Age group, educational level, sun exposure frequency and daytime and daily practice of exercise were significantly associated with vitamin D status. Overall, vitamin D deficiency was common among pregnant Saudi women in Riyadh. Steps should be taken to address the current situation, including increased sunlight exposure, consumption of fatty fish, and vitamin D supplements. 10.3390/nu8020077
    Prevalence and determinants of vitamin D deficiency in the third trimester of pregnancy: a multicentre study in Switzerland. Krieger Jean-Philippe,Cabaset Sophie,Canonica Claudia,Christoffel Ladina,Richard Aline,Schröder Therese,von Wattenwyl Begoña Lipp,Rohrmann Sabine,Lötscher Katharina Quack The British journal of nutrition Vitamin D deficiency during pregnancy is associated with negative health consequences for mothers and their infants. Data on the vitamin D status of pregnant women in Switzerland are scarce. A three-centre study was conducted in the obstetric departments of Zurich, Bellinzona and Samedan (Switzerland) to investigate the prevalence and determinants of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D)<50 nmol/l) in 3rd-trimester pregnant women living in Switzerland (n 305), and the correlation between 25(OH)D in pregnant women and their offspring at birth (n 278). Demographic and questionnaire data were used to explore the determinants of vitamin D deficiency. Median concentration of serum 25(OH)D in the third trimester of pregnancy was 46·0 nmol/l (1st-3rd quartiles: 30·5-68·5), representing a 53·4 % prevalence of vitamin D deficiency. 25(OH)D levels in the umbilcal cord blood (median: 50·0 nmol/l; 1st-3rd quartiles: 31·0-76·6) strongly correlated with mothers' serum 25(OH)D (Spearman's correlation ρ=0·79, P<0·001). Multivariable logistic regression analysis showed that significant determinants of vitamin D deficiency in pregnant women were centre of study, country of origin, season of delivery and vitamin D supplement intake. Near-term BMI, skin colour, use of sunscreen and mothers' education, although each not individually significant, collectively improved the ability of the model to explain vitamin D status. Low vitamin D levels were common in this sample of pregnant women and their newborns' cord blood. Vitamin D supplement intake was the most actionable determinant of vitamin D status, suggesting that vitamin D supplementation during pregnancy should receive more attention in clinical practice. 10.1017/S0007114517003634
    Vitamin D Deficiency Prevalence and Predictors in Early Pregnancy among Arab Women. Al-Musharaf Sara,Fouda Mona A,Turkestani Iqbal Z,Al-Ajlan Abdulrahman,Sabico Shaun,Alnaami Abdullah M,Wani Kaiser,Hussain Syed Danish,Alraqebah Buthaynah,Al-Serehi Amal,Alshingetti Naemah M,Al-Daghri Nasser,McTernan Philip G,Wimalawansa Sunil J,Saravanan Ponnusamy Nutrients Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are limited. This study aims to fill this gap. A total of 578 Saudi women in their 1 trimester of pregnancy were recruited between January 2014 and December 2015 from three tertiary care antenatal clinics in Riyadh, Saudi Arabia. Information collected includes socio-economic, anthropometric, and biochemical data, including serum vitamin D (25(OH)D) levels, intake of calcium and vitamin D, physical activity, and sun exposure indices. Pregnant women with 25(OH)D levels <50 nmol/L were considered vitamin D deficient. The majority of participants ( = 468 (81%)) were vitamin D deficient. High levels of indoor activity, whole body clothing, multiparity, total cholesterol/HDL ratio(>3.5), low HDL-cholesterol, and living in West Riyadh were significant independent predictors for vitamin D deficiency, with odds ratios (ORs) (95% confidence interval) of 25.4 (5.5&ndash;117.3), 17.8 (2.3&ndash;138.5), 4.0 (1.7&ndash;9.5), 3.3 (1.4&ndash;7.9), 2.8 (1.2&ndash;6.4), and 2.0 (1.1&ndash;3.5), respectively. Factors like increased physical activity, sun exposure at noon, sunrise or sunset, high educational status, and residence in North Riyadh were protective against vitamin D deficiency with ORs 0.2 (0.1&ndash;0.5); 0.2 (0.1&ndash;0.6); 0.3 (0.1&ndash;0.9); and 0.4 (0.2&ndash;0.8), respectively. All ORs were adjusted for age, BMI, sun exposure, parity, summer season, vitamin D intake, multivitamin intake, physical activity, education, employment, living in the north, and coverage with clothing. In conclusion, the prevalence of vitamin D deficiency among Saudi women during early pregnancy was high (81%). Timely detection and appropriate supplementation with adequate amounts of vitamin D should reduce the risks of vitamin D deficiency and its complications during pregnancy. 10.3390/nu10040489
    High prevalence of vitamin D deficiency in pregnant Korean women: the first trimester and the winter season as risk factors for vitamin D deficiency. Choi Rihwa,Kim Seonwoo,Yoo Heejin,Cho Yoon Young,Kim Sun Wook,Chung Jae Hoon,Oh Soo-young,Lee Soo-Youn Nutrients We investigated the vitamin D status of Korean women during pregnancy and assessed the effects of vitamin D deficiency on two pregnancy outcomes; preterm births and the births of small for gestational age. We measured the serum 25-hydroxyvitamin D levels in 220 pregnant Korean women who were recruited prospectively and compared these levels with those of 500 healthy non-pregnant women. We analyzed vitamin D status according to patient demographics, season, and obstetrical characteristics; moreover, we also assessed pregnancy outcomes. The overall prevalence of vitamin D deficiency(<20 ng/mL) in pregnant women and healthy non-pregnant women was 77.3% and 79.2%; respectively; and the prevalence of severe vitamin D deficiency (<10 ng/mL) was 28.6% and 7.2%; respectively (p < 0.05). Vitamin D deficiency was more prevalent in the winter (100%) than in the summer (45.5%) in pregnant Korean women. A higher risk of vitamin D deficiency was observed in the first trimester than in the third trimester (adjusted OR 4.3; p < 0.05). No significant association was observed between vitamin D deficiency and any of the pregnancy outcomes examined. Further research focusing on the long-term consequences of vitamin D deficiency during pregnancy in Korean women is warranted. 10.3390/nu7053427
    Prevalence of Vitamin D deficiency in the North-West region of Russia: A cross-sectional study. Karonova T,Andreeva A,Nikitina I,Belyaeva O,Mokhova E,Galkina O,Vasilyeva E,Grineva E The Journal of steroid biochemistry and molecular biology Russia is a country with geographic and economic preconditions for development of vitamin D deficiency. We analyzed serum 25(OH)D level in residents from North-West region (59-61° North latitude) of Russia to study the prevalence of vitamin D insufficiency and deficiency and its associations with gender, age, obesity and diet. The study population included 1664 residents (1544 adults 18-75 y.o. and 120 children/adolescents of 3-17 y.o.). Serum 25(OH)D was determined in 1226 participants by electrochemiluminescence immunoassay. We used a questionnaire to check the frequency of dairy and fish products intake as well as the use of vitamin supplements. The serum 25(OH)D level was 9.8-147.5nmol/L, mean level in adults population was 54.8±0.7nMol/L, in children/adolescents-46.8±1.6 nmol/L. We revealed that 16.8% of the study population had a 25(OH)D level more than 75nMol/L, 37.5% had insufficiency and 45.7% had vitamin D deficiency. Serum 25(OH)D level in women was lower than in men (53.9±0.8 and 67.2±2.2nmol/L; p<0.01). We did not find association between vitamin D status and age. Patients with normal BMI had higher 25(OH)D level than those with overweight and obesity (52.5±2.8 and 44.8±2.0 nmol/L, p<0.05). Negative correlations between 25(OH)D and BMI (r=-0.17, p=0.03) and WC (r=-0.15, p=0.02) were found. Questionnaire analyses showed that regular fish intake (minimum once per week) was associated with higher 25(OH)D level, while dairy products and vitamin supplements intake did not seem to have any effect on vitamin D status. This study showed high prevalence of vitamin D insufficiency and deficiency in adults and adolescent population from North-West region of Russia, and an association of low serum 25(OH)D level with female gender, obesity and low fish products diet. 10.1016/j.jsbmb.2016.03.026
    Vitamin D deficiency at the time of delivery - Prevalence and risk of postpartum infections. Axelsson Daniel,Brynhildsen Jan,Blomberg Marie PloS one BACKGROUND:Postpartum infections are a common cause of morbidity after childbirth. Vitamin D deficiency has been shown to increase the risk for several infections in a non-pregnant population. Vitamin D deficiency has been described as common in pregnant women. OBJECTIVE:To investigate whether vitamin D deficiency in pregnant women in labor was associated with an increased risk of overall postpartum infectious morbidity within eight weeks of delivery. A secondary aim was to estimate the prevalence of vitamin D deficiency among pregnant women in Linköping, Sweden at the time of delivery. MATERIAL AND METHODS:Serum vitamin D levels in labor were analyzed for 1397 women. Vitamin D deficiency was defined as serum levels <50 nmol/L. All ICD-10 codes given to the women eight weeks postpartum were reviewed and postpartum infections were defined as the presence of an ICD-10 code suggestive of infection. The prevalence of postpartum infections among women with sufficient vitamin D levels was compared with women with vitamin D deficiency. Adjusted Odds Ratios and 95% confidence intervals for postpartum infections were calculated using multivariate logistic regression analysis. RESULTS:Fifty eight per cent of the women had serum vitamin D levels <50 nmol/L. The proportion of women with vitamin D deficiency varied, as expected, with season. No association between vitamin D deficiency and postpartum infections was found. For vitamin D 25-50 nmol/L the adjusted Odds Ratio was 0.85 (95% confidence interval 0.56-1.29) and for vitamin D <25 nmol/L the adjusted Odds Ratio was 1.15 (95% confidence interval 0.66-2.03). Women who smoked or who had a cesarean section had an increased risk of postpartum infections. CONCLUSIONS:Vitamin D deficiency was more common than previously reported in Swedish pregnant women. No association between vitamin D deficiency and postpartum infections was found. Other well-known risk factors for postpartum infection were identified. 10.1371/journal.pone.0226673
