Research Article - Biomedical Research (2017) Volume 28, Issue 7
Knowledge and practice of vitamin D deficiency among people lives in Riyadh, Saudi Arabia-A cross-sectional studySalmeen D. Babelghaith, Syed Wajid*, Meshal A.Al-Zaaqi, Ahmed S.Al-Malki, Faisal D.Al-Amri, Saeed Alfadly, Sultan Alghadeer and Mohammed N. Alarifi
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Saudi Arabia
- *Corresponding Author:
- Syed Wajid
Department of Clinical Pharmacy
College of Pharmacy
King Saud University, Saudi Arabia
Accepted on December 6, 2016
This study evaluated the knowledge, attitude and practice towards vitamin D deficiency among Saudi population. A cross-sectional study utilizing an online survey was conducted. Descriptive statistics was applied. About 98.4% heard about vitamin D, most of them knew that the sun is important source of vitamin D, unfortunately only 46.4% of participants who is like going out to sun. A few of participants (13.7%) thought that they have sufficient sun exposure. Majority of participants 93.1% knew that vitamin D is important for bone health, and 48.4% of participants knew the presence of relation between vitamin D deficiency and other diseases such as diabetes, cardiovascular, and depression. In addition, the most of participants (91.0%) reported that vitamin D source was the sun. This study found inadequate knowledge, and poor practice about vitamin D deficiency. More efforts should be carried out for the public to improve their knowledge and attitude about vitamin D.
Vitamin D, Knowledge, Practice, Deficiency.
Vitamin D deficiency is the most common nutritional deficiency and is highly alarming in Saudi Arabia and worldwide epidemic [1-3]. It has been recognized as an international public health problem due to its significant role for the most common medical Conditions for the skeletal system [4,5]. The main function of Vitamin D's is to reserve calcium and phosphorus homoeostasis by increasing the efficacy of intestinal calcium and phosphorus absorption in order to maintain signal transduction, metabolic activities, and neuromuscular function, and to promote skeletal mineralization. Several studies have shown that sunlight is the most important source of vitamin D deficiency [6,7]. Historically vitamin D deficiency causes rickets, osteomalacia, osteoporosis (weak bones), and osteogenesis imperfecta, in which the bones are especially brittle and easily broken .
Studies form varies countries confirm that association between Vitamin D deficiency to other major diseases such as numerous types of cancer [1,5,9] coronary heart disease  diabetes [10,11], hypertension, Alzheimer’s [1,6] and multiple sclerosis .
Production of vitamin D in human body is greatly depends on exposure to sunlight but some of the sunniest parts of the world have the highest rates of vitamin D deficiency. However numerous factors have contributed to dangerously low vitamin D levels in Saudi Arabia. The peoples of Saudi Arabia mostly followed indoor lifestyle due to extreme of temperature, besides that it is supposed to be lack of vitamin D, due to cultural traditions whereby Muslim communities avoid body exposure to sun [13,14]. Ghada states that Risk factors for hypovitaminosis D included female gender, multi-parity, season, conservative clothing style, low socioeconomic status, and urban living .
Although Siddiqui  postulates that sun exposure in Saudi Arabia is limited because women wear an abaya hiding them completely from head to toe [11,14]. In addition a lack of awareness of the importance of vitamin D is noted by Siddiqui.
However little is known about public knowledge and practice towards vitamin D among Saudi people, specific to Riyadh city. To the best of our knowledge and after a broad literature review, only two studies were found on this topic, among adult males and female student were conducted in Riyadh city of Saudi Arabia. A qualitative exploration study was done among female students and found poor practice regarding vitamin D . Another cross -sectional study did in Riyadh city among adult female (n=310) to assess their knowledge and practice of vitamin D. it reported that their knowledge was insufficient . On the contrary, this study aimed to find out Knowledge, and practice of vitamin D deficiency among people lives in Riyadh, Saudi Arabia.
