Abstract
Suboptimal vitamin D status is common throughout Asia particularly in women and in infants. Vitamin D deficiency rickets is endemic in parts of northern Asia. Vitamin D inadequacy may also be contributing to the burden of osteoporosis and other diseases in the region. Vitamin D intakes are low in Asia and food fortification is uncommon. In the north cold temperatures and a lack of UV light prevent dermal vitamin D status in the winter months. In the south where there is sufficient UV year-round, cultural and religious practices that require women to wear clothing that conceals most of their skin when outdoors contribute to suboptimal vitamin D status. Further sun aversion for cosmetic reasons, avoidance of hot outdoor temperatures, and keeping infants indoors are also likely contributors. Strategies are required to improve the vitamin D status of Asian populations.
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References
Strand MA, Perry J, Zhao J et al (2007) Severe Vitamin D-deficiency and the health of North China children. Matern Child Health J 13(1):144–150
Du X, Greenfield H, Fraser DR et al (2001) Vitamin D deficiency and associated factors in adolescent girls in Beijing. Am J Clin Nutr 74:494–500
Woo J, Lam C, Leung J et al (2007) Very high rates of vitamin D insufficiency in women of child-bearing age living in Beijing and Hong Kong. Brt J Nutr 99:1330–1334
Yan L, Prentice A, Zhang H et al (2000) Vitamin D status and parathyroid hormone concentrations in Chinese women and men from north-east of the People’s Republic of China. Eur J Clin Nutr 54:68–72
Wat WZ, Leung JY, Tam S et al (2007) Prevalence and impact of vitamin D insufficiency in southern Chinese adults. Ann Nutr Metab 51:59–64
Yan L, Zhou B, Wang X et al (2003) Older people in China and the United Kingdom differ in the relationships among parathyroid hormone, vitamin D, and bone mineral status. Bone 33:620–627
Kuroda E, Okano T, Mizuno N et al (1981) Plasma levels of 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 in maternal, cord and neonatal blood. J Nutr Sci Vitaminol (Tokyo) 27:55–65
Nakamura K, Nashimoto M, Matsuyama S et al (2001) Low serum concentrations of 25-hydroxyvitamin D in young adult Japanese women: a cross sectional study. Nutrition 17:921–925
Nakamura K, Nashimoto M, Yamamoto M (2000) Summer/winter differences in the serum 25-hydroxyvitamin D3 and parathyroid hormone levels of Japanese women. Int J Biometeorol 44:186–189
Nakamura K, Tsugawa N, Saito T et al (2008) Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: yokogoshi Study. Bone 42:271–277
Lander RL, Enkhjargal T, Batjargal J et al (2008) Multiple micronutrient deficiencies persist during early childhood in Mongolia. Asia Pac J Clin Nutr 17:429–440
Ganmaa D, Tserendolgor U, Frazier L et al (2008) Effects of vitamin D fortified milk on vitamin D status in Mongolian school age children. Asia Pac J Clin Nutr 17:68–71
Bakhtiyarova S, Lesnyak O, Kyznesova N et al (2006) Vitamin D status among patients with hip fracture and elderly control subjects in Yekaterinburg, Russia. Osteoporos Int 17:441–446
Namgung R, Tsang RC, Lee C et al (1998) Low total body bone mineral content and high bone resorption in Korean winter-born versus summer-born newborn infants. J Pediatr 132:421–425
Kim JH, Moon SJ (2000) Time spent outdoors and seasonal variation in serum concentrations of 25-hydroxyvitamin D in Korean women. Int J Food Sci Nutr 51:439–451
Rizzoli R, Eisman JA, Norquist J et al (2006) Risk factors for vitamin D inadequacy among women with osteoporosis: an international epidemiological study. Int J Clin Pract 60:1013–1019
Tsai KS, Hsu SH, Cheng JP et al (1997) Vitamin D stores of urban women in Taipei: effect on bone density and bone turnover, and seasonal variation. Bone 20:371–374
Lee WP, Lin LW, Yeh SH et al (2002) Correlations among serum calcium, vitamin D and parathyroid hormone levels in the elderly in southern Taiwan. J Nurs Res 10:65–72
Strand MA, Perry J, Jin M et al (2007) Diagnosis of rickets and reassessment of prevalence among rural children in northern China. Pediatr Int 49:202–209
Fraser DR (2004) Vitamin D-deficiency in Asia. J Steroid Biochem Mol Biol 89–90:491–495
Tserendolgor U, Mawson J, MacDonald A et al (1998) Prevalence of rickets in Mongolia. Asia Pac J Clin Nutr 7:325–328
Nutrition Research Center & UNICEF(2000) Report on the 1999 2nd National Child and Nutrition Survey. Ulaanbatar.
