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Prevalence and predictors of vitamin D deficiency in Lebanon: 2016–2022, before and during the COVID-19 outbreak

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Abstract

Background

Vitamin D deficiency is very common worldwide, particularly in Middle-Eastern countries. Recent Lebanese studies demonstrated an improvement in vitamin D status over time. However, the comparison between the years before and during the COVID-19 outbreak has never been analyzed in the Middle-East area. This study aimed to determine the prevalence and the predictors of 25-hydroxyvitamin D (25(OH)D) levels during the last 7 years.

Methods

Serum 25(OH)D levels from a large laboratory database were retrospectively collected from Hôtel-Dieu de France Hospital between January 2016 and June 2022 (N = 66,127). Data related to age, gender, season and year of sampling were also retrieved.

Results

Mean age of the population was 50.6 ± 19 years, 62.7% were women, 5.3% were children and adolescents, 67.6% adults and 27% elderly. Mean serum 25(OH)D level was 25.7 ± 11.9 ng/mL. The overall population with vitamin D sufficiency (>30 ng/mL) was 31.9%. The increase in mean serum 25(OH)D observed between 2016 and 2022 was 6.36 ng/mL (p < 0.0001). The prevalence of 25(OH)D deficiency (<30 ng/mL) decreased from 76.2% in 2016 to 56.5% in 2022 (p < 0.0001) with a significant difference between the period before and during the COVID-19 outbreak (72.3% vs.42.5%, p < 0.0001). In a multivariate logistic regression, older age, female sex, summer season, years of the COVID-19 outbreak and outpatient samples were protective factors against the risk of hypovitaminosis D (p < 0.0001 for all variables).

Conclusion

Our study showed a continuous positive change in vitamin D status time, most notably after the COVID-19 outbreak. Further studies are needed to assess the clinical impact of the pandemic on vitamin D status in our population.

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Data availability

Data are available upon request from the corresponding author.

References

  1. A. Zendehdel, M. Arefi, Molecular evidence of role of vitamin D deficiency in various extraskeletal diseases. J. Cell Biochem. 120(6), 8829–8840 (2019). https://doi.org/10.1002/jcb.28185

    Article  CAS  PubMed  Google Scholar 

  2. R. Bouillon, C. Marcocci, G. Carmeliet, D. Bikle, J.H. White, B. Dawson-Hughes et al. Skeletal and extraskeletal actions of vitamin D: current evidence and outstanding questions. Endocr. Rev. 40(4), 1109–1151 (2019). https://doi.org/10.1210/er.2018-00126

    Article  PubMed  Google Scholar 

  3. H. Glerup, K. Mikkelsen, L. Poulsen, E. Hass, S. Overbeck, J. Thomsen et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J. Intern. Med. 247(2), 260–268 (2000). https://doi.org/10.1046/j.1365-2796.2000.00595.x

    Article  CAS  PubMed  Google Scholar 

  4. J. Bartley, Vitamin D: emerging roles in infection and immunity. Expert Rev. Anti Infect. Ther. 8(12), 1359–1369 (2010). https://doi.org/10.1586/eri.10.102

    Article  CAS  PubMed  Google Scholar 

  5. D. Bassil, M. Rahme, M. Hoteit, G.E.H. Fuleihan, Hypovitaminosis D in the Middle East and North Africa: prevalence, risk factors and impact on outcomes. Dermatoendocrinol 5(2), 274–298 (2013). https://doi.org/10.4161/derm.25111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. A.A. Yates, S.A. Schlicker, C.W. Suitor, Dietary Reference Intakes: the new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J. Am. Diet. Assoc. 98(6), 699–706 (1998). https://doi.org/10.1016/S0002-8223(98)00160-6

