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Introduction: Cholecalciferol plays vital role in bone mineralization. Major circulating and storage form of vitamin D is 25-hydroxycholecalciferol {25(OH)D3} which is formed in the liver after 25-hydroxylation. It is also the form of vitamin D that is measured in blood tests to detect deficiency of vitamin D. There is scarcity of literature to support the best therapy at the lowest effective dose that is practicable, cost efficient, and devoid of probable side effects. Oral medication compliance is a major stumbling block to replenishing vitamin D levels in the body. Vitamin D administered intramuscularly (i.m.) may be able to overcome this limitation. Aim: To compare the effectiveness of oral versus intramuscular vitamin D in adults with fracture around hip and vitamin D deficiency. Materials and Methods: This prospective interventional study was conducted in Orthopaedics Ward in Mahatma Gandhi Institute of Medical Sciences, Jaipur, Rajasthan, India, from January 2020 to June 2021. Total 60 male and female, above 18 years, with fractures around the hip and vitamin D levels less 30 ng/mL were included in the study. In group O (n=30) patient received oral vitamin D supplementation of 60000 IU once a week for 6 weeks . In group I (n=30) patient received single dose of 600000 IU vitamin D injection (i.m.). Follow-up of patients was done at baseline, 6 weeks and 12 weeeks for serum values of vitamin D, calcium, alkaline phosphatase and parathyroid hormone levels. Bivariate analytical techniques has been used to measure the improvement of group I with group O. results: The mean age in group I was 60.40±16.38 years and in group O was 59.47±15.17 years (p-value=0.82). There were total 31 females, 13 in group I and 18 in group O. No significant difference was observed among the groups in vitamin D level at the baseline, {group I: 13.84 ± 3.54 ng/mL; group O: 16.45 ± 6.3 ng/mL, p-value=0.053}. At 6 weeks, the mean value of the vitamin D significantly increased in both groups (p-value=0.001; group I: 40.94±4.67 ng/mL and group O: 33.64±9.89 ng/mL). At the 12th week, the mean value of the vitamin D was significantly higher in group I (44.52±7.09 ng/mL) compared to group O (24.65±10.92 ng/mL), p-value<0.001. The vitamin D mean was significantly raised with the time in group I and group O at 6 weeks and still remained increased at 12 weeks in group I but not in group O. conclusion: The present study concluded that although both administration routes are effective and appear to be safe, intramuscular application is more effective in increasing 25(OH) D levels and sustaining it for a longer period of time as compared to oral dose. [ABSTRACT FROM AUTHOR]

Background: SARS-COV-2 is also known as coronavirus causes an infectious disease has caused a global concern due to its pandemic nature. In India, nearly 36 million cases and 5.1 lakh deaths have been recorded so far. Laboratory biomarkers play an important role in improving the clinical situational awareness by predicting risk stratification and by discriminating between severe and non-severe cases. There is no sufficient information available regarding the role of C-reactive protein (CRP), lactate dehydrogenase (LDH), Vitamin D, and interleukin-6 (IL-6) in the prognosis of COVID-19 patients in Southern part of India. Aims and Objectives: We aim to retrospectively analyze CRP, LDH, Vitamin D, and IL-6 in COVID-19 patients. Materials and Methods: The observational and retrospective study was carried out from the case records of 103 patients from November 2021 to February 2022 in which CRP, LDH, Vitamin D, IL-6, COVID-19 Reporting and Data System (CO-RADS), and CT sore were analyzed during admission and follow-up period in the hospital. Mean, mean difference, standard deviation, standard error difference, and P value were calculated. P<0.05 was considered to be significant. Results: CRP, LDH, IL-6, Vitamin D, CO-RADS, and CT score were decreased during the follow-up period when these levels were compared at the time of admission in the hospital, while there is an increase in Vitamin D levels during the follow-up period. Conclusion: The use of reliable and easy to use assays such as CRP, LDH, Vitamin D, and IL-6 plays an important role in the diagnosis and prognosis of COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Heart Failure is a leading cause of mortality worldwide including India. Most cross sectional studies have demonstrated heart failure is associated with deficiency of essential micronutrients including Vitamin D which may play a important role in pathogenesis of ventricular remodelling in heart failure. Aim: Our study performed aimed to determine the effect of supplementation in patients of Heart Failure presenting with Vitamin D deficiency to our institute on severity of Heart Failure. Design and Method: 97 patients of Heart failure coming to our institute were given conventional therapies for Heart Failure along with Vitamin supplementation based on serum Vitamin D levels and followed up for 3 months. Results: Patient of Heart failure having Vitamin D deficiency had significant reduction in cardiac biomarkers (NT-pro BNP levels), improvement in Left ventricular ejection fraction (LVEF) and more favourable reverse remodelling determined by Left ventricular end diastolic and systolic diameter (LVEDD & LVESD) though quality of life determined by WHODAS 2.0 score did not changed following 12 weeks supplementation of High Dose Vitamin D. Conclusion: Recognising and treatment of Vitamin D deficiency may determine long term prognosis in patients of Heart Failure. [ABSTRACT FROM AUTHOR]

• rs118204012 "AA" genotype is significantly associated with susceptibility to tuberculosis. • rs118204012 "AG" and "GG" genotypes significantly associated with TB protection. • Males are associated with higher TB risk than females. • Vitamin D insufficiency was found higher in rs118204012 "AA" genotype positive patients. Genetic factors are reported to be connected with tuberculosis (TB) infection. Studies have shown that genetic variations in genes involved in the vitamin D pathway influence the levels of vitamin D found in the bloodstream (serum). Cyp27b1 (1α-hydroxylase) is an enzyme that activates the synthesis of bioactive vitamin D 3 by hydroxylation of 25(OH)D 3. The in vitro studies reported rare gene variants of Cyp27b1 such as rs118204011 and rs118204012, associated with loss of Cyp27b1 function and lower serum vitamin D levels. Globally, a critical gap exists in understanding the link between these gene variants with TB and vitamin D levels. Hence, the study objective is to comprehend the association of Cyp27b1 rs118204009 (G/A), rs118204011 (C/T), and rs118204012 (A/G) with tuberculosis susceptibility/protection and to assess the influence of gene variants on vitamin D levels in both healthy controls (HCs) and those with pulmonary tuberculosis (PTB) in South India. Genomic DNA extraction was performed by salting-out procedure and subsequently genotyped through polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. Vitamin D level was measured by Enzyme-Linked Immunosorbent Assay (ELISA). In rs118204012 (A/G), a substantial association was found with PTB susceptibility in allele 'A' [Odds Ratio (OR): 1.52 (1.02–2.26); p = 0.044] and 'AA' genotype [OR: 1.69 (1.02–2.81); p = 0.040] through the dominant model. Allele 'G' [OR: 0.66 (0.44–0.98); p = 0.044) was found to be associated with protection against TB. Males were associated with increased susceptibility towards TB compared to females in the rs118204011 "CC" [OR: 3.94 (1.94–7.98); p = 0.002] and rs118204012 'AA' [OR: 4.57 (2.13–9.79); p = 0.0001] genotypes. Vitamin D insufficiency (<30 ng/ml) was more prevalent in PTB patients (66.67 %) with the rs118201012 'AA' genotype compared with healthy controls (57.14 %). This genotype was associated with disease susceptible odds ratio of 1.5. Cyp27b1 rs118204012 'AA' genotype was found to have association with vitamin D insufficiency and TB susceptibility. In terms of gender, our findings suggest that male individuals are correlated with a higher TB risk. This suggest that the gene variants may be involved in the downstream processing of serum Vitamin D levels and its association with the disease. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D deficiency is one of the most common nutritional deficiencies worldwide. The amount and quality of bone at the implant installation site have an impact on the implant's prognosis however, the effects of menopause on jaw bone remain unknown. Few studies have looked at the prevalence of vitamin D deficiency in India's general population, but none have looked at the link between vitamin D deficiency (osteoporosis) and postmenopausal women's jaw Bone Mineral Density (BMD). This is the first study of its sort in India to look at postmenopausal women's vitamin D levels and jaw BMD. Aim: To evaluate and correlate vitamin D levels and jaw BMD in pre and postmenopausal females undergoing implant therapy. Materials and Methods: This cross-sectional study will include 50 partially or completely premenopausal (n=25) and postmenopausal females (n=25) having edentulous anterior and posterior maxillary and mandibular jaws. Females will be tested to evaluate their vitamin D levels and jaw BMD with Cone Beam Computed Tomography (CBCT) and results will be recorded in Hounsfield Units (HU) using Planmeca romexis viewer software. Chi-square test and Students t-test will be used. [ABSTRACT FROM AUTHOR]

