Effect of different dress style on vitamin D level in healthy young Orthodox and ultra-Orthodox students in Israel.
Ultra-orthodox Jewish lifestyle, which encourages modest dress and indoor scholarly activity, represents a risk factor for vitamin-D deficiency. Our study in healthy young males from higher education religious institutions located in the same geographical area showed frequent and severe vitamin D deficiency, strongly correlated with the degree of sun exposure. However, PTH level was usually normal.


BACKGROUND
Ultra-orthodox Jewish lifestyle encourages modest dress and indoor scholarly activity. As such, it represents a risk factor for vitamin-D deficiency, a worldwide problem previously underestimated in sunny countries. Our aim was to characterize the vitamin-D status of religious Jewish males according to sun exposure and outdoor activity, and study the correlation between serum 25-hydroxyvitamin D (25(OH) D) and PTH level.


METHODS
Seventy-four young adult males were recruited from three Jewish higher education institutions (Yeshiva) in Jerusalem. Yeshiva-A ultra-Orthodox students (aged 20.1 ± 0.6) wear traditional clothing, live in dormitories and stay mostly indoor. Yeshiva-B ultra-Orthodox students (aged 33.0 ± 4.2) dress similarly but have regular outdoor activities. Yeshiva-C religious students (aged 19 ± 2.0) participate in a mixed army/Yeshiva program. Weekly outdoor activity time and degree of sun exposure were estimated by questionnaire.


RESULTS
25(OH)D was 8.9 ± 3.6, 10.2 ± 5.7 and 21.7 ± 10.4 ng/ml (mean ± SD) in Yeshiva A, B and C. 25(OH)D was correlated with degree of sun exposure (r = 0.54, p < 0.0001) and inversely correlated with PTH (r = -0.3, p = 0.01). Levels below 20 ng/ml were considered as vitamin D deficiency. PTH was normal in 87% of vitamin D-deficient subjects from Yeshiva-A and Yeshiva-C (mean age 20), compared to 52% of Yeshiva-B students (mean age 33). Bone mineral density studied in a random subset (n = 14) of vitamin D-deficient subjects showed Z-scores of -1.5 ± 1.0, -1.8 ± 0.8, -2.1 ± 0.4 in femoral neck, spine and radius.


CONCLUSIONS
Severe vitamin-D deficiency is extremely prevalent in ultra-Orthodox males. Despite rare secondary hyperparathyroidism, they represent an important previously unrecognized high-risk group for metabolic bone disease.
Diabetes and Endocrinology, Clalit Health Services, Jerusalem, Israel. tsuranat@netvision.net.il
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D000293:Adolescent; D000328:Adult; D015519:Bone Density; D003020:Clothing; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000208:ethnology*; D007599:Judaism; D008019:Life Style; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D013472:Sunlight; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology; D055815:Young Adult
D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D