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Vitamin D deficiency by geographical area and 25-hydroxyvitamin D cut-offs, updated from Bouillon (24).
Source publication
![Mean 25-hydroxyvitamin D [25(OH)D] concentrations in Malaysia according...](publication/365494384/figure/fig5/AS:11431281239113064@1714170190545/Mean-25-hydroxyvitamin-D-25OHD-concentrations-in-Malaysia-according-to-states-Data_Q320.jpg)
Purpose
To estimate the vitamin D status of participants residing in Malaysia.
Methods
PubMed, Scopus, Web of Science, and MyJurnal were searched up to June 2022 without language restrictions. Studies that reported the 25-hydroxyvitamin D [25(OH)D] concentrations and defined their cut-off for deficiency or insufficiency from healthy participants r...
Contexts in source publication
Context 1
... study indicates that vitamin D deficiency/insufficiency in Malaysia can be considered very high compared to other regions worldwide. Table 2 is adapted and updated from a commentary on reviews or systematic reviews of vitamin D status for a country or continent by Bouillon (24). Vitamin D levels < 30 nmol/L in Malaysia are approximately equal to the African continent, but the proportion of levels <50 nmol/L is much higher. ...Context 2
... study indicates that vitamin D deficiency/insufficiency in Malaysia can be considered very high compared to other regions worldwide. Table 2 is adapted and updated from a commentary on reviews or systematic reviews of vitamin D status for a country or continent by Bouillon (24). Vitamin D levels < 30 nmol/L in Malaysia are approximately equal to the African continent, but the proportion of levels <50 nmol/L is much higher. ...Citations
... Vitamin D deficiency is a global health concern with significant implications for population health. Systematic reviews (1)(2)(3)(4)(5)(6) indicate that rates of vitamin D deficiency, when defined as blood level <50 nmol/L (7,8), are as high as 47.9% globally (range 19 to 72%) ( Table 1) (1). In Australia, approximately three-quarters of the adult population have suboptimal vitamin D status; the rate of vitamin D deficiency is 31% (1) and insufficiency (50 to 75 nmol/L) a further 43% (16). ...
Vitamin D deficiency and insufficiency is a public health issue, with low dietary vitamin D intakes a contributing factor. Rates of vitamin D deficiency are 31% in Australia, and up to 72% in some regions globally. While supplementation is often prescribed as an alternative to additional sun exposure, complementary approaches including food-based solutions are needed. Yet, food-centric dietary guidelines are not always adequate for meeting vitamin D needs. Edible mushrooms such as Agaricus bisporus can produce over 100% of vitamin D recommendations (10 μg/day, Institute of Medicine) per 75 g serve (18 μg) on exposure to UV-light, with the vitamin D 2 produced showing good stability during cooking and processing. However, mushrooms are overlooked as a vitamin D source in dietary guidelines. Our dietary modelling shows that four serves/week of UV-exposed button mushrooms can support most Australian adults in meeting vitamin D recommendations, and UV-exposed mushrooms have been found to increase vitamin D status in deficient individuals. While recent evidence suggests some differences between vitamin D 2 and vitamin D 3 in physiological activities, vitamin D 2 from mushrooms can be part of a larger solution to increasing dietary vitamin D intakes, as well as an important focus for public health policy. Mushrooms exposed to UV represent an important tool in the strategic toolkit for addressing vitamin D deficiency in Australia and globally. Health authorities lead the recognition and promotion of mushrooms as a natural, vegan, safe, and sustainable vitamin D food source.
... Determining optimal vitamin D concentrations remains challenging, but it is generally agreed that levels below 30 nmol/L (12 ng/mL) are considered deficient [3]. Vitamin D deficiency can result from various factors, such as reduced sun exposure [4], low dietary intake of foods containing vitamin D [5], skin colour, clothing choices, and malabsorption syndromes like coeliac disease [6], inflammatory bowel disease [7], short bowel syndrome [8] and venous thromboembolisms [9]. ...
