Vitamin–D Deficiency

Causes, Consequences, and Management

Deepika Chilkuri, Assistant Professor, Department of Pharmaceutical Management, National Institute of Pharmaceutical Education and Research (NIPER)

The human body requires Vitamin–D for optimum functioning. Vitamin–D deficiency or inadequacy can cause a broad spectrum of ailments ranging from cancer to depression in all age groups, i.e., infants to the adult population. There is a severe need to bring Vitamin–D deficiency and awareness to the fore. There are several safe and economical ways to obtain Vitamin–D to keep adequacy related illnesses at bay.

Introduction

Over the recent decades, Vitamin–D has been gaining immense attention for its role in maintaining good health. However, research has established that the inadequacy of Vitamin–D is a worldwide issue and extensive population-based research studies corroborate the beliefs that insufficient 25 OHD levels link to various health conditions (Adams & Hewison, 2010) (Grant, 2006). Supplementation of Vitamin–D is safe and essentially inexpensive, but despite these factors, it is noted that Vitamin–D deficiency often remains undiagnosed or is undertreated among the global population (Kennel et al., 2010).

Children with Vitamin–D insufficiency exhibit skeletal deformities beginning at the age of six months. While leg bowing is the most common symptom, knock knees (genu valgum) can also develop. Vitamin–D deficient children may be cranky and unwilling to gain weight (Pearce & Cheetham, 2010). Deficiency of Vitamin–D in adults can cause a range of symptoms, ranging from joint and muscle aches to depression. Low bone density measured may also indicate a Vitamin–D deficiency.

The amount of Vitamin–D of the pregnant mother is a strong predictor of her infant's Vitamin–D status. Low maternal Vitamin–D status is considered a significant cause of rickets recurrence in many ethnic group children. However, this issue is not limited to prenatal /women who are pregnant from ethnic groups who live in regions where the climate is moderate. Data indicates a significant incidence of low vitamin–D levels among expecting women across several regions, including Asia, Europe, the United States, and Australia.

Vitamin–d Deficiency: Diseases

Vitamin–D deficiency is combined with an increased risk of contracting various diseases, including osteoporosis, cardiovascular disease, diabetes, certain types of cancer, and infectious diseases such as tuberculosis (Prentice, 2008) (Lips, 2006). The 25-hydroxy Vitamin–D is a statistic for Vitamin–D levels in the body and is a vital determinant of bone health and other chronic health conditions. The most accurate test for assessing vitamin–D stores in the body estimates 25 OHD levels. There is continued debate on the "recommended" range (25-80 ng/mL) of Vitamin – D. The deficiency of Vitamin–D and inadequacy criteria are broadly disputed (Kennel et al., 2010).

Numerous illnesses accompany Vitamin–D inadequacy. Vitamin–D is critical in preventing unfavourable health problems and diseases such as muscular and skeletal disorders. Research studies have also been shown to lower the probability of cancer, particularly colon and lung cancer (Gorham et al., 2005) (Zhou et al., 2005).

There is mounting proof from environmental and individual research studies that the risk of certain cancers is related to the amount of solar radiation exposure. For example, a population with higher exposure to solar radiation may be at a lesser risk for certain cancers than those with more secondary exposure to the sun, including colon, rectal, breast, prostate cancers and lymphoma. Additionally, there is evidence that high Vitamin–D levels in the blood correlate with a decreased risk of developing certain cancers like gastrointestinal and, to a much lesser degree, prostate cancers (Kricker & Armstrong, 2006).

Several studies demonstrate that Vitamin–D helps prevent autoimmune diseases like multiple sclerosis and Type-I Diabetes. Vitamin–D appears to lower the incidence of rheumatoid arthritis, Type-II Diabetes, high blood pressure, and coronary heart conditions on a more tenuous basis (Grant, 2006).

The growth in global obesity is predicted to exacerbate Vitamin–D deficiency, magnifying adverse consequences on the skeletal health system, immune response to pathogens, and metabolic state. Vitamin–D deficiency should be sought in particular while screening and treating skeletal fluorosis, otherwise immunocompromised, and obese individuals due to its prevalence, simplicity of diagnosis, and easy, inexpensive, and effective ways of treatment (Adams & Hewison, 2010).

Vitamin D deficiency causes rickets which is characterised as a delay or failure in the endochondral ossification of limb bones. The disease is a leading cause of bone-related abnormalities in children. Osteomalacia, or softening of bones, is another condition that is associated with Vitamin–D deficiency. These diseases cause discomfort, hypocalcaemia fits, weakness of muscular limbs, heart, and respiratory medical conditions.

It is vital to ensure that pregnant women maintain adequate Vitamin–D levels during the prenatal period. Vitamin–D deficiency during this phase can lead to long term implications, including poor brain development. Vitamin–D is vital for maintaining healthy mental faculties later in life. Deficiency of Vitamin–D additionally is one of the critical reasons for schizophrenia and depression. Children born to women who had Vitamin–D deficiency during pregnancy and had limited exposure to the sun are at an elevated risk of wheezing diseases (Holick, 2006).

Vitamin–D: Sources

Vitamin–D is obtained from ultraviolet-B (UVB) radiation, diet, and supplementation. It is produced in the skin when it is exposed to UVB sun radiation or obtained through food sources such as supplements. The inadequacy of Vitamin–D is frequently observed in people who do receive not enough sun exposure, have restricted oral intake, or have a digestive problem. It is easily diagnosed by monitoring the amount of 25-hydroxy Vitamin–D with a simple blood test (Kennel et al., 2010).