    Prevalence of vitamin D deficiency and its associated factors in three regions of Saudi Arabia. Kaddam Ibrahim M,Al-Shaikh Adnan M,Abaalkhail Bahaa A,Asseri Khalid S,Al-Saleh Yousef M,Al-Qarni Ali A,Al-Shuaibi Ahmed M,Tamimi Waleed G,Mukhtar Abdelmoneim M Saudi medical journal 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. 10.15537/smj.2017.4.18753
    Prevalence of vitamin D deficiency in sickle cell disease: a systematic review. Nolan Vikki G,Nottage Kerri A,Cole Elliott W,Hankins Jane S,Gurney James G PloS one Vitamin D deficiency has emerged as a public health focus in recent years and patients with sickle cell disease (SCD) reportedly have a high prevalence of the condition. Our objectives were to summarize definitions of vitamin D deficiency and insufficiency used in the literature, and to determine the prevalence and magnitude of each in patients with SCD through a systematic review conducted according to PRISMA guidelines. From a PubMed search, 34 potential articles were identified and 15 met eligibility criteria for inclusion. Definitions of deficiency and insufficiency varied greatly across studies making direct comparisons difficult. This review provides evidence to suggest that suboptimal vitamin D levels are highly prevalent among those with SCD, far more so than in comparable non-SCD patients or matched control populations. Defining deficiency as vitamin D < 20 ng/mL, prevalence estimates in SCD populations range from 56.4% to 96.4%. When compared with results from the population-based National Health and Nutrition Examination Survey, however, the general African American population appeared to have a similarly high prevalence of vitamin D deficiency. African American patients with and without SCD were both substantially higher than that of Caucasians. What remains to be determined is whether there are adverse health effects for patients with SCD because of concurrent vitamin D deficiency. 10.1371/journal.pone.0119908
    Prevalence of Vitamin D deficiency in Pakistan and implications for the future. Riaz H,Finlayson A E,Bashir S,Hussain S,Mahmood S,Malik F,Godman B Expert review of clinical pharmacology BACKGROUND AND AIMS:vitamin D deficiency (25-hydroxyvitamin D) affects over one billion people worldwide. Vitamin D deficiency results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of vitamin D deficiency in Pakistan despite appreciable levels of sunshine. However, none have assessed vitamin D deficiency across all age groups, genders, incomes, and locations to guide future strategies. METHODS:Questionnaire and blood sampling among 4830 randomly selected citizens. RESULTS:High levels of deficiency among all age groups, genders, income levels, and locations. Amongst the selected citizens, 53.5% had vitamin D deficiency, 31.2% had insufficient vitamin D, and only 15.3% normal vitamin D. CONCLUSION:High rates of vitamin D deficiency in Pakistan despite high levels of sunshine and previous Food Acts asking for food fortification with vitamin D. Public health strategies are needed to address high deficiency rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups. 10.1586/17512433.2016.1122519
    Incidence and characteristics of vitamin D deficiency rickets in New Zealand children: a New Zealand Paediatric Surveillance Unit study. Wheeler Benjamin J,Dickson Nigel P,Houghton Lisa A,Ward Leanne M,Taylor Barry J Australian and New Zealand journal of public health OBJECTIVE:To investigate the incidence and characteristics of vitamin D deficiency rickets in New Zealand (NZ). METHODS:Prospective surveillance among paediatricians of Vitamin D Deficiency Rickets was conducted by the New Zealand Paediatric Surveillance Unit (NZPSU) for 36 months, from July 2010 to June 2013, inclusive. Inclusion criteria were: children and adolescents <15 years of age with vitamin D deficiency rickets (defined by low serum 25-hydroxyvitamin D and elevated alkaline phosphatase levels, and/or radiological rickets). RESULTS:Fifty-eight children with confirmed vitamin D deficiency rickets were identified. Median age was 1.4 (range 0.3-11) years, 47% were male, and 95% of the children were born in NZ; however, the majority of the mothers (68%) were born outside NZ. Overall annual incidence of rickets in children aged <15 years was 2.2/100,000 (95%CI 1.4-3.5); with incidence in those <3 years being 10.5/100,000 (95%CI 6.7-16.6). Skeletal abnormalities, poor growth and motor delay were the most common presenting features, with hypocalcaemic convulsion in 16% of children. Key risk factors identified were: darker skin pigment, Indian and African ethnicity, age <3 years, exclusive breast feeding, and southern latitude, particularly when combined with season (winter/spring). Of the patients reported, none had received appropriate vitamin D supplementation. CONCLUSIONS:Vitamin D deficiency rickets remains a problem for NZ children. Key risk factors remain similar to those identified in the international literature. Preventative targeted vitamin D supplementation, as per existing national guidelines, was lacking in all cases reported. IMPLICATIONS:Vitamin D deficiency rickets is the most significant manifestation of vitamin D deficiency in growing children. To reduce the incidence of this disease among those at high risk, increasing awareness and implementation of current public health policies for targeted maternal, infant and child supplementation are required. 10.1111/1753-6405.12390
    Extremely High Prevalence of Maternal and Neonatal Vitamin D Deficiency in the Arab Population. Fouda Mona A,Turkestani Iqbal Z,Almusharraf Sara,Al-Ajlan Abdulrahman,Angkaya-Bagayawa Fatima F,Sabico Shaun,Mohammed Ashry Gad,Hassanato Rana,Al-Serehi Amal,Alshingetti Naemah M,Al-Daghri Nasser M Neonatology BACKGROUND:Vitamin D deficiency is a global public health problem. The published literature on vitamin D deficiency is limited among Arab pregnant women and its association with different metabolic markers. OBJECTIVE:To determine the prevalence of vitamin D deficiency in Arab pregnant women and neonates and its association with various biomarker profiles. METHODS:This is a multicenter study taken from a large prospective project in Riyadh, the capital city of Saudi Arabia. Maternal biochemical levels were measured routinely. Maternal and neonatal 25(OH)D levels were assessed using a chemiluminescence immunoassay. A total of 1,097 pregnant women >16 years old with gestational ages <24 weeks were recruited from different tertiary hospitals in Riyadh between February 2011 and June 2012. RESULTS:Almost 85% of pregnant subjects had 25(OH)D level <50 nmol/L. Vitamin D deficiency among neonates was 88%. Maternal 25(OH)D was significantly associated with neonatal 25(OH)D (r = 0.54, p < 0.01), as well as serum calcium (r = 0.16, p = 0.02) and phosphate levels (r = 0.17, p = 0.02), and had an inverse correlation with parathyroid hormone (r = -0.22, p = 0.001). CONCLUSION:Maternal and neonatal vitamin D deficiency is alarmingly high in Arabs and significantly associated with each another. Universal screening for serum 25(OH)D may be appropriate for Arab mothers and vitamin D supplementation mandatory until term. The study puts a spotlight on vitamin D deficiency with the hope that health professionals will address it adequately to prevent the known long-term consequences for metabolism and bone health of both mothers and their children. 10.1159/000475704
    Seasonality of vitamin D concentrations and the incidence of vitamin D deficiency in children and adolescents from central Poland. Smyczyńska Joanna,Smyczyńska Urszula,Stawerska Renata,Domagalska-Nalewajek Hanna,Lewiński Andrzej,Hilczer Maciej Pediatric endocrinology, diabetes, and metabolism INTRODUCTION:Vitamin D3 [25(OH)D] deficiency is a significant problem in Polish children. In many regions of the world, 25(OH)D concentrations show seasonal variation and differences between boys and girls, due to seasonal differences in insolation, as well as different sociological and cultural factors. THE AIM OF THE STUDY:The aim of the study was to assess the seasonal variations of 25(OH)D concentrations and the incidence of vitamin D deficiency in children from central Poland. MATERIAL AND METHODS:The analysis comprised 1275 children, age 3-18 (11.2 ±4.0) years, with disorders of growing and/or puberty, obesity, and other complaints that could be related to endocrine diseases, except for ones with calcium-phosphorus imbalance, impaired parathyroid hormone secretion, and diseases that may influence vitamin D supply. RESULTS:Seasonal variability of 25(OH)D concentrations was observed with maximal levels in August and minimal in January and close relationship between 25(OH)D levels and insolation in the previous two months. In all the quarters, 25(OH)D concentrations were lower in girls than in boys and in older vs. younger children. The median value of 25(OH)D concentrations was below the lower limit of optimal range during the whole year. High incidence of 25(OH)D deficiency was observed (from 10.7% in August to 80.4% in January) together with low proportion of normal 25(OH)D levels (from 3.6% in January to 42.1% in August). CONCLUSIONS:Our results are consistent with previous reports on inadequate vitamin D supplementation in Polish children and adolescents, pointing out the necessity to implement current recommendations concerning vitamin D supplementation and the need for further studies on the consequences vitamin D deficiency for health of children and adolescents, with special attention to the pleiotropic effects of vitamin D. 10.5114/pedm.2019.85814
    A systematic review and meta-analysis of prevalence of vitamin D deficiency among adolescent girls in selected Indian states. Jeyakumar Angeline,Shinde Vidhya Nutrition and health BACKGROUND::Vitamin D deficiency among adolescents is an emerging public health priority as adolescence marks a period of rapid growth and the onset of the reproductive phase. However, lack of national prevalence data and intervention strategies is of public health concern. OBJECTIVE::The objective of this study was to determine the pooled prevalence of vitamin D deficiency among adolescent girls in selected Indian states. METHODS::A systematic literature review was performed using three different search engines. The searches yielded nine eligible articles. Study quality was assessed for 10 different criteria. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among adolescent girls and to assess the heterogeneity among selected studies. RESULTS::A sample of n=1352 was used to study prevalence among adolescent girls. The random effects combined estimate for overall prevalence was 25.70% (95% CI 3.89-2137.9). High heterogeneity (tau=1.71, I=100%) was observed and seven out of nine studies showed low to moderate risk and two showed high risk of bias. The test for overall effect was observed to be Z=0.77 ( p=0.44). CONCLUSIONS::High prevalence of vitamin D deficiency among adolescent girls identifies the need to introduce screening of adolescents and introduce proven public-health interventions such as fortification of foods to address deficiency. 10.1177/0260106018805360
