title: Vitamin D status and determinants of deficiency among non-pregnant Jordanian women of reproductive age.
abstract: OBJECTIVE
  Vitamin D deficiency, a risk factor for osteomalacia and osteoporosis, is a re-emerging health problem globally. While sunlight is an important vitamin D source, previous investigations among women whose culture encourages skin covering have been small, not nationally representative, or both. We investigated serum 25-hydroxyvitamin D (25(OH)D(3)) status and factors associated with deficiency in a nationally representative survey of 2013 Jordanian women of reproductive age in Spring 2010.
  
  
  METHODS
  We measured 25(OH)D(3) concentrations by liquid chromatography-tandem mass spectrometry and calculated prevalence ratios for deficiency associated with skin covering and other factors.
  
  
  RESULTS
  Results showed 60.3% (95% CI: 57.1-63.4%) deficiency (<12 ng/ml) and 95.7% (95% CI: 94.4-96.8%) insufficiency (<20 ng/ml) among women. Prevalence of deficiency was 1.60 times higher for women who covered with a scarf/hijab (95% CI: 1.06-2.40, P = 0.024) and 1.87 times higher for women who wore full cover, or a niqab (95% CI: 1.20-2.93, P = 0.006), compared with the women who did not wear a scarf/hijab or niqab. Compared with rural women completing at least secondary education, prevalence of deficiency was 1.30 times higher for urban women of the same education level (95% CI: 1.08-1.57, P = 0.006), 1.18 times higher for urban women completing less than secondary education (95% CI: 0.98-1.43, P = 0.09), and 0.66 times lower for rural women completing less than secondary education (95% CI: 0.52-0.84, P = 0.001).
  
  
  CONCLUSIONS
  Vitamin D deficiency and insufficiency pose significant public health problems in Jordanian women. Prevalence of deficiency is significantly higher among urban women and among women who cover with a scarf/hijab or niqab.
authors.affiliation: Epidemic Intelligence Service assigned to the Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Nichols
authors.forename: I M D
authors.initials: IM
authors.lastname: Khatib
authors.forename: N J
authors.initials: NJ
authors.lastname: Aburto
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
authors.forename: K S
authors.initials: KS
authors.lastname: Scanlon
authors.forename: J P
authors.initials: JP
authors.lastname: Wirth
authors.forename: M K
authors.initials: MK
authors.lastname: Serdula
mesh_terms: D000293:Adolescent; D000328:Adult; D003020:Clothing; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D008875:Middle Aged; D010018:Osteomalacia / Q000209:etiology; D010024:Osteoporosis / Q000209:etiology; D015995:Prevalence; D011634:Public Health; D012424:Rural Population; D012867:Skin; D013472:Sunlight; D014505:Urban Population; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D