Prevalence and Correlates of Vitamin D Deficiency Among Children and Adolescents From a Nationally Representative Survey in India

Objective: To evaluate the prevalence of vitamin D deficiency (VDD) and its correlates among apparently healthy children and adolescents. Methods: We carried out a secondary analysis of data of Comprehensive National Nutrition Survey 2016-18 to analyze the pre-valence and predictors of VDD among Indian children and adolescents. Results: The over-all prevalence of VDD in preschool children (1-4 years), school age (5-9 years) children, and adolescents (10-19 years) was 13.7%, 18.2%, and 23.9%, respectively. Age, living in urban area, and winter season were significantly associated with VDD. Vegetarian diet and high-income households were the main risk factors observed in 5-19 years age category. Female sex and less than three hour of physical activity/week were independent risk factors among adolescents. Conclusion: The prevalence and determinants of VDD across different age-groups are reported, and these should be interpreted and addressed to decrease the burden of VDD in India.

Perceived stress, life events & coping among higher secondary students of Hyderabad, India: A pilot study.

Background & objectives: Psychosocial stressors leading to allostatic load need to be explored further as these have great scope for early intervention. Stress studies done in India are mostly based on sources of stress and objective measures of stress. Therefore, the objective of the present study was to assess stress appraisal among students (16-17 yr) and to identify institution-specific differences (Private vs. Government) in stress appraisal and coping. Methods: The study was carried out among 16-17 yr old apparently normal students. Eighty students were recruited from six schools ensuring equal representation from gender/category of schools (Government/ Private). Validated and culturally adaptable behavioural scales for perceived stress (PSS), stressful life events (LES) and coping were administered. Psychological morbidity was assessed using GHQ-12. Data on 75 students were available for statistical analysis. Results: The students of both Government and Private schools showed similar stress perception, though the former tend to have a higher mean score. The scores were significantly higher on avoidance coping (P<0.05). The stepwise regression model showed coping as the independent predictor of perceived stress (R2= 10%). Interpretation & conclusions: Students from Government schools had significantly higher scores on avoidance coping and therefore, suitable for a systematic study on chronic stress for early intervention.

Prevalence of Clinical and Sub-Clinical Vitamin A Deficiency Among Rural Preschool Children of West Bengal, India.

A community based cross-sectional study was carried out in rural areas of West Bengal with the aim to assess the prevalence of vitamin A deficiency (VAD) among rural preschool children. Clinical examination was carried out on 9,228 children for the signs and symptoms of VAD and a sub-sample of 590 children were covered for the estimation of blood vitamin A levels using dried blood spot (DBS) method. The prevalence of Bitot’s spots was 0.6% (95% CI=0.44, 0.76), which is more than the public health significance, and it increased with increase in age. The prevalence was significantly higher (P<0.001) among boys (0.8%) as compared to girls (0.4%). The proportion of children with subclinical vitamin A deficiency (blood vitamin A < 20μg/dL) was 61% (95% CI: 52.3-65.1), and it was significantly (P<0.01) higher among the children of lower socioeconomic communities.

Iron-zinc interaction during uptake in human intestinal Caco-2 cell line: Kinetic analyses and possible mechanism.

Iron and zinc interact at the enterocyte during absorption, but the mechanism(s) remain elusive. The aim was, therefore, to understand the mechanism of interaction using kinetic analyses of iron and zinc uptake, individually and in combination under normal and altered cellular mineral concentrations in human intestinal Caco-2 cell line. Striking differences in kinetic parameters were observed between iron and zinc uptake. Iron uptake followed a two-component model, while zinc uptake followed a three-component model. Iron uptake had a Km of 3.6 µM and Vmax of 452 pmol/mg protein/min, while zinc uptake had a Km of 42 µM and Vmax of 3.09 pmol/mg protein/min. Zinc dose-dependently inhibited iron uptake through mixed-inhibition but iron marginally increased zinc uptake. Cellular zinc repletion doubled iron uptake and eliminated inhibition, but zinc depletion decreased iron uptake. Iron pre-treatment had no effect on zinc uptake. Based on these results, a two-transporter model of iron uptake, comprising the apical iron uptake transporter divalent metal ion transporter-1 (DMT-1) and an unknown putative transporter was derived. This model for DMT-1 was verified by immunoblotting. These results implied that cellular zinc status profoundly influenced iron uptake and its interactions with zinc during uptake. DMT-1 might not simultaneously transport iron and zinc, providing a mechanistic basis for observed interactions.

Double fortified salt at crossroads.

Iron Deficiency Anemia (IDA) and Iodine Deficiency Disorders (IDD) are the major public health problems often co-existing in many regions in our country. National Institute of Nutrition (NIN) has promoted the technology of double fortification of common salt with iodine and iron as a strategy to control both deficiencies under food-based approaches. Two other formulations of double fortified salt (DFS) have been subsequently developed by other agencies. NIN formulation & Nutrisalt have a stabilizer/promoter to maintain the stability of iodine in the presence of iron. The Micronutrient Initiative (MI) formulation uses physical separation of iodine by microencapsulation. NIN carried out extensive studies on stability, bioavailability, acceptability, safety and impact (including in community) of DFS. Feasibility both at factory level production and community level implementation have been worked out. MI salt had also undergone stability, acceptability and impact studies. No data is reported on the stability of Nutrisalt except that good stability is claimed in the available reports. In principle, the strategy of double fortification of salt with iron and iodine is sound with uniformly good impact on urinary iodine excretion and prevention of anemia. However, striking increments in hemoglobin (Hb) were not readily demonstrated since the intended purpose of DFS was only to provide iron at maintenance level and not therapeutic level. Complexities in the experimental designs, confounding variables and quality of the ingredients in salts also contributed to difficulties in interpretation of Hb status in studies involving DFS. Along with improvements contemplated in formulation to enhance the stability and bioavailibility, DFS should be able to fulfil the promise and realise its potential in reducing iron and iodine deficiency amongst our poor population in the next few years.