Extreme Vitamin D deficiency in most low middle income countries which had studies

Created January 2018

Is vitamin D deficiency a public health concern for low middle income countries? A systematic literature review

European Journal of Nutrition, pp 1–21, Online: 17 Jan 2018, https://doi.org/10.1007/s00394-018-1607-3

Kevin D. Cashman, Tony Sheehy, Colette M. O’Neill

Extreme = More than 20% of a group has less than 8-12 ng of vitamin D 1. See also VitaminDWiki 10 Most-visited pages in Middle East category {LISTPAGES} 10 Most-visited pages in World category {LISTPAGES} Deficiency of Vitamin D category listing has items along with related searches

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image

**
C children,
W-CBA women of child-bearing age,
I infant,
A adults,
OA older adults **

FAO estimation of Vitamin D intake from food

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Purpose

Vitamin D deficiency has been receiving increasing attention as a potential public health concern in low and lower-middle income countries (LMICs), of which there are currently 83. We aimed to conduct a comprehensive systematic literature review (SLR) of available data on vitamin D status and prevalence of vitamin D deficiency in all 83 LMICs.

Methods

We followed the general methodology for SLRs in the area of serum 25-hydroxyvitamin D. Highest priority was placed on identifying relevant population-based studies, followed by cross-sectional studies, and to a lesser extent case-control studies. We adopted the public health convention that a prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D < 25/30 nmol/L) at > 20% in the entire population and/or at-risk population subgroups (infants, children, women of child-bearing age, pregnancy) constitutes a public health issue that may warrant intervention.

Results

Our SLR revealed that of the 83 LMICs, 65% (n = 54 countries) had no published studies with vitamin D data suitable for inclusion.

Using data from the remaining third, a number of LMICs had evidence of excess burden of vitamin D deficiency in one or more population subgroup(s) using the above convention (Afghanistan, Pakistan, India, Tunisia and Mongolia) as well as possibly other LMICs, albeit with much more limited data. Several LMICs had no evidence of excess burden.

Conclusion

Vitamin D deficiency is a public health issue in some, but certainly not all, LMICs. There is a clear need for targeting public health strategies for prevention of vitamin D deficiency in those LMICs with excess burden.

References

References

  1. United Nations. http://www.un.org/en/development/desa/policy/wesp/wespcurrent/2014wespcountry_classification.pdf. Accessed 15 May 2017

  2. World Bank. https://datahelpdesk.worldbank.org/knowledge-base/articles/906519-world-bank-country-and-lending-groups. Accessed 15 May 2017

  3. The World Health Organization (2014) Comprehensive implementation plan on maternal, infant and young child nutrition. http://apps.who.int/iris/bitstream/10665/113048/1/WHONMH NHD14.1eng.pdf?ua=1. Accessed 17 May 2017

  4. Coulter JB (2014) Nutrition and malnutrition in low- and middle- income countries. Paediatr Int Child Health 34(4):233-235

  5. Solomons NW, Bermudez OI (2008) Nutrition in the elderly in developing countries. In: Semba RD, Bloem MW, Piot P (eds) Nutrition and health in developing countries. Humana, Louisville, pp 577-599

  6. Cashman KD (2018) Vitamin D deficiency: a public health issue in high-, middle- and low-income countries or just hype? In: Bie- salski HK, Birner R (eds) Hidden hunger. Strategies to improve nutrition quality. World Rev Nutr Diet, vol 118. Basel, Karger, pp 206-214. https://doi.org/10.1159/000484391

  7. Roth DE, Abrams SA, Aloia J, Bourassa MW, Calvo M, Cashman KD, Jefferds ME, Jones KS, Kapner H, Martineau AR, Neufeld L, Thacher TD, Whiting S, Bergeron G, Brown K, Combs G, De-Regil LM, Mithal A, Schleicher RL (2017) Global prevalence & disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries (in review, Annals of the NY Academy of Science)

  8. Cashman KD, Dowling KG, Skrabakova Z, Gonzalez-Gross M, Valtuena J, De Henauw S, Moreno L, Damsgaard CT, Michaelsen KF, Mplgaard C, Jorde R, Grimnes G, Moschonis G, Mavrogianni C, Manios Y, Thamm M, Mensink GB, Raben- berg M, Busch MA, Cox L, Meadows S, Goldberg G, Prentice

