Vitamin D and bone mineral density status of healthy schoolchildren in northern India

Oral vs. injected: which vitamin D boost works best for low levels?

OBJECTIVES

Vitamin D is essential for maintaining bone and mineral balance. This study aims to identify the most effective route for achieving optimal vitamin D levels (≥30 ng/mL) to support bone and mineral health.

METHODS

In this open-label randomized trial, 132 participants aged 18-60 with initial serum vitamin D levels below 30 ng/mL were divided into three intervention groups: daily 800 I.U. oral tablet (Group A), weekly 60,000 I.U. oral sachet (Group B), and monthly 300,000 I.U. intramuscular injection (Group C). The study assessed changes in their serum vitamin D levels at six and 12 weeks.

RESULTS

The monthly intramuscular (IM) group consistently had the highest mean vitamin D levels at six weeks 38.38(±9.953) (p<0.002) and 12 weeks 48.15(±7.71) (p<0.001). Vitamin D insufficiency was reduced to 34.8 % at six weeks (p=0.434) and 6.8 % at 12 weeks (p=0.002). Notably, 100 % of the monthly IM group achieved vitamin D sufficiency at 12 weeks.

CONCLUSIONS

The monthly IM route demonstrated superior effectiveness compared to tablets and sachets at both the 6-week and 12-week points. A significantly larger number of monthly IM participants achieved vitamin D sufficiency compared to the other groups.

Vitamin D status and determinants in Indian children and adolescents: a multicentre study

Studies performed on Indian children to assess vitamin-D status have been on small sample sizes, limited to specific geographical locations and used non-standard methods to measure 25(OH)D₃. This multicentre study assessed 25(OH)D₃ concentrations from dried blood spots (DBS) in 5–18-year-old Indian children and adolescents using a standardized protocol and identified factors contributing towards vitamin D deficiency. Cross-sectional, observational school-based study was conducted by multi-stage stratified random sampling. A city and nearby village were selected from 6 Indian states covering wide geographical areas. Demography, anthropometry, body-composition, dietary-intakes and DBS samples were collected. 25(OH)D₃ was assessed from DBS using Liquid chromatography with tandem-mass spectrometry. Vitamin-D status was assessed in 2500 children; with additional data collected on a subset (n = 669) to assess predictors. Mean vitamin-D concentration was 45.8 ± 23.9 nmol/L, 36.8% of subjects had sufficient vitamin-D (> 50 nmol/L); rural subjects and boys had higher concentrations (p < 0.05). On regression analysis, younger age, female-gender, overweight and urban residence significantly contributed to deficiency. More than half the Indian children/adolescents were vitamin-D deficient or insufficient. Our study reinforces vitamin-D deficiency as a major public health problem and the need for supplementation, food fortification and educating the population as initiatives required to improve sufficiency status.

High burden of hypovitaminosis D among the children and adolescents in South Asia: a systematic review and meta-analysis

BACKGROUND

Vitamin D is vital for the growth and development of children. While deficiency and/or insufficiency of vitamin D among South Asian children are frequently reported in the literature, the lack of a meta-analysis has left its true extent poorly characterized. In this study, we aimed to conduct a systematic review and perform meta-analyses of the prevalence of hypovitaminosis D among the children of the South Asian countries.

METHODS

Two major electronic search engines (PubMed and Scopus) and one database (Google scholar) were used; original studies, conducted among South Asian children and adolescents and published between 1 January 2001 and 31 December 2019. A random-effect meta-analysis was also performed to calculate the pooled prevalence of hypovitaminosis D followed by subgroup analyses for countries and age groups.

RESULTS

After applying inclusion and exclusion criteria, a total of 41 studies with a total population size of 18,233 were finally selected. The overall prevalence of hypovitaminosis D was 61% [95% CI: 46% to 71%] with highly significant heterogeneity (I2 = 99.72%; p < 0.0001). The average level of serum vitamin D ranged from 5 ng/mL to 34 ng/mL, with a weighted mean of 19.15 ng/mL (weighted standard deviation 11.59 ng/mL). Country-wise analysis showed that hypovitaminosis D in Afghanistan was the highest [96.2%; 95% CI: 91% to 99%], followed by Pakistan [94%; 95% CI: 90% to 96%], India [64%; 95% CI: 46% to 79%], Bangladesh [35.48%; 95% CI: 32% to 39%], Nepal [35%; 95% CI: 1% to 83%], and Sri Lanka [25%; 95% CI: 16% to 36%]. Age group analyses revealed that hypovitaminosis D was most prevalent among neonates [85%; 95% CI: 76% to 91%], followed by school-going children [57%; 95% CI: 33% to 80%], and preschool children [55%; 95% CI: 35% to 75%].

CONCLUSION

This study generates quantitative evidence and specific extent of hypovitaminosis D in the South Asian countries as a public health concern. Being the first systematic review for this region, results from this study will create awareness and will facilitate adopting mitigation strategies by the policymakers and the governments to address this problem.

Sunlight, dietary habits, genetic polymorphisms and vitamin D deficiency in urban and rural infants of Bangladesh

We conducted an observational study to assess the prevalence and risk factors of vitamin D deficiency in 12–24 months old children living in urban and rural Bangladesh. Serum 25-hydroxyvitamin D (free 25(OH)D) level, socio-demographic status, anthropometric status, dietary intake, exposure to sunlight and single nucleotide polymorphisms in vitamin-D pathway genes were measured in 208 children. Vitamin D deficiency (free 25(OH)D < 50 nmol/l) was reported in 47% of the children. Multivariable logistic regression model identified duration to sunlight exposure (regression coefficient, β =  − 0.01; 95% CI 0.00, − 0.02; p-value < 0.05), UV index (β =  − 0.36; 95% CI 0.00, − 0.02; p-value < 0.05) and breast-feeding (β =  − 1.15; 95% CI − 0.43, − 1.86; p-value < 0.05) to be negatively associated with vitamin D deficiency. We measured the role of single nucleotide polymorphisms in pathway genes (GC-rs7041 T > G, rs4588 C > A, CYP2R1-rs206793 A > G, CYP27B1-rs10877012 A > C and DHCR7-rs12785878 G > T) and found statistically significant differences in serum vitamin D levels between various genotypes. SNPs for CYP27B1 (CA & CC genotype) had statistically significant positive association (β = 1.61; 95% CI 2.79, 0.42; p-value < 0.05) and TT genotype of GC-rs7041 had negative association (β =  − 1.33; 95% CI − 0.02, − 2.64; p-value < 0.05) with vitamin-D deficiency in the surveyed children.

Assessment of Practice and Factors associated with Sunlight Exposure of Infants among Mothers in Debre Berhan Town, North Shewa Zone, Amhara Region, Ethiopia

Background

Vitamin D deficiency is a common worldwide problem with its prevalence magnified in infants. Prevalence in infants is believed to range from 2.7% to 45% in different countries of the world. Appropriate sunlight exposure of skin is thought to be vital for the prevention of vitamin D deficiency. However, due to a dearth of study the practice of sunlight exposure is incompletely understood. Thus, assessing practice and factors affecting sunlight exposure of infants by mothers was relevant.

Objective

To assess practice level and factors associated with sunlight exposure of infants by mothers in Debre Berhan town, North Showa, Ethiopia, 2019.

Materials and Methods

A community-based cross-sectional study was conducted to collect relevant data among 530 mothers with infants at selected kebeles in Debre Berhan town. A simple random sampling technique was used to select kebeles and systematic sampling was complemented to identify study participant. Data were collected with interview using a pre-tested structured and semi-structured questionnaire. Bivariable and multivariable logistic regressions were run to examine the association among dependent and independent variable. Significant association was declared at P value ≤0.05.

Results

All the mothers were interviewed and 65.7% of them had good practice in sunning of their infant. In multi-variable analysis, mothers who are housewives or government employees, have a maternal age of 33 and above, perceive that sunlight strengthen infant bones, perceive that sunlight makes their infants healthier, and who got information from health-care professionals were significantly associated with good practice in sunning of their infant.

Conclusion and Recommendation

Finding of this study indicated that 34.3% of participants have poor practice in sunning of infants. This is a pointer that sunlight exposure of infants still needs attention from the government and other concerned bodies.

Concentration levels of serum 25-Hydroxyvitamin-D and vitamin D deficiency among children and adolescents of India: a descriptive cross-sectional study

Background

Vitamin D is an essential micronutrient for the overall health and well-being of individuals. For strong musculoskeletal and neurological development of human body, vitamin D levels during childhood and adolescence have key importance. This is the first national-level study that analyzes the deficiency and concentration of serum 25-Hydroxyvitamin D [25(OH)D)] among Indian children and adolescents with respect to various demographic and socioeconomic characteristics.

