Vitamin D or cholecalcierol deficiency is considered to be the most common nutritional deficiency and also one of the most common undiagnosed medical conditions in the world.
What is vitamin D?
It is a fat-soluble vitamin that is naturally present in very few foods. It is produced by the body when sunlight strikes the skin.
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Sources of Vitamin D:
It is present in fatty fish like salmon, tuna and mackerel and a small amount in beef liver and egg yolks. In western countries, milk and cereal and other foods are fortified with vitamin D. If you are a vegetarian then possible sources could be sun-dried shiitake and button mushrooms!
Role of Vitamin D in the body:
Several important functions include regulating the absorption of calcium and phosphorus, which are important to keep bones and teeth healthy. Deficiency of this vitamin leads to a condition called Rickets & Osteomalacia.
It has an important role in immunity development, function of the musculoskeletal system, blocks the release of parathyroid hormone (this hormone reabsorbs bone tissue making it brittle). It is of significance in gene coding proteins involved in cell proliferation and reduction.
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Deficiency of Vitamin D and Reasons:
Endogenous our body’s production of vitamin D occurs when sunlight strikes the skin as explained. These can be influenced by:
- Geography- latitude, time of day, shade and air pollution.
- Age of individual- Infants require less time to synthesize Vitamin D as compared to older children.
- Pigmentation – Higher the amount of melanin or pigment in the skin, lesser the Vitamin D production as it acts as a natural sunscreen. This is why India, despite being a tropical country, we continue to be deficient in Vitamin D.
- Lifestyle- Less outdoor exposure, sedentary lifestyles, cover-up clothing etc.
- Decreased nutritional intake of Vitamin- Strict vegan diet does not allow the natural intake of Vitamin D.
- Medical conditions – Liver disease, pancreatic disease, cystic fibrosis, Obesity, drugs like certain anti-tuberculous medicines and anti-epileptic medicines, asthma, chronic kidney disease.
How Vitamin D affects the growth of the Child?
To understand its role, the deficiency manifestations will explain its importance.
In Vitamin D deficient child, the intestinal absorption of calcium and phosphorus is decreased. Parathyroid gland (another endocrine gland closely interlinked) recognizes that there is low serum calcium and releases Parathyroid hormone in an effort to normalize and bring it back to normal range. It does so from the bones and does not allow normal mineralization of bones to occur with calcium and phosphorus. Over a period of time, weeks to months, bones become brittle; leading to stunting, rickets or osteomalacia.
Early symptoms include musculoskeletal pain, periodontal (teeth) pain, loss of appetite, diarrhoea, burning pain in the mouth or throat, etc. Vitamin D is present in a variety of receptors throughout our immune system, lack of which gives rise to frequent infections and thereby compromising nutrition and growth.
Daily intake of Vitamin D in the form of supplements is required. As per the age of the child/ individual, the doses vary:
- Infants – 400IU/day
- 1-6 years – 600-100IU/day
- 6 years – 3000-4000IU/day
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Increased dosing as per preexisting medical condition may be required for e.g. Epilepsy on medications – 2000IU/day, kidney disease- 4000IU/day and such as suggested by the medical professional.
- Routine vitamin D supplementation in all pregnant mothers.
- Screening with blood tests as and when required.
- Lifestyle changes- encouraging outdoor time, sun exposure, applying limited sunscreen.
- Whenever possible, include eggs and fish in the diet.
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