title: Severe vitamin D deficiency in Arab-American women living in Dearborn, Michigan.
abstract: OBJECTIVE
  To determine the prevalence and degree of 25-hydroxyvitamin D deficiency in a group of Arab-American women in the largest, most-concentrated Arab-American settlement in the United States and to search for correlations with dress, diet, and use of vitamin D-fortified foods and vitamin supplements.
  
  
  METHODS
  In this cross-sectional study, Arab-American women, 18 years and older, who attended an ethnic market on April 7 or 14, 2007, were recruited. Participants were interviewed by bilingual English- and Arabic-speaking investigators using a semi-structured interview to assess dress; demographic variables; medical history; medication use; clinical symptoms associated with vitamin D deficiency (eg, joint or bone pain, muscle weakness); and dietary intake of vitamin D from fortified orange juice, milk, and vitamin supplementation. Blood samples were drawn to measure concentrations of serum calcium, creatinine, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D. Participants were initially divided into 2 groups based on whether the woman was veiled and further subdivided into 3 groups on the basis of vitamin D intake from supplemented food sources (milk or vitamin D-fortified orange juice) and vitamin pills: unveiled, veiled and taking supplements, and veiled and taking no supplements.
  
  
  RESULTS
  Eighty-seven women participated. Serum 25-hydroxyvitamin D levels were uniformly low, with the highest levels in the unveiled group (median [interquartile range]) (8.5 ng/mL [5.75-13.5 ng/mL]) followed by the veiled, supplemented group (7 ng/mL [4-11.5 ng/mL]) and the veiled, unsupplemented group (4 ng/mL [2-6.8 ng/mL]). 25-Hydroxyvitamin D levels were lower in women with less experience in the United States and in those with less education. Vitamin D-fortified orange juice consumption had a greater positive predictive effect on serum 25-hydroxyvitamin D levels than either milk or vitamin pills and may possibly serve as a surrogate marker for vitamin D awareness.
  
  
  CONCLUSIONS
  Vitamin D deficiency, as assessed by 25-hydroxyvitamin D concentrations, is endemic in a sample of Arab-American women living in Dearborn, Michigan. These findings potentially identify an important health problem in the largest, most-concentrated Arab-American population in the United States.
authors.affiliation: Henry Ford Hospital, Detroit, Michigan 48202, USA. rhobbs1@hfhs.org
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Hobbs
authors.forename: Zeina
authors.initials: Z
authors.lastname: Habib
authors.forename: Dalal
authors.initials: D
authors.lastname: Alromaihi
authors.forename: Leila
authors.initials: L
authors.lastname: Idi
authors.forename: Nayana
authors.initials: N
authors.lastname: Parikh
authors.forename: Frank
authors.initials: F
authors.lastname: Blocki
authors.forename: D Sudhaker
authors.initials: DS
authors.lastname: Rao
mesh_terms: D000328:Adult; D003020:Clothing; D003430:Cross-Sectional Studies; D004032:Diet; D019587:Dietary Supplements; D004522:Educational Status; D005260:Female; D005527:Food, Fortified; D006801:Humans; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D008877:Middle East / Q000208:ethnology; D015995:Prevalence; D012720:Severity of Illness Index; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D