  9. Dekker JM, Nijpels G, Pilz S, Swart KM, van Schoor NM, Lips P, Eiriksdottir G, Gudnason V, Cotch MF, Koskinen S, Lamberg-Allardt C, Durazo-Arvizu RA, Sempos CT, Kiely M (2016) Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr 103:1033-1044

  10. Cashman KD, Kiely M (2011) Towards prevention of vitamin D deficiency and beyond: knowledge gaps and research needs in vitamin D nutrition and public health. Br J Nutr 106:1617-1627

  11. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes

  12. Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales- Torres J, IOF Committee of Scientific Advisors (CSA) Nutrition Working Group (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807-1820

  13. Lips P (2010) Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol 121:297-300

  14. van Schoor NM, Lips P (2011) Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 25:671-680

  15. Hilger J, Friedel A, Herr R, Rausch T, Roos F, Wahl DA, Pierroz DD, Weber P, Hoffmann K (2014) A systematic review of vitamin D status in populations worldwide. Br J Nutr 111:23-45

  16. Palacios C, Gonzalez L (2014) Is vitamin D deficiency a major global public health problem?. J Steroid Biochem Mol Biol 144(Pt A):138-145

  17. Hagenau T, Vest R, Gissel TN, Poulsen CS, Erlandsen M, Mosekilde L, Vestergaard P (2009) Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis. Osteoporos Int 20:133-140

  18. Manios Y, Moschonis G, Lambrinou CP, Tsoutsoulopoulou K, Gonzalez-Gross M, Kiely M, Cashman KD (2017) A systematic review of vitamin D status in southern European countries. Eur J Nutr. https://doi.org/10.1007/s00394-017-1564-2 (Epub ahead of print)

  19. Sheehy T, Sharma S (2011) The nutrition transition in the Republic of Ireland: trends in energy and nutrient supply from 1961 to 2007 using Food and Agriculture Organization food balance sheets. Br J Nutr 106:1078-1089

  20. Seamans KM, Cashman KD (2009) Existing and potentially novel functional markers of vitamin D status: a systematic review. Am J Clin Nutr 89(6):1997s-2008s

  21. Black LJ, Seamans KM, Cashman KD et al (2012) An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification. J Nutr 142(6):1102-1108

  22. Cashman KD, Kiely M, Seamans KM et al (2016) Effect of ultraviolet light-exposed mushrooms on vitamin D status: liquid chromatography-tandem mass spectrometry reanalysis of biobanked sera from a randomized controlled trial and a systematic review plus meta-analysis. J Nutr 146(3):565-575

  23. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:2535

  24. Institute of Medicine Food and Nutrition Board (2011) dietary reference intakes for calcium and vitamin D; National Academy, Washington, DC

  25. Scientific Advisory Committee on Nutrition Report on Vitamin D and Health. https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report. Accessed on 1 July 2016

  26. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) (2016) Scientific opinion on dietary reference values for vitamin D. EFSA J 14:4547

  27. NORDEN Nordic Nutrition Recommendations, 5th Edition (NNR5)—Vitamin D. http://www.slv.se/en-gb/Startpage-NNR/ Public-consultation11/. Accessed 28 Aug 2013

  28. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society (2011) Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:1911-1930

  29. FAOSTAT (2017) Food balance sheets. http://faostat.fao.org/site/368/default.aspx. Accessed June 2017

  30. Food Standards Agency (2002) McCance and Widdowson’s composition of foods, 6th edn. Royal Society of Chemistry, Cambridge

  31. GAIN. http://www.gainhealth.org/programs/initiatives/#global- tracking). Accessed June 2017

  32. EPA. https://www.epa.gov/sunsafety/uv-index-scale-1. Accessed 7 July 2016

  33. McKenzie R, Smale D, Kotkamp M (2004) Relationship between UVB and erythemally weighted radiation. Photochem Photobiol Sci 3:252-256

  34. The World Health Organization. http://www.who.int/uv/inter-sunprogramme/activities/uv_index/en/index3.html. Accessed 15 May 2017

  35. World Factbook https://www.cia.gov/library/publications/the-world-factbook/fields/2122.html. Accessed July 2017

  36. Pollution. http://aqicn.org/faq/2015-05-16/world-health-organization-2014-air-pollution-ranking/. Accessed July 2017

  37. Classification scale for skin complexions around the world. https://plasticsurgerykey.com/ classification-scale-for-skin-complexions-around-the-world/

