Fig 1 - uploaded by Suphia M Sherbeeni
Content may be subject to copyright.
Middle East in the context of major continents and regions. Definition of Middle Eastern countries varies; countries discussed in the chapter are labeled above. Countries considered in the chapter include: Bahrain, Egypt with its Sinai Peninsula in Asia, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, Turkey, the United Arab Emirates, and Yemen
Source publication
Information from limited studies suggests that vitamin D levels in Middle Eastern populations are among the lowest in the
world. Vitamin D insufficiency or deficiency affects a large proportion of the population in most countries and almost everyone
in some countries such as Saudi Arabia and United Arab Emirates. Particularly at risk are the young,...
Similar publications
Background and aims:
Vitamin D deficiency (25-hydroxyvitamin D - VitDD) affects over one billion people worldwide. VitDD results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of VDD in Pakistan despite appreciable levels of sunshine. However, none have assessed VitDD across all age groups, gende...
Vitamin D (VD) is unique among the vitamins in the fact that it can either be synthesized in the skin from exposure to
sunlight or taken from the diet. Apart from its role in calcium and bone homeostasis, VD and its metabolites are now known
to have important roles in various other functions of human health, of which many still await to be discover...
Mounting evidence from observational and clinical trials indicates that optimal vitamin D reduces the risk of many diseases. We used observational studies and recent data on 25-hydroxyvitamin D [25(OH)D] concentrations of Canadians from Cycle 3 of the Canadian Health Measures Survey to estimate the reduction in disease incidence, mortality rates, a...
Recent studies have shown that in spite of being generally close to the equator; vitamin D deficiency is common in South East Asian countries. In order to quantify micronutrient status for women and children in Cambodia; a nationally-representative survey was conducted in 2014 linked to the Cambodian Demographic Health Survey. The countrywide media...
Objective
. To assess the level of 25-hydroxyvitamin D status among a sample of Egyptian schoolchildren and to evaluate predictors of deficiency and insufficiency.
Subjects and Methods
. A cross-sectional study comprising 200 prepubescent schoolchildren aged from 9 to 11 years was performed. A questionnaire including frequency of midday sun exposur...
Citations
... Low vitamin D levels may be caused by genetics, traditional dress that reduces skin exposure, low dietary and supplemental vitamin D intake, and avoidance of hot, sunny weather 38 . Although Saudi Arabia's policymakers attempted to address their country's hypovitaminosis D by fortifying milk with cholecalciferol, their efforts did not yield material differences in fracture rates because of the limited consumption of dairy products in the country 39 . Compared with many other parts of the world, the MENA region is at an increased risk for vitamin D deficiency and osteoporosis, highlighting the need for long-term screening and prevention strategies at national and regional levels 36,40 . ...
Background
Lower-extremity fractures (LEFs) account for >30% of all skeletal injuries, contributing to the global health and economic burden. Fracture epidemiology in the Middle East and North Africa (MENA) region has been studied little. Health factors and disease epidemiology differ greatly among populations in MENA despite cultural, political, and economic similarities among the region’s countries. This study examined the epidemiology of LEFs and the need for rehabilitation in MENA from 1990 to 2019.
Methods
We examined the epidemiology of fractures of the pelvis, hip, femur, patella, tibia, fibula, ankle, and foot bones using Global Burden of Disease (GBD) data. Fracture incidence, counts, and rates were measured for males and females across age groups in the 21 MENA countries as identified by the GBD data set. Associations between years of healthy life lost due to disability (YLD) resulting from fracture and the Socio-demographic Index (SDI) were analyzed.
Results
In contrast to the global trend, the age-standardized incidence rate (ASIR) of LEFs in the MENA region increased by 4.57% from 1990 to 2019. In 2019, the highest ASIR among fractures was attributed to fractures of the patella, fibula, tibia, or ankle (434.36 per 100,000), most frequently occurring among those 20 to 24 years of age. In 2019, the highest ASIR of all fractures was noted in Saudi Arabia (2,010.56 per 100,000) and the lowest, in Sudan (523.29 per 100,000). The greatest increases from 1990 to 2019 in the ASIR of LEFs were noted in Yemen (132.39%), Syria (107.27%), and Afghanistan (94.47%), while the largest decreases were found in Kuwait (−62.72%), Sudan (−48.72%), and Iran (−45.37%). In 2019, the YLD rate of LEFs had increased to 277.65 per 100,000, up from 235.55 per 100,000 in 1990.