Vitamin–D levels are also affected by latitude, season, and day of the week. The more obliquely sunlight enters the atmosphere of the earth; the more ultraviolet radiation is absorbed. The more distance one travels from the equator; the fewer months have the appropriate sunshine. For example, sunlight is efficient for cholecalciferol production only between April and October at latitudes above roughly 40°. As a result, Vitamin–D status is often greater towards the end of summer than winter at these latitudes.

Individuals who wear clothing that covers them essentially, i.e., head to foot, or who use sunscreen, expose very little skin to sun rays. Current efforts to prevent skin cancer frequently emphasise the importance of reducing exposure to the sun but do not highlight the critical role and need for adequate exposure to the sun for Vitamin–D production in the skin. Traditional clothing that covers most of the body largely contributes to a high prevalence of Vitamin–D deficiency, particularly among populations belonging to hot and tropical regions of the world.

Foods that can be consumed daily and are naturally rich in Vitamin–D are very few. For example, oily fish and egg yolk are the two most frequently used food items that boost Vitamin–D upon consumption. In addition, meat contains quantifiable amounts of Vitamin–D and its metabolites can significantly contribute to total Vitamin–D intake. Vitamin–D supplements, such as fish liver oils or synthetic Vitamin–D, are becoming more widely available and can significantly increase Vitamin–D consumption in people who use them consistently. In various countries those at risk of Vitamin–D deficiency, supplementation is recommended for specific groups based on their demography.

Additionally, those populations who consider themselves vegetarian or vegan also have food items fortified with Vitamin–D supplements. Vitamin–D is added to margarine, fat spreads, milk, juices, and breakfast cereals in several countries worldwide. Additionally, Vitamin–D is also made available in particular foods, such as infant formula milk. Vitamin–D is required or optionally added to certain foods in certain countries as a fortifier.

Conclusion

Inadequacy of Vitamin–D in the body is thus connected to numerous ailments, including but not limited to osteoporosis, diabetes, cardiovascular diseases, malignancies, and several infectious diseases like tuberculosis. Vitamin–D is critical for the health of both the skeletal and non-skeletal systems. It is widely accepted now that many people have Vitamin–D levels below recommended good health standards. Vitamin–D is acquired primarily from exposure to Ultraviolet-B (UVB) radiation through sunshine and cutaneous Vitamin–D production. Vitamin–D production can be affected by latitude, cultural clothing practises, season, sun avoidance, and sunscreen protection. While Vitamin–D deficiency may be related to gastrointestinal, hepatic, and renal illness, hypovitaminosis - D is most frequently caused by insufficient consumption. Meat contains quantifiable Vitamin–D and its metabolites in adequate amounts and can contribute significantly to dietary Vitamin–D consumption. Oily fish and egg yolk are the two most common foods high in Vitamin – D. Dietary Vitamin–D supplements, such as fish liver oils, are becoming more readily accessible for consumption, reducing the adversities linked to Vitamin–D deficiency. A few changes, including diet, sun exposure and supplements as recommended by a medical practitioner, can combat various diseases associated with Vitamin–D deficiency.

Bibliography

Adams, J. S., & Hewison, M. (2010). Update in vitamin D. Journal of Clinical Endocrinology and Metabolism, 95(2), 471–478. https://doi.org/10.1210/jc.2009-1773

Grant, W. B. (2006). Epidemiology of disease risks in relation to vitamin D insufficiency. Progress in Biophysics and Molecular Biology, 92(1), 65–79. https://doi.org/10.1016/j.pbiomolbio.2006.02.013

Holick, M. F. (2006). Vitamin D: Its role in cancer prevention and treatment. Progress in Biophysics and Molecular Biology, 92(1), 49–59. https://doi.org/10.1016/j.pbiomolbio.2006.02.014

Kennel, K. A., Drake, M. T., & Hurley, D. L. (2010). Vitamin D deficiency in adults: When to test and how to treat. Mayo Clinic Proceedings, 85(8), 752–758. https://doi.org/10.4065/mcp.2010.0138

Kricker, A., & Armstrong, B. (2006). Does sunlight have a beneficial influence on certain cancers? Progress in Biophysics and Molecular Biology, 92(1), 132–139. https://doi.org/10.1016/j.pbiomolbio.2006.02.015

Lips, P. (2006). Vitamin D physiology. Progress in Biophysics and Molecular Biology, 92(1), 4–8. https://doi.org/10.1016/j.pbiomolbio.2006.02.016

Pearce, S. H. S., & Cheetham, T. D. (2010). Diagnosis and management of vitamin D deficiency. BMJ (Online), 340(7738), 142–147. https://doi.org/10.1136/bmj.b5664

Prentice, A. (2008). Vitamin D deficiency: A global perspective. Nutrition Reviews, 66(SUPPL.2), 153–164. https://doi.org/10.1111/j.1753-4887.2008.00100.x

Deepika Chilkuri

Deepika Chilkuri is an Assistant Professor at the Department of Pharmaceutical Management, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India. Her area of research interest is pharmaceutical and healthcare management. She comes with extensive industry and teaching experience working in India and USA.

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