Knowledge and attitudes about vitamin D, and behaviors related to vitamin D in adults with and without coronary heart disease in Saudi Arabia

Abstract

BackgroundVitamin D deficiency is prevailing in Saudi Arabia. Recent national data indicated an inverse association between vitamin D status and coronary heart disease (CHD), which increases concerns about vitamin D deficiency as a serious public health problem. Therefore, the current study aimed to investigate whether knowledge, attitudes and behaviors related to vitamin D contribute to the prevalence of vitamin D deficiency among adults with and without CHD in Saudi Arabia.MethodsThis case-control study consisted of 130 CHD cases and 195 matched controls. The study subjects were recruited from three hospitals in Saudi Arabia. Structured interviews were completed to collect data on participants’ socio-demographics, knowledge about vitamin D, attitudes toward sun exposure, and behaviors related to vitamin D. Also, serum vitamin D levels were measured.ResultsSevere vitamin D deficiency [serum 25(OH)D < 10 ng/mL] was more prevalent in the CHD cases than in the controls (46% and 3%, respectively). The total knowledge score was higher in the controls than in the cases [2.5 (±1.8) and 1.6 (±2.2), respectively]. The cases had better attitudes toward sun exposure compared to the controls (p = 0.001); however, the controls had better attitudes toward vitamin D compared to the cases (p = 0.001). The controls had a higher consumption of multivitamin supplements than the cases (6.7% and 0.8%, respectively; p = 0.010). Similarly, the controls had a higher consumption of butter (p = 0.001), oily fish (p = 0.004), and liver (p = 0.003) than the cases; however, the cases had a significantly higher intake of milk (p = 0.001). A multivariate logistic regression showed that vitamin D deficiency [25(OH)D < 20 ng/mL] was associated with low levels of knowledge about vitamin D, with an odds ratio of 1.82 (95% CI: 1.08–3.06, P = 0.024). Vitamin D deficiency was also associated with low intake of vitamin supplements, with an odds ratio of 4.35 (95% CI: 2.12–8.92, P < 0.001).ConclusionThe present study revealed that low levels of knowledge about vitamin D and low consumption of vitamin supplementation, including vitamin D, calcium, multivitamin, and calcium supplements with vitamin D, may have contributed to the higher prevalence of vitamin D deficiency among the CHD cases than among the controls. Further studies using a qualitative approach are crucial to explore the underlying reasons for low knowledge about vitamin D and behaviors related to vitamin D including the intake of vitamin supplementation that may contribute to the high burden of vitamin D deficiency in the country.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4183-1) contains supplementary material, which is available to authorized users.

Assessment of Awareness, Knowledge, Attitude, and the Practice of Vitamin D among the General Public in Malaysia

“…However, although breast milk provides babies with the best source of nutrients, it may not provide the adequate amount of vitamin D that is needed to absorb calcium. 33,34 The study demonstrated negative attitudes of participants towards Vitamin D and sunlight exposure, which was also reported in the previous studies. 16,24,28,35 Although majority of them acknowledged the importance of Vitamin D for their health, they disliked exposing themselves under the sun, even among those who has adequate knowledge about vitamin D. 16,24 Based on the findings, it can be speculated that the reason of sunlight avoidance may be caused by the changes in lifestyle due to modernization and to have a paler skin in order to blend into the current cultural trend.…”

“…Our findings are aligned to results of previous studies. 16,[29][30][31][32] It had shown that breast milk contains an insufficient amount of vitamin D for infants and thus, exclusively breastfed infants should be supplemented with vitamin D. 33 However, only 6% of the participants recognised that formula milk is the source of Vitamin D for infants instead of breast milk, regardless of gender. The possible reason for this might be due to the opinion of public that breast milk contains all required nutrients for infants.…”

Effects of knowledge of vitamin D on attitudes toward sun exposure among middle-aged and elderly Indonesian adults

“…A previous study reported that having a good level of knowledge on vitamin D significantly contributes to the positive behavior in maintaining the vitamin D sufficiency. 13 Vitamin D has a pivotal role in regulating the absorption of calcium and phosphor in order to maintain optimum bone mineral density. 3 Vitamin D has two forms, namely vitamin D2 and vitamin D3.…”

Gender-specific differences in the awareness and intake of vitamin D among adult population in Qassim region

“…It is unrealistic to make a comparison of the current finding with the data previously reported in Saudi Arabia since the populations examined, outcome of interest, and tools used in the studies are different. [ 13 14 15 18 ] Actually, one of these studies used a qualitative approach in studying the awareness. [ 15 ] Nevertheless, individual awareness items in the current study are probably better than seen in previous studies in Saudi Arabia.…”

“…Data were collected using a self-administered study questionnaire covering the following sections; demographics, medical history, awareness of Vitamin D, and intake of Vitamin D. The questionnaire developed after a review of similar studies[ 13 18 ] was revised by a consultant dermatologist. A pilot study was conducted on 10 volunteers to ensure clarity and appropriateness of the questions and estimate the time required for completion of the questionnaire.…”