Despite Malaysia’s year-round sunny climate, vitamin D deficiency is surprisingly common among Malaysians. However, we hypothesise that vitamin D levels among coastal populations are above average. Thus, we aim to investigate vitamin D levels and correlate them with the potential contributing factors from three selected coastal villages in Johor, Melaka, and Negeri Sembilan. Convenient sampling was employed to recruit 120 Malay male and female participants, and dried blood spots (DBS) were obtained to measure 25 (OH) vitamin D3 levels via immunoassay. Participants also completed two questionnaires: the Sun Exposure and Protection Index (SEPI) and a validated food frequency questionnaire for Malaysians. The participant pool comprised 35.20% males and 64.80% females who completed all questionnaires and underwent DBS sampling. Our analysis revealed a significant difference (p < 0.05) based on skin tones, impacting various facets of the SEPI, including sunscreen usage, protective clothing utilisation, and the adoption of protective headwear. Furthermore, gender emerged as another pivotal factor, demonstrating significant distinctions in these SEPI components. Nevertheless, there is a weak correlation between SEPI scores and vitamin D levels. Subsequent regression analysis did produce statistically significant results (p = 0.018), yet the associated low R2 value indicated a weak correlation between dietary vitamin D intake that impacts vitamin D levels. In conclusion, our preliminary findings indicate that sun exposure and dietary factors are not the sole determinants of 25-OH vitamin D3 levels. However, we require more samples from various coastal locations for a definitive justification.
... Concerning microvascular complications, vitamin D deficiency may be involved in diabetic neuropathy interfering with nociceptor functions by causing diabetic nerve damage [90], and diabetic retinopathy increasing the severity and playing a role in the pathogenesis via its effects on the immune system and angiogenesis [91]. Lastly, a lack of Vitamin D promotes macrovascular complications such as endothelial dysfunction and arterial stiffness [92,93], peripheral arterial disease, and carotid arterial plaque [94]. Vitamin D might have a direct effect on vascular stiffness. ...
In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is an essential hormone in regulating calcium/phosphorous balance and in the pathogenesis of inflammation, insulin resistance, and obesity. The main forms of vitamin D, Cholecalciferol (Vitamin D3) and Ergocalciferol (Vitamin D2) are converted into the active form (1,25-dihydroxyvitamin D) thanks to two hydroxylations in the liver, kidney, pancreas, and immune cells. Some anti-inflammatory cytokines are produced at higher levels by vitamin D, while some pro-inflammatory cytokines are released at lower levels. Toll-Like Receptor (TLR) expression is increased, and a pro-inflammatory state is also linked to low levels of vitamin D. Regardless of how it affects inflammation, various pathways suggest that vitamin D directly improves insulin sensitivity and secretion. The level of vitamin D in the body may change the ratio of pro- to anti-inflammatory cytokines, which would impact insulin action, lipid metabolism, and the development and function of adipose tissue. Many studies have demonstrated an inverse relationship between vitamin D concentrations and pro-inflammatory markers, insulin resistance, glucose intolerance, metabolic syndrome, obesity, and cardiovascular disease. It is interesting to note that several long-term studies also revealed an inverse correlation between vitamin D levels and the occurrence of diabetes mellitus. Vitamin D supplementation in people has controversial effects. While some studies demonstrated improvements in insulin sensitivity, glucose, and lipid metabolism, others revealed no significant effect on glycemic homeostasis and inflammation. This review aims to provide insight into the molecular basis of the relationship between vitamin D, insulin resistance, metabolic syndrome, type 1 and 2 diabetes, gestational diabetes, and cardiovascular diseases.
... Globally, the prevalence of vitamin D deficiency (25(OH)D level < 20 ng/ml) is estimated to be 24-40% in the United States and Europe [11]. In Malaysia, the pooled proportion of people with vitamin D deficiency is approximately 64% [12]. The relationship between vitamin D deficiency and epilepsy has been studied, with the prevalence of adults with epilepsy suffering from vitamin D deficiency ranging from 31% to 45% [13,14]. ...
... Vitamin D deficiency was observed in 45.9% of the participants, whereas 23.9% had vitamin D insufficiency. This is comparable to our local cohort of the general population with vitamin D deficiency ($64%), but slightly higher than the global prevalence of adults with epilepsy suffering from vitamin D deficiency (31%-45%) [12][13][14]. However, it is essential to note that various studies included in the meta-analysis have different cut-off points. ...