Introduction: Despite an agricultural country, India confronting malnutrition as a major public health challenge, where every second child is at risk of malnutrition. The nation ranking second in population with disproportionate rural and urban demography, further poor penetration of government assisted programs in remote, underserved areas fuelling the malnutrition in rural areas. Methods: This cross-sectional study was conducted in Department of Community Medicine of Rohilkhand Medical College and Hospital. Total 465 schoolchildren in rural and urban areas of Bareilly district were screened for malnutrition and their socio-demographic profiles were studied. Results: Overall, the prevalence of malnutrition in schoolchildren of Bareilly district was %40.2. Fraction contributed by urban and rural territories was %35.2 and %43, respectively. The prevalence of malnutrition was found higher in rural area as compared to urban area and the difference was statistically significant (P<0.001). Conclusion: The study shows %43 prevalence of malnutrition in rural areas and under nutrition was the main cause of malnutrition attributed by poverty and illiteracy. However, urban areas reported %7.8 lower prevalence of malnutrition, but alarming trends of overweight and obesity %15.2. [ABSTRACT FROM AUTHOR]

Introduction: Drug Resistant Tuberculosis (DR-TB) is a rapidly escalating problem. Vitamin D and calcium serum levels can be an important determinant of Multidrug-Resistant Tuberculosis (MDR-TB) infection, progression to disease. The link between the serum level of 25-hydroxy vitamin-D {25(OH) D and MDR-TB is an emerging area for conducting evidencebased research. Aim: To assess the serum 25(OH)D and calcium levels and its deficiency in all the patients with drug resistant tuberculosis. Materials and Methods: This retrospective, observational study was conducted in the Department of Pulmonary Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, from October 2019 to October 2020, in the newly detected 100 patients experiencing DR-TB. Patients sputum/body fluid samples were subjected for GeneXpert/Line Probe Assay (LPA) examinations to confirm resistance to anti-tubercular drugs. The frequency and prevalence of mean serum vitamin D and mean serum calcium levels were recorded based on age and gender. DR-TB categorised into H-Mono resistance, MDR-TB, Pre-Extensively Drug Resistant (Pre-XDR) and XDR-PTB, based on GeneXpert and LPA of sputum/body fluid. Descriptive statistics were used to determine the characteristics of all the patients. All the statistical analysis was done using the STATA software. Results: Mean age of study population was 31.12±15.49 years. Among them 63 were males and 37 were females. The mean serum vitamin D level of 10.87±8.49 ng/mL (deficient) and serum calcium level of 8.62±0.82 mg/dL (normal) was reported. Mean serum vitamin D levels were deficient in all the four types of DR-TB (p-value=0.04), while changes in mean serum calcium level was non significant (p-value=0.15). Conclusion: All patients with DR-TB have significant propensity to vitamin D deficiency. While changes in mean serum calcium level was non significant. [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]

Objective: Aim of the present study is to find out the level of vitamin D in patients of early rheumatoid arthritis and investigate association of vitamin D deficiency with the disease activity in rheumatoid arthritis. Methods: A case control study comprising 90 case of early rheumatoid arthritis and 80 age and sex matched control carried out at tertiary care hospital in western province of Uttar Pradesh India between January 2017 and June 2021. Baseline data along with vitamin D level was recorded in both the group. Disease activity was recorded using clinical disease activity index (CDAI) in all patients of rheumatoid arthritis. Results: Vitamin D deficiency was significantly higher in rheumatoid arthritis patients compared to healthy control from same geographic region (56.7% vs 32.5%, p value = 0.002%). Disease activity assessed by clinical disease severity index (CDAI) was inversely correlated with vitamin D level(r= -0.23, p-value 0.028) and. Joint pain was also inversely correlated with vitamin d level(r= -0.37, p value <0.0001). However, there was no significant association of vitamin D level with joint swelling, tenderness and erythrocyte sedimentation rate. Conclusions: In our study vitamin D deficiency was more common in patients of rheumatoid arthritis. Disease activity and joint pain were inversely correlated with vitamin D level. However, there was no significant association of vitamin D level with joint swelling and tenderness. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is been traditionally known as anti-ricketic factor or sunshine vitamin. Vitamin D is a fat-soluble vitamin and its synthesis in the body is dependent on multiple factors like latitude, atmospheric pollution, clothing, skin pigmentation duration and time of exposure to sunlight. Assessment of vitamin D status of an individual is best reflected by measurement of circulating vitamin D metabolites. 2 metabolites S, namely 25, hydroxyvitamin D 1,25 dihydroxy vitamin D. Exposure to sunlight is responsible for physiological production of vitamin D endogenously in the skin from 7 dehydrocholesterol present in the subcutaneous fat. Vitamin D deficiency prevails in epidemic proportion all over the India subcontinent with a prevalence of 70%-100% in the general population. Association of vitamin D deficiency with a variety of nonspecific bone pain particularly in women. Vitamin D deficiency was recently suggested to trigger chronic disease. Planter heel pain is a common musculoskeletal foot disorder that can have a negative impact on activities of daily living and it is of multifactorial etiology. Pathogenesis of planter heel pain is considered to be excessive cumulative strain at the enthesis of the plantar facia. Low vitamin D levels have been associated with an increased in inflammatory cytokines and a significantly increased risk of pneumonia viral upper respiratory tract infections. Experimental reports have shown vitamin D has a role in reducing the risk of COVID-19 including consideration of the fact that the outbreak occurred in winter and the fact the vitamin D deficiency contributes to acute respiratory distress syndrome and case-fatality rates increased with age and with chronic disease co-morbidity, both of which are associated with a lower 1,25(OH)2D co-contraction. Aim of Study: Aim of the study is to find correlation between vitamin D and heel pain in healthy adults. Objective: To determine if there is correlation between vitamin D and heel pain in healthy adults. Materials and Methods: 108 patients were assessed using NPRS for heel pain and also assessed for Vitamin D using lap reports in south Gujarat. The method of the sampling was convenient. All the subjects were familiarized about the whole procedure. Results: The result showed negative correlation (p=0.023) between vitamin D and heel pain in healthy adults. The subjects used in the study was male and female age of 15 to 60. Lab reports was used to check vitamin D and NPRS was used to assess the heel pain. The level of the significance is 0.023 (<0.05) for vitamin D and heel pain. Conclusion: The result of the study showed negative correlation between heel pain and vitamin D in healthy adults. By increasing the sun exposure and intake of vitamin D medicine heel pain can be decreased in healthy adults. For clinical purpose, physical therapist can advise the patient who have heel pain to go for vitamin D testing. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a bacterial infection that usually affects the lungs, although it can also affect other parts of the body. Vitamin D deficiency and response to treatment have been demonstrated in patients with active TB in several studies, but not in MDR-TB patients, which is a new observation in the present study., Objective: To study the time to initial sputum culture conversion and to associate baseline vitamin D levels and response to treatment in patients with PTB Cat I and MDR-TB., Methods: A total of 897 North Indian participants were recruited and divided into three groups: treatment-naïve PTB Cat I, MDR-TB, and healthy controls. Serum biochemistry, including 25-hydroxyvitamin D and calcium, was measured in all participants with PTB, Cat I, and MDR-TB., Results: PTB Cat I patients had high bacillary load grading at baseline compared to 2 nd month followed by 6 th month of treatment. More severe chest radiographic features, such as cavitation and the presence of bilateral disease at baseline. Mean sputum smear conversion times were 0.95 ± 0.7 months and culture conversion to negative occurred at a mean time of 0.8 ± 0.7 in PTB Cat I patients compared to MDR-TB patients on average sputum smear and time of 2.4 ± 3 months. Significantly lower mean serum 25-hyroxyvitamin D concentration was found in the 6 th month than in the 2 nd month and baseline in PTB Cat I., Conclusion: Low serum vitamin D deficiency was observed in both groups during treatment and is one of the important factors responsible for susceptibility to TB in both groups; however, its significance is uncertain. Patients with continuous positive sputum for multidrug-resistant tuberculosis (MDR-TB) had a worse prognosis than those with sputum bacteriology conversion. Two months into a treatment regimen, sputum smear conversions may be a useful indicator of an MDR-TB patient's prognosis.

