Insufficiency and shortage of vitamin D are now widespread illnesses [1]. Vitamin D is a family of fat-soluble prohormones that comes in various forms, including D2 (ergocalciferol) and D3 (cholecalciferol) [2]. It is an essential steroid involved in bone metabolism, cell proliferation, differentiation and mineral regulation in the body [3]. The primary function of vitamin D is to enhance calcium absorption from the small intestine [4]. Despite ample sunlight in the region, Saudi Arabia continues to experience a high prevalence of vitamin D deficiency. Approximately 76.1% of the population is affected by this deficiency, with the youngest age group (30-40 years) exhibiting the highest percentage of deficiency [5].   In 2020, research was conducted among the Saudi adult population and the result has shown a lowest score of 0 and a maximum score of 14; it has been demonstrated that the average score was 9.64±2.5 [6].   Studies have been published on the awareness of vitamin D deficiency in the general population in Jeddah, Saudi Arabia. Reported that the average score for knowledge was 5.9±1.7 (or 39.3%). Benefits knowledge was scored at 3.6±1.2 (60%). For sources, the mean knowledge score was 2.8 1.6 (35%), while for toxicity, it was 0.3±0.1 (30%) [7]. Saudi Arabian cities are characterized by average knowledge and awareness about vitamin D deficiency. In Al-Baha region, 41.7% of participants had a diagnosis of vitamin D deficiency, while 96.8% of participants were aware of vitamin D. When compared to male participants (36.3%), a startlingly high percentage of female participants (49.1%) had a diagnosis of vitamin D deficiency (p-value = 0.009) [8].   This study is essential because it addresses an important gap in the knowledge base of prior research on the subject. Numerous studies have been carried out in various areas, such as the Al-Qassim region in Saudi Arabia in 2018, where there was a significant association between overall awareness of vitamin D and consumption of at least two sources of vitamin D in men (p = 0.001) but not in women (p = 0.920). Despite having higher awareness than men, women had significantly less exposure to the sun. Additionally, Ibrahim et al. [1] study found that vitamin D deficiency and insufficiency are extremely common in Saudi Arabia's Central, Western and Eastern regions.   Similar to globally, a 2018 study in Pakistan found that university students had poor knowledge of vitamin D despite being a high-risk population. Interventions are required to raise public awareness of vitamin D's significance to health (Amina).   These studies have shed important light on the significance of adults in Saudi Arabia being aware of vitamin D deficiency, with certain areas demonstrating a severe lack of awareness across all regions. A recent and comprehensive assessment of Saudi Arabia's general population as a whole is, however, lacking. Therefore, our research proposal aims to fill this gap by conducting an updated study on a large sample size that represents all regions of Saudi Arabia. By including participants from various regions, we can ensure that our findings are representative of the entire population and provide a more accurate understanding of the Knowledge and awareness of vitamin D deficiency among adults in Saudi Arabia.   Objectives The objective of this cross-sectional study is to assess the knowledge, attitude and practice of vitamin D deficiency among adults in Saudi Arabia.

Study Design This is a cross-sectional descriptive study on vitamin D deficiency awareness was followed STROBE guidelines, conducted in the Kingdom of Saudi Arabia (KSA), a country in West Asia, from August 2023 to March 2025.   Study Setting Participants, Recruitment and Sampling Procedure: The study focused on Saudi Arabian adults aged 18 and above as the target population. Participants were recruited in September 2023 from individuals who received the questionnaire.   Sample Size The study sample was determined by the Raosoft calculator. Keeping a response distribution of 50%, a margin of error of 5% and a confidence level of 95%, the calculated sample size was 377.   