Abstract
BackgroundRecent studies have demonstrated a relationship between poor vitamin D status and respiratory infections and diarrhea among young children. Acute lower respiratory infections (ALRI) and diarrhea are among the two most important causes of death in under-5 children. In this paper, we examined the extent to which vitamin-D deficiency (<10 ng/ml) predicts ALRI, clinical pneumonia and diarrhea among 6 to 30 months old children.MethodsWe used data from a randomized controlled trial (RCT) of daily folic acid and/or vitamin B12 supplementation for six months in 6 to 30 months old children conducted in Delhi, India. Generalized estimating equations (GEE) were used to examine the associations between vitamin-D deficiency and episodes of ALRI, clinical pneumonia and diarrhea.ResultsOf the 960 subjects who had vitamin-D concentrations measured, 331(34.5%) were vitamin-D deficient. We found, after controlling for relevant potential confounders (age, sex, breastfeeding status, wasting, stunting, underweight, anemia status and season), that the risk of ALRI was significantly higher among vitamin-D deficient (OR 1.26; 95% CI: 1.03 to 1.55) compared to vitamin-D-replete children in the six months follow-up period. Vitamin-D status was not associated with episodes of diarrhea or clinical pneumonia.ConclusionVitamin-D deficiency is common in young children in New Delhi and is associated with a higher risk of ALRI. The role of vitamin D in Indian children needs to be elucidated in further studies.
Highlights
Vitamin D deficiency is considered to be the most common nutritional deficiency and often one of the most commonly undiagnosed medical conditions in the world [1]
After controlling for relevant potential confounders, that the risk of Acute lower respiratory infections (ALRI) was significantly higher among vitamin-D deficient compared to vitamin-D-replete children in the six months follow-up period
Vitamin-D status was not associated with episodes of diarrhea or clinical pneumonia
Summary
Vitamin D deficiency is considered to be the most common nutritional deficiency and often one of the most commonly undiagnosed medical conditions in the world [1]. The prevalence of vitamin D deficiency in young children is around 50–90% in the Indian subcontinent [2]. Vitamin D is a potent immune-modulator of adaptive and innate immune responses [4]. In vitro studies have shown that 1,25-dihydroxyvitaminD3, the active metabolite of vitamin D, is important for promoting and regulating immune responses [5,6]. Observational studies suggest a link between low vitamin D concentrations and an increased risk of lower and upper respiratory tract infections in infants and young children [7]. A recent prospective cohort study found that vitamin-D deficiency was associated with increased rates of diarrheal illnesses among school-aged children [8]. The extent to which vitamin D deficiency predicts these infections in young children is less clear
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