    High prevalence of vitamin D deficiency in school-age children in Tehran, 2008: a red alert. Neyestani Tirang R,Hajifaraji Majid,Omidvar Nasrin,Eshraghian Mohammad R,Shariatzadeh Nastaran,Kalayi Ali,Gharavi A'azam,Khalaji Niloufar,Haidari Homa,Zowghi Telma,Nikooyeh Bahareh Public health nutrition OBJECTIVE:To assess the vitamin D status of 9-12-year-old primary-school children in Tehran during autumn and winter 2007-2008. DESIGN:A descriptive cross-sectional study. SETTING:Primary schools of Tehran city, Iran. SUBJECTS:A total of 1111 children aged 9-12 years (573 boys and 538 girls) from sixty primary schools were enrolled in the study. Weight, height, BMI and serum levels of Ca, P, Mg, 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (iPTH), osteocalcin and bone-specific alkaline phosphatase of all the participants were assessed. Dietary Ca intake was also evaluated using a quantitative FFQ for a subsample of the study population (n 503). Vitamin D sufficiency was defined on the basis of serum levels of 25(OH)D as either ≥37 nmol/l (criterion 1) or ≥50 nmol/l (criterion 2). RESULTS:Daily intake of Ca did not differ significantly between boys and girls (929·6 (sd 436·7) mg and 909·5 (sd 465·5) mg, respectively). However, on the basis of the first criterion, approximately 86 % of the children had vitamin D deficiency, with 38·3 % being severely deficient (25(OH)D < 12·5 nmol/l). According to the second criterion, prevalence of vitamin D deficiency rose to 91·7 %. Prevalence of vitamin D deficiency was higher in girls than in boys by either criterion. Serum levels of 25(OH)D inversely correlated with iPTH (r = -0·154, P < 0·001) and BMI (r = -0·092, P = 0·002) but directly correlated with duration of sun exposure (r = 0·115, P < 0·001). CONCLUSIONS:The high prevalence of vitamin D deficiency among schoolchildren (especially among girls) warrants immediate interventions for proper nutritional support. 10.1017/S1368980011000188
    Predictors of vitamin D deficiency and insufficiency in adult Bahrainis: a cross-sectional study. Golbahar Jamal,Al-Saffar Nida,Altayab Diab Diab,Al-Othman Sara,Darwish Abdullah,Al-Kafaji Ghada Public health nutrition OBJECTIVE:High prevalence of hypovitaminosis D has been reported to be common in different regions of the Middle East. The objective of the present study was to examine the predictors of vitamin D deficiency and insufficiency in Bahrainis. DESIGN:A cross-sectional study. SETTING:Blood transfusion volunteers at a blood bank. SUBJECTS:Serum levels of total 25-hydroxyvitamin D, bone markers and other parameters such age, sex, season and clothing style in the 500 healthy Bahrainis were investigated. RESULTS:In the entire cohort the prevalence of vitamin D deficiency was 49.4% and the relative risk of vitamin D deficiency increased significantly by 1.1, 1.2, 1.5, 1.7 and 1.2 fold with younger age group (P = 0.03), hyperparathyroidism (P = 0.01), low serum Ca (P < 0.001), warm and hot months of the year (P < 0.0001) and female sex (P = 0.002), respectively. In females the prevalence of vitamin D deficiency was 67.6% and the relative risk of vitamin D deficiency increased significantly by 1.1, 1.2, 1.2, 1.2 and 1.4 fold with younger age group (P = 0.04), hyperparathyroidism (P = 0.03), low serum Ca (P = 0.001), warm and hot months of the year (P = 0.001) and conservative clothing style (P = 0.04), respectively. In contrast, in males the prevalence of vitamin D deficiency was 31.2% and the relative risk of vitamin D deficiency was increased by 1.6 fold in warm and hot months of the year (P < 0.0001). CONCLUSIONS:High prevalence of low circulating levels of vitamin D and the relative risk factors associated with vitamin D deficiency and insufficiency observed in the present study suggest an urgent need for public health interventions including vitamin D food fortification in Bahrain. 10.1017/S136898001300030X
    Vitamin D Deficiency is Widespread in Tunisian Pregnant Women and Inversely Associated with the Level of Education. Fenina Hana,Chelli Dalenda,Ben Fradj Mohamed Kacem,Feki Moncef,Sfar Ezzeddine,Kaabachi Naziha Clinical laboratory BACKGROUND:Vitamin D deficiency seems to be common in pregnant women and would be associated with an increased risk of maternal and fetal poor outcomes. This study aimed to determine the prevalence and the main risk factors for vitamin D deficiency in pregnant women living in a sun-rich environment. METHODS:A total of 255 pregnant women living in Tunis City (latitude, 36 degrees N) were randomly selected at 12 - 18 weeks of gestation. Plasma 25-hydroxyvitamin D (25-OHD) was assessed by chemiluminescence immunoassay method. A logistic regression model adjusting for confounding variables was used to identify the independent risk factors for vitamin D deficiency. RESULTS:Plasma 25-OHD concentrations ranged from 4.02 to 78.3 nmol/L [median (IQR), 18.0 (13.6)]. More than 96% of the study population had 25-OHD levels below 50 nmol/L with 82.3% of women having vitamin D deficiency (25-OHD < 30 nmol/L) and 31.4% of women having severe vitamin D deficiency (25-OHD < 15 nmol/L). Daily dietary vitamin D intake [median (IQR), 3.49 (2.92) μg] was clearly lower than the recommended dose. Vitamin D deficiency was more frequent during the low-sunshine season, and in veiled women and those with an average level of education. In multivariate analysis, the independent predictors of vitamin D deficiency were low sunshine season [multi-adjusted OR (95% CI), 2.29 (1.24 - 4.22); p < 0.01], covering clothing [OR (95% CI), 2.54 (1.23 - 5.24); p < 0.05], and average level of education [OR (95% CI), 2.11 (1.09 - 5.91); p < 0.05]. CONCLUSIONS:Tunisian pregnant women, especially those with average/high level of education, are exposed to a high risk of vitamin D deficiency. The main causes of hypovitaminosis D are low sunshine exposure and little dietary vitamin D intake. Public health policies should target the awareness for optimal and safe sun exposure and adequate vitamin D dietary intake. Otherwise, tolerable vitamin D supplementation should be prescribed. 10.7754/clin.lab.2015.150806
    Vitamin D deficiency in school-age children is associated with sociodemographic and lifestyle factors. Voortman Trudy,van den Hooven Edith H,Heijboer Annemieke C,Hofman Albert,Jaddoe Vincent Wv,Franco Oscar H The Journal of nutrition BACKGROUND:There is concern about a reemergence of vitamin D deficiency in children in developed countries. OBJECTIVES:The aims of this study were to describe vitamin D status in the Generation R study, a large multiethnic cohort of 6-y-old children in The Netherlands, and to examine sociodemographic, lifestyle, and dietary determinants of vitamin D deficiency. METHODS:We measured serum 25-hydroxyvitamin D [25(OH)D] concentrations in 4167 children aged 6 y and defined deficiency following recommended cutoffs. We examined the associations between subject characteristics and vitamin D deficiency with the use of multivariable logistic regression analyses. RESULTS:Serum 25(OH)D concentrations ranged from 4 to 211 nmol/L (median: 64 nmol/L), with 6.2% of the children having severely deficient (<25 nmol/L), 23.6% deficient (25 to <50 nmol/L), 36.5% sufficient (50 to <75 nmol/L), and 33.7% optimal (≥75 nmol/L) 25(OH)D concentrations. The prevalence of vitamin D deficiency [25(OH)D <50 nmol/L] was higher in winter (51.3%) than in summer (10.3%); and higher in African, Asian, Turkish, and Moroccan children (54.5%) than in those with a Dutch or other Western ethnic background (17.6%). In multivariable models, several factors were associated with vitamin D deficiency, including household income (OR: 1.74; 95% CI: 1.34, 2.27 for low vs. high income), child age (OR: 1.39; 95% CI: 1.20, 1.62 per year), child television watching (OR: 1.32; 95% CI: 1.06, 1.64 for ≥2 vs. <2 h/d), and playing outside (OR: 0.71; 95% CI: 0.57, 0.89 for ≥1 vs. <1 h/d). In a subgroup with dietary data (n = 1915), vitamin D deficiency was associated with a lower diet quality, but not with vitamin D intake or supplement use in early childhood. CONCLUSIONS:Suboptimal vitamin D status is common among 6-y-old children in The Netherlands, especially among non-Western children and in winter and spring. Important modifiable factors associated with vitamin D deficiency were overall diet quality, sedentary behavior, and playing outside. 10.3945/jn.114.208280
    Mini Review: Prevalence and correlates of vitamin D deficiency-perspectives from Pakistan. Akhtar Saeed Pakistan journal of pharmaceutical sciences Health outcomes of vitamin D deficiency (VDD) are beyond rickets, osteomalacia, osteoporosis, falls and fractures and have now touched the boundaries of CVD, diabetes and many types of cancer. Therefore, thinking of mere dependence on the sun to meet vitamin D requirements under the existing set of conditions is erroneous. Pakistan as a developing economy of South Asia and a region spanning latitude 24° 35' North and longitude 61° East to 78° East, gravely suffers from increased VDD among pregnant women, neonates, infants, children, adolescents, adults, and the elderly people despite its abundant sunshine. Multiple indicators inflating VDD have been widely reported such as food habits, sociocultural and religious taboos, restricted sun exposure, unavailability of fortified diets, age, season, gender, lack of vitamin D supplementation, skin pigmentation and genetic factors. Strategies entailing mandatory food fortification, pragmatic implementation of vitamin D supplementation program, developing awareness on health damaging effects of the syndrome and sagacious sun exposure in tandem with global support to incline the government, program managers and consumers, need to be followed. Concerted efforts are further required to scale up the surveillance and monitoring of the magnitude of VDD by taking NGOs, industry, academia and health sector into loop to devise remedies for VDD in Pakistan.