Methods

Data of Comprehensive National Nutrition Survey (CNNS, 2016–18) was utilized for the present study. Vitamin D levels were assessed based on serum 25-hydroxyvitamin D concentration. Prevalence of vitamin D deficiency has been shown for the three age groups: 0–4 years (n = 12,764), 5–9 years (n = 13,482), 10–19 years (n = 13,065). Vitamin D deficiency was defined as: serum 25(OH)D < 12 ng/mL; and insufficiency as: 12 ng/ml ≤ 25(OH) < 20 ng/ml. 25(OH) D level higher than 20 ng/mL was accepted as adequate. Random slope multilevel logistic regression models were employed to assess the demographic and socioeconomic correlates of vitamin D deficiency.

Results

Mean serum 25(OH)D concentration level was found to be 19.51 ± 8.76, 17.73 ± 7.91, and 17.07 ± 8.16 ng/ml in age group 0–4 years, 5–9 years and 10–19 years respectively. 49.12% of the children aged 0–4 years were having insufficient level of vitamin D. Prevalence of vitamin D deficiency was comparatively higher among female adolescents (76.16%), adolescents living in rural region (67.48), Sikh individuals (0–4 years: 76.28%; 5–9 years: 90.26%; 10–19 years: 89.56%), and adolescents coming from rich households. North-Indian individuals were having substantially higher odds of vitamin D deficiency in all the three age groups.

Conclusion

The present study demonstrated that the prevalence of vitamin D deficiency is considerably high among children and adolescents of India. The study highlights high-risk group which require prompt policy interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02803-z.

Prevalence of Low Level of Vitamin D Among COVID-19 Patients and Associated Risk Factors in India - A Hospital-Based Study

Background

The world is facing the most challenging pandemic in the 21st century. The developed and developing countries are facing the burden equally and no proven treatment options available. Recent studies suggest the plausibility of vitamin D therapy and prophylaxis for COVID-19, in the setting where the deficiency is more prevalent. Though evaluation of vitamin D status is not a routine in India, the present study focuses on the level of Vitamin d among COVID-19 patients.

Methods

The study was a hospital-based cross-sectional to find the status of vitamin D among COVID-19 patients in a tertiary care hospital, Patna, Bihar, India. The demographic, comorbidity data were taken, and the level of vitamin D was measured by a chemiluminescence-based immunoassay analyzer. The analysis compared the level of deficiency and insufficiency among different groups of COVID-19 patients. The role of DM and HTN as risk factors for mortality was compared.

Results

Among the total study participants (156), 42.31% were obese and 17.31% were severe as per clinical severity. The total prevalence of vitamin D deficiency was 58.97% and insufficiency was 89.1%. The prevalence was found high among male (61.02%), overweight (65.52%), and severe (62.96%) patients. The severity increases with advanced age (p<0.05) and important risk factors for mortality are DM, HTN, and advanced age.

Conclusion

The level of vitamin D can be assessed for the prognosis of COIVD-19 patients and help to modify the treatment protocol. Appropriate therapeutic/preventive intervention of vitamin D can alter the course and severity of COVID-19.

The Influence of Sunlight Exposure and Sun Protecting Behaviours on Allergic Outcomes in Early Childhood

The dramatic rise in allergic disease has occurred in tandem with recent environmental changes and increasing indoor lifestyle culture. While multifactorial, one consistent allergy risk factor has been reduced sunlight exposure. However, vitamin D supplementation studies have been disappointing in preventing allergy, raising possible independent effects of ultraviolet (UV) light exposure. The aim of this study was to examine whether UV light exposure influences the development of allergic disease in early childhood. Direct sunlight exposure (290-380 nm) in early infancy was measured via UV dosimeters. Outdoor exposure, sun protective behaviours, and allergy outcomes were assessed over the first 2.5 years of life with clinical assessment appointments at 3, 6, 12 and 30 months of age. Children with eczema had less (p = 0.038) direct UV light exposure between 0-3 months of age (median (IQR) 747 (473-1439) J/m²) than children without eczema (median (IQR) 1204 (1717-1843) J/m²); and less outdoor exposure time (7 min/day) between 11 a.m. and 3 p.m. compared to children without eczema (20 min/day, p = 0.011). These associations were seen independent of vitamin D status, and after adjusting for other potential confounders. Whilst we could not find any associations between direct UV light exposure and other allergic disease outcomes, exposure to UV light appears to be beneficial in reducing the risk of eczema development in early childhood. Further research is required to determine optimal levels of UV light exposure while balancing the potential risks.

Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study

Objective  To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures.

Methods  The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups.

Results  The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B ( p  < 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012).

Conclusion  Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.

Prevalence and Risk Factors for Hypovitaminosis D among Healthy Adolescents in Kota Bharu, Kelantan

OBJECTIVE

We aim to study the prevalence and risk factors of hypovitaminosis D among healthy adolescents in Kota Bharu, Kelantan based on the most recent Paediatric Consensus guideline.

METHODOLOGY

Ten public schools were selected from Kota Bharu, Kelantan. We analysed their demography (age, gender, ethnicity, income), measured their anthropometry (height, weight, BMI) and finally analysed their vitamin D and intactParathyroid hormone levels.

RESULTS

The prevalence of hypovitaminosis D was 16.9% among healthy teenagers with mean age of 15.9±1.39 years. Multivariate analysis showed female gender (adjusted OR, 95% CI): 23.7 (5.64, 100.3) and Chinese 0.24 (0.07, 0.84) were the significant predictors for hypovitaminosis D.

CONCLUSION

The prevalence of healthy adolescents with hypovitaminosis D in Kota Bharu, Kelantan was 16.9% using the most recent cut off value of 30 nmol/L from the global consensus 2016. Female and Malay were the significant risk factors associated with hypovitaminosis D. Higher cut off value would result in overestimation of prevalence rate of hypovitaminosis D.

Evaluating Vitamin D levels in Rheumatic Heart Disease patients and matched controls: A case-control study from Nepal

Background

Diagnosis and treatment for Rheumatic Heart Disease (RHD) is inaccessible for many of the 33 million people in low and middle income countries living with this disease. More knowledge about risk factors and pathophysiologic mechanisms involved is needed in order to prevent disease and optimize treatment. This study investigated risk factors in a Nepalese population, with a special focus on Vitamin D deficiency because of its immunomodulatory effects.

Methods

Ninety-nine patients with confirmed RHD diagnosis and 97 matched, cardiac-healthy controls selected by echocardiography were recruited from hospitals in the Central and Western region of Nepal. Serum 25(OH)D concentrations were assessed using dried blood spots and anthropometric values measured to evaluate nutritional status. Conditional logistic regression analysis was used to define association between vitamin D deficiency and RHD.

Results

The mean age of RHD patients was 31 years (range 9–70) and for healthy controls 32 years (range 9–65), with a 4:1 female to male ratio. Vitamin D levels were lower than expected in both RDH and controls. RHD patients had lower vitamin D levels than controls with a mean s-25(OH)D concentration of 39 nmol/l (range 8.7–89.4) compared with controls 45 nmol/l (range 14.5–86.7) (p-value = 0.02). People with Vitamin D insufficiency had a higher risk (OR = 2.59; 95% CI: 1.04–6.50) of also having RHD compared to people with Vitamin D concentrations >50 nmol/l. Body mass index was significantly lower in RHD patients (22.6; 95% CI, 21.5–23.2) compared to controls (24.2; 95% CI, 23.3–25.1).

Conclusion

RHD patients in Nepal have lower Vitamin D levels and overall poor nutritional status compared to the non-RHD controls. Longitudinal studies are needed to explore the causality between RHD and vitamin D level. Future research is also recommended among Nepali general population to confirm the low level of vitamin D as reported in our control group.

Changing Trend in Vitamin D Status from 2008 to 2016: An Experience from a Tertiary Care Institute in North India

BACKGROUND

Serum 25-hydroxyvitamin D (25(OH)D) assays have become readily available in India over the past decade. A large number of cross-sectional studies have been performed on the vitamin D status and the prevalence of vitamin D deficiency (VDD) in India. However, seasonal and long-term trends in serum 25(OH)D levels have been reported less frequently.

AIM

To determine the seasonal and year-wise variation in vitamin D status at a tertiary care hospital in north India.

