Irony is India’s friend in virtually all aspects of life – India has increasing number of billionaires but per capita incomes are not rising fast enough, India has some incredibly intelligent people but also employs one of the highest %age of population in low return agriculture. Same is with Sunlight and Vit D deficiency. India has on average more than 300 days of sunlight in most parts of country but a vast population is Vit D Deficient on account of, Heliophobia.
Vitamin D deficiency is highly prevalent in India, yet no standardised guidelines exist for classifying vitamin D status or its prevention and treatment for Indians. Even more, there is no consensus specific to Vitamin D supplementation for the Indian population, and there are inconsistencies in the cut-off values for deficiency, severe deficiency and insufficiency across various existing guidelines.
An expert group of 41 endocrinologists from across India have developed the consensus using the DELPHI method, achieving over 90% agreement on all recommendations. The consensus defines Vitamin D deficiency, severe deficiency, and insufficiency thus recommending supplementation strategies to maintain physiological 25(OH) D levels of 40–60 ng/mL (100–150 nmol/L).
Copy of Guidelines – Vit D Supplementation Guidelines for Indians
Vit D3 Deficiency – Extent of Deficiency in Indians
Vitamin D deficiency is reported worldwide, both in sunshine-deficient and sunshine-sufficient nations, yet it continues to be one of the most under-diagnosed and under-treated nutritional deficiencies.
Findings of a systematic review and meta-analysis have shown that Vitamin D deficiency is highly prevalent among adults from South Asian countries.
India is a heliophobic (sun-fearing) nation, with almost 490 million people deficient in vitamin D. In a multicenter study, more than half the Indian children or adolescents were reported to be vitamin D deficient or insufficient—a trend that also applies to Indian adults.
Why Sufficient Levels of Vit D3 are critical
Sufficient serum levels of 25-hydroxyvitamin D (25[OH] D) are required to maintain the skeletal and extra-skeletal physiologic effects. Inadequate vitamin D status is prevalent worldwide, which, apart from the well-known skeletal effects, has also been related to autoimmune disorders, cardiovascular diseases, cancers, insulin resistance, inflammation, neurological disorders, poor pregnancy outcomes, and enhanced mortality risk.
Guidelines from India
The two major bodies, i.e. The Institute of Medicine (IOM) and the Endocrine Society (ES), have different opinions regarding the thresholds for defining Vitamin D deficiency, which are <12.5 ng/ml (31.25 nmol/L) and <20 ng/ml (50 nmol/L), respectively.
This discrepancy occurs due to the interpretation of data surrounding the PTH plateau threshold. PTH levels are inversely associated with 25(OH) D.
IOM strictly believes that PTH values decline to a plateau at levels between 15 and 50 ng/ml (37.5 and 125 nmol/L), depending on age, race, ethnicity, body composition, renal function, and geographic location.
ES believes that PTH begins to plateau in adults who have serum 25-hydroxyvitamin D levels between 30 and 40 ng/ml (75 and 100 nmol/L). Hence the different in cut-off values.
It is also worth considering that the calcium absorptive performance at 20 ng/mL (50 nmol/L) of 25(OH) D is much lower than 34.4 ng/mL (86 nmol/L). This suggests that lower serum 25(OH) D levels may not provide the full benefit of calcium intake.
Recommendations and statements by Group of 41 Endocrinologists
Recommendation 1: Vitamin D deficiency, severe deficiency, and insufficiency can be defined as
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Deficiency <20 ng/mL (50 nmol/L) of serum 25-hydroxyvitamin D
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Severe deficiency <10 ng/mL (25 nmol/L) of serum 25-hydroxyvitamin D
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Insufficiency: 20–30 ng/mL (50-75 nmol/L) of serum 25(OH) D levels.
Recommendation 2: Prevention of vitamin D deficiency in the general population is recommended irrespective of age, physical activity, and lifestyle.
Recommendation 3: The aim of vitamin D3 therapy should be to achieve a physiological 25(OH) D level (40–60 ng/mL or 100–150 nmol/L).
Recommendation 4: If disease-specific practice guidelines are unavailable, strategies for preventing vitamin D deficiency in high-risk groups should be similar to those for the general population.
Recommendation 5: The vitamin D supplement/replacement regimen in adults should be:
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Vitamin D sufficiency – cholecalciferol 60,000IU, once a month
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Vitamin D insufficiency – cholecalciferol 60,000IU, once a week for 8 weeks (once sufficiency is achieved, transition to cholecalciferol 60,000 IU, once a month)
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Vitamin D deficiency: Cholecalciferol 60,000 IU, once a week for 12 weeks (once sufficiency is achieved, transition to cholecalciferol 60,000 IU, once a month).