|Year : 2014 | Volume
| Issue : 2 | Page : 83-84
Vitamin-D: Deficiency in abundance
Department of Medicine, MGIMS, Sevagram, Wardha, Maharashtra, India
|Date of Web Publication||11-Aug-2014|
Editor in chief JMGIMS
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta O. Vitamin-D: Deficiency in abundance. J Mahatma Gandhi Inst Med Sci 2014;19:83-4
It is evident from the studies that 10 minutes moderate summer sun exposure can supply 3000-5000 units of Vitamin D to an individual.  India is situated between 8.4 and 37.6 North latitude and the majority of population lives in the region having abundance of sunlight round the year; hence it is expected that Indian subjects should not have problems of Vitamin D deficiency. However, the recent studies done in the country reported Vitamin D deficiency to be very high (from 70% to 100%) throughout India in all age groups, including the health professionals.  The electronic gadgets, computers and the television keep us occupied indoor, away from the outdoor activities and exposure to sunlight, and this has been speculated as the main reasons for the same.
Vitamin D is considered essential for mineralization and strengthening the bones and clinically prevents the occurrence of rickets and recurrent fractures in the human being due to osteopenia. Studies have reported that Vitamin D acts as a hormone with receptors in many tissues of the body like bone, breast, brain, colon, pancreas and placenta. Besides affecting bone metabolism, it regulates normal cell differentiation and proliferation (playing a role in the prevention of cancer), promotes insulin sensitivity, regulates blood sugar, and regulates more than 200 genes  and immune system of the body. Thus, Vitamin D sufficiency is critical for good health and disease prevention.
A large number of studies suggest that there may be a link between low levels of Vitamin D and cardiovascular diseases. The Heart and Soul study reported that out of 946 individuals with stable cardiovascular disease 323 (34.1%) suffered a cardiovascular event during the follow-up period of 8 years. After adjusting for sociodemographic and other co-morbid conditions Vitamin D level of < 2 ng/ml was independently related to cardiovascular events (hazard ratio = 1.30, 95% confidence interval: 1.01, 1.67). 
Another meta-analysis of eight prospective cohort studies from Europe and the United States which included men and women and all age groups (50-79 years) was done to investigate the prognostic association of 25(OH)D measurements with all-cause, cardiovascular, and cancer mortality. The mean follow-up time ranged from 4.2 to 15.9 years. The median 25(OH)D concentrations by cohort varied between 24 and 62 nmol/L. There was no clear trend in 25(OH)D by age, but the median 25(OH)D concentrations were consistently lower among women than men. During follow-up 6695 study participants died, including 2624 deaths from cardiovascular diseases and 2227 deaths from cancer (in those who had cancer). The lowest quintile of 25(OH)D was associated with increased all-cause cardiovascular mortality. 
Many retrospective studies have correlated the low levels of Vitamin D (<30 ng/ml) to airway hyper responsiveness, impaired lung functions increased frequency of exacerbations and reduced corticosteroid responsiveness in bronchial asthma. Subjects who reached normal Vitamin D levels had significant reductions in exacerbations of asthma and the decreased rate of first treatment failure.  Though this effect of Vitamin D supplementation was observed at 28 weeks. 
There are evidences that Vitamin D protects against the cancer of the breast, prostate and colon and seasonal affective disorders particularly depression. Deficiency of Vitamin D has also been associated with weight gain, metabolic syndrome and polycystic ovarian syndrome.
The current issue of the journal carries a review article "pregnancy and Vitamin D" by Ingole and Ingole (page no 89) emphasizing that maternal risks due to Vitamin D deﬁciency includes eclampsia, increased risk of gestational diabetes mellitus, glucose intolerance; and fetal risks include the risk of rickets, osteoporotic fracture in late adulthood. Hence pregnant females should be screened for Vitamin D blood levels and if found deficient, should be supplemented.
Vitamin D supplementation not only improves insulin sensitivity but also shifts the micro biome from a prediabetes spectrum to a healthy signature. Serum markers of gut permeability were also improved in men treated with Vitamin D. Taken together, the results suggest that Vitamin D may modulate gut permeability and prevent low-grade inflammation associated with obesity and insulin resistance and may prevent the development of diabetes. 
However, 25(OH)D concentrations vary strongly by age, sex, season, education, obesity, physical activity, and smoking. Though low concentration of 25(OH)D may be a marker of poor health, there is no consensus of the cut-off value of ideal 25(OH)D and what is the daily dose of Vitamin D should be taken by the individuals of different age groups.
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