MATERIALS AND METHODS

Using hospital records, the data on serum 25(OH) D assays performed in its endocrinology laboratory between 2008 and 2016 were obtained. For analysis of seasonal trends, the months of a year were divided into following seasons: March to June (summer season), July to October (rainy season), and November to February (winter season). VDD was defined as serum 25(OH)D concentration <20 ng/mL.

RESULTS

A total of 26,339 assays of serum 25(OH)D were analyzed in the study. The year-wise assay numbers increased steadily from 2008 to peak in the year 2012, followed by a decline and a second smaller peak in the year 2016. The mean serum 25(OH)D concentration increased from 19.1 ± 16.4 ng/mL in 2008 to 21.7 ± 17.1 ng/mL in 2016 (P = 0.02). Between 2008 and 2016, the prevalence of VDD decreased from 71.9% to 54.3% in females, and from 56.7% to 52.1% in males. The levels in rainy season were significantly higher as compared to winters and summers (P < 0.05 for both). Hypervitaminosis D (serum 25(OH)D >100 ng/mL) and vitamin D toxicity (serum 25(OH)D >150 ng/mL) were seen in 319 (1.2%) and 27 (0.1%) assays, respectively.

CONCLUSIONS

This study provides data on seasonal and year-wise trends in vitamin D status over a long period of time at a tertiary care hospital in north India. A long-term trend toward improving vitamin D status, especially in females, was noted in the study. The prevalence of VDD was found to decrease in the analyzed samples during the study period.

Association of Vitamin D and Parathyroid Hormone Levels in Overweight and Obese Adolescents

Vitamin D deficiency in known to be high in obese and overweight adolescents. Few studies in other countries have shown lower parathyroid hormone (PTH) levels in obese adolescents despite high vitamin D deficiency. The aim of the study is to assess vitamin D and PTH levels and their relationship in overweight and obese adolescents in Telangana. This cross-sectional study was carried out in 108 overweight and obese boys and girls aged 12-18 years. A pretested Questionnaire was administered to collect information on demographics, sun exposure, medical and nutritional history. Anthropometry and blood sample was collected for estimating 25 hydroxy vitamin D, and PTH. Body mass index Z scores (WHO growth standards) were used for assessing overweight and obesity in adolescents. 54.6% of the subjects were boys. Mean (SD) levels of vitamin D and PTH were 18.25 (9.26) ng/mL and 45.39 (28.23) ng/L respectively. The prevalence of vitamin D deficiency and insufficiency in the current study was 54.6% and 25.9% respectively. However, PTH levels were high only in 24.2% of subjects (> 65 ng/L). There was an inverse but non-significant correlation between vitamin D and PTH. The association was same after adjusting for age, gender and weight. Our study highlights the high prevalence of vitamin D deficiency among overweight and obese adolescents in Telangana. Despite high vitamin D deficiency, very few had high PTH levels and the vitamin D-PTH axis may be altered in overweight and obese adolescents.

Cross-sectional Study on Vitamin D Levels in Stress Urinary Incontinence in Women in a Tertiary Referral Center in India

OBJECTIVE

To assess the levels of vitamin D in patients with Stress Urinary Incontinence (SUI) in gynecology clinic of All India Institute of Medical Sciences, New Delhi.

MATERIALS AND METHODS

This is a cross sectional study on a total of 40 women presenting to gynecology outpatient department with stress urinary incontinence diagnosed by history and examination. The women were divided with moderate, severe and very severe SUI confirmed by incontinence severity index (ISI) and pad test. Vitamin D (serum 25 OH D) levels were measured in all cases by electrochemiluminenscene Immunoassay (ECLIA) using Roche Elecsys 2010 and levels of =30 ng/ml were taken as sufficient while levels between 20-30 ng/ml as insufficient and <20 ng/ml as deficient. Statistical analysis was performed using ANOVA test with P value of <0.05 taken as significant.

RESULTS

Mean age of patients was 41.6 years. Mean parity was 2.73 and mean duration of symptoms was 4.14 years. Vitamin D levels ranged between 6-38 ng/ml with mean being 17.15±8.1 ng/ml. Levels were deficient (<20 ng/ml) in 30 (75%) women, insufficient (20-30ng/ml) in 7 (17.5%) women and sufficient (>30ng/ml) in 3 (7.57%) women. There was no significant correlation between severely of SUI and levels of vitamin D with Vit D being 19.18±5.76 ng/ml in moderate SUI, 16.96±9.03 ng/ml in severe SUI and 13.60 ± 2.09 ng/ml in very severe SUI.

CONCLUSION

There was very high prevalence of vitamin D deficiency in SUI patients with 75% patients showing deficient levels and 17.5% showing insufficient levels in SUI patients. There is need to provide vitamin D supplementation in such women.

Prevalence of hypovitaminosis D in India & way forward

Deficiency of vitamin D or hypovitaminosis D is widespread irrespective of age, gender, race and geography and has emerged as an important area of research. Vitamin D deficiency may lead to osteoporosis (osteomalacia in adults and rickets in children) along with calcium deficiency. Its deficiency is linked with low bone mass, weakness of muscles and increased risk of fracture. However, further research is needed to link deficiency of vitamin D with extra-skeletal consequences such as cancer, cardiovascular disease, diabetes, infections and autoimmune disorders. The causes of vitamin D deficiency include length and timing of sun exposure, amount of skin exposed, latitude, season, level of pollution in atmosphere, clothing, skin pigmentation, application of sunscreen, dietary factors and genetic factors. The primary source is sunlight, and the dietary sources include animal products such as fatty fish, food items fortified with vitamin D and supplements. Different cut-offs have been used to define hypovitaminosis D and its severity in different studies. Based on the findings from some Indian studies, a high prevalence of hypovitaminosis D was observed among different age groups. Hypovitaminosis D ranged from 84.9 to 100 per cent among school-going children, 42 to 74 per cent among pregnant women, 44.3 to 66.7 per cent among infants, 70 to 81.1 per cent among lactating mothers and 30 to 91.2 per cent among adults. To tackle the problem of hypovitaminosis D in India, vitamin D fortification in staple foods, supplementation of vitamin D along with calcium, inclusion of local fortified food items in supplementary nutrition programmes launched by the government, cooperation from stakeholders from food industry and creating awareness among physicians and the general population may help in combating the problem to some extent.

Bone Health, Body Composition, and Vitamin D Status of Black Preadolescent Children in South Africa

Optimal bone health is important in children to reduce the risk of osteoporosis later in life. Both body composition and vitamin D play an important role in bone health. This study aimed to describe bone health, body composition, and vitamin D status, and the relationship between these among a group of conveniently sampled black preadolescent South African children (n = 84) using a cross-sectional study. Body composition, bone mineral density (BMD), and bone mineral content (BMC) were assessed using dual x-ray absorptiometry. Levels of 25-hydroxyvitamin D (25(OH)D) (n = 59) were assessed using dried blood spots. A quarter (25%) of children presented with low bone mass density for their chronological age (BMD Z-score < -2) and 7% with low BMC-for-age (BMC Z-score < -2), while only 34% of the children had sufficient vitamin D status (25(OH)D ≥ 30 ng/mL). Lean mass was the greatest body compositional determinant for variances observed in bone health measures. Body composition and bone health parameters were not significantly different across vitamin D status groups (p > 0.05), except for lumbar spine bone mineral apparent density (LS-BMAD) (p < 0.01). No association was found between bone parameters at all sites and levels of 25(OH)D (p > 0.05). Further research, using larger representative samples of South African children including all race groups is needed before any conclusions and subsequent recommendation among this population group can be made.

Cardiovascular Risk Factors and Their Association with Vitamin D Deficiency in Mexican Women of Reproductive Age

Based on a nationally representative sample of young Mexican women aged 20 to 49 years (n = 3260), we sought to explore whether cardiovascular risk factors and acute myocardial infarction (AMI) were associated with vitamin D deficiency (VDD, defined as 25-OH-D <50 nmol/L). To this end, we obtained sociodemographic, serum and anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). Analyses were developed through logistic regression models adjusted for potential confounders. The prevalence of VDD was significantly higher in obese women (42.5%, 95% CI; 37.3–47.9) compared to women with a normal body mass index (29.9%, 95% CI; 23.5–37.1, p = 0.05), in those with high total cholesterol (TC) (45.6% 95% CI; 39.4–51.9) compared to those with normal TC levels (33.9%, 95% CI 30–38.1, p = 0.03), and in those with insulin resistance (IR) (44%, 95% CI; 36.9–51.7) or type 2 diabetes mellitus (T2DM) (58.6%, 95% CI 46.9–69.4) compared to those with normal glycemia (no insulin resistance: 34.7%, 95% CI; 30.9–38.8, p = 0.04 and no T2DM: 34.9%, 95% CI 31.4–38.6, p < 0.001). Utilizing individual models to estimate cardiovascular risk according to VDD, we found that the odds of being obese (odds ratio, OR: 1.53, 95% CI 1.02–2.32, p = 0.05), or having high TC levels (OR: 1.43, 95% CI; 1.05–2.01, p = 0.03), T2DM (OR: 2.64, 95% CI; 1.65–4.03, p < 0.001), or IR (OR: 1.48, 95% CI 1.04–2.10, p = 0.026) were significantly higher in women with VDD (p < 0.05). Odds were not statistically significant for overweight, high blood pressure, sedentarism, AMI, high serum concentration of triglycerides, homocysteine, or C-reactive protein models. In conclusion, our results indicate that young Mexican women with VDD show a higher prevalence of cardiovascular risk factors.

