No-sunshine lifestyles are putting an increasing number of Indian infants at the risk of bone deformities, seizures and poor growth, a significant new study of Vitamin-D prevalence among newborns and their mothers has shown.
Conducted by paediatricians from the All-India Institute of Medical Sciences (AIIMS), the research, for the first time, provides evidence to the government on the urgency of Vitamin-D supplements for pregnant women being covered under the national health programmes across the country. The study reveals acute Vitamin D deficiencies in exclusively breastfed babies and even greater shortages of the vitamin in their mothers.
Of the 98 healthy infants (aged 2.5 to 3.5 months) and their mothers studied for the purpose (47 enrolled in winter and 51 in summer to determine seasonal variations in Vitamin D prevalence, if any), the researchers found shockingly high combined prevalence of Vitamin D deficiency in 86.5 per cent infants and 92.6 per cent mothers. Among those with severely deficient levels, the paediatricians found hyperparathyroidism (a condition wherein the thyroid glands secrete large quantities of parathormone to maintain low calcium levels in the body) in 90.3 per cent infants and 73.1 per cent mothers. They further found evidence of radiological rickets (babies wrists were X-rayed to find if they had rickets due to low Vitamin D and calcium levels) in 30.3 per cent infants.
“The presence of hyperparathyroidism among infants and mothers with low Vitamin D levels proves low calcium levels in their bodies and is clear evidence of Vitamin D shortage. It is to make up for calcium loss that thyroid glands secrete parathormone in greater quantities resulting in a condition called hyperparathyroidism. The parathormone maintains calcium levels in the body by mobilising calcium from bones to the blood. Long-term effects of such a mobilisation include bowing of legs among children, seizures marked by cramps of hands and feet and their abnormal posturing, or even abnormally square-shaped heads,” Dr Vandana Jain, assistant professor, paediatrics, AIIMS and lead author of the study told The Tribune. She said the newly found high prevalence of Vitamin D among Indian infants and their mothers was higher than that in the US but consistent with that in Greece, the UAE and Pakistan. The deficiency of Vitamin D in India is even lower for girls, starting from adolescence, with a recent study finding 90.3 per cent schoolgirls reporting such deficiency.
“Vitamin D deficiency among infants and mothers in both summers and winters can be attributed to decreased cutaneous synthesis of Vitamin D due to higher skin pigmentation in India. But the primary reason appears to be less exposure to the sun, lack of participation in outdoor activities and excessive use of sunscreens by women, who block UV rays essential for the skin to synthesise Vitamin D,” Jain added, recommending 15 minute exposure of arms and legs to the sun from 10 am to 3 pm daily.
The most important takeaway from the report is Vitamin D supplement for pregnant and lactating women in India, as is recommended by the American and European Academies of Paediatrics. The AIIMS study argues for the Indian Association of Paediatrics to make a similar recommendation to the government, which could consider providing supplements in the national programme.
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By: Richard Alleyne —
Casualty departments are dealing with dozens of emergency cases where infants are having seizures as a direct result of not getting enough vitamin D, which is essential for healthy teeth and bones.
In one case, a baby suffered brain damage after a fit.
The study said the extreme cases are part of an escalating problem of a deficiency of the vitamin, which the body makes when exposed to sunlight.
The report in the London Journal of Primary Care blames indoor lifestyles and the use of high sun protection factor creams for a health issue unheard of a decade ago.
The findings have prompted experts to call for vitamin D pills to be made more widely available on the NHS, especially for pregnant women.
The study reveals the introduction of schemes offering mothers supplements has been slow. Some areas of London have no vitamin packs available and people are ignorant about the benefits of vitamin D, which is also found in oily fish, liver and eggs.
Colin Michie, a co-author of the study, said vitamin D deficiency was no longer a “poor” problem and the middle classes are just as vulnerable.
The consultant paediatrician, who works at Ealing Hospital and BMI Clementine Churchill, said GPs should be more alert to symptoms such as muscle aches and pains.
He told the Evening Standard: “This is a totally avoidable condition which is now a public health issue. It’s affecting middle-class children because they’re overprotecting with sunscreen and not going out as much.
SPF is also increasingly in cosmetics used by young women.
“The more dramatic cases tend to be in people who wear traditional clothing and so are covered up.” However, he added, GPs also see a growing number of low-level cases in other groups.
Warnings over the links between sunburn and skin cancer have prompted some people to shun the sun. The actress Gwyneth Paltrow has revealed recently that she was diagnosed with very poor vitamin D levels after years of keeping her skin covered.
A special investigation is being launched into the extent of emergency admissions for patients with vitamin D deficiency.The British Paediatric Surveillance Unit will gather data from hospitals from next year.