    Article  CAS  PubMed  Google Scholar 

  7. K. Amrein, M. Scherkl, M. Hoffmann, S. Neuwersch-Sommeregger, M. Köstenberger, A. Tmava Berisha et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur. J. Clin. Nutr. 74(11), 1498–1513 (2020). https://doi.org/10.1038/s41430-020-0558-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. A.C. Ross, J.E. Manson, S.A. Abrams, J.F. Aloia, P.M. Brannon, S.K. Clinton et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J. Clin. Endocrinol. Metab. 96(1), 53–58 (2011). https://doi.org/10.1210/jc.2010-2704

    Article  CAS  PubMed  Google Scholar 

  9. H.A. Bischoff-Ferrari, E. Giovannucci, W.C. Willett, T. Dietrich, B. Dawson-Hughes, Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am. J. Clin. Nutr. 84(1), 18–28 (2006). https://doi.org/10.1093/ajcn/84.1.18

    Article  CAS  PubMed  Google Scholar 

  10. P. Lips, K.D. Cashman, C. Lamberg-Allardt, H.A. Bischoff-Ferrari, B. Obermayer-Pietsch, M.L. Bianchi et al. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur. J. Endocrinol. 180(4), P23–P54 (2019). https://doi.org/10.1530/EJE-18-0736

    Article  CAS  PubMed  Google Scholar 

  11. A.N. Hussain, A.H. Alkhenizan, M. El Shaker, H. Raef, A. Gabr, Increasing trends and significance of hypovitaminosis D: a population-based study in the Kingdom of Saudi Arabia. Arch. Osteoporos. 9, 190 (2014). https://doi.org/10.1007/s11657-014-0190-3

    Article  PubMed  Google Scholar 

  12. M.H. Gannagé-Yared, R. Chemali, N. Yaacoub, G. Halaby, Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J. Bone Min. Res. 15(9), 1856–1862 (2000). https://doi.org/10.1359/jbmr.2000.15.9.1856

    Article  Google Scholar 

  13. M.H. Gannagé-Yared, E. Helou, V. Zaraket, S. Abi Akl, L. Antonios, M.L. Moussalli et al. Serum 25 hydroxyvitamin D in employees of a Middle Eastern university hospital. J. Endocrinol. Invest. 37(6), 541–546 (2014). https://doi.org/10.1007/s40618-014-0061-1

    Article  CAS  PubMed  Google Scholar 

  14. A. Arabi, R. El Rassi, G. El-Hajj Fuleihan, Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat. Rev. Endocrinol. 6(10), 550–561 (2010). https://doi.org/10.1038/nrendo.2010.146

    Article  CAS  PubMed  Google Scholar 

  15. R.K. Saad, V.C. Akiki, M. Rahme, S. Ajjour, M. Assaad, G.A. El-Hajj Fuleihan, Time trends and predictors of hypovitaminosis D across the life course: 2009-2016. Metabolism 105, 154138 (2020). https://doi.org/10.1016/j.metabol.2020.154138

    Article  CAS  PubMed  Google Scholar 

  16. M. Hoteit, L. Al-Shaar, C. Yazbeck, M. Bou Sleiman, T. Ghalayini, G.E.H. Fuleihan, Hypovitaminosis D in a sunny country: time trends, predictors, and implications for practice guidelines. Metabolism 63(7), 968–978 (2014). https://doi.org/10.1016/j.metabol.2014.04.009

    Article  CAS  PubMed  Google Scholar 

  17. P. Lips, R.T. de Jongh, N.M. van Schoor, Trends in vitamin D status around the world. JBMR Plus 5(12), e10585 (2021). https://doi.org/10.1002/jbm4.10585

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. R.L. Schleicher, M.R. Sternberg, D.A. Lacher, C.T. Sempos, A.C. Looker, R.A. Durazo-Arvizu et al. The vitamin D status of the US population from 1988 to 2010 using standardized serum concentrations of 25-hydroxyvitamin D shows recent modest increases. Am. J. Clin. Nutr. 104(2), 454–461 (2016). https://doi.org/10.3945/ajcn.115.127985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. M. Pereira, A. Dantas Damascena, L.M. Galvão Azevedo, T. de Almeida Oliveira, J. da Mota Santana, Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis. Crit. Rev. Food Sci. Nutr. 62(5), 1308–1316 (2022). https://doi.org/10.1080/10408398.2020.1841090

