Search

Vitamin D (VitD) is a naturally occurring, fat-soluble vitamin which regulates calcium and phosphate homeostasis in the human body and is also known to have a neuroprotective role. VitD deficiency has often been associated with impaired cognition and a higher risk of dementia. In this study, we aimed to explore the relationship between levels of VitD and cognitive functioning in adult individuals. 982 cognitively healthy adults (≥ 45 years) were recruited as part of the CBR-Tata Longitudinal Study for Aging (TLSA). Addenbrooke's cognitive examination-III (ACE-III) and Hindi mental status examination (HMSE) were used to measure cognitive functioning. 25-hydroxyvitamin D [25(OH)D] levels were measured from the collected serum sample and classified into three groups— deficient (< 20 ng/ml), insufficient (20–29 ng/ml) and normal (≥ 30 ng/ml). Statistical analysis was done using IBM SPSS software, version 28.0.1.1(15). The mean age of the participants was 61.24 ± 9 years. Among 982 participants, 572 (58%) were deficient, 224 (23%) insufficient and only 186 (19%) had normal levels of VitD. Kruskal–Wallis H test revealed a significant difference in age (p = 0.015) and education (p = 0.021) across VitD levels and the Chi-square test revealed a significant association between gender (p = 0.001) and dyslipidemia status (p = 0.045) with VitD levels. After adjusting for age, education, gender and dyslipidemia status, GLM revealed that individuals with deficient (p = 0.038) levels of VitD had lower scores in ACE-III verbal fluency as compared to normal. Additionally, we also found that 91.2% individuals who had VitD deficiency were also having dyslipidemia. It is concerning that VitD deficiency impacts lipid metabolism. Lower levels of VitD also negatively impacts verbal fluency in adult individuals. Verbal fluency involves higher order cognitive functions and this result provides us with a scope to further investigate the different domains of cognition in relation to VitD deficiency and other associated disorders. [ABSTRACT FROM AUTHOR]

Background: The incidence of type 1 diabetes (T1D) is showing a rising trend all over the world, and these patients are living longer than before. With increasing longevity, they are at increased risk of chronic complications including fractures. However, the bone mineral density (BMD) data in T1D patients are conflicting and variable across the studies. Here, we aimed to study the BMD in adult patients with T1D and delineate its predictors. Material and methods: We recruited 40 T1D patients and equal number of age- and sex-matched control subjects. Clinical, biochemical, hormonal, and densitometric assessments were performed for each of the participants and compared between the two groups. Results: The median age of T1D and control subjects was 23.5 (21–27.75) years and 24 (22–26) years, respectively. The median duration of diabetes in T1D patients was 12.5 (9–15.75) years with a mean HbA1C of 8.7 ± 1.9%. The serum corrected calcium, phosphorous, alkaline phosphatase, creatinine, and plasma 25-hydroxyvitamin D and iPTH levels were comparable between the groups. In T1D subjects, the mean lumbar spine and left hip BMD were 0.876 ± 0.154 gm/cm2 and 0.780 ± 0.112 gm/cm2, respectively, which corresponded to mean Z-scores of -1.5 ± 1.4 and -1.4 ± 0.9, respectively, which were significantly lower compared to control group. Multiple linear regression analyses showed that BMI and serum albumin were significant determinant of lumbar spine and hip BMD, respectively, in patients with T1D. Conclusion: Patients of T1D have apparently reduced BMD, which is being influenced by BMI and serum albumin level. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of sunlight exposure and oral vitamin D3 supplementation to achieve vitamin D sufficiency in infants at 6 months of age. Design: Open-label randomized controlled trial. Setting: Public hospital in Northern India (28.7°N). Participant: Breastfed infants at 6–8 weeks of age. Intervention: Randomized to receive sunlight exposure (40% body surface area for a minimum of 30 minutes/week) or oral vitamin D3 supplementation (400 IU/day) till 6 months of age. Outcome: Primary — proportion of infants having vitamin D sufficiency (>20 ng/mL). Secondary — proportion of infants developing vitamin D deficiency (<12ng/mL) and rickets in both the groups at 6 months of age. Results: Eighty (40 in each group) infants with mean (SD) age 47.8 (4.5) days were enrolled. The proportion of infants with vitamin D sufficiency increased after intervention in the vitamin D group from 10.8% to 35.1% (P=0.01) but remained the same in sunlight group (13.9%) and was significant on comparison between both groups (P=0.037). The mean (SD) compliance rate was 72.9 (3.4)% and 59.7 (23.6)% in the vitamin D and sunlight group, respectively (P=0.01). The geometric mean (95% CI) serum 25(OH) D levels in the vitamin D and sunlight group were 16.23 (13.58–19.40) and 11.89 (9.93–14.23) ng/mL, respectively; (P=0.02), after adjusting baseline serum 25(OH)D with a geometric mean ratio of 1.36 (1.06–1.76). Two infants in sunlight group developed rickets. Conclusion: Oral vitamin D3 supplementation is more efficacious than sunlight in achieving vitamin D sufficiency in breastfed infants during the first 6 months of life due to better compliance. [ABSTRACT FROM AUTHOR]