Method for Data Collection and Instrument (Data Collection Technique and Tools) A cross-sectional survey was conducted using the Knowledge, Attitude and Practice (KAP) regarding vitamin D questionnaire. The questionnaire consisted of 47 questions divided into five sections: demographic information, general knowledge, nutrition knowledge, attitude and practice. The demographic information included age, gender, nationality and residential area. D-KAP-38 included 11 general knowledge items, 5 nutrition knowledge items, 12 attitude items and 10 practice items. The possible responses are Yes/No/I don’t know options. Some questions are rated on a 5 Likert scale with the possible responses of “strongly disagree to strongly agree,” and some questions are rated on a 5 Likert scale with the possible responses of never/rarely/sometimes/often/always.   The validity and reliability of the questionnaire were tested in a pilot study with 30 individuals who were not part of the main sample. The Cronbach’s alpha coefficient for the knowledge and awareness sections was 0.82 and 0.79, respectively, indicating good internal consistency.   Scoring System About 47 questions in our survey include 38 questions about general knowledge, nutrition knowledge, attitude and practice. General knowledge. The possible responses are “Yes/No/I don’t know,” which should be scored as 2/0/1, respectively. Hence, the total raw scores of “general knowledge” ranged from 0 to 22, which proportionately transformed to 0-100. Nutrition Knowledge The possible responses are “Yes/No/I don’t know” and the scores of 0/2/1 are respectively allocated to all of them except for Q21, which should be inversely scored as 2/0/1. Total raw scores of “nutrition knowledge” ranged from 0 to 10, which proportionately transformed to 0-100. Attitude: The related questions are rated on a 5 Likert scale with the possible responses of “strongly disagree to strongly agree” and the allocated scores of 1 to 5, respectively. Total raw scores of attitudes range from 12 to 60 and proportionately transform to 0-100. Practice: The related questions are rated on a 5 Likert scale with the possible responses of “never/rarely/sometimes/often/always”. The scores of 1 to 5 allocated to the responses of questions 38, 39, 40,41, 43 and 45 and other questions should be scored inversely. The raw scores of “practices” ranged from 10 to 50 and were then proportionately transformed to 0-100.   Analysis and Entry Method   Collected Data was entered on a computer using the Microsoft Excel program (2016) For Windows. Data was then transferred to the Statistical Package for Social Science Software (SPSS) program, version 20. To be statistically analyzed

Table 1 displays various demographic parameters of the participants with a total number of (383). The respondents' mean age was 30.1 years and the standard deviation was 12.9. The age distribution was very diverse, 21-24 years, with 33.4% of the sample. Overall, 59.3% were females and all were Saudi nationals. Most of the 68.9% were unmarried and highly educated, 79.6% with a bachelor's degree.   Makkah was geographically the leading residential region (49.1%) and most participants had a monthly income below 5000 SAR (59.3%). In terms of occupation, 30.8% of students and 24.3% were unemployed. Among participants who examined social interaction, 54.8% regarded the internet as the one most often accessed in pursuing their social impulses.   As shown in Figure 1, in our comprehensive medical research study examining the knowledge, attitude and practice regarding vitamin D deficiency among adults in Saudi Arabia, a total sample of 383 individuals was analyzed to identify key findings. Notably, the data revealed that a significant majority, comprising 336 participants, acknowledged their awareness of potential vitamin D deficiency, underscoring a heightened consciousness of this health issue among the population. Conversely, only 15 respondents reported a lack of awareness, while 32 participants expressed uncertainty about their knowledge on the subject.   