Cross-sectional study reveals a high prevalence of vitamin D deficiency among healthy school children in central Kerala, India

Ayyappan Anitha, Suresh A. Poovathinal, Vijitha Viswambharan, Ismail Thanseem, Mahesh M. Vasu, Ranjitha M.


Background: Authors examined serum vitamin D status among the healthy school children belonging to the south Indian state of Kerala.

Methods: A cross-sectional study, participants were recruited through medical camps organized in Thrissur and Palakkad districts of central Kerala during the months of March and April 2017. A 174 healthy school children (98 males and 76 females) aged 5-13 years were recruited for the study. The children were found to be healthy on the basis of physical examination by a Paediatrician. None of the children had any symptoms of skeletal deformities. All the children were drug-naive. Data on height, weight, skin color, food habits, physical activities and socio-economic status were recorded. A 2ml of peripheral blood samples were collected from the participants. Total vitamin D in the serum was estimated by chemiluminescence immunoassay (CLIA).

Results: VDD was observed in 60.92% and insufficiency in 30.46% of the participants. Only 8.62% of the participants had normal vitamin D levels. The mean vitamin D level was 19.93 ng/ml. Males had significantly higher vitamin D levels compared to females. Factors such as age, height, weight, diet, skin color and socio-economic status did not influence vitamin D levels.

Conclusions: This is the first study of vitamin D status among the school-age children of Kerala. This paper adds further evidence to the reports indicating high prevalence of subclinical VDD among children across India and calls for action.


Hypovitaminosis D, India, Kerala,Vitamin D

Full Text:



Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-81.

Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporosis Int. 1997;7(5):439-3.

Whiting SJ, Langlois KA, Vatanparast H, Greene-Finestone LS. The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. Am J Clin Nutr. 2011;94:128-35.

Prentice A, Schoenmakers I, Jones KS, Jarjou LMA, Goldberg GR. Vitamin D deficiency and its health consequences in Africa. Clin Rev Bone Miner Metab.2009;7:94-106.

Van der Mei IAF, Ponsonby A-L, Engelsen O, Pasco JA, McGrath JJ, Eyles DW, et al. The high prevalence of vitamin D insufficiency across Australian populations is only partly explained by season and latitude. Environ Health Perspect. 2007;115:1132-9.

Maeda SS, Kunii IS, Hayashi L, Lazaretti-Castro M. The effect of sun exposure on 25-hydroxyvitamin D concentrations in young healthy subjects living in the city of Sao Paulo, Brazil. Brazilian J Med Biol Res.2007;40:1653-9.

Yu S, Fang H, Han J, Cheng X, Xia L, Li S, et al. The high prevalence of hypovitaminosis D in China: a multicenter vitamin D status survey. Med. 2015;94(8).

Sedrani SH. Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region. Ann Nutr Metab. 1984;28:181-5.

Rich-Edwards JW, Ganmaa D, Kleinman K, Sumberzul N, Holick MF, Lkhagvasuren T, et al. Randomized trial of fortified milk and supplements to raise 25-hydroxyvitamin D concentrations in schoolchildren in Mongolia. Am J Clin Nutr. 2011;94:578-4.

Rockell JEP, Skeaff CM, Williams SM, Green TJ. Serum 25-hydroxyvitamin D concentrations of New Zealanders aged 15 years and older. Osteoporos Int. 2006;17:1382-9.

Gupta A. Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients. 2014;6(2):729 -75.

Selvarajan S, Gunaseelan V, Anandabaskar N, Xavier AS, Srinivasamurthy S, Kamalanathan SK, Sahoo JP. Systematic review on vitamin D level in apparently healthy Indian population and analysis of its associated factors. Ind J Endocrinol Metab 2017;21:765-5.

Aparna P, Muthathal S, Nongkynrih B, Gupta SK. Vitamin D deficiency in India. J Family Med Prim Care. 2018;7:324-30.

Vasudevan J, Reddy GMM, Jenifer AST, Devi U MR. Prevalence and factors associated with vitamin D deficiency in Indian children: A hospital based cross sectional study. Pediatric Oncall. 2014;11.

Sharawat I, Sitaraman S, Dawman L. Prevalence of vitamin D deficiency among healthy school children in Jaipur district, Rajasthan, India. Int J Pediatr. 2015;3:801.

Basu S, Gupta R, Mitra M, Ghosh A. Prevalence of vitamin D deficiency in a pediatric hospital of eastern India. Indian J Clin Biochem. 2015;30:167-3.

Marwaha RK, Tandon N, Reddy DRHK, Aggarwal R, Singh R, Sawhney RC, et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr.2005;82:477-82.

Ananda TK, Thuruthiyath N, Thomas EP. Subclinical Vitamin D Deficiency in Children from Thrissur, Kerala. Indian Pediatr. 2018;55(5):434-5.

Khan AM, Sindhu TG, Vijayakumar M. Vitamin D status in 3-6-year-old children of Mananthavady ICDS block in Wayanad, Kerala, India. Int J Contemp Pediatr.2018;5:1226-30.

Baidya A, Chowdhury S, Mukhopadhyay S, Ghosh S. Profile of vitamin D in a cohort of physicians and diabetologists in Kolkata. Indian J Endocrinol Metab.2012;16:S416-7.

Libon F, Cavalier E, Nikkels AF. Skin color is relevant to vitamin D synthesis. Dermatol (Basel) 2013;227:250-4.

Garg D, Gupta R, Ahuja J. Association of vitamin D deficiency with demographic factors and socio economic status of parents of Indian children under 5 years of age. Int J Med Sci Edu. 2016;3:373-80.

Leger-Guist’hau J, Domingues-Faria C, Miolanne M, Peyrol F, Gerbaud L, Perreira B, et al. Low socio-economic status is a newly identified independent risk factor for poor vitamin D status in severely obese adults. J Hum Nutr Diet. 2017;30:203-15.

Haider W, Zaib A, Abbasi A, Saleem A, Mir S, Shah BR, et al. Assessment of vitamin D status in general population of Muzaffarabad district & effect of supplementation on serum vitamin D levels in general population of Muzaffarabad district. J Nursing Health Sci. 2013;2(1):27-31.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clinical Endocrinol Metabol. 2011;96(7):1911-30.

Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: What clinicians need to know. J Clin Endocrinol Metab. 2011;96:53-8.