    Article  CAS  PubMed  Google Scholar 

  20. J.M. Rhodes, S. Subramanian, E. Laird, G. Griffin, R.A. Kenny, Perspective: vitamin D deficiency and COVID-19 severity – plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis. J. Intern. Med. 289(1), 97–115 (2021). https://doi.org/10.1111/joim.13149

    Article  CAS  PubMed  Google Scholar 

  21. E. Cereda, L. Bogliolo, C. Klersy, F. Lobascio, S. Masi, S. Crotti et al. Vitamin D 25OH deficiency in COVID-19 patients admitted to a tertiary referral hospital. Clin. Nutr. Edinb. Scotl. 40(4), 2469–2472 (2021). https://doi.org/10.1016/j.clnu.2020.10.055

    Article  CAS  Google Scholar 

  22. G.E. Carpagnano, V. Di Lecce, V.N. Quaranta, A. Zito, E. Buonamico, E. Capozza et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J. Endocrinol. Invest. 44(4), 765–771 (2021). https://doi.org/10.1007/s40618-020-01370-x

    Article  CAS  PubMed  Google Scholar 

  23. A. Radujkovic, T. Hippchen, S. Tiwari-Heckler, S. Dreher, M. Boxberger, U. Merle, Vitamin D deficiency and outcome of COVID-19 patients. Nutrients 12(9), E2757 (2020). https://doi.org/10.3390/nu12092757

    Article  CAS  Google Scholar 

  24. S. Sabico, M.A. Enani, E. Sheshah, N.J. Aljohani, D.A. Aldisi, N.H. Alotaibi et al. Effects of a 2-week 5000 IU versus 1000 IU vitamin D3 supplementation on recovery of symptoms in patients with mild to moderate COVID-19: a randomized clinical trial. Nutrients 13(7), 2170 (2021). https://doi.org/10.3390/nu13072170

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. M. Miraglia Del Giudice, C. Indolfi, G. Dinardo, F. Decimo, A. Decimo, A. Klain, Vitamin D status can affect COVID-19 outcomes also in pediatric population. PharmaNutrition 22, 100319 (2022). https://doi.org/10.1016/j.phanu.2022.100319

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. A. Puścion-Jakubik, J. Bielecka, M. Grabia, A. Mielech, R. Markiewicz-Żukowska, K. Mielcarek et al. Consumption of food supplements during the three COVID-19 waves in Poland-focus on zinc and vitamin D. Nutrients 13(10), 3361 (2021). https://doi.org/10.3390/nu13103361

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. S. Çimke, D. Yıldırım Gürkan, Determination of interest in vitamin use during COVID-19 pandemic using Google Trends data: infodemiology study. Nutrition 85, 111138 (2021). https://doi.org/10.1016/j.nut.2020.111138

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. M. Mikulic, Change in usage of dietary supplements due to COVID-19 among U.S. adults as of August 2020, by gender. https://www.statista.com/statistics/1180357/dietary-supplement-usage-change-due-to-covid-us-adults-by-gender/

  29. H. Mohsen, N. Yazbeck, A. Al-Jawaldeh, N. Bou Chahine, H. Hamieh, Y. Mourad et al. Knowledge, attitudes, and practices related to dietary supplementation, before and during the COVID-19 pandemic: findings from a cross-sectional survey in the Lebanese population. Int. J. Environ. Res. Public Health 18(16), 8856 (2021). https://doi.org/10.3390/ijerph18168856

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. R.S. Wong, K.T.S. Tung, H.K. So, W.H.S. Wong, S.Y. Wong, H.W. Tsang et al. Impact of COVID-19 pandemic on serum vitamin D level among infants and toddlers: an interrupted time series analysis and before-and-after comparison. Nutrients 13(4), 1270 (2021). https://doi.org/10.3390/nu13041270