Aim: To study the effect of vitamin D supplementation in severity and control of bronchial asthma in children in Bihar region Methods: A cross-sectional, prospective study was conducted in the Department of pediatrics, Vardhman institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for 1 year, after taking the approval of the protocol review committee and institutional ethics committee. 53 asthmatic patients and 53 healthy controls were included in this study. The level of serum vitamin D in both groups was measured by radioimmunoassay (RIA) method at the reference lab and was categorized as sufficient (> 30 ng/ml), insufficient (20 to 30 ng/ml), or deficient (< 20 ng/ml). The severity of asthma was also stratified according to the asthma guideline into four grades of intermittent or mild, moderate, severe persistent. Results: Regarding rate of admission, 13.2% of patients were hospitalized once, 9.4% of patients were hospitalized twice, and 1.9% of them were also hospitalized three times. In the patients group and regarding the severity of asthma, 11.3% were classified as mild asthma, 45.3% as moderate asthma, and 43.4% as severe asthma. Also regarding control status of asthma, the disease was controlled in 18.9 %, partially controlled in 34.0 %, and uncontrolled in 47.2 %. According to the level of disease attack risk, 5 of 31 children aged less than 5 years (16.1%) classified as high-risk, while 7 of 22 children older than 5 years (31.8%) classified as high risk. Assessing the serum level of vitamin D showed that the asthmatic children had significantly lower level of vitamin D compared to normal cases (14.53 ± 8.10 ng.ml versus 22.45 ± 13.46 ng/ml, p < 0.001). Also, in the groups with and without asthma, the prevalence of vitamin D deficiency was 73.6 and 49.1%, and the prevalence of vitamin D insufficiency was 18.9 and 18.9 %, while normal vitamin D level was revealed in 7.5 and 32.1%, respectively with a significant difference (p = 0.005). In this regard, mean serum level of vitamin D in the patients with mild asthma was 12.85 ± 7.06 ng/ml, in the group with moderate asthma was 16.98 ± 8.63 ng/ml, in the patients with severe asthma was 12.42 ± 7.52 ng/ml, and in those with persistent asthma was 12.01 ± 5.00 ng/ml (p = 0.25). Conclusion: Vitamin D deficiency and insufficiency is a common finding among asthmatic children that may be associated by the physiological mechanism of this phenomenon. In fact, it seems that the use of supplement vitamin D can prevent progression of childhood asthma. [ABSTRACT FROM AUTHOR]

Background: Administration of vitamin D to unselected heterogeneous critically ill patients did not demonstrate outcome benefit. The current study was undertaken to identify if early administration of vitamin D can reduce intensive care unit (ICU) length of stay and improve clinical outcomes in critically ill patients with sepsis. Methods: This single-center randomized double-blind placebo-controlled trial was done in the ICU and emergency inpatient ward of a tertiary care teaching institute in New Delhi, India. A total of 126 adult patients aged 18 to 80 years of either sex diagnosed to have sepsis were included within 24 hours of admission to the hospital and randomized into vitamin D or placebo groups. The patients in the intervention group received vitamin D3 540,000 units dissolved in 45 mL of milk. The placebo group received 45 mL of milk. Results: The median length of ICU stay (8 vs 9 days; p = 0.32), median length of hospital stay (12 vs 12 days; p = 0.33), median duration of vasopressors requirement (4 vs 3 days; p = 0.84), median duration of mechanical ventilation (5 vs 7 days; p = 0.23), requirement of tracheostomy (34 vs 39%; p = 0.71), and 90-day mortality [35 vs 46%; p = 0.29; HR 0.72 (0.42-1.24)] were similar in vitamin D and placebo arm. A subgroup analysis in patients with severe vitamin D deficiency (vitamin D <12 ng/mL) revealed a significantly decreased incidence of tracheostomy (28 vs 57%; p = 0.04), a trend toward decreased 90-day mortality [34 vs 66%; p = 0.08; HR 0.44 (0.19-1.01)], and duration of mechanical ventilation (6 vs 11 days; p = 0.05) in patients receiving vitamin D. Conclusion: Administration of large-dose vitamin D within 24 hours of admission does not reduce the length of ICU stay in critically ill sepsis patients. [ABSTRACT FROM AUTHOR]

Aim: Children with sickle cell disease (SCD) are at high risk of vitamin D deficiency (VDD). The prevalence of VDD in different countries is between 65-100% in these patients. The present study was undertaken to find the prevalence of VDD among sickle cell children and to assess the association of co-morbidities with VDD. Materials and Methods: Total 89 children who were attending a sickle cell clinic/admitted to paediatric wards of a Tertiary Care Centre were enrolled in this study. After their history, clinical examination and anthropometry were investigated, samples were taken for serum 25-hydroxy vitamin D ng/mL and calcium level assessment. The outcome was morbidity in sickle cell children in terms of frequency of pain episodes, number of febrile episodes, number of blood transfusions and total number of admissions. Results: Out of 89 cases, 58 (65.17%) cases were deficient in vitamin D (<20 ng/dL), 22 (24.72%) cases had insufficiency (20-30 ng/dL) and 9 (10.11%) cases had normal vitamin D levels (>30 ng/dL). The mean vitamin D level was 19.42ng/dL. Morbidity in SCD was more in VDD children compared to vitamin D sufficient children with significance in the number of pain episodes and the total number of hospital admissions but not in the number of admissions for acute febrile illness or the total number of blood transfusions. Conclusion: VDD was prevalent in 65.17% of children with SCD. Children between 4-12 years were more affected with a male predominance. As this study involved children with SCD alone, future studies need to be carried out involving children without SCD to establish a better possible link between vitamin-D and SCD morbidity. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The primary objective of this study was to intervene with vitamin D supplementation in rural-based women with pre-diabetes (impaired fasting glucose or impaired glucose tolerance) to prevent development of type 2 diabetes (T2DM). Methods: This was an open-label randomized placebo-controlled trial conducted in rural women with pre-diabetes and vitamin D deficiency (Clinicaltrials.gov NCT02513888). Women aged 20-60 years with pre-diabetes were selected from rural Haryana (north India) and followed up for two years. A semi-structured questionnaire was used to collect information on socio-demographic and behavioral details, like sun exposure, dietary habits, etc., The intervention group received vitamin D supplementation while control group received lactose granules as placebo. Equal doses of calcium carbonate were given to both the groups. Results: A total of 132 participants were recruited in the study (58 each in the intervention and control groups). It was observed that there was no statistical significance in the incidence of diabetes in the control group as compared to the intervention group at the end of 2 years (P = 0.701). Conclusion: Though during the first year there was some delay in development of DM in the intervention group but at the end of two years there was no significant effect of vitamin D supplementation in delaying the incidence of diabetes in these women after two years. Trial registration: (Clinicaltrials.gov NCT02513888). [ABSTRACT FROM AUTHOR]

