Knowledge regarding vitamin D deficiency among students

 

Shwetha M. N¹, Nancy Chandra Priya. P¹

¹Lecturer, St. Martha’s College of Nursing, Nrupathungaroad, Bangalore -560001

²Lecturer, St. Martha’s College of Nursing, Nrupathungaroad, Bangalore -560001

 

ABSTRACT:

Background: Vitamin D is one of the major vitamin and very essential for maintenance of normal growth and development of strong bones. It is often referred to as the "sunshine vitamin" because it can be synthesized in the body from the ultraviolet rays provided by the sun. Sunlight is the main and natural source of vitamin D and most foods contain very little amount of it. The main action of vitamin D is to help calcium and phosphorus in our diet to be absorbed from the gut. It is essential to investigate the knowledge regarding vitamin D which plays an important role in establishing healthy behaviors that contribute to the difference in vitamin D status. Aim: To assess the knowledge regarding vitamin D deficiency among students in selected college. Method: A self-structured knowledge questionnaire on vitamin D deficiency was developed to collect the data. The project was conducted at St. Martha’s college of nursing, Bengaluru among 58 students. Non-probability purposive sampling technique was used for selection of samples and the data was analyzed and interpreted by using descriptive and inferential statistics. An information pamphlet was distributed among students. Findings: The finding of the study revealed that 41.38 % have adequate knowledge, 55.18% have moderate knowledge, and 3.44% have inadequate knowledge regarding vitamin D deficiency. The data analysis regarding association between knowledge score with selected demographic variables revealed that there is no association between knowledge score with selected baseline variables such as age, religion, monthly income, exercise, time spend outdoor, source of information, dietary pattern, use of sunscreen, , previous history with vitamin D deficiency. Conclusion: It is clear from the results of this study that students have moderate knowledge regarding vitamin D deficiency. It also emphasizes the need for increasing students’ knowledge on vitamin D deficiency to prevent the occurrence of the disease.

 

INTRODUCTION:

Vitamin D is one of the major vitamin and very essential for maintenance of normal growth and development of strong bones¹. Vitamin D is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D, also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D, also known as calcitriol².

Vitamin D is essential for promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and prevent hypocalcemictetany. It is also needed for bone growth and bone remodeling by osteoblasts and Osteoclasts. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and Osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from Osteoporosis. Vitamin D has other roles in human health, including modulation of neuromuscular and immune function and reduction of inflammation³.

 

Worldwide it is estimated that there are at least 1 billion people deficient in vitamin D, mainly because of the inadequate exposure to sunlight and inadequate dietary intake of vitamin D⁴.

 

In India, since majority of the population live in areas receiving ample sunlight, vitamin D deficiency was expected to be uncommon. However, recent studies suggest that vitamin D deficiency is very common in apparently healthy individuals at all age groups and both genders in northern as well as southern India⁵. Limited data from northern India on vitamin D status in pregnant women in all 3 trimesters reveal unexpectedly high prevalence (74-98%) of hypovitaminosis D. Zargar et al. report that among the 92 healthy natives (64 men and 28 non‐pregnant/non‐lactating women, aged 18–40 years) residing in Kashmir for at least 5 years, 76 (83%) of the subjects had vitamin D deficiency in Kashmir valley of Indian subcontinent⁶. Studies have also shown that the vitamin D status of urban population is lower than the rural population and this difference has been attributed to dress code, occupation, duration of exposure to sunlight⁷.

 

A study was conducted to determine the status of vitamin D according to age groups among 1151 individuals in Kasturba Medical College Hospital, Manipal, Karnataka. Out of the total, 384 were males and 767 were females. Only 13% of the total study population was normal (157 out of 1151-79 males, 78 females). Nearly 70% of the total study population was vitamin D deficient (798 out of 1151-226 males, 572 females) and 17% showed vitamin D insufficiency (196 out of 1151-79 males, 117 females). Among males, only 21% (79 out of 384) had normal vitamin D status whereas 58.9% (226 out of 384) had vitamin D deficiency and 20.6% (79 out of 384) had vitamin D insufficiency. Likewise, among females only 10% (78 out of 767) had normal vitamin D status, 74.6% (572 out of 767) were vitamin D deficient and 15.3% (117 out of 767) were vitamin D insufficient⁸.