Material and Methods
A cross-sectional study using developed questionnaire was carried out at Riyadh city, Saudi Arabia between February and April, 2016. An online Survey tool was used to administer the questionnaire among people who lives in Riyadh, Saudi Arabia, to determine their knowledge and practice about vitamin D deficiency. An invitation message using social media (Twitter®, Facebook® and WhatsApp®), and emails to participate in this study was sent to family members, friends and community with a link to the survey. The questionnaire consisted of a 15 item questionnaire was developed from different available literature related to knowledge, and practice towards Vitamin D deficiency. Also, demographic data were collected in questionnaire. The questionnaire was translated to Arabic language utilizing a forward backward method. It was validated in pilot study among eleven of Saudi people and the Cronbach’s alpha value was 0.067.
The completed data was entered into Statistical Package for the Social Sciences (SPSS) version 22 software (SPSS Inc., Chicago, IL, SA) for statistical analysis. Descriptive statistics include percentages, and frequency distribution was applied
Table 1 gives the general characteristics of participants with age ranging from 18 to 60. More than half (54.8%) of participants aged 18 to 25. The majority of participants were females (54.2%), 45.8% were males, and about 94. Percentage of participants was Saudi. About half of participants have university degree.
|Age in years|
|60 or more||6 (1.2)|
|Both Arabic & English||200 (40.3)|
|Primary school/Intermediate school||14 (2.08)|
|High school||192 (38.7)|
|Master/ philosophy degree||35 (7.0)|
Table 1. Distribution of general characteristics of participants.
Vitamin D and sources information knowledge
Almost all participants (98.4) have heard of vitamin D. The most frequent sources of Vitamin D information were health care provider (44%), followed by friends (29.8%), and then media (26.2%) as shown in Table 2.
|Items||Number (N)||Percent (%)|
|Heard of Vitamin D|
|Source of information|
|Health care professional||218||44|
|Relatives and friends||148||29.8|
Table 2. Vitamin D and sources information.
Vitamin D and sun exposure practice
Only 46.4% of participants reported that they like to go into the sun, and 11.3% of then use used a parasol to shade from the sun. Only 21% of participants used sunscreen products containing SPF>15, and 2.1% out of those use sunscreen daily. A few participants (13.7%) believed that they have enough sun exposure.
Approximately 43% of participants are complaining from vitamin D deficiency symptoms, versus 24% with no vitamin D deficiency. About 33.3% of the participants revealed that they did not know if they complain from vitamin D deficiency symptoms. In addition, 52.2% of participants were suffering from muscle pain. Only 9.7% of participants had taken medications for muscle pain. Results are presented in Table 3.
|Items||Number (N)||Percent (%)|
|Do you like going in the sun|
|No/ do not know||265||53.4|
|Do you often use a parasol to shade from the sun?|
|Do you use sunscreen products containing SPF>15|
|How often sunscreen is used?|
|Do you think you have enough exposure to sunlight?|
|Do not know||428||86.3|
|Are you complaining from vitamin D deficiency symptoms?|
|Do not know||165||33.3|
|Do you suffer from muscle pain and fatigue?|
|Do not know||35||7.1|
|Do you take treatment for muscle pain and fatigue (who suffer)|
Table 3. Frequency of participants’ practice towards vitamin D and sun exposure.
Knowledge of health benefits of vitamin D
Majority of participants (93.1%) knew that vitamin D is essential for bone health. Only 66.3% of the participants revealed that muscle pain related to vitamin D deficiency. However, 48.8% of our subjects believed that vitamin D deficiency is related to other diseases like: cardiovascular, diabetes, depression, hypercholesterolemia, cancer and multiple sclerosis, versus 14.9% believed there is no relationship and 36.7% of the participants did not know the relationship. It was interesting that majority of participants (89.3%) would like to do vitamin D test as shown in Table 4.
|Items||Frequency (N)||Percent (%)|
|Do you know that vitamin D is good for bone health?|
|No/ don’t know||34||6.9|
|Does muscle pain could be related to vitamin D deficiency?|
|Do you think that vitamin D deficiency is related to other diseases like: cardiovascular, diabetes, depression, hypercholesterolemia, cancer and multiple sclerosis?|
|Willing to undergo a test for vitamin D?|
|If you are deficient of vitamin D, do you want to take vitamin D supplementation?|
Table 4. Participants’ knowledge for vitamin D health benefits.
