Many Saudi Arabian girls have a poor vitamin D status

A new study shows that 64% of 15 to 18-year-old girls in Saudi Arabia have low blood vitamin D concentrations, which is a cause for concern, given that there is currently no public health policy for vitamin D in the Kingdom.

In order to determine the extent of poor vitamin D status in school boys and girls from ages 6 to 18, and to examine whether age, physical activity or veiling had any effect on the status, vitamin D concentrations
(25-hydroxyvitamin D) were measured in blood samples of 150 boys (aged 7–16) and 150 girls (aged 6 to 18)
at Saudi Arabian schools (1). The study results showed that vitamin D status was significantly lower in girls than boys in all age groups. The girls ages 15 to 18 had the lowest level: a total of 64% of them had a 25-hydroxy-vitamin D status below 25 nmol/l in comparison to 31% in the group of 13 to 14-year-olds, 26% in the group of 10 to 12–year-olds and 25% in the group of 6 to 9-year-olds. No boys had a vitamin D status below 25 nmol/l. Fully veiled girls had lower vitamin D status than partly veiled or unveiled girls. Low vitamin D status was associated with lower bone mass in the groups of 6 to 9-year-olds and 13 to 14-year-olds.

The researchers concluded that the significant insufficient vitamin D status detected in many study participants was a cause for concern since there is currently no public health policy for vitamin D in the Kingdom of Saudi Arabia. Experts commented that the picture of nutritional status in Arab countries has changed drastically over the past 30 years as a result of the social and economic situation (2). In general, unhealthy dietary habits, including insufficient micronutrient intakes, have increased the risk of cardiovascular disease, cancer, diabetes and osteoporosis. In addition to iron (3) and vitamin A (4), vitamin D has been identified as most critical. In order to correct this deficiency state (2), it would be necessary to implement mandatory vitamin D food fortification or supplement use, particularly in the winter time, and to encourage a more active outdoor lifestyle.

An insufficient vitamin D status can result from low sunlight exposure in addition to an inadequate dietary intake of vitamin D. An adequate vitamin D and calcium intake is essential for optimal peak bone mass accretion during childhood and adolescence since it is a period of rapid skeletal growth. Although Arab countries are sunny, there is a relatively high prevalence of vitamin D deficiency (25-hydroxyvitamin D below 30 ng/mL). In adults, it has been reported that the prevalence of low bone mass in the Arab world is higher than in Western (5). Another study revealed a high prevalence of vitamin D deficiency (68.8%) found mainly in the group of 11 to 16-year-olds and more commonly among girls (6). This deficiency was mainly related with low sunlight exposure. Several studies raised the issue of the traditional women’s dress in the Arab world, e.g., wearing veils or whole body covers, as a factor for vitamin D deficiency (7).

1. Al-Ghamdi M. A. et al. Differences in vitamin D status and calcium metabolism in Saudi Arabian boys and girls aged 6 to 18 years: effects of age, gender, extent of veiling and physical activity with concomitant implications for bone health. Public Health Nutr. Published online February 2012.
2. Musaiger A. O. et al. The paradox of nutrition-related diseases in the Arab countries: the need for action. Int. J. Environ. Res. Public Health. 2011; 8:3637–3671.
3. WHO/EMRO. Guidelines for the Control of Iron Deficiency; World Health Regional Office of East Mediterranean: Cairo, Egypt, 1998.
4. Mason J. et al. Recent trends in malnutrition in developing regions: Vitamin A defciency, anemia, iodine defciency, and child underweight. Food Nutr. Bull. 2005; 26:1–106.
5. Maalouf G. et al. Middle East and North Africa consensus on osteoporosis. J. Musculoskelet. Neuronal Interact. 2007; 7:131–143.
6. Bener A. et al. High prevalence of vitamin D deficiency in young children in a highly sunny humid country: A global health problem. Minerva Pediatr. 2009; 61:15–22.
7. Allali F. et al. The impact of clothing style on bone mineral density among post menopausal women in Morocco: A case-control study. BMC Public Health. 2006; 19:135.