    Vitamin D deficiency: A single centre analysis of patients from 136 countries. Haq Afrozul,Svobodová Jitka,Imran Samira,Stanford Charles,Razzaque Mohammed S The Journal of steroid biochemistry and molecular biology Vitamin D deficiency is a global problem, thought to be related to lack of sunlight exposure, and usually accompanied by reduced dietary intake. This study was designed to determine vitamin D status of 60,979 patients admitted to the Burjeel Hospital of VPS healthcare in Abu Dhabi, United Arab Emirates (UAE) from October 2012 to September 2014. The total concentrations of vitamin D [25(OH)D] of all the studied patients were measured in a single laboratory. Of the studied patients, 57.5% were female and 42.5% were male. Serum 25(OH)D (total) measurements showed 82.5% of the studied patients have vitamin D deficiency to insufficiency. 26.4% of females and 18.4% of males have extreme deficiency of 25(OH)D. There was higher variability of vitamin D in group of females then males according to coefficient of variation. In our studied cohort teenagers (13-19 years) have shown the lowest levels of serum vitamin D (data not shown and will be communicated as a separate publication). The prevalence of hypovitaminosis D is significantly high among population of UAE, Saudi Arabia and many Middle Eastern countries, especially among women, despite abundant sunshine. 86.1% UAE nationals and 78.9% visitors of other nationalities were found <75nmol/L of 25(OH)D. 28.4% of UAE nationals and 17.5% of visitors of other nationalities have extreme deficiency of 25(OH)D. Our results are significant, as all of our patients are residing permanently in the UAE or visitors that has yearlong sunlight. In addition, measuring 25(OH)D concentrations in a single laboratory minimized test level variations. Our current study formed the basis of further studies to determine if vitamin D deficiency and insufficiency can aggravate systemic diseases, including hypertension, diabetes or obesity that are also wide-spread in the Middle Eastern region. 10.1016/j.jsbmb.2016.02.007
    Prevalence of vitamin D deficiency among adult population of Isfahan City, Iran. Hovsepian Silva,Amini Massoud,Aminorroaya Ashraf,Amini Peyvand,Iraj Bijan Journal of health, population, and nutrition Determination of vitamin D status in different age-groups in a community and in different climates of a country is necessary and has important implications for general health. The study was conducted to determine the prevalence of vitamin D deficiency among the adult population of Isfahan, a centrally-located city in Iran. In this cross-sectional study, 1,111 healthy people-243 men and 868 women--aged 41.4 (mean 14 and range 20-80) years, who attended a single-consultation outpatient clinic, were selected. Serum 25-hydroxy vitamin D (25-OHD), parathyroid hormone (PTH), calcium and phosphorus concentrations were measured. Mild, moderate and severe vitamin D deficiencies were defined as 25-OHD values of 20-30 ng/mL, 10-20 ng/mL, and < 10 ng/mL respectively. The median (range) concentrations of 25-OHD were 21 (4.0-105.0) ng/mL in males and 18 (1.5-117) ng/mL in females (p = 0.05). The prevalence of mild, moderate and severe vitamin D deficiencies among the adult population was 19.6%, 23.9%, and 26.9% respectively. Vitamin D deficiency was more prevalent among women (p = 0.001) and younger age-group (p = 0.001). Medians of 25-OHD in spring-summer and autumn-winter were 21 ng/mL and 18 ng/mL respectively (p = 0.005). The prevalence of severe vitamin D deficiency was higher in autumn-winter than in spring-summer (odds ratio = 1.6, 95% confidence interval 1.2-2.2, p = 0.001). The prevalence of vitamin D deficiency was high in a sunny city--Isfahan--especially among women and younger population. The high prevalence of vitamin D deficiency in this city emphasizes the necessity of vitamin D supplementation as more exposure to sun is limited due to the type of clothing required by current law. 10.3329/jhpn.v29i2.7857
    [High prevalence of vitamin D deficiency in the south-west Netherlands]. Boonman-de Winter Leandra J M,Albersen Arjan,Mohrmann Karin,Bakx-van Baal Carla M A C,Meijer Timmerman Thijssen Dirk W,Bressers J P H M Hans Nederlands tijdschrift voor geneeskunde OBJECTIVE:To determine how often vitamin D deficiency occurs in the populations of a city, the countryside and urbanised areas of the countryside, and also the influence of the seasons. DESIGN:Cross-sectional study carried out in the winter and summer of 2013. Trend analysis from requests for determination of vitamin D levels by general practitioners between January 2010 and August 2012. METHOD:In a random sample survey of all blood samples received by SHL-Groep (diagnostic center for primary care) between 21-01-2013 - 10-03-2013 (winter period) and 01-08-2013 - 30-08-2013 (summer period), Vitamin D levels of the residual material were measured. We reported the results by age group, gender and postal code area in the following areas: The Hague (city), Province of Zeeland (countryside) and West Brabant (urbanised countryside). In addition, the average vitamin D concentration obtained from all the requests for determination of vitamin D levels between January 2010 and August 2012 was measured against the time of year. RESULTS:During the winter period 58.8% of the 2503 participants had a vitamin D serum concentration of < 50 nmol/l (The Hague: 65.6%; Zeeland: 50.9%). A total of 29.9% had vitamin D levels of < 30 nmol/l. In men under the age of 50 years, this was 38.2%. Of the 1910 people tested during the summer, 35.4% had a vitamin D level of < 50 nmol/l (The Hague: 43.7%; Zeeland: 33.5%). 11.6% had a vitamin D level < 30 nmol/l. General practitioners requested the vitamin D levels of 50,441 patients. The average vitamin D level varies considerably with the seasons. CONCLUSION:Vitamin D deficiency occurs frequently, even in relatively young people and more so in cities than in the countryside. The average vitamin D concentration varies with the seasons.
    Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Bodnar Lisa M,Platt Robert W,Simhan Hyagriv N Obstetrics and gynecology OBJECTIVE:To estimate the association between maternal 25-hydroxyvitamin D concentrations and risk of preterm birth subtypes. METHODS:We performed a case-cohort study using data and banked samples from patients at a teaching hospital in Pittsburgh, Pennsylvania. Eligible participants were women with a prenatal aneuploidy screening serum sample at or before 20 weeks of gestation who subsequently delivered a singleton, liveborn neonate. Of the 12,861 eligible women, we selected 2,327 at random as well as all remaining preterm birth cases for a total of 1,126 cases. Serum 25-hydroxyvitamin D was measured using liquid chromatography-tandem mass spectrometry. Multivariable log-binomial regression models were used to estimate associations between maternal vitamin D status and preterm birth at 37 weeks of gestation (separately by spontaneous or indicated) and preterm birth at less than 34 weeks of gestation. RESULTS:The incidence of preterm birth at less than 37 weeks of gestation was 8.6% overall and 11.3%, 8.6%, and 7.3% among mothers with serum 25-hydroxyvitamin D less than 50, 50-74.9, and 75 nmol/L or greater, respectively (P<.01). After adjustment for maternal race and ethnicity, prepregnancy body mass index, season, smoking, and other confounders, the risk of preterm birth at less than 37 weeks of gestation significantly decreased as 25-hydroxyvitamin D increased to approximately 90 nmol/L and then plateaued (test of nonlinearity P<.01). Results were similar when limiting to cases that were medically indicated or occurred spontaneously and cases occurring at less than 34 weeks of gestation. CONCLUSION:Our data support a protective association maternal vitamin D sufficiency and preterm birth that combined with extant epidemiologic data may provide justification for a randomized clinical trial of maternal vitamin D replacement or supplementation to prevent preterm birth. 10.1097/AOG.0000000000000621
    Public health implications of standardized 25-hydroxyvitamin D levels: a decrease in the prevalence of vitamin D deficiency among older women in Germany. Perna Laura,Haug Ulrike,Schöttker Ben,Müller Heiko,Raum Elke,Jansen Eugène H J M,Brenner Hermann Preventive medicine OBJECTIVE:To compare the public health implications of using unstandardized immunoassay measurements of serum 25-hydroxyvitamin D [25(OH)D] concentrations versus using measurements standardized by liquid chromatography tandem-mass spectrometry (LC-MS/MS) when assessing the prevalence of 25(OH)D insufficiency and deficiency in various subgroups of individuals. METHOD:We standardized immunoassay-based measurements of 25(OH)D with LC-MS/MS in a population-based sample of 5386 women aged 50-74 recruited in 2000-2002 in Germany. We used multivariate regression to assess 25(OH)D determinants and the association of vitamin D deficiency with health status. RESULTS:Prevalences of 25(OH)D levels <50 nmol/L (insufficiency) and <30 nmol/L (deficiency) decreased considerably by standardization. The decrease in vitamin D deficiency (from 64.4% to 17.9%) was particularly strong in March-May among women aged ≥ 65. Independent of season of blood draw and standardization, women ≥ 70 years, obese, or currently smoking had an increased risk of having 25(OH)D levels <30 nmol/L. CONCLUSION:The proportion of older women with vitamin D deficiency in Germany is much lower than previously reported, but prevalence of vitamin D insufficiency is high. Standardization of 25(OH)D values by immunoassay methods to LC-MS/MS equivalent values or direct measurement by LC-MS/MS is indispensable in drawing valid conclusions about the health implications of vitamin D deficiency or insufficiency. 10.1016/j.ypmed.2012.06.010
    Vitamin D deficiency in pregnant women and newborns in Lagos, Nigeria. Owie Emmanuel,Afolabi Bosede Bukola Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology We aimed to determine the prevalence of Vitamin D deficiency among pregnant women and their newborns in order to make recommendations for Vitamin D supplementation, if necessary. It was a cross-sectional study carried out over a period of 12 months. Information such as use of Vitamin D supplements, number of daytime hours spent outdoors and dressing style was obtained from 166 pregnant women in Lagos, Nigeria; maternal and cord blood 25(OH)D concentration was determined using ELISA. The prevalence of Vitamin D deficiency (<20 ng/mL) in the mothers and newborns was 4.8% and 29.5%, respectively, while insufficiency (21-29 ng/mL) was 28.3% and 46.1%, respectively. Vitamin D supplement use during pregnancy, daytime outdoor exposure and mothers' dressing style were significantly associated with maternal serum 25(OH)D concentration (p < .05). Our study showed that despite a sunny environment like ours, inadequate serum 25(OH)D concentration is still considerable among pregnant women and their newborns and suggests a need for Vitamin D supplementation in pregnant women. Impact Statement What is already known on this subject? Vitamin D is an essential vitamin that plays a major role in maintaining pregnancy and ensuring adequate skeletal formation in the foetus. Studies have shown that there is high Vitamin D deficiency in pregnant women in the temperate regions of the world and thus Vitamin D supplements are being offered to these pregnant women. Studies have also shown that the foetal/neonatal serum Vitamin D level is a reflection of the maternal level. What the results of this study add? The results of this study adds that there may be some factors preventing adequate delivery of Vitamin D from the maternal circulation to the foetal circulation, because despite a low prevalence of Vitamin D deficiency in the mothers, their neonates had a high deficiency rate. What the implications are of these findings for clinical practice and/or further research? The implications of these findings are; further research is warranted in order to find what could be causing a reduced delivery of Vitamin D from the mothers to their foetuses, so as to prevent it if possible. Second, these findings suggest that our pregnant women should still receive a form of Vitamin D supplements, so as to raise their serum Vitamin D to a level which would guarantee optimal foetal concentration. 10.1080/01443615.2017.1396299
