|Year : 2014 | Volume
| Issue : 2 | Page : 74-76
Vitamin D deficiency health population overview
Yousef Abdullah Al Turki
Departments of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Web Publication||9-Oct-2014|
Yousef Abdullah Al Turki
Departments of Family and Community Medicine, College of Medicine, King Saud University, 28054 Riyadh 11437
Source of Support: None, Conflict of Interest: None
The aim of this mini review article is to highlight the causes and recommend some policy about vitamin D deficiency worldwide. Vitamin D deficiency is the most common nutritional deficiency and very likely the most common medical condition in the world. The body requires higher intake of Vitamin D. The spectrum of these common disorders is of particular concern because observational studies have demonstrated that vitamin D insufficiency is widespread in many regions of the world, including industrialized countries. In conclusion, improving the availability of diets rich in vitamin D, to all people at a cheap price in the community markets is important. Exposure to sun is also a main source of vitamin D, so it is essential to increase health education about the importance of sun exposure to all age groups. It is important to plan according to each country's social and cultural aspects, without creating anxiety in the public.
نقص فيتامين D بين الاصحاء - مقال استعراضى
الهدف من هذه المقالة الموجزة تسليط الضوء على أسباب نقص فيتامين D حول العالم واقتراح بعض التوصيات للمساهمة في إيجاد حلول لهذه المشكلة.
يعد نقص فيتامين D من مشكلات سوء التغذية كما أنه في الوقت ذاته أكثر المشكلات االصحية شيوعا في العالم. ولتفادي هذه المشكلة لا بد من تناول كمية كبيرة من فيتامين D لسد حاجة الجسم منه و يعد نقص هذا الفايتمين من أهم المشكلات الصحية لأن الدراسات التي رصدت هذه الظاهرة قد أثبتت أنها منتشرة على نطاق واسع في مناطق كثيرة من العالم ، بما في ذلك الدول الصناعية.
وخلصت الدراسات الى التوصيات الاتية:
ــ زيادة الثقيف الصحي بأهمية فيتلمين D لصحة الجسم
ــ توفيرالوجبات الغذائية الغنية بفيتامين D بأسعار رخيصة
ــ التعرض لأشعة الشمس التي تعدّ مصدرا أساسيا لفيتامين D
ــ أن تخطط كل دولة لحل هذه المشكلة وفقا لجوانبها الاجتماعية و الثقافية دون أن يشع سكانها بالقلق منهذه المشكلة
Keywords: Diet, lack of sun exposure, vitamin D deficiency, world wide
|How to cite this article:|
Al Turki YA. Vitamin D deficiency health population overview
. Saudi J Sports Med 2014;14:74-6
| Biological role of vitamin d|| |
The biological role of vitamin D, via its 1,25(OH) 2 D 3 , is to control calcium and phosphate homeostasis to help the deposition of bone mineral. This happens when 1,25(OH) 2 D 3 stimulates and helps intestinal calcium and phosphate absorption, thus increasing the calcium in blood.  Vitamin D3 is synthesized in the skin through the exposure of ultraviolet light of the sun, or it is taken from food. After that hydroxylation in the liver into 25-hydroxyvitamin D (25(OH) D) and kidney into 1,25-dihydroxyvitamin D (1,25(OH) 2D), so the active metabolite can enter the cell, then it will bind with the vitamin D receptor and subsequently to calcium-binding protein. The calcium-binding protein mediates calcium absorption from the gut. The production of 1,25(OH) 2D is stimulated by parathyroid hormone (PTH) and decreased by calcium. 