Background: Blood pressure (BP) is associated with serum levels of Vitamin D3, lipid profile, and thyroid hormones among adults. However, limited information is available regarding such associations in adolescents. Objectives: The objectives of this study were to estimate the prevalence of Vitamin D3 deficiency, dyslipidemia, and thyroid dysfunction among secondary school students of Agartala and to determine their associations with BP. Methodology: This cross-sectional study was conducted from April 1, 2018, to December 31, 2018, among 1000 secondary-level school students of Agartala municipal corporation area, chosen by multistage sampling ensuring proportionate representation. Results: The prevalence of Vitamin D3 deficiency, thyroid dysfunction, and dyslipidemia was found to be 79.4%, 62.8%, and 37.5%, respectively. Among the respondents, 58.1% had raised BP, 16.7% were overweight, 5.3% were obese, and 48.3% had high waist--hip ratio (WHR). Among them, 70.97% of the fatty participants, 82.27% with high body mass index (BMI), and 69.05% with either low or normal WHR had significantly raised BP (P < 0.05). Out of total, 58.26% of the participants with normal serum D3 level, 59.95% with either euthyroid or hyperthyroid status, and 62.13% with dyslipidemia had raised BP, though these were not significant (P > 0.05). Binary logistic regression model has identified higher BMI, higher body fat content, high WHR, habit of consuming extra salt, and fast food on a regular basis as significant determinants of raised BP in this population (P < 0.05). Conclusion: Hypovitaminosis D, thyroid dysfunction, and dyslipidemia are prevalent among adolescents of Northeast India, but they did not emerge as significant determinants of BP in this population. [ABSTRACT FROM AUTHOR]

In a defined geographic area in rural India (1,60,000 population), osteoporosis detection and calcium and vitamin D supplementation program was instituted. Of the eligible 15,386 subjects, 5,992 (38%) participated in the program; 2,882 (48%) had osteopenia and osteoporosis; supervised calcium and vitamin D supplementation was instituted; 2,113 (73.3% of those identified) completed 2 years of supplementation. The mean duration of the follow-up was 5 years (range 2–8 years). On follow-up, three groups emerged; those who were regular, those who were irregular, and those who did not take supplements. In those who were regular with calcium and vitamin D supplementation, we found a significant reduction in fractures (RR 0.27, 95% CI 0.09–0.81) compared with those who did not take supplements. There was no significant difference in falls between the three groups. Mortality was significantly lower (RR 0.53, 95% CI 0.31–0.91) in those who were regular with calcium and vitamin D supplements compared to those who did not take supplements. While the reduction in fractures was probably due to calcium and vitamin D supplementation, the reduction in mortality was probably because those who took regular supplements accessed healthcare services more readily for other comorbidities as part of their follow-up program. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background and Objective: Despite abundant sunshine, India is a country with high prevalence of vitamin D deficiency. It has been suggested that vitamin D deficiency could be a potential cause of chronic non-specific musculoskeletal pain. The study was conducted to evaluate the effect of supplementation of vitamin D and calcium on patients suffering with chronic non-specific musculoskeletal pain. Methodology: The experimental trial was a pre-post study conducted on 50 hypovitaminosis D patients aged 30–60 years visiting a local orthopedician or physician with complain of chronic non-specific musculoskeletal pain. Oral supplementation with vitamin D and calcium was given for 3 months. Before the intervention trial, pain, physical activity, serum vitamin D, serum calcium, body mass index and waist to hip ratio (WHR) of the respondents were assessed, which was statistically compared with post-intervention data of the same parameters. Assessment of pain was carried out using visual analog scale. Physical activity levels were compared pre and post the intervention. Also, fatigue, mood alteration, and sleep were compared. Results: Ninety percent of the subjects had vitamin D deficiency. Thirty-six percent of the subjects had severe chronic non-specific musculoskeletal pain, whereas 56% had moderate chronic non-specific musculoskeletal pain. The mean pain score prior to intervention was 6.22 which significantly decreased to 3.52. Mean vitamin D levels significantly rose from 17.38 ng/ml to 39.40 ng/ml. Serum vitamin D, serum calcium, and physical activity levels increased, whereas pain, weight, BMI, and WHR decreased significantly post-intervention. Conclusions: Supplementation with vitamin D and calcium decreases chronic non-specific musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Calcium and vitamin D are inseparable nutrients required for bone health. In the past half a century, the dietary calcium intake of rural, tribal, and urban India has declined. Though India is the largest producer of milk and cereals, the major source of calcium in India is through non-dairy products. The highest intake of cereals and lowest intake of milk & milk products was observed in rural and tribal subjects whereas, the intake of cereals, milk & milk products were similar in both urban and metropolitan subjects. One of the reasons for lower calcium intake was the proportion of calcium derived from dairy sources. Over the past half a century, the average 30-day consumption of cereals in the rural and urban population has declined by 30%. The Per Capita Cereal Consumption (PCCC)has declined despite sustained raise in Monthly Per capita Consumption Expenditure (MPCE) in both rural and urban households. The cereal consumption was the highest in the lowest income group, despite spending smaller portion of their income, as cereals were supplied through public distribution system (PDS). About 85% of the Indian population are vitamin D deficient despite abundant sunlight. Dietary calcium deficiency can cause secondary vitamin D deficiency. Though India as a nation is the largest producer of milk, there is profound shortage of calcium intake in the diet with all negative consequences on bone health. There is a decline in dietary calcium in the background of upward revision of RDI/RDA. There is a gap in the production-consumption-supply chain with respect to dietary calcium. To achieve a strong bone health across India, it is imperative to have population based strategies addressing different segments including supplementing dietary/supplemental calcium in ICDS, mid-day-meals scheme, public distribution system, educational strategies. Other measures like mass food fortification, biofortification, bioaddition, leveraging digital technologies, investments from corporate sector are some measures which can address this problem. India is a vast country with diverse social, cultural and dietary habits. No single measure can address this problem and requires a multi-pronged strategic approach to tackle the dietary calcium deficiency to achieve strong bone health while solving the problem of nutritional deficiency. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is documented to be more prevalent in Type 2 Diabetes Mellitus (T2DM) and is associated with diabetic nephropathy. Aim and Objective: To investigate the vitamin D status in T2DM patients with and without nephropathy in eastern part of southern India. Material and Methods: This crosssectional study included 150 study subjects. Routine laboratory measurements were done using commercially available kits on Vitros 5,1 FS auto analyzer from Ortho Clinical Diagnosis (OCD), United Kingdom, based on the principle of Reflectance Photometry. Serum 25-hydroxyvitamin D was measured by using chemiluminescence immunoassay methods. Results were analysed using IBM-SPSS version 20. Results: Vitamin D levels were observed to be lower in the diabetic nephropathy (18.44 ± 8.69 ng/mL) as compared to control (26.55 ± 7.88 ng/mL) and T2DM (19.64 ± 9.93 ng/mL) subjects and were correlated significantly with HbA1c and microalbumin. A markedly higher proportion of study subjects with vitamin D deficiency as well as insufficiency in T2DM and diabetic nephropathy group. Conclusion: Patients with type 2 diabetes and diabetic nephropathy had a low serum vitamin D level than healthy control. Vitamin D estimation in such patients may aid in the diagnosis and treatment as well as to prevent further complication. [ABSTRACT FROM AUTHOR]