    Prevalence of vitamin D deficiency in otherwise healthy individuals between the ages of 18 and 90 years in southeast Turkey. Öztürk Zeynel Abidin,Gol Mehmet,Türkbeyler İbrahim Halil Wiener klinische Wochenschrift 10.1007/s00508-017-1241-8
    High prevalence of vitamin D deficiency in pregnant women: a national cross-sectional survey. Vandevijvere Stefanie,Amsalkhir Sihame,Van Oyen Herman,Moreno-Reyes Rodrigo PloS one An increasing number of studies suggest that vitamin D deficiency during pregnancy is associated with multiple adverse health outcomes in mothers, neonates and children. There are no representative country data available on vitamin D status of pregnant women in Europe. The aim of this study was to estimate the prevalence of vitamin D deficiency among Belgian pregnant women and to assess the determinants of vitamin D status in the first and third trimester of pregnancy. The women were selected via a multi-stage proportionate-to-size sampling design. Blood samples were collected and a questionnaire was completed face-to-face. 55 obstetric clinics were randomly selected and 1311 pregnant women participated in the study. The median serum 25-hydroxyvitamin D [25-(OH)D] concentration was significantly lower in the first trimester (20.4 ng/ml) than in third trimester (22.7 ng/ml). Of all women, 74.1% (95%CI = 71.8-76.5%) were vitamin D insufficient (25-(OH)D <30 ng/ml), 44.6% (95%CI = 41.9-47.3%) were vitamin D deficient (25-(OH)D <20 ng/ml), while 12.1% (95%CI = 10.3-13.8%) were severely vitamin D deficient (25-(OH)D <10 ng/ml). Of all women included, 62.0% reported taking vitamin D-containing multivitamins, of which only 24.2% started taking those before pregnancy. The risk of vitamin D deficiency (25-(OH)D <20 ng/ml) was significantly higher for less educated women and women who reported not going on holidays to sunny climates. The risk of severe vitamin D deficiency (25-(OH)D <10 ng/ml) decreased for women who reported alcohol consumption during pregnancy, decreased with more frequent use of sunscreen lotion and increased for smokers and women who reported preference for shadow. In conclusion, vitamin D deficiency is highly prevalent among pregnant women in Belgium and this raises concerns about the health consequences for the mother and the offspring. A targeted screening strategy to detect and treat women at high risk of severe vitamin D deficiency is needed in Belgium and in Europe. 10.1371/journal.pone.0043868
    Obesity and vitamin D deficiency: a systematic review and meta-analysis. Pereira-Santos M,Costa P R F,Assis A M O,Santos C A S T,Santos D B Obesity reviews : an official journal of the International Association for the Study of Obesity Over the past decade, there have been an increasing number of studies on the association between vitamin D deficiency and anthropometric state. However, we did not identify any meta-analyses of the relationship between obesity and vitamin D deficiency in different age groups. Thus, we evaluated the association between obesity and vitamin D deficiency. We searched for observational studies published up to April 2014 in PubMed/Medline, Web of Science and Scopus databases. We performed a meta-analysis in accordance with the random-effects model to obtain the summary measurement (prevalence ratio, PR). Among the 29,882 articles identified, 23 met the inclusion criteria. The prevalence of vitamin D deficiency was 35% higher in obese subjects compared to the eutrophic group (PR: 1.35; 95% CI: 1.21-1.50) and 24% higher than in the overweight group (PR: 1.24; 95% CI: 1.14-1.34). These results indicate that the prevalence of vitamin D deficiency was more elevated in obese subjects. The vitamin D deficiency was associated with obesity irrespective of age, latitude, cut-offs to define vitamin D deficiency and the Human Development Index of the study location. 10.1111/obr.12239
    High prevalence of vitamin D deficiency among women of child-bearing age in Lahore Pakistan, associating with lack of sun exposure and illiteracy. Junaid Kashaf,Rehman Abdul,Jolliffe David A,Wood Kristie,Martineau Adrian R BMC women's health BACKGROUND:Vitamin D status is a key determinant of maternal and neonatal health. Deficiency has been reported to be common in Pakistani women, but information regarding environmental and genetic determinants of vitamin D status is lacking in this population. METHODS:We conducted a cross-sectional study among three groups of healthy women living in Lahore, Pakistan: university students, students or employees of Medrasas or Islamic Institutes, and employees working in office, hospital or domestic settings. Multivariate analysis was performed to identify environmental and genetic determinants of vitamin D status: polymorphisms in genes encoding the vitamin D receptor, vitamin D 25-hydroxylase enzyme CYP2R1 and vitamin D binding protein [DBP] were investigated. We also conducted analyses to identify determinants of body ache and bone pain in this population, and to determine the sensitivity and specificity of testing for hypocalcaemia and raised serum alkaline phosphatase to screen for vitamin D deficiency. RESULTS:Of 215 participants, 156 (73 %) were vitamin D deficient (serum 25[OH]D <50 nmol/L). Risk of vitamin D deficiency was independently associated with illiteracy (adjusted OR 4.0, 95 % CI 1.03-15.52, P = 0.04), <30 min sun exposure per day (adjusted OR 2.13, 95 % CI 1.08-4.19, P = 0.02), sampling in January to March (adjusted OR 2.38, 95 % CI 1.20-4.70), P = 0.01) and lack of regular intake of multivitamins (adjusted OR 2.61, 95 % CI 1.32-5.16, p = 0.005). Participants with the GG genotype of the rs4588 polymorphism in the gene encoding vitamin D binding protein tended to have lower 25(OH)D concentrations than those with GT/TT genotypes (95 % CI for difference 22.7 to -0.13 nmol/L, P = 0.053). Vitamin D deficiency was independently associated with increased risk of body ache or bone pain (adjusted OR 4.43, 95 % CI 2.07 to 9.49, P = 0.001). Hypocalcaemia (serum calcium concentration ≤9.5 mg/dL) and raised alkaline phosphatase concentration (≥280 IU/L) had low sensitivity and very low specificity for identification of vitamin D deficiency. CONCLUSION:Vitamin D deficiency is common among healthy women of child-bearing age in Lahore, Pakistan: illiteracy, decreased sun exposure and lack of multivitamin intake are risk factors. 10.1186/s12905-015-0242-x
    High Prevalence of Vitamin D Deficiency and Associated Risk Factors among Employed Women in a Sunny Industrial City. Hassannia Tahereh,GhaznaviRad Ehsan,Vakili Rosita,Taheri Sohaila,Rezaee Seyed Abdolrahim International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition BACKGROUND:Vitamin D deficiency is a public health concern associated with the pathogenesis of several chronic disorders, particularly in women. AIM:To evaluate serum vitamin D levels and its deficiency and risk factors among employed women in a sunny industrial city. METHODS:In this cross-sectional study, serum vitamin D levels, biochemical and hematological factors were assessed in 382 healthy employed women. Demographic information was collected using a standard questionnaire and data was analyzed by SPSS software. RESULTS:The mean vitamin D serum level was 22 ± 19.8 ng/ml. Prevalence of vitamin D deficiency and insufficiency were 62 % and 12.94 %, respectively. Deficiency was more common among younger subjects (< 29 years old). 23.5 % of subjects had normal and 1.35 % had toxic levels of vitamin D. Maximum serum level was observed in part-time job employees (33 ng/ml), and the lowest in Media and Culture Organizations (15 ng/ml).Vitamin D deficiency was associated with the lack of sunlight exposure at home, and taking anti-hypertensive medications. The common symptoms in deficiency condition were history of hyperlipidemia, depression, weakness, fatigue, finger tingling, leg cramps, and body and muscle pain. Moreover, LDL-cholesterol serum levels were significantly higher in the vitamin D deficiency group, with a prevalence of 40 %. CONCLUSION:The symptoms of vitamin D deficiency including depression, weakness, fatigue, tingling, leg cramps and body and muscle pain have been observed in more than 90 % after recruitment and treatment. Therefore, for improving the health and productivity of employees, a routine monitoring system for vitamin D and the other factors should be put in place. 10.1024/0300-9831/a000231
    Prevalence of vitamin D deficiency among Iranian adolescents. Ebrahimi Mehdi,Khashayar Patricia,Keshtkar Abbasali,Etemad Koroush,Dini Mahboubeh,Mohammadi Zahra,Ebrahimi Hossein,Chaman Reza,Larijani Bagher Journal of pediatric endocrinology & metabolism : JPEM OBJECTIVE:Despite the high prevalence of vitamin D deficiency in adults worldwide, not many studies have evaluated the condition in adolescents. The present study was therefore conducted to assess the prevalence of vitamin D deficiency in a group of students from Shahroud, Iran. METHODS:The cross-sectional descriptive analytical study was conducted on junior high and high school students of both genders from urban and rural areas of Shahroud, the largest city of Semnan Province in Iran, in winter 2011. The combination of stratified and cluster random sampling methods was applied in the study. A questionnaire on the demographic data, socioeconomic status, lifestyle habits (sun exposure, physical activity, dairy consumption), and drug and personal history was completed for each student. Blood samples were taken to assess vitamin D levels. RESULTS:One thousand forty-seven students from four junior high and six high schools were recruited. From among them, 42.2% were boys and 57.8% were girls. Mean and standard deviation of vitamin D levels in the studied population were 14.7 ± 9.4 ng/mL. Only 7.2% of the boys and 3.8% of the girls had sensible sun exposure. The median of milk consumption was 3 glasses per week, ranging from 0 to 7. CONCLUSION:It could be concluded that vitamin D deficiency is quite prevalent among the Iranian adolescents, and this is mainly because this group follows an unhealthy lifestyle due to osteoporosis. 10.1515/jpem-2013-0428
    Rickets and vitamin D deficiency in Alaska native children. Singleton Rosalyn,Lescher Rachel,Gessner Bradford D,Benson Matthew,Bulkow Lisa,Rosenfeld John,Thomas Timothy,Holman Robert C,Haberling Dana,Bruce Michael,Bartholomew Michael,Tiesinga James Journal of pediatric endocrinology & metabolism : JPEM BACKGROUND:Rickets and vitamin D deficiency appeared to increase in Alaskan children starting in the 1990s. We evaluated the epidemiology of rickets and vitamin D deficiency in Alaska native (AN) children in 2001-2010. METHODS:We analyzed 2001-2010 visits with rickets or vitamin D deficiency diagnosis for AN and American Indian children and the general US population aged <10 years. We conducted a case-control study of AN rickets/vitamin D deficient cases and age- and region-matched controls. RESULTS:In AN children, annual rickets-associated hospitalization rate (2.23/100,000 children/year) was higher than the general US rate (1.23; 95% CI 1.08-1.39). Rickets incidence increased with latitude. Rickets/vitamin D deficiency cases were more likely to have malnutrition (OR 38.1; 95% CI 4.9-294), had similar breast-feeding prevalence, and were less likely to have received vitamin D supplementation (OR 0.23; 95% CI 0.1-0.87) than controls. CONCLUSIONS:Our findings highlight the importance of latitude, malnutrition, and lack of vitamin D supplementation as risk factors for rickets. 10.1515/jpem-2014-0446
