Vitamin D insufficiency is high in Malaysia: A systematic review and meta-analysis of studies on vitamin D status in Malaysia

Abstract Vitamin D plays an important role in the immune system and many non-communicable diseases. The prevalence of vitamin D deficiency for the overall population of Malaysia is unknown. This study systematically reviewed and pooled studies that report vitamin D status from participants residing in Malaysia. PubMed, Scopus, Web of Science and MyJurnal were searched up to June 2021 without language restrictions. We include studies that reported the 25-hydroxyvitamin D (25(OH)D) concentrations and defined their cut-off for deficiency or insufficiency from healthy participants residing in Malaysia. Random effects model was used to pool vitamin D status using established cut-offs of < 30nmol/L, < 50nmol/L, and < 75nmol/L according to age group. We identified 203 studies, of which we included 31 studies in the meta-analysis. The pooled proportion for < 30nmol/L was 21% (95% CI 9–36, n = 2,438 from 10 studies), while the pooled proportion < 50nmol/L was 64% (95% CI 55–72, n = 13,927 from 29 studies), and < 75nmol/L was 85% (95% CI 61–100, n = 1,376 from 5 studies). Heterogeneity was high (I² ranged from 98–99%). Higher proportions of vitamin D insufficiency (defined as < 50nmol/L) were found in participants living in the urban areas (compared to rural areas), in females (compared to males), and in Malays and Malaysian Indians (compared to Malaysian Chinese) ethnicities. In conclusion, vitamin D insufficiency is highly prevalent in Malaysia, despite being a country that is close to the equator. We strongly urge prompt public health measures to improve the vitamin D status in Malaysia.

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Prevalence of vitamin D deficiency and insufficiency among schoolchildren in Greece: the role of sex, degree of urbanisation and seasonality

British Journal Of Nutrition ◽

10.1017/s0007114517002422 ◽

2017 ◽

Vol 118 (7) ◽

pp. 550-558 ◽

Cited By ~ 14

Author(s):

Yannis Manios ◽

George Moschonis ◽

Toine Hulshof ◽

Anne-Sophie Bourhis ◽

George L. J. Hull ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Urban Areas ◽

Urban Region ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

Primary Schoolchildren ◽

Region Of Residence ◽

25 Hydroxyvitamin D

AbstractThe current study was aiming to report the prevalence of suboptimal vitamin D status among schoolchildren in Greece and investigate the role of sex, urbanisation and seasonality on vitamin D status. A sample of 2386 schoolchildren (9–13 years old) from four distinct prefectures was examined. The prevalence of 25-hydroxyvitamin D (25(OH)D) concentration <30 and <50 nmol/l (vitamin D deficiency and insufficiency respectively) was 5·2 and 52·5 %, respectively. Girls had a higher prevalence of 25(OH)D<30 (7·2 v. 3·2 %) and 50 nmol/l (57·0 v. 48·0 %) than boys (P<0·001). The highest prevalence rates of 25(OH)D<30 and 50 nmol/l (9·1 and 73·1 %, respectively) were observed during spring (April to June), whereas the lowest (1·5 and 31·9 %, respectively) during autumn (October to December). The prevalence of 25(OH)D<50 nmol/l was higher in urban/semi-urban than rural regions, particularly during spring months (74·6 v. 47·2 %; P<0·001). Female sex, urban/semi-urban region of residence and spring months were found to increase the likelihood of vitamin D deficiency and insufficiency, with the highest OR observed for spring months (7·47; 95 % CI 3·23, 17·3 and 5·14; 95 % CI 3·84, 6·89 for 25(OH)D<30 and 50 nmol/l respectively). In conclusion, despite the southerly latitude, the prevalence of low vitamin D status among primary schoolchildren in Greece is comparable to or exceeds the prevalence reported among children and adolescents on a European level. Sub-populations at highest risk are girls in urban/semi-urban areas during spring months, thus indicating the need for effective initiatives to support adequate vitamin D status in these population groups.

