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Vitamin D Deficiency in Saudi Arabian Women

== Introduction: Vitamin D plays a significant role in the protection of bone disease, cancers, heart disease, and autoimmune diseases; for that, must take adequate amount of vitamin D, so the body can take benefit from it (Stechschulte, Kirsner, & Federman, 2009). However, vitamin D deficiency causes bone disease principally Osteoporosis in adults and Rickets in children (Elshafie, Al-Khashan, & Mishriky, 2012). In addition, vitamin D can be obtained through the daily diet either plant sources or animal sources; for example, cod liver oil, salmon, mackerel, and herring, and that form of vitamin D called vitamin D2 (ergocalciferol). In the United States there are specific foods are fortified with vitamin D, like milk, yogurt, cheeses, various breads, and some kinds of juice. On the other hand, there is another form of vitamin D, and it is called vitamin D3 (cholecalciferol); Vitamin D3 can be obtained through exposure to ultraviolet B irradiation from sunlight (Stechschulte et al., 2009). Nevertheless, although some countries are known as sunny weather like Saudi Arabia, but women there are less exposure to the sunlight than women who live in not sunny countries, and this is due to the customs and traditions that limit their exposure to sunlight (Elshafie et al., 2012). There are proofs that the rate of rickets in the Middle East is more than in the West population, and show that 20%-80% of healthy people also suffer from vitamin D deficiency. Moreover, two studies were done in Saudi Arabia proved that 81% of Saudi women are vitamin D deficient (Floor, Christie, & MASON, 2011).

Factors of Vitamin D Deficiency in Saudi Arabian Women: There are several reasons for women in Saudi Arabia to prevent exposure to sunlight; the most important reason is the outside temperature is very hot, which makes women prefer to stay indoors. Second reason, Saudi woman wear a black (abaya) outside, which covered from her head to her toes, and this goes back to traditions in Saudi Arabia. In addition, Saudi women don’t expose themselves to sunlight for beauty purposes because they think that it is hurtful to their skin. (Floor et al., 2011). Also, design of buildings in Saudi Arabia limits the entry of sunlight into houses. Therefore, Saudi women are less exposure to sunlight than other women in different countries, so they more vulnerable to vitamin D deficiency(Elshafie et al., 2012) Furthermore, one study has shown that the air pollution in Saudi Arabia reduces the percentage of Ultra Violet B on the ground(Abokrysha T, 2012). Additionally, nutritional factors play a role in vitamin D deficiency through eating foods that do not contain vitamin D, and lack of intake vitamin D supplementation to recompense that deficiency. Also, vitamin D deficiency is related to the lack of exercise in Saudi Arabian women(Elshafie et al., 2012). Finally, lack of awareness between women in Saudi Arabia is one of the main causes of vitamin D deficiency(Floor et al., 2011).

Vitamin D Deficiency in Women With Fibromyalgia Syndrome in Saudi Arabia: First of all, fibromyalgia syndrome is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas (Wolfe, Ross, Anderson, Russel, & Herbert, 1995) (Okumus et al., 2013) There is a conflict between many studies regarding the relationship between vitamin D deficiency and fibromyalgia syndrome; many studies have reported “a positive relation” and others “found no relation”  (Abokrysha T, 2012; Okumus et al., 2013). However, lack of vitamin D leads to a series of biochemical reactions that hampers bone metabolism and health, which impaired good bone mineralization leads to a spongy matrix to form under periosteal membranes covering the skeleton. Furthermore, this gelatin is similar to matrix can absorb liquids, expand, and result external pressure on periosteal tissues, which causes pain where are strongly innervated these tissues with sensory pain fibers (Abokrysha T, 2012). Nevertheless, there is a study was done in Saudi Arabia to determine the prevalence of vitamin D deficiency between women who suffer from fibromyalgia; that study has shown there is a high prevalence of very low concentrations of vitamin D in Saudi women with fibromyalgia syndrome. Finally, Vitamin D deficiency often appears in patients with fibromyalgia syndrome in Saudi Arabia. As a result, high doses of vitamin D may result in treatment most of the symptoms. Also, this population need further study, and may it is necessary to supply foods with vitamin D (Abokrysha T, 2012)

