{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:39:01Z","timestamp":1762079941001,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deputyship for Research &amp; Innovation, Ministry of Education in Saudi Arabia","award":["IFKSURG-2-934"],"award-info":[{"award-number":["IFKSURG-2-934"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Emerging evidence suggests an intricate relationship between vitamin D, Ca2+, and inflammation-driven anemia. We, thus, investigated the patterns of serum 25(OH)D3, Ca2+, ferritin, and iron in healthy and anemic members of the Saudi population. Methods: A population-based, retrospective, cross-sectional study was designed to analyze data for 14,229 subjects, aged 3\u2013110 years, obtained from Al-Borg Medical Laboratories, over a six-year period (2014\u20132020). Gender and age differences were analyzed for 25(OH)D3, Ca2+, hemoglobin, ferritin, and iron. Results: Vitamin D deficiency was extremely prevalent (98.47%) irrespective of age or gender, despite an increasing trend with age, in clear contrast to serum Ca2+. Ferritin was significantly lower in young adult and adult females, compared to elderly females, whereas iron was significantly reduced in females; in particular, adult females compared to young adults or elderly adults. Only anemic adult males had significantly lower 25(OH)D3, while Ca2+ was consistently significantly diminished in anemics of all age groups, independent of gender. Notably, hypocalcemic subjects were 2.36 times more likely to be anemic. Moreover, ferritin, but not iron, was significantly diminished in anemics, which was only evident in young adults and adults. However, both ferritin and iron showed positive correlation with hematocrit, hemoglobin, MCH, MCHC, and MCV. Conclusions: Despite being significantly lower in anemics, 25(OH)D3 is not particularly associated with anemia, while hypocalcemia is associated with an increased risk for anemia. Assessment of vitamin D and Ca2+ status may be valuable in the clinical management of anemia in the Saudi population.<\/jats:p>","DOI":"10.3390\/life12122119","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T02:16:41Z","timestamp":1671157001000},"page":"2119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Patterns of 25-Hydroxyvitamin D3, Calcium Status, and Anemia in the Saudi Population: A Cross-Sectional Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3095-9154","authenticated-orcid":false,"given":"Mohammad A.","family":"Alfhili","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6689-7004","authenticated-orcid":false,"given":"Ahmed M.","family":"Basudan","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Alfaifi","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4176-335X","authenticated-orcid":false,"given":"Zuhier A.","family":"Awan","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Al-Borg Medical Laboratories, Department of Clinical Pathology, Jeddah 23437, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0554-4790","authenticated-orcid":false,"given":"Mohammed R.","family":"Algethami","sequence":"additional","affiliation":[{"name":"Preventive Medicine and Public Health, Ministry of Health, Jeddah 23325, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jawaher","family":"Alsughayyir","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"115881","DOI":"10.1016\/j.taap.2022.115881","article-title":"Geraniin inhibits whole blood IFN-gamma and IL-6 and promotes IL-1beta and IL-8, and stimulates calcium-dependent and sucrose-sensitive erythrocyte death","volume":"436","author":"Alsughayyir","year":"2022","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.hoc.2014.04.005","article-title":"Anemia of inflammation","volume":"28","author":"Nemeth","year":"2014","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/jfcm.JFCM_73_17","article-title":"Vitamin D deficiency in Saudi Arabians: A reality or simply hype: A meta-analysis (2008\u20132015)","volume":"25","author":"Alani","year":"2018","journal-title":"J. Fam. Community Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1038\/ejcn.2014.286","article-title":"Determinants of vitamin D deficiency among undergraduate medical students in Saudi Arabia","volume":"69","author":"BinSaeed","year":"2015","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_5","first-page":"e12420","article-title":"Disorders of Calcium Metabolism: Hypocalcemia and Hypercalcemia","volume":"13","author":"Tinawi","year":"2021","journal-title":"Cureus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1097\/MED.0000000000000199","article-title":"Vitamin D and anemia: Insights into an emerging association","volume":"22","author":"Smith","year":"2015","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"doi-asserted-by":"crossref","unstructured":"Alfhili, M.A., Alsughayyir, J., Basudan, A., Ghneim, H.K., Aboul-Soud, M.A.M., Marie, M., Dera, A., Alfaifi, M., Alkhathami, A.G., and Awan, Z.A. (2022). Isolated and Combined Effect of Age and Gender on Neutrophil-Lymphocyte Ratio in the Hyperglycemic Saudi Population. Medicina, 