Mr Michie analysed the cases of 17 babies and infants treated at Ealing Hospital for a severe lack of vitamin D between 2006 and 2008. He found many experienced a delay in walking, a problem last common in Victorian times.
Cancer Research UK is considering changing it guidelines concerning sun exposure because of the problem.
Instead of advising people to stay out the midday sun completely, it may suggest that a few minutes exposure could be healthy.
Children who took vitamin D supplements during the cold and flu season escaped seasonal flu and asthma attacks, according to a study published in the American Journal of Clinical Nutrition and reported by Reuters.
For the three-month study, done during cold and flu season, researchers from the Jikei University School of Medicine in Tokyo randomly assigned 167 children, ages 6 to 15, to take 1,200 international units (IU) of vitamin D-3 or a placebo each day.
Vitamin D-3 is more readily absorbed and more potent than vitamin D-2 (usually found in multivitamins).
Scientists noted that only 18 children taking vitamin D caught influenza A compared with 31 kids taking the placebo. Overall, the vitamin D group was 58 percent less likely to catch influenza A.
In addition, vitamin D also seemed to suppress asthma attacks in children with a history of asthma. Two children taking the supplement had asthma attacks compared with 12 children taking the placebo.
Based on the study, researchers concluded that vitamin D-3 supplements may reduce influenza A. They also suggested parents check with their pediatricians about giving their children 1,200 IU of vitamin D per day starting in September to prevent asthma and flu during the flu season.
By Irene Lane, DC Healthy Living Examiner March 4, 2010
Vitamin D deficiencies among young people are more prevalent than one would think. If you adhered to medical advice and shunned the sun for most of your adult life or maintained a strict vegetarian diet, you may be at risk for a vitamin D deficiency. Increasingly, research is revealing the importance of vitamin D as protection against a host of health problems including cardiovascular disease, cognitive impairment, asthma and cancer. Are you at risk?
Dr. Mary Wilkinson, an oncologist / hematologist who practices in Northern Virginia and who has been consistently listed in Washingtonian Magazine as a leading doctor in the Washington, D.C. area says, “The medical community is just realizing that there is a more complex interaction between vitamin D and cellular growth than what has been previously identified. Nonetheless, people who have used sunscreen liberally or have just stayed away from the sun entirely are more likely to have a vitamin D deficiency.”
What are the lifestyle and individual risks for a vitamin D deficiency? Known as the sunshine vitamin, vitamin D is produced by the body in response to sunlight and is essential for strong bones because it helps the body absorb calcium. It is also occurs naturally in a few foods — including fish, egg yolks and fish liver oils as well as in fortified dairy and grain products. But a deficiency can occur for a number of reasons including:
- Following a strict vegetarian diet since the natural sources are animal-based
- Limiting your exposure to the sun
- Having dark skin because the pigment melanin reduces ability to make vitamin D
- Inability for your kidneys to convert vitamin D into its active form
- Inability to absorb vitamin D due to Crohn’s disease, cystic fibrosis or celiac disease
- Having a body mass index of 30 or greater
What are its symptoms? Vitamin D deficiency may be characterized by muscle weakness or bone pain, increased rate of fractures, low energy and fatigue, lowered immunity, symptoms of depression and mood swings and sleep irregularities. Over time, if the deficiency is not detected, osteoporosis, depression, heart disease and stroke, colon or prostate cancer in men, breast cancer in women, diabetes, parathyroid problems, immune system malfunction and weight loss may develop. Dr. Wilkinson adds, “Since we’ve only been measuring vitamin D levels more readily in the last few years, we are unsure if the deficiency causes breast cancer, for example, or if a vitamin D deficiency is merely associated with breast cancer.”
What test confirms the deficiency? The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test. In the kidneys, 25-hydroxy vitamin D changes into an active form of the vitamin that helps to control calcium and phosphate levels in the body. Those levels can be measured through the blood test. The normal range is 30.0 to 74.0 nanograms per milliliter (ng/mL). A lower level indicates a vitamin D deficiency. Dr. Wilkinson emphasizes that “being in the middle of the range is very important since we do know that cancer recurrence is associated with both low and high levels of vitamin D. In this case, being in the middle of the range is best.”
How is one treated for the deficiency? Treatment involves getting more vitamin D — through diet, prescription supplements and spending more time in the sun.
How can one prevent the deficiency?
1. Allow yourself limited (no more than 15 minutes) unprotected sun exposure 2. Eat a diet rich in nutrient-dense foods such as fatty fish, egg yolks, fortified organic milk and other dairy products, and organic meats like liver 3. Take a multivitamin that includes fish oil every day 4. Take a vitamin D supplement