Prevalence and determinants of vitamin D deficiency and insufficiency among three immigrant groups in Finland: evidence from a population-based study using standardised 25-hydroxyvitamin D data

AbstractObjective:We investigated the determinants of serum 25-hydroxyvitamin D [S-25(OH)D] and dietary vitamin D sources among three immigrant groups in Finland and compared their S-25(OH)D to the general Finnish population.Design:Cross-sectional population-based Migrant Health and Wellbeing Study and the nationally representative Finnish Health 2011 Survey. S-25(OH)D was standardised according to the Vitamin D Standardisation Program. Vitamin D sources were assessed by interview.Setting:Six different municipalities in Finland (60°–63°N).Participants:Immigrants aged 18–64 years (446 Russians, 346 Somalis, 500 Kurds), 798 Finns aged 30–64 years.Results:The mean of S-25(OH)D was 64 (95 % CI 62, 66), 44 (95 % CI 41, 46), 35 (95 % CI 34, 37) and 64 (95 % CI 62, 66) nmol/l for Russians, Somalis, Kurds and Finns, respectively. S-25(OH)D among Somalis and Kurds was lower compared with Finns (P < 0·001). The prevalence of vitamin D deficiency (S-25(OH)D <30 nmol/l) and insufficiency (S-25(OH)D <50 nmol/l) was higher among immigrants than Finns (P < 0·001). Vitamin D-rich foods differed between the groups; vitamin D-fortified fat spread consumption was higher among Somalis (91 %) than among Russians (73 %) and Kurds (60 %); fish was less consumed among Kurds (17 %) than among Russians (43 %) and Somalis (38 %); and 57 % Russians, 56 % Kurds and 36 % Somalis consumed vitamin D-fortified dairy daily (P < 0·001 for all). Daily smoking, alcohol consumption and winter blood sampling were determinants of vitamin D insufficiency (P ≤ 0·03). Older age, physical activity, fish and vitamin D-fortified dairy consumption were associated with lower odds of insufficiency (P ≤ 0·04).Conclusions:Vitamin D status differed among immigrant groups and the determinants are, to some degree, associated with learned or existing cultural behaviours.

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Prevalence of 25-hydroxyvitamin D deficiency in Korean adolescents: association with age, season and parental vitamin D status

Public Health Nutrition ◽

10.1017/s1368980012004703 ◽

2012 ◽

Vol 17 (1) ◽

pp. 122-130 ◽

Cited By ~ 35

Author(s):

Shin Hye Kim ◽

Min Kyung Oh ◽

Ran Namgung ◽

Mi Jung Park

Keyword(s):

Vitamin D ◽

High School Students ◽

Vitamin D Deficiency ◽

Vitamin D Insufficiency ◽

Vitamin D Status ◽

School Students ◽

Cross Sectional ◽

Korean Adolescents ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

AbstractObjectiveWe aimed to assess the prevalence and associated factors of vitamin D deficiency in healthy adolescents and to determine parent–adolescent association in vitamin D status.DesignA cross-sectional study.SettingData from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008–2009. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using 125I-labelled RIA kits. Vitamin D deficiency in adolescents was defined as 25(OH)D level <27·5 nmol/l, and 25(OH)D levels between 27·5 and <50 nmol/l were considered insufficient. For the parents, vitamin D deficiency was defined as 25(OH)D level <50 nmol/l.SubjectsThe study population consisted of 2062 adolescents (1095 boys, 967 girls; aged 10–18 years) and their parents (1005 fathers, 1341 mothers).ResultsOverall, 13·4 % of adolescents (boys 11·7 %, girls 15·4 %) were 25(OH)D deficient, 54·7 % were 25(OH)D insufficient. Prevalence of vitamin D deficiency increased with age (P < 0·0001). Parental vitamin D deficiency was more prevalent in vitamin D-deficient adolescents than in non-deficient adolescents (all P < 0·0001). In multivariate logistic regression analyses, predictors for vitamin D deficiency were senior high school students (OR = 3·45–4·33), winter/spring season (OR = 3·18–5·11/5·35–7·36) and parental vitamin D deficiency (OR = 1·78–4·88; all P < 0·05).ConclusionsVitamin D insufficiency is prevalent among healthy Korean adolescents and the parent–offspring association warrants vitamin D screening for family members of deficient individuals.

