Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes.
Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes.
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DOI：
10.4161/derm.25111
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发表时间：
2013-04-01
期刊：
影响因子：
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通讯作者：
Fuleihan Gel-H
中科院分区：
文献类型：
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作者：
Bassil D;Rahme M;Hoteit M;Fuleihan Gel-H
背景：中东和北非(MENA)地区是全球维生素D缺乏症发病率最高的地区。目的：我们系统地回顾了该地区维生素D缺乏症、软骨病和软骨病的患病率，它们的预测因素和对主要结果的影响。方法：使用Medline、Pubmed和Embase搜索引擎，输入关键词和概念，结合感兴趣的各个国家。检索限于2000-2012年；使用的是2000年前的综述文章。结果：在这个阳光充足的地区，软骨病和软骨病仍然存在。维生素D缺乏症的发生率在30-90%之间，考虑到理想的血清25羟基维生素D[25(OH)D]为20 ng/ml。高龄、女性、多胎、服装款式、季节、社会经济状况和城市生活是公认的成人维生素D缺乏症的预测因素。长时间母乳喂养而不补充维生素D和膳食钙摄入量低是公认的儿童软骨病和维生素D缺乏症的危险因素。描述了与风湿性疾病的疼痛评分和疾病活动性、丙型肝炎的病毒载量和白介素量、体重指数、血脂和胰岛素敏感性、血压、心力衰竭和死亡率的关系。在一项研究中，成年人暴露在阳光下可以降低代谢综合征的患病率。很少有随机维生素D试验显示，大多数母亲或儿童未能达到理想的25(OH)D水平，即使剂量远远超过目前的推荐剂量。在青春期女孩中进行的一项试验显示，骨骼和瘦体重增加了很多。结论：MENA患者普遍存在维生素D缺乏症。缺乏以人群为基础的研究，对婴儿、青春期前儿童和孕妇的研究存在差距，阻碍了制定针对区域的指导方针，并构成影响这一慢性和最常见的亚临床疾病的主要障碍。
Background: The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide. Aim: We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region. Methods: Medline, Pubmed and Embase search engines, entering keywords and concepts, combined with individual countries of interest, were used. Search was limited years 2000–2012; and review articles were used for the period preceding year 2000. Results: Rickets and osteomalacia still occur in this sunny region. Hypovitaminosis D prevails, with rates varying 30–90%, considering a desirable serum 25 hydroxy-vitamin D [25(OH)D] of 20 ng/ml. Advancing age, female gender, multi-parity, clothing style, season, socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults. Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children.. Associations with pain score and disease activity in rheumatologic disorders, viral load and interleukins in hepatitis C, BMI, lipids and insulin sensitivity, blood pressure, heart failure and mortality are described. Sun exposure in adults decreased prevalence of metabolic syndrome in one study. Few randomized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level, even with doses by far exceeding current recommendations. A trial in adolescent girls reveals substantial bone and lean mass increments. Conclusion: Hypovitaminosis D is prevalent in MENA. The lack of populations based studies, gaps in studies in infants, pre-pubertal children and pregnant women, hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often subclinical disease.