  38. Prentice A, Schoenmakers I, Jones KS et al (2009) Vitamin D deficiency and its health consequences in Africa. Clin Rev Bone Miner Metab 7(1):94-106

  39. Jehan F, Voloc A, Esterle L et al (2010) Growth, calcium status and vitamin D receptor (VDR) promoter genotype in European children with normal or low calcium intake. J Steroid Biochem Mol Biol 121(1):117-120

  40. Lander RL, Enkhjargal T, Batjargal J et al (2008) Multiple micronutrient deficiencies persist during early childhood in Mongolia. Asia Pac J Clin Nutr 17(3):429-440

  41. Uush T (2013) Prevalence of classic signs and symptoms of rickets and vitamin D deficiency in Mongolian children and women. J Steroid Biochem Mol Biol 136:207-210

  42. Ganmaa D, Holick MF, Rich-Edwards JW et al (2014) Vitamin D deficiency in reproductive age Mongolian women: a cross sectional study. J Steroid Biochem Mol Biol 139:1-6

  43. Bromage S, Rich-Edwards JW, Tselmen D et al (2016) Seasonal epidemiology of serum 25-hydroxyvitamin D concentrations among healthy adults living in rural and urban areas in Mongolia. Nutrients 8(10):592

  44. Food and Nutrition Research Institute, Department of Science and Technology Bicutan, Taguig City, Metro Manila (2015) Phillipines: 8th National Nutrition Survey 2013

  45. Raso AA, Navarra SV, Li-Yu J et al (2009) Survey of vitamin D levels among post-menopausal Filipino women with osteoporosis. Int J Rheum Dis 12(3):225-229

  46. Poh BK, Rojroongwasinkul N, Nguyen BK et al (2016) 25-hydroxy-vitamin D demography and the risk of vitamin D insufficiency in the South East Asian Nutrition Surveys (SEA- NUTS). Asia Pac J Clin Nutr 25(3):538-548

  47. Laillou A, Wieringa F, Tran TN et al (2013) Hypovitaminosis D and mild hypocalcaemia are highly prevalent among young Vietnamese children and women and related to low dietary intake. PLoS One 8(5):e63979

  48. Ho-Pham LT, Nguyen ND, Lai TQ et al (2011) Vitamin D status and parathyroid hormone in a urban population in Vietnam. Osteoporos Int 22(1):241-248

  49. Nguyen HT, von Schoultz B, Nguyen TV et al (2012) Vitamin D deficiency in northern Vietnam: prevalence, risk factors and associations with bone mineral density. Bone 51(6):1029-1034

  50. Ho-Pham LT, Vu BQ, Lai TQ et al (2012) Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans. Eur J Clin Nutr 66(1):75-82

  51. Smith G, Wimalawansa SJ, Laillou A et al (2016) High prevalence of vitamin D Deficiency in Cambodian women: a common deficiency in a Sunny Country. Nutrients 8(5):290

  52. National Institute of Statistics, Directorate General for Health, ICF International (2015) Cambodia Demographic and Health Survey 2014

  53. Green TJ, Skeaff CM, Rockell JE et al (2008) Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur. Eur J Clin Nutr 62(3):373-378

  54. Sarmidi S, Setiyohadi B, Kw SA (2008) Vitamin D status and hyperparathyroisism in postmenopausal osteoporotic patients in Cipto Mangunkusumo hospital Jakarta. Acta Med Indones 40(2):69-73

  55. Rinaldi I, Setiati S, Oemardi M et al (2007) Correlation between serum vitamin D (25(OH)D) concentration and quadriceps femo- ris muscle strength in Indonesian elderly women living in three nursing homes. Acta Med Indones 39(3):107-111

  56. Manaseki-Holland S, Zulf Mughal M, Bhutta Z et al (2008) Vitamin D status of socio-economically deprived children in Kabul, Afghanistan. Int J Vitam Nutr Res 78(1):16-20

  57. Ministry of Public Health, UNICEF, and Aga Khan University (AKU), Karachi, Pakistan. (2013) National Nutrition Survey Afghanistan

  58. Anwar S, Iqbal MP, Azam I et al (2016) Urban and rural comparison of vitamin D status in Pakistani pregnant women and neonates. J Obstet Gynaecol 36(3):318-323