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Relationship Between Vitamin D Deficiency And Insulin Resistance In Obese Children

Global Journal of Health Science ◽

10.5539/gjhs.v13n1p82 ◽

2020 ◽

Vol 13 (1) ◽

pp. 82

Author(s):

Aidah Juliaty ◽

Putri Lestari Gabrilasari ◽

Dasril Daud ◽

Johan Setyawan Lisal

Keyword(s):

Insulin Resistance ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Cross Sectional Study ◽

Bivariate Analysis ◽

Obese Children ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Deficiency Group

INTRODUCTION: Obesity represents the major risk factor for development of insulin resistance during childhood and adolescents. In obesity, adipose tissue release free fatty acids, various hormones, and cytokines, resulting in insulin resistance. This study aimed to establish the correlation between vitamin D deficiency and the incidence of insulin resistance in obese children. DESIGN AND METHOD: This analytical cross-sectional study was arranged from December 2019 - February 2020 included 96 students aged 11 - 17 years old from junior and senior high school who met the criteria for obesity in Makassar. The study subjects were parted into two groups, obese children with vitamin D deficiency (levels of 25-hydroxyvitamin D ≤ 20 ng/ml) and obese children without vitamin D deficiency group (levels of 25-hydroxyvitamin D > 20 ng/ml). Data were analyzed using univariate and bivariate analysis. RESULTS: The frequency of insulin resistance in obese children with vitamin D deficiency was 28 (54.9%), while obese children without vitamin D deficiency was 10 (22.2%). Based on statistical analysis, the frequency of the occurrence of insulin resistance in vitamin D deficiency obese children was higher than in obese children without vitamin D deficiency with OR = 4.261 (95% CI 1.744 – 10.411), p = 0.001. CONCLUSION: The risk of insulin resistance in obese children with vitamin D deficiency is 4.261 times higher than obese children without vitamin D deficiency.

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Vitamin D Deficiency Is Common in Ghana despite Abundance of Sunlight: A Multicentre Comparative Cross-Sectional Study

Journal of Nutrition and Metabolism ◽

10.1155/2021/9987141 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Samuel Asamoah Sakyi ◽

Maxwell Hubert Antwi ◽

Linda Ahenkorah Fondjo ◽

Edwin Ferguson Laing ◽

Richard K. Dadzie Ephraim ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Geographical Area ◽

Daily Intake ◽

Cross Sectional Study ◽

The Body ◽

Sectional Study ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

Background. Vitamin D is a steroid hormone important for the normal functioning of the body. It is produced through skin exposure to sunlight and from the diet. Although Ghana is located in the tropics where sunlight is abundant, factors like culture, diet, skin pigmentation, variation in the ozone layer, and geographical area influence the optimization of vitamin D concentration. It is imperative to evaluate the interplay between sunshine exposure, proinflammatory cytokines, and mediators of vitamin D metabolism and their relationship to vitamin D status in three geographical sections among apparent healthy Ghanaians. Methods and Results. In a cross-sectional study, a total of five hundred (500) healthy blood donors from three geographical areas in Ghana were enrolled. Their age ranged from 17 to 55 years with a mean age of 27.97 ± 8.87 years. The overall prevalence rate of vitamin D deficiency was 43.6% (218/500), with 41.2% (91/221), 45.3% (63/139), and 45.7% (64/140) of vitamin D deficiency being recorded in participants from the Northern Sector (NS), Middle Belt (MB), and Southern Sector (SS), respectively. However, there were no significant differences in the proportions of vitamin D deficiency across various geographical sectors. The median 25-hydroxyvitamin D serum levels were compared among geographical areas (NS, MB, and SS) and there were no significant differences ( P = 0.275 ) after adjusting for confounding factors. 25-Hydroxyvitamin D correlated positively with corrected ionized calcium (rs = 0.622, P ≤ 0.001 ) and phosphorus (rs = 0.299, P ≤ 0.001 ) and negatively correlated with SBP (rs = −0.092, P = 0.039 ), vitamin D binding protein (VDBP) (rs = −0.421, P ≤ 0.001 ), intact parathyroid hormone (iPTH) (rs = −0.0568, rs ≤ 0.001), IFN-gamma (rs = −0.684, P ≤ 0.001 ), and TNF-alpha (rs = −0.600, P ≤ 0.001 ). After adjusting for possible confounders, not having knowledge about vitamin D foods, taking fewer vitamin D foods, and higher levels of IF-γ and IL-10 were associated with a higher risk of having vitamin D deficiency. Conclusion. The prevalence of 25-hydroxyvitamin D deficiency is high among the general adult population in Ghana despite the abundance of sunlight. Increasing knowledge on vitamin D diet coupled with a daily intake of vitamin D dietary supplements is likely to reduce the risk of developing 25-hydroxyvitamin D deficiency.

