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Impact of Vitamin D Deficiency Across Life Stages: Strategies to Overcome this Public Health Problem

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Maj Gen RK Marwaha (Rtd), Delhi    19 November 2018

  1.  Poor bone health is responsible for causation of 8.9 million fractures annually worldwide. Lifetime risk for hip, vertebral and wrist fracture is 30-40%. High morbidity and mortality are associated with osteoporotic fractures.
  2. Vitamin D maintains blood calcium level in normal range which is vital for normal functioning of nervous system, bone growth and achieving peak bone density.
  3. Adverse effects of vitamin D deficiency – Children and adolescents: Poor growth velocity; rickets; short stature; low bone mass; genu varum; genu valgum. Adults and old age: Muscle pain and fatigue; osteomalacia; osteoporosis; hip, spine, forearm and other fractures; possibly an increased prevalence of autoimmune disorders, cardiovascular diseases (CVDs), skin disorders, cancers and infections. Deficiency/insufficiency in pregnancy and lactation: Adverse maternal outcomes such as osteomalacia, pre-eclampsia and preterm deliveries; lower birth weight; lower crown heel length, head circumference and mid arm circumference; low bone mass; poor/delayed growth; rickets in utero/at birth; tetany; neonatal hypocalcemic seizures; abnormal enamel formation and dental caries.
  4. Dietary calcium intake is low in children and adults in India. Indian diets are predominantly vegetarian, based on cereals and legumes, and are deficient in milk and milk products. Low calcium content is further compromised by high levels of phytates in the vegetarian diets.
  5. A dose of 6,00,000 IU of vitamin D is effective in treatment of nutritional rickets. A one time intramuscular injection of vitamin D is equally efficacious in treatment of nutritional rickets as staggered administration of the same dose orally over a period of 10 weeks.
  6. Combination therapy with both vitamin D and calcium yields better healing of rickets than either modality alone. In the absence of vitamin D fortification of foods, diet alone appears to have an insignificant role.
  7. Physical activity and adequate sun exposure are vital for attaining peak bone mass in Indian context. Supplementing milk fortified with vitamin D to children is an effective and safe method of addressing the major public health issue of vitamin D deficiency in children.

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