Culture, Sun Exposure and Vitamin D Deficiency in Benghazi Libya

Background: Vitamin D is produced from sunlight exposure through ultraviolet B radiation of the skin. Several factors affect sunlight exposure include time of day, seasonal variation, lower absorption of vitamin D due to dark skin color, sunscreen use, clothing and coverage for cultural or religious reasons along with behavioral attitudes. There is a dearth of studies looking into socio-cultural and behavioral reasons for vitamin D deficiency in the Middle East particularly in Libya. The aim of this study was to identify sun exposure and cultural influences on vitamin D status among patients attending three out patient clinics in Benghazi.

Methods: A cross-sectional sample of 287 subjects who were attending three polyclinics in Benghazi. 258 females, and 29 males. Data on participants’ attitudes and behaviors in relation to sun exposure, cultural and skin tone preference were collected using interviews and questionnaires.

Results: Duration of sun exposure, use of sun block, wearing long sleeves, believing lighter skin is more attractive than darker and feeling unhappy if the sun made the skin darker were all significantly different between different serum vitamin D level groups and predicted lower vitamin D levels. Vitamin D deficiency was 76.1%, insufficiency was 15.2% and Vitamin D sufficiency was 8.7% in our study.

Conclusion: Culture, attitudes and sun exposure behavior could be major contributing factors to the observed high prevalence of VDD in this study. Circulating concentrations of 25(OH)D was significantly lower in subjects with less sun exposure and in those exhibiting negative attitudes toward sunlight. A more accurate measure for culture, behavior and knowledge and sun exposure in a controlled environment is needed to confirm these findings.