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Vitamin D Status and Supplementation in Elite Irish Athletes

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.23.5.441 ◽

2013 ◽

Vol 23 (5) ◽

pp. 441-448 ◽

Cited By ~ 17

Author(s):

Pamela J. Magee ◽

L. Kirsty Pourshahidi ◽

Julie M. W. Wallace ◽

John Cleary ◽

Joe Conway ◽

...

Keyword(s):

Vitamin D ◽

Biochemical Analysis ◽

Vitamin D Insufficiency ◽

Early Spring ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

High Prevalence ◽

25 Hydroxyvitamin D ◽

And Training ◽

Vitamin D Supplement

Background:A high prevalence of vitamin D insufficiency/deficiency, which may impact on health and training ability, is evident among athletes worldwide. This observational study investigated the vitamin D status of elite Irish athletes and determined the effect of wintertime supplementation on status.Methods:Serum 25-hydroxyvitamin D [25(OH)D], calcium, and plasma parathyroid hormone were analyzed in elite athletes in November 2010 (17 boxers, 33 paralympians) or March 2011 (34 Gaelic Athletic Association [GAA] players). A subset of boxers and paralympians (n = 27) were supplemented during the winter months with either 5,000 IU vitamin D3/d for 10–12 weeks or 50,000 IU on one or two occasions. Biochemical analysis was repeated following supplementation.Results:Median 25(OH)D of all athletes at baseline was 48.4 nmol/L. Vitamin D insufficiency/deficiency (serum 25(OH)D <50 nmol/L) was particularly evident among GAA players (94%) due to month of sampling. Wintertime supplementation (all doses) significantly increased 25(OH)D (median 62.8 nmol/L at baseline vs. 71.1 nmol/L in April or May; p = .001) and corrected any insufficiencies/deficiencies in this subset of athletes. In contrast, 25(OH)D significantly decreased in those that did not receive a vitamin D supplement, with 74% of athletes classed as vitamin D insufficient/deficient after winter, compared with only 35% at baseline.Conclusions:This study has highlighted a high prevalence of vitamin D insufficiency/deficiency among elite Irish athletes and demonstrated that wintertime vitamin D3 supplementation is an appropriate regimen to ensure vitamin D sufficiency in athletes during winter and early spring.

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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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Preoperative Vitamin D Deficiency is a Risk Factor for Postthyroidectomy Hypoparathyroidism: A Systematic Review and Meta-Analysis of Observational Studies

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab039 ◽

2021 ◽

Author(s):

Konstantina D Vaitsi ◽

Panagiotis Anagnostis ◽

Stavroula Veneti ◽

Theodosios S Papavramidis ◽

Dimitrios G Goulis

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Meta Analysis ◽

Vitamin D Status ◽

Pubmed Central ◽

Hydroxyvitamin D ◽

Study Selection ◽

Postoperative Hypoparathyroidism ◽

Increased Risk ◽

25 Hydroxyvitamin D

Abstract Context Whether preoperative vitamin D deficiency (VDD) contributes to postoperative hypoparathyroidism (hypoPT) risk is unknown. Objective This work aimed to meta-analyze the best available evidence regarding the association between preoperative vitamin D status and hypoPT risk. Methods A comprehensive literature search was conducted in PubMed, CENTRAL, and Scopus databases, up to October 31, 2020. Study selection included patients undergoing thyroidectomy with preoperative vitamin D status and postoperative hypoPT data. Two researchers independently extracted data from eligible studies. Data were expressed as risk ratio (RR) with 95% CI. The I2 index was employed for heterogeneity. Results Thirty-nine studies were included in the quantitative analysis (61 915 cases with transient and 5712 with permanent hypoPT). Patients with VDD demonstrated a higher risk for transient hypoPT compared with those with preoperative vitamin D sufficiency (RR 1.92, 95% CI, 1.50-2.45, I2 = 85%). These results remained significant for patients with preoperative 25-hydroxyvitamin D concentrations less than or equal to 20 ng/mL (mild VDD; RR 1.46, 95% CI, 1.10-1.94, I2 = 88%) and less than or equal to 10 ng/mL (severe VDD; RR 1.98, 95% CI 1.42-2.76, I2 = 85%). The risk of permanent hypoPT was increased only in cases with severe VDD (RR 2.45, 95% CI, 1.30-4.63, I2 = 45%). No difference was evident in subgroup analysis according to study design or quality. Conclusion Patients with preoperative VDD are at increased risk of transient hypoPT following thyroidectomy. The risk for permanent hypoPT is increased only for those with severe VDD.

