Effect of different dress style on vitamin D level in healthy young Orthodox and ultra-Orthodox students in Israel.
Osteoporos Int. 2011 Nov;22(11):2895-8. Epub 2010 Nov 26.
Tsur A, Metzger M, Dresner-Pollak R.
Diabetes and Endocrinology, Clalit Health Services, Jerusalem, Israel, tsuranat at netvision.net.il.
Ultra-orthodox Jewish lifestyle, which encourages modest dress and indoor scholarly activity, represents a risk factor for vitamin-D deficiency. Our study in healthy young males from higher education religious institutions located in the same geographical area showed frequent and severe vitamin D deficiency, strongly correlated with the degree of sun exposure. However, PTH level was usually normal.
INTRODUCTION: Ultra-orthodox Jewish lifestyle encourages modest dress and indoor scholarly activity. As such, it represents a risk factor for vitamin-D deficiency, a worldwide problem previously underestimated in sunny countries. Our aim was to characterize the vitamin-D status of religious Jewish males according to sun exposure and outdoor activity, and study the correlation between serum 25-hydroxyvitamin D (25(OH) D) and PTH level.
METHODS: Seventy-four young adult males were recruited from three Jewish higher education institutions (Yeshiva) in Jerusalem.
- Yeshiva-A ultra-Orthodox students (aged 20.1?±?0.6) wear traditional clothing, live in dormitories and stay mostly indoor.
- Yeshiva-B ultra-Orthodox students (aged 33.0?±?4.2) dress similarly but have regular outdoor activities.
- Yeshiva-C religious students (aged 19?±?2.0) participate in a mixed army/Yeshiva program. Weekly outdoor activity time and degree of sun exposure were estimated by questionnaire.
RESULTS: 25(OH)D was 8.9?±?3.6, 10.2?±?5.7 and 21.7?±?10.4 ng/ml (mean?±?SD) in Yeshiva A, B and C. 25(OH)D was correlated with degree of sun exposure (r?=?0.54, p?<?0.0001) and inversely correlated with PTH (r?=?-0.3, p?=?0.01). Levels below 20 ng/ml were considered as vitamin D deficiency. PTH was normal in 87% of vitamin D-deficient subjects from Yeshiva-A and Yeshiva-C (mean age 20), compared to 52% of Yeshiva-B students (mean age 33). Bone mineral density studied in a random subset (n?=?14) of vitamin D-deficient subjects showed Z-scores of -1.5?±?1.0, -1.8?±?0.8, -2.1?±?0.4 in femoral neck, spine and radius.
CONCLUSIONS: Severe vitamin-D deficiency is extremely prevalent in ultra-Orthodox males. Despite rare secondary hyperparathyroidism, they represent an important previously unrecognized high-risk group for metabolic bone disease.
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A: 9 ng modest clothing and indoor
B: 10 ng traditional clothing and indoor
C: 22 ng traditional clothing and outdoor
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