  59. Aga Khan University, Pakistan, Pakistan Medical Research Council (PMRC), Nutrition Wing, Cabinet Division, Government of Pakistan, and UNICEF Pakistan. (2011) National Nutrition Survey Pakistan 2011

  60. Hassan S, Muzammil SM, Jafri L et al (2015) An audit of clinical laboratory data of 25 [OH]D at Aga Khan University as reflecting vitamin D deficiency in Pakistan. J Pak Med Assoc 65(11):1247-1250

  61. Riaz H, Finlayson AE, Bashir S et al (2016) Prevalence of Vitamin D deficiency in Pakistan and implications for the future. Expert Rev Clin Pharmacol 9(2):329-338

  62. Iqbal R, Jafri L, Haroon A et al (2013) Illuminating the dark side—vitamin D status in different localities of Karachi. J Coll Physicians Surg Pak 23(8):604-606

  63. Mehboobali N, Iqbal SP, Iqbal MP (2015) High prevalence of vitamin D deficiency and insufficiency in a low income periurban community in Karachi. J Pak Med Assoc 65(9):946-949

  64. Haugen J, Ulak M, Chandyo RK et al (2016) Low prevalence of vitamin D insufficiency among Nepalese infants despite high prevalence of vitamin D insufficiency among their mothers. Nutrients 8(12):825

  65. Schulze KJ, Christian P, Wu LS et al (2014) Micronutrient deficiencies are common in 6- to 8-year-old children of rural Nepal, with prevalence estimates modestly affected by inflammation. J Nutr 144(6):979-987

  66. Jiang T, Christian P, Khatry SK et al (2005) Micronutrient deficiencies in early pregnancy are common, concurrent, and vary by season among rural Nepali pregnant women. J Nutr 135(5):1106-1112

  67. Perumal N, Al Mahmud A, Baqui AH et al (2015) Prenatal vitamin D supplementation and infant vitamin D status in Bangladesh. Public Health Nutr:1-9

  68. Islam MZ, Akhtaruzzaman M, Lamberg-Allardt C (2006) Hypo- vitaminosis D is common in both veiled and nonveiled Bangladeshi women. Asia Pac J Clin Nutr 15(1):81-87

  69. Islam MZ, Lamberg-Allardt C, Karkkainen M et al (2002) Vitamin D deficiency: a concern in premenopausal Bangladeshi women of two socio-economic groups in rural and urban region. Eur J Clin Nutr 56(1):51-56

  70. Sachan A, Gupta R, Das V et al (2005) High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr 81(5):1060-1064

  71. Marwaha RK, Tandon N, Chopra S et al (2011) Vitamin D status in pregnant Indian women across trimesters and different seasons and its correlation with neonatal serum 25-hydroxyvitamin D levels. Br J Nutr 106(9):1383-1389

  72. Farrant HJ, Krishnaveni GV, Hill JC et al (2009) Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr 63(5):646-652

  73. Krishnaveni GV, Veena SR, Winder NR et al (2011) Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon Study. Am J Clin Nutr 93(3):628-635

  74. Filteau S, Rehman AM, Yousafzai A et al (2016) Associations of vitamin D status, bone health and anthropometry, with gross motor development and performance of school-aged Indian children who were born at term with low birth weight. BMJ Open 6(1):e009268

  75. Kapil U, Pandey RM, Goswami R et al (2017) Prevalence of Vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India. Indian J Endocrinol Metab 21(1):178-183

  76. Basu S, Gupta R, Mitra M et al (2015) Prevalence of vitamin d deficiency in a pediatric hospital of eastern India. Indian J Clin Biochem 30(2):167-173

  77. Veena SR, Krishnaveni GV, Srinivasan K et al (2017) Association between maternal vitamin D status during pregnancy and offspring cognitive function during childhood and adolescence. Asia Pac J Clin Nutr 26(3):438-449

  78. Puri S, Marwaha RK, Agarwal N et al (2008) Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr 99(4):876-882

  79. Harinarayan CV, Ramalakshmi T, Prasad UV et al (2008) Vitamin D status in Andhra Pradesh: a population based study. Indian J Med Res 127(3):211-218

  80. Beloyartseva M, Mithal A, Kaur P et al (2012) Widespread vitamin D deficiency among Indian health care professionals. Arch Osteoporos 7:187-192

