Nutritional and General Awareness of Vitamin D Status among Adult Population in Sulaymaniyah Governorate, Kurdistan Region, Iraq: A Cross-Sectional Study
https://doi.org/10.24017/science.2023.1.3
Abstract views: 785 / PDF downloads: 0Abstract
The health benefits of vitamin D are widely acknowledged by scientific and public health specialists. In Iraq, vitamin D deficiency and inadequacy are highly prevalent. However, public knowledge on this problem is scarce. This research aimed to evaluate the participants' knowledge about vitamin D, particularly their nutrition-related understanding and behavior, along with their overall attitude toward sun exposure. A descriptive cross-sectional survey of Iraqi adults over 18 was performed with a collection of serum 25(OH)D result between June and September 2022. The observed serum vitamin D indicated that only 25% of the participant had healthy (>30 ng/ml) vitamin D levels. The majority of participants, 90.9%, were aware of vitamin D. Media and primary health care centers were major vitamin D information sources (57.3 and 32%, respectively). Despite believing sunshine is the principal source of vitamin D (90.2%), respondents lacked understanding about the duration (26.3%) and frequency (30%) of sun exposure. In addition, less than 10% of individuals attributed vitamin D shortage to kidney and liver problems, fat malabsorption, obesity, and bariatric surgery. Nevertheless, more than two-thirds (83.3%) of participants defined the positive role of vitamin D in preventing osteoporosis and immune system strengthening (61%). Furthermore, nutritional awareness among the participants was variable. Approximately, 75% misrepresented the percentage of vitamin D supplied by food, over 50% believed that fruit and vegetables are vitamin D sources, 43% of vegetarians are not at risk for vitamin D deficiency, and rather plants considered (70.3%) as an approach to lessen vitamin D deficiency. Additionally, optimal daily intake was recognized by only 10%. Similarly, only 18.3% was aware of the optimal level of serum vitamin D. Notably, 54% was entirely ignorant of the benefits of dietary fortification. Although 55% of the surveyed population used vitamin D supplements, and 76% acknowledged it through their doctor's recommendation, exceeding two-thirds incorrectly anticipated that drinking tea would impair vitamin D absorption. Therefore, 90% would buy supplements without a prescription if needed. Implementing nutrition education initiatives, encouraging healthy lifestyles, and supporting vitamin D examination should be included in Iraq's health care system.
Keywords:
Vitamin D deficiency, nutrition, sun, knowledge, health, supplements
References
[1] D. Vitamin, "Fact sheet for health professionals," Natl. Institutes Heal. Off. Diet. Suppl. Available online https//ods. od. nih. gov/factsheets/VitaminC-HealthProfessional, 2017.
[2] H. B. Del Valle, A. L. Yaktine, C. L. Taylor, and A. C. Ross, "Dietary reference intakes for calcium and vitamin D," 2011.
[3] F. Remelli, A. Vitali, A. Zurlo, and S. Volpato, "Vitamin D deficiency and sarcopenia in older persons," Nutrients, vol. 11, p. 2861, 2019.
https://doi.org/10.3390/nu11122861
[4] N. Charoenngam, A. Shirvani, and M. F. Holick, "Vitamin D for skeletal and non-skeletal health: What we should know," Journal of clinical orthopaedics and trauma, vol. 10, pp. 1082-1093, 2019.
https://doi.org/10.1016/j.jcot.2019.07.004
[5] C. O'Connor, D. Glatt, L. White, and R. Revuelta Iniesta, "Knowledge, Attitudes and Perceptions towards Vitamin D in a UK Adult Population: A Cross-Sectional Study," Int J Environ Res Public Health, vol. 15, Oct 27 2018.
https://doi.org/10.3390/ijerph15112387
[6] M. Matsui, "Vitamin D update. Curr Derm Rep 9: 323-330," ed, 2020.
https://doi.org/10.1007/s13671-020-00315-0
[7] S. A. Lanham-New, A. R. Webb, K. D. Cashman, J. L. Buttriss, J. L. Fallowfield, T. Masud, et al., "Vitamin D and SARS-CoV-2 virus/COVID-19 disease," BMJ Nutrition, Prevention & Health, vol. 3, p. 106, 2020.