Background: Lower serum 25-hydroxyvitamin D [25(OH)D] is associated with greater adiposity and adverse cardiometabolic risk profile. The evidence is inconsistent among South Asian Indians. We aimed to examine associations between 25(OH)D and cardiovascular (CVD) risk markers in a rural and urban cohort from South India. Subjects/Methods: In this cross sectional study, 373 individuals (men, n = 205) underwent detailed CVD risk marker assessment including anthropometry [body mass index (BMI), waist, (WC) and hip circumferences (HC)], body composition analysis using dual energy x-ray absorptiometry (DXA), blood pressure and biochemical analysis (glucose, insulin and lipids). The distribution of CVD risk factors were compared across serum 25(OH)D levels, stratified as deficiency (<20 ng/ml), insufficiency (20 to 29 ng/ml) and normal (≥30 ng/ml) levels. Multiple regression analysis, adjusting for potential confounders, was used to study associations of 25(OH)D with adiposity and cardiometabolic traits. Results: The mean and standard deviation (SD) of age, BMI and 25(OH)D levels were 41.4 (1.1) years, 25.5 (4.8) kg/m2 and 23.4 (10.4) ng/ml respectively. The prevalence of 25(OH)D deficiency was 39.9% in this cohort. Individuals in the 25(OH)D deficiency category had significantly higher mean (SD) BMI [26.6 (5.1) kg/m2], waist circumference [89.9 (12.5) cm] and total fat mass [20.6 (7.9) kg] compared with the Vitamin D sufficient group [BMI: 24.0 (4.4); WC 84.7 (12.0); total fat mass: 15.2 (6.8)]. Significantly inverse associations were observed with DXA measured total and regional fat depots with 25(OH)D levels, while anthropometric indices of adiposity showed significant inverse association only in women. After adjusting for total fat mass, no significant associations were observed between 25(OH)D and the cardiometabolic traits. Conclusions: Our results confirm that lower 25(OH)D is independently associated with both total and regional adiposity, but not with cardiometabolic traits, in this population. [ABSTRACT FROM AUTHOR]

Objective: Vitamin D deficiency is widely prevalent worldwide. This has led to a significant surge in referrals for vitamin D assessment in recent years. The cost-effectiveness and rationalization of this practice is uncertain. This study aimed to evaluate the referral pattern for vitamin D testing from a tertiary center in southern India. Materials and Methods: This was a cross-sectional study done over a period of one year (2017). A total of 95,750 individuals, referred for vitamin D screening were included in this study. Details regarding referring departments and indications for referral were obtained from the computerized hospital information processing system (CHIPS). Results: The study population exhibited a female preponderance (54.1%) with mean (SD) age of 40.3 (18.5) years. Overall, 44% were found to have vitamin D deficiency. Most of the referrals were from nephrology (15.4%), neurology (10.1%), and orthopedics (9.1%). Nevertheless, dermatology, the staff-clinic, and hematology which contributed to 3.3%, 1.7%, and 1.7% of referrals, had a higher proportion of vitamin D deficiency of 59.1%, 57.7%, and 64.6%, respectively. Although the most common indications for referral were generalized body aches (20.5%) and degenerative bone disorders (20.1%), the proportion of subjects with vitamin D deficiency referred for these indications were 46.1% and 41.6%, respectively. In contrast, chronic steroid use that accounted for 3.3% of the referrals had 59.1% of subjects who were deficient in vitamin D. Conclusion: To ensure a rational approach to vitamin D testing, clinicians ought to use their discretion to screen those truly at risk for vitamin D deficiency on a case to case basis and avoid indiscriminate testing of the same. [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]

Introduction: Febrile seizure is one of the most common paediatric emergencies encountered in a paediatric practice. There have been studies done with regards to iron deficiency anaemia and family history and chances of a child developing febrile seizure. Many studies state that vitamin D has a role in development of brain and seizure activity. Aim: To find the association between Vitamin D levels and febrile seizures in children and assessing the nutritional status of children with febrile seizures. Materials and Methods: Fifty consecutive children (developmentally normal), between ages of 9-60 months, presenting with febrile seizures to the Paediatric Department, from February 2019 to January 2020, were enrolled. Antenatal history regarding birth order, maternal weight gain, antenatal check-ups, antenatal supplements and medical problems in mother if any, were noted. Birth history, birth weight, breast feeding, complimentary feeding and present diet history were noted. The height and weight were documented. Skin colour was noted based on Fitzpatrick scale. Vitamin D levels were classified as deficient if blood levels were <10 IU; insufficient if between 10-30 IU and sufficient, if the levels were >30 IU. Collected data were analysed and compared using Sigma Plot 13 and Chi-square test was done and a p-value <0.05 was considered as statistically significant. Results: Vitamin D insufficiency was prevalent in 68% of children. The dark skin, reduced time spent outdoors, clothing habits and diet and antenatal factors contribute to this vitamin D insufficiency. A 58% of children had Height for Age Z (HAZ) score less than -1SD and 62% of children had Weight for Age Z (WAZ) score less than -1SD. On correlating the Complete Blood Count (CBC) values with iron deficiency it was found that 56% of children with febrile seizure had anaemia based on Red-cell Distribution Width (RDW) value >14.5. Febrile seizure was less common in summer (16%). Conclusion: A 68% of children had vitamin D insufficiency. A 56% of children had low iron based on RDW. The nutritional status of children was poor as assessed by HAZ and WAZ scores. [ABSTRACT FROM AUTHOR]

Objective: Hashimoto's thyroiditis (HT) is a variant of autoimmune thyroid disorders (AITD) which has been associated with vitamin D (vit-D) deficiency. However, whether vit-D supplementation is linked to reduction of thyroid autoantibodies and improvement of thyroid function is not well characterized. The present study was planned to evaluate the effect of vit-D supplementation on possible improvement of thyroid autoantibody titer and thyroid hormone profile in patients with AITD subjects. Methods: Twenty-three patients of HT were given weekly supplementation of 60,000 IU vit-D for 8 weeks followed by once a month for another 4 months. After 6 months of vit-D supplementation, thyroid autoantibody titer (TPO antibody) and thyroid hormone profile was rechecked. Results: Mean serum vit-D was increased significantly from 15.33 ± 5.71 to 41.22 ± 12.24 ng/mL (normal levels) after supplementation. There was significant increase in thyroid autoantibody titre (from 746.8 ± 332.2 to 954.1 ±4 59.8 IU/ml; P = 0.006) and TSH level (7.23 ± 3.16 to 3.04 ± 2.62 (mIU/L); P = 0.01) following 6 months of vit-D supplementation. Conclusion: Vitamin-D levels were low in AITD patients in eastern India and, its supplementation in HT patients increased thyroid antibody titer and there was significant reduction in serum TSH and increased in free T4. [ABSTRACT FROM AUTHOR]

