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Hypovitaminosis D in developing countries—prevalence, risk factors and outcomes

Abstract

Hypovitaminosis D is a prevalent disorder in developing countries. Clinical manifestations of hypovitaminosis D include musculoskeletal disorders, such as nonspecific muscle pain, poor muscle strength and low BMD, as well as nonmusculoskeletal disorders, such as an increased risk of respiratory infections, diabetes mellitus and possibly cardiovascular diseases. In developing countries, the prevalence of hypovitaminosis D varies widely by and within regions; prevalence ranges between 30–90%, according to the cut-off value used within specific regions, and is independent of latitude. A high prevalence of the disorder exists in China and Mongolia, especially in children, of whom up to 50% are reported to have serum 25-hydroxyvitamin D levels <12.5 nmol/l. Despite ample sunshine throughout the year, one-third to one-half of individuals living in Sub-Saharan Africa and the Middle East have serum 25-hydroxyvitamin D levels <25 nmol/l, according to studies published in the past decade. Hypovitaminosis D is also prevalent in children and the elderly living in Latin America. Risk factors for hypovitaminosis D in developing countries are similar to those reported in Western countries and include extremes of age, female sex, winter season, dark skin pigmentation, malnutrition, lack of sun exposure, a covered clothing style and obesity. Clinical trials to assess the effect of vitamin D supplementation on classical and nonclassical clinical outcomes in developing countries are needed.

Key Points

  • Hypovitaminosis D is a widespread disorder in developing countries, regardless of their latitude

  • The disorder is highly prevalent in China, Mongolia, Sub-Saharan Africa, the Middle East and Latin America, especially in children, the elderly and women

  • Risk factors are similar to those reported in Western countries and include extremes of age, female sex, winter season, low socioeconomic status, malnutrition, covered clothing style and dark skin

  • Clinical manifestations of hypovitaminosis D are not limited to musculoskeletal disorders, but may also include an increased risk of respiratory infections, diabetes mellitus and possibly cardiovascular diseases

  • Public health-awareness campaigns, as well as food fortification with vitamin D are efficacious and affordable means to prevent vitamin D deficiency

  • Clinical trials are needed to assess the effect of vitamin D supplementation on the burden of both communicable and noncommunicable diseases in developing countries

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Figure 1: World map indicating developing countries as classified by World Bank criteria in color and relating latitude by geographic regions to skin ability to synthesize vitamin D as estimated from information provided in an article by Tavera-Mendoza and White.1
Figure 2: Metabolism of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D for nonskeletal functions.

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A. Arabi, R. El Rassi and G. El-Hajj Fuleihan researched the data for the article, provided a substantial contribution to discussions of the content and reviewed and/or edited the manuscript before submission. A. Arabi and G. El-Hajj Fuleihan wrote the article.

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Correspondence to Ghada El-Hajj Fuleihan.

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Arabi, A., El Rassi, R. & El-Hajj Fuleihan, G. Hypovitaminosis D in developing countries—prevalence, risk factors and outcomes. Nat Rev Endocrinol 6, 550–561 (2010). https://doi.org/10.1038/nrendo.2010.146

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