https://doi.org/10.1136/bmjnph-2020-000089
[8] R. M. Abdulrahman and B. M. A. Rahman, "Prevalence of vitamin D level in the serum of patients living in Erbil city, Iraq, referred to private clinical laboratory and effect of age and sex on it," Journal of Biological Research-Bollettino della Società Italiana di Biologia Sperimentale, vol. 91, 2018.
https://doi.org/10.4081/jbr.2018.6916
[9] M. Anwar, F. El-Dahiyat, A. Jairoun, R. Raed, I. Butt, W. Abdel-Majid, et al., "The sunshine under our skin: public knowledge and practices about vitamin D deficiency in Al Ain, United Arab Emirates," Archives of Osteoporosis, vol. 14, pp. 1-7, 2019.
https://doi.org/10.1007/s11657-019-0671-5
[10] G. Bjørklund, "Vitamin D deficiency: a global health problem," Annals of Environmental Science and Toxicology, vol. 1, pp. 023-024, 2016.
https://doi.org/10.17352/pjest.000004
[11] L. M. Hall, M. G. Kimlin, P. A. Aronov, B. D. Hammock, J. R. Slusser, L. R. Woodhouse, et al., "Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations," The Journal of nutrition, vol. 140, pp. 542-550, 2010.
https://doi.org/10.3945/jn.109.115253
[12] K. Horton-French, E. Dunlop, R. M. Lucas, G. Pereira, and L. J. Black, "Prevalence and predictors of vitamin D deficiency among African immigrants living in Australia," International journal of environmental research and public health, vol. 16, p. 2855, 2019.
https://doi.org/10.3390/ijerph16162855
[13] L. Y. Mohammed, S. A. Jamal, N. R. Hussein, and I. A. Naqid, "The Prevalence of Vitamin D Deficiency and Associated Risk Factors among General Populations in Duhok Province, Kurdistan Region, Iraq," J Contemp Med Sci| Vol, vol. 7, pp. 330-333, 2021.
https://doi.org/10.22317/jcms.v7i6.1073
[14] O. Ibrahim, N. Al-Tameemi, and D. Dawoud, "Knowledge and perceptions of vitamin D deficiency among the United Arab Emirates population," Asian J. Pharmaceut. Clin. Res, vol. 12, pp. 183-186, 2019.
https://doi.org/10.22159/ajpcr.2019.v12i18.33988
[15] K. Yammine and H. Al Adham, "The status of serum vitamin D in the population of the United Arab Emirates," EMHJ-Eastern Mediterranean Health Journal, vol. 22, pp. 682-686, 2016.
https://doi.org/10.26719/2016.22.9.682
[16] L. H. Alamoudi, R. Z. Almuteeri, M. E. Al-Otaibi, D. A. Alshaer, S. K. Fatani, M. M. Alghamdi, et al., "Awareness of vitamin D deficiency among the general population in Jeddah, Saudi Arabia," Journal of nutrition and metabolism, vol. 2019, 2019.
https://doi.org/10.1155/2019/4138187
[17] N. Aljefree, P. Lee, and F. Ahmed, "Exploring knowledge and attitudes about vitamin D among adults in Saudi Arabia: A qualitative study," in Healthcare, 2017, p. 76.
https://doi.org/10.3390/healthcare5040076
[18] S. A. Abdullah, R. M. Abdulrahman, and K. A. Omer, "Vitamin D level study within the population in Sulaymaniyah City-IRAQ," multiple sclerosis, vol. 11, p. 12, 2018.
https://doi.org/10.14500/icpas2018.mim32
[19] S. Al Janaby and G. Al Timimy, "Prevalence of Vitamin D Deficiency of Females in Karbala, Iraq, 2017," Karbala journal of medicine, vol. 13, 2020.
[20] S. T. Ali, H. T. Qadir, S. K. Moufak, M. A. Mohammed Al-Badri, and M. N. Abbas, "A Statistical Study to Determine the Factors of Vitamin D Deficiency in Men: the City of Baghdad as a Model," Indian Journal of Forensic Medicine & Toxicology, vol. 14, 2020.
