Hypovitaminosis D in the Middle East and North Africa: Prevalence, Risk Factors and Impact on Outcomes

Overview

Journal Dermatoendocrinol

Specialty Endocrinology

Date 2013 Nov 7

PMID 24194968

Citations 72

Authors

Darina Bassil

Maya Rahme

Maha Hoteit

Ghada El-Hajj Fuleihan

Affiliations

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Abstract

Background: The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide.

Aim: We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region.

Methods: 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.

Results: 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.

Conclusion: 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.

Citing Articles

The Sunshine Paradox: Unraveling Risk Factors for Low Vitamin D Status Among Non-Pregnant Women in Lebanon.

El-Mallah C, Yarparvar A, Galetti V, Obeid O, Boutros M, Safadi G Nutrients. 2025; 17(5).

PMID: 40077674 PMC: 11901458. DOI: 10.3390/nu17050804.

Evaluating the Role of Vitamin D in Prediabetes Management, Insights from RCTs in the MENA Region: A Comprehensive Systematic Review.

Al-Hetar M, Rusli N, Kamaruzzaman M, Al-Goshae H, Wan Ngah W, Shah S J Clin Med. 2025; 14(4).

PMID: 40004770 PMC: 11856371. DOI: 10.3390/jcm14041239.

The Impact and Efficacy of Vitamin D Fortification.

Alnafisah R, Alragea A, Alzamil M, Alqahtani A Nutrients. 2025; 16(24.

PMID: 39770943 PMC: 11677708. DOI: 10.3390/nu16244322.

The dietary fiber and micronutrient composition of traditional foods from Lebanon and their contribution to dietary adequacy: A call for action.

Hoteit M, Zoghbi E, Rady A, Shankiti I, Sacre Y, Hanna-Wakim L PLoS One. 2024; 19(10):e0312429.

PMID: 39471186 PMC: 11521292. DOI: 10.1371/journal.pone.0312429.

Vitamin D Deficiency-A Public Health Issue in Children.

Herdea A, Marie H, Ionescu A, Sandu D, Pribeagu S, Ulici A Children (Basel). 2024; 11(9).

PMID: 39334594 PMC: 11429966. DOI: 10.3390/children11091061.

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