Sunshine all year round; yet deficient in vitamin D

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Sri Lanka despite being a tropical country has a high prevalence of ‘sunshine vitamin’ deficiency amongst various age groups including children for over few years and like many other Asian countries, pays almost no attention to the matter.

Vitamin D is called “the sunshine vitamin” as one’s body makes vitamin D from cholesterol once exposed to sun. The sun’s ultraviolet B (UVB) rays hit cholesterol in the skin cells, providing the energy for vitamin D synthesis to occur.

Two separate surveys carried out locally between the years 2017 and 2021  revealed that both children and adults in Sri Lanka were either deficient or insufficient of vitamin D levels. 

In a survey headed by Dr. Renuka Jayatissa, Head of the  Nutrition Unit of the Medical Research Institute (MRI)   published in 2019 on Vitamin D deficiency among children aged 10-18 years in Sri Lanka found that  although  Sri Lanka was a tropical country, Vitamin D Deficiency  (VDD) was prevalent among school children between the ages of 10-18 years.

Public health problem

The survey team comprising Prof. Sarath Lekawasam, Jayawardana M, Ranbanda, Samantha Ranasingha, Amila G. Perera  and Krishan H. De Silva highlighted that the Vitamin D Deficiency (VDD) and Insufficiency (VDI) were  public health problems in many countries and that limited data was available on the prevalence of VDD/VDI in Sri Lanka.

The objective of the survey was to determine the prevalence and associated factors of VDD in children aged 10-18 years.

The survey comprising a cross-sectional study among school children between the ages of 10-18 years at national level included  2,525 children. It was carried out from July to November 2017.  “Serum 25(OH-Hydroxyvitamin)D concentration and the patterns of vitamin D rich foods consumption were assessed. VDD and VDI cut offs were set at serum 25(OH)D concentrations of <12 ng/mL and 12-20 ng/mL, respectively as defined by global consensus in 2016,” the survey report noted. 

 The results at the time showed that  the  prevalence of VDD was highest in the Central Province  at 32.2 per cent and the highest prevalence of VDI was  in the Sabaragamuwa Province at 58.9 per cent. 

“VDD and VDI were lowest in North Central Province (0.7 per cent and 34.7 per cent, respectively). 

It was deduced at the time that  it was important to develop a VDD preventive strategy, especially for high risk groups.

A second survey was published by BioScientifica in 2021 on Vitamin D deficiency, associated factors and possible adverse outcome in a tertiary care institution in Sri Lanka. The Survey done by  Drs. Ishara Ranathunga,  Manilka Sumanatilleke and Noel Somasundaram carried out  a descriptive  cross sectional study from March 2019 till March 2020 at the Endocrinology Unit of the National Hospital, Colombo.  

Sampling was done recruiting patients who had vitamin D Assessment as a part of the routine medical care.  A total of 153 subjects who met the inclusion and exclusion criteria were recruited into the study over a period of one year. Out of the study population, majority were females (85.6 per cent). The population mean age was 52.1 (S.D. ± 14.38) years and ranged from 18 to 89 years.

“Majority of the patients who has undergone vitamin D level assessment in the study setting had vitamin D levels in the deficient or insufficient range. The skin colour, frequency of fish or meat intake per week and screen time per day had a positive association with the vitamin D status,” the study team noted in their conclusion. 

It’s what your body needs

Why Vitamin D is important 

Vitamin D is  important to regulating the amount of calcium and phosphate in the body,  nutrients which are needed to keep bones, teeth and muscles healthy. Paucity of vitamin D can lead to bone deformities such as rickets in children and bone pain caused by a condition called ‘osteomalacia’ among adults. To quote  a health care website  vitamin D also played a role in:

Reducing the risk of multiple sclerosis (MS). 

Decreasing the chance of heart disease. 

Low vitamin D levels have been linked to increased risk of heart diseases such as hypertension, heart failure, and stroke.  

It also supports immune health. People who do not have adequate vitamin D levels might be at increased risk of infections and autoimmune diseases, such as rheumatoid arthritis, type 1 diabetes, and inflammatory bowel disease and  Reducing the likelihood of severe illnesses. 

Current situation 

Although a proper survey has not been carried out with regard to the current situation of the vitamin D level in children within the past two to three years,   Paediatric Endocrinologist of the Lady Ridgeway Hospital, Dr. Navoda Atapattu observed that staying out of doors being exposed to the  sun between 10 am to three in the evening would help build up the level of Vitamin D  in children.

“With schools reopening children would at least have some time out in sun within this period-at least while waiting for their transport service,” she pointed out.

Fresh milk should also be fortified by vitamin D, she said.  However, the Milk packs containing fresh milk do not mention the percentage of the vital vitamin D content, Dr. Atapattu said. 

Oily fish and other dairy products also contain vitamin D but may not provide the daily requirement of 400- 600 IU, Dr. Atapattu said.  

 Consultant Endocrinologist, National Hospital, Colombo Dr. Manilka Sumanatilleke  said that the lack of data after 2020 till date with regard to the Vitamin D made made it difficult to establish the current situation.  “Things have been somewhat disrupted since 2020. “However, what can be said is that thousands of local patients were on vitamin D treatment. Also, patients with a good level of the vitamin  suffered less complications when infected by Covid-19,” he said. 

Dr. Sumanatilleke  who is also the President of the Diabetic Association of Sri Lanka (DASL) observed that testing and treatment for vitamin D deficiency was available even in State hospitals as well.  

Sri Lanka is still going through the ordeal which started in 2020 with the onset of Covid-19. Children have had to go through months and months of online learning during which they have had less out door exposure. With the still unsettled school education, and the long periods of tuition classes to make up for lost time in the school atmosphere, young children of schooling age have very little time for outdoor activities so as to be exposed to the sunlight. 

Added to this burden, is the current blow to the economy which has sent prices of even the vitamin supplements, reaching un-affordable heights in the market. Added to this is the cost of dairy products which have topped the Rs 1,000. Fresh milk too which was less than Rs 250 one year ago is now over Rs 400 making it difficult even for middle income consumers to purchase such essentials for their children. 

It is probably more important than  ever to carry out a survey on the vitamin D levels of children and adults alike in order to assess the impact that their style of life has had on it during the past three years.

By Dilanthi Jayamanne