... Concerning microvascular complications, vitamin D deficiency may be involved in diabetic neuropathy interfering with nociceptor functions by causing diabetic nerve damage [88], and diabetic retinopathy increasing the severity and playing a role in the pathogenesis through its effects on the immune system and angiogenesis [89]. Lastly, lack of Vitamin D promotes macrovascular complications such as endothelial dysfunction and arterial stiffness [90,91], peripheral arterial disease and carotid arterial plaque [92]. Hence, hypovitaminosis D (as deficiency or insufficiency) embrace several complications in diabetic patients; therefore, screening for vitamin D levels in T2DM patients may play a crucial role in defining the outcomes. ...
In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is a key hormone involved in the regulation of calcium/phosphorous balance and it has been implicated in the pathogenesis of inflammation, insulin resistance and obesity. Cholecalciferol (Vitamin D3) and Ergocalciferol (Vitamin D2) are the main form of vitamin D: the active form (1,25-dihydroxyvitamin D) is the result of two hydroxylations that take place in liver, kidney, pancreas and immune cells. Some anti-inflammatory cytokines are produced at higher levels by vitamin D, while some pro-inflammatory cytokines are released at lower levels. Toll-Like Receptor (TLR) expression is increased and a pro-inflammatory state is also linked to low levels of vitamin D. Regardless of how it affects inflammation, various pathways suggest that vitamin D directly improves insulin sensitivity and secretion. The level of vitamin D in the body may change the ratio of pro- to anti-inflammatory cytokines, which would impact insulin action, lipid metabolism, and the development and function of adipose tissue. Many studies have demonstrated an inverse relationship between vitamin D concentrations and pro-inflammatory markers, insulin resistance, glucose intolerance, metabolic syndrome, obesity and cardiovascular disease. It's interesting to note that several long-term studies also revealed an inverse correlation between vitamin D level and the occurrence of diabetes mellitus. Vitamin D supplementation in people has controversial effects, in fact while some studies demonstrated improvements in insulin sensitivity, glucose and lipid metabolism, others revealed no significant effect on glycemic control and inflammation. The aim of this review is to provide insight into the molecular basis of the relationship between vitamin D, insulin-resistance, metabolic syndrome, type 1 and 2 diabetes, gestational diabetes, and cardiovascular diseases.
... In 2022, Saffian et al. published a systematic review and meta-analysis of studies on vitamin D status among Malaysian populations [41]. The systematic review had the following two inclusion criteria: ...
... The recommendations made in the reviews by Md Isa et al. [30] and Saffian et al. [41] will be considered in the context of the recommendations proposed at the end of this Position Paper. ...
... In 2022, Saffian et al. published a systematic review and meta-analysis of studies on vitamin D status among Malaysian populations [41]. The systematic review had the following two inclusion criteria: ...
... The recommendations made in the reviews by Md Isa et al. [30] and Saffian et al. [41] will be considered in the context of the recommendations proposed at the end of this Position Paper. ...
Purpose:
Vitamin D deficiency and insufficiency is common among populations globally, and in Asia and Malaysia. The purpose of this Position Paper is to propose recommendations for both clinicians and non-clinicians to promote vitamin D sufficiency in Malaysian adults. Formation of a national multisector, multidisciplinary alliance is also proposed to progress initiatives relating to safe sun exposure, adequate vitamin D intake through food fortification, and vitamin D supplementation for high-risk groups.
Methods:
Literature reviews were undertaken to inform summaries of the following: vitamin D status globally and in Asian and Malaysian populations, vitamin D status among individuals with common medical conditions, and current recommendations to achieve vitamin D sufficiency through sun exposure, food intake and supplementation. Recommendations were based on the findings of the literature reviews, recent European guidance on vitamin D supplementation, the 2018 road map for action on vitamin D in low- and middle-income countries, and research recommendations proposed by the Malaysian Ministry of Health in 2017.