Vitamin D Deficiency in the Gulf Cooperation Council: Exploring the Triad of Genetic Predisposition, the Gut Microbiome and the Immune System

Vitamin D is a fat soluble secosteroid that is primarily synthesized in the skin upon exposure to Ultraviolet B (UVB) sun rays. Vitamin D is essential for the growth and development of bones and helps in reducing inflammation by strengthening muscles and the immune system. Despite the endless supply of sunlight in the Gulf Cooperation Council (GCC) countries which includes United Arab Emirates, Qatar, Kuwait, Bahrain, Saudi Arabia, and Oman, Vitamin D deficiency in the (GCC) general population at various age groups remains alarmingly high. In parallel runs the increasing prevalence of acute and chronic illnesses including, autoimmune diseases, cancer, type 1 diabetes mellitus, cardiovascular disease and Inflammatory bowel disease in the adult as well as the pediatric population of these countries. The exact association between Vitamin D deficiency and chronic disease conditions remains unclear; however, studies have focused on the mechanism of Vitamin D regulation by assessing the role of the Vitamin D associated genes/proteins such as VDR (Vitamin D receptor), VDBP (Vitamin D Binding protein), CYP27B1 as these are integral parts of the Vitamin D signaling pathway. VDR is known to regulate the expression of more than 200 genes across a wide array of tissues in the human body and may play a role in controlling the Vitamin D levels. Moreover, reduced Vitamin D level and downregulation of VDR have been linked to gut dysbiosis, highlighting an intriguing role for the gut microbiome in the Vitamin D metabolism. However, this role is not fully described yet. In this review, we aim to expand our understanding of the causes of Vitamin D deficiency in the GCC countries and explore the potential relationship between the genetic predisposition, Vitamin D levels, immune system and the gut microbiome composition. Trying to unravel this complex interaction may aid in understanding the mechanism by which Vitamin D contributes to various disease conditions and will pave the way toward new therapeutics treatments for Vitamin D deficiency and its associated outcomes.

Effect of Vitamin D Supplementation on Bone Turnover Markers in Children and Adolescents from North India

OBJECTIVES

Vitamin D is known to play an important role in bone mineral metabolism. Its deficiency may affect growth and status of bone markers in children. Hence, we undertook to study the status of bone markers in children with vitamin D deficiency (VDD) and impact of vitamin D3 supplementation on them.

MATERIALS AND METHODS

Total 468 out of 615 children and adolescents with VDD, who were given either of the three doses (600, 1000, and 2000) of vitamin D supplementation, were included in the study. These 468 children with pre- and postsupplementation preserved samples with available anthropometry, serum biochemistry, 25-hydroxy-vitamin D, and parathormone were evaluated for bone formation (procollagen type 1 amino-terminal propeptide [P1NP]) and resorption (β-cross laps [CTx]) markers.

RESULTS

The mean age and body mass index of these children were 11.3 ± 2.3 years (boys: 11.5 ± 2.4; girls: 12.2 ± 1.2 years; P = 0.03) and 18.1 ± 3.8 kg/m² (boys: 18.2 ± 3.9; girls: 17.6 ± 3.2 kg/m²; P = 0.208), respectively. There were 8.8% subjects with severe, 42.7% with moderate, and 48.5% with mild VDD. There was a significant decline in serum P1NP (from 691 ± 233 ng/ml to 640 ± 259 ng/ml, P < 0.001) and CTx (from 1.67 ± 0.53 ng/ml to 1.39 ± 0.51 ng/ml, P < 0.001) following supplementation. Though decline in serum P1NP and CTx levels was observed in both boys and girls, among all three supplementation groups and VDD categories, the effect was more marked in serum CTx than P1NP levels.

CONCLUSIONS

Vitamin D supplementation in VDD children resulted in decrease in both bone formation (P1NP) and resorption (CTx). The impact, however, was more marked on bone resorption than bone formation.

Vitamin D Status of School Children in and around Guwahati

CONTEXT

Peripubertal and adolescent children are vulnerable to vitamin D deficiency as this is the period of rapid skeletal growth.

AIMS

This study was done to assess the vitamin D status in school children between the age of 8-14 years attending the government schools in rural and urban areas of Assam in Northeast India.

SETTINGS AND DESIGN

This was a cross-sectional observational study.

MATERIALS AND METHODS

About 500 students (350 from rural and 150 from urban areas) were recruited in the study. Serum 25-hydroxy vitamin-D [25(OH)D], parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase were measured in fasting state. Daily nutrition intake and sunlight exposure were assessed.

STATISTICAL ANALYSIS

Student's t-test and Pearson correlation test were done to assess the association between different variables. P value <0.05 was considered significant.

RESULTS

The prevalence of vitamin D deficiency was 8.4% and vitamin D insufficiency was 14.2%. There was no significant difference of mean 25(OH)D levels and sun exposure between rural and urban children. Out of 42 children with vitamin D deficiency, 36 (85.7%) had sun exposure <20% and 41 (97.6%) had calcium intake < 1000 mg/day. The rural children had a higher calcium intake as compared to urban children (P = 0.005). There was a significant positive correlation of mean 25(OH)D levels with serum calcium, sun exposure and calcium intake.

CONCLUSION

The prevalence of vitamin D deficiency in peripubertal and adolescent age group children in and around Guwahati city of Assam is comparatively lower than that in other parts of the country.

Correlation of Serum Vitamin D Levels in Lactating Mothers and Their Infants

BACKGROUND

Although Vitamin D deficiency is highly prevalent in Indians, data on Vitamin D eficiency in lactating mothers and exclusively breast fed infants is inadequate.

OBJECTIVE

This study was done to evaluate the prevalence of Vitamin D deficiency in lactating mothers and their infants and to find out any correlation between them.

MATERIALS AND METHODS

This hospital based, cross sectional study included 200 healthy infants between 1-30 days and their mothers. Serum sample was collected from both for Ca, inorganic phosphate (IP), alkaline phosphatase (ALP), and 25(OH)D.

RESULTS

Mean serum 25(OH)D level of mothers was 11.33 ± 5.86 ng/ml with a range of 2-37 ng/ml. Hypovitaminosis D was defined as serum 25(OH)D level <10 ng/ml. Almost 94 (47%) of mothers were having hypovitaminosis D. Mean serum 25(OH)D level of infants was 11.92 ± 7.89 ng/dl with a range of 2.5-68 ng/dl. Ninety (45%) infants were having hypovitaminosis D. There was a moderate positive correlation between individual mothers' and infants' serum 25(OH)D values (Pearson coefficient = 0.516, P < 0.001). Using logistic regression, it was found that infants born to mothers with hypovitaminosis D carry a 4.47 times more risk of developing hypovitaminosis D as compared to infants born to mothers with normal serum 25(OH)D (Odds ratio = 4.47, P < 0.001).

CONCLUSION

This study shows a high prevalence of Vitamin D deficiency in lactating mothers and their breastfeeding infants with a positive correlation between them. These results provide a justification for adequate Vitamin D supplementation of all exclusively breastfeeding infants and highlight the urgent need to improve maternal Vitamin D status.

Epidemiology and risk factors of hypovitaminosis D in a cohort of internationally adopted children: a retrospective study

Background

Predictors of hypovitaminosis D were extensively studied in the adult population, leading to an approximately complete understanding of them, while there is a lack of studies in the pediatric population, especially in migrant and internationally adopted children.

In this retrospective study, we tried to identify the major laboratory predictors of hypovitaminosis D in a cohort of internationally adopted children.

Methods

Data were extracted from the database of the “Ethnopediatrics Outpatient Clinic” of the “A. Gemelli” Foundation University Hospital in Rome, Italy. Our study included 873 children evaluated from March 2007 to May 2016. Analysis of variance, chi square test, t test and multivariate logistic regression were performed, a “p” value < 0.05 was considered significant, with a confidence interval of 95%.

