Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y

European Journal of Clinical Nutrition volume 58, pages 563–567 (2004)Cite this article

Abstract

Objectives: To determine whether subclinical vitamin D deficiency in Indian children under 5 y of age is a risk factor for severe acute lower respiratory infection (ALRI).

Design: A hospital-based case-control study.

Setting: Sanjeevani Paediatrics Hospital, a private hospital in Indapur, India.

Participants: A total of 150 children including 80 cases and 70 controls, aged 2–60 months, were enrolled. Case definition of severe ALRI as given by the World Health Organization was used for cases. Controls were healthy children attending outpatients' service for immunization.

Main outcome measure: Association of serum 25-hydroxyvitamin D3 (25OHD3) with severe ALRI, controlling for demographic and other potential risk factors.

Results: Serum 25OHD3 increased with age. Factors significantly associated with decreased risk of severe ALRI in univariate analysis were: exclusive breastfeeding in the first 4 months (cases 35/78 (45%), controls 41/64 (64%); P=0.02); introduction of other dietary liquids than milk only after 6 months (cases 46/70 (66%), controls 31/66 (47%); P=0.03); use of liquid petroleum cooking fuel (cases 32/80 (40%), controls 40/70 (57%); P=0.04); infant not covered in swaddling cloths when exposed to sunlight before crawling (cases 11/52 (21%), controls 25/54 (46%); P=0.006); and serum 25OHD3 >22.5 nmol/l (cases 16/80 (20%), controls 48/70 (69%); P<0.001). In multivariate analysis, factors associated with significantly lower odds ratio for having severe ALRI were: serum 25OHD3 >22.5 nmol/l (OR: 0.09; 95% CI 0.03–0.24; P<0.001) and exclusive breastfeeding in the first 4 months of life (OR 0.42; 95% CI 0.18–0.99; P=0.046) with age and height/age as significant covariates.

Conclusion: Subclinical vitamin D deficiency and nonexclusive breastfeeding in the first 4 months of life were significant risk factors for severe ALRI in Indian children.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  • Agarwal KS, Mughal MZ, Upadhyay P, Berry JL, Mawer EB & Puliyel JM (2002): The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch. Dis. Child. 87, 11–13.

    Article  Google Scholar 

  • Andran N, Yordam N & Ozon A (2002): Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition 18, 47–50.

    Article  Google Scholar 

  • Atiq M, Suria A, Nizami SQ & Ahmed I (1998): Vitamin D status of breastfed Pakistani infants. Acta Paediatr. 87, 737–740.

    Article  CAS  Google Scholar 

  • Banajeh SM, Al-Sunbali NN & Al-Sanhani (1997): Clinical characteristics and outcome of children aged under 5 years hospitalised with severe pneumonia in Yemen. Ann. Trop. Paediatr. 17, 321–326.

    Article  CAS  Google Scholar 

  • Bosch X (1998): Hypercalemia due to endogenous overproduction of active vitamin D in identical twins with cat-scratch disease. JAMA 279, 532–534.

    Article  CAS  Google Scholar 

  • Broor S, Pandey RM, Ghosh M, Maitreyi RS, Lodha R, Singhal T & Kabra SK (2001): Risk factors for severe acute lower respiratory tract infection in under-five children. Indian Pediatr. 38, 1361–1369.

    CAS  PubMed  Google Scholar 

  • Cantorna MT (2000): Vitamin D and autoimmunity: is vitamin D status an environmental factor affecting autoimmune disease prevalence? Proc. Soc. Exp. Biol. Med. 223, 230–233.

    Article  CAS  Google Scholar 

  • Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N & Kochupillai N (2000): Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am. J. Clin. Nutr. 72, 472–475.

    Article  CAS  Google Scholar 

  • Haug CJ, Aukrust P, Haug E, Morkrid L, Muller F & Froland SS (1998): Severe deficiency of 1,25-dihydroxyvitamin D3 in human immunodeficiency virus infection: association with immunological hyperactivity and only minor changes in calcium homeostasis. J. Clin. Endocrinol. Metab. 83, 3832–3838.

    Article  CAS  Google Scholar 

  • Holick MF (2002): Too little vitamin D in premenopausal women: why should we care? Am. J. Clin. Nutr. 76, 3–4.

    Article  CAS  Google Scholar 

  • Kumar P (1993): Modified BG Prasad's socio-economic classification. Indian J. Community Med. 18, 60–61.