| Background of vitamin d deficiency worldwide|| |
In areas such as Arab countries, Asia, and Africa where there is plentiful sunlight, it would be expected that the vitamin D level is adequate in the majority of the population. In Saudi Arabia we noted that a substantial proportion of patients as well as healthy subjects coming for routine screening have subnormal levels of vitamin D. ,,,,, Research results showed increased prevalence of vitamin D deficiency between Saudi (both males and females) in the studied group of subjects. Researchers hypothesize that the reported vitamin D deficiency in the studied group of Saudi may reflect a possible inadequacy of the current level of vitamin D fortification of food products.  A cross-sectional study was carried out in November 2009 on male and female medical students in Dammam, Saudi Arabia. In 100% of the students, the vitamin D level was low. The prevalence of vitamin D deficiency in all students was 96.0% (92.64% in males and 99.03% in females), while the remaining 4% had vitamin D insufficiency. Males had a statistically significant higher body mass index as well as consumption of dairy products, while the consumption of seafood was significantly higher in females. There was no difference between the two groups in terms of exposure to the sun.  It is well established that low levels of 25(OH) Vitamin D are a common finding world over. A high proportion of the asymptomatic population worldwide have low levels of vitamin D. Vitamin D deficiency in mothers and infants is a global health disorder despite recognition that it is preventable. The spectrum of these common disorders is of particular concern because observational studies have demonstrated that vitamin D insufficiency is widespread in many regions of the world, including industrialized countries. A recent nationwide survey in the United Kingdom showed that more than 50% of the adult population have insufficient levels of vitamin D. The specific causes for this observed high prevalence of low 25OH vitamin D levels are not clear and need to be investigated further. ,,,,,,
| How People Need More Vitamin D Than They Ingested in Their Diet and Combined with Sun Exposure?|| |
Vitamin D deficiency is the most common nutritional deficiency and very likely the most common medical condition in the world. ,, There is a multitude of causes of vitamin D deficiency, but the major cause has been the need of higher intake than is currently recommended by the Institute of Medicine and other health agencies.  The likely reason is that essentially every tissue and cell in the body has a Vitamin D receptor (VDR) and thus, to have enough vitamin D to satisfy all of these cellular requirements, the blood level of 25(OH) D needs to be above 30 ng/ml. It has been estimated that for every 100 IU of vitamin D ingested that the blood level of 25(OH) D increases by 1 ng/ml. Thus to theoretically achieve a blood level above 30 ng/ml requires the ingestion of 3000 IU of vitamin D a day. There is evidence, however, that when the blood levels of 25(OH) D are less than 15 ng/ml, the body is able to more efficiently use vitamin D to raise the blood level to about 20 ng/ml. To raise the blood level of 25(OH) D above 20 ng/ml requires the ingestion of 100 IU of vitamin D for every 1-ng increase; therefore to increase the blood level to the minimum 30 ng/ml requires the ingestion of at least 1000 IU of vitamin D a day for adults. There is a great need to significantly increase the recommended adequate intakes of vitamin D. All neonates during the first year of life should take at least 400 IU/d of vitamin D, and increasing it to 1000 IU/d may provide additional health benefits. Children, 1 year and older should take at least 400 IU/d of vitamin D as recently recommended by the American Academy of Pediatrics, but they should consider increasing intake up to 2000 IU/d to derive maximum health benefits from vitamin D. Prepubertal and teenage girls who received 2000 IU of vitamin D per day for a year showed improvement in their musculoskeletal health with no untoward toxicity. All adults should be taking 2000 IU of vitamin D per day. 
| Vitamin d deficiency in mother and infant is a global health problem|| |
Vitamin D deficiency in mothers and infants is a global health disorder despite recognition that it is preventable. , Vitamin D supplementation in a single or continued dose during pregnancy increases serum vitamin D concentrations as measured by 25-hydroxyvitamin D at term. The clinical significance of this finding and the potential use of this intervention as a part of routine antenatal care are yet to be determined, as the number of high quality trials and outcomes reported is too limited to draw conclusions on its usefulness and safety. Further rigorous randomized trials are required to evaluate the role of vitamin D supplementation in pregnancy. 
| What Changed That A Large Part of the World's Population Has Lower Vitamin D Levels Than the Optimal?|| |
People all over the world might have changed their life styles by decreasing their intake of diets, which are rich in vitamin D, and by avoiding sun exposure, as they were trying to protect their skin from sun. This might be the influence of some previous health message to avoid sun exposure. So it is recommended to increase community awareness of the importance of vitamin D and to implement scientific evidence based guidelines on how to obtain it by fully considering and understanding the cultural aspect of each community is necessary. Skin cancers might relate to heavy exposure to ultraviolet (UV) radiation and, for decades sun protection has been promoted in various public health education campaigns. Skin being the primary site for the synthesis of active form of vitamin D, excessive sun protection could lead to vitamin D-deficient states. But, the results have so far been conflicting. ,,
| Conclusion and policy to alter the situation|| |
Vitamin D deficiency is a common health issue worldwide, which needs to be approached scientifically by an evidence-based approach, without creating panic or anxiety among people in the community. Improving availability of diets rich in vitamin D to all people at a cheap price in the community markets is important. Exposure to sun is a main source of vitamin D, so it is essential to increase health education about the importance of exposure to sun in all age groups. It is important to plan according to each country's social and cultural aspects, without creating anxiety or worries about vitamin D deficiency among public. School health education will be an important aspect in improving the younger age group to avoid this problem in their future. Further, community based researches about the possible causes of vitamin D deficiency in each community is recommended, and finally to implement simple, acceptable and practical scientific evidence based advice suitable to each community.
| References|| |
Haussler MR, Whitfield GK, Haussler CA, Hsieh JC, Thompson PD, Selznick SH, et al
. The nuclear vitamin D receptor: Biological and molecular regulatory properties revealed. J Bone Miner Res 1998;13:325-49.
