Osteomalacia in Northern India

Vitamin D Status in South Asian Populations - Risks and Opportunities

Human body acquires a significant amount of vitamin D by cutaneous synthesis under the action of sunlight and less is supplied through nutritional sources. Diversified sociocultural and economic determinants have been identified that limit the dietary intake of vitamin D and enough distribution of sunlight to maintain optimal levels of 25-hydroxyvitamin D (25(OH)D). Consequently, the world has witnessed a high prevalence of hypovitaminosis D in resource-limited South Asian countries. The purpose of this review is to provide a South Asian perspective of vitamin D status, critically examining India, Pakistan, Bangladesh, and Sri Lanka, and to shed light on potential determinants (latitude and season, sunshine exposure habits, age, gender, and genetic factors) leading to hypovitaminosis D among a variety of population groups. Literature search was carried out using bibliographic databases "PubMed," "Google Scholar," and "ScienceDirect.com." Serum 25(OH)D level, 20-50 nmol/L, was mainly taken as vitamin D deficiency, and determinants of low serum 25(OH)D concentration of the population under study were also considered. The review concludes that vitamin D deficiency is highly prevalent among South Asian populations and global efforts are needed to overcome hypovitaminosis in the region. In addition, dietary diversification, supplementation and fortification of foods with vitamin D, adequate exposure to sunlight, and consumption of animal foods were suggested as viable approaches to maintain 25(OH)D levels for optimal health.

Observations on the vitamin D state of pregnant Asian women in London

Vitamin D nutrition in pregnancy was investigated in 115 Asian women living in London, and in 50 of their newborn infants. Mean serum 25-hydroxy cholecalciferal (25-OHD) concentration at the beginning of the last trimester was 20.2 nmol/l, and fell to 16.0 nmol/1 post partum. Thirty-six per cent of the women post partum and 32 per cent of the infants had undetectable 25-OHD concentrations (less than 3 nmol/l). Such low values are commonly associated with osteomalacia and rickets. The bone isoenzyme of alkaline phosphatase was elevated in 20 per cent of the women post partum, and in 50 per cent of the infants, indicating the presence of sub-clinical bone disease. Five infants had symptomatic hypocalcaemia. Vitamin D deficiency was most likely to occur in Pakistanis, Hindu Indians and East African Asians, and in vegetarians. All British Asians should receive supplementary Vitamin D during pregnancy.

Occult osteomalacia amongst healthy and pregnant women in Pakistan

A survey has been carried out on 206 healthy Pakistani women attending with their sick children at the paediatric outpatients department and 252 pregnant Pakistani women near term attending the antenatal clinic of the Karachi Prosgraduate Medical Centre. 12-6% of helathy women and 33% of pregnant women had biochemical abnormalities in serum calcium, phosphorus, and alkaline phosphatase which were corrected with subsequent administration of vitamin D. The absence of clinical disease has been ascribed to the supplementation received through the ultraviolet irradiation of the skin.

Diets and living conditions of Asian boys in Coventry with and without signs of rickets

1. The diets and living conditions of nin Asian boys with biochemical, and in most instances also radiological, signs of rickets were compared with those of nine other boys who appeared to be normal. The groups were matched according to age, religion, place of father's origin and boy's own place of birth. 2. There were no outstanding differences between the diets of the boys with, and of those without signs of rickets. All had adequate to high calcium intakes. Most of the boys had low intakes of vitamin D, and those withsigns of rickets generally had lower intakes than the normal boys. The food tables used for making the calculations of vitamin D intakes report the amount of the vitamin in the lipid fraction of milk. If it proves to be true that most of the vitamin D activity of milk is in the aqueous fraction, the boys would have been getting considerably more vitamin D than the results suggested, and their average intake may have been about 3-5mug/d. 3. It was not possible to make any quantitative measure of the exposure of the boys to sunlight. All Asian boys studied appeared to have their bodies more completely covered than British or West Indian boys. 4. The problem of why nine boys had signs of rickets and nine had none has not been solved. It is suggested that those with signs of rickets may have had higher requirements for vitamin D than others. When the intake of vitamin D is low and exposure to sunlight is minimal, those with high requirements will be the ones to develop signs of rickets.