  81. Shivane VK, Sarathi V, Bandgar T et al (2011) High prevalence of hypovitaminosis D in young healthy adults from the western part of India. Postgrad Med J 87(1030):514-518

  82. Goswami R, Marwaha RK, Gupta N et al (2009) Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. Br J Nutr 102(3):382-386

  83. Marwaha RK, Tandon N, Garg MK et al (2011) Bone health in healthy Indian population aged 50 years and above. Osteoporos Int 22(11):2829-2836

  84. Marasinghe E, Chackrewarthy S, Abeysena C et al (2015) Micronutrient status and its relationship with nutritional status in preschool children in urban Sri Lanka. Asia Pac J Clin Nutr 24(1):144-151

  85. Hettiarachchi M, Liyanage C (2012) Coexisting micronutrient deficiencies among Sri Lankan pre-school children: a community-based study. Matern Child Nutr 8(2):259-266

  86. Meyer HE, Holvik K, Lofthus CM et al (2008) Vitamin D status in Sri Lankans living in Sri Lanka and Norway. Br J Nutr 99(5):941-944

  87. Fenina H, Chelli D, Ben Fradj MK et al (2016) Vitamin D deficiency is widespread in Tunisian pregnant women and inversely associated with the level of education. Clin Lab 62(5):801-806

  88. Ayadi ID, Nouaili EB, Talbi E et al (2016) Prevalence of vitamin D deficiency in mothers and their newborns in a Tunisian population. Int J Gynaecol Obstet 133(2):192-195

  89. Bezrati I, Hammami R, Ben Fradj MK et al (2016) Association of plasma 25-hydroxyvitamin D with physical performance in physically active children. Appl Physiol Nutr Metab 41(11):1124—1128

  90. Meddeb N, Sahli H, Chahed M et al (2005) Vitamin D deficiency in Tunisia. Osteoporos Int 16(2):180-183

  91. Nasri K, Ben Fradj MK, Feki M et al (2016) Maternal 25-hydrox- yvitamin D level and the occurrence of neural tube defects in Tunisia. Int J Gynaecol Obstet 134(2):131—134

  92. Bahlous A, Farjallah N, Bouzid K et al (2009) Hypovitaminosis D in Tunisian osteoporotic postmenopausal women and the relationship with bone fractures. Tunis Med 87(3):188-190

  93. Loudyi FM, Kassouati J, Kabiri M et al (2016) Vitamin D status in Moroccan pregnant women and newborns: reports of 102 cases. Pan Afr Med J 24:170

  94. El Maghraoui A, Ouzzif Z, Mounach A et al (2012) Hypovi- taminosis D and prevalent asymptomatic vertebral fractures in Moroccan postmenopausal women. BMC Womens Health 12:11

  95. El Maataoui A, Biaz A, El Machtani S et al (2016) Vitamin D status in healthy Moroccan men and women aged 50 years and older: a cross-sectional study. Arch Osteoporos 11(1):24

  96. El Lithy A, Abdella RM, El-Faissal YM et al (2014) The relationship between low maternal serum vitamin D levels and glyce- mic control in gestational diabetes assessed by HbA1c levels: an observational cross-sectional study. BMC Pregnancy Childbirth 14:362

  97. El Rifai NM, Abdel Moety GA, Gaafar HM et al (2014) Vitamin D deficiency in Egyptian mothers and their neonates and possible related factors. J Matern Fetal Neonatal Med 27(10):1064-1068

  98. Abd-Allah SH, Pasha HF, Hagrass HA et al (2014) Vitamin D status and vitamin D receptor gene polymorphisms and susceptibility to type 1 diabetes in Egyptian children. Gene 536(2):430-434

  99. Abu Shady MM, Youssef MM, Salah El-Din EM et al (2016) Predictors of serum 25-hydroxyvitamin D concentrations among a sample of Egyptian schoolchildren. Sci World J 2016:8175768- 1-8175768-7.https://www. ncbi.nlm.nih.gov/pmc/articles/ PMC4749821/

  100. Botros RM, Sabry IM, Abdelbaky RS et al (2015) Vitamin D deficiency among healthy Egyptian females. Endocrinol Nutr 62(7):314-321

  101. Ragab WS, Saleh WF, Tawfik LT (2013) Vitamin D deficiency in postmenopausal Egyptian women. Int J Gynaecol Obstet 123(1):75-76