World Vision Mongolia(2005) Effectiveness of Home-Based Fortification of Complementary Foods with Sprinkles in an Integrated Nutrition Program to Address Rickets and Anemia. Ulaanbaatar.
Miyako K, Kinjo S, Kohno H (2005) Vitamin D deficiency rickets caused by improper lifestyle in Japanese children. Pediatr Int 47:142–146
Thacher TD, Fischer PR, Strand MA et al (2006) Nutritional rickets around the world: causes and future directions. Ann Trop Paediatri 26:1–16
Yorifuji J, Yorifuji T, Tachibana K et al (2008) Craniotabes in normal newborns: the earliest sign of subclinical vitamin D deficiency. J Clin Endocrinol Metab 93:1784–1788
Lau EM, Woo J, Swaminathan R et al (1989) Plasma 25-hydroxyvitamin D concentration in patients with hip fracture in Hong Kong. Gerontology 35:198–204
Lim SK, Kung AW, Sompongse S et al (2008) Vitamin D inadequacy in postmenopausal women in Eastern Asia. Curr Med Res Opin 24:99–106
Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501
Strand MA, Perry J, Guo J et al (2008) Doing the month: rickets and post-partum convalescence in rural China. Midwifery doi:10.1016/j.midw.2007.10.008
Kung AW, Lee KK (2006) Knowledge of vitamin D and perceptions and attitudes toward sunlight among Chinese middle-aged and elderly women: a population survey in Hong Kong. BMC Public Health 6:226
Manaseki-Holland S, Zulf Mughal M, Bhutta Z et al (2008) Vitamin D status of socio-economically deprived children in Kabul, Afghanistan. Int J Vitam Nutr Res 78:16–20
Baroncelli GI, Bertelloni S, Ceccarelli C et al (2000) Bone turnover in children with vitamin D deficiency rickets before and during treatment. Acta Paediatrca 89:513–518
Hatun S, Islam O, Cizmecioglu F et al (2005) Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr 135:218–222
Olmez D, Bober E, Buyukgebiz A et al (2006) The frequency of vitamin D insufficiency in healthy female adolescents. Acta Paediatrica 95:1266–1269
Budak N, Cicek B, Sahin H et al (2004) Bone mineral density and serum 25-hydroxyvitamin D level: is there any difference according to the dressing style of the female university students. Int J Food Sci Nutr 55:569–575
Guzel R, Kozanoglu E, Guler-Uysal F et al (2001) Vitamin D status and bone mineral density of veiled and unveiled Turkish women. J Womens Health Gend Based Med 10:765–770
Guler T, Sivas F, Baskan BM et al (2007) The effect of outfitting style on bone mineral density. Rheumatol Int 27:723–727
Basaran S, Guzel R, Coskun-Benlidayi I et al (2007) Vitamin D status: effects on quality of life in osteoporosis among Turkish women. Qual Life Res 16:1491–1499
Salek M, Hashemipour M, Aminorroaya A et al (2008) Vitamin D deficiency among pregnant women and their newborns in Isfahan, Iran. Exp Clin Endocrinol Diabetes 116:352–356
Maghbooli Z, Hossein-Nezhad A, Shafaei AR et al (2007) Vitamin D status in mothers and their newborns in Iran. BMC Pregnancy Childbirth 7:1
Moussavi M, Heidarpour R, Aminorroaya A et al (2005) Prevalence of vitamin D deficiency in Isfahani high school students in 2004. Horm Res 64:144–148
Rabbani A, Alavian SM, Motlagh ME et al (2009) Vitamin D insufficiency among children and adolescents living in Tehran, Iran. J Trop Pediatr 55:188–191
Hashemipour S, Larijani B, Adibi H et al (2004) Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 4:38
Maghbooli Z, Hossein-nezhad A, Karimi F et al (2008) Correlation between vitamin D-3 deficiency and insulin resistance in pregnancy. Diabetes-Metab Res 24:27–32
Hosseinpanah F, Rambod M, Hossein-nejad A et al (2008) Association between vitamin D and bone mineral density in Iranian postmenopausal women. J Bone Miner Metab 26:86–92
Fuleihan GE, Nabulsi M, Choucair M et al (2001) Hypovitaminosis D in healthy schoolchildren. Pediatrics 107:E53