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Vitamin D Status in Japanese Adults: Relationship of Serum 25-Hydroxyvitamin D with Simultaneously Measured Dietary Vitamin D Intake and Ultraviolet Ray Exposure

Nutrients ◽

10.3390/nu12030743 ◽

2020 ◽

Vol 12 (3) ◽

pp. 743 ◽

Cited By ~ 2

Author(s):

Keiko Asakura ◽

Norihito Etoh ◽

Haruhiko Imamura ◽

Takehiro Michikawa ◽

Takahiro Nakamura ◽

...

Keyword(s):

Vitamin D ◽

Exposure Time ◽

Serum Vitamin ◽

Vitamin D Insufficiency ◽

Uv Exposure ◽

Dietary Vitamin ◽

Hydroxyvitamin D ◽

Vitamin D Intake ◽

25 Hydroxyvitamin D ◽

Ultraviolet Ray

Vitamin D insufficiency/deficiency is prevalent worldwide. We investigated the effect of vitamin D intake and ultraviolet ray (UV) exposure on serum vitamin D concentration in Japan. A total of 107 healthy adult participants were recruited from Hokkaido (43° N) and Kumamoto (33° N) prefectures. All participants undertook surveys in both summer and winter. Serum 25-hydroxyvitamin D (25(OH)D3) was examined, and vitamin D intake was assessed with a diet history questionnaire. UV exposure was measured with a wearable UV dosimeter. Regression analysis was performed to investigate the relationship between these factors, with covariates such as sun avoidance behavior. The prevalence of vitamin D insufficiency (serum 25(OH)D3; 12 ng/mL (30 nmol/L) ≤ and <20 ng/mL (50 nmol/L))/deficiency (<12 ng/mL) was 47.7% in summer and 82.2% in winter. UV exposure time was short in Kumamoto (the urban area), at 11.6 min in summer and 14.9 min in winter. In Hokkaido (the rural area), UV exposure time was 58.3 min in summer and 22.5 min in winter. Vitamin D intake was significantly associated with serum 25(OH)D3, and a 1 μg/1000kcal increase in intake was necessary to increase 25(OH)D3 by 0.88 ng/mL in summer and by 1.7 ng/mL in winter. UV exposure time was significantly associated with serum 25(OH)D3 in summer, and a 10 min increase in UV exposure time was necessary to increase 25(OH)D3 by 0.47 ng/mL. Although consideration of personal occupation and lifestyle is necessary, most Japanese may need to increase both vitamin D intake and UV exposure.