    Vitamin D status in the first-trimester: effects of Vitamin D deficiency on pregnancy outcomes. Ates Seda,Sevket Osman,Ozcan Pinar,Ozkal Fulya,Kaya Mehmet Onur,Dane Banu African health sciences OBJECTIVE:To assess serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester and to determine the factors affecting deficiency levels and its association with pregnancy outcomes. METHODS:Serum 25(OH)D concentrations were measured at 11-14 weeks' gestation in 229 singleton pregnancies using liquid chromatography-tandem mass spectrometry. RESULTS:The median serum 25(OH)D concentration was 10.8 ng/mL and 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL. Logistic regression analysis revealed that covered dressing style, lack of multivitamin intake, season of blood sampling (November-April) were factors associated with 25(OH)D deficiency. There was a negative correlation between 25(OH)D levels and gestational age at sampling. Low 25(OH)D levels were not associated with adverse pregnancy outcomes. Higher rate of cesarean section (CS) was noted in women with 25(OH)D ≥10 ng/mL compared to those with 25(OH)D < 10mg/ml (p= 0.01). CONCLUSION:A high prevalence of vitamin D deficiency was observed in early pregnancy which was related to dress code, use of multi-vitamins and season at sampling. Low 25(OH)D levels were not related with adverse pregnancy outcomes. Women with severe vitamin D deficiency were more likely to deliver vaginally. 10.4314/ahs.v16i1.5
    Higher prevalence of vitamin D deficiency in German pregnant women compared to non-pregnant women. Gellert Sandra,Ströhle Alexander,Bitterlich Norman,Hahn Andreas Archives of gynecology and obstetrics PURPOSE:Adequate vitamin D status is crucial for normal development of the fetus and for maternal health. As data on vitamin D status (25-hydroxyvitamin D, 25(OH)D) in German women of different states of pregnancy were not available, this study compared the vitamin D status of German women in all trimesters of pregnancy with that of non-pregnant women. METHODS:The study sample of 858 women (18-45 years) was recruited from April 2013 to March 2015 as a part of the cross-sectional Germany-wide VitaMinFemin study. Serum 25(OH)D levels were determined using chemiluminescence immunoassay. RESULTS:A total of 78.1% of the pregnant women and 53.9% of the non-pregnant women had a vitamin D status <50.0 nmol/L (p < 0.001). In pregnant women, the multivariate binary analysis showed that winter [odds ratio (OR) 13.5], longitude of residence between 6.3°E and 8.9°E (OR 2.0) or 9.0°E and 10.9°E (OR 2.3) and third trimester (OR 2.3) were associated with a higher risk of vitamin D status <25.0 nmol/L, whereas increasing age per one year (OR 0.9) with a lower risk. Compared with non-pregnant women, pregnant women were 3.7 times more likely to have a vitamin D status <25.0 nmol/L. CONCLUSION:A low vitamin D status is prevalent among German pregnant women and should be improved to supply mother and fetus adequately. 10.1007/s00404-017-4398-5
    Prevalence and correlates of vitamin D deficiency in US adults. Forrest Kimberly Y Z,Stuhldreher Wendy L Nutrition research (New York, N.Y.) Mounting evidence suggests that vitamin D deficiency could be linked to several chronic diseases, including cardiovascular disease and cancer. The purpose of this study was to examine the prevalence of vitamin D deficiency and its correlates to test the hypothesis that vitamin D deficiency was common in the US population, especially in certain minority groups. The National Health and Nutrition Examination Survey 2005 to 2006 data were analyzed for vitamin D levels in adult participants (N = 4495). Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D concentrations ≤20 ng/mL (50 nmol/L). The overall prevalence rate of vitamin D deficiency was 41.6%, with the highest rate seen in blacks (82.1%), followed by Hispanics (69.2%). Vitamin D deficiency was significantly more common among those who had no college education, were obese, with a poor health status, hypertension, low high-density lipoprotein cholesterol level, or not consuming milk daily (all P < .001). Multivariate analyses showed that being from a non-white race, not college educated, obese, having low high-density lipoprotein cholesterol, poor health, and no daily milk consumption were all significantly, independently associated with vitamin D deficiency (all P < .05). In summary, vitamin D deficiency was common in the US population, especially among blacks and Hispanics. Given that vitamin D deficiency is linked to some of the important risk factors of leading causes of death in the United States, it is important that health professionals are aware of this connection and offer dietary and other intervention strategies to correct vitamin D deficiency, especially in minority groups. 10.1016/j.nutres.2010.12.001
    [Epidemiology of vitamin-D deficiency]. Souberbielle Jean-Claude Geriatrie et psychologie neuropsychiatrie du vieillissement The 25-hydroxyvitamin D (25OHD) serum concentration is the consensual marker of vitamin D status. In the general population, the Institute of Medicine considers that a 25OHD level >20 ng/mL is sufficient for bone health in most subjects. In osteoporosis patients, in those who have a pathology or who receive drugs that may increase the risk of osteoporosis, as well as in patients with chronic kidney disease, many experts think that an optimal vitamin D status is better defined by a 25OHD concentration >30 ng/mL. In the French general population, 43-50% of subjects have a 25OHD level <20 ng/mL and approximately 80% have a 25OHD <30 ng/mL. In chronic diseased patients, as well as in some categories of the general population such as elderly people, the percentage of subjects with a 25OHD level below 20 ng/mL is frequently well above 50%. Epidemiologic studies allow us to identify risk factors for vitamin D deficiency such as ageing, overweight, dark skin pigmentation, wearing covering clothes, or having a low level of outdoor activity. This will help to target vitamin D supplementation to "at-risk" subjects. However, discussions on means to improve the vitamin D status of the overall population such as allowing higher levels of food fortification, are needed. 10.1684/pnv.2016.0589
    Successful public health action to reduce the incidence of symptomatic vitamin D deficiency. Moy Robert John,McGee Eleanor,Debelle Geoff D,Mather Ian,Shaw Nicholas J Archives of disease in childhood BACKGROUND:In response to a resurgence of symptomatic cases of vitamin D deficiency in a high-risk predominantly ethnic minority population, a programme of universal rather than targeted vitamin D supplementation was begun with a public awareness campaign about the importance of vitamin D. OBJECTIVE:To evaluate the effectiveness of this programme in reducing case numbers. METHODS:Cases of symptomatic vitamin D deficiency in children under 5 years resident in a primary care trust catchment area presenting at local hospitals were identified through laboratory records of low vitamin D levels which were cross-checked against medical records to confirm the diagnosis. Comparisons were made of the case incidence rate, level of public knowledge and vitamin supplement uptake rate at the onset of the programme in 2005 and 4 years later. RESULTS:The number of cases of symptomatic vitamin D deficiency in those under 5 years fell by 59% (case incidence rate falling from 120/100 000 to 49/100 000) despite the supplement uptake rate rising only to 17%. Public awareness of vitamin D deficiency rose to near universal levels. CONCLUSIONS:A programme of universal rather than targeted Healthy Start vitamin D supplementation for pregnant and lactating women and young children has led to a substantial decrease in cases of symptomatic vitamin D deficiency in a high-risk population. Supplementation was also started at a younger age than in the national programme. This approach has implications for the delivery of vitamin D supplementation programmes in similar populations. 10.1136/archdischild-2012-302287
    Independent association of severe vitamin D deficiency as a risk of acute myocardial infarction in Indians. Roy Ambuj,Lakshmy Ramakrishnan,Tarik Mohamad,Tandon Nikhil,Reddy K Srinath,Prabhakaran Dorairaj Indian heart journal BACKGROUND:Association of vitamin D deficiency with coronary heart disease (CHD) has been widely reported. Emerging data has shown high prevalence of vitamin D deficiency among Indians. However, this association has not been studied in Indians. METHODS:A case-control study with 120 consecutive cases of first incident acute myocardial infarction (MI) and 120 age and gender matched healthy controls was conducted at All India Institute of Medical Sciences, New Delhi. The standard clinical and biochemical risk factors for MI were assessed for both cases and controls. Serum 25 (OH) vitamin D assay was performed from stored samples for cases and controls using radioimmunoassay. RESULTS:Vitamin D deficiency [25(OH) D < 30 ng/ml] was highly prevalent in cases and controls (98.3% and 95.8% respectively) with median levels lower in cases (6 ng/ml and 11.1 ng/ml respectively; p < 0.001). The cases were more likely to have diabetes, hypertension and consume tobacco and alcohol. They had higher waist hip ratio, total and LDL cholesterol. Multivariate logistic regression analysis revealed severe vitamin D deficiency [25(OH) vitamin D < 10 ng/ml] was associated with a risk of MI with an odds ratio of 4.5 (95% CI 2.2-9.2). CONCLUSIONS:This study reveals high prevalence of vitamin D deficiency among cases of acute MI and controls from India, with levels of 25 (OH)D being significantly lower among cases. Despite rampant hypovitaminosis, severe vitamin D deficiency was associated with acute MI after adjusting for conventional risk factors. This association needs to be tested in larger studies in different regions of the country. 10.1016/j.ihj.2015.02.002
    High prevalence of vitamin D deficiency and cancer in Saudi Arabian populations: Can we hypothesize a link? Nabi Gowher,Hobani Yahya,Sarwat Maryam Medical hypotheses Inspite of having so much sunshine, Saudi Arabian population is suffering from the deficiency of the 'sunshine vitamin', vitamin D, measured in the serum as 25-OHD level. According to a recent report, about 83.6% of Saudi population is vitamin D deficient. 31.9% have severe, 32% have moderate and 19.7% have mild vitamin D deficiency (VDD). The severity of VDD differs with age, gender and region. Females are more severely vitamin D deficient than males. Various factors contributing towards it deficiency are linked to their housing designs, religious practices, lifestyle choices and dark skin color. The increasing incidences of breast, prostate and colon cancer among this society are also raising an alarm. The presence of vitamin D receptor (VDR) and the enzyme responsible for conversion of the 25(OH)D in its active metabolite 25(OH)2D3 in extra renal tissue shows the involvement of vitamin D in other diseases like cancer, diabetes, multiple sclerosis etc. About 2000 genes related to various types of diseases are found to be regulated by VDRs. These genes possess vitamin D responsive elements (VDREs) in their promoters. Studies on population of other regions also have shown correlation with low serum levels of 25(OH)D and certain diseases So, we hypothesized that vitamin D deficiencies might cause a higher prevalence of these diseases in the Kingdom. 10.1016/j.mehy.2015.04.006
