An Update on Vitamin D Deficiency Status in Malaysia

Abstract

Vitamin D is essential for maintaining serum calcium levels, ensuring sufficient bone mineralization, immunomodulatory properties, and a protective effect on the cardiovascular system, renal disease, cancer, as well as in pregnancy. Vitamin D deficiency is prevalent worldwide, and it is not related to a country’s development index. However, the data on vitamin D deficiencies are primarily taken from out-of-date, small-scale studies on target age groups or specific diseases, rather than from large-scale, population-based surveys. In Malaysia, for the past 16 years, studies were conducted involving adult men and women, pregnant women, postmenopausal women, adolescent, and children especially with specific diseases such as spina bifida, epilepsy, chronic liver disease, and atopic dermatitis. Only a few large surveys were conducted involving children and adolescents. Across the specific target population studied, vitamin D deficiency and insufficiency were seen particularly among females, Indians, and those of Malay ethnicity. This is related to widely known causes of vitamin D deficiency such as skin type (melanin) and sun avoidant lifestyles that include covering clothes, largely practiced by Malay Muslims in Malaysia. Other related causes or the high-risk groups are breastfed infants, the elderly, the obese, those on medications, and those characterized by fat malabsorption and geophysical factors. Vitamin D deficiency can be managed with pharmacological or non-pharmacological approaches, depending on the severity. The objective is to raise serum vitamin D to a normal level, hence, relieving the symptoms and reducing the adverse health outcomes. Despite no clear guidelines in treating vitamin D deficiency in Malaysia, this condition can be prevented with taking adequate vitamin D in food resources, sun exposure, or supplementation. Special attention should be given to high-risk groups including infants, obese patients, and the elderly.

Beyond the Tropics: Unraveling the Complex Relationship between Sun Exposure, Dietary Intake, and Vitamin D Deficiency in Coastal Malaysians

“…Sun exposure enables vitamin D synthesis, with approximately 50% to 90% absorbed through the skin [ 1 ]. This process involves multiple steps, beginning with 7-dehydrocholesterol in the skin and through exposure to ultraviolet B rays [ 2 ].…”

“…Due to its equatorial position, Malaysia experiences a relatively consistent number of daylight hours year-round. Surprisingly, despite Malaysia’s equatorial location with abundant sunlight, local studies have revealed a significant prevalence of vitamin D deficiency among Malaysians [ 2 , 13 ]. This discrepancy is noteworthy given the country’s tropical climate, which receives an ample 7–8 h of intense daily sunlight, far exceeding the 6–8 min required for adequate vitamin D production, as stated in a previous Nordic study [ 14 ].…”

The Impact of Vitamin D Deficiency and Insufficiency on the Outcome of Type 2 Diabetes Mellitus Patients: A Systematic Review

“…Vitamin D, generally known as calciferol, is a fat-soluble vitamin [ 9 ]. There are two main forms of vitamin D: ergocalciferol (vitamin D 2 ) and calciferol (vitamin D 3 ).…”

“…Vitamin D is mostly synthesised endogenously when the skin is exposed to ultraviolet B from sunlight, which produces cholecalciferol, and subsequently transported to the liver by the vitamin D binding protein (VDBP). The first hydroxylation occurs in the liver, where 25-hydroxyvitamin is converted to 25-hydroxyvitamin D 3, which is the inactive form of vitamin D, with the help of 25 hydroxylase enzymes [ 9 , 15 ]. Subsequently, the vitamin D-binding protein binds to 25-hydroxyvitamin D 3 and transports it to the kidney for a second hydroxylation.…”

“…Subsequently, the vitamin D-binding protein binds to 25-hydroxyvitamin D 3 and transports it to the kidney for a second hydroxylation. This activation process is carried out by the 1-α 25 hydroxylase enzyme in the kidneys, where 25-hydroxyvitamin D 3 is converted to 1,25(OH) 2 D 3 , the active form of vitamin D [ 9 ].…”