Table 2 shows findings from the study of knowledge, attitudes and practice of vitamin D deficiency among adults in Saudi Arabia provides valuable insights into public awareness and misperception of a critical health issue. A large majority of participants (87.7%) were aware that individuals working indoors are at greater risk for vitamin D deficiency and 86.9% were also aware of   Table 1: Sociodemographic characteristics of participants (n = 383) Parameter Number Percentage Age (Mean:30.1, STD:12.9) 18 to 20 76 19.8 21 to 24 128 33.4 25 to 45 95 24.8 46 or more 84 21.9 Gender Female 227 59.3 Male 156 40.7 Nationality Saudi 383 100.0 Non-Saudi 0 0 Marital status Single 264 68.9 Married 114 29.8 Widowed 5 1.3 Educational level Primary 8 2.1 High school 32 8.4 Diploma 20 5.2 Bachelor’s degree 305 79.6 Postgraduate 18 4.7 Residential region Riyadh 82 21.4 Eastern region 69 18.0 Qassim 37 9.7 Madinah 7 1.8 Makkah 188 49.1 Monthly income Less than 5000 227 59.3 5000 to 10000 63 16.4 10001 to 15000 34 8.9 More than 15000 59 15.4 Occupation Student 118 30.8 Healthcare sector 36 9.4 Nonhealthcare sector 48 12.5 Unemployed 93 24.3 Others 88 23.0 Sources of socialising Relatives and friends 145 37.9 Internet 210 54.8 Hospitals or clinics 5 1.3 Others 23 6.0   Table 2: Parameters related to general and nutritional knowledge regarding vitamin D (n = 383) Parameter Number Percentage People who work indoors are at high risk of vitamin D deficiency No 15 3.9 I don’t know 32 8.4 Yes 336 87.7 Vitamin D intake more than the dietary recommendations could be harmful No 12 3.1 I don’t know 37 9.7 Yes 334 87.2 Elderly people are at high risk of vitamin D deficiency No 6 1.6 I don’t know 44 11.5 Yes 333 86.9 Inappropriate dietary intakes are related to vitamin D deficiency No 44 11.5 I don’t know 56 14.6 Yes 283 73.9 Vitamin D supplement intake requirements differ for different age groups No 22 5.7 I don’t know 20 5.2 Yes 341 89.0 Pregnant and lactating women are at high risk of vitamin D deficiency No 25 6.5 I don’t know 97 25.3 Yes 261 68.1 Most of the vitamin D required is produced when the skin is directly exposed to the sun No 43 11.2 I don’t know 65 17.0 Yes 275 71.8 Currently, vitamin D deficiency is one of the most important health issues in our country No 8 2.1 I don’t know 40 10.4 Yes 335 87.5 Bone pain and fatigue are among the vitamin D deficiency No 10 2.6 I don’t know 71 18.5 Yes 302 78.9 Vitamin D supplement intake requirements differ in various seasons of the year No 122 31.9 I don’t know 114 29.8 Yes 147 38.4 Both men and women are at risk of vitamin D deficiency No 10 2.6 I don’t know 5 1.3 Yes 368 96.1 Fatty fish are one of the main dietary sources of vitamin D No 37 9.7 I don’t know 137 35.8 Yes 209 54.6 Dairy products are one of the main dietary sources of vitamin D No 78 20.4 I don’t know 129 33.7 Yes 176 46.0 Eggs are one of the main dietary sources of vitamin D No 62 16.2 I don’t know 138 36.0 Yes 183 47.8 Meat and poultry are the main dietary sources of vitamin D No 92 24.0 I don’t know 143 37.3 Yes 148 38.6 Fruits are one of the main dietary sources of vitamin D No 84 21.9 I don’t know 82 21.4 Yes 217 56.7       Figure 1: Illustrates whether people who work indoors have a high risk of vitamin D deficiency among participants   the same risk among the elderly. Eighty-seven point two per cent of respondents affirmed they believe vitamin D intake could be harmful if taken in excess. Significantly, 73.9% cited improper dietary intakes as contributing to deficiency and 89.0% concluded that vitamin D supplement requirements are different in each age group. In addition, 68.1% could identify pregnant and lactating women as being at risk and 71.8% understood that a high percentage of vitamin D is produced in the skin by exposure to sunlight.   As shown in Figure 2, A notable aspect of the study pertains to the impact of urbanization on sun exposure and, consequently, vitamin D synthesis. Specifically, 148 respondents agreed that urbanization hinders sun exposure   Table 3: Participants’ attitude regarding vitamin D (n = 383) Parameter Number Percentage Urbanization prevents sun exposure and production of required vitamin D Agree 148 38.6 Strongly agree 59 15.4 Disagree 57 14.9 Strongly disagree 8 2.1 No idea 111 29.0 A shortage of public places for outdoor activities prevents the sun exposure required for production of vitamin D Agree 145 37.9 Strongly agree 126 32.9 Disagree 31 8.1 Strongly disagree 15 3.9 No idea 66 