Vitamin D2026-05

The Co-occurrence of Iron and vitamin D deficiency in the middle east: A regional review with a focus on Saudi Arabia as a case study for integrated public health strategies.

Essawi Khaled — The Journal of steroid biochemistry and molecular biology

Summary

A review of studies in the Middle East, especially Saudi Arabia, shows that many people suffer from both iron and vitamin D deficiencies at the same time. These combined deficiencies can lead to more severe health problems, highlighting the need for public health strategies that address both issues together rather than separately.

AI-generated summary — read the original

Key points

Iron and vitamin D deficiencies are common and often occur together in the Middle East.
This dual deficiency can worsen health problems, especially for children and mothers.
Current public health efforts often treat these deficiencies separately, which may be less effective.
Integrated strategies that address both iron and vitamin D together are needed for better health outcomes.

What the study looked at

{ "what_question_the_study_asked": "This review investigated how often iron and vitamin D deficiencies occur together in the Middle East, particularly in Saudi Arabia. It also explored the potential reasons for this co-occurrence, its health impacts, and how public health efforts could be improved to tackle both issues simultaneously.", "how_it_was_studied": "Researchers conducted a narrative review, which means they gathered and analyzed existing scientific literature, studies, and data from the region. They synthesized information from various published papers to provide a comprehensive overview rather than conducting new experiments with participants.", "what_it_found": "The review confirmed that both iron and vitamin D deficiencies are highly prevalent and frequently overlap in the Middle East. This dual deficiency can worsen health outcomes, affecting growth, brain function, and immune responses, especially in children and mothers. The study concluded that current public health strategies often address these deficiencies in isolation, suggesting that integrated approaches, like combined food fortification or supplementation, would be more effective. It emphasized the importance of collecting national data on both deficiencies to guide these combined efforts." }

Dietary takeaway

Given that iron and vitamin D deficiencies often appear together, it's wise to consider both nutrients in your daily diet. Incorporate foods rich in vitamin D, such as fatty fish, fortified dairy, and sun-exposed mushrooms, alongside iron-rich options like lean meats, legumes, and dark leafy greens. While a balanced diet is crucial, remember that this review summarizes existing research and individual nutritional needs can vary, so it's not a definitive guide for personal health decisions.

Abstract

Iron deficiency (ID) and vitamin D deficiency (VDD) often occur together in Saudi Arabia and across the Middle East, influenced by shared cultural, dietary, and environmental factors. This narrative review compiles evidence on this dual issue, exploring epidemiology, mechanisms, clinical effects, and public health strategies. Data confirm significant overlap: VDD affects 60-88% of Saudi adults and 60-81% of children, while ID impacts 23-36% of adults and 20-49% of children. Throughout this review, vitamin D deficiency (VDD) is defined per original study criteria, most commonly as 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL (<50 nmol/L), consistent with pre-2024 Endocrine Society guidelines. We acknowledge the 2024 Endocrine Society revised guideline, which defines deficiency as < 12 ng/mL (<30 nmol/L) and eliminates the 'insufficiency' category; prevalence estimates would be substantially lower under this newer threshold. Their co-occurrence may be linked through common inflammatory pathways affecting hepcidin regulation and vitamin D activation, although human data are inconsistent. Combined deficiencies worsen health outcomes, including impaired growth, neurocognitive issues, immune problems, and adverse effects on maternal and child health. Diagnosis is difficult due to nonspecific symptoms and biomarker limitations during inflammation. Current interventions such as food fortification and supplementation, are hampered by isolated approaches and a lack of nationally representative combined prevalence data. The top priority is conducting a national survey to measure the prevalence of concurrent ID and VDD. Once this data is available, integrated strategies such as dual fortification, combined supplementation protocols, and culturally-sensitive public health campaigns can be effectively implemented. This framework offers an evidence-based approach to translating epidemiological and mechanistic insights into measurable public health improvements in Saudi Arabia and the wider Middle East.

View on PubMed →DOI: 10.1016/j.jsbmb.2026.107040