Knowledge of vitamin D sources
This study revealed that only 3.2% of participants do not know the sources of vitamin D. the most reported t vitamin D source was the sun (91%), followed by Vitamin D supplements (73%), milk products (47.6%), fatty fish (45.8%), and then eggs (30.8%) (Table 5).
|Resources||Frequency (N)||Percentage (%)|
|Vitamin D supplement*||364||73.4|
Table 5. Frequency of responses for knowledge of vitamin D sources.
This study assessed the practice of participants about vitamin D and their sun exposure. This study found that less than half of the participants had expose to sun daily. This is consistent with the results of a cross-sectional study did in Riyadh city among female . Our findings are lower than that of a study was done in Kuwait to assess general population’ awareness, knowledge and attitude regarding sun protection, and its relation with vitamin D deficiency. It showed that many of participants (80%), exposed to sun daily . We found only 21% of participants used sunscreen products containing SPF>15, and 2.1% out of those use sunscreen daily. Similar findings was found in previous studies did in Riyadh city among female . Another study by Christie  carried out in Saudi Arabia, among female students; found that subjects had inadequate in their knowledge towards vitamin D. In addition, it found subjects had limited sun exposure due to intense heat .
Vitamin D deficiency is related to a number of disorders included cancer, chronic diseases and physical impairments related particularly to the bones. This study found almost all of participants (91.3%) knew that vitamin D is a vital for bone health, but less than half of participants believed that vitamin D deficiency is related to other diseases such as cardiovascular, diabetes, depression, hypercholesterolemia, cancer and multiple sclerosis. Our finding was better than previous studies, a study was done in Kuwait  found only 29.5% of subjects knew that. Although low levels of vitamin D is associated with cardiovascular disorders. Many studies have reported cardiovascular diseases among patients with vitamin D deficiency [19-21]. However, Our finding is better than previous studies, a study was done among Saudi female and found about 25.6% of them had correct answer towards importance of vitamin D . Another study was done in Australia mentioned that 76% of subjects know that Vitamin is a good for bone .
The most importance sources of vitamin D are nutritional (10-20%) and the cutaneous synthesis under the action of sun light (80-90%) . About 90% of respondents reported that they achieve their VD requirement by sunlight exposure, followed by Vitamin D supplements (73%), milk products (47.6%), fatty fish (45.8%), and then eggs (30.8%). These findings indicated that participants had a good knowledge and awareness about the importance of sun rays as a source of vitamin D, but they did not practice enough exposure to sun. In comparison to previous studies  85.5% of subjects identified the sun as main vitamin D source, followed by milk products (60%). Although the almost of participants in the present study identified the sun and vitamin D supplements as sources of vitamin D, while a minor of participants identified accurate food sources as sources of vitamin D.
This study found the main sources of vitamin D information were health care provider (44%), followed by friends (29.8%), and then media (26.2%). Health care provider is a good contributing factor to increase patient’s sufficient knowledge of vitamin D. These findings is contracts with previous studies, where 16 found the most sources of vitamin D were physicians (37.4%), followed by TV program (34.8%) and then media (32.0%). A similar study was done in United Arab Emirates reported that more than half of participants trusted that the media is the main sources of their knowledge about vitamin d deficiency .
Results showed some understanding towards the insight of vitamin D among Saudi people. But they had inadequate benefit knowledge of vitamin D particular, its effect on cardiovascular system as well as they have poor practice of sun exposure. The results emphasized the importance of establishing continuing education programs to the public helps structure more awareness and knowledge about vitamin D importance.