Conclusions
Between 1990 and 2019, LEFs increased in the MENA region. Violence, war, and road traffic accidents increased, leading to a high rate of fractures, especially among youth. Low bone-mineral density related to vitamin D deficiency has also been reported as a risk factor for fracture in the region. Regional health authorities should be informed of fracture patterns by this study.
Level of Evidence
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
... A similar prevalence of vitamin D deficiency was also reported in UAE women. 49,50 Furthermore, in Saudi Arabian subjects with back pain, 83% had vitamin D levels below 22.5 nmol/L. 51 Similar severe deficiency was also reported from Kuwait. ...
Qatar has a high burden of chronic diseases including obesity, cardiovascular disease and type 2 diabetes mellitus. Low serum vitamin D levels have been implicated in the development and progression of a range of these chronic conditions. The prevalence of vitamin D insufficiency or deficiency in the general population of Qatar has still not been investigated. The aim of this study was to carry out a systematic review of published studies documenting the prevalence of vitamin D insufficiency or deficiency in the Qatari population. A search strategy was developed for online databases (PubMed, Ovid MEDLINE, Embase and Embase Classic) between 1980 to the last week of August 2012, and bibliographies of the included studies were further searched for additional reports. Search terms used were QATAR and VITAMIN D. Studies reporting the serum levels of vitamin D in several Qatari sub-populations were identified. Weighted-average vitamin D serum levels and prevalence of low vitamin D status (<75 nmol/L) were calculated. Subgroup analysis was carried out by age. The quality of each study was evaluated according to four criteria: national representativeness, representation of males and females, the sample size, and the sampling protocol. A total of 16 relevant publications were identified, and 8 of these (reporting from 7 unique studies) met our inclusion and exclusion criteria with a total number of 1,699 Qatari subjects. The pooled sample size weighted-average vitamin D concentration (±SD) was 45.3±14.3 nmol/L (95% CI: 44.6-46.0; range 29.2-66.9 nmol/L). The weighted-average prevalence of low vitamin D status was 90.4% (95% CI: 90.1-91.0; range 83%-91%). Age was inversely correlated with vitamin D levels and directly with its insufficiency/deficiency prevalence. There have only been a few studies on the prevalence of low vitamin D in Qatar a very high prevalence of vitamin D insufficiency/deficiency in Qatar that increases with age has been suggested. The present report underlines the need to develop a nationally representative study to further evaluate vitamin D status in Qatar. Given the growing evidence of the role of vitamin D in chronic disease, this study could help develop public health strategies for disease prevention in Qatar.
... On the other hand, vitamin D deficiency is generally prevalent around the world, but is again most usually seen in Asia and surprisingly the Middle East, despite its relatively high sunshine exposure [9]. Although these observations stem mostly from non-population-based analyses, they have in most cases, consistent across reviews over the last years [12]. these findings can be explained by the relatively high Vitamin D Deficiency in the Middle East, and it's Management in Primary Care 1128 frequency of certain predisposing factors for the development of vitamin D deficiency in this area. ...
... 12 In Saudi Arabia, more than 30% of young healthy women are reported to be vitamin D deficient despite the presence of high UV sunlight throughout the year. 13,14 While many studies have focused on the relationship between vitamin D and the incidence of breast cancer, only a few have investigated the potential relationship between serum 25(OH)D status and cancer survival. 15 Vitamin D plays a role in reducing the risk of many cancer types, including those of the breast, stomach, colon, and prostate. ...
Objectives:
To assess the role of serum vitamin D and other nutritional factors in women with breast cancer in Saudi.
