Paradoxical Vitamin D deficiency in a sunny country: A narrative review of the literature from the United Arab Emirates (1992–2018)

Abstract

Invited Review IntroduCtIonVitamin D deficiency (VDD) is a global problem, which is related to lack of sunlight exposure, with a contribution from reduced dietary intake. [1,2] VDD affects mainly the skeletal structure and function. In addition, there are a number of recognized nonskeletal effects that have wide ramifications. [3] Despite living in a sunny country all year round, paradoxically, hypovitaminosis D with clearly demonstrable low serum Vitamin D levels has been repeatedly recorded in the United Arab Emirates (UAE) and the surrounding Arabian Gulf countries. This problem has attracted increasing clinical and academic interests. However, the relevant publications are too widely scattered in different types of journals of different levels of access for the interested clinician and researcher to follow them and may be difficult to grasp them. Hence, in the present article, we aimed to present a narration of the international literature focusing on Vitamin D status and the clinical implications of its deficiency to make it available for practicing clinicians and researchers developing a new interest in the subject. materIals and methodsThis is a narrative nonsystematic review of the literature on the epidemiological and clinical aspects of Vitamin D status in the UAE, a country which is invariably sunny on a daily basis all the year round. PubMed search was conducted Deficiency of Vitamin D is a global problem related to lack of sunlight exposure and reduced dietary intake. Vitamin D deficiency (VDD) affects mainly skeletal structure and function but has a number of recognized nonskeletal effects that have wide ramifications. It sounds ironic that low serum Vitamin D levels are widely documented in a sunny country like the United Arab Emirates (UAE). The study objective was to review the literature on VDD in the UAE. This is a narrative nonsystematic review of the literature on the epidemiological and clinical aspects of Vitamin D status in the UAE based on PubMed search using two search terms "Vitamin D" and "Emirates." We discuss the various themes that emerged as follows: epidemiology and disease burden of VDD in the UAE population in general and in specific groups (adults, children, females, and pregnant and nursing mothers); awareness of dietary intake, climate, genetics, and metabolic factors affecting serum Vitamin D levels; and the overview of current clinical management guidelines, interventional trials, and clinical practices. VDD is a widely documented health problem in the UAE population as a whole and in several special groups. This may have serious skeletal and nonskeletal health implications.

Food Sources of Fiber and Micronutrients of Concern in Infants and Children in the United Arab Emirates: Findings from the Feeding Infants and Toddlers Study (FITS) and the Kids Nutrition and Health Survey (KNHS) 2020

“…Cow’s milk is fortified in the UAE with 10 mcg of vitamin D3 per liter. Given that the RDA for Vitamin D is 15 mcg for children 4 years and older, the observed milk intake in our population of 1.2 cups (data not shown) would only cover 20% of the RDA for Vitamin D. Although the UAE does not have local standards of fortification for milk, considering that vitamin D targets in the US and Canada are between 10 and 20 mcg (new target in Canada) per liter, a higher fortification level for milk in the UAE could be warranted, especially since vitamin D deficiency has been identified as a major public health concern in the UAE population as a whole [ 43 ]. Regarding fortified milk products, we observed that I/YC formula provides iron, zinc, calcium, folate, vitamin A, and vitamin D to 24- to 47.9-month-old children.…”

Adaptation and co‐adaptation of skin pigmentation and vitamin D genes in native Americans

“…As commented earlier, low levels of vitamin D may be a more general feature in Native American populations, but how much this condition reflects health problems and medical implications is controversial (Frost, 2012(Frost, , 2016Grant, 2012). Low concentrations of vitamin D are also reported in other populations such as South Asians, African-Americans, Arabians, Hispanics, and Africans (Akhtar, Aggarwal, & Jain, 2019;Beshyah et al, 2019;Cashman et al, 2019;Dhaliwal, Islam, Mikhail, Ragolia, & Aloia, 2020;Gopal-Kothandapani et al, 2019;Harris & Dawson-Hughes, 1998;Sedrani, 1984). A metaanalysis considering 394 studies concluded that the average serum calcidiol levels are higher in populations identified as "Caucasians" or "white-skinned" than in "non-Caucasians" or "non-white-skinned" individuals (Hagenau et al, 2009).…”

Diagnosis and management of X-linked hypophosphatemia in children and adolescent in the Gulf Cooperation Council countries

“…This is not surprising as there is considerable clinical overlap between the various types of rickets and osteomalacia. Furthermore, cases of vitamin D deficiency as well as rickets and osteomalacia are common in the GCC countries, despite year-long abundance sunshine [16][17][18]. Due to the ongoing high levels of consanguinity in the region [19][20][21][22], recessively inherited conditions giving rise to calcipenic and phosphopenic rickets have also been misdiagnosed as XLH.…”