title: Ethnicity, Clothing Style, and Body Mass Index are Significant Predictors of Vitamin D Insufficiency in Germany.
abstract: OBJECTIVE
  To analyze risk factors for vitamin D insufficiency in Germany with respect to ethnicity, sex, and clothing style.
  
  
  METHODS
  We analyzed the routine diagnostic work-ups of 1,231 adult (45.9 ± 17.9 years old) German (n = 1,034) and Turk residents (n = 197) referred with nonspecific symptoms to the Thyroid Centers at St. Elisabeth-Hospital in Dorsten, Germany and Bottrop, Germany to assess for metabolic diseases. All subjects underwent a routine examination that consisted of a questionnaire, lab tests for 25-hydroxyvitamin-D (25OHD), and thyroid profile. Turk females with traditional clothing (headscarf and covered legs and arms) were considered to wear "covered clothing." Logistic-regression was performed to identify factors that could predict vitamin D deficiency (<20 ng/mL) and insufficiency (20-30 ng/mL).
  
  
  RESULTS
  Vitamin D insufficiency was seen in 33% of Germans and 74.1% of Turks, and vitamin D deficiency was present in 11.3% and 44.2% of Germans and Turks, respectively (P<.001). The mean 25OHD value in Turk females with covered clothes was lower than that in Turk females with conventional clothing (16.3 ± 12.3 vs. 27.2 ± 15.8, P<.001). Vitamin D insufficiency was present in 86.0% of Turk females with covered clothing versus 62.8% with conventional clothing (odds ratio [OR] = 3.6, P = .002). Ethnicity, body mass index (BMI), and clothing style were significant predictors of vitamin D deficiency and insufficiency by logistic regression (P<.001).
  
  
  CONCLUSIONS
  (1) Vitamin D insufficiency among Turk residents in Germany is higher compared to Germans. The highest prevalence was present in Turk females with covered clothing. (2) Monitoring vitamin D in Turk residents in Germany is warranted. (3) Vitamin D supplements and access to facilities with sunlight exposure for females with covered clothing and all individuals with poor diets or limited access to sun exposure may prevent future health burden due to vitamin D insufficiency.
authors.affiliation: Clinic & Policlinic for Nuclear Medicine, University Hospital Essen, Germany Clinic for Radiology & Nuclear Medicine, St. Elisabeth Hospital, Dorsten, Germany Thyroid Center Bottrop & Thyroid Center Dorsten, Germany.
authors.forename: Jamshid
authors.initials: J
authors.lastname: Farahati
authors.affiliation: Clinic & Policlinic for Nuclear Medicine, University Hospital Essen, Germany.
authors.forename: James
authors.initials: J
authors.lastname: Nagarajah
authors.affiliation: Clinic for Radiology & Nuclear Medicine, St. Elisabeth Hospital, Dorsten, Germany Thyroid Center Bottrop & Thyroid Center Dorsten, Germany.
authors.forename: Elena
authors.initials: E
authors.lastname: Gilman
authors.affiliation: Clinic for Radiology & Nuclear Medicine, St. Elisabeth Hospital, Dorsten, Germany Thyroid Center Bottrop & Thyroid Center Dorsten, Germany.
authors.forename: Soha
authors.initials: S
authors.lastname: Mahjoob
authors.affiliation: Endocrine research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Moussavi
authors.initials: M
authors.lastname: Zohreh
authors.affiliation: Clinic & Policlinic for Nuclear Medicine, University Hospital Essen, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rosenbaum-Krumme
authors.affiliation: Clinic & Policlinic for Nuclear Medicine, University Hospital Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.affiliation: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: S Rasoul
authors.initials: SR
authors.lastname: Zakavi
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003020:Clothing; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000453:epidemiology* / Q000208:ethnology
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D