Department of Endocrinology & Metabolism, Institute of Postgraduate Medical Education & Research, Kolkata, India.
Department of Endocrinology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India.
Indian J Med Res. 2024;159(3 & 4):315-321. doi: 10.25259/IJMR_233_2024.
Background & objectives Globally, vitamin D deficiency has been incriminated in poor bone health and growth retardation in children, impaired adult musculoskeletal health (classically described), increased risk of cardiovascular events, immune dysfunction, neurologic disorders, insulin resistance and its multiple sequelae, polycystic ovary syndrome (PCOS) and certain cancers. This review intends to holistically highlight the burden of vitamin D deficiency among children in India, the public health importance, and potential therapeutic and preventive options, utilizing the concept of implementation research. Methods A systematic search was carried out on PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Cochrane database, clinicaltrials.gov, Google Scholar, and ctri.nic.in with the keywords or MeSH terms namely 'vitamin D', 'cholecalciferol', 'ergocalciferol', 'children', connected with appropriate boolean operators. Results Vitamin D deficiency/insufficiency prevalence varies from 70-90 per cent in Indian children. Rickets, stunting, impaired bone mineral health, and dental health are common problems in these children. Serum 25-hydroxy vitamin D (25(OH)D) should be maintained >20 ng/ml in children. Oral vitamin D supplementation has a high therapeutic window (1200-10,000 IU/d well tolerated). Fortification of grains, cereal, milk, bread, fruit juice, yogurt, and cheese with vitamin D has been tried in different countries across the globe. From Indian perspective, fortification of food items which is virtually used by everyone would be ideal like fortified milk or cooking oil. Fortification of "laddus" made from "Bengal gram" with vitamin D as a part of a mid-day meal programme for children can be an option. Interpretation & conclusions There is enough evidence from India to suggest the importance and utility of food fortification with vitamin D to address the epidemic of vitamin D deficiency/insufficiency in children.
在全球范围内，维生素 D 缺乏与儿童骨骼健康不良和生长迟缓、成年人肌肉骨骼健康受损（经典描述）、心血管事件风险增加、免疫功能障碍、神经紊乱、胰岛素抵抗及其多种后果、多囊卵巢综合征（PCOS）和某些癌症有关。本综述旨在综合强调印度儿童维生素 D 缺乏的负担、公共卫生重要性以及利用实施研究概念的潜在治疗和预防选择。
通过关键词或 MeSH 术语在 PubMed、Embase、中国国家知识基础设施（CNKI）和 Cochrane 数据库、clinicaltrials.gov、Google Scholar 和 ctri.nic.in 上进行了系统搜索，使用的关键词或 MeSH 术语是“维生素 D”、“胆钙化醇”、“麦角钙化醇”、“儿童”，并使用了适当的布尔运算符。
印度儿童的维生素 D 缺乏/不足患病率为 70-90%。佝偻病、发育迟缓、骨骼矿物质健康受损和口腔健康问题在这些儿童中很常见。儿童血清 25-羟维生素 D（25(OH)D）应保持>20ng/ml。口服维生素 D 补充剂具有较高的治疗窗（1200-10000IU/d 可耐受）。全球不同国家尝试了谷物、麦片、牛奶、面包、果汁、酸奶和奶酪中添加维生素 D。从印度的角度来看，强化每个人都在使用的食品项目（如强化牛奶或食用油）将是理想的选择。在儿童的午餐计划中，用维生素 D 强化“孟加拉豆”制成的“糖球”可以作为一种选择。
印度有足够的证据表明，用维生素 D 强化食品来解决儿童维生素 D 缺乏/不足的流行是重要且有用的。
