Vitamin D Intake among Premenopausal Women Living in Jeddah: Food Sources and Relationship to Demographic Factors and Bone Health

Abstract

Background Saudi women depend on food sources to maintain their serum 25(OH) D concentrations because covering by traditional clothing and time spent indoors limit their sun exposure. Little is known about vitamin D intake and its main food sources in Saudi Arabia. In addition, the association between vitamin D and calcium intake and bone mineral density (BMD) in young women is not well researched. Objectives To assess the adequacy of vitamin D intake among Saudi women as compared to the estimated average requirements (EARs), to identify dietary vitamin D sources, to examine potential determinants of vitamin D intake, and to assess bone health and the association of calcium and vitamin D intake with BMD. Methods This cross-sectional study was conducted in 257 premenopausal women aged 20–50 years in Jeddah, Saudi Arabia. Dietary vitamin D and calcium were assessed by the Semiquantitative Food Frequency Questionnaire. BMD was measured using dual-energy X-ray absorptiometry (DXA) in a subset of women (n=102) at the lumbar spine and femur neck. Results Sixty-five percent of women were below the EAR for vitamin D, and 61% fell below the EAR for calcium. Dairy products, supplements, and fish contributed most to vitamin D intake. Increased age was an independent determinant of sufficient vitamin D intake (p < 0.001). The prevalence of osteopenia was 33% in the lumbar spine and 30% in the femur neck. There was a significant positive association between calcium intake and BMD at the lumbar spine (p=0.043) after controlling for body mass index and energy intake. Vitamin D intake was not significantly different between women with low and normal bone mass. Conclusion Premenopausal women in Jeddah have insufficient vitamin D and calcium intakes. Public health strategies to improve nutrition in young women are needed, and expanding fortification programs to include all dairy products would be useful.

The Possibility of Applying the Vitamin D Brief Food Frequency Questionnaire as a Tool for a Country with No Vitamin D Data in Food Composition Tables

“…Such a positive validation, as in the presented study, indicates that the validated Cro-VIDEO-FFQ questionnaire may be applied to assess the vitamin D intake in the Croatian young women population, which was previously indicated as necessary due to general high prevalence of vitamin D deficiency in a Croatian population [ 10 ] and due to the need to monitor the intake [ 17 ]. Moreover, the lack of vitamin D data in the Croatian food composition tables imposes such actions for the public health purposes.…”

“…In our study, the main sources of vitamin D for young women were fish products, meat products, eggs, and dairy products. At the same time, while other questionnaires were used, Bärebring et al [ 22 ] observed fish products, spread margarine, and dairy products (including fortified ones) mainly as vitamin D sources for Swedish young women population, while Zareef et al [ 17 ] observed dairy products (including fortified ones) and fish products as the less important for Saudi Arabian young women. The main difference in comparison with other populations is the role of meat products as a source of vitamin D in the Croatian population, although the general vitamin D content in meat products is rather low [ 27 ].…”

“…Especially for vitamin D, the assessment of intake is very important not only due to commonly observed too low intake [ 3 ], but also because even fortification does not guarantee the intake correction and so the intake must be monitored [ 17 ]. To conduct such monitoring of intake, the food frequency questionnaires may be applied if they are validated and the results of validation are satisfactory.…”

“…The other method to assess the intake is the method of the food frequency questionnaire, which enables the assessment of the frequency of product consumption, and based on that, the assessment of nutrient intake as well [ 13 ]. Although there are some food frequency questionnaires developed to assess the vitamin D intake and validated for United States of America [ 14 ], Canada [ 15 ], United Arab Emirates [ 16 ], Saudi Arab [ 17 ], South Korea [ 18 ], Serbia [ 19 ], Poland [ 20 ], Finland [ 21 ], Sweden [ 22 ], United Kingdom [ 23 ], or Ireland [ 24 ], there is no such questionnaire developed and validated for Croatia.…”

Vitamin D Deficiency Practice Among Female Medical Students in Ajman, Uae

“…Young populations living in sunny areas like UAE, Saudi Arabia, and India have a high prevalence of VDD due to insufficient knowledge and practice of vitamin D and its health implications [9][10][11][12][13][14] . Especially female adolescents are in danger to develop osteoporosis in their later life due to their risky behavior of physical inactivity, sun-avoidance behavior, low intake of dairy products and poor diets 14,15 .…”