17.2 Full time indoor occupation prevents the sun exposure required for production of vitamin D Agree 176 46.0 Strongly agree 173 45.2 Disagree 5 1.3 Strongly disagree 7 1.8 No idea 22 5.7 Inefficient education regarding benefits of sun exposure prevents production of required vitamin D through sun exposure Agree 162 42.3 Strongly agree 107 27.9 Disagree 30 7.8 No idea 84 21.9 The undesirable taste of sea foods for Iranians is one of the barriers to their consumption of dietary sources of vitamin D Agree 53 13.8 Strongly agree 43 11.2 Disagree 22 5.7 Strongly disagree 19 5.0 No idea 246 64.2 In vitamin D deficiency, supplement intake is more effective compared to dietary intake and sun exposure Agree 157 41.0 Strongly agree 109 28.5 Disagree 63 16.4 Strongly disagree 19 5.0 No idea 35 9.1 Taking vitamin D supplement, unless recommended by physicians is wrong Agree 183 47.8 Strongly agree 123 32.1 Disagree 36 9.4 No idea 41 10.7 Unwillingness of individuals to take vitamin D supplements is one of the barriers of providing this nutrient Agree 159 41.5 Strongly agree 97 25.3 Disagree 32 8.4 No idea 95 24.8 Taking supplements is necessary for treatment of vitamin D deficiency but not for its prevention Agree 158 41.3 Strongly agree 134 35.0 Disagree 20 5.2 Strongly disagree 24 6.3 No idea 47 12.3 Permanent use of sunscreens on face, neck and hands prevents the sun exposure required for production of vitamin D Agree 35 9.1 Strongly agree 59 15.4 Disagree 128 33.4 Strongly disagree 26 6.8 No idea 135 35.2 Taking supplement is only necessary in case of lack of exposure to sunlight Agree 127 33.2 Strongly agree 91 23.8 Disagree 90 23.5 Strongly disagree 18 4.7 No idea 57 14.9 A high expense of dietary sources of vitamin D is one of the barriers of providing this nutrient Agree 88 23.0 Strongly agree 78 20.4 Disagree 61 15.9 No idea 156 40.7   necessary for vitamin D production, while an additional 59 strongly agreed with this assertion. In contrast, 57 participants disagreed and 8 strongly disagreed; however, 111 remained uncertain.   Table 3 shows a great part of respondents admitted that urbanization (54%; combined agree/strongly agree) as well as the lack of public outdoor spaces (70.8%; combined agree/strongly agree) made the sun exposure needed to produce vitamin D impossible to obtain. In fact, almost all participants (91.2%) understood that the lack of sun is inherent to full time indoor occupations. Education was a key factor whereby 70.2% of patients agreed that poor awareness of the benefits of sun exposure is part of the causal chain of vitamin D deficiency. Most   Table 4: Practice level regarding vitamin D (n = 383) Parameters Number Percentage For sufficient exposure to sunlight I regularly engage in outdoor physical activities Never 58 15.1 Sometimes 152 39.7 Always 38 9.9 Often 48 12.5 Rarely 87 22.7 To be vitamin D sufficient, I consume fortified milk Never 43 11.2 Sometimes 118 30.8 Always 30 7.8 Often 65 17.0 Rarely 127 33.2 In order to be vitamin D sufficient, I consume fish at least twice a week Never 74 19.3 Sometimes 85 22.2 Always 33 8.6 Often 41 10.7 Rarely 150 39.2 For sufficient exposure to sunlight I walk outdoors daily Never 52 13.6 Sometimes 115 30.0 Always 60 15.7 Often 64 16.7 Rarely 92 24.0 I use caps/hats to avoid severe sun exposure Never 98 25.6 Sometimes 63 16.4 Always 83 21.7 Often 78 20.4 Rarely 61 15.9 To be vitamin D sufficient, I take vitamin D supplements Never 53 13.8 Sometimes 142 37.1 Always 79 20.6 Often 66 17.2 Rarely 43 11.2 I use sunscreen on my hands Never 98 25.6 Sometimes 88 23.0 Always 88 23.0 Often 34 8.9 Rarely 75 19.6 During the day I am directly exposed to sunlight (outdoors) Never 36 9.4 Sometimes 130 33.9 Always 68 17.8 Often 42 11.0 Rarely 107 27.9 During the day I am indirectly exposed to sunlight (through glass) Never 32 8.4 Sometimes 89 23.2 Always 90 23.5 Often 85 22.2 Rarely 87 22.7 I use sunscreen on my face Never 76 19.8 Sometimes 84 21.9 Always 98 25.6 Often 111 29.0 Rarely 14 3.7       Figure 2: Illustrates whether urbanization prevents sun exposure and production of vitamin D among participants   participants held the belief that supplement intake is better than dietary sources, with 69.5% in agreement that supplement intake is preferable to nutritional status, yet this group included a notable (79.9%) opinion that supplement intake without physician recommendation is inappropriate.   