International Journal of Health & Allied Sciences

EDITORIAL
Year
: 2014  |  Volume : 3  |  Issue : 2  |  Page : 77--78

Vitamin D deficiency in India: Are we overconcerned?


Prashant Vishwanath1, Praveen Kulkarni2, Akila Prashant1,  
1 Department of Biochemistry, Jagadguru Sri Shivarathreeswara Medical College, Jagadguru Sri Shivarathreeswara University, Mysore, Karnataka, India
2 Department of Community Medicine, Jagadguru Sri Shivarathreeswara Medical College, Jagadguru Sri Shivarathreeswara University, Mysore, Karnataka, India

Correspondence Address:
Prashant Vishwanath
Department of Biochemistry, Jagadguru Sri Shivarathreeswara Medical College, Jagadguru Sri Shivarathreeswara University, Mysore, Karnataka
India




How to cite this article:
Vishwanath P, Kulkarni P, Prashant A. Vitamin D deficiency in India: Are we overconcerned?.Int J Health Allied Sci 2014;3:77-78


How to cite this URL:
Vishwanath P, Kulkarni P, Prashant A. Vitamin D deficiency in India: Are we overconcerned?. Int J Health Allied Sci [serial online] 2014 [cited 2019 Oct 14 ];3:77-78
Available from: http://www.ijhas.in/text.asp?2014/3/2/77/132688


Full Text

The concern for vitamin D estimation has increased tremendously in India despite the fact that it is located between 8.4° and 37.6° north latitude with the majority of its population living in regions experiencing ample sunlight throughout the year. This trend is proportionate to the published data in the last 8 years regarding prevalence of vitamin D deficiency (VDD) status in the Indian subcontinent. As per the report of International Osteoporosis Foundation, in North India, 96% of noenates, 91% of healthy school girls, 78% of healthy hospital staff, and 84% of pregnant women were found to have hypovitaminosis D. [1] On the other hand, prevalence of vitamin D deficiency in southern India was estimated to be 40% among males and 70% among females. There was also a significant rural urban variation in the vitamin D deficiency status that was attributed to the diversity of occupation which the people were involved in. [2]

But it is important to note that the studies which have reported an increased prevalence of vitamin D deficiency in India have taken the cut-off limits of approximately 20 ng/ml for severe vitamin D deficiency, cut-off limits of 30 ng/ml for moderate vitamin D deficiency, and a cut-off limit of <35 ng/ml as mild deficiency. [3]

Though some of the researchers in India have tried to establish the cut-off limits for vitamin D deficiency, it is still largely based on the reference range provided by the company supplying the kit or the international standards. India is unique due to its large population diversity which definitely affects the vitamin D levels in the established population as described above. In the absence of such defined reference ranges established for the diverse Indian population, it is wrong to predict that Indian population is deficient of vitamin D. The blame on vitamin D deficiency is easy in the Indian subcontinent which is harder to prove and still harder to disprove. The initiative of Indian Council of Medical Research (ICMR) to study vitamins D levels in a large cohort of individuals representing the varied Indian population would definitely help in understanding the impact of vitamin D deficiency with regards to Indian population, and a task force has been formed to look into the concerns of vitamin D deficiency.

It is the need of the hour for each laboratory, estimating and reporting total vitamin D levels to establish a population-based reference range and then report vitamin D levels, thereby preventing a bias for overreported VDD in India. Even in the number of publications citing VDD, majority have reported deficient levels without establishing reference ranges for their own laboratories, wherein the guidelines clearly prescribes that the deficient state is when a person falls below 95 th percentile of the normal population. There is also a need to look beyond the box by correlating the results of laboratory techniques with the clinical and radiological manifestations which can substantially bring down the overestimation of burden.

The published data in India have overlooked this consideration though majority of the population under study have been reported as vitamin D deficient considering international standards. World Health Organization (WHO) has defined populations based on the latitude and longitude as per which India should have been vitamin-D-deficiency-resistant country. However, due to omission of certain important considerations, we have over the period of time reported an exaggerated deficiency of vitamin D which I am sure will be rectified once the reference ranges are established in the Indian subcontinent. If we go by the published statistics of Vitamin D deficiency in India, then definitely we have to change the definition of health as 80% of populations is supposed to be deficient in an abundantly available vitamin. Though it would be right to say that calcium levels reported in the Indian subcontinent have been low, it represents a small proportion of total population mainly in the paediatric age group. But to label majority of the population in India as deficient of vitamin D would not be right without having an established reference range in the local population. Another important omission in most of the reported studies in reporting of VDD based on the estimation of vitamin D alone. Ideally calcium-vitamin D-parathyroid hormone endocrine axis evaluation should be considered before labeling a person as deficient in vitamin D, as estimation of parathyroid hormone levels are normal in at least 50% of the population having low vitamin D levels, implying that vitamin D levels alone cannot predict the actual deficiency. [4]

It is also a matter of serious consideration that the so called VDD based on western standards would invariably lead to its overenthusiastic supplementation without any added benefits; conversely, it may harm the individual with hypervitaminosis D. This also calls for re-tailoring of dietary guidelines for vitamin D intake among different age-groups and sexes. As public health interventions like vitamin D fortification of food materials are tedious both on operational and financial domains, such interventions should be withheld until we standardize the cut offs for defining vitamin D deficiency status.

References

1Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. IOF Committee of Scientific Advisors (CSA) Nutrition Working Group. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009;20:1807-20.
2Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D, Srinivasarao PV, Sarma KV, et al. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr 2007;85:1062-7.
3Rosen AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 Report on dietary reference intakes for calcium and vitamin d from the institute of medicine: What clinicians need to know. J Clin Endocrinol Metab 2011;96:53-8.
4Garg MK, Kalra S, Mahalle N. Defining vitamin D deficiency, using surrogate markers. Indian J Endocrinol Metab 2013;17:784-6.