Correspondence

Hypovitaminosis D in a Sunny Country

N Engl J Med 1999; 340:1840-1841June 10, 1999

Article

To the Editor:

Some normal subjects and a substantial proportion of patients with various illnesses in the United States and northern Europe have vitamin D insufficiency,1-4 but information from countries located in more southern latitudes is scarce.

We measured serum 25-hydroxyvitamin D and parathyroid hormone during the summer (August through October) in 465 women from the village of Nabi-Shit (latitude, 33.5 degrees north) in central Lebanon. We studied a random sample of women, most of whom were of reproductive age, who were eating a regular Middle Eastern diet, including dairy products. The dress code requires the head, arms, and legs to be covered. None of the women were taking medication known to affect the metabolism of vitamin D. Serum 25-hydroxyvitamin D was measured by a competitive protein-binding assay with use of the Diasoren Incstar kit (Incstar, Stillwater, Minn.), and serum parathyroid hormone was measured with use of the ELSA-PTH immunoradiometric assay (Cis Bio International, Gif-sur-Yvette, France). The mean (±SD) serum concentration of 25-hydroxyvitamin D was 11±14 ng per milliliter (28±35 nmol per liter). Sixty percent of the women had concentrations of less than 10 ng per milliliter (25 nmol per liter), 35 percent had concentrations between 10 and 20 ng per milliliter (25 and 50 nmol per liter), and 5 percent had concentrations greater than 20 ng per milliliter (50 nmol per liter). There was a trend toward a decrease in the mean concentration of 25-hydroxyvitamin D with age (Table 1Table 1Mean Serum Concentrations of 25-Hydroxyvitamin D and Parathyroid Hormone in 465 Women from the Village of Nabi-Shit in the Bekaa Valley, Lebanon.). The mean serum concentration of parathyroid hormone was 31±27 pg per milliliter. There was an inverse relation between serum concentrations of parathyroid hormone and 25-hydroxyvitamin D (data not shown). When serum 25-hydroxyvitamin D values were categorized as <10, 10 to 20, or >20 ng per milliliter, the corresponding mean serum parathyroid hormone values were 30±12, 26±11, and 23±11 pg per milliliter, respectively, thus changing in an inverse pattern, as expected.

Our data demonstrate that a substantial number of healthy young women in central Lebanon had vitamin D insufficiency in the summer. Despite the lack of symptoms, it is likely that hypovitaminosis D has deleterious effects on calcium metabolism and ultimately the skeleton. Our findings may be explained by the lack of a governmental mandate that food be supplemented with vitamin D and by the cultural habits of the women. Hypovitaminosis D is being increasingly recognized as a common yet easily modifiable risk factor for osteoporosis.3,5 Our results underscore that it can also be endemic even in young women in sunny countries.

Ghada El-Hajj Fuleihan, M.D., M.P.H.
Mary Deeb, Ph.D.
American University of Beirut Medical Center, Beirut, Lebanon

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Citing Articles (23)

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   Raman K. Marwaha, Nikhil Tandon, Neha Agarwal, Seema Puri, Rashmi Agarwal, Satveer Singh, Kalaivani Mani. (2010) Impact of two regimens of vitamin D supplementation on calcium — vitamin D — PTH axis of schoolgirls of Delhi. Indian Pediatrics 47:9, 761-769
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    Waqas Ahmed, Naseer Khan, Charles J. Glueck, Suman Pandey, Ping Wang, Naila Goldenberg, Muhammad Uppal, Suraj Khanal. (2009) Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Translational Research 153:1, 11-16
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