Vitamin D Status and Breast Cancer in Saudi Arabian Women: Studies have shown that women who have higher levels of vitamin D when they diagnose with breast cancer, they get a few tumors and better survival (cancer.ca, 2015). According to the Saudi Arabian National Cancer Registry, in 2007 breast cancer was the most common cancer between Saudi women. Furthermore, in Saudi Arabia women who less than 40 years, breast cancer is common between them more than women in the United States. Women in Saudi Arabia are more susceptible to vitamin D deficiency because of the dark skin and lack of exposure to sunlight. Also, epidemiologic studies have found there is an invers relation between breast cancer and vitamin D level. However, the role of vitamin D in preventing breast cancer is debatable. Nevertheless, there are no many studies proving the relation between vitamin D deficiency and breast cancer among women in Saudi Arabia (Yousef et al., 2013).

Conclusion: There are several reasons of the etiology of vitamin D deficiency in Saudi Arabian women. The most important reason is the lack of exposure to sunlight, and that because of urbanization and traditional customs. Additionally, the darker skin and unhealthy diet are playing a role in vitamin D deficiency among Saudi Arabian women (Fonseca, Tongia, El-Hazmi, & Abu-Aisha, 1984) Therefore, taking supplementations is very important to compensate the lack of vitamin D. Furthermore, the government should provide more private areas for women in Saudi Arabia to uncover freely. Also, fortifying more foods with vitamin D is needed in Saudi Arabia to decrease the percentage of vitamin D deficient women (Floor, CHRISTIE, & MASON, 2011).

References Abokrysha T, N. (2012). Vitamin D deficiency in women with fibromyalgia in saudi arabia.13(3), 452-458. doi:10.1111/j.1526-4637.2011.01304.x cancer.ca. (2015). Breast cancer. Elshafie, D. E., Al-Khashan, H., & Mishriky, A. M. (2012). Comparison of vitamin D deficiency in saudi married couples. European Journal of Clinical Nutrition, 66(6), 742-745. doi:10.1038/ejcn.2012.29 Floor, T. E., Christie, & MASON, L. (2011). Knowledge, attitude and practice regarding vitamin D deficiency among female students in saudi arabia: a qualitative exploration.14(3), 22-29. doi:10.1111/j.1756-185X.2011.01624.x Floor, T. E., CHRISTIE, & MASON, L. (2011). Knowledge, attitude and practice regarding vitamin D deficiency among female students in saudi arabia: A qualitative exploration.14(3), 22-29. doi:10.1111/j.1756-185X.2011.01624.x Fonseca, V., Tongia, R., El-Hazmi, M., & Abu-Aisha, H. (1984). 60, 589-591. doi:10.1136/pgmj.60.707.589 Okumus, M., Koybası, M., Tuncay, F., Ceceli, E., Ayhan, F., Yorgancioglu, R., & Borman, P. (2013). Fibromyalgia syndrome: Is it related to vitamin D deficiency in premenopausal female patients? Pain Management Nursing, 14(4), e156-e163. doi:http://dx.doi.org.proxy2.lib.umanitoba.ca/10.1016/j.pmn.2011.09.006 Stechschulte, S. A., Kirsner, R. S., & Federman, D. G. (2009). Vitamin D: Bone and beyond, rationale and recommendations for supplementation. The American Journal of Medicine, 122(9), 793-802. doi:http://dx.doi.org.proxy2.lib.umanitoba.ca/10.1016/j.amjmed.2009.02.029 Yousef, M. F., Jacobs, E. T., Kang, P. T., Hakim, I. A., Going, S., Yousef, J. M., Thomson, C. A. (2013). Vitamin D status and breast cancer in saudi arabian women: case-control study.98, 105-110.