Vitamin D is one of the thoroughly studied risk factors in the pathogenesis of allergic rhinitis (AR). Low serum level of vitamin D is well documented in the urban population of India. The supplementation policy of vitamin D is not uniform among practitioners. The study aims to assess the impact of vitamin D deficiency on AR & long-term quality of life in perennial AR patients with low vitamin D levels after its supplementation in the urban population. The policy for evaluation of serum level of vitamin D & its supplementation in deficit patients in AR is not uniform in our hospital. The data was extracted from the hospital records & the patients came to OPD in the year 2018–2019. Inclusion criteria were the clinical diagnosis (ARIA guideline) of the perennial form of AR where vitamin D assessment was performed before prescribing treatment & the patients received a complete course of vitamin D as per the recommendation followed in our Institute. The patients received oral antihistaminic & topical steroids based nasal spray and were clubbed together as a control group whereas, in the study group, the patients were pooled together who received vitamin D supplementation along with oral antihistaminic & topical steroids based nasal spray. Pre-treatment & post-treatment (at 8 weeks, 6 months, and 12 months) SNOT-22 scores were obtained from the records. The data were analyzed statistically using repeated measures ANOVA test. The study showed a significant decrease in the SNOT-22 score in both Groups in comparison to pre-treatment scores, but post-treatment group comparison was not found statistically significant at each point of comparison. The scores were found on the lower side in the study group at the initial two evaluation points whereas it was higher at the third point of evaluation. This study showed the additional therapeutic effect of vitamin D supplementation as an adjunct in the treatment of perennial AR patients but the effectiveness of the treatment does not last forever so maintenance therapy is required especially in areas following the Indian lifestyle. [ABSTRACT FROM AUTHOR]