    The prevalence of vitamin D deficiency and relationship with fracture risk in older women presenting in Australian general practice. Robinson Penelope J,Bell Robin J,Lanzafame Alfred,Kirby Catherine,Weekes Andrew,Piterman Leon,Davis Susan R Australasian journal on ageing AIM:To investigate vitamin D status among older women and to explore relationships between vitamin D and fracture risk and vertebral fractures. METHODS:A total of 267 general practitioners recruited 2466 women aged >70 years with no known osteoporosis or fragility fracture. Serum 25-hydroxy vitamin D (25(OH)D), bone mineral density by dual-energy X-ray absorptiometry (DXA) and vertebral fracture on thoracolumbar X-ray were determined. RESULTS:A total of 2368 women, median age 76 years, provided data and of these 13% were on vitamin D supplements. 25(OH)D levels were available for 907 (44.1%) of those not taking vitamin D. 88.3% of these had a level below 75 nmol/L. Serum 25(OH)D was negatively associated with age (P = 0.003) and body mass index (P < 0.001), and positively associated with lower latitude, femoral neck DXA T-score (P = 0.044) and being Caucasian (P < 0.001). CONCLUSIONS:The vitamin D status of community-dwelling older Australian women is inadequate, yet the use of supplements is low. 10.1111/j.1741-6612.2011.00553.x
    High prevalence of vitamin D deficiency in pregnant women and its relationship with adverse pregnancy outcomes in Guizhou, China. Hong-Bi Song,Yin Xu,Xiaowu Yang,Ying Wang,Yang Xu,Ting Cao,Na Wei The Journal of international medical research OBJECTIVE:This study was performed to investigate the prevalence of vitamin D deficiency in pregnant women in Guizhou, China and its correlation with adverse infant and maternal outcomes during the perinatal period. METHODS:In total, 220 pregnant women who received perinatal care and delivered in the Affiliated Hospital of Guizhou Medical University from November 2014 to April 2015 were enrolled. Each woman's serum vitamin D concentration was tested during early pregnancy, and its correlation with adverse infant and maternal outcomes in the perinatal period was analyzed. RESULTS:The mean serum vitamin D concentration was 29.5 ± 5.8 nmol/L. More than 90% of pregnant women had vitamin D insufficiency. Additionally, 38.4% of women with vitamin D deficiency and 22.2% with vitamin D inadequacy developed adverse perinatal outcomes. The vitamin D level was negatively correlated with adverse pregnancy outcomes. CONCLUSION:Vitamin D deficiency is highly prevalent among pregnant women in Guizhou, China. The incidence of adverse perinatal outcomes was far higher in association with vitamin D deficiency than sufficiency. A negative correlation was found between the vitamin D level and the incidence of adverse perinatal outcomes in pregnant women. Therefore, targeted screening and proper supplementation are needed during early pregnancy. 10.1177/0300060518781477
    Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Roth Daniel E,Abrams Steven A,Aloia John,Bergeron Gilles,Bourassa Megan W,Brown Kenneth H,Calvo Mona S,Cashman Kevin D,Combs Gerald,De-Regil Luz María,Jefferds Maria Elena,Jones Kerry S,Kapner Hallie,Martineau Adrian R,Neufeld Lynnette M,Schleicher Rosemary L,Thacher Tom D,Whiting Susan J Annals of the New York Academy of Sciences Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations. 10.1111/nyas.13968
    Age and gender differences in the prevalence and correlates of vitamin D deficiency. AlQuaiz AlJohara M,Kazi Ambreen,Fouda Mona,Alyousefi Nada Archives of osteoporosis Younger adults and males had a higher prevalence of vitamin D deficiency compared to older participants and females. Low intake of milk, central obesity, and lack of use of vitamin D supplements were associated with vitamin D deficiency, highlighting potentially important avenues for preventive intervention. BACKGROUND:Vitamin D deficiency is a public health concern. This study's objective was to measure the prevalence of vitamin D deficiency and determine its correlates among Saudi adults in Riyadh, Saudi Arabia. METHODS:A cross-sectional study was conducted with 2835 Saudi males and females aged 30-75 years in 18 different primary health care centers (PHCC) in Riyadh. Detailed interviews on sociodemographic and lifestyle factors and anthropometric measurements were conducted. Serum calcium, phosphorus, parathyroid, alkaline phosphatase, and 25(OH) vitamin D were measured. Multiple logistic regression analyses were conducted. RESULTS:The mean age (SD) of male and female participants was 43.0 (± 11.7) and 42.8 (± 10.3) years, respectively. Serum 25(OH) vitamin D assays for participants revealed that 72.0% (n = 695) of males and 64.0% (n = 1191) of females had levels < 50 nmol/L (deficiency), whereas 17.3% (n = 166) and 19.4% (n = 362), respectively, had levels of 50-75 nmol/L (insufficiency). Multivariate analyses for males revealed that lack of use of vitamin D supplements [adjusted odds ratio (aOR) = 4.0, 95% CI 1.7, 9.4], younger age [30-40 years aOR = 3.6, 95% CI 1.7, 7.3 and 41-50 years aOR = 4.2, 95% CI 2.0, 8.8], low milk intake [aOR = 1.7, 95% CI 1.0, 2.8], consumption of cola drinks [aOR = 2.0, 95% CI 1.1, 3.9], and central obesity [aOR = 1.8, 95% CI 1.0, 3.4] were associated with low vitamin D. In females, lack of use of vitamin D supplements [aOR = 3.7, 95% CI 2.8, 4.9], younger age [30-40 years aOR = 3.4, 95% CI 2.0, 5.8 and 41-50 years aOR = 2.8, 95% CI 1.6, 4.7], central obesity [aOR = 1.4, 95% CI 1.0, 2.2], and seasonal variation [aOR = 1.6, 95% CI 1.3, 2.1] had higher odds for vitamin D deficiency. Significantly lower levels were observed for men than women for mean serum 25(OH) vitamin D [42.6 (± 24.1) vs. 46.8 (± 30.5)], parathyroid hormone [5.3 (± 2.9) vs. 5.9 (± 2.7)], and phosphorus [1.1 (± 0.2) vs. 1.2 (± 0.2)], respectively; alkaline phosphatase levels [106 (± 32.8) vs. 99 (± 27.8)] [p < 0.01] were significantly higher in males than females. CONCLUSION:Vitamin D deficiency was highly prevalent, particularly among young adults and those with central obesity. Proper fortification policy, health education, and regular screening PHCCs may help prevent and treat vitamin D deficiency. 10.1007/s11657-018-0461-5
    Impact of season and different vitamin D thresholds on prevalence of vitamin D deficiency in epidemiological cohorts-a note of caution. Schramm Sara,Lahner Harald,Jöckel Karl-Heinz,Erbel Raimund,Führer Dagmar,Moebus Susanne, Endocrine PURPOSE:We investigated the impact of different cut-offs on the prevalence of 25-hydroxyvitamin D [25-(OH)D] deficiency. METHODS:We used baseline data of 4149 participants (45-75 years, 50% women) of the population-based Heinz Nixdorf Recall study. Serum 25-(OH)D was measured with the Roche Cobas assay. Quartiles (p25, p50, and p75) were calculated. Data were stratified by months, sex, and age. According to the recommendations of 'Dachverband Osteologie', Endocrine Society and National Institute of Health we used 25-(OH)D thresholds of 12, 20, and 30 ng/ml to estimate vitamin D deficiency. RESULTS:Overall the median of 25-(OH)D was 19.8 ng/ml (p25 = 14.4 ng/ml, p75 = 26.6 ng/ml), with highest concentrations in July (p50 = 23.8 ng/ml, p25 = 18.2 ng/ml, and p75 = 31.2 ng/ml) and lowest in March (p50 = 15.8 ng/ml, p25 = 11.5 ng/ml, and p75 = 20.6 ng/ml). Prevalence of vitamin D deficiency rose from 16, 51 up to 83% using the cut-offs of <12, <20 ng/ml, and <30 ng/ml, respectively. With respect to seasonal variance, prevalence of vitamin D deficiency rose to 92% in February/March using the cut-off <30 ng/ml (<12: 28%, <20 ng/ml: 71%) whereas in June/July prevalence of vitamin D deficiency decreased to 71% (<12: 6%, <20 ng/ml: 30%). The chance to attest the diagnosis of vitamin D deficiency for cut-off 12 ng/ml in March is 6.4-fold higher than in June, for cut-off 20 ng/ml, 5.5-fold higher and for cut-off 30 ng/ml, 3.1-fold higher. CONCLUSIONS:Guidelines to define vitamin D deficiency revealed extremely different prevalence rates ranging between 6 and 92%. Accounting for collection time and antecedent sun exposure are important to reduce bias in research studies and improve decision-making in clinical care. Vitamin D thresholds have to be rethought. 10.1007/s12020-017-1292-7
    Prevalence and Trends of Vitamin D Deficiency among Iranian Adults: A Longitudinal Study from 2001-2013. Khosravi-Boroujeni Hossein,Sarrafzadegan Nizal,Sadeghi Masoumeh,Roohafza Hamidreza,Ng Shu-Kay,Pourmogaddas Ali,Ahmed Faruk Journal of nutritional science and vitaminology Vitamin D deficiency/insufficiency is currently considered to be a re-emerging public health problem globally. This study was designed to determine the prevalence of vitamin D deficiency and insufficiency and to investigate its trend from 2001 to 2013 in a longitudinal study of Iranian adults. This study was part of a population-based, longitudinal ongoing study of Iranian healthy adults aged 35 y and older at baseline. Serum vitamin D level was assessed in a sub-sample of 370 subjects, who were apparently healthy at the time of recruitment in 2001 and were free from MetS, in three phases (2001, 2007 and 2013) during the 12-y study period. Adjusted prevalence and trend of vitamin D deficiency were calculated. Mean serum vitamin D levels increased over the time of the study (52.12, 54.27 and 62.28 nmol/L, respectively) and the prevalence of vitamin D deficiency decreased (30.5, 27.0 and 24.4, respectively). However, the prevalence of vitamin D insufficiency did not change over this time period. The risk of vitamin D deficiency decreased significantly in 2007 [OR: 0.73 (95% CI: 0.53, 0.99)] and 2013 [OR: 0.50 (95% CI: 0.36, 0.70)] compared to the baseline. The present study demonstrated some improvement in serum vitamin D levels, while the prevalence of vitamin D inadequacy was still high. Considering the possible health consequences of vitamin D deficiency, there is an urgent need for developing population-wide strategies, such as supplementation and fortification, to prevent or control vitamin D deficiency. 10.3177/jnsv.63.284
    Prevalence and Predictors of Vitamin D Deficiency among African Immigrants Living in Australia. Horton-French Kahlea,Dunlop Eleanor,Lucas Robyn M,Pereira Gavin,Black Lucinda J International journal of environmental research and public health Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations <50 nmol/L) is a public health issue in Australia and internationally. Those with darker skin require a greater dose of ultraviolet B radiation from sunlight than those with paler skin to synthesise adequate amounts of vitamin D. Using data from the 2011-2013 Australian Health Survey, we investigated the prevalence and predictors of vitamin D deficiency in African immigrants aged ≥18 years living in Australia ( = 236). Serum 25(OH)D was measured using a liquid chromatography-tandem mass spectrometry method that is certified to international reference measurement procedures. Poisson regression was used to investigate independent predictors of vitamin D deficiency. A total of 36% of adults were vitamin D deficient (35% of men, 37% of women). The prevalence ratio (PR) of vitamin D deficiency decreased by 2% per year of age (PR 0.98; 95% CI (0.97, 0.99); = 0.004) and was 1.6 times higher in those with low/sedentary, compared to moderate/high, physical activity levels (PR 1.64; 95% CI (1.12, 2.39); = 0.011). The greatest risk was for those assessed during winter/spring compared with summer/autumn (PR 1.89; 95% CI (1.33, 2.64); < 0.001). Culturally appropriate messaging on safe sun exposure and dietary vitamin D is warranted in order to promote vitamin D sufficiency in African immigrants living in Australia. 10.3390/ijerph16162855