Table 4 shows results of this study on the knowledge and practice and attitude on vitamin D deficiency among adults in Saudi Arabia provided some insights on the practices toward vitamin D sufficiency. Further, a large proportion of participants reported infrequent outdoor physical activity, i.e. having participated in outdoor physical activity at least once a month among 39.7% and never among 15.1%. Additionally, dietary practices   Table 5: Shows general knowledge of vitamin D score results Knowledge level Frequency Percent High general knowledge level 244 63.7 Moderate general knowledge 127 33.2 Low general knowledge level 12 3.1 Total 383 100.0   Table 6: Shows nutrition knowledge about vitamin D score results Knowledge level Frequency Percent High nutrition knowledge level 34 8.9 Moderate nutrition knowledge 81 21.1 Low nutrition knowledge 268 70.0 Total 383 100.0   Table 7: Shows attitude of vitamin D score results Knowledge level Frequency Percent High attitude level 110 28.7 Moderate attitude level 256 66.8 Low attitude level 17 4.4 Total 383 100.0   Table 8: Shows practice of vitamin D score results Knowledge level Frequency Percent High practice level 117 30.5 Moderate practice level 225 58.7 Low practice level 41 10.7 Total 383 100.0   followed a troubling track, as 33.2% of respondents consumed fortified milk rarely, half of whom (16.3%) claimed not to consume any dairy products, while 39.2% of respondents said they do not eat fish at least twice a week, both of which are important to have enough vitamin D. Vitamin D supplements were used by 37.1% of participants sometimes and 20.6% said they always used them. Furthermore, the data revealed that many people keep their hands and faces out of direct sun, with 25.6% never applying sunscreen to their hands ever and 19.8% never putting sunscreen on their faces.   Table 5 shows the findings of my research on the knowledge, attitude and practice regarding vitamin D deficiency among adults in Saudi Arabia reveal that a significant majority exhibits a high level of general knowledge about vitamin D, with 63.7% of participants scoring highly in this area, encompassing a total of 244 individuals. Meanwhile, 33.2% of the respondents demonstrated a moderate level of knowledge, amounting to 127 individuals, while a small minority, consisting of only 3.1% or 12 participants, displayed a low level of general knowledge.   Table 6 shows findings from my medical research article, which investigates the knowledge, attitude and practices related to vitamin D deficiency among adults in Saudi Arabia, reveal concerning trends in nutritional awareness. As demonstrated in Table 6, the results indicate that only 8.9% of participants exhibited a high level of nutrition knowledge regarding vitamin D, while 21.1% displayed moderate knowledge. Alarmingly, the majority-70.0%-of respondents reported low levels of nutritional knowledge in this area.   Table 7 shows findings from the medical research article examining the knowledge, attitudes and practices regarding vitamin D deficiency among adults in Saudi Arabia illuminate significant trends in public perception. As illustrated in Table 7, the results reveal that a predominant 66.8% of participants exhibited a moderate attitude towards vitamin D, while only 28.7% demonstrated a high level of awareness, suggesting a substantial gap in optimal understanding. Notably, a minimal 4.4% of respondents reflected a low attitude level, indicating that most individuals have at least some recognition of the importance of vitamin D.   Table 8 shows findings of this study, which aimed to assess the knowledge, attitudes and practices concerning vitamin D deficiency among adults in Saudi Arabia, revealing significant insights into the practices related to vitamin D intake. As indicated in Table 8, the categorization of practice levels among the 383 participants illustrates that only 30.5% exhibited a high level of practice regarding vitamin D supplementation and lifestyle choices aligned with sufficient vitamin D levels. In contrast, a substantial majority, 58.7%, demonstrated a moderate practice level, suggesting that while some awareness and actions are present, they may not be sufficient to prevent deficiency. Alarmingly, 10.7% of respondents reported low practice levels.   