Results

We did not find any significant correlation between Vitamin D and Calcium, Phosphates or Magnesium levels within the population we examined. Moreover, parathyroid hormone is not a good predictor of Vitamin D Status.

Conclusions

Considering the strong influence Vitamin D status has not only on bone health, but also on general well-being, it is due to perform a vitamin D assessment as soon as possible, especially in internationally adopted children.

Electronic supplementary material

The online version of this article (10.1186/s13052-018-0527-4) contains supplementary material, which is available to authorized users.

Risk factors of vitamin D deficiency among 15-year-old adolescents participating in the Malaysian Health and Adolescents Longitudinal Research Team Study (MyHeARTs)

Background

This study is to determine the prevalence and risk factors of vitamin D deficiency (vitamin D ≤ 50 nmol/L) among 15-year-old Malaysian adolescents. By identifying potential risk factors, prevention strategies and interventions can be carried out to improve the vitamin D status in adolescents.

Methods and findings

Stratified random sampling design was used to select adolescents from 15 urban and rural secondary schools in Selangor, Perak and Kuala Lumpur, Malaysia. Data collection was carried out from 1^st April 2014 to 30^th June 2014. Information regarding socio-demographic characteristics, sun exposure and sun protective behaviours, clinical data and environmental factors were collected. Blood for total vitamin D was sampled. Descriptive and multivariate logistic regressions were performed. Total 1061 participants were analyzed (62% were female; mean age 15.1 ± 0.4 years). The prevalence of vitamin D deficiency was 33%. Mean vitamin D was lower in female (53 ± 15 nmol), obese (body fat percentage (≥25%^m; ≥33.8%^f) (56 ± 16 nmol/L), Malays (58 ± 18 nmol/L) and Indians (58 ± 15 nmol/L). In multivariate analysis, female (OR = 5.5; 95% CI: 3.4–7.5), Malay (OR = 3.2; 95% CI: 1.3–8.0), Indian (OR = 4.3; 95% CI: 1.6–12.0) and those always wearing long sleeve (OR = 2.4; 95% CI: 1.1–5.4) were more likely to have vitamin D deficiency. For female participants, ethnicity {Malays (OR = 6.7; 95% CI: 2.0–18.5), Indian (OR = 4.5; 95% CI: 1.8–19.3)} was an important risk factors. Cloud cover, school residence, skin pigmentation, sun-exposure and sun-protective behaviours were not significant risk factors. The limitation of this study was recall bias as it relied on self-reported on the sun exposure and protective behaviours. The diet factors were not included in this analysis.

Conclusions

The prevalence of Vitamin D deficiency among Malaysian adolescents was considerable. Gender, ethnicity and clothing style were important risk factors.

Vitamin D Supplementation in Childhood - A Review of Guidelines

Vitamin D, a unique vitamin with endocrine function is required in the human body primarily for calcium homeostasis and possibly several other functions. Deficiency of the vitamin is extremely frequent world-wide. Studies on Indian population place the prevalence of deficiency at 70 to 100% in healthy individuals. There are several guidelines available on definition of vitamin D deficiency and supplementation in healthy children and adults. Sufficiency or deficiency of the vitamin depend upon the levels of 25OHD and various cut-offs are suggested by different groups formulating the guidelines. Although the vitamin is synthesized in the skin with the help of sunlight, it is mostly agreed by various groups that oral supplementation must be done in infants and in certain high risk groups. No such formal guidelines currently exist for Indian children though there is a need to develop one.

The roles of vitamin D and dietary calcium in nutritional rickets

The etiology and pathogenesis of nutritional rickets are becoming progressively clearer. Vitamin D deficiency has generally been considered the major or only player in the pathogenesis of nutritional rickets. However, recent research into calcium deficiency has now provided clinicians with reasons to investigate and manage patients with nutritional rickets more appropriately.

The important question when assessing cases of nutritional rickets is: “Is it calcium or vitamin D deficiency or both that play a major role in the pathogenesis of the disease?”

The case presentation in this review highlights the risk factors, clinical presentation and pathophysiology of nutritional rickets in a young South African black child from a semi-urban area in Johannesburg, a city with abundant sunshine throughout the year.

•

Vitamin D and calcium deficiencies play synergistic roles in nutritional rickets.

•

Dietary calcium intake of <300 mg/day increases the risk of nutritional rickets.

•

Vitamin D status is worsened by dietary calcium deficiency itself.

•

Marked elevation of 1,25-dihydroxyvitamin D is characteristic of calcium deficiency.

•

Preventative strategies needed to decrease the prevalence of nutritional rickets.

Systematic Review on Vitamin D Level in Apparently Healthy Indian Population and Analysis of Its Associated Factors

BACKGROUND

Vitamin D which is involved in the maintenance of bone mineral homeostasis has been found to portray various pleiotropic effects. Although it has been widely accepted that serum 25-hydroxy Vitamin D level above 30 ng/ml is considered optimal for the biological actions of Vitamin D, there is a need to explore the levels of Vitamin D reported among Indians from various regions of the country. Hence, this systematic review aims to appraise the status of Vitamin D levels reported from apparently healthy Indians across various parts of India.

METHODOLOGY

A comprehensive literature search was carried out to identify the range of Vitamin D levels among apparently healthy individuals from various parts of India, with the search term "Vitamin D and India" in the search portals of PubMed, Google Scholar, Indmed, and ScienceDirect. A total of 2998 articles were retrieved by the above search strategy, of which only forty studies fulfilled the criteria to be included in the systematic review. Studies done in various states were compiled under the respective zones based on the classification of Indian zones as specified in Zonal maps of India.

RESULTS

The level of Vitamin D from all the forty included studies ranged from 3.15 ± 1.4 to 52.9 ± 33.7 ng/ml. The effect size of Vitamin D level was higher in the South Zone compared to other zones.

CONCLUSION

The present study shows that Vitamin D deficiency is prevalent among apparently healthy Indians living in different regions of India, irrespective of their exposure to sunlight.

Vitamin D and Chronic Diseases

Vitamin D is one of the essential nutrients to sustain the human health. As a member of the steroid hormone family, it has a classic role in regulating metabolism of calcium and a non-classic role in affecting cell proliferation and differentiation. Epidemiological studies have shown that 25OHD deficiency is closely associated with common chronic diseases such as bone metabolic disorders, tumors, cardiovascular diseases, and diabetes. 25OHD deficiency is also a risk factor for neuropsychiatric disorders and autoimmune diseases. 25OHD deficiency is highly prevalent in the world. It is therefore necessary to know the adverse health effects of 25OHD deficiency, and to design interventions and early treatments for those who are likely to have low levels of 25OHD.

Epidemic of Vitamin D Deficiency and Its Management: Awareness among Indian Medical Undergraduates

Vitamin D deficiency is prevalent across all age groups in epidemic proportions. The purpose of this study was to acquire a baseline assessment and create awareness among medical students regarding vitamin D. A cross-sectional, voluntary survey was conducted among undergraduate medical students. Data were collected using a questionnaire which assessed the level of knowledge students had with regard to where vitamin D comes from, what it does for health, how much is recommended, factors that affect its levels, and deficiency management. Majority of students were unaware that vitamin D deficiency has attained epidemic proportions. Though bone and skeletal disorders as a complication of vitamin D deficiency were known, a large number were unaware of systemic consequences (diabetes mellitus, cardiovascular diseases, and cancers). Only one-third of respondents were aware of duration and timing of sun exposure required for adequate serum vitamin D levels. However, we observed lack of awareness among students regarding the various biochemical forms, dose, and duration of vitamin D supplementation for treatment of nutritional deficiency. Our study highlighted a lack of knowledge about the importance of vitamin D, worldwide prevalence of vitamin D deficiency, and its management among medical students. Promoting vitamin D health awareness, if replicated across populations, could lead to positive health outcomes globally.

Dietary Profiles of First-Generation South Asian Indian Adolescents in the United States

This study aimed to describe the dietary profile and health characteristics of first-generation South Asian Indian (SAI) adolescents in the United States because SAIs have a high prevalence of cardiovascular disease and diabetes, and dietary risk factors for those diseases begin in youth. A descriptive cross-sectional design was used to examine age, gender, usual dietary intake, body composition, blood pressure, blood glucose, and length of residency among 56 first-generation, urban SAI adolescents. Intake of saturated fat exceeded recommendations for all participants, and potassium, magnesium, calcium, vitamin D, and fiber intakes were insufficient in nearly all. Sodium intake exceeded recommendations for most males. Cholesterol intake and sweets consumption was lower among those who lived in the U.S. longer. There were no associations of dietary patterns with health characteristics. Dietary patterns that may increase future disease risk included high saturated fats and low potassium, magnesium, calcium, vitamin D, and fiber.

