Vitamin D deficiency is normal in otherwise healthy young children in the Indian subcontinent

Recent studies of healthy children in the Indian subcontinent show that around 90% are vitamin D deficient (serum 25(OH)D below 50 nmol/l). Clinical indications of the deficiency seen as bone formation abnormalities were visible in around 10% of these children.

A recent study of 280 healthy children aged one to five years from rural Nepal (1) found that an astonishing 91.1% were deficient in vitamin D (defined here as ˂ 50 nmol/l S 25(OH)D). The study was conducted in the winter months, therefore it reasonable to assume these were the lowest levels.

Interestingly, it seems a similar story exists in the rest of the Indian subcontinent. A series of studies conducted there report levels below 50 nmol/l S 25(OH)D in healthy children in a range of 36–90%. Some of these studies also report visible developmental bone abnormalities such as wrist widening, wide anterior fontanelle and leg bowing (2).

A study of 5,137 older healthy children aged 10–18 years in northern India (3) found that 92.6% of the poorer children had vitamin D levels below 50 nmol/l S-25(OH)D. For the richer children, there was a marginal improvement to 84.9%. Critically, 10.9% of the children demonstrated visual symptoms of the deficiency.

The American Academy of Pediatrics recommends a daily vitamin D intake of 10 μg/day (equivalent to 400IU/day) for all children (2). Sadly, this is rarely achieved in the Indian subcontinent where there is little fortification of food products and no common practice of supplementation. Regulatory intervention is necessary if an epidemic of bone malformation is to be avoided.

1. Avagyan D, Neupane SP, Gundersen TE et al, “Vitamin D status in pre-school children in rural Nepal”, Public Health Nutrition 2015, doi:10.1017/S136898001500083X
2. Angurana SK & Mahajan V, “Vitamin D deficiency among healthy children in developing countries: an epidemic being recognised”, Public Health Nutrition 2015, doi:10.1017/S1368980015002487
3. Marwaha RK, Tandon N, Reddy DR et al., “Vitamin D and bone mineral density status of healthy school children in northern India”, Am J Clin Nutr 2005, 82:477–482.