[21] M. A. Abdulrahman, S. Y. Alkass, and N. I. Mohammed, "Total and free vitamin D status among apparently healthy adults living in Duhok Governorate," Scientific Reports, vol. 12, pp. 1-14, 2022.
https://doi.org/10.1038/s41598-022-05775-x
[22] A. Badawi, P. Arora, E. Sadoun, A.-A. Al-Thani, and M. H. Al Thani, "Prevalence of vitamin D insufficiency in Qatar: a systematic review," Journal of public health research, vol. 1, p. 229, 2012.
https://doi.org/10.4081/jphr.2012.e36
[23] M. A. A. Amal H. Uzrail, Reem Alkalbani, Raghad Al Kofahi and Abeer Kadhim, "Knowledge, Attitude and Practice (KAP) Towards Vitamin D Deficiency in the Jordanian Adult Population: A Cross-Sectional Study," Research Journal of Medical Sciences, vol. 15, pp. 62-71, 2021.
[24] A. Qatatsheh, R. Tayyem, I. Al-Shami, M. A. Al-Holy, and A. S. Al-Rethaia, "Vitamin D deficiency among Jordanian university students and employees," Nutrition & Food Science, vol. 45, pp. 68-82, 2015.
https://doi.org/10.1108/NFS-01-2014-0008
[25] A. W. Kung and K.-K. Lee, "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, vol. 6, pp. 1-7, 2006.
https://doi.org/10.1186/1471-2458-6-226
[26] Y. Lhamo, P. K. Chugh, S. R. Gautam, and C. Tripathi, "Epidemic of Vitamin D deficiency and its management: awareness among indian medical undergraduates," Journal of environmental and public health, vol. 2017, 2017.
https://doi.org/10.1155/2017/2517207
[27] S. Kotta, D. Gadhvi, N. Jakeways, M. Saeed, R. Sohanpal, S. Hull, et al., ""Test me and treat me"-attitudes to vitamin D deficiency and supplementation: a qualitative study," BMJ open, vol. 5, p. e007401, 2015.
https://doi.org/10.1136/bmjopen-2014-007401
[28] M. Varaprasanna Rao and M. Alam, "Exploring Knowledge, Attitude and Practice (KAP) Towards Vitamin D among Arts and Commerce Students in Vistas Chennai," 2021.
[29] S. R. Vanga, M. Good, P. A. Howard, and J. L. Vacek, "Role of vitamin D in cardiovascular health," The American journal of cardiology, vol. 106, pp. 798-805, 2010.
https://doi.org/10.1016/j.amjcard.2010.04.042
[30] M. F. Holick and T. C. Chen, "Vitamin D deficiency: a worldwide problem with health consequences," The American Journal of Clinical Nutrition, vol. 87, pp. 1080S-1086S, 2008.
https://doi.org/10.1093/ajcn/87.4.1080S
[31] F. A. Al-Haddad, F. T. Al-Mahroos, H. S. Al-Sahlawi, and E. Al-Amer, "The impact of dietary intake and sun exposure on vitamin D deficiency among couples," Bahrain Medical Bulletin, vol. 158, pp. 1-5, 2014.
https://doi.org/10.12816/0004465
[32] M. F. Holick, N. C. Binkley, H. A. Bischoff-Ferrari, C. M. Gordon, D. A. Hanley, R. P. Heaney, et al., "Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline," J Clin Endocrinol Metab, vol. 96, pp. 1911-30, Jul 2011.
https://doi.org/10.1210/jc.2011-0385
[33] R. E. Allen, A. D. Dangour, A. E. Tedstone, and Z. Chalabi, "Does fortification of staple foods improve vitamin D intakes and status of groups at risk of deficiency? A United Kingdom modeling study," Am J Clin Nutr, vol. 102, pp. 338-44, Aug 2015.
https://doi.org/10.3945/ajcn.115.107409
[34] A. Mithal, D. A. Wahl, J.-P. Bonjour, P. Burckhardt, B. Dawson-Hughes, J. A. Eisman, et al., "Global vitamin D status and determinants of hypovitaminosis D," Osteoporosis international, vol. 20, pp. 1807-1820, 2009.