Nutrient Status of Vitamin D among Chinese Children

Background: Vitamin D deficiency is considered to be a public health problem. However, the nutrient status of vitamin D in Chinese children is unclear. The aim of this study was to describe the vitamin D status among children aged under 18 years in southeast China. Methods: Children who visited the Huzhou Maternal and Child Care Hospital from January 2012 to August 2015 were included in this large cross-sectional study. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by electrochemiluminescence immunoassay. Vitamin D status was defined as deficiency (25(OH)D < 20 ng/mL), insufficiency (25(OH)D: 20–29 ng/mL) and sufficiency (25(OH)D ≥ 30 ng/mL). The association between relevant variables and vitamin D status was analyzed by a using generalized estimated equation model and a multivariate regression model. Results: 13,997 children aged under 18 years were included. Of these, 23.3% children suffered from low vitamin D status (deficiency and insufficiency), while 76.7% had a sufficient vitamin D status. The prevalence of low vitamin D status was 29.7% in winter and 23.4% in spring, which was higher than that in summer (21.4%) and autumn (19.9%). Clinical visiting children (32.1%) suffered more from low vitamin D than health examination children (17.6%). Additionally, age and season were independently and significantly associated with 25(OH)D concentrations, respectively. Conclusions: The deficiency and insufficiency status of vitamin D was very common among newborns and children aged one to 17 years. This indicates that more sunshine and vitamin D–fortified foods are necessary among Chinese children.

Effect of oral versus intramuscular Vitamin D replacement in apparently healthy adults with Vitamin D deficiency

CONTEXT

A number of controversies exist regarding appropriate treatment strategy for Vitamin D deficiency.

AIMS

The aim of this study was to investigate the efficacy of equivalent doses of oral cholecalciferol (60,000 IU weekly for 5 weeks) versus intramuscular (IM) cholecalciferol (300,000 IU) in correcting Vitamin D deficiency in apparently healthy volunteers working in a hospital.

SETTINGS AND DESIGN

Prospective randomized open-label single institution study.

SUBJECTS AND METHODS

This study enrolled 40 apparently healthy adults with Vitamin D deficiency into 2 arms. The oral cholecalciferol group (n = 20) received oral cholecalciferol 60,000 IU weekly for 5 weeks while the IM cholecalciferol group (n = 20) received a single injection of cholecalciferol 300,000 IU. The main outcome measure was serum 25-hydroxyvitamin D (25OHD) levels at baseline, 6 and 12 weeks after the intervention.

STATISTICAL ANALYSIS USED

Differences in serum 25OHD and other biochemical parameters at baseline and follow-up were analyzed using general linear model.

RESULTS

Mean 25OHD level at baseline was 5.99 ± 1.07 ng/mL and 7.40 ± 1.13 ng/mL (P = 0.332) in the oral cholecalciferol and IM cholecalciferol group, respectively. In the oral cholecalciferol group, serum 25OHD level was 20.20 ± 1.65 ng/mL at 6 weeks and 16.66 ± 1.36 ng/mL at 12 weeks. The corresponding serum 25OHD levels in the IM cholecalciferol group were 20.74 ± 1.81 ng/mL and 25.46 ± 1.37 ng/mL at 6 and 12 weeks, respectively. At 12 weeks, the mean 25OHD levels in IM cholecalciferol group was higher as compared to the oral cholecalciferol group (25.46 ± 1.37 vs. 16.66 ± 1.36 ng/mL; P < 0.001).

CONCLUSIONS

Both oral and IM routes are effective for the treatment of Vitamin D deficiency. 25-hydroxyvitamin D levels in the IM cholecalciferol group showed a sustained increase from baseline.

Association between vitamin D status and serum parathyroid hormone concentration and calcaneal stiffness in Japanese adolescents: sex differences in susceptibility to vitamin D deficiency

There is currently insufficient information on serum 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) concentrations, and bone mineral status in healthy adolescents to allow reference values to be set. This study aimed to provide comparable data on vitamin D status in Japanese adolescents and to assess sex differences in susceptibility to vitamin D insufficiency. Serum 25OHD and PTH concentrations were measured in 1,380 healthy adolescents (aged 12-18 years). Subjects completed a questionnaire on exercise history, diet, and lifestyle factors. Calcaneal stiffness was evaluated by quantitative ultrasound. Serum 25OHD concentrations in boys and girls were 60.8 ± 18.3 and 52.8 ± 17.0 nmol/L, respectively. Approximately 30 % of boys and 47 % of girls had suboptimal 25OHD concentrations (<50 nmol/L). Serum PTH concentration was negatively correlated with serum 25OHD concentration in boys, but negatively correlated with calcium intake rather than serum 25OHD in girls. In contrast, the increment in calcaneal stiffness as a result of elevation of serum 25OHD was higher in girls than in boys. As vitamin D deficiency is common in Japanese adolescents, it was estimated that intakes of ≥12 and ≥14 μg/day vitamin D would be required to reach 25OHD concentrations of 50 nmol/L in boys and girls, respectively. Moreover, the results of the present study indicate that vitamin D deficiency has a greater association with calcaneal stiffness in girls than in boys.

Regional and seasonal variations in ultraviolet B irradiation and vitamin D synthesis in India

Evaluation of ultraviolet B index (UVBI) and its impact on vitamin D synthesis is important. We observed the maximum UVBI between 11 am and 1 pm. There was no increase in serum 25(OH)D levels following sun exposure during winter as the UVBI was significantly low, emphasizing the need for vitamin D supplementation during these months.

INTRODUCTION

The amount of vitamin D3 synthesizing UVB irradiation (290-320 nm) reaching the earth's surface at different altitudes and seasons in different parts of India and it's impact on vitamin D synthesis has not been well studied.

METHODS

The hourly UVB index (UVBI) from 10 am to 3 pm everyday for 12 months was measured by a solar meter in 4 different zones (North, Northeast, West and South) of the country. To study the impact of sun light exposure on vitamin D synthesis during winter, healthy school children aged 10-15 years were exposed to sunlight for a period of 30 min per day, between 11 am to 12 noon with 10 % body surface area, for 4 weeks. The main outcome measures were serum 25(OH)D, PTH, calcium, phosphate, and alkaline phosphatase levels before and after sun exposure.

RESULTS

The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. The highest UVBI was recorded from the North zone (4.5 ± 2.7 μW/Cm(2)), while the least was recorded in the Northeast zone (2.1 ± 1.2 μW/Cm(2)). UVBI readings in the Northeast zone were consistently low throughout the year, while all the other three zones showed significant seasonal fluctuations. Surprisingly, we observed a significant decrease in serum 25(OH)D levels from baseline (6.3 ± 4.6 to 5.1 ± 2.7 ng/mL; p < 0.001) despite sun exposure.

CONCLUSION

The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. No increase in the serum 25(OH)D levels was observed following sun exposure in winter, emphasizing the need for vitamin D supplementation during these months.

Serum Vitamin D Status and Outcome among Critically Ill Children Admitted to the Pediatric Intensive Care Unit in South India

OBJECTIVES

To determine the vitamin D status and the association between vitamin D status and the clinical outcome of critically ill children admitted to pediatric intensive care unit (PICU) in South India.

METHODS

Fifty-four consecutive children with medical and surgical diagnoses were included with parental consent. Severity of illness was assessed using PIM-2 score; Sequential Organ Failure Assessment Cardiovascular Score (CV-SOFA) was used to describe vasopressor use. Serum for 25(OH) D levels was obtained as close as possible to the ICU admission. Vitamin D deficiency was defined as serum 25(OH) D level < 20 ng/ml (50 nmol/L). Primary outcome measures were serum 25(OH) D level and in-hospital all cause mortality. Secondary outcomes were illness severity, vasopressor requirement, use of mechanical ventilation and duration of ICU stay.