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. L. Yu, H.J. Ke, D. Che, S.L. Luo, Y. Guo, J.L. Wu, Effect of pandemic-related confinement on vitamin D status among children aged 0-6 years in Guangzhou, China: a cross-sectional study. Risk Manag. Healthc. Policy 13, 2669–2675 (2020). https://doi.org/10.2147/RMHP.S282495

    Article  PubMed  PubMed Central  Google Scholar 

  32. A.R. Bizri, H.H. Khachfe, M.Y. Fares, U. Musharrafieh, COVID-19 pandemic: an insult over injury for Lebanon. J. Community Health 46(3), 487–493 (2021). https://doi.org/10.1007/s10900-020-00884-y

    Article  PubMed  Google Scholar 

  33. K.A. Herrick, R.J. Storandt, J. Afful, C.M. Pfeiffer, R.L. Schleicher, J.J. Gahche et al. Vitamin D status in the United States, 2011-2014. Am. J. Clin. Nutr. 110(1), 150–157 (2019). https://doi.org/10.1093/ajcn/nqz037

    Article  PubMed  PubMed Central  Google Scholar 

  34. D.M. Mitchell, K. Ruppert, N. Udupa, F. Bassir, K. Darakananda, D.H. Solomon et al. Temporal increases in 25-hydroxyvitamin D in midlife women: longitudinal results from the Study of Women’s Health Across the Nation. Clin. Endocrinol. (Oxf.) 91(1), 48–57 (2019). https://doi.org/10.1111/cen.13986

    Article  CAS  PubMed  Google Scholar 

  35. T. Jääskeläinen, S.T. Itkonen, A. Lundqvist, M. Erkkola, T. Koskela, K. Lakkala et al. The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am. J. Clin. Nutr. 105(6), 1512–1520 (2017). https://doi.org/10.3945/ajcn.116.151415

    Article  PubMed  Google Scholar 

  36. S. Andersen, P. Laurberg, B. Hvingel, K. Kleinschmidt, L. Heickendorff, L. Mosekilde, Vitamin D status in Greenland is influenced by diet and ethnicity: a population-based survey in an Arctic society in transition. Br. J. Nutr. 109(5), 928–935 (2013). https://doi.org/10.1017/S0007114512002097

    Article  CAS  PubMed  Google Scholar 

  37. H. Khosravi-Boroujeni, N. Sarrafzadegan, M. Sadeghi, H. Roohafza, S.K. Ng, A. Pourmogaddas et al. Prevalence and trends of vitamin D deficiency among Iranian adults: a longitudinal study from 2001–2013. J. Nutr. Sci. Vitaminol. (Tokyo) 63(5), 284–290 (2017). https://doi.org/10.3177/jnsv.63.284

    Article  CAS  PubMed  Google Scholar 

  38. N.M. Al-Daghri, S.D. Hussain, M.G.A. Ansari, M.N.K. Khattak, N. Aljohani, Y. Al-Saleh, et al. Decreasing prevalence of vitamin D deficiency in the central region of Saudi Arabia (2008-2017). J. Steroid Biochem. Mol. Biol. 212, 105920 (2021). https://doi.org/10.1016/j.jsbmb.2021.105920

    Article  CAS  PubMed  Google Scholar 

  39. M. Chakhtoura, W.D. Leslie, M. McClung, A.M. Cheung, G.E.H. Fuleihan, The FRAX-based Lebanese osteoporosis treatment guidelines: rationale for a hybrid model. Osteoporos. Int. 28(1), 127–137 (2017). https://doi.org/10.1007/s00198-016-3766-5

    Article  CAS  PubMed  Google Scholar 

  40. R. Lordan, Dietary supplements and nutraceuticals market growth during the coronavirus pandemic – implications for consumers and regulatory oversight. PharmaNutrition 18, 100282 (2021). https://doi.org/10.1016/j.phanu.2021.100282

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. J. Hamulka, M. Jeruszka-Bielak, M. Górnicka, M.E. Drywień, M.A. Zielinska-Pukos, Dietary supplements during COVID-19 outbreak. Results of Google Trends analysis supported by PLifeCOVID-19 online studies. Nutrients 13(1), E54 (2020). https://doi.org/10.3390/nu13010054