 

 

 

The growing body of evidence, implicating vitamin D deficiency as a risk factor for many diseases right from birth throughout lifespan and the lack of knowledge regarding vitamin D deficiency makes the investigators to feel the need to assess the knowledge and provide health education by providing an information booklet regarding prevention of vitamin D deficiency among students in selected college⁹.

 

MATERIALS AND METHODS:

Descriptive research design was selected. Ethical clearance from the local ethics committee was obtained. 58I year Basic BSc Nursing students of St. Martha’s College of Nursing were selected by non-probability convenient sampling technique. An informed consent was taken from each subject. Age between 18-21 years were selected and who were not present at the time of data collection were excluded from the study. After the sample selection, demographic variables of the samples were assessed with respect to age, religion, dietary pattern, monthly income, exercise, time spent outdoors per day, use of sunscreen, previous history with vitamin D deficiency and sources of information. Structured knowledge questionnaire was administered to assess the knowledge regarding vitamin D deficiency. Each subject took 30 – 40 minutes to complete the questionnaire.

 

RESULTS:

Out of 58 students, majority of the participants 72% acquired information about vitamin D deficiency from health professional, 14% from media, 9% from the families and 5% from others.

 

 

Fig 1: Distribution of samples with reference to level of knowledge regarding vitamin D deficiency among students.

 

The level of knowledge regarding vitamin d deficiency reveals that 3.44% of students have inadequate knowledge, 55.18% of students have moderate knowledge and 41.38% of students have adequate knowledge regarding vitamin D deficiency.

 

The overall mean level of knowledge regarding vitamin D deficiency is 21.58 with SD 3.64 among the students.

The data analysis regarding association between knowledge score with selected demographic variables revealed that there is no association between knowledge score with selected baseline variables such as age, religion, dietary pattern, monthly income, exercise, time spent outdoors per day, use of sunscreen, previous history with vitamin D deficiency and sources of information.

 

DISCUSSION:

The present study aimed to assess the knowledge regarding vitamin D deficiency among students. The findings were similar to the descriptive study conducted to assess awareness, knowledge, and attitudes regarding vitamin D and its sources among Saudi Arabian children. 100 patients (vitamin D-deficient children) and 100 healthy children participated in the study. Participants were interviewed separately on topics including their awareness, knowledge, and attitudes regarding vitamin D using multiple-choice and short-answer questions. The study results revealed that only 28% were aware of the sources of vitamin D, while 64% of healthy subjects were aware. Similarly, only 50% of patients and their parents knew of the health benefits of vitamin D, while 70% of healthy subjects had knowledge. The study concluded that most vitamin D deficient cases were unaware of vitamin D sources. However, half of the patient/parents were aware of benefits of vitamin D. Hence, we recommend that an improved campaign for awareness, knowledge, and attitudes regarding vitamin D and its sources are needed¹⁰.

 

Another study was conducted to investigate the knowledge, attitude and practice (KAP) towards vitamin D deficiency, sun exposure, supplementation and fortification in a sample of female Saudi Arabian students. A focus group and eight in depth one-to-one semi-structured interviews were conducted and analyzed using thematic analysis. Participants were limited in their knowledge about vitamin D and vitamin D deficiency. They reported limited sun exposure due to intense heat, cultural reasons for covering the body, and an infrastructure that makes sun exposure difficult. Important barriers for the prevention of vitamin D deficiency in Saudi Arabia were highlighted.   Recommendations for more research in specific areas including the prevalence of vitamin D deficiency and recommended daily allowances of supplementation are made. Governmental actions including increasing awareness of the importance of vitamin D and guidelines on how to obtain it are necessary. Creating areas where women, particularly those of lower socio-economic status, can enjoy sun exposure as well as fortifying more foods would go some way towards tackling this problem¹¹.