- Holick MF. The vitamin D epidemic and its health consequences. J Nutr 2005; 135: 2739-2748.
- Fuleihan G. Vitamin D deficiency in the Middle East and its health consequences for children and adults. Clinic Rev Bone Miner Metab 2009; 7: 77-93.
- Khalsa K. The vitamin D revolution, how the power of this amazing vitamin can change your life. Hay House New York 2009.
- Masood S, Iqbal M. Prevalence of vitamin D deficiency in South-Asia. Pak J Med Sci 2008; 24: 891-897.
- Grant W. An estimate of premature cancer mortality in the U.S due to Inadequate doses of solar ultraviolet-B radiation. Cancer 2005; 94: 1867-1875.
- Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281.
- Vieth R, Kimball S. Vitamin D in congestive heart failure. Am J Clin Nutr 2006; 83: 731-732.
- Glerup H, Mikkelsen K, Poulsen K. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med 2000; 247: 260-268.
- Lappe J, Travers-Gustafson D, Davies K, Recker R, Heaney R. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007; 85: 1586-1591.
- Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001; 358: 1500-1503.
- Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007; 92: 2017-2029.
- Mahon BD, Gordon SA, Cruz J, Cosman F, Cantorna MT. Cytokine profile in patients with multiple sclerosis following vitamin D supplementation. J Neuroimmunol 2003; 134: 128-132.
- Siddiqui A. Prevalence of vitamin D deficiency rickets in adolescent school girls in Western region, Saudi Arabia. Saudi Med J 2007; 28: 441-444.
- Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine (Phila Pa 1976) 2003; 28: 177-179.
- Christie FT, Mason L. Knowledge, attitude and practice regarding vitamin D deficiency among female students in Saudi Arabia: a qualitative exploration. Int J Rheum Dis 2011; 14: 22-29.
- Habib FM, Al-Motairi WA, Al-Mutairi WM. Vitamin D deficiency: knowledge and practice among adult Saudi females. Glo Adv Res J Med Sci 2014; 3: 95-101.
- Al-Mutairi N, Issa BI, Nair V. Photoprotection and vitamin D status: a study on awareness, knowledge and attitude towards sun protection in general population from Kuwait, and its relation with vitamin D levels. Indian J Dermatol Venereol Leprol 2012; 78: 342-349.
- Al Bathi BA, Al Zayed KE, Al Qenai M, Makboul G. Knowledge, attitude and practice of patients attending primary care centers toward vitamin D in Kuwait. Alexandria Med J 2012; 48: 277-282.
- Zittermann A, Schleithoff SS, Koerfer R. Putting cardiovascular disease and vitamin D insufficiency into perspective. Br J Nutr 2005; 94: 483-492.
- Belen E, Aykan AC, Kalaycioglu E, Sungur MA, Sungur A, Cetin M. Low-level vitamin D is associated with atrial fibrillation in patients with chronic heart failure. Adv Clin Exp Med 2016; 25: 51-57.
- Modarresi-Ghazani F, Hejazi ME, Gharekhani A, Entezari-Maleki T. Role of vitamin D in cardiovascular disease. Arch Iran Med 2016; 19: 359-362.
- Vu LH, van der Pols JC, Whiteman DC, Kimlin MG, Neale RE. Knowledge and attitudes about Vitamin D and impact on sun protection practices among urban office workers in Brisbane, Australia. Cancer Epidemiol Biomarkers Prev 2010; 19: 1784-1789.
- Dawodu A, Kochiyil J, Altaye N. Pilot study of sunlight exposure and vitamin D status in Arab women of childbearing age. East Mediterr Health J 2011; 17: 570-574.
- Salmanpour VA, Ibrahim HS, Salameh AG, Yahya AM, Debal BK. Vitamin D deficiency: knowledge and practices among the adult population in Sharjah, United Arab Emirates. Arch Osteoporos 2016; 11: 15.