    Article  CAS  Google Scholar 

  42. W.B. Grant, H. Lahore, S.L. McDonnell, C.A. Baggerly, C.B. French, J.L. Aliano et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients 12(4), E988 (2020). https://doi.org/10.3390/nu12040988

    Article  CAS  Google Scholar 

  43. G. El-Hajj Fuleihan, R. Baddoura, H. Awada, A. Arabi, J. Okais, First update of the Lebanese guidelines for osteoporosis assessment and treatment. J. Clin. Densitom. 11(3), 383–396 (2008). https://doi.org/10.1016/j.jocd.2008.02.006

    Article  PubMed  Google Scholar 

  44. H.A. Algaeed, M.I. AlJaber, A.I. Alwehaibi, L.I. AlJaber, A.M. Arafah, M.A. Aloyayri et al. General public knowledge and use of dietary supplements in Riyadh, Saudi Arabia. J. Fam. Med Prim. Care 8(10), 3147–3154 (2019). https://doi.org/10.4103/jfmpc.jfmpc_511_19

    Article  Google Scholar 

  45. S. Hussain, M. Elnajeh, Prevalence and risk factors for hypovitaminosis D among healthy adolescents in Kota Bharu, Kelantan. J. ASEAN Fed. Endocr. Soc. 35(2), 176–180 (2020). https://doi.org/10.15605/jafes.035.02.05

    Article  PubMed  PubMed Central  Google Scholar 

  46. H.A. Alfawaz, N. Khan, G.A. Aljumah, S.D. Hussain, N.M. Al-Daghri, Dietary intake and supplement use among Saudi residents during COVID-19 lockdown. Int J. Environ. Res. Public Health 18(12), 6435 (2021). https://doi.org/10.3390/ijerph18126435

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. P. D’Amelio, L. Quacquarelli, Hypovitaminosis D and aging: is there a role in muscle and brain health? Nutrients 12(3), E628 (2020). https://doi.org/10.3390/nu12030628

    Article  CAS  Google Scholar 

  48. M.H. Gannagé-Yared, G. Maalouf, S. Khalife, S. Challita, Y. Yaghi, N. Ziade et al. Prevalence and predictors of vitamin D inadequacy amongst Lebanese osteoporotic women. Br. J. Nutr. 101(4), 487–491 (2009). https://doi.org/10.1017/S0007114508023404

    Article  CAS  PubMed  Google Scholar 

  49. N.M. Al-Daghri, O.S. Al-Attas, M.S. Alokail, K.M. Alkharfy, E. El-Kholie, M. Yousef et al. Increased vitamin D supplementation recommended during summer season in the gulf region: a counterintuitive seasonal effect in vitamin D levels in adult, overweight and obese Middle Eastern residents. Clin. Endocrinol. (Oxf.) 76(3), 346–350 (2012). https://doi.org/10.1111/j.1365-2265.2011.04219.x

    Article  CAS  PubMed  Google Scholar 

  50. S.A. Quraishi, C.A. Camargo, Vitamin D in acute stress and critical illness. Curr. Opin. Clin. Nutr. Metab. Care 15(6), 625–634 (2012). https://doi.org/10.1097/MCO.0b013e328358fc2b

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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  1. Department of Endocrinology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

    Diala Harkous, Nada Ghorayeb & Marie-Hélène Gannagé-Yared

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D.H.: conceptualization, data curation, writing—original draft preparation. N.G.: software, formal analysis, writing—reviewing and editing. M.-H.G.-Y.: conceptualization, supervision, formal analysis, methodology, software, writing—original draft, reviewing and editing.

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Harkous, D., Ghorayeb, N. & Gannagé-Yared, MH. Prevalence and predictors of vitamin D deficiency in Lebanon: 2016–2022, before and during the COVID-19 outbreak. Endocrine 82, 654–663 (2023). https://doi.org/10.1007/s12020-023-03483-8

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