Methods:
A total of 500 women (250 patients with breast cancer and 250 controls) aged 30-60 years were recruited from King Saud Medical City and King Fahad Medical City, Riyadh, Saudi Arabia, between May 2015 and June 2016. In this cross-sectional study, blood pressure, plasma concentrations of vitamin D, and calcium levels were evaluated. A 3-day dietary record was used to assess dietary intake.
Results:
The mean body mass index was 31.2±7.0 kg/m2 for the breast cancer group and 30.7±7.6 kg/m2 for the control group. More than 80% of the participants had insufficient vitamin D levels (less than 75.0 nmol/L). The mean cholesterol intake was significantly (p=0.001) lower in the control group (233.1±75.1 mg) than in the breast cancer group (257.2±84.8 mg). Breast density was found to be significantly associated with vitamin D deficiency-symptoms. Severe paresthesia was also significantly associated with breast cancer. The incidence of other vitamin D deficiency-symptoms was significantly higher in the control group.
Conclusion:
Due to prevalence of vitamin D deficiency in Saudi Arabia, it is difficult to determine the relationship to breast cancer. The incidence of it is associated with old age and high cholesterol intake, and paresthesia may be a symptom of breast cancer.
... However, the optimal health requirement of vitamin D in food to be effective in increasing serum 25-OH-VitD concentrations to100 nmol/L is approximately 1000-3000 IU/day [119][120][121][122][123][124][125]. Some studies have highlighted the cultural and traditional dresses and dress styles of both genders, which cover the body extensively, including the face and hands in women, as another cause vitamin D deficiencies in the Gulf region and Arab countries [74,76,77,80,83,86,118,[126][127][128]. Furthermore, El-Hajj et al. [20] found that the level of hypovitaminosis D was lowest in girls who followed the dress code of covering their heads, arms, and legs. ...
Background: Although many studies have highlighted the association between obesity and vitamin D, the results remain inconsistent. Therefore, we assessed this correlation in association with other parameters. Our objectives in this study were to demonstrate the relationship between gender and vitamin D deficiency, to examine the association of age with vitamin D deficiency and to investigate the correlation between body mass index and vitamin D deficiency. Methods: The levels of serum 25-hydroxyvitamin D (25-OH-VitD), age, gender and body mass index (BMI) of the 422 participants were analysed by T-test, ANOVA and multiple regressions using the Statistics Package for Social Sciences. Results: Overall, 84.4 per cent of study participants had either mild or severe vitamin D deficiency using a cutoff level of 25-OH-VitD of ≤ 30 ng/ml. The statistical analysis indicated that there was a significant correlation between gender and 25-OH-VitD levels. Conversely, no significant correlations of age and BMI with 25-OH-VitD were recognized. Furthermore, the directions of the correlations of 25-OH-VitD levels with the independent variables were as follows: positive with gender, negative with age and negative with BMI. Conclusion: The levels of 25-OH-VitD were influenced significantly by gender but not by BMI and age. Female patients seem to suffer more from vitamin D deficiency than do males. High BMI decreases the levels of 25-OH-VitD, pushing the body towards vitamin D deficiency. The same effect is reported for the patient age. The effect of gender on the 25-OH-VitD levels is higher than the effects of BMI and age. 2 Abdulameer M. Abu Nailah et al.
... Despite the fact that the sun shines over 300 days per year in our country, the lowest levels registered in the winter across all age groups reflect the shorter day, and the lower sun exposure in this season due to school and/or colder weather. Vitamin D predictors identified here-in have been previously demonstrated in other studies from the region, with the exception of an inverse seasonal pattern in gulf countries due to the scorching heat in summer [4,6,34]. Additional predictors identified in studies from Asia, Europe, and the US include sun exposure, skin pigmentation, air pollution, consumption of fatty fish, cod liver oil, margarine, exercise, physical performance score, and physician counseling [5,34]. ...
... Vitamin D predictors identified here-in have been previously demonstrated in other studies from the region, with the exception of an inverse seasonal pattern in gulf countries due to the scorching heat in summer [4,6,34]. Additional predictors identified in studies from Asia, Europe, and the US include sun exposure, skin pigmentation, air pollution, consumption of fatty fish, cod liver oil, margarine, exercise, physical performance score, and physician counseling [5,34]. In light of the high prevalence of hypovitaminosis D in apparently healthy individuals, current guidelines do not recommend routine screen of vitamin D, and reserve testing to high risk individuals, which is supported by our data [12,35]. ...