58.","key":"ref_7","DOI":"10.3390\/medicina58081040"},{"doi-asserted-by":"crossref","unstructured":"Alfhili, M.A., Alsughayyir, J., Basudan, A.M., Alsubki, R., Alqahtani, S., Awan, Z.A., Algethami, M.R., and Al-Sheikh, Y.A. (2022). Monocyte-Lymphocyte Ratio and Dysglycemia: A Retrospective, Cross-Sectional Study of the Saudi Population. Healthcare, 10.","key":"ref_8","DOI":"10.3390\/healthcare10112289"},{"doi-asserted-by":"crossref","unstructured":"Almehmadi, M., Salih, M., Elmissbah, T.E., Alsharif, A., Alsiwiehri, N., Alzahrani, K., Shafie, A., and Dahlawi, H. (2021). Prevalence of anemia among Saudi patients with solid cancers at diagnosis in King Faisal Hospital, Taif Province, Kingdom of Saudi Arabia. PLoS ONE, 16.","key":"ref_9","DOI":"10.1371\/journal.pone.0246202"},{"key":"ref_10","first-page":"1462","article-title":"Evaluation of anemia in children","volume":"81","author":"Janus","year":"2010","journal-title":"Am. Fam. Physician"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2808","DOI":"10.1001\/jama.1990.03450210108045","article-title":"Clinical Methods: The History, Physical, and Laboratory Examinations","volume":"264","author":"Goldstein","year":"1990","journal-title":"JAMA"},{"doi-asserted-by":"crossref","unstructured":"Briguglio, M., Hrelia, S., Malaguti, M., Lombardi, G., Riso, P., Porrini, M., Perazzo, P., and Banfi, G. (2020). The Central Role of Iron in Human Nutrition: From Folk to Contemporary Medicine. Nutrients, 12.","key":"ref_12","DOI":"10.3390\/nu12061761"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7895","DOI":"10.2147\/IJGM.S379597","article-title":"Patterns of Dyslipidemia in the Anemic and Nonanemic Hypertensive Saudi Population: A Cross-Sectional Study","volume":"15","author":"Alfhili","year":"2022","journal-title":"Int. J. Gen. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.ecl.2013.02.004","article-title":"Vitamin D and aging","volume":"42","author":"Gallagher","year":"2013","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"277S","DOI":"10.1093\/ajcn\/85.1.277S","article-title":"Multivitamin-multimineral supplements: Who uses them?","volume":"85","author":"Rock","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_16","first-page":"69","article-title":"Vitamin D and inflammatory diseases","volume":"7","author":"Yin","year":"2014","journal-title":"J. Inflamm. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1159\/000450892","article-title":"Relationship between Anemia and Serum Concentrations of Calcium and Phosphorus in Advanced Non-Dialysis-Dependent Chronic Kidney Disease","volume":"135","author":"Boronat","year":"2017","journal-title":"Nephron"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2739S","DOI":"10.1093\/jn\/135.11.2739S","article-title":"The vitamin D epidemic and its health consequences","volume":"135","author":"Holick","year":"2005","journal-title":"J. Nutr."},{"doi-asserted-by":"crossref","unstructured":"Shirazi, L., Almquist, M., Malm, J., Wirfalt, E., and Manjer, J. (2013). Determinants of serum levels of vitamin D: A study of life-style, menopausal status, dietary intake, serum calcium, and PTH. BMC Women\u2019s Health, 13.","key":"ref_19","DOI":"10.1186\/1472-6874-13-33"},{"doi-asserted-by":"crossref","unstructured":"Lotito, A., Teramoto, M., Cheung, M., Becker, K., and Sukumar, D. (2017). Serum Parathyroid Hormone Responses to Vitamin D Supplementation in Overweight\/Obese Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients, 9.","key":"ref_20","DOI":"10.3390\/nu9030241"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.arcped.2017.11.011","article-title":"Impact of obesity on biomarkers of iron and vitamin D status in children and adolescents: The risk of misinterpretation","volume":"25","author":"Frelut","year":"2018","journal-title":"Arch. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1017\/S0007114515003189","article-title":"Determinants of parathyroid hormone response to vitamin D supplementation: A systematic review and meta-analysis of randomised controlled trials","volume":"114","author":"Moslehi","year":"2015","journal-title":"Br. J. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jsbmb.2018.10.011","article-title":"Effect of 16-weeks vitamin D replacement on calcium-phosphate homeostasis in overweight and obese adults","volume":"186","author":"Mesinovic","year":"2019","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1210\/jc.2013-3978","article-title":"Vitamin D treatment in primary hyperparathyroidism: A randomized placebo controlled trial","volume":"99","author":"Rolighed","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","first-page":"1019","article-title":"The Relationship between Vitamin D Levels and Iron Deficiency and Anemia in Adults Applied for Periodic Medical Examination","volume":"66","author":"Ozen","year":"2020","journal-title":"Clin. Lab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"519","DOI":"10.2174\/1871530318666181029160242","article-title":"Vitamin D Status in Egyptian Adolescent Females with Iron Deficiency Anemia and Its Correlation with Serum Iron Indices","volume":"19","author":"Zahran","year":"2019","journal-title":"Endocr. Metab. Immune Disord. Drug