Justification: The emerging literature on prevalence of vitamin D deficiency in India, prevention and treatment strategies of rickets, and extra-skeletal benefits of vitamin D suggest the need for revising the existing guidelines for prevention and treatment of vitamin D deficiency in India. Objectives: To review the emerging literature on vitamin D prevalence and need for universal vitamin D supplementation. To suggest optimum vitamin D therapy for treatment of asymptomatic and symptomatic vitamin D deficiency, and rickets. To evaluate the extra-skeletal health benefits of vitamin D in children. Process: A National consultative committee was formed that comprised of clinicians, epidemiologists, endocrinologists, and nutritionists. The Committee conducted deliberations on different aspects of vitamin D deficiency and rickets through ten online meetings between March and September, 2021. A draft guideline was formulated, which was reviewed and approved by all Committee members. Recommendations: The group reiterates the serum 25-hydroxy vitamin D cutoffs proposed for vitamin D deficiency, insufficiency, and sufficiency as <12 ng/mL, 12–20 ng/mL and >20 ng/mL, respectively. Vitamin D toxicity is defined as serum 25OHD >100 ng/mL with hypercalcemia and/or hypercalciuria. Vitamin D supplementation in doses of 400 IU/day is recommended during infancy; however, the estimated average requirement in older children and adolescents (400–600 IU/day, respectively) should be met from diet and natural sources like sunlight. Rickets and vitamin D deficiency should be treated with oral cholecalciferol, preferably in a daily dosing schedule (2000 IU below 1 year of age and 3000 IU in older children) for 12 weeks. If compliance to daily dosing cannot be ensured, intermittent regimens may be prescribed for children above 6 months of age. Universal vitamin D supplementation is not recommended in childhood pneumonia, diarrhea, tuberculosis, HIV and non-infectious conditions like asthma, atopic dermatitis, and developmental disorders. Serum 25-hydroxy vitamin D level of >20 ng/mL should be maintained in children with conditions at high-risk for vitamin deficiency, like nephrotic syndrome, chronic liver disease, chronic renal failure, and intake of anticonvulsants or glucocorticoids. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is a widely prevalent condition with patients in both symptomatic and asymptomatic spectrum. With the lack of routine screening there exists an unknown population of Indian Orthopaedic surgeons who are deficient in Vitamin D and lead to an unexplained loss of quality of work and increased susceptibility to various other diseases. The easiest access to resources for supplementation is available to this group of treating physicians however its use for their personal cure is rarely recognised. This study aims to highlight this endemic disease and to find out its correlation with other parameters Methods: It is a prospective observational study including 150 practicing orthopaedic surgeons from entire India who visited our centre during 3 months duration for various educational meetings. Venous sample was collected after due informed consent and analysed at a single laboratory for 25-OH Cholecalciferol levels by a chemiluminescent assay. All the samples were analysed and a questionnaire was sent to the participants via google forms regarding various parameters under study. Results: The mean serum Vitamin D levels were 18.6 ± 9.67 ng/ml in the sample studied. 17 out of 150 participants (11.3%) were found to have sufficient serum levels of 25(OH) Cholecalciferol. 105 participants (70%) were having deficient levels and 28 (18.7%) had insufficient levels of Vitamin D. Overall 88.7% participants had Vitamin D deficiency among the sample studied. Conclusion: This widespread prevalence of Vitamin D deficiency warrants frequent screening and routine supplementation of Vitamin D in orthopaedic surgeons thereby providing a low cost solution to improve the troublesome situation among healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of hip and vertebral fractures. The increased fracture risk has largely been attributed to poor bone quality and microarchitecture. The contribution of bone quantity, measured as areal bone mineral density (BMD), to the risk of fracture is variable with most studies showing an increase in BMD in T2DM. The present study was undertaken to find out the prevalence of osteoporosis and osteopenia (based on BMD) in a cohort of patients with T2DM and delineate the possible modifiable and non-modifiable risk factors. Methods: In this cross-sectional observational study, 252 otherwise ostensibly healthy patients with T2DM underwent dual energy X-ray absorptiometry (DEXA) scan. Osteoporosis and osteopenia were defined based on T-scores. The effect of modifiable and non-modifiable risk factors on BMD and osteoporosis were assessed. Results: The mean age of the cohort was 59.9 years with a M:F ratio 2.9:3.4. The mean BMD at the lumbar spine and hip were 0.892 g/cm2 and 0.715 g/cm2, respectively. Males had significantly higher BMD at both the sites compared to females. The prevalence of osteoporosis and osteopenia was 33% and 40%, respectively. Female gender, increasing age, normal body mass index (BMI), low serum 25-hydroxyvitamin D, and use of pioglitazone were significantly associated with the risk of osteoporosis. Conclusion: The prevalence of osteoporosis and osteopenia in patients with T2DM is high. Female gender, increasing age, normal BMI, low serum 25-hydroxyvitamin D, and pioglitazone use further increase the risk of osteoporosis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the seasonal change in serum 25-hydroxyvitamin D (25-OHD) level in healthy infants and to relate it to common childhood morbidities. Methods: 72 healthy breastfed infants residing in Delhi were enrolled at the end of summer and followed till the end of winter [mean (SD) duration 200 (10) d]. Serum 25-OHD was estimated at baseline and follow-up. Infants were monitored for common childhood diseases. Results: Mean (SD) serum 25-OHD level was lower at the end of winter (20.7 (8.02) ng/mL) than summer (22.9 (8.70) ng/mL) [mean difference (95% CI) −2.14 ng/mL (−3.36, −1.06), P<0.001). The seasonal distribution of children according to vitamin D status in summer and winter — Deficient (15.3%, 12.5%), Insufficient (19.4%, 30.6%) and Sufficient (65.3%, 56.9%), respectively was comparable P=0.17). The morbidity profile remained unaffected by change in vitamin D status from summer to winter. Conclusions: Seasonal changes in vitamin D levels do not have significant clinical effect or effect on overall vitamin D status in apparently healthy infants from North India. This may have implications for results of population surveys for vitamin D status, irrespective of the season when they are conducted. [ABSTRACT FROM AUTHOR]