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Comparison of Vitamin D and 25-Hydroxyvitamin D Concentrations in Human Breast Milk between 1989 and 2016–2017

Nutrients ◽

10.3390/nu13020573 ◽

2021 ◽

Vol 13 (2) ◽

pp. 573

Author(s):

Naoko Tsugawa ◽

Mayu Nishino ◽

Akiko Kuwabara ◽

Honami Ogasawara ◽

Maya Kamao ◽

...

Keyword(s):

Vitamin D ◽

Breast Milk ◽

Sun Exposure ◽

Stepwise Multiple Regression ◽

Human Breast Milk ◽

Vitamin D Status ◽

Human Breast ◽

Hydroxyvitamin D ◽

Lactating Mothers ◽

25 Hydroxyvitamin D

Background: Breast milk is considered the optimal source of nutrition during infancy. Although the vitamin D concentration in human breast milk is generally considered poor for infants, vitamin D in breast milk is an important source for exclusively breastfed infants. Increases in vitamin D insufficiency and deficiency in lactating mothers may reduce vitamin D concentrations in breast milk. This study aimed to compare vitamin D and 25-hydroxyvitamin D (25OHD) concentrations in breast milk collected in 1989 and 2016–2017 and simultaneously analyze them with liquid chromatography-tandem mass spectrometry (LC-MS/MS); the association between the lifestyle of recent lactating mothers (2016–2017) and vitamin D status in human breast milk was also evaluated. Method: Lactating mothers were recruited from three regions of Japan in 1989 (n = 72) and 2016–2017 (n = 90), and milk from 3–4 months was collected in summer and winter. The samples were strictly sealed and stored at −80℃ until measurement. Breast milk vitamin D and 25OHD concentrations were analyzed by LC-MS/MS. Vitamin D intake, sun exposure, and sunscreen use of the lactating mothers in 2016–2017 were assessed. Results: Both vitamin D and 25OHD concentrations in breast milk were higher in the summer regardless of the survey year. Significantly lower vitamin D and 25OHD concentrations were observed in 2016–2017 compared with 1989 in summer, but no survey year difference was observed in winter. The stepwise multiple regression analyses identified season, daily outdoor activity, and suntan in the last 12 months as independent factors associated with vitamin D3 concentrations. Conclusion: The results suggest that low vitamin D status in recent lactating mothers may have decreased vitamin D and 25OHD concentrations in breast milk compared with the 1980s. These results are helpful for developing public health strategies to improve vitamin D status in lactating mothers and infants.

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COVID-19 Disease Severity and Death in Relation to Vitamin D Status among SARS-CoV-2-Positive UAE Residents

Nutrients ◽

10.3390/nu13051714 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1714

Author(s):

Habiba AlSafar ◽

William B. Grant ◽

Rafiq Hijazi ◽

Maimunah Uddin ◽

Nawal Alkaabi ◽

...

Keyword(s):

Vitamin D ◽

United Arab Emirates ◽

Blood Levels ◽

Vitamin D Status ◽

Hospital Visit ◽

Serum Samples ◽

Hydroxyvitamin D ◽

Increased Risk ◽

Multiethnic Population ◽

25 Hydroxyvitamin D

Insufficient blood levels of the neurohormone vitamin D are associated with increased risk of COVID-19 severity and mortality. Despite the global rollout of vaccinations and promising preliminary results, the focus remains on additional preventive measures to manage COVID-19. Results conflict on vitamin D’s plausible role in preventing and treating COVID-19. We examined the relation between vitamin D status and COVID-19 severity and mortality among the multiethnic population of the United Arab Emirates. Our observational study used data for 522 participants who tested positive for SARS-CoV-2 at one of the main hospitals in Abu Dhabi and Dubai. Only 464 of those patients were included for data analysis. Demographic and clinical data were retrospectively analyzed. Serum samples immediately drawn at the first hospital visit were used to measure serum 25-hydroxyvitamin D [25(OH)D] concentrations through automated electrochemiluminescence. Levels < 12 ng/mL were significantly associated with higher risk of severe COVID-19 infection and of death. Age was the only other independent risk factor, whereas comorbidities and smoking did not contribute to the outcomes upon adjustment. Sex of patients was not an important predictor for severity or death. Our study is the first conducted in the UAE to measure 25(OH)D levels in SARS-CoV-2-positive patients and confirm the association of levels < 12 ng/mL with COVID-19 severity and mortality.

