VITAMIN D STATUS IN A HEALTHY TUNISIAN POPULATION

  • Afef BAHLOUS Laboratory of Clinical Biochemistry and Hormonology; Pasteur Institute of Tunis, University of Tunis-El Manar, Tunis, Tunisia.
  • Asma KRIR Laboratory of Clinical Biochemistry and Hormonology; Pasteur Institute of Tunis
  • Mehdi MRAD Immuno-Rheumatology Research Laboratory, Rheumatology Department, La Rabta Hospital, University of Tunis-El Manar, Tunis, Tunisia.
  • BOUKSILA Mouna Immuno-Rheumatology Research Laboratory, Rheumatology Department, La Rabta Hospital, University of Tunis-El Manar, Tunis, Tunisia.
  • KALAI Safa Laboratory of Clinical Biochemistry and Hormonology; Pasteur Institute of Tunis, University of Tunis-El Manar, Tunis, Tunisia.
  • KILANI Osman Laboratory of Clinical Biochemistry and Hormonology; Pasteur Institute of Tunis, University of Tunis-El Manar, Tunis, Tunisia.
  • CHEOUR EL KATEB Elhem Rheumatology Department, La Rabta Hospital, Medicine School of Tunis, University of Tunis-El Manar, Tunis, Tunisia.
  • LAADHARI Nizar Charles Nicolle Hospital, Occupational Pathology and Fitness for work service, University of Tunis-El Manar Tunis, Tunisia
DOI: https://doi.org/10.5937/jomb0-30247
Keywords: Healthy volunteers; Parathyroid hormone; Prevalence; Tunisia; Vitamin D deficiency

Abstract


Vitamin D deficiency is one of the most common medical conditions worldwide. In Tunisia, several studies evaluated Vitamin D status, but this was concerning specific populations (pregnant women, obese or diabetic patients and children with asthma). The only study that evaluated Vitamin D status in a healthy Tunisian population was conducted by Meddeb and al. in 2002. The update of data available, based on the currently recommended limits, is necessary. This study aimed to estimate the prevalence of hypovitaminosis D in a healthy Tunisian population, and correlate the values with potential risk factors.

It was conducted on 209 Tunisian healthy subjects. Data collected included clinical characteristics and dietary intakes. We measured 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), glycemia, creatinine, calcium, phosphorus, proteins and alkaline phosphatase levels. Hypovitaminosis D was retained for 25(OH)D concentrations <30ng/ml. Vitamin D deficiency was defined by 25(OH)D concentrations <10 ng/ml.

The prevalence of hypovitaminosis D and vitamin D deficiency were respectively 92.3% and 47.6%. The main factors that were significantly associated with low vitamin D levels in our multivariate analysis were veiling, living in rural areas and sunscreen use. However, sex, age, socioeconomic level, phototype, solar exposure score, smoking and bone mass index, were not statistically associated with hypovitaminosis D. The study of relationship between vitamin D status and serum PTH levels showed a significative and negative correlation (p< 0.005).

Given the high prevalence of vitamin D, an adapted health policy is essential. A widespread vitamin D supplementation and food fortification seems to be necessary in Tunisia.

