Literature DB >> 30294588

Vitamin D Deficiency in Children: Is There a Need for Routine Supplementation?

Suresh K Angurana1.   

Abstract

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Year:  2018        PMID: 30294588      PMCID: PMC6166549          DOI: 10.4103/ijem.IJEM_215_18

Source DB:  PubMed          Journal:  Indian J Endocrinol Metab        ISSN: 2230-9500


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Sir, I read with interest article entitled “Determinants of Vitamin D Status in Indian School-children” by Mandlik et al.[1] The authors noted that, in school children (n = 359) aged 6–12 years from a semirural government-run primary school, only 5% had sufficient levels of 25-hydroxy vitamin D [25(OH) D levels >75 nmol/L] and the rest had either vitamin D deficiency (VDD) (24%) or insufficiency (71%), despite majority of children (80%) reporting sunlight exposure of ≥2 hours. I would like to make few important comments. The authors mentioned that the duration of sunlight exposure had positive association (P < 0.05) whereas body fat percentage had negative association (β = –0.307; standard error = 0.1388; P < 0.05) with serum 25(OH)D levels. Other ways of demonstrating relationship between two quantitative variables is correlation (positive or negative correlation), though it also does not necessarily indicate causal relationship. Regression equation can tell about the degree of change in one variable with a particular change in the second variable. The authors screened 544 children in the age group of 6–12 years (elementary school grade 1–4) from a single school in this cross-sectional study. It implies that there were 136 students in each grade (grade 1–4). Is this a real scenario to have so many students in a single grade? Authors did not mention the period of year when this study was conducted. VDD is season dependent with lower 25(OH)D levels in winter months.[2] Few studies from north India also demonstrated that the prevalence of VDD in apparently healthy children is as high as 90%.[345] In a study involving 338 apparently healthy children in the age group of 3 months to 12 years belonging to the upper socioeconomic group in Chandigarh, the prevalence of VDD was 40.3%. On univariate analysis, VDD was associated with relatively younger age group, female sex, failure to thrive, exclusive breast-feeding, inadequate sun exposure, and no vitamin D supplements.[5] The differences observed in the prevalence of VDD among healthy children in different studies could be due to different populations studied, latitude of residence, sunlight exposure, skin color, environmental pollution and weather, vitamin D intake (diet and supplementation), different methods used to measure 25(OH) D, and different cut-off values.[5] The American Academy of Pediatrics recommends intake of 10 μg/d (400 IU/d) vitamin D for all infants, children, and adolescents, beginning in the first few days of life.[6] In India and other southeast Asian countries, where the burden of VDD is high, there are no such recommendations regarding routine supplementation or fortification of food products with vitamin D. Recently, Indian Academy of Pediatrics published practice guidelines for Pediatricians for the prevention and treatment of vitamin D and calcium deficiency in children and adolescents.[7] In view of high prevalence of VDD in India and the important effects of vitamin D on skeletal and extraskeletal health, there is need to study the effect of routine supplementation of vitamin D in Indian children taking into account cost–benefit ratio.

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Conflicts of interest

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  7 in total

Review 1.  Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes.

Authors:  Asma Arabi; Rola El Rassi; Ghada El-Hajj Fuleihan
Journal:  Nat Rev Endocrinol       Date:  2010-10       Impact factor: 43.330

2.  Prevention and Treatment of Vitamin D and Calcium Deficiency in Children and Adolescents: Indian Academy of Pediatrics (IAP) Guidelines.

Authors:  Anuradha Khadilkar; Vaman Khadilkar; Jagdish Chinnappa; Narendra Rathi; Rajesh Khadgawat; S Balasubramanian; Bakul Parekh; Pramod Jog
Journal:  Indian Pediatr       Date:  2017-07-15       Impact factor: 1.411

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

Authors:  Raman K Marwaha; Nikhil Tandon; Devi Reddy H K Reddy; Rashmi Aggarwal; Rajvir Singh; Ramesh C Sawhney; Bobbin Saluja; M Ashraf Ganie; Satveer Singh
Journal:  Am J Clin Nutr       Date:  2005-08       Impact factor: 7.045

4.  Prevalence of vitamin D deficiency in apparently healthy children in north India.

Authors:  Suresh Kumar Angurana; Renu Suthar Angurana; Gagan Mahajan; Neeraj Kumar; Vikas Mahajan
Journal:  J Pediatr Endocrinol Metab       Date:  2014-11       Impact factor: 1.634

5.  Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.

Authors:  Carol L Wagner; Frank R Greer
Journal:  Pediatrics       Date:  2008-11       Impact factor: 7.124

6.  Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle.

Authors:  Seema Puri; Raman K Marwaha; Neha Agarwal; Nikhil Tandon; Rashmi Agarwal; Khushi Grewal; D H K Reddy; Satveer Singh
Journal:  Br J Nutr       Date:  2007-10-01       Impact factor: 3.718

7.  Determinants of Vitamin D Status in Indian School-children.

Authors:  Rubina Mandlik; Neha Kajale; Veena Ekbote; Vivek Patwardhan; Vaman Khadilkar; Shashi Chiplonkar; Anuradha Khadilkar
Journal:  Indian J Endocrinol Metab       Date:  2018 Mar-Apr
  7 in total

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