https://doi.org/10.1007/s00198-009-0954-6
[35] F. Alshahrani and N. Aljohani, "Vitamin D: deficiency, sufficiency and toxicity," Nutrients, vol. 5, pp. 3605-16, Sep 13 2013.
https://doi.org/10.3390/nu5093605
[36] A. C. Ross, "The 2011 report on dietary reference intakes for calcium and vitamin D," Public Health Nutr, vol. 14, pp. 938-9, May 2011.
https://doi.org/10.1017/S1368980011000565
[37] J. Golbahar, N. Al-Saffar, D. A. Diab, S. Al-Othman, and A. Darwish, "Vitamin D status in adults: a cross sectional study," Bahrain Medical Bulletin, vol. 35, pp. 1-11, 2013.
https://doi.org/10.12816/0000510
[38] S. Pilz, A. Tomaschitz, E. Ritz, and T. R. Pieber, "Vitamin D status and arterial hypertension: a systematic review," Nature reviews cardiology, vol. 6, p. 621, 2009.
https://doi.org/10.1038/nrcardio.2009.135
[39] E. Wintermeyer, C. Ihle, S. Ehnert, U. Stöckle, G. Ochs, P. De Zwart, et al., "Crucial role of vitamin D in the musculoskeletal system," Nutrients, vol. 8, p. 319, 2016.
https://doi.org/10.3390/nu8060319
[40] M. F. Holick, "Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease," The American Journal of Clinical Nutrition, vol. 80, pp. 1678S-1688S, 2004.
https://doi.org/10.1093/ajcn/80.6.1678S
[41] K. R. G. (KRG). (Jun 2022). Sulaymaniyah Governorate Facts and Figures [Government]. Available: https://gov.krd/boi-en/why-kurdistan/region/facts-figures/
[42] L. H. Vu, J. C. van der Pols, D. C. Whiteman, M. G. Kimlin, and R. E. Neale, "Knowledge and attitudes about vitamin D and impact on sun protection practices among urban office workers in Brisbane, Australia," Cancer epidemiology, biomarkers & prevention, vol. 19, pp. 1784-1789, 2010.
https://doi.org/10.1158/1055-9965.EPI-10-0127
[43] T. A. A. f. D. A. (AAD). (10 October). Vitamin D stats and facts. Available: https://www.aad.org/media/stats-vitamin-d
[44] E. E. Elrayah, L. Rogers, R. Doggui, and A. Al-Jawaldeh, "Vitamin D Insufficiency and Deficiency in the Eastern Mediterranean Region (EMR)-Misconceptions in Public Health Practice: A Scoping Review 2019-2020," Journal of Nutritional Science and Vitaminology, vol. 66, pp. 389-395, 2020.
https://doi.org/10.3177/jnsv.66.389
[45] S. M. Kimball and M. F. Holick, "Official recommendations for vitamin D through the life stages in developed countries," European Journal of Clinical Nutrition, vol. 74, pp. 1514-1518, 2020.
https://doi.org/10.1038/s41430-020-00706-3
[2] H. B. Del Valle, A. L. Yaktine, C. L. Taylor, and A. C. Ross, "Dietary reference intakes for calcium and vitamin D," 2011.
[3] F. Remelli, A. Vitali, A. Zurlo, and S. Volpato, "Vitamin D deficiency and sarcopenia in older persons," Nutrients, vol. 11, p. 2861, 2019.
https://doi.org/10.3390/nu11122861
[4] N. Charoenngam, A. Shirvani, and M. F. Holick, "Vitamin D for skeletal and non-skeletal health: What we should know," Journal of clinical orthopaedics and trauma, vol. 10, pp. 1082-1093, 2019.
https://doi.org/10.1016/j.jcot.2019.07.004
[5] C. O'Connor, D. Glatt, L. White, and R. Revuelta Iniesta, "Knowledge, Attitudes and Perceptions towards Vitamin D in a UK Adult Population: A Cross-Sectional Study," Int J Environ Res Public Health, vol. 15, Oct 27 2018.