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Vitamin D Status and Seasonal Variation among Danish Children and Adults: A Descriptive Study

Nutrients ◽

10.3390/nu10111801 ◽

2018 ◽

Vol 10 (11) ◽

pp. 1801 ◽

Cited By ~ 20

Author(s):

Louise Hansen ◽

Anne Tjønneland ◽

Brian Køster ◽

Christine Brot ◽

Rikke Andersen ◽

...

Keyword(s):

Vitamin D ◽

Seasonal Variation ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

Supplement Use ◽

Wide Range ◽

Adults And Children ◽

25 Hydroxyvitamin D ◽

Vitamin D Supplement ◽

Very High

The aim of the present study was to describe vitamin D status and seasonal variation in the general Danish population. In this study, 3092 persons aged 2 to 69 years (2565 adults, 527 children) had blood drawn twice (spring and autumn) between 2012 and 2014. A sub-sample of participants had blood samples taken monthly over a year. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by liquid chromatography mass spectrometry, and information on supplement use was assessed from questionnaires. Seasonal variations in 25(OH)D concentrations were evaluated graphically and descriptively, and status according to age, sex, and supplement use was described. It was found that 86% of both adults and children were vitamin D-sufficient in either spring and or/autumn; however, many had a spring concentration below 50 nmol/L. A wide range of 25(OH)D concentrations were found in spring and autumn, with very low and very high values in both seasons. Among adults, women in general had higher median 25(OH)D concentrations than men. Furthermore, vitamin D supplement use was substantial and affected the median concentrations markedly, more so during spring than autumn. Seasonal variation was thus found to be substantial, and bi-seasonal measurements are vital in order to capture the sizable fluctuations in vitamin D status in this Nordic population.

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Weight and skin colour as predictors of vitamin D status: results of an epidemiological investigation using nationally representative data

Public Health Nutrition ◽

10.1017/s1368980016000173 ◽

2016 ◽

Vol 20 (10) ◽

pp. 1857-1864 ◽

Cited By ~ 5

Author(s):

Sonali Rajan ◽

Tom Weishaar ◽

Bryan Keller

Keyword(s):

Vitamin D ◽

Body Weight ◽

Skin Colour ◽

Vitamin D Status ◽

Epidemiological Investigation ◽

Dietary Recommendations ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Nationally Representative ◽

The Impact

AbstractObjectiveCurrent US dietary recommendations for vitamin D vary by age. Recent research suggests that body weight and skin colour are also major determinants of vitamin D status. The objective of the present epidemiological investigation was to clarify the role of age as a predictor of vitamin D status, while accounting for body weight and skin colour, among a nationally representative sample.DesignWe calculated the mean serum 25-hydroxyvitamin D levels for the US population by age and weight, as well as by weight and race/ethnicity group. Multiple regression analyses were utilized to evaluate age and weight as predictors of vitamin D status: serum 25-hydroxyvitamin D levels with age alone, age and body weight, and age, body weight and their two-way interaction were modelled for the entire sample and each age subgroup. Graphical data were developed using B-spline non-linear regression.SettingNational Health and Nutrition Examination Survey (31 934 unweighted cases).SubjectsIndividuals aged 1 year and older.ResultsThere were highly significant differences in mean vitamin D status among US residents by weight and skin colour, with those having darker skin colour or higher body weight having worse vitamin D status. Although a significant factor, the impact of age on vitamin D status was notably less than the impact of body weight.ConclusionsVitamin D status varied predominantly by body weight and skin colour. Recommendations by nutritionists for diet and supplementation needs should take this into account if vitamin D-related health disparities are to be meaningfully reduced across the USA.

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