Table 9 shows that general knowledge about vitamin D has statistically significant relation to age (p-value = 0.038), marital status (p-value = 0.0001), educational level (p-value = 0.0001), residential region (p-value = 0.0001), monthly income (p-value = 0.004), occupation (p-value = 0.0001) and sources of socialising (p-value = 0.0001). It also shows a statistically insignificant relation to gender.   Table 10 shows attitude level regarding vitamin D has statistically significant relation to educational level (p-value = 0.0001), residential region (p-value = 0.001),   Table 9: Relation between general knowledge about vitamin D and sociodemographic characteristics Parameters General knowledge level Total (N = 383) p-value* High general knowledge level Moderate or low general knowledge Gender Female 150 77 227 0.244 61.5% 55.4% 59.3% Male 94 62 156 38.5% 44.6% 40.7% Age 18 to 20 49 27 76 0.038 20.1% 19.4% 19.8% 21 to 24 71 57 128 29.1% 41.0% 33.4% 25 to 45 61 34 95 25.0% 24.5% 24.8% 46 or more 63 21 84 25.8% 15.1% 21.9% Marital status Single 156 108 264 0.0001 63.9% 77.7% 68.9% Married 88 26 114 36.1% 18.7% 29.8% Widowed 0 5 5 0.0% 3.6% 1.3% Educational level Primary 8 0 8 0.0001 3.3% 0.0% 2.1% High school 27 5 32 11.1% 3.6% 8.4% Diploma 5 15 20 2.0% 10.8% 5.2% Bachelor’s degree 186 119 305 76.2% 85.6% 79.6% Postgraduate 18 0 18 7.4% 0.0% 4.7% Residential region Riyadh 54 28 82 0.0001 22.1% 20.1% 21.4% Eastern region 43 26 69 17.6% 18.7% 18.0% Qassim 12 25 37 4.9% 18.0% 9.7% Madinah 7 0 7 2.9% 0.0% 1.8% Makkah 128 60 188 52.5% 43.2% 49.1% Monthly income Less than 5000 143 84 227 0.004 58.6% 60.4% 59.3% 5000 to 10000 31 32 63 12.7% 23.0% 16.4% 10001 to 15000 29 5 34 11.9% 3.6% 8.9% More than 15000 41 18 59 16.8% 12.9% 15.4% Occupation Student 51 67 118 0.0001 20.9% 48.2% 30.8% Healthcare sector 36 0 36 14.8% 0.0% 9.4% Nonhealthcare sector 11 37 48 4.5% 26.6% 12.5% Unemployed 78 15 93 32.0% 10.8% 24.3% Others 68 20 88 27.9% 14.4% 23.0% Sources of socialising Relatives and friends 106 39 145 0.0001 43.4% 28.1% 37.9% Internet 115 95 210 47.1% 68.3% 54.8% Hospitals or clinics 5 0 5 2.0% 0.0% 1.3% Others 18 5 23 7.4% 3.6% 6.0% *p-value was considered significant if ≤0.05   Table 10: Attitude level regarding vitamin D in association with sociodemographic characteristics Parameters Attitude level Total (N = 383) p-value* High attitude level Moderate or low attitude level Gender Female 67 160 227 0.678 60.9% 58.6% 59.3% Male 43 113 156 39.1% 41.4% 40.7% Age 18 to 20 15 61 76 0.193 13.6% 22.3% 19.8% 21 to 24 37 91 128 33.6% 33.3% 33.4% 25 to 45 33 62 95 30.0% 22.7% 24.8% 46 or more 25 59 84 22.7% 21.6% 21.9% Marital status Single 83 181 264 0.112 75.5% 66.3% 68.9% Married 27 87 114 24.5% 31.9% 29.8% Widowed 0 5 5 0.0% 1.8% 1.3% Educational level Primary 0 8 8 0.0001 0.0% 2.9% 2.1% High school 0 32 32 0.0% 11.7% 8.4% Diploma 2 18 20 1.8% 6.6% 5.2% Bachelor’s degree 104 201 305 94.5% 73.6% 79.6% Postgraduate 4 14 18 3.6% 5.1% 4.7% Residential region Riyadh 23 59 82 0.001 20.9% 21.6% 21.4% Eastern region 18 51 69 16.4% 18.7% 18.0% Qassim 11 26 37 10.0% 9.5% 9.7% Madinah 7 0 7 6.4% 0.0% 1.8% Makkah 51 137 188 46.4% 50.2% 49.1% Monthly income Less than 5000 55 172 227 0.054 50.0% 63.0% 59.3% 5000 to 10000 22 41 63 20.0% 15.0% 16.4% 10001 to 15000 9 25 34 8.2% 9.2% 8.9% More than 15000 24 35 59 21.8% 12.8% 15.4% Occupation Student 17 101 118 0.0001 15.5% 37.0% 30.8% Healthcare sector 14 22 36 12.7% 8.1% 9.4% Nonhealthcare sector 11 37 48 10.0% 13.6% 12.5% Unemployed 41 52 93 37.3% 19.0% 24.3% Others 27 61 88 24.5% 22.3% 23.0% Sources of socialising Relatives and friends 32 113 145 0.043 29.1% 41.4% 37.9% Internet 66 144 210 60.0% 52.7% 54.8% Hospitals or clinics 1 4 5 0.9% 1.5% 1.3% Others 11 12 23 10.0% 4.4% 6.0% *p-value was considered significant if ≤0.05   occupation (p-value = 0.0001) and sources of socialising (p-value = 0.043). It also shows statistically insignificant relation to gender, age, marital status and monthly income.