References

1. Hilger J, Friedel A, Herr R, Rausch T, Roos F, Wahl DA, et al. A systematic review of vitamin D status in populations worldwide. Br J Nutr. 14 janv 2014;111(1):23‑45.
2. Jurutka PW, Whitfield GK, Hsieh JC, Thompson PD, Haussler CA, Haussler MR. Molecular nature of the vitamin D receptor and its role in regulation of gene expression. Rev Endocr Metab Disord. avr 2001;2(2):203‑16.
3. Ma J, Stampfer MJ, Gann PH, Hough HL, Giovannucci E, Kelsey KT, et al. Vitamin D receptor polymorphisms, circulating vitamin D metabolites, and risk of prostate cancer in United States physicians. Cancer Epidemiol Biomarkers Prev. 1 mai 1998;7(5):385‑90.
4. Zittermann A, Pilz S. Vitamin D and Cardiovascular Disease: An Update. Anticancer Res. sept 2019;39(9):4627‑35.
5. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl):1678S-88S.
6. Laird E, Rhodes J, Kenny RA. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19. Ir Med J. 7 mai 2020;113(5):81.
7. Jain A, Chaurasia R, Sengar NS, Singh M, Mahor S, Narain S. Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. Scientific Reports. 19 nov 2020;10(1):20191.
8. Hovsepian S, Amini M, Aminorroaya A, Amini P, Iraj B. Prevalence of Vitamin D Deficiency among Adult Population of Isfahan City, Iran. J Health Popul Nutr. avr 2011;29(2):149‑55.
9. G R, Gupta A. Vitamin D Deficiency in India: Prevalence, Causalities and Interventions. Nutrients. 21 févr 2014;6(2):729‑75.
10. Meddeb N, Sahli H, Chahed M, Abdelmoula J, Feki M, Salah H, et al. Vitamin D deficiency in Tunisia. Osteoporos Int. févr 2005;16(2):180‑3.
11. Bouvard B, Annveiller C, Sallé A, Beauchet O, Chappard D, Audran M, et al. Les effets extra-osseux de la vitamine D : faits, questions et controverses. Revue du Rhumatisme. nov 2010;77:A18‑25.
12. Garabédian M, Menn S, Walrant-Debray O, Teinturier C, Delaveyne R, Roden A. Prévention de la carence en vitamine D chez l’enfant et l’adolescent. II. Validation d’un abaque décisionnel non invasif prenant en compte l’exposition solaire et les apports exogènes de vitamine D. Archives de Pédiatrie. avr 2005;12(4):410‑9.
13. Fitzpatrick TB. The Validity and Practicality of Sun-Reactive Skin Types I Through VI. Arch Dermatol. 1 juin 1988;124(6):869.
14. Holick MF. Vitamin D Status: Measurement, Interpretation, and Clinical Application. Annals of Epidemiology. févr 2009;19(2):73‑8.
15. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. juill 2005;16(7):713‑6.
16. Hosmer DW, Lemeshow S, Klar J. Goodness-of-Fit Testing for the Logistic Regression Model when the Estimated Probabilities are Small. Biometrical Journal. 1988;30(8):911‑24.
17. De R, Sa A, J A, G B, Mw B, Kh B, et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci. 18 sept 2018;1430(1):44‑79.
18. Berriche O, Othmen RB, Sfar H, Boumeftah S, Bhouri S, Amrouche C, et al. Statut en vitamine D dans une population d’obèses tunisiens. Annales d’Endocrinologie. 1 sept 2015;76(4):565.
19. Abdesselem H, Melki A, Ben Amor N, Denguir C, Kammoun I, Ben Salem L. Influence de la supplémentation en vitamine D chez des diabétiques type 2 déficitaires en 25 (OH) D. Annales d’Endocrinologie. 1 sept 2017;78(4):404.
20. Allali F, El Aichaoui S, Khazani H, Benyahia B, Saoud B, El Kabbaj S, et al. High Prevalence of Hypovitaminosis D in Morocco: Relationship to Lifestyle, Physical Performance, Bone Markers, and Bone Mineral Density. Seminars in Arthritis and Rheumatism. juin 2009;38(6):444‑51.
21. Baidya A, Chowdhury S, Mukhopadhyay S, Ghosh S. Profile of vitamin D in a cohort of physicians and diabetologists in Kolkata. Indian J Endocrinol Metab. déc 2012;16(Suppl 2):S416‑7.
22. Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N. Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. The American Journal of Clinical Nutrition. 1 août 2000;72(2):472‑5.
23. Skull SA, Ngeow JYY, Biggs BA, Street A, Ebeling PR. Vitamin D deficiency is common and unrecognized among recently arrived adult immigrants from The Horn of Africa. Intern Med J. févr 2003;33(1‑2):47‑51.
24. Souberbielle J-C, Massart C, Brailly-Tabard S, Cavalier E, Chanson P. Prevalence and determinants of vitamin D deficiency in healthy French adults: the VARIETE study. Endocrine. août 2016;53(2):543‑50.
25. Ramlau-Hansen CH, Moeller UK, Bonde JP, Olsen J, Thulstrup AM. Are serum levels of vitamin D associated with semen quality? Results from a cross-sectional study in young healthy men. Fertil Steril. 1 mars 2011;95(3):1000‑4.