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Vitamin D status of children in Kerala, southern India

Public Health Nutrition ◽

10.1017/s1368980018003622 ◽

2019 ◽

Vol 23 (7) ◽

pp. 1179-1183 ◽

Cited By ~ 1

Author(s):

Madhava Vijayakumar ◽

Vijayalakshmi Bhatia ◽

Biju George

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Sun Exposure ◽

Southern India ◽

Fish Diet ◽

Vitamin D Status ◽

Cross Sectional ◽

Dietary Recall ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

AbstractObjectiveTo study plasma 25-hydroxyvitamin D (25(OH)D) status of children in Kerala, southern India, and its relationship with sociodemographic variables.DesignCross-sectional observational study.SettingTertiary government hospital.ParticipantsChildren (n 296) with trivial acute illness were enrolled. Sun exposure and Ca and vitamin D intakes (7 d dietary recall) were documented. Serum Ca, P, alkaline phosphatase, plasma 25(OH)D and parathyroid hormone (PTH) were measured.ResultsPrevalence of vitamin D deficiency (plasma 25(OH)D <30 nmol/l) was 11·1% (median, interquartile range (IQR): 52·6, 38·4–65·6 nmol/l). Children who ate fish daily had significantly higher plasma 25(OH)D than those who did not (median, IQR: 52·5, 40·8–68·9 v. 49·1, 36·2–60·7 nmol/l; P = 0·02). Those investigated in the months of March–May showed highest 25(OH)D v. those enrolled during other times (median, IQR: 58·7, 45·6–81·4 v. 45·5, 35·6–57·4 nmol/l; P <0·001). Plasma 25(OH)D correlated positively with serum P (r = 0·24, P <0·001) and Ca intake (r = 0·16, P 0·03), negatively with age (r = −0·13, P 0·03) and PTH (r = −0·22, P <0·001.). On linear regression, summer season (March–May), lower age, daily fish intake and higher Ca intake were independently associated with plasma 25(OH)D.ConclusionsPrevalence of vitamin D deficiency is low in Kerala. The natural fish diet of coastal Kerala and the latitude may be protective. Public health policy in India should take account of this geographical diversity.

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Very high rates of vitamin D insufficiency in women of child-bearing age living in Beijing and Hong Kong

British Journal Of Nutrition ◽

10.1017/s0007114507844382 ◽

2008 ◽

Vol 99 (6) ◽

pp. 1330-1334 ◽

Cited By ~ 43

Author(s):

Jean Woo ◽

Christopher W. K. Lam ◽

Jason Leung ◽

Winny Y. Lau ◽

Edith Lau ◽

...

Keyword(s):

Vitamin D ◽

Hong Kong ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Vitamin D Insufficiency ◽

Dietary Intakes ◽

Hydroxyvitamin D ◽

The North ◽

25 Hydroxyvitamin D ◽

The Relationship

We aimed to describe the vitamin D status of young women living in two Chinese cities in the spring – Beijing in the north (latitude 39° north) and Hong Kong (latitude 22° north) in the south. We also examined the relationship between serum 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations to determine a threshold for serum 25-hydroxyvitamin D above which there is no further suppression of PTH. Finally, we examined whether dietary Ca intake influences this relationship. Non-pregnant women aged 18–40 years (n 441) were recruited between February and June. Fasting blood was collected and dietary intakes were assessed using 5 d food records. Mean serum 25-hydroxyvitamin D concentration was lower in Beijing than Hong Kong women (29 v. 34 nmol/l; P < 0·001). Vitamin D deficiency ( ≤ 25 nmol/l) was indicated in 40 % of Beijing and 18 % of Hong Kong women, and over 90 % of women in both cities were insufficient ( ≤ 50 nmol/l). Mean Ca and vitamin D intakes were 478 mg/d and 2·0 μg/d, respectively. The relationship between 25-hydroxyvitamin D concentration and PTH was linear throughout the range with a slope of − 0·36 (different from 0; P < 0·001; R 0·26), with no apparent threshold. There was no influence of Ca intake on the relationship between 25-hydroxyvitamin D and PTH concentration. Vitamin D deficiency is common and insufficiency is very common in non-pregnant women in Hong Kong and Beijing during spring. Serum 25-hydroxyvitamin D was inversely associated with PTH with no apparent threshold. Strategies such as vitamin D fortification or supplementation may be required.