Fuleihan GE, Gundberg CM, Gleason R et al (1994) Racial differences in parathyroid hormone dynamics. J Clin Endocrinol Metab 79:1642–1647
Gannage-Yared MH, Chemali R, Yaacoub N et al (2000) Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res 15:1856–1862
Gannage-Yared MH, Maalouf G, Khalife S et al (2009) Prevalence and predictors of vitamin D inadequacy amongst Lebanese osteoporotic women. Br J Nutr 101:487–491
Mukamel MN, Weisman Y, Somech R et al (2001) Vitamin D deficiency and insufficiency in Orthodox and non-Orthodox Jewish mothers in Israel. Isr Med Assoc J 3:419–421
Hochwald O (2004) Hypovitaminosis D among inpatients in sunny country. Isr Med Assoc J 6:381
Mishal AA (2001) Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos Int 12:931–935
Molla AM, Al Badawi M, Hammoud MS et al (2005) Vitamin D status of mothers and their neonates in Kuwait. Pediatr Int 47:649–652
Dawodu A, Agarwal M, Hossain M et al (2003) Hypovitaminosis D and vitamin D deficiency in exclusively breast-feeding infants and their mothers in summer: a justification for vitamin D supplementation of breast-feeding infants. J Pediatr 142:169–173
Dawodu A, Agarwal M, Sankarankutty M et al (2005) Higher prevalence of vitamin D deficiency in mothers of rachitic than nonrachitic children. J Pediatr 147:109–111
Saadi HF, Dawodu A, Afandi BO et al (2007) Efficacy of daily and monthly high-dose calciferol in vitamin D-deficient nulliparous and lactating women. Am J Clin Nutr 85:1565–1571
Saadi HF, Nagelkerke N, Benedict S et al (2006) Predictors and relationships of serum 25 hydroxyvitamin D concentration with bone turnover markers, bone mineral density, and vitamin D receptor genotype in Emirati women. Bone 39:1136–1143
Al-Mustafa ZH, Al-Madan M, Al-Majid HJ et al (2007) Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia. Ann Trop Paediatr 27:63–67
Siddiqui TS, Rai MI (2005) Presentation and predisposing factors of nutritional rickets in children of Hazara Division. J Ayub Med Coll Abbottabad 17:29–32
Karatekin G, Kaya A, Salihoglu O et al (2009) Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 63:373–477
Baroncelli GI, Bereket A, El Kholy M et al (2008) Rickets in the Middle East: role of environment and genetic predisposition. J Clin Endocrinol Metab 93:1743–1750
Andiran N, Yordam N, Ozon A (2002) Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition 18:47–50
Nabulsi M, Mahfoud Z, Maalouf J et al (2008) Impact of maternal veiling during pregnancy and socioeconomic status on offspring’s musculoskeletal health. Osteoporos Int 19:295–302
Dawodu A, Dawson KP, Amirlak I et al (2001) Diet, clothing, sunshine exposure and micronutrient status of Arab infants and young children. Ann Trop Paediatr 21:39–44
Mirsaeid Ghazi AA, Rais Zadeh F, Pezeshk P et al (2004) Seasonal variation of serum 25 hydroxy D3 in residents of Tehran. J Endocrinol Invest 27:676–679
Atli T, Gullu S, Uysal AR et al (2005) The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population. Arch Gerontol Geriatr 40:53–60
Ramavat LG (1999) Vitamin D deficiency rickets at birth in Kuwait. Indian J Pediatr 66:37–43
Najada AS, Habashneh MS, Khader M (2004) The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr 50:364–368
Soliman AT, Al Khalaf F, Alhemaidi N et al (2008) Linear growth in relation to the circulating concentrations of insulin-like growth factor I, parathyroid hormone, and 25-hydroxy vitamin D in children with nutritional rickets before and after treatment: endocrine adaptation to vitamin D deficiency. Metabolism 57:95–102
Dahifar H, Faraji A, Yassobi S et al (2007) Asymptomatic rickets in adolescent girls. Indian J Pediatr 74:571–575