26. Luxwolda MF, Kuipers RS, Kema IP, Dijck-Brouwer DAJ, Muskiet FAJ. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. British Journal of Nutrition. nov 2012;108(9):1557‑61.
27. Sridhar SB, Rao PG, Multani SK, Jain M. Assessment of prevalence of hypovitaminosis D in multiethnic population of the United Arab Emirates. J Adv Pharm Technol Res. juin 2016;7(2):48‑53.
28. Erkal MZ, Wilde J, Bilgin Y, Akinci A, Demir E, Bödeker RH, et al. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int. 2006;17(8):1133‑40.
29. Hintzpeter B, Mensink GBM, Thierfelder W, Müller MJ, Scheidt-Nave C. Vitamin D status and health correlates among German adults. Eur J Clin Nutr. sept 2008;62(9):1079‑89.
30. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1 oct 1985;76(4):1536‑8.
31. Gallagher JC, Riggs BL, Deluca HF. Effect of Estrogen on Calcium Absorption and Serum Vitamin D Metabolites in Postmenopausal Osteoporosis. J Clin Endocrinol Metab. 1 déc 1980;51(6):1359‑64.
32. Lamberg-Allardt CJE, Outila TA, Kärkkäinen MUM, Rita HJ, Valsta LM. Vitamin D Deficiency and Bone Health in Healthy Adults in Finland: Could This Be a Concern in Other Parts of Europe? J Bone Miner Res. 1 nov 2001;16(11):2066‑73.
33. Sayed-Hassan R, Abazid N, Koudsi A, Alourfi Z. Vitamin D status and parathyroid hormone levels in relation to bone mineral density in apparently healthy Syrian adults. Arch Osteoporos. 2016;11:18.
34. BenOthman R. Statut en vitamine D dans une population d’obèses Tunisiens. 2015.
35. Abdessalem Abbessi H. Influence de la supplémentation en vitamine D sur l’équilibre glycémique des diabétiques de type 2 2016. Number of pages p. 2016.
36. Al-Horani H, Abu Dayyih W, Mallah E, Hamad M, Mima M, Awad R, et al. Nationality, Gender, Age, and Body Mass Index Influences on Vitamin D Concentration among Elderly Patients and Young Iraqi and Jordanian in Jordan. Biochemistry Research International. 24 mars 2016;2016:1‑8.
37. Nichols E, Khatib I, Aburto N, Sullivan K, Scanlon K, Wirth JP, et al. Vitamin D status and determinants of deficiency among non-pregnant Jordanian women of reproductive age. European journal of clinical nutrition. 14 mars 2012;66:751‑6.
38. Alzaheb R, Al-Amer O. Prevalence and Predictors of Hypovitaminosis D Among Female University Students in Tabuk, Saudi Arabia. Clinical medicine insights Women’s health. 2017;
39. Holick MF, Chen TC, Lu Z, Sauter E. Vitamin D and skin physiology: a D-lightful story. J Bone Miner Res. déc 2007;22 Suppl 2:V28-33.
40. Lippi G, Bonelli P, Buonocore R, Aloe R. Birth season and vitamin D concentration in adulthood. Ann Transl Med. sept 2015;3(16):231.
41. Matsuoka LY, Wortsman J, Hanifan N, Holick MF. Chronic sunscreen use decreases circulating concentrations of 25-hydroxyvitamin D. A preliminary study. Arch Dermatol. déc 1988;124(12):1802‑4.
42. Kockott D, Herzog B, Reichrath J, Keane K, Holick MF. New Approach to Develop Optimized Sunscreens that Enable Cutaneous Vitamin D Formation with Minimal Erythema Risk. PLOS ONE. 29 janv 2016;11(1):e0145509.
43. Quaggiotto P, Tran H, Bhanugopan M. Vitamin D deficiency remains prevalent despite increased laboratory testing in New South Wales, Australia. Singapore medical journal. 2014;55(5):271‑80.
44. Lejnieks A, Slaidina A, Zvaigzne A, Soboleva U, Eivazova G, Daukste I, et al. Vitamin D status and its seasonal variations and association with parathyroid hormone concentration in healthy women in Riga. Medicina (Kaunas). 2013;49(7):329‑34.
45. Kilicarslan A, Aslan A, Gezgen G. The role of vitamin D deficiency in parathyroid hormone levels. Turkish Journal of Medical Sciences. 1 janv 2013;43:368‑72.
46. Tsugawa N, Uenishi K, Ishida H, Ozaki R, Takase T, Minekami T, et al. Association between vitamin D status and serum parathyroid hormone concentration and calcaneal stiffness in Japanese adolescents: sex differences in susceptibility to vitamin D deficiency. J Bone Miner Metab. juill 2016;34(4):464‑74.
Published
2022/01/12
Issue
Vol. 41 No. 2 (2022): Journal of Medical Biochemistry
Section
Original paper

Copyright (c) 2022 Asma KRIR, Afef BAHLOUS, Mehdi MRAD, BOUKSILA Mouna, KALAI Safa, KILANI Osman, CHEOUR EL KATEB Elhem, LAADHARI Nizar

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