https://doi.org/10.3390/ijerph15112387
[6] M. Matsui, "Vitamin D update. Curr Derm Rep 9: 323-330," ed, 2020.
https://doi.org/10.1007/s13671-020-00315-0
[7] S. A. Lanham-New, A. R. Webb, K. D. Cashman, J. L. Buttriss, J. L. Fallowfield, T. Masud, et al., "Vitamin D and SARS-CoV-2 virus/COVID-19 disease," BMJ Nutrition, Prevention & Health, vol. 3, p. 106, 2020.
https://doi.org/10.1136/bmjnph-2020-000089
[8] R. M. Abdulrahman and B. M. A. Rahman, "Prevalence of vitamin D level in the serum of patients living in Erbil city, Iraq, referred to private clinical laboratory and effect of age and sex on it," Journal of Biological Research-Bollettino della Società Italiana di Biologia Sperimentale, vol. 91, 2018.
https://doi.org/10.4081/jbr.2018.6916
[9] M. Anwar, F. El-Dahiyat, A. Jairoun, R. Raed, I. Butt, W. Abdel-Majid, et al., "The sunshine under our skin: public knowledge and practices about vitamin D deficiency in Al Ain, United Arab Emirates," Archives of Osteoporosis, vol. 14, pp. 1-7, 2019.
https://doi.org/10.1007/s11657-019-0671-5
[10] G. Bjørklund, "Vitamin D deficiency: a global health problem," Annals of Environmental Science and Toxicology, vol. 1, pp. 023-024, 2016.
https://doi.org/10.17352/pjest.000004
[11] L. M. Hall, M. G. Kimlin, P. A. Aronov, B. D. Hammock, J. R. Slusser, L. R. Woodhouse, et al., "Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations," The Journal of nutrition, vol. 140, pp. 542-550, 2010.
https://doi.org/10.3945/jn.109.115253
[12] K. Horton-French, E. Dunlop, R. M. Lucas, G. Pereira, and L. J. Black, "Prevalence and predictors of vitamin D deficiency among African immigrants living in Australia," International journal of environmental research and public health, vol. 16, p. 2855, 2019.
https://doi.org/10.3390/ijerph16162855
[13] L. Y. Mohammed, S. A. Jamal, N. R. Hussein, and I. A. Naqid, "The Prevalence of Vitamin D Deficiency and Associated Risk Factors among General Populations in Duhok Province, Kurdistan Region, Iraq," J Contemp Med Sci| Vol, vol. 7, pp. 330-333, 2021.
https://doi.org/10.22317/jcms.v7i6.1073
[14] O. Ibrahim, N. Al-Tameemi, and D. Dawoud, "Knowledge and perceptions of vitamin D deficiency among the United Arab Emirates population," Asian J. Pharmaceut. Clin. Res, vol. 12, pp. 183-186, 2019.
https://doi.org/10.22159/ajpcr.2019.v12i18.33988
[15] K. Yammine and H. Al Adham, "The status of serum vitamin D in the population of the United Arab Emirates," EMHJ-Eastern Mediterranean Health Journal, vol. 22, pp. 682-686, 2016.
https://doi.org/10.26719/2016.22.9.682
[16] L. H. Alamoudi, R. Z. Almuteeri, M. E. Al-Otaibi, D. A. Alshaer, S. K. Fatani, M. M. Alghamdi, et al., "Awareness of vitamin D deficiency among the general population in Jeddah, Saudi Arabia," Journal of nutrition and metabolism, vol. 2019, 2019.
https://doi.org/10.1155/2019/4138187
[17] N. Aljefree, P. Lee, and F. Ahmed, "Exploring knowledge and attitudes about vitamin D among adults in Saudi Arabia: A qualitative study," in Healthcare, 2017, p. 76.
https://doi.org/10.3390/healthcare5040076
[18] S. A. Abdullah, R. M. Abdulrahman, and K. A. Omer, "Vitamin D level study within the population in Sulaymaniyah City-IRAQ," multiple sclerosis, vol. 11, p. 12, 2018.
https://doi.org/10.14500/icpas2018.mim32
[19] S. Al Janaby and G. Al Timimy, "Prevalence of Vitamin D Deficiency of Females in Karbala, Iraq, 2017," Karbala journal of medicine, vol. 13, 2020.
