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Vitamin D levels in the Middle East: very low, especially in summer – June 2012

Vitamin D Deficiency in Middle East

Endocr Rev, Vol. 33 (03_MeetingAbstracts): MON-347
Copyright © 2012 by The Endocrine Society ENDO 2012: June 23-26, 2012, Houston, Texas
Nishanth Sanalkumar, MBBS, MD, FACE1, Priya Sreekumaran Nair, MBBS, DCH, DNB2 and Srinivas Bontha, MBBS, MD, MRCP1
1 Endocrinology and Diabetes, Al Zahra Hospital Sharjah, United Arab Emirates
2 Pediatrics, Dr Sunny Medical Center Sharjah, United Arab Emirates

Despite ample sunshine,Vitamin D deficiency is reported from several countries in middle east(1). We describe the prevalence of vitamin D deficiency in patients who were seen in the outpatient clinics of Al Zahra Hospital, Sharjah, UAE over a period of 14 months.

Methods: We analyzed the demographic profile of all patients who had 25-hydroxy vitamin D (25[OH]D) levels tested at the Al Zahra hospital, Sharjah from January 2010 to February 2011.Severity of vitamin D deficiency was determined based on the serum 25[OH]D level.Total 25[OH]D level in serum was measured using Diasorin chemiluminescence assay (normal range 75-200 nmol/L).Vitamin D deficiency was defined as 25[OH]D levels below 50 nmol/L (20 ng/mL). Levels between 50-75 nmol/L (20-30 ng/mL)was taken as vitamin D insufficiency and above 75 nmol/L (30 ng/mL), normal. Patients with 25[OH]D levels below 25 nmol/L (10 ng/mL) were considered to have severe vitamin D deficiency.The mean 25[OH]D levels in different nationalities, age groups and in men and women were compared.Statistical analysis was done using SPSS 10.0 statistical software.

Results: Serum 25[OH]D levels were available for 3449 patients. Mean age(±SD) of the population tested was 38.6 ±13.4 years. Male to female ratio was 1:3.

{Wonder: are there so many women in the Middle East hospitals due to such low levels of vitamin D?}

More than 60 nationalities were represented and were divided into 5 groups – UAE nationals, Non UAE Arabs, Caucasians, South Asians, Others.
The mean (±SD) 25[OH]D level was 30.34 ± 18.09 nmol/L.

Only 111 patients (3.2%) had normal vitamin D levels.
{97% have less than 30 ng}
Vitamin D insufficiency was present in 399 patients (11.6%) and
deficiency in 2939 patients (85.2%).
Nearly half of all the patients tested had severe vitamin D deficiency (n 1629; 47.2%).

The 25 [OH]D level was low in both sexes, but it was significantly lower in females compared with males (29.5±18.3 vs 33.5±16.9 nmol/L).
{probably due to very conservative clothing}

Mean 25[OH]D level was below normal in all nationalities, but was lowest in UAE nationals (27.29nmol/L) and highest in Caucasians (39.97 nmol/L).
Vitamin D level was low across all ages.
It was relatively better in the first decade (45.8nmol/L).

Mean 25[OH]D levels were higher in January to June period compared with July-December.
{They REALLY avoid the hot summer sun}

Conclusion: Vitamin D deficiency, including severe vitamin D deficiency, is very common in Sharjah.
Daily supplementation with 400-800 IU of vitamin D is recommended for prophylaxis(2), but higher doses may be needed to keep the 25[OH]D levels above 75 nmol/L.

(1)The Middle East and Africa Regional Audit. The Epidemiology, cost and burden of Osteoporosis in 2011. www.iofbonehealth.org. (2)Holick MF, Binkley NC, Heike A. Evaluation, Treatment and Prevention of Vitamin D deficiency. J Clin Endocrinol Metab July 2011, 96(7) 1911-30.

Nothing to Disclose: NS, PSN, SB
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By VitaminDWiki

People with darker skin typically have lower levels of D

  1. Dark skin produces less vitamin D per minute than white
  2. People with dark skin often want to have lighter skin – so avoid the sun
  3. People with dark skin do not feel that they need to tan – so do not seek out the sun

The average person in Turkey probably has somewhat more vitamin D for at least two reasons

  1. Patients in the hospital may have been inside for many days – not getting any sun
  2. Surgery, trauma, and various diseases which have vicious circles with vitamin D - all decrease the levels of vitamin D

See also VitaminDWiki

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