The document discusses the high prevalence of vitamin D deficiency in India, ranging from 47.8% to 96% across different age groups. It outlines the various factors that contribute to vitamin D deficiency in India, including reduced sun exposure, lifestyle changes, dietary habits, and cultural practices. The document also examines the methods used to test vitamin D status and the effects of vitamin D deficiency on health.

1. Prevalence and determinates of vitamin D
deficiency in India By V.S. Deepika rani
M.Sc. I year (Applied Nutrition)
Reg. no. 15MSAN16
PUBLIC HEALTH AND COMMUNITY NUTRITION
Mentor- Dr. A Laxmaiah Sir
Scientist ‘F’ (Sr. Deputy Director)
&
HOD of community studies
National Institute of Nutrition, ICMR

2. Introduction
• Prevalence in India - 70 - 100%.
• Factors like lifestyle changes, socio religious and cultural practices
etc. do not facilitate adequate sun exposure .
• most under- diagnosed and under- treated .Wide spread in
individuals irrespective of their age, gender, race and geography etc.
• Rickets in children and osteopenia, osteoporosis and fractures in
the adults.
-Ritu G and Ajay gupta – Vitamin D deficiency in India: Prevalence, Causalities and interventions.
Nutrients, 2014.

3. Background
• Till early 1990’s- VDD was considered to be rare in India - measuring
serum calcium and alkaline phosphatase in Indian population.
• Till the year 2000 there was no systematic study which directly assessed
body vitamin D status of Indians.
• A study conducted among apparently healthy subjects to measure their
serum 25(OH) D level documented significant hypovitaminosis D & was
present in up to 90% of subjects.
• There is a wide spread prevalence in all age groups.
- Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N and Kochupillai N, 2000
Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in
Delhi, Am J ClinNutr, 72; 472-5.

4. Testing of vitamin D status
• Plasma concentration of 25(OH) D3,
1, 25 (OH) 2 D3,
vitamin D binding protein levels are tested.
• Immunoassays such as RIA, ELISA, chemiluminescence immunoassay
and protein binding assays are used in routine testing of 25(OH) D in
clinical laboratories.
• LCTMS (liquid chromatography tandem mass spectrometry) is the
widely accepted reference method for 25 (OH) D measurements.

5. To define Vitamin D status
Classification given by Lips :
o mild hypovitaminosis D : 10–20 ng/ml,
o moderate hypovitaminosis D : 5-10 ng/ml,
o severe hypovitaminosis D : less than 5 ng/ml
Usual cut off taken are
*Different cut off’s are taken for different age groups.
- Lips P, 2011 Vitamin D Deficiency and secondary hyperparathyroidism in the elderly:
consequences of bone loss and fractures and therapeutic impications. Endocr Rev, 22; 477-501.
Serum conc. Of 25(OH)D
(ng/ml)
Vitamin D status
<12 VDD
12-20 insufficiency of vitamin D
>20 sufficiency of vitamin D
>50 (particularly when
>60ng/ml)
potential adverse effects in
adults

6. Effects of vitamin D deficiency
In children
In adults

7. Association of vitamin D with human diseases
Vitamin D
association
with disease
Author and year
T-2 DM R. Goswami et al, 2008
G. Bhanuprakashreddy et al,
2015
CVD Zittermann et al 2008
Autoimmunity R. Goswami et al, 2008
Tuberculosis R. Goswami et al, 2008
Cancer Schwartz et al, 1998
Deshmukh. 2013
osteoarthritis R. Goswami et al, 2008 Present knowledge in Nutrition by Ekhard
E. Ziegler and L.J Filer, Edition 7. pg. no.
206.

8. Prevalence of vitamin D deficiency in India
0 20 40 60 80 100
3 months
< 5 years
adolescents
pregnant women
lactating women
adults
elderly
Prevalence of VDD( %)
67-96
47.8
83.7
80
61.4
94.8
91.2

