Vitamin D deficiency in Bangladesh: A review of prevalence, causes and recommendations for mitigation.

Vitamin D is essential for the maintenance of calcium homeostasis and bone mineralization. Overt deficiency of vitamin D causes rickets in children and osteomalacia in adults. Vitamin D deficiency is an important public health problem worldwide. This review examines the available published data from all peer-reviewed original research articles of community and hospital-based research carried out on vitamin D status in different population groups in Bangladesh. Baseline data of intervention trials are also included. The available selected articles were in English and retrieved from 2002 to January 2022. The paper concentrates on underlying factors for increased prevalence of vitamin D deficiency in Bangladesh. Studies uniformly report very high prevalences of hypovitaminosis D among different population groups. Age and sex-specific comparisons indicate that prevalence is higher for the elderly and women. Hypovitaminosis D ranged from 21 to 75 % for infants, children, and adolescents, 38 to 100 percent for premenopausal women, 66 to 94.2 % for pregnant women, 6 to 91.3 % for adult men and 82 to 95.8 % for postmenopausal women. Important underlying factors related to this silent epidemic include dark skin colour, homebound and sedentariness, insufficient sunlight exposure, atmospheric pollution, clothing style, obesity, use of sunscreen and no supplementation. A comprehensive strategy to alleviate and control the health consequences of vitamin D deficiency is needed. This would include the creation of public awareness, refrain in sunscreen usage, exposure to sunlight, regular exercise, food fortification, and supplementation with vitamin D (bearing in mind potential differences between them and food-based sources).

Seeking optimal means to address micronutrient deficiencies in food supplements: A case study from the Bangladesh Integrated Nutrition Project.

In seeking to improve the micronutrient contents of a food supplement used in a major community-based nutrition project in Bangladesh, operations research was conducted to compare the provision of needed micronutrients through additional food sources (fresh or dried fruits or vegetables), a micronutrient multi-mix, and a combination of the two. Micronutrient gaps (the difference between micronutrient requirements and actual micronutrient intake) were estimated for four groups of project beneficiaries, with target intakes defined as requirements for iron, calcium, zinc, vitamin A, vitamin C, riboflavin, niacin, and vitamin B12 recommended by the Food and Agriculture Organization/World Health Organization. Primary focus was placed on iron and vitamin A. Cost and bulk constraint analyses, based on cost of supplement, feasibility of delivery, and serving volume needed to achieve micronutrient targets, were used for comparing the supplement options. In terms of these analyses, the micronutrient multimix proved, by far, to be the most advantageous. Food options, however, are arguably desirable in that they provide dietary benefits additional to that of known micronutrients and may increase demand to boost production of domestic fruits and vegetables for the population as a whole. The study concludes that it is cost-effective to use powdered micronutrient mixes for such specific purposes as enrichment of supplementary food and food fortification, but encourages production and consumption of micronutrient-rich foods through programme messages and activities.

Hypovitaminosis D is common in both veiled and nonveiled Bangladeshi women.

The present cross-sectional study was designed to evaluate the vitamin D status in three groups of women in Bangladesh by using serum 25-hydroxyvitamin D (S-25-OHD), alkaline phosphatase (S-ALP), calcium (S-Ca) and phosphate (S-P). Sampling was undertaken at three locations in the city of Dhaka, Bangladesh. Representative subjects of three groups of women aged 18-60 years were studied. Study subjects included nonveiled young women = group A (N = 36, mean+/- SD age 22.3 +/- 1.9 years), veiled women =group B (N = 30, mean+/- SD age 47.7+/- 9.4 years) and nonveiled diabetic women = group C (N = 55, mean +/- SD age 50.2 +/- 5.9 years). The mean value of S-25-OHD was not significantly different in the groups. The distribution of S-25-OHD concentration in all groups was shifted overall toward the lower limit of the normal range. Vitamin D deficiency (serum 25-OHD level <25 nmol/l) was detected in 39% of young women (university students), 30% in veiled women and 38% in diabetic women, respectively. Vitamin D insufficiency defined as serum 25-OHD concentration <40 nmol/l was detected in 78% of group A, 83% in group B and 76% in group C, respectively. As indicated, prevalence of vitamin D insufficiency was a bit higher in group B compared with the other groups studied although it was not statistically significant (P > 0.05). In the present study, there were several independent predictors of serum 25-OHD, i.e. both increasing parity (r = 0.286; P < 0.005) and increasing time spent outdoors (r = 0.515; P < 0.001) were associated with significant increase in serum 25-OHD. A strongly significant inverse correlation between serum ALP and 25-OHD (r = -0.303;P<0.001) was observed. The results showed that women in Bangladesh, regardless of different age-groups, lifestyle and clothing, were at risk of developing hypovitaminosis D. The results emphasize the appropriate health message for vitamin D needs in Bangladeshi women, since vitamin D insufficiency significantly affects bone integrity.

Nutritional status of women in Bangladesh: comparison of energy intake and nutritional status of a low income rural group with a high income urban group.

This study evaluated the influence of socio-economic status on energy intake (EI), anthropometric characteristics and body composition (BC) of premenopausal Bangladeshi women in two socio-economic groups. This cross-sectional study measured height, weight, biceps and triceps skinfolds by standard procedures. A three-day dietary record was used to estimate EI. The biceps and triceps skinfolds were used to calculate total body fat (TBF), fat-free mass (FFM) and body fat percentage (BF%) according to Durnin and Womersley. FAO/WHO/UNU equations were used to calculate basal metabolic rates (BMR). Two locations in Bangladesh were studied; the Dhaka city area and the west region of the subdistrict Nandail (Betagair Union) in the district of Mymensingh. Study subjects were premenopausal women (N =191) aged 16(40 years. The high socio-economic group (group H, N =90) consisted of women with high income and educational level. The low socio-economic group (group L, N =101) consisted of rural, low income, illiterate women. Both groups contained three subgroups (non-pregnant, non-lactating =1, pregnant =2, lactating =3). Socio-economic status had a significant effect on body weight, height, biceps and triceps skinfolds, BMI, TBF, FFM and BF% (P<0.001). These variables were significantly higher (P<0.001) in all subgroups of group H than in the corresponding subgroups of group L. The influence of physiological status on most of these variables was not significant. EI was, however, influenced by both socio-economic (P<0.001) and physiological(P<0.05) status. The mean EI was significantly lower (P<0.001) in all subgroups of group L than in the corresponding subgroups of group H. The contributory sources were different in high and low income groups. In both groups, EI was lower than the recommended level. Based on the dietary and anthropometric results, we conclude that malnutrition is a common feature among low income rural women. This contradicts findings in western countries, where obesity is prevalent in low income groups.