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      Vitamin D level and its determinants among Sudanese Women: Does it matter in a sunshine African Country?

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          Abstract

          Background:

          Vitamin D deficiency is a worldwide concern. The aim of the current study was to determine the vitamin D level and its contributing factors in Sudanese women.

          Methods:

          In this cross-sectional study, 251 Sudanese women attending Family Health Centers in Khartoum, Sudan were interviewed. Following the exclusion of confounding factors, samples from 190 women were analzsed. Serum 25 hydroxyvitamin D “25(OH) D” was quantified using competitive electrochemiluminescence immunoassay.

          Results:

          Participants’ age ranged from 18 to 85 years with a mean age (±SD) of 40.2 (±14.06) years. The mean (±SD) vitamin D level was 13.4 (±6.72) ng/ml, ranged 3.00–36.5 ng/ml and the median was 12.7 ng/mL. In total, 157 out of 190 (82.6%) had vitamin D serum levels below 20 ng/ml (deficient); of whom, 52 (27.4%) were in the age group 21–30 years ( P value = 0.228). The correlation between vitamin D level and residence outside Khartoum, sun-exposed face and hands, and face and limbs in comparison with being completely covered were found to be statistically significant ( p values 0.008, 0.023, and 0.036).

          Conclusion:

          This study displayed a high percentage (82.6%.) of vitamin D deficiency among women in Sudan, and this in part may indicate that sunshine alone cannot guarantee vitamin D sufficiency in the tropics. Family physicians in tropical countries should screen those with clinical presentations related to vitamin D deficiency.

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          Most cited references26

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          Periconceptional multivitamin use reduces the risk of preeclampsia.

          The objective was to assess the independent effect of regular periconceptional multivitamin use on the risk of preeclampsia. Pregnant women (n=1,835) enrolled in the Pregnancy Exposures and Preeclampsia Prevention Study (Pittsburgh, Pennsylvania, 1997-2001) at less than 16 weeks' gestation were asked whether they regularly used multivitamins or prenatal vitamins in the past 6 months. Women were classified as users or nonusers. The unadjusted prevalence of preeclampsia was 4.4% in nonusers and 3.8% in users. After adjustment for race/ethnicity, marital status, parity, prepregnancy physical activity, and income in a multiple logistic regression model, regular use of multivitamins was associated with a 45% reduction in preeclampsia risk compared with nonuse (odds ratio (OR)=0.55, 95% confidence interval (CI): 0.32, 0.95). Prepregnancy overweight modified this effect. After confounder adjustment, lean multivitamin users had a 71% reduction in preeclampsia risk compared with lean nonusers (OR=0.29, 95% CI: 0.12, 0.65). In contrast, there was no relation between multivitamin use and preeclampsia among overweight women (OR=1.08, 95% CI: 0.52, 2.25). A sensitivity analysis for unmeasured confounding by fruit and vegetable intake supported these conclusions. If confirmed by others, these results suggest that regular use of a multivitamin supplement in the periconceptional period may help to prevent preeclampsia, particularly among lean women.
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            High Prevalence of Vitamin D Deficiency in Pregnant Women: A National Cross-Sectional Survey

