Children, adults suffering from Vitamin D deficiency

Since the infant's mother is a physician, as her child grew she noticed her toddler's legs were slightly curved. The child was just 18 months old then. She took her child to Bangladesh Shishu Hospital and Institute in the capital. After a blood test, the child was diagnosed with Vitamin D deficiency.

The child was undergoing treatment at the endocrinology department of the hospital. The child was advised to be given Vitamin D regularly. The child is now 22 months old. The mother told Prothom Alo on 28 May that her child’s legs were now normal and has no deficit of Vitamin D.

Head of the endocrinology department and an associate professor at Bangladesh Shishu Hospital and Institute, Rabi Biswas was involved in the treatment of that child. Rabi Biswas told Prothom Alo, "Legs get curved from rickets and rickets is caused from the Vitamin D deficiency."

"A lot of children come to this hospital with Vitamin D deficiency, but actually not just children, but more than 60 per cent of the population in this country has Vitamin D deficiency. It’s a nationwide concern," he said.

Vitamin D is type of micronutrient. The human body requires this micronutrient in a very small amount but it is required indeed on a daily basis. About 10 to 15 per cent of the Vitamin D requirement comes from the food while, the remaining 85 to 90 per cent is sourced from the sun.

When children suffer from rickets due to the lack of Vitamin D, their bones weaken or get deformed. Meanwhile, adults suffer from ‘osteomalacia’ which, causes pain in the bones and weakens the muscles.

Older men and women suffer from ‘osteoporosis’ as a result of long-term Vitamin D deficiency. This makes the bones grow thin and brittle. Suffering from osteoporosis weakens the muscles and the risk of falling down increases. People with Vitamin D deficiency suffer from constant pain.

Anxiety and depression are more common among these people. Vitamin D helps the body absorb calcium and phosphate effectively. Physicians recommending the use of Vitamin D supplement in their prescriptions have turned into a common practice in recent years.

However, there are various beliefs about Vitamin D deficiency in circulation across the country. There’s a belief that people who remain in the sun more don’t experience Vitamin D deficiency. But that hasn’t been proven in any research.

It has been noticed that like the urban population, rural people also have Vitamin D deficiency. A research showed that half of the children in the country are suffering from Vitamin D deficiency. A lot of people do not have a clear conception of how much sunlight is actually useful and what it is useful for.

Former head of the paediatric department at Chittagong Medical College, Professor Pranab Kumar Chowdhury has done a study on the level of Vitamin D in the body of 524 children who came for treatment in a clinic of Chattogram city. These children aged from zero to 18 years have undergone treatment at the clinic between July 2012 and December 2017.

Alongside recording data on the socio-economic condition, food habits, lifestyle, subject-wise and environmental diversity in the schools of those children, their weight was also recorded at the time of conducting this study. In addition to that, after collecting blood samples from each and every one of those children the level of Vitamin D present in their blood was measured as well.

The tests run on the blood samples showed that, 265 or 50.57 per cent of those children has Vitamin D deficiency. The meaning of this deficiency is that these children had less than 22 nanogram of Vitamin D per millilitre of their blood in their body. 

The ratio of boys and girls having Vitamin D deficiency was almost balanced. However, a difference was noticed among rural and urban children. There are more children suffering from Vitamin D deficiency in cities.

The study showed that 79.9 per cent of the children in cities are suffering from this deficiency. The rate is 43.6 in villages. Meanwhile, children weighing more have a higher deficiency of Vitamin D.

Even the adults suffer from Vitamin D deficiency. But, many people are neither aware of nor realise this. A middle-aged journalist was suffering from physical complications. The person was experience body aches and weakness.

At one point he weighed himself and found out that he had lost 11 kg. After sometime, he realised his muscles had grown weaker. Then one day he saw in the mirror that the skin on his arm was lose and drooping.

That journalist visited quite a few kinds of physicians including medicine and orthopedics specialists in several hospitals starting from general hospitals to renowned clinics in the capital. Yet the situation didn’t improve. 

One of the physicians had noted that this journalist was suffering from a condition called early aging. This patient went to Singapore in 2018 and started treatment at Mount Elizabeth Hospital there.