Background: Vitamin D, a fat-soluble vitamin has its receptor present in myriad of tissues and it modulates multiple cellular processes. Vitamin D deficiency is reported to be associated with coronary artery disease. Cardiovascular disease is the leading cause of mortality worldwide. Aims and Objective: The primary outcome was to investigate if there is a correlation of 25-OH levels with the percentage of luminal stenosis, as measured with coronary angiogram. The secondary outcome was to determine the differences in angiographically proven luminal stenosis across categories of 25-OH vitamin D levels. Materials and Methods: Thirty patients with acute coronary syndrome with diabetes mellitus were included in this cross-sectional descriptive study. All patients were tested for fasting vitamin D levels, fasting blood sugar, HbA1C and serum creatinine. Detailed history of the patients was recorded. Data was analyzed by the statistical software SPSS version 19 and p value<0.05 was considered significant. Statistical tests like Chi- square, independent t test and log regression was used. Results: In this study 30 patients undergoing coronary angiography for acute coronary syndrome, Vitamin D levels showed severe deficiency in 6.7% (2) cases while mild deficiency was seen in 50% of the cases. Patients with single vessel disease on the coronary angiogram had lower mean HbA1C(9.18)levels in our study. Patients with triple vessel disease had poorly controlled mean HbA1Clevels (10.42). Conclusion: In this study we did not find any significant difference between the serum Vitamin D deficiency levels with patients with angiographic severity of the coronary artery disease. Patients with poorly controlled diabetes mellitus had more severe angiographic proven coronary artery disease. [ABSTRACT FROM AUTHOR]

The present study assessed the prevalence of vitamin D deficiency in an urban south Indian population in individuals with different grades of glucose tolerance. A total of 1500 individuals (900 normal glucose tolerance (NGT), 300 prediabetes and 300 with type 2 diabetes mellitus (T2DM)) who were not on vitamin D supplementation were randomly selected from the Chennai Urban Rural Epidemiological Study follow-up study. Anthropometric, clinical examination and biochemical investigations (25-hydroxyvitamin D (25(OH)D), insulin, glycated Hb (HbA1c) and serum lipids) were measured. Vitamin D deficiency was defined as serum 25(OH)D < 20·0 ng/ml, insufficiency as 20–29·9 ng/ml and sufficiency as ≥30 ng/ml. Of the 1500 individuals studied, 45 % were males and the mean age was 46 (sd 12) years. Vitamin D levels lowered with increasing degrees of glucose tolerance (NGT: 21 (sd 11); prediabetes: 19 (sd 10); T2DM: 18 (sd 11) ng/ml, P < 0·001). The overall prevalence of vitamin D deficiency was 55 % and was significantly higher among individuals with T2DM (63 %) followed by prediabetes (58 %) and NGT (51 %) (Pfor trend < 0·001). Women had 1·6 times the risk of vitamin D deficiency compared with men (unadjusted OR 1·6 (95 % CI 1·3, 2·0) and adjusted OR 1·6 (95 % CI 1·2, 1·9)). However, there was no increasing trend observed with increasing age. The prevalence of abdominal obesity (66 v. 49 %), generalised obesity (80 v. 64 %), the metabolic syndrome (45 v. 37 %) and insulin resistance (38 v. 27 %) was significantly higher in those with vitamin D deficiency compared with those without. This study shows that vitamin D deficiency is highly prevalent in this urban south Indian population and was higher among individuals with T2DM and prediabetes compared with those with NGT. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to find out the prevalence of metabolic syndrome (MS) and 25-hydroxyvitamin D (25[OH] D) status as well as their association among rural elderly women of West Bengal, India. Materials and Methods: This cross-sectional study was conducted among elderly women residing at Amdanga Block, North 24 Parganas District of West Bengal, India, from April 2014 to August 2018. A total of 236 randomly selected rural elderly women aged between 60 and 70 years of age were included. Serum 25(OH)D, blood pressure (BP), waist circumference (WC), fasting blood glucose (FBG), triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C) were measured using standard procedures. MS was defined as per the International Diabetes Federation, 2005 (for Asian-Indians) criteria. Statistical tests were done using SPSS software. Results: The prevalence of Vitamin D deficiency (VDD)/Vitamin D insufficiency was 53.5%. The prevalence of MS was 34%. Of all the studied elderly having MS, 23.2% and 34% were Vitamin D insufficient and deficient, respectively. Among the studied women, 18.3% and 45% with WC ≤80 cm; 21.4% and 42.9% with FBG >100 mg/dl; 22.8% and 33.7% with TG ≥150 mg/dl; 22.1% and 31.1% with HDL-C <50 mg/dl; and 22% and 34.2% with BP ≥130/85 mm of Hg had Vitamin D insufficiency and VDD, respectively. Significant statistical association was found between WC (P = 0.003) and MS (P = 0.008) with serum 25(OH)D status using Chi-square test (P = 0.01). Significant negative correlation existed between WC, MS, and serum 25(OH)D level. MS itself found to predict the serum 25(OH)D level significantly. Conclusion: 25(OH)D had significant inverse and direct relationship with MS and WC. Low 25(OH)D may be one of the potential risk factors for developing MS in elderly women or vice versa. [ABSTRACT FROM AUTHOR]

Objective: To study plasma 25-hydroxyvitamin D (25(OH)D) status of children in Kerala, southern India, and its relationship with sociodemographic variables.Design: Cross-sectional observational study.Setting: Tertiary government hospital.Participants: Children (n 296) with trivial acute illness were enrolled. Sun exposure and Ca and vitamin D intakes (7 d dietary recall) were documented. Serum Ca, P, alkaline phosphatase, plasma 25(OH)D and parathyroid hormone (PTH) were measured.Results: Prevalence of vitamin D deficiency (plasma 25(OH)D <30 nmol/l) was 11·1% (median, interquartile range (IQR): 52·6, 38·4-65·6 nmol/l). Children who ate fish daily had significantly higher plasma 25(OH)D than those who did not (median, IQR: 52·5, 40·8-68·9 v. 49·1, 36·2-60·7 nmol/l; P = 0·02). Those investigated in the months of March-May showed highest 25(OH)D v. those enrolled during other times (median, IQR: 58·7, 45·6-81·4 v. 45·5, 35·6-57·4 nmol/l; P <0·001). Plasma 25(OH)D correlated positively with serum P (r = 0·24, P <0·001) and Ca intake (r = 0·16, P 0·03), negatively with age (r = -0·13, P 0·03) and PTH (r = -0·22, P <0·001.). On linear regression, summer season (March-May), lower age, daily fish intake and higher Ca intake were independently associated with plasma 25(OH)D.Conclusions: Prevalence of vitamin D deficiency is low in Kerala. The natural fish diet of coastal Kerala and the latitude may be protective. Public health policy in India should take account of this geographical diversity. [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]

Childhood nephrotic syndrome (NS) is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia associated with peripheral edema. Children with NS lose 25-OH vitamin D binding protein in urine, and can have low blood levels of this metabolite. The present hospital-based study was carried out on a total of 50 children with nephrotic syndrome who are in remission, in the age group of 1-15 years of either gender, attending to our pediatric nephrology clinic. 46% had clear deficiency of vitamin D, while insufficiency was present in 28% and normal levels in only 26% of patients. There was significant difference (p<0.05) in 25-OH vitamin D levels between frequent relapsers (FR) as compared to infrequent relapsers (IR) and first episode of nephrotic syndrome. Hypocalcemia was present in 86% of patients, hypophosphatemia in 10% of patients, hyperphosphatemia in 50% and raised alkaline phosphatase in 36% of patients. Strong positive correlation is observed between serum calcium and vitamin D levels (r=0.720; p<0.001) and moderate negative correlation between phosphorous and vitamin D levels (r= -0.577; p<0.001, but insignificant relation between vitamin D and alkaline phosphate levels (r= -0.248; p<0.082). It is concluded that vitamin D deficiency is common among children with nephrotic syndrome even after remission of proteinuria. There exists a strong positive correlation between serum calcium and vitamin D levels. [ABSTRACT FROM AUTHOR]

