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Year : 2020  |  Volume : 4  |  Issue : 4  |  Page : 157-158

Environmental practices and serum Vitamin D deficiency

Department of Internal Medicine, College of Medicine, QU Health, Qatar University; Department of Internal Medicine, Weill Cornell-Affiliated Hamad General Hospital (Hamad Medical Corporation); Department of Internal Medicine, Weill Cornell College of Medicine, New York and Doha, Qatar

Date of Submission27-Nov-2020
Date of Acceptance28-Nov-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Dr. Mohammed Ibn-Mas'ud Danjuma
Department of Internal Medicine, College of Medicine, QU Health, Qatar University, Doha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/LJMS.LJMS_102_20

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How to cite this article:
Danjuma MI. Environmental practices and serum Vitamin D deficiency. Libyan J Med Sci 2020;4:157-8

How to cite this URL:
Danjuma MI. Environmental practices and serum Vitamin D deficiency. Libyan J Med Sci [serial online] 2020 [cited 2023 Mar 28];4:157-8. Available from: https://www.ljmsonline.com/text.asp?2020/4/4/157/305238

Vitamin D deficiency is a well-established morbidity worldwide, with several factors reported to account for differences in its reported prevalence estimates. High prevalence rates between 12% and 96% have been reported in the Middle East and North Africa (MENA) region.[1] Factors impacting on these rates includes seasonal variation, as well as cultural practices such as dress codes (reducing frequent exposure of the body to sunlight common in Islamic jurisdictions) among others.

In this issue of Libyan Journal of Medical Sciences, Al-Graiw et al.[2] have investigated the association between Vitamin D deficiency and its untoward influence on bone health among Libyan female patient cohorts living in Tripoli, as well as a host of risk factors impacting on this. Their findings of about 87.7% of the patients within their study cohort having serum Vitamin D concentrations below “normal” levels (25-hydroxyvitamin D [25(OH)D]-levels <30 ng/mL) appears consistent with that reported by Mallah et al.[3] The proportion of those with “severe” Vitamin D deficiency (defined as 25(OH)D-levels <10 ng/ml) was apparent in over half of the study cohort (50.8%). One of the factors explored in this study was the contribution of dressing code to the intensity and duration of sunlight exposure, a factor critical in Vitamin D synthesis. The point estimate of Vitamin D deficiency prevalence attributable to decreased sunlight exposure due to the Islamic dressing code from this study falls within the ballpark of recently published prevalence estimates from centers in the Middle East, Europe, and the USA.[4],[5],[6]

This study provides insight into the key factors contributing to the unusually high prevalence of Vitamin D deficiency in this vulnerable population. Duration and intensity of sunlight exposure undoubtedly remain a key determinant of Vitamin D deficiency prevalence rates reported from this study, as well as those from previously published reports in the MENA region. However, a recurring limitation apparent in Al-Graiw et al.'s study,[2] as was obvious in other previous reports is the study design. A cross-sectional design of a limited patient sample is probably unlikely to wholly influence national government's decision regarding this rising morbidity. In addition, the confusion around the exact deficiency of Vitamin D deficiency has been exacerbated by debate as to what constitutes “insufficient,” “sufficient,” and “severe” Vitamin D deficiency among other iteration of Vitamin D thresholds reported elsewhere in the literature. For clinicians, the exact Vitamin D replacement threshold would appear more clinically useful to clinicians involved in their day-to-day care of patients, rather than the multiple deficiency thresholds, which at best have no bearing on clinical decision-making. There is therefore need for more work in this area, particularly amongst patient populations within the MENA region where this dress code is common. This work should initially focus on well-designed epidemiological cohort studies to ascertain an agreed definition of Vitamin D deficiency (consistent with the requirement of the region); the exact point and period prevalence estimates; as well as other factors impacting on these estimates. This will then both inform design of future intervention studies as well aid therapeutic commissioning by local, regional, and national governments within the MENA region.

Finally, it is pertinent to reiterate the importance of data reported by Al-Graiw et al.,[2] and to encourage more work in this area, especially the impact of dressing code on the vitamin deficiency prevalence estimates in Libya and across the MENA region.

  References Top

Chakhtoura M, Rahme M, Chamoun N, Fuleihan GE. Vitamin D in the Middle East and North Africa. Bone Rep 2018;8:135-46.  Back to cited text no. 1
Al-Graiw MH, Draid MM, Zaidi AM, Al-Griwet al HH. Serum Vitamin D levels and associated risk factors among libyan females living in Tripoli, Libya: A cross sectional Study. Libyan J Med Sci 2020;4:169-173.  Back to cited text no. 2
  [Full text]  
Mallah EM, Hamad MF, Elmanaseer MA, Qinna NA, Idkaidek NM, Arafat TA, et al. Plasma concentrations of 25-hydroxyvitamin d among jordanians: Effect of biological and habitual factors on vitamin d status. BMC Clin Pathol 2011;11:8.  Back to cited text no. 3
Hatun S, Islam O, Cizmecioglu F, Kara B, Babaoglu K, Berk F, et al. Subclinical vitamin d deficiency is increased in adolescent girls who wear concealing clothing. J Nutr 2005;135:218-22.  Back to cited text no. 4
Meddeb N, Sahli H, Chahed M, Abdelmoula J, Feki M, Salah H, et al. Vitamin D deficiency in tunisia. Osteoporos Int 2005;16:180-3.  Back to cited text no. 5
Hobbs RD, Habib Z, Alromaihi D, Idi L, Parikh N, Blocki F, et al. Severe vitamin D deficiency in Arab-American women living in Dearborn, Michigan. Endocr Pract 2009;15:35-40.  Back to cited text no. 6


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