Results:
Recommendations on assessment of vitamin D in the adult Malaysian population include using serum or plasma 25-hydroxyvitamin D concentration as a biomarker, widespread participation by Malaysian laboratories in the Vitamin D Standardization Program, adoption of the US Endocrine Society definitions of vitamin D deficiency and insufficiency, and development of a comprehensive nationwide vitamin D status study. Specific high-risk groups are identified for vitamin D assessment and recommendations relating to loading doses and ongoing management are also made.
Conclusion:
This Position Paper provides individual clinicians and national stakeholder organisations with clear recommendations to achieve vitamin D sufficiency in the adult population of Malaysia.
... Firstly, the majority of the diabetic patients with vitD non-deficiency in this study fall under the category of vitD insufficiency with 25(OH)D levels between 50 and 75 nmol/L, instead of having normal (sufficient) 25(OH)D levels of above 75 nmol/L. Our population in Malaysia has a very high prevalence of subjects with vitD deficiency and insufficiency, pooled proportion of subjects with levels <50 nmol/L was approximately 64 % (Mohd Saffian et al., 2022). Recruitment of diabetic patients with normal vitD levels will be very limited in view that diabetic patients commonly present with lower vitD levels (Munisamy et al., 2016). ...
Low vitamin D (vitD) levels have been reported to be a risk factor for diabetes-related cardiovascular complications. This study examined the effects of vitD deficiency on oxidative stress (OS), inflammation, and levels of the vasoconstrictor angiotensin II (Ang II) in the microvascular tissue of type 2 diabetic patients. Patients were categorized into (i) vitD non-deficient diabetics (DNP, n = 10) and (ii) vitD-deficient diabetics (DDP, n = 10), based on their serum 25(OH)D levels. Subcutaneous fat tissues with intact blood vessels were collected during lower limb surgical procedures. The blood vessel were isolated; measurements of the antioxidant enzyme superoxide dismutase (SOD) activity, OS marker malondialdehyde (MDA), Ang II, and the inflammatory marker, TNF-α of the microvascular tissues were determined. Elevated MDA levels and reduced SOD activity, with higher levels of TNF-α and Ang II were observed in the microvascular tissues of DDP compared to DNP. VitD deficiency did not associate with glycemic parameters (fasting blood glucose and glycated hemoglobin) levels. In conclusion, vitD deficiency was correlated with higher microvascular tissue OS, inflammation, and Ang II levels in type 2 diabetic patients. This may contribute to early vasculopathy that occurs in diabetic patients, thus, may contribute to the planning of therapeutic strategies to delay or prevent cardiovascular complications.
... For example, among pregnant mothers, vitamin D deficiency increases the risk of gestational diabetes mellitus [21]. The current evidence discusses the outcome of vitamin D deficiency among the general population instead of a specific population such as T2DM patients [22]. ...
... Our review demonstrated that vitamin D deficiency is related to macrovascular complications such as peripheral arterial disease and carotid arterial plaque. In our review, two studies discussed the association with peripheral arterial disease, in which it was demonstrated that vitamin D deficiency is associated with endothelial dysfunction as well as arterial stiffness [19,22]. Other than that, Ding et al. found that vitamin D deficiency is related to carotid arterial plaque formation [53]. ...
Vitamin D deficiency and insufficiency are public health concerns that have contributed to multiple negative health outcomes. Recent studies have revealed that vitamin D deficiency and insufficiency influence glycaemic control and the development of diabetes complications. The goal of this systematic review is to summarise the latest evidence on the impact of vitamin D deficiency and insufficiency on the outcome of Type 2 Diabetes Mellitus (T2DM) patients. In this PRISMA-guided systematic review, articles were sourced from three databases, namely, PubMed, Scopus, and Web of Science. The review only included literature published from 2012 until 2022, and 33 eligible studies met the inclusion criteria for this review. The included articles were critically appraised using the Mixed Method Appraisal Tool (MMAT). According to our findings, vitamin D deficiency or insufficiency is associated with mental health status, macrovascular and microvascular complications of T2DM, metabolic syndrome, increased risk of obesity, increased blood pressure, dyslipidaemia, glycaemic control, nerve-related disease, musculoskeletal-related complications, and reduced quality of life. Due to the diverse implications of vitamin D deficiency and insufficiency, screening for vitamin D levels in T2DM patients may be beneficial.