RESULTS

Of the 54 children, two were excluded due to insufficient serum for vitamin D analysis. Median age was 17.5 mo (IQR = 4.5-78); 38.5 % were infants. Higher age was associated with low vitamin D levels (r s  = -0.34; p 0.01). Median serum 25(OH) D level was 25.1 ng/ml (IQR = 16.2-34.2). Shock (30.8 %), CNS conditions (23.1 %) and respiratory illnesses (21.2 %) were the three most common reasons for admission to the PICU. Vitamin D deficiency was seen in 40.3 % of the critically ill children. Higher PIM score or SOFA score were associated with low vitamin levels (r s  = -0.29, p 0.04 and r s  = -0.29, p 0.05 respectively). Children who were mechanically ventilated had a significantly lower median serum 25(OH) D level than those who were not on ventilation [19.5 ng/ml (IQR = 14.6-27.7)] vs. 32.1 ng/ml[(IQR = 16.5-50.9), p 0.01]. Serum 25(OH) D level was also positively associated with serum calcium levels (r s = 0.32, p 0.03). The proportion of children who died or were discharged terminally at parental request was 23.8 % among those with serum 25(OH) D level < 20 ng/ml as compared to 16.1 % among those with serum 25(OH) D level > 20 ng/ml (p 0.49).

CONCLUSIONS

Vitamin D deficiency is common among pediatric patients admitted to PICU in South India. Low serum 25(OH) D level was associated with higher severity of illness, need for mechanical ventilation, more vasopressor use and lower serum calcium levels. No association between vitamin D status and mortality was demonstrated.

Influence of Vitamin D Receptor Gene Fok1 Polymorphism on Bone Mass Accrual Post Calcium and Vitamin D Supplementation

OBJECTIVE

To examine the association of vitamin D receptor (VDR) gene polymorphisms of the Fok1 locus on bone mass accrual in Indian girls used to a low calcium intake.

METHODS

An intervention trial was undertaken in 102 girls aged 8-16 y, attending a state run school in Pune city, India. All girls received 500 mg calcium daily and 30,000 IU of vitamin D3 quarterly for one year. Dietary calcium intake was evaluated. Bone mineral content (BMC), bone area (BA) and bone mineral density (BMD) were measured at total body using Dual Energy X-ray Absorptiometry (Lunar DPX-PRO). Polymorphisms of the Fok1 locus of the vitamin D Receptor (VDR) gene were detected using SYBR Green quantitative polymerase chain reaction.

RESULTS

The prevalence of Fok1 polymorphism was 43.1% (Ff), 9.8% (ff) and 47.1% (FF). At baseline, FF genotype had significantly lower BMD as compared to ff and Ff genotype (p < 0.05). At baseline, majority of girls (82.4%) were hypocalcemic with low calcium intake. Post-supplementation, FF genotype had significantly lower bone mass as compared to ff and Ff genotype. Significant increase in BMC [Ff (17.9%); ff (18.1%); FF (17.4%)], and BMD [Ff (5.4 %); ff (6.3%); FF (4.8%)] was observed post supplementation (p value < 0.05), though percentage increase in BMC and BMD was similar for three Fok1 polymorphisms (p > 0.1).

CONCLUSIONS

VDR gene polymorphism, as defined by Fok1 genotype had no positive influence on bone mass accrual in response to calcium supplementation.

Vitamin D as a marker of cognitive decline in elderly Indian population

Objectives:

Very few studies in India have addressed the role of vitamin D in cognitive function. The present study was conducted to assess the serum levels of 25-hydroxyvitamin D (25(OH)D) and its association with markers of cognitive impairment and homocysteine levels in the elderly Indian population.

Materials and Methods:

The study population consisted of patients with dementia (Group A, n = 32), mild cognitive impairment (MCI; Group B, n = 24), and elderly age-matched controls (Group C, n = 30). Measurement of serum levels of 25(OH)D and total homocysteine were done.

Results:

Significant decreased concentration of 25(OH)D and increased concentration of homocysteine was observed. Association of serum levels of vitamin D with markers of cognitive decline as well as serum homocysteine levels was observed in patients with dementia and MCI when compared to controls.

Conclusion:

Correlation of vitamin D with markers of cognitive decline and homocysteine opens a new door for early diagnosis of cognitive impairment.

Bone mineral content has stronger association with lean mass than fat mass among Indian urban adolescents

INTRODUCTION

There are conflicting reports on the relationship of lean mass (LM) and fat mass (FM) with bone mineral content (BMC). Given the high prevalence of Vitamin D deficiency in India, we planned the study to evaluate the relationship between LM and FM with BMC in Indian children and adolescents. The objective of the study was to evaluate the relationship of BMC with LM and FM.

MATERIALS AND METHODS

Total and regional BMC, LM, and FM using dual energy X-ray absorptiometry and pubertal staging were assessed in 1403 children and adolescents (boys [B]: 826; girls [G]: 577). BMC index, BMC/LM and BMC/FM ratio, were calculated.

RESULTS

The age ranged from 5 to 18 years, with a mean age of 13.2 ± 2.7 years. BMC adjusted for height (BMC index and BMC/height ratio) was comparable in both genders. There was no difference in total BMC between genders in the prepubertal group but were higher in more advanced stages of pubertal maturation. The correlation of total as well as regional BMC was stronger for LM (B: Total BMC - 0.880, trunk - 0.715, leg - 0.894, arm - 0.891; G: Total BMC - 0.827, leg - 0.846, arm - 0.815 (all value indicate r (2), P < 0.0001 for all) when compared with FM (B: Total BMC - 0.776, trunk - 0.676, leg - 0.772, arm - 0.728; G: Total BMC - 0.781, leg - 0.741, arm - 0.689; all P < 0.0001) except at trunk BMC (LM - 0.682 vs. FM - 0.721; all P < 0.0001), even after controlling for age, height, pubertal stage, and biochemical parameters.

CONCLUSIONS

BMC had a stronger positive correlation with LM than FM.

Vitamin D status and determinants of deficiency in non-supplemented athletes during the winter months in Tunisia

Recent reports suggest that hypovitaminosis D in athletes is as common as in the general population. This study was devised to examine vitamin D status and determinants of deficiency in athletes living in a sunny country (Tunisia). One hundred and fifty national elite athletes, training outdoors (n = 83) or indoors (n = 67), were enrolled from January to February 2012. Plasma 25-hydroxyvitamin D was measured by radioimmunoassay. Concentrations were between 50 and 75 nmol · l^-1 in 21.3% of participants, between 25 and 50 nmol · l^-1 in 55.3% of participants and <25 nmol · l^-1 in 14.7% of participants. The concentrations were significantly lower in indoor athletes than outdoor athletes (36.2±19.0 nmol · l^-1 vs. 49.1±19.2 nmol · l^-1; p < 0.001). In multivariate analysis, vitamin D deficiency (25-hydroxyvitamin D <50 nmol · l^-1) was associated with indoor sports [multi-adjusted odds ratio (95% confidence interval), 5.03 (1.64-15.4); p = 0.005], female gender [3.72 (1.44-9.65); p = 0.007] and age < 18 years [2.40 (1.01-5.85); p = 0.05]. Athletes living in sun-rich environments are exposed to a high risk of vitamin D inadequacy. Given the importance of vitamin D in health and athletic ability, targeting sufficient levels of plasma 25-hydroxyvitamin D in athletes is well justified.

Is the Association between Vitamin D and Cardiovascular Disease Risk Confounded by Obesity? Evidence from the Andhra Pradesh Children and Parents Study (APCAPS)

Background

Evidence of an association between serum vitamin D and cardiovascular disease risk is inconsistent and comes predominantly from studies in high-income settings. We assessed the association between serum levels of 25-hydroxyvitamin D₃ (25(OH)D) and cardiovascular disease risk factors in a population of young Indian adults.

Methods

Cross-sectional analyses of data from APCAPS (Andhra Pradesh Children and Parents Study); a prospective birth cohort study in rural south India. Participants were 1038 (40.3% females) adults aged 18-24 years. Main outcome measures were blood pressures, fasting serum lipids (cholesterols and triglycerides), fasting glucose, insulin, measures of arterial stiffness (aortic augmentation index and aortic pulse wave velocity (aPWV)), carotid intima-media thickness, body mass index (BMI) and body fat (dual X-ray absorptiometry).

Results

Vitamin D deficiency (≤20ng/ml) was observed in 41.1% of this lean (mean BMI: 19.5) and active (mean minutes of moderate or vigorous physical activity per day: 186) population. Vitamin D deficiency was associated with higher median body fat in both males (15.9% body fat in vitamin D deficient males vs. 14.6% in non-deficient males, p<0.05) and females (29.1% body fat in vitamin D deficient females vs. 27.8% in non-deficient females, p<0.05) but no associations were observed between vitamin D deficiency and mean BMI or median fat mass index (FMI). Except a weak inverse association with fasting insulin in males, there was no clear association between serum vitamin D levels and cardiovascular disease risk factors in fully adjusted models.