Objectives: To document bone mineral density of children and adolescents with cystic fibrosis. Design: Cross-sectional study. Setting: Tertiary-care center of Northern India, July 2012 to August 2015. Participants: 52 children aged 6-18 years with cystic fibrosis and 62 healthy controls of similar age and sex. Methods: Both patients and controls were stratified into two groups, as pre-pubertal and peri-/post-pubertal, and compared for whole body bone mineral density, measured using dual energy X-ray absorptiometry. Serum levels of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D and parathyroid hormone were measured in children with cystic fibrosis. Results: Compared with controls, the mean (SD) bone mineral density of children with cystic fibrosis was significantly lower in both the pre-pubertal (0.7 (0.1) g/cm vs 0.9 (0.1) g/cm; P<0.001)) and peri-/post-pubertal groups (0.9 (0.1) g/cm vs 1.1 (0.1) g/cm; P<0.001). Also, the mean (SD) bone mineral apparent density of pre-pubertal and peri-/post-pubertal cystic fibrosis patients was lower than the controls ( P<0.001 and P= 0.01, respectively). Thirty-seven (71.2%) cystic fibrosis patients had serum 25-hydroxyvitamin D level below 15 ng/mL. Conclusion: Bone mineral density of children with cystic fibrosis was significantly lower than controls; majority of them were vitamin-D deficient. Intervening at an early stage of the disease and providing optimal therapy involving simultaneous management of the several factors affecting bone mineral accretion may be beneficial in improving bone health of these patients. [ABSTRACT FROM AUTHOR]

Objectives: The frequent prescription of calcium supplements with vitamin D by health practitioners is a topic of concern globally. The present study was designed to find out whether the calcium supplements with vitamin D really affect serum and urinary calcium levels in post-menopausal women. Design, Settings & Participants: The age-matched comparative study was performed among postmenopausal women who were already on and those who were not on calcium supplements with vitamin D for a period of time in relation to the estimation of the serum calcium and the urine calcium levels. Sixty healthy postmenopausal women were enrolled, with thirty among them forming the study group (SG) - who were on calcium supplements with vitamin D for a period of a month, three months, and up to twelve months - were studied and compared the results obtained with the age-matched control group (CG) of thirty post-menopausal women who were not on calcium supplements. Measurements: The serum and the urinary calcium levels were estimated by using appropriate biochemical methods and the data were analysed using relevant statistical methods. Results: The serum calcium levels did not vary significantly in SG in spite of consuming calcium supplements over a period of time, whereas the urinary calcium levels increased progressively (p value < 0.005) in those who have taken calcium supplements for a year compared to those who have taken for a month. Conclusion: Thus, the calcium supplements were of little significance on the serum calcium levels, but have a significant effect on the urinary calcium levels in post-menopausal women. [ABSTRACT FROM AUTHOR]

Objective: To determine the role of oral vitamin D supplementation for resolution of severe pneumonia in under-five children. Design: Randomized, double blind, placebo-controlled trial. Setting: Inpatients from a tertiary care hospital. Participants: Two hundred children [mean (SD) age: 13.9 (11.7) months; boys: 120] between 2 months to 5 years with severe pneumonia. Pneumonia was diagnosed in the presence of fever, cough, tachypnea (as per WHO cut-offs) and crepitations. Children with pneumonia and chest indrawing or at least one of the danger sign (inability to feed, lethargy, cyanosis) were diagnosed as having severe pneumonia. The two groups were comparable for baseline characteristics including age, anthropometry, socio-demographic profile, and clinical and laboratory parameters. Intervention: Oral vitamin D (1000 IU for <1 year and 2000 IU for >1 year) ( n=100) or placebo (lactose) ( n=100) once a day for 5 days, from enrolment. Both the groups received antibiotics as per the Indian Academy of Pediatrics guidelines, and supportive care (oxygen, intravenous fluids and monitoring). Outcome variables: Primary: time to resolution of severe pneumonia. Secondary: duration of hospitalization and time to resolution of tachypnea, chest retractions and inability to feed. Results: Median duration (SE, 95% CI) of resolution of severe pneumonia was similar in the two groups [vitamin D: 72 (3.7, 64.7-79.3) hours; placebo: 64 (4.5, 55.2-72.8) hours]. Duration of hospitalization and time to resolution of tachypnea, chest retractions, and inability to feed were also comparable between the two groups. Conclusion: Short-term supplementation with oral vitamin D (1000-2000 IU per day for 5 days) has no beneficial effect on resolution of severe pneumonia in under-five children. Further studies need to be conducted with higher dose of Vitamin D or longer duration of supplementation to corroborate these findings. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of supplementation with oral vitamin D3 (cholecalciferol) on bone mineral biochemical parameters of school-going girls. Setting: Government school (government-aided) and Private school (fee paying) in Delhi. Design: Randomized controlled trial. Intervention: Cholecalciferol granules (60,000 IU) orally with water, either once in two months (two-monthly D3 group) or once a month (one-monthly D3 group) for one year. Participants: 290 healthy schoolgirls (6-17 y), 124 from lower socioeconomic strata (LSES) (attending government schools) and 166 from upper socioeconomic strata (USES) (attending private schools). Outcome measures: Serum 25(OH)D, calcium, phosphorus, parathyroid hormone, and alkaline phosphatase levels at 6 and 12 months after start of supplementation. Results: At baseline, 93.7% schoolgirls were vitamin D deficient [25(OH)D<50 nmol/L]. While significant increase in serum calcium and decrease in alkaline phosphatase levels was noted in both groups with both interventions, PTH response was inconsistent, in LSES subjects, two-monthly D3 and one-monthly D3 supplementation resulted in a significant increase in serum 25(OH)D levels by 8.3 nmol/L and 11.0 nmol/L, respectively at 6 months (P<0.05). Similarly, the increase in the two intervention arms in USES subjects was 10.5 nmol/L and 16.0 nmol/L, respectively (P < 0.05). In both groups, this increase in serum 25(OH)D levels persisted at 12 months (P<0.05). Despite supplementation with 60,000 IU of Vitamin D3 (monthly or two-monthly), only 47% were vitamin D sufficient at the end of one year. Conclusions: 60,000 IU of cholecalciferol, monthly or two-monthly, resulted in a significant increase in serum 25(OH)D levels in vitamin D deficient schoolgirls. [ABSTRACT FROM AUTHOR]