[20] S. T. Ali, H. T. Qadir, S. K. Moufak, M. A. Mohammed Al-Badri, and M. N. Abbas, "A Statistical Study to Determine the Factors of Vitamin D Deficiency in Men: the City of Baghdad as a Model," Indian Journal of Forensic Medicine & Toxicology, vol. 14, 2020.
[21] M. A. Abdulrahman, S. Y. Alkass, and N. I. Mohammed, "Total and free vitamin D status among apparently healthy adults living in Duhok Governorate," Scientific Reports, vol. 12, pp. 1-14, 2022.
https://doi.org/10.1038/s41598-022-05775-x
[22] A. Badawi, P. Arora, E. Sadoun, A.-A. Al-Thani, and M. H. Al Thani, "Prevalence of vitamin D insufficiency in Qatar: a systematic review," Journal of public health research, vol. 1, p. 229, 2012.
https://doi.org/10.4081/jphr.2012.e36
[23] M. A. A. Amal H. Uzrail, Reem Alkalbani, Raghad Al Kofahi and Abeer Kadhim, "Knowledge, Attitude and Practice (KAP) Towards Vitamin D Deficiency in the Jordanian Adult Population: A Cross-Sectional Study," Research Journal of Medical Sciences, vol. 15, pp. 62-71, 2021.
[24] A. Qatatsheh, R. Tayyem, I. Al-Shami, M. A. Al-Holy, and A. S. Al-Rethaia, "Vitamin D deficiency among Jordanian university students and employees," Nutrition & Food Science, vol. 45, pp. 68-82, 2015.
https://doi.org/10.1108/NFS-01-2014-0008
[25] A. W. Kung and K.-K. Lee, "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, vol. 6, pp. 1-7, 2006.
https://doi.org/10.1186/1471-2458-6-226
[26] Y. Lhamo, P. K. Chugh, S. R. Gautam, and C. Tripathi, "Epidemic of Vitamin D deficiency and its management: awareness among indian medical undergraduates," Journal of environmental and public health, vol. 2017, 2017.
https://doi.org/10.1155/2017/2517207
[27] S. Kotta, D. Gadhvi, N. Jakeways, M. Saeed, R. Sohanpal, S. Hull, et al., ""Test me and treat me"-attitudes to vitamin D deficiency and supplementation: a qualitative study," BMJ open, vol. 5, p. e007401, 2015.
https://doi.org/10.1136/bmjopen-2014-007401
[28] M. Varaprasanna Rao and M. Alam, "Exploring Knowledge, Attitude and Practice (KAP) Towards Vitamin D among Arts and Commerce Students in Vistas Chennai," 2021.
[29] S. R. Vanga, M. Good, P. A. Howard, and J. L. Vacek, "Role of vitamin D in cardiovascular health," The American journal of cardiology, vol. 106, pp. 798-805, 2010.
https://doi.org/10.1016/j.amjcard.2010.04.042
[30] M. F. Holick and T. C. Chen, "Vitamin D deficiency: a worldwide problem with health consequences," The American Journal of Clinical Nutrition, vol. 87, pp. 1080S-1086S, 2008.
https://doi.org/10.1093/ajcn/87.4.1080S
[31] F. A. Al-Haddad, F. T. Al-Mahroos, H. S. Al-Sahlawi, and E. Al-Amer, "The impact of dietary intake and sun exposure on vitamin D deficiency among couples," Bahrain Medical Bulletin, vol. 158, pp. 1-5, 2014.
https://doi.org/10.12816/0004465
[32] M. F. Holick, N. C. Binkley, H. A. Bischoff-Ferrari, C. M. Gordon, D. A. Hanley, R. P. Heaney, et al., "Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline," J Clin Endocrinol Metab, vol. 96, pp. 1911-30, Jul 2011.
https://doi.org/10.1210/jc.2011-0385
[33] R. E. Allen, A. D. Dangour, A. E. Tedstone, and Z. Chalabi, "Does fortification of staple foods improve vitamin D intakes and status of groups at risk of deficiency? A United Kingdom modeling study," Am J Clin Nutr, vol. 102, pp. 338-44, Aug 2015.
