Review Vitamin D in Saudi Arabia: Prevalence,distribution and disease associations Nasser M. Al-Daghri a,b, * a Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University,Riyadh 11451, Saudi Arabia b Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia A R T I C L E I N F O Article history: Received 27 June 2016 Received in revised form 14 November 2016 Accepted 23 December 2016 Available online 24 December 2016 Keywords: Vitamin D Saudi Arabia Vitamin D related-diseases Prevalence A B S T R A C T More than 33 years have passed since the first paper highlighting vitamin D deficiency as a public health concern in Saudi Arabia was published in 1983. Despite “early” detection,it wasn’t until the year 2010 where the interest in vitamin D research grew exponentially worldwide and was finally visible in Saudi clinical and academic areas. Since then,many landmark studies have been generated with regards to the physiologic functions of vitamin D,both skeletal and extra-skeletal. This review is limited to the prevalence,distribution A systematic review on the prevalence studies done in KSA from 2011 to 2016 was done and revealed that the prevalence of vitamin D deficiency (<50 nmol/l) in Saudi Arabia among different populations (adults,children and adolescents,newborns and pregnant/lactating women) is 81.0% (Confidence Interval 95% 68.0–90.0),in line with most neighboring Gulf countries. Vitamin D deficiency in KSA has been mostly associated with bone and insulin-resistant diseases but limited data are available to prove causality. In conclusion,there is a need to develop local consensus guidelines that will identify candidates for screening,monitoring and treating those who are at most risk for vitamin D deficiency complications. © 2016 Elsevier Ltd. All rights reserved. Contents 1. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 2.1. Meta-analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 4.1. Vitamin D deficiency in KSA and in the middle east . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 4.2. Vitamin D deficiency has been associated with a wide range of diseases in the saudi community . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 4.3. How do we move forward from vitamin d deficiency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Competing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 1. Background During the last decade,no other micronutrient has gained and sustained massive interest in the fields of health and biomedical research community as much as vitamin D. Globally,vitamin D deficiency is widespread and is considered an epidemic [1]. The Middle East and North African (MENA) region in general has a very high prevalence of vitamin D deficiency [defined as 25(OH) D levels * Corresponding author at: Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department,College of Science,King Saud University,PO Box,2455, Riyadh,11451,Saudi Arabia. E-mail address: aldaghri2011@gmail.com (N.M. Al-Daghri). http://dx.doi.org/10.1016/j.jsbmb.2016.12.017 0960-0760/© 2016 Elsevier Ltd. All rights reserved. Journal of Steroid Biochemistry & Molecular Biology 175 (2018) 102–107 Contents lists available at ScienceDirect Journal of Steroid Biochemistry & Molecular Biology journa l homepage: www.e lsevier.com/loca te/jsbmb