    Google Scholar 

  • Lubani MM, Al-Sheb TS, Sharda DC, Quattawi SA, Ahmed SAH, Moussa MA & Reavey PC (1989): Vitamin-D deficiency rickets in Kuwait: the prevalence of preventable disease. Ann.Trop. Paediatr. 3, 134–139.

    Article  Google Scholar 

  • Monto AS & Lehmann D (1998): Acute respiratory infections (ARI) in children: prospects for prevention. Vaccine 16, 1582–1588.

    Article  CAS  Google Scholar 

  • Muhe L, Lulseged S, Mason KE & Simoes EAF (1997): Case–control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet 349, 1801–1804.

    Article  CAS  Google Scholar 

  • National Institute of Nutrition, India (1996): Food composition tables. In Nutritive Value of Indian Foods, eds C Gopalan, BVR Sastri, SC Balasubramanian, pp 45–95. Hyderabad: National Institute of Nutrition, Indian Council of Medical Research.

  • Pichler J, Gerstmayr M, Szepfalusi Z, Urbanek R, Peterlik M & Willheim M (2002): 1α,25(OH)2D3 inhibits not only Th1 but also Th2 differentiation in human cord blood T cells. Pediatr. Res. 52, 12–18.

    CAS  PubMed  Google Scholar 

  • Rockett KA, Brookes R, Udalova I, Vidal V, Hill AVS & Kwiatkowski D (1998): 1,25-Dihydroxyvitamin D3 induces nitric oxide synthase and suppresses growth of Mycobacterium tuberculosis in a human macrophage-like cell line. Infect. Immun. 66, 5314–5321.

    CAS  PubMed  PubMed Central  Google Scholar 

  • United State Agency for International Development (2002): Acute Respiratory Infection (ARI) Programs. Global Health—Child Survival. Washington, DC: USAID.

  • Vitamin A and Pneumonia Working Group (1995): Potential interventions for the prevention of childhood pneumonia in developing countries: a meta-analysis of data from field trials to assess the impact of vitamin A supplementation on pneumonia morbidity and mortality. Bull. WHO 73, 609–619.

  • Wilkinson RJ, Llewelyn M, Toossi Z, Patel P, Pasvol G, Lalvani A, Wright D, Latif M & Davidson RN (2000): Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case–control study. Lancet 355, 618–621.

    Article  CAS  Google Scholar 

  • World Health Organization (1995): The Management of Acute Respiratory Infection in Children: Practical Guidelines for Outpatient Care. Geneva: WHO.

  • World Health Organization (1998): Complementary Feeding Of Young Children In Developing Countries. Geneva: WHO.

  • World Health Organization Collaborative Study Team on the Role of Breastfeeding in the Prevention of Infant Mortality (2000): Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 355, 451–455.

  • Zinc Investigators' Collaborative Group (1999): Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J. Pediatr. 135, 689–697.

Download references

Acknowledgements

We thank all the parents and children who participated in the study, and the Sanjeevani Paediatrics Hospital, Indapur and Dr L Kadam for their cooperation. We also thank Drs B Mulay, S Doshi and V Ranaware for carrying out laboratory work, and Drs N Thaware, L Hande, R Kavitkar and M Jamdar for their helpful advice and guidance, and S Lewycka, Institute of Child Health, for statistical advice. This work was undertaken in collaboration with Great Ormond Street Hospital for Children NHS Trust, which receives a proportion of its funding from the NHS Executive. Financial support for the work was provided from personal funds in connection with V Wayse's MSc degree at the Institute of Child Health.

Author information

Authors and Affiliations

  1. Centre for International Child Health, Institute of Child Health, University College London, London, UK

    V Wayse, A Yousafzai & S Filteau

  2. J N Medical College, Nehru Nagar, Belgaum, 590010, India

    K Mogale

Authors
  1. V Wayse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Yousafzai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Mogale
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Filteau
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Guarantor: S Filteau.

Contributors: VW was involved in designing the study and collected and analysed the data. SF was involved in study design and statistical analysis. AY was involved in data analysis. KM was involved in data collection. VW and SF wrote the first draft of the paper and all authors contributed to the final draft.

Corresponding author

Correspondence to S Filteau.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wayse, V., Yousafzai, A., Mogale, K. et al. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 58, 563–567 (2004). https://doi.org/10.1038/sj.ejcn.1601845

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601845

Keywords

This article is cited by

Search

Advanced search

Quick links