Lips P. Vitamin D physiology. Prog Biophys Mol Biol 2006;92:4-8.
Elsammak MY, Al-Wossaibi AA, Al-Howeish A, Alsaeed J. High prevalence of vitamin D deficiency in the sunny Eastern region of Saudi Arabia: A hospital-based study. East Mediterr Health J 2011;17:317-22.
Al-Othman A, Al-Musharaf S, Al-Daghri NM, Krishnaswamy S, Yusuf DS, Alkharfy KM, et al
. Effect of physical activity and sun exposure on vitamin D status of Saudi children and adolescents. BMC Pediatr 2012;12:92.
Kanan RM, Al Saleh YM, Fakhoury HM, Adham M, Aljaser S, Tamimi W. Year-round vitamin D deficiency among Saudi female out-patients. Public Health Nutr 2013;16:544-8.
Mansour MM, Alhadidi KM. Vitamin D deficiency in children living in Jeddah, Saudi Arabia. Indian J Endocrinol Metab 2012;16:263-9.
Elshafie DE, Al-Khashan HI, Mishriky AM. Comparison of vitamin D deficiency in Saudi married couples. Eur J Clin Nutr 2012;66:742-5.
Sadat-Ali M, Al Elq AH, Al-Turki HA, Al-Mulhim FA, Al-Ali AK. Influence of vitamin D levels on bone mineral density and osteoporosis. Ann Saudi Med 2011;31:602-8.
El Sammak MY, Al Wosaibi AA, Al Howeish A, Alsaeed J. Vitamin d deficiency in Saudi Arabs. Horm Metab Res 2010;42:364-8.
Al Elq AH. The status of Vitamin D in medical students in the preclerkship years of a Saudi medical school. J Family Community Med 2012;19:100-4.
Sheikh A, Saeed Z, Jafri SA, Yazdani I, Hussain SA. Vitamin D levels in asymptomatic adults--a population survey in Karachi, Pakistan. PLoS One 2012;7:e33452.
Alshishtawy MM. Vitamin D Deficiency: This clandestine endemic disease is veiled no more. Sultan Qaboos Univ Med J 2012;12:140-52.
Holick MF. Vitamin D: Extraskeletal health. Rheum Dis Clin North Am 2012;38:141-60.
Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ 2010;340:b5664.
Dawodu A, Wagner CL. Prevention of vitamin D deficiency in mothers and infants worldwide-a paradigm shift. Paediatr Int Child Health 2012;32:3-13.
Mithal A, Kaur P. Osteoporosis in Asia: A call to action. Curr Osteoporos Rep 2012;10:245-7.
Nguyen HT, von Schoultz B, Nguyen TV, Dzung DN, Duc PT, Thuy VT, et al
. Vitamin D deficiency in northern Vietnam: Prevalence, risk factors and associations with bone mineral density. Bone 2012;51:1029-34.
Mutlu GY, Kusdal Y, Ozsu E, Cizmecioglu FM, Hatun S. Prevention of Vitamin D deficiency in infancy: Daily 400 IU vitamin D is sufficient. Int J Pediatr Endocrinol 2011;2011:4.
De-Regil LM, Palacios C, Ansary A, Kulier R, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2012;2:CD008873.
Christie FT, Mason L. Knowledge, attitude and practice regarding vitamin D deficiency among female students in Saudi Arabia: A qualitative exploration. Int J Rheum Dis 2011;14:e22-9.
Al-Mutairi N, Issa BI, Nair V. Photoprotection and vitamin D status: A study on awareness, knowledge and attitude towards sun protection in general population from Kuwait, and its relation with vitamin D levels. Indian J Dermatol Venereol Leprol 2012;78:342-9.
Sinha A, Cheetham TD, Pearce SH. Prevention and treatment of vitamin D deficiency. Calcif Tissue Int 2013;92:207-15.