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 ង 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. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is important for brain function and linear growth. Vitamin D deficiency during pregnancy has been linked with impaired neurodevelopment during early childhood. However, there is limited evidence from population-based studies on the long-term impact of vitamin D deficiency on cognitive development and linear growth. The objective of the current analysis is to examine whether vitamin D deficiency during infancy and early childhood is associated with cognitive development and linear growth measured in school age.Methods: This is a follow-up study of a placebo-controlled trial among 1000 North Indian children 6-30 months of age. We measured growth and neurodevelopment in 791 of these children when they were 6-9 years old. Neurodevelopment was measured using the Wechsler Intelligence Scale for Children, 4th edition INDIA, the Crichton Verbal Scale, NEPSY-II subtests, and the BRIEF 2. We categorized vitamin D concentrations during infancy and early childhood according to the US Institute of Medicine's recommendations; serum 25(OH)D < 12 ng/ml as deficient; 12-20 ng/ml as inadequate; > 20 ng/ml as sufficient. In multivariable regression models, adjusting for relevant confounders, we estimated the association between vitamin D status, growth and neurodevelopmental outcomes.Results: Among the 791 children, baseline vitamin D status was available for 716. Of these, 45.8% were vitamin D deficient, 32.7% were inadequate, and 21.5% were sufficient. Vitamin D status was not associated with any of the cognitive outcomes or linear growth [Adjusted β coefficient for height for age z-score between deficient and sufficient children was - 0.06 (95% CI - 0.24 to 0.11)] at follow up.Conclusion: Our findings do not support the notion that poor vitamin D status in early childhood is an important limitation for cognitive development and linear growth.Trial Registration: The trial was first registered at www.clinicaltrials.gov as NCT00717730 in July, 2008, and at CTRI/2010/091/001090 in August, 2010 and then as CTRI/2016/11/007494 in November 2016. [ABSTRACT FROM AUTHOR]

There is a common belief among the laity and even physicians that sun exposure is a useful source of vitamin D. However, despite the fact that sun exposure occurs almost throughout the year in India, vitamin D deficiency is widely prevalent. Although several authors have reported on the duration of sun exposure required to synthesize adequate amounts of vitamin D in the human body, they have not followed a standard and uniform protocol for measurement of sun exposure and vitamin D synthesis. For these and many other reasons, the results are difficult to interpret. The American Academy of Pediatrics (AAP) has clearly stated that infants should be protected from the sun as much as possible and vitamin D requirements should be met through diet and fortified foods rather than deliberate sun exposure. However, this recommendation is frequently ignored in clinical practice. This review aims to summarize the available literature on benefits and harm of unprotected sun exposure in infants and children with a focus on skin phototype IV to VI. Dermatologists and pediatricians in India should counsel parents about the need for sun protection, especially in fair-skinned infants and children. [ABSTRACT FROM AUTHOR]

Background: The impact of diabetic foot infections is enormous in India. Studies on vitamin D levels in diabetes mellitus foot infections are scarce. The primary objective of the present study was to compare the serum vitamin D level between diabetics with foot infections and those without foot infections and the secondary objective was to assess the association between the vitamin D level and the severity of foot infections and outcomes. Methods: The study included 176 type 2 diabetics who attended Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, between September 2012 and June 2014. The serum vitamin D level was measured for 88 diabetics with foot infections (Group 1) and 88 without foot infections (Group 2) using the ELISA 25OH vitamin D DIAsource kit (DIAsource ImmunoAssays S.A., Belgium) and compared. Both groups were followed up for 6 months for outcomes. The qualitative variables were analyzed using the χ² test and the quantitative variables using the Student t test. The statistical analyses were performed using SPSS, version 17.0. A P value of less than 0.05 was considered significant. Results: The mean serum vitamin D level was not significantly different between the two groups (P=0.306). Among the patients in Group 1 who either required amputations or died, 97.44% had subnormal vitamin D levels in contrast to 59.18% in those who were grafted or achieved wound healing (P=0.001). Among those who achieved wound healing within 6 months, 78.9% had normal vitamin D levels (P=0.0006). Conclusion: The study found no significant difference in the serum level of vitamin D between diabetics with and without foot infections. However, vitamin D deficiency was associated with a poor outcome in diabetics with foot infections. [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]

