Abstract

Vitamin D deficiency has been shown to affect iron status via decreased calcitriol production, translating to decreased erythropoiesis. The present study aimed to determine for the first time whether vitamin D supplementation can affect iron levels among Arab adolescents. A total of 125 out of the initial 200 Saudi adolescents with vitamin D deficiency (serum 25(OH)D < 50 nmol/L) were selected from the Vitamin D-School Project of King Saud University in Riyadh, Saudi Arabia. Cluster randomization was done in schools, and students received either vitamin D tablets (1000 IU/day) (N = 53, mean age 14.1 ± 1.0 years) or vitamin D-fortified milk (40IU/200mL) (N = 72, mean age 14.8 ± 1.4 years). Both groups received nutritional counseling. Anthropometrics, glucose, lipids, iron indices, and 25(OH)D were measured at baseline and after six months. Within group analysis showed that post-intervention, serum 25(OH)D significantly increased by as much as 50%, and a parallel decrease of −42% (p-values <0.001 and 0.002, respectively) was observed in serum iron in the tablet group. These changes were not observed in the control group. Between-group analysis showed a clinically significant increase in serum 25(OH)D (p = 0.001) and decrease in iron (p < 0.001) in the tablet group. The present findings suggest a possible inhibitory role of vitamin D supplementation in the iron indices of healthy adolescents whose 25(OH)D levels are sub-optimal but not severely deficient, implying that the causal relationship between both micronutrients may be dependent on the severity of deficiency, type of iron disorder, and other vascular conditions that are known to affect hematologic indices. Well-designed, randomized trials are needed to confirm the present findings.

Highlights

  • Through the last decade, vitamin D has gained considerable interest in health and biomedical research [1]

  • East and North African regions, including the Kingdom of Saudi Arabia (KSA), are not spared from this micronutrient deficiency, and have among the highest rates of vitamin D deficiency in the world [3,4]

  • The Vitamin D School Project is a collaborative project between King Saud University and the Ministry of Education in Riyadh, Saudi Arabia, ascertaining the beneficial effects of 1000 IU/day vitamin D supplementation and other vitamin D correction strategies, including vitamin D-fortified milk consumption and overall public health awareness in raising vitamin D levels

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Summary

Introduction

Vitamin D has gained considerable interest in health and biomedical research [1]. Vitamin D deficiency is widespread and is considered a pandemic [2]. East and North African regions, including the Kingdom of Saudi Arabia (KSA), are not spared from this micronutrient deficiency, and have among the highest rates of vitamin D deficiency in the world [3,4]. Among the most common risk factors for vitamin D deficiency in the Middle-East include female gender and their clothing style, multi-parity, sedentary lifestyle, urban living and socio-economic status for adults, and longer than average breastfeeding as well as low dietary vitamin D and calcium intake in children [5].

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