 

 

Similar study can be replicated using large samples and thereby findings can be generalized in a better way. An experimental study can be conducted with a control group and a study can be conducted on association between vitamin D deficiency and type 2 diabetes mellitus.

 

ACKNOWLEDGEMENTS:

I thank the students who spent their valid time to participate in the study and the management for granting permission to conduct the study.

 

CONFLICT OF INTEREST:

The author declares no conflict of interest.

 

REFERENCES:

1.        Holick vitamin Shils ME, Olson JA, Shike M, Ross CA, eds. Modern nutrition in health and disease.  9th ed. Baltimore: Williams & Williams, 1999:329–45

2.        RavinderGoswami Nandita Gupta Deepti Goswami Raman Kumar Marwaha Nikhil Tandon Narayana Kochupillai.

3.        The American Journal Of Clinical Nutrition, Volume 72, Issue 2, 1 August 2000, Pages 472-475, https://doi.org/10.1093/ajcn/72.2.472.Published:01 August 2000

4.        Hodgkin P, Hine PM, Kay GH, Lumb GA, Stanbury SW. Vitamin D deficiency in Asians at home and in Britain. Lancet. 1973; 302:167–172. 8). Lips P, Chapuy MC, Dawson-Hughes B, Pols HA, Holick MF. An international comparison of serum 25-hydroxyvitamin D measurements. Osteoporosis Int. 1999; 9:394–397.

5.        Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi.:Goswami R1, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N.

6.        Epidemiology of vitamin D insufficiency and deficiency in a population in a sunny country: Geospatial meta-analysis in Brazil Marcos Pereira-Santos José Yure Gomes dos Santos,Gisele Queiroz Carvalho, Djanilson Barbosa dos Santos &Ana Marlúcia OliveiraAccepted author version posted online: 08 Feb 2018, Published online: 09 Mar 2018: https://doi.org/10.1080/10408398.2018.1437711 Current Scenario of Prevalence of Vitamin D Deficiency in Ostensibly Healthy Indian Population: A Hospital Based Retrospective Study:KirtikarShukla,  Shikha Sharma, Aditi Gupta, ArunRaizada, and KaminiVinayak

7.        1Ibrahim M. Kaddam, Adnan M. Al-Shaikh, Bahaa A.   Abaalkhail, Khalid S. Asseri, Yousef M. Al-Saleh, Ali A. Al-Qarni, Ahmed M. Al-Shuaibi, Waleed G. Tamimi, and Abdelmoneim M. Mukhtar, Tangpricha  V Pearce , TCHolick  MF. Vitamin D insufficiency among free-living healthy young adults Am J Med. 2002;112659- 662PubMedGoogle Scholar / Crossref

8.        Chakhtoura M, Rahme M, Chamoun N, El-Hajj Fuleihan G. Bone Rep. 2018 Mar 17;8:135- 146. doi: 10.1016/j.bonr.2018.03.004. eCollection 2018 Jun.

9.        Fatimah MA, Bassam SB. Knowledge, awareness, attitudes and sources of vitamin D deficiency and sufficiency in Saudi children: Available from: URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880661/ Saudi Med J. 2016 May; 37(5): 579–583.

10.      Christie FT, Mason L.Knowledge, attitude and practice regarding vitamin D deficiency among female students in Saudi Arabia: a qualitative exploration: Available from: URL: https://www.ncbi.nlm.nih.gov/pubmed/21816009. Int J Rheum Dis. 2011 Aug;14(3):e22-9.

 

 

 

 

 

Received on 30.08.2018         Modified on 16.10.2018

Accepted on 01.11.2018      ©A&V Publications All right reserved