    Prevalence of vitamin D deficiency in cord blood of newborns and the association with maternal vitamin D status. Ariyawatkul Kansuda,Lersbuasin Porntita European journal of pediatrics Vitamin D deficiency is common in Southeast Asia but there are limited data in pregnant women and neonates. This study aimed to determine the prevalence of vitamin D deficiency in cord blood of newborns and the association with maternal vitamin D status. A total of 94 pregnant women and their neonates were included. Clinical data and venous maternal blood for calcium, phosphate, albumin, alkaline phosphatase, magnesium, intact parathyroid hormone (iPTH), and vitamin D (25OHD) were obtained on the day of labor. Cord blood was collected following delivery to evaluate vitamin D status of newborns. Mean serum maternal and cord blood 25OHD levels were 25.42 ± 8.07 and 14.85 ± 5.13 ng/mL. The prevalence of vitamin D deficiency (25OHD < 12 ng/mL) and insufficiency (25OHD 12-20 ng/mL) in cord blood of newborns were 20.2 and 69.1%, respectively. There was a significant correlation between maternal and cord blood vitamin D levels (r = 0.86; P < 0.001). The factors associated with cord blood vitamin D deficiency were low maternal 25OHD level and no vitamin D supplement during pregnancy. CONCLUSION:There is a high prevalence of vitamin D deficiency among Thai neonates. Adequate prenatal vitamin D supplementation should be implemented as routine antenatal care. What is Known: • Vitamin D deficiency is prevalent in Southeast Asia. • There are widespread vitamin D deficiency among Thai populations including pregnant women. What is New: • There is a high prevalence of vitamin D deficiency among Thai neonates. • The factors associated with cord blood vitamin D deficiency are low maternal vitamin D level and no vitamin D supplement during pregnancy. 10.1007/s00431-018-3210-2
    Prevalence and predictors of vitamin D deficiency in a nationally representative sample of adults participating in the 2011-2013 Australian Health Survey. Malacova Eva,Cheang Peihua Rachel,Dunlop Eleanor,Sherriff Jill L,Lucas Robyn M,Daly Robin M,Nowson Caryl A,Black Lucinda J The British journal of nutrition Vitamin D deficiency is recognised as a public health problem globally, and a high prevalence of deficiency has previously been reported in Australia. This study details the prevalence of vitamin D deficiency in a nationally representative sample of Australian adults aged ≥25 years, using an internationally standardised method to measure serum 25-hydroxyvitamin D (25(OH)D) concentrations and identifies demographic and lifestyle factors associated with vitamin D deficiency. We used data from the 2011-2013 Australian Health Survey (n 5034 with complete information on potential predictors and serum 25(OH)D concentrations). Serum 25(OH)D concentrations were measured by a liquid chromatography-tandem MS that is certified to the reference measurement procedures developed by the National Institute of Standards and Technology, Ghent University and the US Centers for Disease Control and Prevention. Vitamin D deficiency and insufficiency were defined as serum 25(OH)D concentrations &lt;50 nmol/l and 50 to &lt;75 nmol/l, respectively. Overall, 20 % of participants (19 % men; 21 % women) were classified as vitamin D deficient, with a further 43 % classified as insufficient (45 % men; 42 % women). Independent predictors of vitamin D deficiency included being born in a country other than Australia or the main English-speaking countries, residing in southern (higher latitude) states of Australia, being assessed during winter or spring, being obese, smoking (women only), having low physical activity levels and not taking vitamin D or Ca supplements. Given our increasingly indoor lifestyles, there is a need to develop and promote strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches. 10.1017/S0007114519000151
    Vitamin D Deficiency, Prevalence and Treatment in Neonatal Period. Fedakâr Atiye Endocrine, metabolic & immune disorders drug targets OBJECTIVE:Maternal vitamin D deficiency is an important risk factor that causes infantile rickets in the neonatal and infantile period. The aim of this study was to review the prevalence, clinical characteristics, and treatment of vitamin D deficiency and the follow-ups with infants and their mothers by the neonatal intensive care unit of Afiyet Hospital in Turkey. METHODS:Calcium (Ca), phosphorus (P) and 25 (OH) vitamin D were studied and prospectively recorded in infants and their mothers detected to have hypocalcemia during routine biochemistry tests performed on the third postnatal day of the patients follow up and treated with different diagnoses. RESULTS:A total of 2,460 infants were admitted into the neonatal intensive care unit between August 2014 and January 2018. Of the infants included in the study, 324 (66.1%) were male and 166 (33.8%) were female, and 366 (74.6%) of them had been delivered by cesarean section (C/S), 124 (25.3%) of them had been delivered by Normal Spontaneous Delivery (NSD). Hypocalcemia was detected in 490 (19.9%) of the infants. In a total of 190 (38.7%) infants and 86 mothers (17.5%), the levels of 25 (OH) vitamin D were found to be below the laboratory detection limit of <3 ng/ml. When vitamin D deficiency + insufficiency is assessed by season, 151 of them were found to be in summer (30.99%), 118 in spring (24.18%), 117 in the winter season(23.87%), and 93 in autumn(18.97%), respectively. There was a statistically significant positive correlation of 78.7% between the vitamins D values of the mothers and the infants (p: 0.000, p<0.05). CONCLUSION:This study conducted that a positive correlation of between the vitamin D values of the mothers and the infants. In order to prevent maternal vitamin D deficiency, the appropriate dose of prophylaxis providing optimal levels of vitamin D and should be given by according to the levels of 25 (OH) D vitamin during pregnancy. 10.2174/1871530319666190215152045
    Population-Based Incidence of Potentially Life-Threatening Complications of Hypocalcemia and the Role of Vitamin D Deficiency. Aul Andrea J,Fischer Philip R,O'Grady Jason S,Mara Kristin C,Maxson Julie A,Meek Alicia M,Petterson Tanya M,Thacher Tom D The Journal of pediatrics OBJECTIVES:To determine the incidence of potentially life-threatening complications of hypocalcemia in infants and children in Olmsted County, Minnesota; and to determine if vitamin D deficiency contributed to these events and was, at the time of clinical presentation, considered as a possible cause. STUDY DESIGN:In this population-based descriptive study, data were abstracted from the Rochester Epidemiology Project, a medical record linkage system covering 95% of patients in Olmsted County, Minnesota. Participants were children aged 0-5 years who resided in Olmsted County between January 1, 1996 and June 30, 2017, and who received diagnoses of seizures, cardiomyopathy, cardiac arrest, respiratory arrest, laryngospasm, and/or tetany. The incidence of hypocalcemia plus a potentially life-threatening complication was calculated. RESULTS:Among 15 419 patients aged 0-5 years in Olmsted County during the study period, 1305 had eligible complications: 460 had serum calcium checked within 14 days of presentation and 85 had hypocalcemia. Patients were excluded when causes other than hypocalcemia likely triggered the complication, leaving 16 children whose complication was attributed to hypocalcemia. Three of these 16 patients had a serum 25-hydroxyvitamin D measurement and 2 were deficient (≤6 ng/mL [15 nmol/L]). Among children aged 0-5 years, the incidence of hypocalcemia plus a potentially life-threatening complication was 6.1 per 100 000 person-years (95% CI, 3.5-10.0). CONCLUSIONS:Vitamin D deficiency is an underinvestigated cause of complications of hypocalcemia in children. Serum calcium and 25-hydroxyvitamin D should be measured in children with these complications to identify possibly life-threatening vitamin D deficiency. 10.1016/j.jpeds.2019.02.018
    Incidence rate and characteristics of symptomatic vitamin D deficiency in children: a nationwide survey in Japan. Kubota Takuo,Nakayama Hirofumi,Kitaoka Taichi,Nakamura Yosikazu,Fukumoto Seiji,Fujiwara Ikuma,Hasegawa Yukihiro,Ihara Kenji,Kitanaka Sachiko,Koyama Satomi,Kusuda Satoshi,Mizuno Haruo,Nagasaki Keisuke,Oba Koji,Sakamoto Yuko,Takubo Noriyuki,Shimizu Toshiaki,Tanahashi Yusuke,Hasegawa Kosei,Tsukahara Hirokazu,Yorifuji Tohru,Michigami Toshimi,Ozono Keiichi Endocrine journal There is concern that vitamin D deficiency is prevalent among children in Japan as well as worldwide. We conducted a nationwide epidemiologic survey of symptomatic vitamin D deficiency to observe its incidence rate among Japanese children. A questionnaire inquiring the number of new patients with vitamin D deficiency rickets and/or hypocalcemia for 3 years was sent to 855 randomly selected hospitals with a pediatrics department in Japan. In this survey, we found that 250 children were diagnosed with symptomatic vitamin D deficiency. The estimated number of patients with symptomatic vitamin D deficiency per year was 183 (95% confidence interval (CI): 145-222). The overall annual incidence rate among children under 15 years of age was 1.1 per 100,000 population (95% CI: 0.9-1.4). The second survey has provided detailed information on 89 patients with symptomatic vitamin D deficiency under 5 years of age in hospitals in the current research group. The nationwide and second surveys estimated the overall annual incidence rate of symptomatic vitamin D deficiency in children under 5 years of age to be 3.5 (2.7-4.2) per 100,000 population. The second survey revealed 83% had bowed legs, 88% had exclusive breastfeeding, 49% had a restricted and/or unbalanced diet and 31% had insufficient sun exposure among the 89 patients. This is the first nationwide survey on definitive clinical vitamin D deficiency in children in Japan. Elucidating the frequency and characteristics of symptomatic vitamin D deficiency among children is useful to develop preventative public health strategies. 10.1507/endocrj.EJ18-0008
    Vitamin D Deficiency Is Not Associated With Growth or the Incidence of Common Morbidities Among Tanzanian Infants. Sudfeld Christopher R,Manji Karim P,Smith Emily R,Aboud Said,Kisenge Rodrick,Fawzi Wafaie W,Duggan Christopher P Journal of pediatric gastroenterology and nutrition OBJECTIVE:The objective of this study was to examine risk factors for vitamin D deficiency and determine the association of vitamin D status with child growth and incidence of common morbidities among Tanzanian infants. METHODS:A prospective cohort of 581 Tanzanian infants born to human immunodeficiency virus (HIV)-uninfected mothers had serum 25-hydroxyvitamin D assessed at 6 weeks and 6 months of age. Infants were seen at monthly clinic visits for growth monitoring until 18 months of age. Physicians examined infants every 3 months or when an illness was noted to document morbidities. RESULTS:The prevalence of vitamin D deficiency (<20 ng/mL) declined from 76.4% at 6 weeks of age to 21.2% at 6 months. Infants who were exclusively breastfed at 6 weeks of age had 2.05 (95% confidence interval 1.11-3.79; P = 0.02) times the risk of vitamin D deficiency as compared formula-fed infants. After multivariate adjustment, there was no association of vitamin D status at 6 weeks or 6 months with the incidence of stunting, wasting, or underweight. There was also no association of low vitamin D with the incidence of diarrhea, upper respiratory infection, acute lower respiratory tract infection, or malaria. CONCLUSIONS:Vitamin D deficiency is common during early infancy, particularly among exclusively breastfed infants; however, these observational data suggest it may not be an important contributor to morbidity and growth among the general population of Tanzanian infants. Future studies of vitamin D among high-risk infants, including those with low birthweight and exposed to HIV, may be warranted. 10.1097/MPG.0000000000001658