9. Details of graph
 Jain V, Gupta N, Kalaivani M, Jain A, Sinha A and Agarwal R, 2011 Vitamin D
deficiency in healthy breastfed term infants at 3 months and their mothers in
India:seasonal variation & determinants, Indian J Med Res, 133(3); 267-71.
 Wayse V, Yousafzai A, Mogale K and Filteau S, 2004 Association of subclinical
vitamin D deficiency with severe acute lower respiratory infection in Indian
children under 5 y. Eur J ClinNutr, 58(4); 563-7.
 Garg MK, Marwaha RK, Khadgawat R, Ramot R, Obroi AK, Mehan N, Gupta N
and Madan R, 2013 Efficacy of Vitamin D loading doses on serum 25-hydroxy
Vitamin D levels in school going adolescents: an open label non-randomized
prospective trial, J PediatrEndocrinolMetab, 26(5-6); 515-23.
 Calvo MS, Whiting SJ and Barton CN, 2005 Vitamin D intake: a global perspective
of current status, J Nutr, 135; 310-316.
 Oren Y, Shapira Y, Agmon-Levin N, Kivity S, Zafrir Y, Altman A, Lerner A and
Shoenfeld Y, 2010 Vitamin D insufficiency in a sunny environment: a
demographic and seasonal analysis, Isr Med Assoc J, 12; 751-756.
 McCollum E A, 1957 History of Nutrition, Houghton Mifflin Co., Boston, MA.
 Hopkins FG, 1906 The analyst and the medical man, Analyst, 31; 385–404.
 Holick MF, 2007 Vitamin D deficiency. N Engl J Med, 357; 266-281.
 Mehrotra P, Marwaha RK , Aneja S, Seth A, Singla BM, Ashraf G, Sharma B,
Sastry A and Tandon N, 2010 Hypovitaminosis D and Hypocalcemic Seizures in
Infancy, Indian Pediatrics, 47; 581-586.
 Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, Saberwal A,
Bhadra K and Mithal A, 2011 Bone health in healthy Indian population aged 50
years and above, OsteoporosInt, 22(11); 2829-36.

10. Marwaha RK, Tandon N, Agarwal N, Puri S, Agarwal R,
Singh S and Mani K, 2010 Impact of two regimens of
Vitamin D supplementation on calcium - Vitamin D –
PTH axis of schoolgirls of Delhi, Indian Pediatr, 47(9);
761-9.
Seth A, Marwaha RK, Singla B, Aneja S, Mehrotra P,
Sastry A, Khurana ML, Mani K, Sharma B, Tandon N
et al. (2009) Vitamin D nutritional status of
exclusively breast fed infants and their mothers. J
PediatrEndocrinolMetab. 22:241-6

11. Determinates of VDD
 Reduced skin synthesis of vitamin D
Use of sunscreen
Skin pigmentation
Aging
Season, latitude and time of day
 Decreased bioavailability
Malabsorption
Obesity
 Increased catabolism
Use of medications
 Mother’s nutrition and breast milk

12.  Decreased synthesis of 25(OH)D
Liver failure
 Increased urinary loss
Kidney diseases
 Dietary, lifestyle factors
Modernization - children in crèche (77%)
Increased pollution – toddlers residing in Delhi
Cultural and traditional habits
Repeated and unplanned pregnancies
Climate in India
Sources of vitamin D
Changing food fads and food habits
- Ekbote VH, Khadilkar AV, Mughal MZ, Hanumante N, Sanwalka N, Khadilkar VV, Chiplonkar
SA, Kant S, Ganacharya R et al. (2010) Sunlight exposure and development of rickets in
Indian toddlers. Indian J Pediatr. 77:61-5.
- Agarwal KS, Mughal MZ, Upadhyay P, Berry JL, Mawer EB, Puliyel JM et al. (2002) The
impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India.
Arch Dis Child. 87:111-3.

13.  Others
Heritable disorders - pseduo vitamin d rickets
Acquired disorders – hyperthyroidism
Genetic factors- ↑ 25(OH) D-24-hydroxylase etc.

14. Conclusion
• Wide spread prevalence of VDD in India is undeniable.
• Low Ca intake + VDD make matters worse.
• Though various scientific papers give prevalence % and prove
the association of vitamin D with various diseases, such studies
where basically from other countries. Only few studies are
carried out in India. Hence there is a need for encouragement
for studies to be carried out in India to prove the same and to
have a valid data for ourselves.

15. Thus recent recommendation of taking 0.8 to 1gm. of
dietary calcium and 400 IU ( 1 to 1.5 g of Ca & 2000 IU
of vit - D- western data) of vitamin D/day should be
adhered to avoid VDD in Indian population .