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Circulating 25-hydroxyvitamin D levels in relation to blood pressure parameters and hypertension in the Shanghai Women's and Men's Health Studies

British Journal Of Nutrition ◽

10.1017/s0007114511005745 ◽

2012 ◽

Vol 108 (3) ◽

pp. 449-458 ◽

Cited By ~ 21

Author(s):

Tsogzolmaa Dorjgochoo ◽

Xiao Ou Shu ◽

Yong-Bing Xiang ◽

Gong Yang ◽

Qiuyin Cai ◽

...

Keyword(s):

Blood Pressure ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Antihypertensive Drugs ◽

Urban China ◽

Inverse Association ◽

Cross Sectional ◽

Who Criteria ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

Little is known about the association of circulating 25-hydroxyvitamin D (25(OH)D) and blood pressure (BP) parameters, including systolic and diastolic BP, pulse pressure (PP), mean arterial pressure (MAP) and hypertension in non-Western populations that have not yet been exposed to foods fortified with vitamins and seldom use vitamin D supplements. A cross-sectional analysis of plasma 25(OH)D levels in association with BP measures was performed for 1460 participants (1055 women and 405 men, aged 40–74 years) of two large cohort studies in Shanghai. Multivariable linear and logistic regressions were conducted. Overall, the prevalence of vitamin D deficiency was 55·8 % using National Health and Nutrition Examination Survey, USA criteria and 29·9 % using WHO criteria. The median plasma 25(OH)D level in the population was 38·0 nmol/l for men and 33·6 nmol/l for women (P < 0·01) among participants who were not on antihypertensive drugs. Among men, BP parameters (systolic BP, diastolic BP and MAP) were significantly and inversely associated with higher quintiles of 25(OH)D compared with the lowest quintile (Ptrend < 0·05 for all). Vitamin D non-deficient status (WHO criteria) was inversely associated with hypertension (ORadjusted = 0·29; 95 % CI 0·10, 0·82). An inverse association was also found between hypertension and the highest quintile of 25(OH)D (ORadjusted = 0·16; 95 % CI 0·04, 0·65 for ≥ 50·6 nmol/l; Ptrend = 0·02). Among women, no significant associations were found for BP parameters and hypertension. The present study shows that vitamin D deficiency is common among adults in urban China. Circulating 25(OH)D levels were inversely related to the levels of individual BP parameters and hypertension among middle-aged and elderly men but not among women. More research is needed to investigate the potential sex differential associations.

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Vitamin D in Therapeutics: Past, Present and Future

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2016/v3/i2/6390 ◽

2016 ◽

Vol 3 (2) ◽

pp. 128

Author(s):

Jeetendra Singh ◽

Sameer B. Dharrao ◽

Tushar Baheti

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Human Body ◽

Indian Population ◽

Vitamin D Insufficiency ◽

Direct Sunlight ◽

Hydroxyvitamin D ◽

Patients At Risk ◽

25 Hydroxyvitamin D ◽

In The Beginning

In the beginning of 20th century vitamin D was classified as a vitamin but later considered as a prohormone ("conditional" vitamin) which influences the expression of more than 200 genes in the human body. Worldwide vitamin D insufficiency affects about 50% of the population and in India about 80% of population has vitamin D level less than normal. In India sunshine is abundant but still Indians are deprived of this sunshine vitamin. Minimal exposure to direct sunlight, staying indoors, use of sunscreen lotions, pollution, clothing, dietary and cooking habits are most important factors for vitamin D deficiency in the Indian population. Serum 25 hydroxyvitamin D level is the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D2 or vitamin D3 is recommended for patients having deficiency, keeping hypervitaminosis in mind.