            An increasing number of studies suggest that vitamin D deficiency during pregnancy is associated with multiple adverse health outcomes in mothers, neonates and children. There are no representative country data available on vitamin D status of pregnant women in Europe. The aim of this study was to estimate the prevalence of vitamin D deficiency among Belgian pregnant women and to assess the determinants of vitamin D status in the first and third trimester of pregnancy. The women were selected via a multi-stage proportionate-to-size sampling design. Blood samples were collected and a questionnaire was completed face-to-face. 55 obstetric clinics were randomly selected and 1311 pregnant women participated in the study. The median serum 25-hydroxyvitamin D [25-(OH)D] concentration was significantly lower in the first trimester (20.4 ng/ml) than in third trimester (22.7 ng/ml). Of all women, 74.1% (95%CI = 71.8–76.5%) were vitamin D insufficient (25-(OH)D <30 ng/ml), 44.6% (95%CI = 41.9–47.3%) were vitamin D deficient (25-(OH)D <20 ng/ml), while 12.1% (95%CI = 10.3–13.8%) were severely vitamin D deficient (25-(OH)D <10 ng/ml). Of all women included, 62.0% reported taking vitamin D-containing multivitamins, of which only 24.2% started taking those before pregnancy. The risk of vitamin D deficiency (25-(OH)D <20 ng/ml) was significantly higher for less educated women and women who reported not going on holidays to sunny climates. The risk of severe vitamin D deficiency (25-(OH)D <10 ng/ml) decreased for women who reported alcohol consumption during pregnancy, decreased with more frequent use of sunscreen lotion and increased for smokers and women who reported preference for shadow. In conclusion, vitamin D deficiency is highly prevalent among pregnant women in Belgium and this raises concerns about the health consequences for the mother and the offspring. A targeted screening strategy to detect and treat women at high risk of severe vitamin D deficiency is needed in Belgium and in Europe.
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              Vitamin D Status and Mortality: A Systematic Review of Observational Studies

              Epidemiological evidence suggests that vitamin D deficiency is associated with increased mortality, but it is unclear whether this is explained by reverse causation, and if there are specific causes of death for which vitamin D might be important. We conducted a systematic review of observational studies investigating associations between circulating 25-hydroxyvitamin D (25(OH)D) concentration and all-cause or cause-specific mortality in generally healthy populations. Relevant studies were identified using PubMed and EMBASE searches. After screening 722 unique records and removing those that were ineligible, 84 articles were included in this review. The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality. This association appeared to be non-linear, with progressively lower mortality with increasing 25(OH)D up to a point, beyond which there was no further decrease. There is moderate evidence that vitamin D status is inversely associated with cancer mortality and death due to respiratory diseases, while for cardiovascular mortality, there is weak evidence of an association in observational studies, which is not supported by the data from intervention or Mendelian randomization studies. The relationship between vitamin D status and other causes of death remains uncertain due to limited data. Larger long-term studies are required to clarify these associations.
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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                2249-4863
                2278-7135
                July 2019
                : 8
                : 7
                : 2389-2394
                Affiliations
                [1 ] Department of Pathology, Omdurman Islamic University, Sudan
                [2 ] Department of Pathology, The National Ribat University, Sudan
                [3 ] Department of Pathology, Faculty of Medicine, Ahfad University for Women, Omdurman, Sudan
                [4 ] Department of Medical Laboratories and Blood Bank, National Ribat University Hospital, Sudan
                [5 ] Department of Pathology, Faculty of Veterinary Medicine, Sudan University for Science and Technology, Sudan
                [6 ] Combined Clinic, Radiation and Isotope Center, Khartoum (RICK) and Department of Surgery, Alneelain University, Sudan
                [7 ] Radiation and Isotope Center, Khartoum (RICK), Sudan
                [8 ] Department of Statistics, Faculty of Sciences, University of Tabouk, Saudi Arabia
                [9 ] Histo Center, Khartoum, Sudan
                [10 ] Department of Medicine and HIV Metabolic Clinic, Milton Keynes University, Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
                [11 ] Armed Forces Centre for Psychiatric Care, Taif, Saudi Arabia
                [12 ] Nephrology Department, Noble's Hospital, Isle of Man IM44RJ, UK
                [13 ] Institute of Pathology, University of Erlangen, Germany
                Author notes
                Address for correspondence: Dr. Nazik Elmalaika Husain, Al-Salha St, Abusiaed, Faculty of Medicine, Omdurman Islamic University, PO. Box: 382, Omdurman - 12217, Khartoum, Sudan. E-mail: nazikhusain@ 123456gmail.com
                Article
                JFMPC-8-2389
                10.4103/jfmpc.jfmpc_247_19
                6691462
                418fffe1-20ec-4bf8-8802-4b909b89f53e
                Copyright: © 2019 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 24 March 2019
                : 25 March 2019
                : 11 June 2019
                Categories
                Original Article

                dietary intake,menopausal state,phc,reproductive health,sudan,sun exposure,vitamin d,women

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