LETTER TO EDITOR

Year : 2018  |  Volume : 7  |  Issue : 5  |  Page : 1146-1147

Vitamin D deficiency: An emerging pandemic

Jogender Kumar¹, Arushi Yadav², Kanhaiya Agrawal^3
1 Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
² Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
³ Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. Jogender Kumar
1044, Sector 15 B Chandigarh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jfmpc.jfmpc_179_18

1. The diagnostic cutoffs of the levels of serum vitamin D given in [Table 1] are based on the Endocrine Society Clinical Practice Guideline (ESCPG) 2011 which are relatively old. A recently published review of guidelines^[2] suggests that all international guidelines except ESCPG agreed upon the cutoff of >20 ng/ml as sufficient, 12–20 ng/ml as insufficient, and <12 as deficient. The same cutoffs have been endorsed by Indian Academy of Pediatrics.^[3] Statistically, also, the cutoff of 20 ng/ml is more appropriate as it coincides with the level that would cover the needs of 97.5% of the population.^[3] Defining a standard cutoff is very necessary as increasing the cutoff will greatly affect the prevalence rate of insufficiency and will increase the treatment rate. Also, the cutoff for toxicity is much lower than given by authors
2. As highlighted by authors that the 25(OH)D rather than 1,25-dihydroxyvitamin D levels should be measured as it greatly depends upon parathyroid hormone concentrations. The same has been endorsed by the American Academy of Nutrition as well as other prominent societies. The other more important reasons for recommending 25(OH)D levels are the very short half-life of 1,25-dihydroxy vitamin D (4 h), little or no relationship of serum levels of 1,25-dihydroxyvitamin D to vitamin D stores, and practical challenge to measure with accuracy due to its picomolar concentrations and lipophilic nature. The measurement of 1,25-dihydroxyvitamin D levels should be reserved for specific conditions like chronic kidney disease, etc. Recently, there is a surge in the request of 1,25-dihydroxyvitamin D levels; hence, it is very important to educate the physicians about these limitations
3. Authors should highlight the role of vitamin D in the pathogenesis of recurrent wheeze as well as asthma. Recent Cochrane review of high-quality studies showed that vitamin D reduced the risk of asthma exacerbation in children as well as adults, hence reduced emergency visits as well as hospitalization.^[4] Also, it has been seen that prolonged vitamin D deficiency may lead to stunting and vitamin D supplementation may be an intervention to prevent and mitigate childhood stunting^[5]
4. Apart from those highlighted by authors, few other reasons for vitamin D deficiency pandemic in India are wrong cooking practices, the high prevalence of lactose intolerance, increased intake of coffee and tea, and lack of adequate supplementation/fortification.

References

1.	Aparna P, Muthathal S, Nongkynrih B, Gupta S. Vitamin D deficiency in India. J Fam Med Prim Care 2018;7:324.
2.	Randev S, Kumar P, Guglani V. Vitamin D supplementation in childhood – A review of guidelines. Indian J Pediatr 2018;85:194-201.
3.	From Indian Academy of Pediatrics ‘Guideline for Vitamin D and Calcium in Children’ Committee, Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, et al. Prevention and treatment of Vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) guidelines. Indian Pediatr 2017;54:567-73.
4.	Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U, et al. Vitamin D for the management of asthma. Cochrane Database Syst Rev 2016;9:CD011511.
5.	Wacker M, Holick MF. Vitamin D – Effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013;5:111-48.