Vitamin D deficiency in immigrants

Abstract

Vitamin D deficiency and rickets are more common in non-western immigrants and refugees than in the native population. Severe vitamin D deficiency (serum 25-hydroxyvitamin D <25 nmol/l) may occur in up to 50% of children and adults of non-western origin. They are not used to sunshine exposure due to the often excessive sunshine in the country of origin. They usually have a more pigmented skin. Non-western immigrants and refugees often wear skin-covering clothes due to religious or cultural tradition. The food contains little vitamin D with the exception of fatty fish. In addition, many immigrants have a low calcium intake. Complaints may include fatigue, pain in shoulders, ribs, lower back and thighs. Neonates and young children may have spasms and convulsions due to hypocalcemia. Older children and adolescents may have bone pain, muscle weakness and skeletal deformities. Widening of the wrist, chest deformities and bowing of the legs may occur, and longitudinal growth is delayed. In adults, muscle weakness and bone pain are predominant. Laboratory examination may show hypocalcemia and hypophosphatemia and elevated alkaline phosphatase. The serum 25(OH)D is below 25 nmol/l in case of severe vitamin D deficiency with symptoms. Impaired 25-hydroxylation or 1α-hydroxylation may occur in case of severe liver or renal disease or by genetic causes. Radiographs of wrists or knees may show widening of the growth plates and cupping of radius and ulna may confirm the diagnosis. In adolescents and adults, radiographs of painful bones may show pseudofractures or Looser zones. Rickets and osteomalacia are treated by vitamin D3 2000 IU/d in infants, 3000–6000 IU/d in older children in combination with calcium 500 mg /d. In osteomalacia, the adult vitamin D3 dose is 2000–3000 IU/d, combined with calcium 1000–2000 mg/d. Prevention of vitamin D deficiency can be done with vitamin D3 400–800 IU/d, depending on age. Nutritional measures include fortification of milk or other foods.

Vitamin D Deficiency is Associated with Increased COVID-19 Severity: Prospective Screening of At-Risk Groups is Medically Indicated

“…Nursing home residents not taking vitamin D supplementation may have a de ciency rate over 60%; even with standard supplementation up to 16% remain de cient [28]. Profound vitamin D de ciency, though of variable percentage depending on the country of origin, has been substantiated in recent immigrants to Minnesota, Calgary, and Amsterdam [29,30,31]. Pregnant women and obese individuals are two additional population groups of concern.…”

Ikke nødvendig med høydosetilskudd av vitamin D

“…Eksempler på slike grupper er innvandrere med bakgrunn fra Asia, Afrika og Midtøsten, som i alle undersøkelser vi kjenner til, har hatt svaert lav vitamin D-status på gruppenivå, forenlig med risiko for rakitt og osteomalasi. Dette er også vist i andre europeiske land (19). Bruk av tilskudd tilsvarende anbefalt daglig inntak (10-20 µg) er tilstrekkelig til å heve vitamin D-status ved lave nivåer.…”

Monitoring of solar spectral ultraviolet irradiance in Aosta, Italy

“…Exposure to solar UV radiation is necessary for living organisms since it triggers a number of beneficial processes (Juzeniene and Moan, 2012;Webb and Engelsen, 2008). However, overexposure is harmful for humans and ecosystems (Caldwell et al, 1998;Häder et al, 2007;Juzeniene et al, 2011;Lucas et al, 2019). Various living organisms, including humans, have slowly adapted through centuries to the levels of UV radiation where they live.…”

“…Fast changing climate conditions, changes in habits and attitudes of people, and the increase in human migration have meant that many people all over the globe are now exposed to either more or less solar UV radiation than in the past (Bornman et al, 2019;Cadario et al, 2015;Hintzpeter et al, 2008;Lips and de Jongh, 2018). Thus, many people either need medical supplements or have to drastically change their sun-exposure habits (Lucas et al, 2019). Continuous and accurate monitoring of the levels and the variability of the solar irradiance in the UV spectral region is necessary for the accurate detection of trends (Glandorf et al, 2005;Weatherhead et al, 1998), as well as estimating different exposure scenarios in order to inform the public and hence to better understand and clarify the balance between the risks and benefits of solar UV radiation under different conditions (Blumthaler, 2018).…”