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Vitamin D3 metabolite ratio as an indicator of vitamin D status and its association with diabetes complications

BMC Endocrine Disorders ◽

10.1186/s12902-020-00641-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lina H. M. Ahmed ◽

Alexandra E. Butler ◽

Soha R. Dargham ◽

Aishah Latif ◽

Omar M. Chidiac ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Diabetic Complications ◽

Cross Sectional Study ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

Dihydroxyvitamin D ◽

Metabolite Ratio ◽

25 Hydroxyvitamin D ◽

Artery Disease

Abstract Background Vitamin D deficiency is diagnosed by total serum 25-hydroxyvitamin D (25(OH)D) concentration and is associated with poor health and increased mortality; however, some populations have low 25(OH) D concentrations without manifestations of vitamin D deficiency. The Vitamin D Metabolite Ratio (VMR) has been suggested as a superior indicator of vitamin D status. Therefore, VMR was determined in a population with type 2 diabetes at high risk for vitamin D deficiency and correlated with diabetic complications. Research design and methods Four hundred sisty patients with type 2 diabetes (T2D) were recruited, all were vitamin D3 supplement naive. Plasma concentration of 25-hydroxyvitamin D3 (25(OH)D3) and its metabolites 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and 24,25-dihydroxyvitamin D3 (24,25(OH)2D3) and its epimer, 3-epi-25-hydroxyvitamin D3 (3-epi-25(OH)D3), were measured by LC-MS/MS analysis. VMR-1 was calculated as a ratio of 24,25(OH)2D3:25(OH)D3; VMR-2 as a ratio of 1,25(OH)2D3:25(OH)D3; VMR-3 was calculated as a ratio of 3-epi-25(OH)D3: 25(OH)D3. Results An association means that there were significant differences between the ratios found for those with versus those without the various diabetic complications studied. VMR-1 was associated with diabetic retinopathy (p = 0.001) and peripheral artery disease (p = 0.012); VMR-2 associated with hypertension (p < 0.001), dyslipidemia (p < 0.001), diabetic retinopathy (p < 0.001), diabetic neuropathy (p < 0.001), coronary artery disease (p = 0.001) and stroke (p < 0.05). VMR-3 associated with hypertension (p < 0.05), dyslipidemia (p < 0.001) and coronary artery disease (p < 0.05). Conclusions In this cross sectional study, whilst not causal, VMR-2 was shown to be the superior predictor of diabetic and cardiovascular complications though not demonstrative of causality in this cross-sectional study population over VMR-1, VMR-3 and the individual vitamin D concentration measurements; VMR-2 associated with both microvascular and cardiovascular indices and therefore may have utility in predicting the development of diabetic complications.

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Vitamin D deficiency is endemic in Middle Eastern sportsmen

Public Health Nutrition ◽

10.1017/s136898000999320x ◽

2010 ◽

Vol 13 (10) ◽

pp. 1528-1534 ◽

Cited By ~ 53

Author(s):

Bruce Hamilton ◽

Justin Grantham ◽

Sebastien Racinais ◽

Hakim Chalabi

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Sports Medicine ◽

Middle Eastern ◽

Young Male ◽

Cross Sectional Study ◽

Mineral Density ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

AbstractObjectiveWhile vitamin D deficiency is well recognized in Middle Eastern women as a result of cultural norms of remaining covered, Middle Eastern men are an under-reported group. Vitamin D is now known to have multiple effects, including an impact on muscle function, thereby increasing the relevance for sportsmen. The aim of the present study was to evaluate serum 25-hydroxyvitamin D (25(OH)D) levels in young male Middle Eastern athletes.DesignCross-sectional study.SettingQatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.SubjectsNinety-three Middle Eastern men presenting to hospital for an annual screening undertook a blood test to evaluate their vitamin D status.ResultsNinety-one per cent of athletes were found to be deficient in 25(OH)D (serum concentration <20 ng/ml). Athletes with severe deficiencies were significantly younger than those with less marked deficiency. A subset of athletes underwent bone mineral density assessment and 59 % were shown to have at least oneZ-score less than −1; despite this, however, no athletes reported a stress fracture. There was no correlation between 25(OH)D concentration and sunlight exposure, skin coverage and skin colouring.ConclusionsThe study revealed that 25(OH)D deficiency is very common among otherwise healthy Middle Eastern male athletes. Given the potentially significant long- and short-term effects of 25(OH)D deficiency, serum 25(OH)D evaluation should be part of the routine assessment in this region.

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