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Vitamin D, Sunshine hours, Dietary supplements, Agriculatural workers, Punjab, Pakistan
Background and aims: Worldwide low levels of vitamin D (< 30ng/dL) is prevalent and linked to
bone disorders, diabetes and coronary heart disease. Deficiency in Vitamin D is a diagnostic challenge in
asymptomatic individuals. The present study aimed to assess the environmental and also the genetic determinants affecting vitamin D deficiency in an asymptomatic rural agricultural population sample of Punjab
province of Pakistan. Material and method: An interview based questionnaire and blood samples for measuring
serum markers were obtained. These include calcium levels, parathyroid hormone and serum 25(OH)
vitamin D. DNA was extracted from the blood samples for genotyping. Results: From 510 study participants,
435 (85.2%) individuals had < 30 ng/dL (low) of vitamin D. Males versus females had a unremarkable difference
in the status of Vitamin D (61.3% vs 56.2%), (p = 0.134). When calcium levels were compared between
the deficiency and insufficiency groups versus the vitamin D sufficiency group, no significant difference was
observed (p = 0.526, 0.155 respectively). Consumption of single milk serving every day (250 ml) (p = 0.818)
and sunlight exposure every day for more than 30 minutes (p = 0.579) also had non-significant associations
with the estimated vitamin D levels. However, oral vitamin D supplementation was significantly associated
(p = 0.024) with the vitamin D levels. Eight SNPs were studied and none showed any statistical significant
association with observed vitamin D levels. Conclusions: We noted a considerable proportion of asymptomatic
individuals from the rural population with low vitamin D levels. There appear to be multifactorial causes of
deficiency in vitamin D and this burgeoning health issue requires further investigations.
2. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(7):1911-30.
3. Mansoor S, Habib A, Ghani F, Fatmi Z, Badruddin S, Mansoor S, et al. Prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults. Clinical biochemistry. 2010;43(18):1431-5.
4. SHERMAN SS, HOLLIS BW, TOBIN JD. Vitamin D Status and Related Parameters in a Healthy Population: The Effects of Age, Sex, and Season*. The Journal of Clinical Endocrinology & Metabolism. 1990;71(2):405-13.
5. Simonelli C. The role of vitamin D deficiency in osteoporosis and fractures. Minnesota medicine. 2005;88(11):34-6.
6. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. The American journal of clinical nutrition. 2008;87(4):1080S-6S.
7. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. The American journal of clinical nutrition. 2004;79(3):362-71.
8. Jurutka PW, Whitfield GK, Hsieh J-C, Thompson PD, Haussler CA, Haussler MR. Molecular nature of the vitamin D receptor and its role in regulation of gene expression. Reviews in Endocrine and Metabolic Disorders. 2001;2(2):203-16.
9. Iqbal R, Khan AH. Possible causes of vitamin D deficiency (VDD) in Pakistani population residing in Pakistan. J Pak Med Assoc. 2010;60(1):1-2.
10. Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. The American journal of clinical nutrition. 2005;81(5):1060-4.
11. Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D, Srinivasarao PV, Sarma KV, et al. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. The American journal of clinical nutrition. 2007;85(4):1062-7.
12. Zuberi LM, Habib A, Haque N, Jabbar A. Vitamin D deficiency in ambulatory patients. Journal of the Pakistan Medical Association. 2008;58(9):482.
13. Badruddin SH, Baig-Ansari N. Overview of Vitamin D and its role in Tuberculosis Prevention and Treatment. Infect Dis J Pakistan. 2008;17:135-8.
14. Thacher TD, Fischer PR, Singh RJ, Roizen J, Levine MA. CYP2R1 mutations impair generation of 25-hydroxyvitamin D and cause an atypical form of vitamin D deficiency. The Journal of Clinical Endocrinology & Metabolism. 2015;100(7):E1005-E13.
15. Harinarayan C, Ramalakshmi T, Venkataprasad U. High prevalence of low dietary calcium and low vitamin D status in healthy south Indians. Asia Pacific journal of clinical nutrition. 2004;13(4):359-64.
16. Hashemipour S, Larijani B, Adibi H, Sedaghat M, Pajouhi M, Bastan-Hagh MH, et al. The status of biochemical parameters in varying degrees of vitamin D deficiency. Journal of bone and mineral metabolism. 2006;24(3):213-8.
17. Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N. Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. The American journal of clinical nutrition. 2000;72(2):472-5.
18. Azizi E, Pavlotsky F, Kudish A, Flint P, Solomon A, Lerman Y, et al. Serum Levels of 25‐Hydroxy‐Vitamin D3 Among Sun‐protected Outdoor Workers in Israel. Photochemistry and photobiology. 2012;88(6):1507-12.
19. Jubiz W, Canterbury JM, Reiss E, Tyler FH. Circadian rhythm in serum parathyroid hormone concentration in human subjects: correlation with serum calcium, phosphate, albumin, and growth hormone levels. The Journal of clinical investigation. 1972;51(8):2040-6.
20. Lederer E. Regulation of serum phosphate. J Physiol. 2014;592(18):3985-95.
21. Pellicane AJ, Wysocki NM, Schnitzer TJ. Prevalence of 25-hydroxyvitamin D deficiency in the outpatient rehabilitation population. American Journal of Physical Medicine & Rehabilitation. 2010;89(11):899-904.
22. Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. New England Journal of Medicine. 1998;338(12):777-83.