The aim of the current study is to investigate the prevalence of hypovitaminosis D in Lebanese subjects, its robust predictors, evaluate the relationship between 25 hydroxy vitamin D [25(OH)D] and parathyroid hormone levels, and derive desirable vitamin D levels, based on a large hospital laboratory database spanning all age groups.
Data from a large representative digitized database of 9147 subjects, mostly outpatients, evaluated between 2000–2004 and 2007–2008, in whom information on age, gender, service, and time of the year, was analyzed. The PTH- 25(OH)D relationship was studied in a subset of 657 adult subjects, in whom such data was available.
At a 25(OH)D cut-offs of < 20 ng/ml, the prevalence of hypovitaminosis D ranged between 58% and 62% in pediatric subjects, 44% and 60% in adults, and 41% and 62% in elderly, in the 2 study periods. At a cut-off < 30 ng/ml, the prevalence was above 78%, in most sub-groups. Regardless of cut-off used, the only significant predictors of high mean 25(OH)D levels were the male gender in the pediatric group, and female gender in adults and elderly, summer/fall seasons, out-patient status, as well as study period. Curve fitting of the PTH-25(OH)D relationship, in adults and elderly, revealed a plateau at 25(OH)D levels of 17–21 ng/ml, depending on sub-study group.
Hypovitaminosis D is prevalent in our sunny country, even using a conservative population- derived cut-off of 20 ng/ml, and thus the need for a public health strategy for supplementation.
... Rickets and osteomalacia represent short-term latency manifestation of in 1986-88 in Saudi Arabia. 9,11 Non-skeletal manifestations of rickets included convulsions in 4-79% of patients, acute chest infections and asthmatic bronchitis in 66% of 500 cases in Saudi Arabia, broncho-pneumonia in 43% of 200 Iranian children and 44% of 250 children from Kuwait. An acute infection or respiratory diseases were the presenting manifestation in 20-60% of cases presenting with rickets in smaller studies from Turkey, Egypt, Jordan and Saudi Arabia, while gastroenteritis accounted for 8-56% of reasons for admission in hospitals in Middle East. ...
... It has been recognized that primary vitamin D deficiency does not adequately describe nutritional rickets explained in some African, Middle Eastern and Asian countries and that concomitant low calcium intake and possibly disturbances of phosphate metabolism, renal compromise and iron deficiency may also play an important role in the pathophysiology of the disease. 9 In our current search, we retrieved 13 publications on rickets, but only 8 were on nutritional rickets. Case series were published in Iran, Saudi Arabia, Kuwait, United Arab Emirates, Qatar and Egypt, with sample sizes ranging 21 to 283 subjects and age ranging from infants all the way to adolescents, with the majority being infants and toddlers. ...
... 1,3 Although such observations stem mostly from non-population based studies, they have for the most part been consistent across reviews over the last decade. [9][10][11][12][13][14] Such findings are explained by the prevalence of specific risk factors for hypovitaminosis D in this region. These include the classic predictors, in addition to conservative concealed clothing style in women in general and in men from gulf countries in particular. ...
The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide.
We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region.
Medline, Pubmed and Embase search engines, entering keywords and concepts, combined with individual countries of interest, were used. Search was limited years 2000-2012; and review articles were used for the period preceding year 2000.
Rickets and osteomalacia still occur in this sunny region. Hypovitaminosis D prevails, with rates varying 30-90%, considering a desirable serum 25 hydroxy-vitamin D [25(OH)D] of 20 ng/ml. Advancing age, female gender, multi-parity, clothing style, season, socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults. Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children.. Associations with pain score and disease activity in rheumatologic disorders, viral load and interleukins in hepatitis C, BMI, lipids and insulin sensitivity, blood pressure, heart failure and mortality are described. Sun exposure in adults decreased prevalence of metabolic syndrome in one study. Few randomized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level, even with doses by far exceeding current recommendations. A trial in adolescent girls reveals substantial bone and lean mass increments.