https://doi.org/10.3945/ajcn.115.107409
[34] A. Mithal, D. A. Wahl, J.-P. Bonjour, P. Burckhardt, B. Dawson-Hughes, J. A. Eisman, et al., "Global vitamin D status and determinants of hypovitaminosis D," Osteoporosis international, vol. 20, pp. 1807-1820, 2009.
https://doi.org/10.1007/s00198-009-0954-6
[35] F. Alshahrani and N. Aljohani, "Vitamin D: deficiency, sufficiency and toxicity," Nutrients, vol. 5, pp. 3605-16, Sep 13 2013.
https://doi.org/10.3390/nu5093605
[36] A. C. Ross, "The 2011 report on dietary reference intakes for calcium and vitamin D," Public Health Nutr, vol. 14, pp. 938-9, May 2011.
https://doi.org/10.1017/S1368980011000565
[37] J. Golbahar, N. Al-Saffar, D. A. Diab, S. Al-Othman, and A. Darwish, "Vitamin D status in adults: a cross sectional study," Bahrain Medical Bulletin, vol. 35, pp. 1-11, 2013.
https://doi.org/10.12816/0000510
[38] S. Pilz, A. Tomaschitz, E. Ritz, and T. R. Pieber, "Vitamin D status and arterial hypertension: a systematic review," Nature reviews cardiology, vol. 6, p. 621, 2009.
https://doi.org/10.1038/nrcardio.2009.135
[39] E. Wintermeyer, C. Ihle, S. Ehnert, U. Stöckle, G. Ochs, P. De Zwart, et al., "Crucial role of vitamin D in the musculoskeletal system," Nutrients, vol. 8, p. 319, 2016.
https://doi.org/10.3390/nu8060319
[40] M. F. Holick, "Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease," The American Journal of Clinical Nutrition, vol. 80, pp. 1678S-1688S, 2004.
https://doi.org/10.1093/ajcn/80.6.1678S
[41] K. R. G. (KRG). (Jun 2022). Sulaymaniyah Governorate Facts and Figures [Government]. Available: https://gov.krd/boi-en/why-kurdistan/region/facts-figures/
[42] L. H. Vu, J. C. van der Pols, D. C. Whiteman, M. G. Kimlin, and R. E. Neale, "Knowledge and attitudes about vitamin D and impact on sun protection practices among urban office workers in Brisbane, Australia," Cancer epidemiology, biomarkers & prevention, vol. 19, pp. 1784-1789, 2010.
https://doi.org/10.1158/1055-9965.EPI-10-0127
[43] T. A. A. f. D. A. (AAD). (10 October). Vitamin D stats and facts. Available: https://www.aad.org/media/stats-vitamin-d
[44] E. E. Elrayah, L. Rogers, R. Doggui, and A. Al-Jawaldeh, "Vitamin D Insufficiency and Deficiency in the Eastern Mediterranean Region (EMR)-Misconceptions in Public Health Practice: A Scoping Review 2019-2020," Journal of Nutritional Science and Vitaminology, vol. 66, pp. 389-395, 2020.
https://doi.org/10.3177/jnsv.66.389
[45] S. M. Kimball and M. F. Holick, "Official recommendations for vitamin D through the life stages in developed countries," European Journal of Clinical Nutrition, vol. 74, pp. 1514-1518, 2020.
https://doi.org/10.1038/s41430-020-00706-3
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R. R. Mohammed Salih, F. N. . Shakor, D. A. Ali, and R. M. . Salih Rashid, “Nutritional and General Awareness of Vitamin D Status among Adult Population in Sulaymaniyah Governorate, Kurdistan Region, Iraq: A Cross-Sectional Study”, KJAR, vol. 8, no. 1, pp. 18–26, Feb. 2023, doi: 10.24017/science.2023.1.3.
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Published
12-02-2023
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Pure and Applied Science
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Copyright (c) 2023 Reder Rafiq Mohammedsalih, Fadhluddin Nasruddin Shakor, Dalia Ardal Ali, Rafiq Mohammedsalih Rashid
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