  102. Aly WW, Hussein MA, Moahamed Ebeid S et al (2014) Prevalence of vitamin D insufficiency among community dwelling elderly in Dakahlia as a representative of rural areas in Egypt. Aging Clin Exp Res 26(1):47-51

  103. Abdeen Z, Ramlawi A, Qaswari R et al (2015) Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data. Public Health Nutr 18(8):1358-1368

  104. Sayed-Hassan R, Abazid N, Alourfi Z (2014) Relationship between 25-hydroxyvitamin D concentrations, serum calcium, and parathyroid hormone in apparently healthy Syrian people. Arch Osteoporos 9:176

  105. Elemraid MA, Mackenzie IJ, Fraser WD et al (2011) A case- control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children. Eur J Clin Nutr 65(8):895-902

  106. Velarde Lopez AA, Gerber JS, Leonard MB et al (2016) Children with lower respiratory tract infections and serum 25-hydroxy- vitamin D3 levels: a case-control study. Pediatr Pulmonol 51(10):1080-1087

  107. Naqvi A, Solomons NW, Campos R et al (2017) Vitamin D status among indigenous Mayan (Kekchi) and Afro-Caribe (Gari- funa) adolescents from Guatemala: a comparative description between two ethnic groups residing on the Rio Dulce at the Caribbean coast in Izabal Province, Guatemala. Public Health Nutr 20(10):1729-1737

  108. Sud SR, Montenegro-Bethancourt G, Bermudez OI et al (2010) Older Mayan residents of the western highlands of Guatemala lack sufficient levels of vitamin D. Nutr Res 30(11):739-746

  109. Braithwaite V, Jarjou LM, Goldberg GR et al (2012) Follow-up study of Gambian children with rickets-like bone deformities and elevated plasma FGF23: possible aetiological factors. Bone 50(1):218-225

  110. Aspray TJ, Yan L, Prentice A (2005) Parathyroid hormone and rates of bone formation are raised in perimenopausal rural Gambian women. Bone 36(4):710-720

  111. Wejse C, Olesen R, Rabna P et al (2007) Serum 25-hydroxyvita- min D in a West African population of tuberculosis patients and unmatched healthy controls. Am J Clin Nutr 86(5):1376-1383

  112. Pfitzner MA, Thacher TD, Pettifor JM et al (1998) Absence of vitamin D deficiency in young Nigerian children. J Pediatr 133(6):740-744

  113. Durazo-Arvizu RA, Aloia JF, Dugas LR et al (2013) 25-hydroxy- vitamin D levels in African American and Nigerian women. Am J Hum Biol 25(4):560-562

  114. Olayiwola IO, Fadupin GT, Agbato SO et al (2014) Serum micronutrient status and nutrient intake of elderly Yoruba people in a slum of Ibadan, Nigeria. Public Health Nutr 17(2):455-461

  115. Feleke Y, Abdulkadir J, Mshana R et al (1999) Low levels of serum calcidiol in an African population compared to a North European population. Eur J Endocrinol 141(4):358-360

  116. Herrador Z, Sordo L, Gadisa E et al (2014) Micronutrient deficiencies and related factors in school-aged children in Ethiopia: a cross-sectional study in Libo Kemkem and Fogera districts, Amhara Regional State. PLoS One 9(12):e112858

  117. Gebreegziabher T, Stoecker BJ (2013) Vitamin D insufficiency in a sunshine-sufficient area: southern Ethiopia. Food Nutr Bull 34(4):429-433

  118. Kosk D, Kramer H, Luke A et al (2017) Dietary factors and fibroblast growth factor-23 levels in young adults with African ancestry. J Bone Miner Metab 35(6):666-674

  119. Durazo-Arvizu RA, Camacho P, Bovet P et al (2014) 25-Hydrox- yvitamin D in African-origin populations at varying latitudes challenges the construct of a physiologic norm. Am J Clin Nutr 100(3):908-914

  120. Njemini R, Meyers I, Demanet C et al (2002) The prevalence of autoantibodies in an elderly sub-Saharan African population. Clin Exp Immunol 127(1):99-106

  121. Njemini R, Smitz J, Demanet C et al (2011) Circulating heat shock protein 70 (Hsp70) in elderly members of a rural population from Cameroon: association with infection and nutrition. Arch Gerontol Geriatr 53(3):359-363