On 27 May, that journalist told Prothom Alo, “None of the physicians in Dhaka had told me even once to get my Vitamin D levels tested. They didn’t even suspect that I was suffering from Vitamin D deficiency.”

“But the physicians in Singapore had realised the issue of Vitamin D deficiency right away after our initial discussion. The test results showed that I was suffering from acute Vitamin D deficiency. I was recommended treatment just for fulfilling the lack of vitamin D,” he added. That journalist is completely cured now.   

Several studies have also showed that a significant share of the adults in this country is also suffering from Vitamin D deficiency. One of the research conducted on 140 fishermen in the coastal district of Cox’s Bazar back in 2019 showed that 70 per cent of the fishermen had Vitamin D deficiency.

Fishermen usually have their body almost bare under the sun while catching fish. These fishermen catch fish being exposed to the sun for six to eight hours. Their age ranged from 19 to 65 years. The researchers measured their Vitamin D levels by testing their blood samples.

Two researchers from Bangladesh Institute of Research and Rehabilitation in Diabetics, Endocrine and Metabolic Disorder and one researcher from Ibrahim Cardiac Medical College had conducted this study. In September 2019, their research was published in IMC Journal of Medical Sciences.

It has been learned from talking to researchers and physicians that though in a limited scale, the issue of Vitamin D deficiency in the country has come up in several other studies as well. Some studies found the situation even worse.

One of the study showed that 100 per cent of the garments employees and 97 per cent of the agricultural and construction labourers are struggling with this deficiency. As much as 82 per cent of the women who have stopped menstruating and visit the physicians with some sort of problems are suffering from Vitamin D deficiency.

Child specialist in Chattogram, professor Pranab Kumar Chowdhury showed in his study that children who are exposed to the sunlight more have less deficiency of Vitamin D. For example, rural children are more exposed to sun compared to urban children.

Even though rural children do suffer from Vitamin D deficiency, it’s comparatively lower than the city children. Similarly, children who don’t go to school remain under the sun more than children, who do attend school. That research showed that the vitamin D deficiency is relatively lower among children not attending school.

Usually, people get less sunlight in winter. And that’s equally true for children as well. It has been found in research that the Vitamin D deficiency in children during winter is twice as much as that in summer.

It is clear from the studies conducted on fishermen and children that the body doesn’t just secure adequate amount of Vitamin D from remaining under the sun only.

Associate professor at Bangladesh Shishu Hospital and Institute Rabi Biswas said that things like one should remain under the sun at what time of the day, in which part of the body, to what portion and for how long are crucial.

After talking to Pranab Kumar Chowdhury and Rabi Biswas it has been learned that the sunlight available from 9:00am to 3:00pm is beneficial. This sunlight has to fall on about 15 to 20 per cent area of the body including the face, the lower parts of the hands and the legs. One should bask in the sun three days in a week for 15 minutes each day.

Physicians have said that the colour of the skin works as a determiner for how long one should remain in the sun. If the skin colour is brown, 45 minutes of sunlight would suffice. Because of our skin colour, people in Bangladesh should remain under sunlight daily for 45 minutes.

Generally, majority of the population in the country are suffering from Vitamin D deficiency on one or another level. However, if a pregnant woman has this deficiency, the child will also be born with Vitamin D deficiency, warned the physicians.

Those who are less exposed to the sunlight after birth and children or adults who remains confined in rooms are in high risk of Vitamin D deficiency. Meanwhile, there is some medication that reduces the quantity of Vitamin D or obstructs the storage of Vitamin D in the body.

Vitamin D deficiency is kind of a nationwide concern. Even a section of the physicians don’t have a clear idea on this topic, let alone common people. It’s necessary to raise public awareness about this.

Professor Pranab Kumar Chowdhury told Prothom Alo that there’s need to provide mothers with Vitamin D supplements right from the pre-partum period. In addition, scientific measures can prevent Vitamin D deficiency in childhood. The most important thing is to undertake mass awareness programmes on the matter of Vitamin D deficiency.

*This report appeared in the print and online versions of Prothom Alo and has been rewritten in English by Nourin Ahmed Monisha.