中東における鉄欠乏とビタミンD欠乏の併発：統合的公衆衛生戦略のためのサウジアラビアを事例とした地域レビュー

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

Abstract（原文）

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.

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