Context: India has 18% of the global population and an increasing burden of chronic respiratory diseases. The prevalence of Metabolic syndrome (MS) was found to be as high as 39.7% among Indian population. Metabolic syndrome is found to be more common in Chronic Obstructive Pulmonary Disease (COPD) when compared to the general population. This study was done to assess the prevalence of metabolic syndrome in COPD and the association of systemic inflammation in COPD patients with metabolic syndrome. Methodology: This study enrolled 150 consecutive consenting patients of stable COPD attending the outpatient pulmonology department. Detailed history, clinical examination, spirometry, and relevant routine laboratory investigations including complete blood count, fasting blood sugar, and lipid profile were done. In addition, hsCRP, Serum lactate and Vitamin D level was assessed in all patients. Diagnosis of COPD and Metabolic syndrome was done according to GOLD guidelines, 2018 and the International Diabetes Federation criteria respectively. Result: The prevalence of metabolic syndrome was found to be 27.3% in our COPD patients. The frequency of metabolic syndrome in GOLD stage I, II, III, and IV was 75%, 32%, 17%, and 13.5%, respectively. Logistic regression analysis showed a significant relationship of blood leucocyte count (OR = 0.342, CI = 0.171-0.686), hs-CRP (OR = 0.020, CI = 0.003-0.122), pack years (OR = 1.083, CI = 1.026-1.14) and vitamin D levels (OR = 1.219, CI = 1.093-1.359) with metabolic syndrome in COPD patients. Conclusion: Metabolic syndrome is a co-morbidity that is very often overlooked in patients of COPD. Systemic inflammation which is a common characteristic of both COPD and Metabolic syndrome has been found to be an important contributor towards cardiovascular morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is high in athletes and has an impact on athletes' performance. Introduction: Assessment of serum Vitamin D levels in healthy North Indian sportspersons and its correlation with serum parathyroid hormone (PTH) levels and bone mineral density (BMD). Materials and Methods: Three-hundred and sixty-nine healthy athletes' aged 1845 years were enrolled. Depending upon Vitamin D levels athletes were categorized into three groups: deficient (<20 ng/ml), insufficient (20-30 ng/ml), and sufficient (>30 ng/ml). BMD and serum PTH levels were assessed in all athletes and correlation was seen with Vitamin D levels. Results: Two-hundred and fifty-eight (69.9%) athletes were Vitamin D deficient, 51/369 (13.8%) were Vitamin D insufficient, and 60/369 (16.3%) athletes were Vitamin D sufficient. There was a direct correlation between low serum Vitamin D levels and low BMD (r = 0.473; P < 0.05). Overall, 114/369 (30%) athletes had low BMD and out of these 114 athletes, 108 (95%) were Vitamin D deficient. Serum PTH levels were found to have inverse relations with both Vitamin D (r= 0.629) and BMD (r=-0.267). Conclusions: Vitamin D deficiency is highly prevalent among the North Indian athletes and the presence of low Vitamin D (<20 ng/ml) levels is associated with low BMD and high PTH levels. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D deficiency has been found to be prevalent among Indian elderly women. Aging has a significant association with decreased concentration of 7-dehydrocholesterol, the precursor of Vitamin D3 in the skin. Objective: The aim is to find out the association between the period of sun exposure and serum 25(OH) D level among rural elderly women of West Bengal, India. Subjects and Methods: The present study was conducted among 236 elderly women aged between 60 and 70 years residing at Amdanga Block, North 24th Parganas district of West Bengal, India. They were assessed for their period of sun exposure and serum 25(OH) D level. Results: The sun exposure index was low from sufficient to deficient Vitamin D status groups, but they were insignificant (P = 0.09). Spearman's correlation test revealed significant positive relationship (0.183 [P = 0.005]) between sun exposure and serum 25(OH) D level. Conclusion: Therefore, for maintaining optimum serum 25(OH) D level, adequate sun exposure for this population is needed, particularly for the individuals having suboptimal Vitamin D status. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency and anemia are clinical conditions that coexist during pregnancy. A high prevalence of Vitamin D deficiency ranging from 50 to 94% is seen throughout the country. The aim of the study was to discover the association between Vitamin D status and iron deficiency anemia during pregnancy. Improving the vitamin D status of pregnant women is crucial to prevent iron deficiency anemia and can improve maternal and fetal outcomes., Methods: A case-control study including 94 primigravida women of age within the age group 18 to 30 years, divided into two groups: a Case Group of 48 patients with already diagnosed iron deficiency anemia (mild to moderate) and a Control Group of 46 antenatal women with normal hemoglobin levels. Data on sociodemographic, clinical characteristics, and the levels of 25(OH) Vitamin D was estimated in both the groups. The association of 25(OH)D levels and anemia was then determined using suitable statistical analysis., Results: Among pregnant women affected with anemia, 75% of women had serum Vitamin D concentrations < 20 ng/ml compared to 52.2% of women in the controls. Maternal serum vitamin D level was significantly lower in pregnant women affected with anemia (19.61 ± 13.12) as compared to control (29.43 ± 24.05); (p = 0.024). A positive correlation was found between hemoglobin and vitamin D levels in pregnant women (Pearson's r = 0.200, p = 0.05)., Conclusions: These findings provide evidence suggesting that Vitamin D deficiency or insufficiency during pregnancy may be a risk factor for anemia and correction of Vitamin D levels can improve hemoglobin levels. Educational efforts should be made to include safe vitamin D intake in antenatal care., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background and Aims: Vitamin D Deficiency/Insufficiency (VDD/VDI) is now recognized as a pandemic. Vitamin D is a versatile yet crucial factor which is vital for many metabolic functions in our body. Till now there is no screening tool for VDD/VDI. The aim of this study is to develop and validate a screening tool Vitamin D Insufficiency Risk Score (VDIRS). Methods: This study was a rural community based cross-sectional study. It was done during May 2016 to April 2017 among 197 adults residing in rural West Bengal. After a thorough literature review and discussion with the field experts, four characteristics (BMI, Physical activity, Daily Sun exposure, Diet) were considered for VDIRS.Data was collected after taking informed consent. After interviewing every individual was examined for height, weight and blood was collected for vitamin 25-(OH) D. Weights were given to VDIRS characteristic according to Adjusted Odds' Ratio. Receiver Operating Characteristics (ROC) curves were utilized to validate and find out optimum cut off for VDIRS using Youden's index for VDD/VDI with the use of R software. Results: Only 133 (67.5%) had Vitamin D insufficiency. On ROC curves for VDIRS for VDI and VDD, AUC was 0.83 and 0.77 which signifies VDIRS as a good screening and predictive tool. A score of VDIRS ≥14 had sensitivity of 78.2% and specificity of 75.0% for VDI.Conclusion: Use of the VDIRS can make mass screening for undiagnosed VDI/VDD in India more cost effective. Researchers strongly believe and perceive a necessity of such validated score in the present scenario. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to compare the Vitamin D3 level in obese children in a tertiary care center in Jammu (Jammu and Kashmir), India, and to find the association between Vitamin D3 levels and the comorbidities of obesity. Materials and Methods: Twenty obese children and 20 controls were included in the study group. Obesity defined by international obesity task force (criteria) Questionnaires Form and anthropomorphic data were collected on patients, and fasting blood glucose, lipids, liver function tests, renal function test and 25-hydroxyvitamin D (25-OHD) were measured. Results: The levels of 25-OHD in the obese group were significantly lower than those of the control group (χ = 0.000). About 80% of obese children and 10% of controls were Vitamin D deficient; similarly, 20% of obese children and 35% of controls had Vitamin D insufficiency. There was no statistical significant difference of mean serum Vitamin D level between male and female children in both cases and controls. Calorie intake (P = 0.11), serum cholesterol, and triglycerides were significantly raised among the obese group with the mean (152.70 ± 18.85) than in the control group (134.65 ± 15.27) (P = 0.002). There was no significant association of 25 (OH) Vitamin D3 level with the other comorbidities of obesity such as deranged blood sugar, liver function tests, and lipid profile. Conclusion: Vitamin D deficiency is significantly more prevalent in obese children and showed a linear relationship, but we were unable to find any significant statistical association between 25 (OH) Vitamin D3 levels with the comorbidities of obesity. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D has many effects apart from its role in calcium metabolism and bone health. Vitamin D is derived from endogenous ultraviolet-B induced vitamin D synthesis in the skin, and the current high prevalence of vitamin D deficiency in India, can be attributed to lifestyle related low sunlight exposure. Identification of the vitamin D receptor (VDR) in almost all human cells, suggests a role in extra skeletal diseases. Studies have shown that vitamin D deficiency is an independent risk factor for hypertension. Aim: To evaluate the association between vitamin D and hypertension in people coming for health check up to a tertiary care center in South India. Materials and Methods: Study was carried out as a cross sectional study in a tertiary care hospital in South India. Participants (520) were both males and females (337 males and 183 females), between the age group of 20-60 years attending the comprehensive health check up clinic of our hospital. Statistical Analysis: Statistical analysis was done using IBM SPSS statistics 20.0. Results: Severe vitamin D deficiency was highly prevalent in people with hypertension than in people without hypertension (P value <0.001). Conclusion: Since India is a tropical country, till recently it was believed that vitamin D deficiency and its ill effects are uncommon. But it was found that, vitamin D deficiency was highly prevalent in people with hypertension in South India, emphasizing the need of early vitamin D supplementation. Therefore, to reduce cardiovascular morbidity, early identification of vitamin D deficiency and appropriate vitamin D supplementation may be of primary importance in population, especially like ours, having high prevalence. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a depigmenting disorder which can be psychologically devastating. Childhood-onset vitiligo has different epidemiological and clinical characteristics as compared to adults. Aims and Objectives: The aim was to study the clinico-epidemiological and hematologic investigation profiles of childhood vitiligo. Materials and Methods: First 200 pediatric patients younger than 18 years, with vitiligo who attended the dermatology outpatient department of a tertiary center in Northeast India, between September 2015 and August 2017 were included in the study. A detailed history and examination along with autoimmune diseases and laboratory parameters were recorded. Results: Among the 200 patients, 62% were girls. The mean age was 10.3 ± 4.9 years. The mean age at onset was 9.1 ± 4.9 years (ranging 2 months–17 years), with duration of disease varying from 1 month to 8 years with mean duration of 1.39 ± 1.63 years. Most common pattern of vitiligo was vulgaris (39.5%) followed by focal (25%), segmental (15.5%) genital (10%), acral and lateral lip (8%), and acrofacial (4%). Family history of vitiligo was seen in 12% of patients. In 96% patients, only <5% of body surface area was affected. Nearly 8.5% had Koebnerization while 9% showed leukotrichia. Thyroid-stimulating hormone and antithyroid peroxidase abnormalities were seen in 4.5% and 1% patients, respectively. Low Vitamin D level was seen in 21.5%. Conclusion: Any depigmented lesion in children should be evaluated and followed up properly to rule out vitiligo. Dermatologists and pediatricians should understand the characteristics of childhood vitiligo properly since it behave differently from adult-onset disease. [ABSTRACT FROM AUTHOR]