Targets"},{"doi-asserted-by":"crossref","unstructured":"Malczewska-Lenczowska, J., Sitkowski, D., Surala, O., Orysiak, J., Szczepanska, B., and Witek, K. (2018). The Association between Iron and Vitamin D Status in Female Elite Athletes. Nutrients, 10.","key":"ref_27","DOI":"10.3390\/nu10020167"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/ejcn.2011.140","article-title":"Impact of gender on vitamin D deficiency in morbidly obese patients: A cross-sectional study","volume":"66","author":"Johnson","year":"2012","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1093\/ajcn\/86.4.959","article-title":"The effects of seasonal variation of 25-hydroxyvitamin D and fat mass on a diagnosis of vitamin D sufficiency","volume":"86","author":"Bolland","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"doi-asserted-by":"crossref","unstructured":"Maeda, S.S., Kunii, I.S., Hayashi, L.F., and Lazaretti-Castro, M. (2010). Increases in summer serum 25-hydroxyvitamin D (25OHD) concentrations in elderly subjects in Sao Paulo, Brazil vary with age, gender and ethnicity. BMC Endocr. Disord., 10.","key":"ref_30","DOI":"10.1186\/1472-6823-10-12"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1038\/sj.ejcn.1600561","article-title":"Determining factors in the iron status of adult women in the SU.VI.MAX study. SUpplementation en VItamines et Mineraux AntioXydants","volume":"52","author":"Galan","year":"1998","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1046\/j.1523-5408.2002.05505.x","article-title":"The effect of calcium consumption on iron absorption and iron status","volume":"5","author":"Harris","year":"2002","journal-title":"Nutr. Clin. Care"},{"doi-asserted-by":"crossref","unstructured":"Zitt, E., Sprenger-Mahr, H., Mundle, M., and Lhotta, K. (2015). Efficacy and safety of body weight-adapted oral cholecalciferol substitution in dialysis patients with vitamin D deficiency. BMC Nephrol., 16.","key":"ref_33","DOI":"10.1186\/s12882-015-0116-3"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jsbmb.2016.08.004","article-title":"Physiological functions of Vitamin D in adipose tissue","volume":"165 Pt B","author":"Abbas","year":"2017","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/obr.12239","article-title":"Obesity and vitamin D deficiency: A systematic review and meta-analysis","volume":"16","author":"Costa","year":"2015","journal-title":"Obes. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"126","DOI":"10.4103\/2008-7802.195212","article-title":"Effects of Iron on Vitamin D Metabolism: A Systematic Review","volume":"7","author":"Vafa","year":"2016","journal-title":"Int. J. Prev. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1093\/qjmed\/hct089","article-title":"Cardiorespiratory fitness in males, and upper limbs muscular strength in females, are positively related with 25-hydroxyvitamin D plasma concentrations in European adolescents: The HELENA study","volume":"106","author":"Valtuena","year":"2013","journal-title":"QJM Int. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1038\/ijo.2015.148","article-title":"Serum 25-Hydroxyvitamin D associated with indicators of body fat and insulin resistance in prepubertal chilean children","volume":"40","author":"Cediel","year":"2016","journal-title":"Int. J. Obes."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4621","DOI":"10.1210\/jc.2015-2956","article-title":"Vitamin D, Muscle Function, and Cardiorespiratory Fitness in Adolescents From the Young Hearts Study","volume":"100","author":"Carson","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/obr.12016","article-title":"Serum 25-hydroxy vitamin D levels in relation to body mass index: A systematic review and meta-analysis","volume":"14","author":"Saneei","year":"2013","journal-title":"Obes. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/ajcn\/72.3.690","article-title":"Decreased bioavailability of vitamin D in obesity","volume":"72","author":"Wortsman","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1111\/apa.13363","article-title":"Vitamin D deficiency is associated with prediabetes in obese Swedish children","volume":"105","author":"Ekbom","year":"2016","journal-title":"Acta Paediatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/jhn.12025","article-title":"The double burden of obesity and iron deficiency on children and adolescents in Greece: The Healthy Growth Study","volume":"26","author":"Manios","year":"2013","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1007\/s00394-016-1155-7","article-title":"A review of iron studies in overweight and obese children and adolescents: A double burden in the young?","volume":"55","author":"Hutchinson","year":"2016","journal-title":"Eur. J. Nutr."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/12\/2119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:42:06Z","timestamp":1760146926000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/12\/2119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,15]]},"references-count":44,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["life12122119"],"URL":"https:\/\/doi.org\/10.3390\/life12122119","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2022,12,15]]}}}