Hypovitaminosis D is prevalent in MENA. The lack of populations based studies, gaps in studies in infants, pre-pubertal children and pregnant women, hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often subclinical disease.
... In concordance, several research reports from other Gulf or Arab countries demonstrate a significant prevalence of vitamin D deficiency, particularly in women, owing to their cultural dress code. 1,[16][17][18][19][20] Paradoxically, in some sunny countries such as the UAE, residents tend to avoid exposure to sunlight because of excessive heat. 2 The first study in adults from the region was conducted in university students and elderly from Saudi Arabia, revealing a mean 25(OH)D status ranging between 10 and 30 nmol/L. 1 The mean 25(OH)D status was near 25 nmol/L in Lebanese, Saudi, Emirati and Iranian women. 3,[21][22][23] Because the UAE has not yet begun fortifying food with vitamin D, many groups in this population could be vulnerable for developing vitamin D deficiency. ...
This study offers evidence that vitamin D deficiency could be a major public health burden among young Emirati adults, mostly because of sun deprivation in a sun-blessed country. This study included a random sample of 138 females and 70 males tested for serum 25-hydroxyvitamin D [25(OH)D] status. To further evaluate the predictors of vitamin D status in this population, the study examined diet, obesity and sun exposure. In summer, the mean serum 25(OH)D concentration for females was 20.9 ± 14.9 nmol/L, whereas that for males was 27.3 ± 15.7 nmol/L. Females scored significantly higher than males on the sun avoidance inventory (SAI), indicating that females avoid sun exposure to a greater extent than males, possibly explaining the lower vitamin D status. A significant negative correlation also existed between SAI and vitamin D status (Pearson's r = -0.33; p < 0.01), but no significant association was evident between vitamin D status and body mass index (Pearson's r = 0.03; p = 0.33) or low dietary intake of vitamin D-fortified foods (Pearson's r = 0.08; p = 0.13). The mean serum 25(OH)D concentration for females tested in winter was 31.3 ± 12.3 nmol/L while in the summer, it was 20.9 ± 14.9 nmol/L. This difference was statistically significant, suggesting that seasonal variation plays an important role in vitamin D status in the United Arab Emirates. Fortification of foods and drinks with vitamin D, supplementation and sensible sun exposure are important steps toward minimizing vitamin D deficiency.
Bringing niqab wearers' voices to the fore, discussing their narratives on religious agency, identity, social interaction, community, and urban spaces, Anna Piela situates women's accounts firmly within UK and US socio-political contexts as well as within media discourses on Islam.
The niqab has recently emerged as one of the most ubiquitous symbols of everything that is perceived to be wrong with Islam: barbarity, backwardness, exploitation of women, and political radicalization. Yet all these notions are assigned to women who wear the niqab without their consultation; “niqab debates” are held without their voices being heard, and, when they do speak, their views are dismissed.
However, the picture painted by the stories told here demonstrates that, for these women, religious symbols such as the niqab are deeply personal, freely chosen, multilayered, and socially situated. Wearing the Niqab gives voice to these women and their stories, and sets the record straight, enhancing understanding of the complex picture around niqab and religious identity and agency.
Bringing niqab wearers’ voices to the fore, discussing their narratives on religious agency, identity, social interaction, community, and urban spaces, Anna Piela situates women’s accounts firmly within UK and US socio-political contexts as well as within media discourses on Islam.
The niqab has recently emerged as one of the most ubiquitous symbols of everything that is perceived to be wrong with Islam: barbarity, backwardness, exploitation of women, and political radicalization. Yet all these notions are assigned to women who wear the niqab without their consultation; “niqab debates” are held without their voices being heard, and, when they do speak, their views are dismissed.
However, the picture painted by the stories told here demonstrates that, for these women, religious symbols such as the niqab are deeply personal, freely chosen, multilayered, and socially situated. Wearing the Niqab gives voice to these women and their stories, and sets the record straight, enhancing understanding of the complex picture around niqab and religious identity and agency.