Conclusions

We did not find clear evidence for an association between serum vitamin D levels and cardiovascular disease risk factors. Our results, consistent with the limited evidence from randomised trials of vitamin D supplementation and Mendelian randomisation experiments, suggest that the postulated link between serum vitamin D and cardiovascular disease may be non-causal. Instead, it may be attributable to confounding by lifestyle factors such as obesity and physical inactivity which may provide more fruitful targets for cardiovascular disease prevention.

Vitamin D deficiency and its predictors in a country with thirteen months of sunshine: the case of school children in central Ethiopia

Studies examining vitamin D status among children living in sunny climates indicated that children did not receive adequate vitamin D, however, this has not been looked at among children living in Ethiopia. In this study, we determined vitamin D deficiency and its predictors among school children aged 11–18 years, examining circulating 25-hydroxy vitamin D [25(OH)D]. The school-based cross-sectional study was conducted in schools in Adama Town (n = 89) and in rural Adama (n = 85) for a total sample of 174. Students were randomly selected using multi-stage stratified sampling method from both settings. Socioeconomic status of parents and demographic, anthropometric, sun exposure status and blood 25(OH)D levels were obtained. Vitamin D deficiency, defined as circulating levels of 25(OH)D <50 nmol/L, was found in 42% of the entire study participants. Prevalence of deficiency was significantly higher among students in urban setting compared to rural (61.8% vs 21.2%, respectively, p<0.001). After controlling for potential confounders using multivariable logistic regression model, duration of exposure to sunlight, amount of body part exposed to sunlight, place of residence, maternal education, body fatness, having TV/computer at home and socioeconomic status were significant predictors of vitamin D deficiency. The findings suggest that Vitamin D deficiency was prevalent in healthy school children living both in urban and rural areas of a country with abundant year round sunshine providing UVB, with the prevalence of deficiency being significantly higher among urban school children who were less exposed to sunlight. Behaviour change communication to enhance exposure to ultraviolet light is critical to prevent vitamin D deficiency in tropical country like Ethiopia. Further study is required to assess the deleterious effect of its deficiency on bone mineral homeostasis of growing children in Ethiopia during their most critical period of bone development.

Coronal alignment of the lower limb and the incidence of constitutional varus knee in korean females

PURPOSE

In total knee arthroplasty (TKA), it is important to restore neutral mechanical alignment. The purpose of this study was to assess whether the lower limb alignment is neutral in healthy Korean females and investigate the incidence of constitutional varus knees among them.

MATERIALS AND METHODS

Weight-bearing full-leg standing radiographs were obtained from 118 healthy females between the ages of 20 to 39 years. One radiologist and two orthopaedic surgeons measured the hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), and femoral anatomic mechanical angle (FAMA) on the radiographs and compared with the traditional gold standard HKAA of 0°, MPTA of 3° varus, and FAMA of 6°.

RESULTS

The interobserver reliability of the three independent observers was high (p<0.001). The HKAA of the study subjects (1.35°±2.04°) was significantly different from the standard HKAA of 0° (p<0.001), but no statistically significant difference was observed in the MPTA (-3.18°±1.61°) and FAMA (5.99°±0.70°) from the standard values (p=0.083 and p=0.887, respectively). The incidence of constitutional varus alignment was 20.34%.

CONCLUSIONS

In Korean females, the mechanical axis of the lower limb was not neutral and the incidence of constitutional varus alignment was slightly higher than that in Western females. We believe that these findings should be taken into consideration in planning reconstructive surgery of the knee, such as TKA, unicompartmental knee arthroplasty, and high tibial osteotomy.

Can vitamin D status be assessed by serum 25OHD in children?

BACKGROUND

To examine the relationship of serum 25-hydroxyvitamin D (25OHD) concentrations with serum parathyroid hormone (PTH) levels, body mass index (BMI), and environmental factors in a population of Caucasian children living at latitude 43°N.

METHODS

Cross-sectional study on 288 children aged 1 month to 13 years who presented to a pediatric emergency unit during a 21-month period.

RESULTS

Mean (SD) serum 25OHD concentrations were 40.6 (17.6), 30.9 (12.0), and 26.4 (9.9) ng/ml (1 ng/ml = 2.5 nmol/l), in children aged 0-1, 2-5, and ≥ 6 years, respectively. Serum PTH levels were 26.6 (13.6), 24.3 (11.9), and 32.7 (12.1) pg/ml in the same groups. Infants had 25OHD concentrations significantly higher. PTH levels were significantly higher in children aged ≥ 6 years. There was no significant correlation between serum 25OHD and PTH concentrations. Totals of 15.6 % and 2.1 % of children had 25OHD values less than 20 and 10 ng/ml, respectively, but none had elevated serum PTH or clinical manifestations related with vitamin D deficiency. Age (inverse correlation) and season (higher values in summer), but not BMI, sex, and time spent outdoors, influenced serum 25OHD concentrations.

CONCLUSIONS

Our results raise doubt on the assumption of only a serum 25OHD threshold as indicative of vitamin D deficiency in children.

Effect of preoperative vitamin D deficiency on postoperative hypocalcemia after thyroid surgery

Background

Transient post thyroidectomy hypocalcemia occurs in up to 30% of patients. We evaluated the effect of vitamin D deficiency on post thyroidectomy hypocalcaemia.

Methods

This is a prospective study which was conducted from November 2010 to January 2013 and a total of 35 patients were included and data was analyzed regarding the relation between preoperative vitamin D3 levels and occurrence of post- thyroidectomy hypocalcemia. Patients were divided into two groups dependent upon the preoperative serum vitamin D level: group 1 with vitamin D levels <20 ng/ml and group 2 with serum vitamin D levels ≥20 ng/ml. Hypocalcemia was defined as a postoperative calcium level <8.5 mg/dl.

Results

There was a difference in postoperative hypocalcemia between the two vitamin D groups. In patients with serum vitamin D ≤20 ng/ml mean pre-operative and post-operative serum calcium levels were 9.3 ± 0.5 and 8.4 ± 0.58 g dl (p < .001) whereas in patients with serum vitamin D levels >20 ng/ml mean pre-operative and post-operative serum calcium were 9.52 ± 0.64 and 8.9 ± 0.5 (p = ns).

Conclusions

Pre-operative serum vitamin D levels have got positive correlation with serum calcium levels in early post-operative period. Patients with serum vitamin D levels <20 ng/ml are highly likely to develop early post-operative hypocalcaemia and the difference between pre-operative and post-operative serum calcium levels in vitamin D deficient patients was significant (p < 0.001).

Vitamin D and skeletal health in infancy and childhood

During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed, rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review, we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however, there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High-quality randomised trials are now required to confirm this benefit.

Vitamin D deficiency in adolescents

The prevalence of severe vitamin D deficiency (VDD) in adolescents is variable but considerably high in many countries, especially in Middle-east and Southeast Asia. Different factors attribute to this deficiency including lack of sunlight exposure due to cultural dress codes and veiling or due to pigmented skin, and less time spent outdoors, because of hot weather, and lower vitamin D intake. A potent adaptation process significantly modifies the clinical presentation and therefore clinical presentations may be subtle and go unnoticed, thus making true prevalence studies difficult. Adolescents with severe VDD may present with vague manifestations including pain in weight-bearing joints, back, thighs and/or calves, difficulty in walking and/or climbing stairs, or running and muscle cramps. Adaptation includes increased parathormone (PTH) and deceased insulin-like growth factor-I (IGF-I) secretion. PTH enhances the tubular reabsorption of Ca and stimulates the kidneys to produce 1, 25-(OH) 2D3 that increases intestinal calcium absorption and dissolves the mineralized collagen matrix in bone, causing osteopenia and osteoporosis to provide enough Ca to prevent hypocalcaemia. Decreased insulin like growth factor-I (IGF-I) delays bone growth to economize calcium consumption. Radiological changes are not uncommon and include osteoporosis/osteopenia affecting long bones as well as vertebrae and ribs, bone cysts, decalcification of the metaphysis of the long bones and pseudo fractures. In severe cases pathological fractures and deformities may occur. Vitamin D treatment of adolescents with VDD differs considerably in different studies and proved to be effective in treating all clinical, biochemical, and radiological manifestations. Different treatment regiments for VDD have been discussed and presented in this mini-review for practical use. Adequate vitamin D replacement after treating VDD, improving calcium intake (milk and dairy products), encouraging adequate exposure to the sun and possible enrichment of the stable food with vitamin D in areas with high prevalence of VDD are important measures to prevent the harmful consequences of VDD.