Fida NM (2003) Assessment of nutritional rickets in Western Saudi Arabia. Saudi Med J 24:337–340
Ozkan B, Doneray H, Karacan M et al (2008) Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur J Pediatr
Gullu S, Erdogan MF, Uysal AR et al (1998) A potential risk for osteomalacia due to sociocultural lifestyle in Turkish women. Endocr J 45:675–678
El-Desouki MI, Othman SM, Fouda MA (2004) Bone mineral density and bone scintigraphy in adult Saudi female patients with osteomalacia. Saudi Med J 25:355–358
Sahibzada AS, Khan MS, Javed M (2004) Presentation of osteomalacia in Kohistani women. J Ayub Med Coll Abbottabad 16:63–65
Herm FB, Killguss H, Stewart AG (2005) Osteomalacia in Hazara District, Pakistan. Trop Doct 35:8–10
Hayirlioglu DA, Gokaslan H, Cimsit C et al (2008) The impact of clothing style on bone mineral density among women in Turkey. Rheumatol Int 28:521–525
Esmaillzadeh A, Samareh S, Azadbakht L (2008) Dietary patterns among pregnant women in the west-north of Iran. Pak J Biol Sci 11:793–796
Salamoun MM, Kizirian AS, Tannous RI et al (2005) Low calcium and vitamin D intake in healthy children and adolescents and their correlates. Eur J Clin Nutr 59:177–184
Dahifar H, Faraji A, Ghorbani A et al (2006) Impact of dietary and lifestyle on vitamin D in healthy student girls aged 11–15 years. J Med Invest 53:204–208
Gannage-Yared MH, Chemali R, Sfeir C et al (2005) Dietary calcium and vitamin D intake in an adult Middle Eastern population: food sources and relation to lifestyle and PTH. Int J Vitam Nutr Res 75:281–289
Kimlin MG (2008) Geographic location and vitamin D synthesis. Mol Aspects Med 29(6):453–461
Dawodu A, Absood G, Patel M et al (1998) Biosocial factors affecting vitamin D status of women of childbearing age in the United Arab Emirates. J Biosoc Sci 30:431–437
Islam MZ, Shamim AA, Kemi V et al (2008) Vitamin D deficiency and low bone status in adult female garment factory workers in Bangladesh. Br J Nutr 99:1322–1329
Islam MZ, Akhtaruzzaman M, Lamberg-Allardt C (2006) Hypovitaminosis D is common in both veiled and nonveiled Bangladeshi women. Asia Pac J Clin Nutr 15:81–87
Bhalala U, Desai M, Parekh P et al (2007) Subclinical hypovitaminosis D among exclusively breastfed young infants. Indian Pediatr 44:897–901
Harinarayan CV, Ramalakshmi T, Prasad UV et al (2008) Vitamin D status in Andhra Pradesh: a population based study. Indian J Med Res 127:211–218
Puri S, Marwaha RK, Agarwal N et al (2008) Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr 99:876–882
Sahu M, Bhatia V, Aggarwal A et al (2008) Vitamin D deficiency in rural girls and pregnant women despite abundant sunshine in northern India. Clin Endocrinol (Oxf) CEN3360 [pii] 10.1111/j.1365–2265.2008.03360.x
Marwaha RK, Tandon N, Reddy DR et al (2005) Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 82:477–482
Zargar AH, Ahmad S, Masoodi SR et al (2007) Vitamin D status in apparently healthy adults in Kashmir Valley of Indian subcontinent. Postgrad Med J 83:713–716
Sachan A, Gupta R, Das V et al (2005) High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr 81:1060–1064
Harinarayan CV (2005) Prevalence of vitamin D insufficiency in postmenopausal south Indian women. Osteoporos Int 16:397–402
Green TJ, Skeaff CM, Rockell JE et al (2008) Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur. Eur J Clin Nutr 62:373–378
Oemardi M, Horowitz M, Wishart JM et al (2007) The effect of menopause on bone mineral density and bone-related biochemical variables in Indonesian women. Clin Endocrinol (Oxf) 67:93–100
Rahman SA, Chee WS, Yassin Z et al (2004) Vitamin D status among postmenopausal Malaysian women. Asia Pac J Clin Nutr 13:255–260