The purpose of the present study was to assess adults’ knowledge, attitudes and practices regarding vitamin D deficiency in Saudi Arabia. Since the vast majority of the population reportedly suffers from vitamin D deficiency in this region, this investigation is particularly important. The results of this study show a great deal of general knowledge about vitamin D, as evidenced by participant responses but as well a disconcertingly low nutritional awareness regarding the dietary sources of vitamin D. In this discussion we shall compare these findings to the results of previous studies and discuss their similarities and discrepancies, as well as the limitations of this study.   Our observation of a very high level of general knowledge of vitamin D, as well as the knowledge mentioned in this study among the populations is above 63.7% that indicates high level of awareness similar with findings by Aljefree et al. [9], who reported widely different knowledge on vitamin D between populations in Saudi Arabia, some of which know relatively well. Nevertheless, poor levels of nutritional knowledge were found about vitamin D; only 8.9% of participants had a high level of knowledge of nutrition. Findings from Al-Faris et al. [10], that traditional foods of Saudi Arabia are poor sources of vitamin D, as also noted here, support this. A big problem with this lack of awareness about dietary sources of vitamin D is that even if they know how vital vitamin D is, it means that they don’t know how to make dietary decisions that could help prevent a deficiency.   In addition, the study found that although the majority of the participants have understood the risks of vitamin D deficiency, such as the vulnerability of the indoor working population and the elderly, there is no correlation between knowledge and practice. For example, only 39.7% of participants said they engaged in outdoor physical activity at least once a month, key to vitamin D synthesis through sunlight exposure. As in the work of Al-Othman et al. [11], this finding is echoed in work showing that physical activity and sun exposure significantly contribute to levels of vitamin D status in children and adolescents in Saudi Arabia. Our finding of the low levels of outdoor activity among adults may reflect findings that broader societal trends, such as urbanization and lifestyle changes that prioritize indoor activities, may be barriers to the levels of sun exposure necessary for optimum vitamin D synthesis.   Furthermore, attitudes toward vitamin D supplementation were divided: A large number of participants felt that supplements are better than dietary sources. This view is in accordance with Hariri [12] who reported how the Saudi population relies on supplements for vitamin D, despite dietary sources that may supply sufficient vitamin D. It's a positive aspect of the overall attitude toward supplementation that 79.9% of participants were concerned that supplementation should be along recommended by a physician, indicating a recognition of the need of professional guidance in managing vitamin D intake.   Demographically we found that there was a strong relation of education with the awareness and attitude towards vitamin D deficiency. The vast majority was highly educated-79.6% had a bachelor's degree. Consistent with Alfaris et al. [13] observations, it is found that education increases awareness about vitamin D deficiency and its diseases. However, despite high educational levels, the many gaps in nutritional knowledge suggest that educational interventions need to be tailored for specific knowledge deficits about dietary sources and the significance of sun exposure.   However, limitations of the present study are its cross-sectional design, which prohibits the making of any inference of causality between knowledge, attitudes and practices around vitamin D deficiency. Furthermore, applying it is reliant on self-reported data that may involve bias as such as participants reporting more information than they truly possess on vitamin D. Additionally, the sample used for the study was mostly young and educated and may not fully reflect the broader Saudi public. Future studies should aim to include a more diverse demographic to better understand vitamin D awareness across different age groups, educational backgrounds and socioeconomic statuses.

While the study of the present study indicates a good level of general knowledge about vitamin D among Saudi adults, it also points out a significant lack of nutritional awareness and actual use of such knowledge. Our findings underscore the urgent need for targeted educational interventions aimed not only at raising awareness of vitamin D but also atfacilitating easy measures to boost dietary intake and sun exposure. Ultimately, closing these gaps is necessary to reduce the prevalence of vitamin D deficiency, which is extremely high in Saudi Arabia and improve public health.   Acknowledgement We acknowledge all of the volunteers who provided samples for this research.   Conflicts of Interest The authors declare no conflict of interest.   Ethical Approval After fully explaining the study and emphasizing that participation is optional, each participant gave their informed consent. The information gathered was safely stored and utilized exclusively for study.