  122. Ramos NL, Sekikubo M, Kironde F et al (2015) The impact of vitamin D on the innate immune response to uropathogenic Escherichia coli during pregnancy. Clin Microbiol Infect 21(5):482.e1-482.e7

  123. Nabeta HW, Kasolo J, Kiggundu RK et al (2015) Serum vitamin D status in children with protein-energy malnutrition admitted to a national referral hospital in Uganda. BMC Res Notes 8:418

  124. Friis H, Range N, Changalucha J et al (2013) Vitamin D status among pulmonary TB patients and non-TB controls: a crosssectional study from Mwanza, Tanzania. PLoS One 8(12):e81142

  125. Luxwolda MF, Kuipers RS, Kema IP et al (2013) Vitamin D status indicators in indigenous populations in East Africa. Eur J Nutr 52(3):1115-1125

  126. Boillat-Blanco N, Bovet P, Ramaiya KL et al (2016) Association between tuberculosis, diabetes and 25 hydroxyvitamin D in Tanzania: a longitudinal case control study. BMC Infect Dis 16(1):626

  127. Turner AN, Carr Reese P, Chen PL et al (2016) Serum vitamin D status and bacterial vaginosis prevalence and incidence in Zimbabwean women. Am J Obstet Gynecol 215(3):332.e1-332.e10

  128. Mastala Y, Nyangulu P, Banda RV et al (2013) Vitamin D deficiency in medical patients at a central hospital in Malawi: a comparison with TB patients from a previous study. PLoS One 8(3):e59017

  129. Robinson SL, Ramirez-Zea M, Roman AV, Villamor E; Nine Mesoamerican Countries Metabolic Syndrome Study (NiMe- CoMeS) Group (2017) Correlates and family aggregation of vitamin D concentrations in school-aged children and their parents in nine Mesoamerican countries. Public Health Nutr. 24:1-12

  130. O’Neill CM, Kazantzidis A, Ryan MJ et al (2016) Seasonal changes in vitamin D-effective UVB availability in Europe and associations with population serum 25-hydroxyvitamin D. Nutrients 8(9). https://doi.org/10.3390/nu8090533

  131. Matsuoka LY, Wortsman J, Haddad JG et al (1991) Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol 127(4):536-538

  132. Jaaskelainen T, Itkonen ST, Lundqvist A, Erkkola M, Koskela T, Lakkala K, Dowling KG, Hull GL, Kroger H, Karppinen J,

  133. Kyllonen E, Harkanen T, Cashman KD, Mannisto S, Lamberg- Allardt C (2017 Jun) The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr 105(6):1512-1520

  134. Cashman KD, Ritz C, Kiely M, Odin Collaborators. Improved dietary guidelines for vitamin D: application of individual participant data (IPD)-level meta-regression analyses. Nutrients 9(5):E469

  135. Yang Z, Laillou A, Smith G et al (2013) A review of vitamin D fortification: implications for nutrition programming in Southeast Asia. Food Nutr Bull 34(2 Suppl):S81-S89

  136. Cashman KD, Hayes A, Galvin K, Merkel J, Jones G, Kaufmann M, Hoofnagle AN, Carter GD, Durazo-Arvizu RA, Sempos CT (2015) Significance of serum 24,25-dihydroxyvitamin D in the assessment of vitamin D status: a double-edged sword? Clin Chem 61:636-645

  137. Carter GD, Berry JL, Gunter E, Jones G, Jones JC, Makin HL, Sufi S, Wheeler MJ (2010) Proficiency testing of 25-Hydrox- yvitamin D (25-OHD) assays. J Steroid Biochem Mol Biol 121:176-179

  138. Binkley N, Sempos CT (2014) Vitamin D standardization program (VDSP). standardizing vitamin D assays: the way forward. J Bone Miner Res 29:1709-1714

  139. Cashman KD, Kiely M, Kinsella M, Durazo-Arvizu RA, Tian L, Zhang Y, Lucey A, Flynn A, Gibney MJ, Vesper HW, Phinney KW, Coates PM, Picciano MF, Sempos CT (2013) Evaluation of Vitamin D Standardization Program protocols for standardizing serum 25-hydroxyvitamin D data: a case study of the program’s potential for national nutrition and health surveys. Am J Clin Nutr 97(6):1235-1242

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