Background/Objectives: Vitamin D is required for bone growth and normal insulin secretion. Maternal hypovitaminosis D may impair fetal growth and increase the risk of gestational diabetes. We have related maternal vitamin D status in pregnancy to maternal and newborn glucose and insulin concentrations, and newborn size, in a South Indian population.Subjects/Methods: Serum 25 hydroxy vitamin D (25(OH)D) concentrations, glucose tolerance, and plasma insulin, proinsulin and 32–33 split proinsulin concentrations were measured at 30 weeks gestation in 559 women who delivered at the Holdsworth Memorial Hospital, Mysore. The babies' anthropometry and cord plasma glucose, insulin and insulin precursor concentrations were measured.Results: In total 66% of women had hypovitaminosis D (25(OH)D concentrations <50 nmol l−1) and 31% were below 28 nmol l−1. There was seasonal variation in 25(OH)D concentrations (P<0.0001). There was no association between maternal 25(OH)D and gestational diabetes (incidence 7% in women with and without hypovitaminosis D). Maternal 25(OH)D concentrations were unrelated to newborn anthropometry or cord plasma variables. In mothers with hypovitaminosis D, higher 25(OH)D concentrations were associated with lower 30-min glucose concentrations (P=0.03) and higher fasting proinsulin concentrations (P=0.04).Conclusions: Hypovitaminosis D at 30 weeks gestation is common in Mysore mothers. It is not associated with an increased risk of gestational diabetes, impaired fetal growth or altered neonatal cord plasma insulin secretory profile.European Journal of Clinical Nutrition (2009) 63, 646–652; doi:10.1038/ejcn.2008.14; published online 20 February 2008 [ABSTRACT FROM AUTHOR]

Vitamin D, a secosteroid, plays an important role in several physiological processes, and its deficiency can lead to numerous pathophysiological conditions in humans. The primary objective of this study was to develop and validate the robustness of a mass spectrometry-based method capable of quantifying 25(OH)D3 for an upcoming epidemiological survey in India and to pilot test it on healthy volunteers. We first describe the development and validation of various experimental parameters that ascertain the robustness and reliability of 25-hydroxy-vitamin D3 (25(OH)D3) extractions and quantitative measurements from Dried Blood Spot (DBS) samples, where we used eight disks of 3 mm each, punched from the circular spot covering the entire circumference of the spot. Next, we conducted a pilot study, comparing 25(OH)D3 levels from serum and DBS samples from 45 participants using a protocol developed for specifically this purpose. We found that the mean 25(OH)D3 concentrations in DBS samples were comparable to the serum levels (P > 0.05). In summary, our extraction and LC–MS protocol for quantitative 25(OH)D3 measurements are robust and reproducible, and will serve as an invaluable tool for upcoming epidemiological surveys in India and perhaps around the world. [ABSTRACT FROM AUTHOR]