Jiang T, Christian P, Khatry SK et al (2005) Micronutrient deficiencies in early pregnancy are common, concurrent, and vary by season among rural Nepali pregnant women. J Nutr 135:1106–1112
Meyer HE, Holvik K, Lofthus CM et al (2008) Vitamin D status in Sri Lankans living in Sri Lanka and Norway. Br J Nutr 99:941–944
Soontrapa S, Chailurkit LO (2005) Difference in serum calcidiol and parathyroid hormone levels between elderly urban vs suburban women. J Med Assoc Thai 88(Suppl 5):S17–S20
Teotia SP, Teotia M (2008) Nutritional bone disease in Indian population. Indian J Med Res 127:219–228
Kabir ML, Rahman M, Talukder K et al (2004) Rickets among children of a coastal area of Bangladesh. Mymensingh Med J 13:53–58
Craviari T, Pettifor JM, Thacher TD et al (2008) Rickets: an overview and future directions, with special reference to Bangladesh. A summary of the Rickets Convergence Group meeting, Dhaka, 26–27 January 2006. J Health Popul Nutr 26:112–121
Fischer PR, Rahman A, Cimma JP et al (1999) Nutritional rickets without vitamin D deficiency in Bangladesh. J Trop Pediatr 45:291–293
Girish M, Subramaniam G (2008) Rickets in exclusively breast fed babies. Indian J Pediatr 75:641–643
Balasubramanian K, Rajeswari J, Gulab Y et al (2003) Varying role of vitamin D deficiency in the etiology of rickets in young children vs. adolescents in northern India. J Trop Pediatr 49:201–206
Unachak K, Visrutaratna P, Dejkamron P et al (2004) Infantile osteopetrosis in four Thai infants. J Pediatr Endocrinol Metab 17:1455–1459
Wong HB (1986) Rickets in Singapore infants and children. J Singapore Paediatr Soc 28:12–20
Stransky E, Dizon-Santos-Ocampo PO (1958) Clinical rickets in the Philippines; report of 22 cases in Manila. J Trop Pediatr 4:17–19
Marwaha RK, Tandon N, Reddy DH et al (2007) Peripheral bone mineral density and its predictors in healthy school girls from two different socioeconomic groups in Delhi. Osteoporos Int 18:375–383
Gozdzik A, Barta JL, Wu H et al (2008) Low wintertime vitamin D levels in a sample of healthy young adults of diverse ancestry living in the Toronto area: associations with vitamin D intake and skin pigmentation. BMC Public Health 8:336
Goswami R, Gupta N, Goswami D et al (2000) Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr 72:472–475
Harinarayan CV, Ramalakshmi T, Venkataprasad U (2004) High prevalence of low dietary calcium and low vitamin D status in healthy south Indians. Asia Pac J Clin Nutr 13:359–364
Bhattacharyya AK (1992) Nutritional rickets in the tropics. World Rev Nutr Diet 67:140–197
Agarwal KS, Mughal MZ, Upadhyay P et al (2002) The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child 87:111–113
Salih FM (2004) Effect of clothing varieties on solar photosynthesis of previtamin D3: an in vitro study. Photodermatol Photoimmunol Photomed 20:53–58
Du X, Zhu K, Trube A et al (2004) School-milk intervention trial enhances growth and bone mineral accretion in Chinese girls aged 10–12 years in Beijing. Br J Nutr 92:159–168
Maalouf J, Nabulsi M, Vieth R et al (2008) Short- and long-term safety of weekly high-dose vitamin D3 supplementation in school children. J Clin Endocrinol Metab 93:2693–2701
Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281
Li Tong GX-x (1995) Prevention of rickets and vitamin D intoxication in China. Acta Paediatrica 84:940–940
Maalouf G, Gannage-Yared MH, Ezzedine J et al (2007) Middle East and North Africa consensus on osteoporosis. J Musculoskelet Neuronal Interact 7:131–143
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Green, T., Venn, B. (2010). Vitamin D in Asia. In: Holick, M. (eds) Vitamin D. Nutrition and Health. Humana Press. https://doi.org/10.1007/978-1-60327-303-9_29
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