Relationship of socio-demographic factors with serum levels of

Relationship of socio-demographic factors with serum levels of vitamin D in a Pakistani population of diabetic patients and healthy controls Khalida Iqbal 1 , Najmul Islam 2, Naseema Mehboobali 1, Ali Asghar 2, Saleem P Iqbal 3, Mohammad Perwaiz Iqbal 1 Departments of Biological & Biomedical Sciences 1 Medicine 2 and Community Health Sciences 3, Aga Khan University

Background

• Insufficiency of vitamin D is a global health problem, especially in developing countries of South Asia • In Pakistan, it varies from 69 -90% in various study populations • Studies carried out in the West, have shown association of certain sociodemographic factors with vitamin D deficiency/insufficiency • Very few studies have been carried out to investigate the relationship of socio-demographic factors with hypovitaminosis D [25(OH) vitamin D levels < 20 ng/ml] in this region

Objective

• To investigate the prevalence of vitamin D deficiency in a hospitalbased Pakistani population • To investigate the role of socio-demographic factors with vitamin D status in this population of patients suffering from diabetes mellitus and age-matched healthy controls

Methodology

• We recruited 111 adult patients with diabetes mellitus (age range 2270 years); 76 males and 35 females from the Endocrinology Clinics of the Aga Khan University Hospital with informed consent • Additionally, 116 age-matched (within 5 years) healthy controls were also recruited from the personnel of the Aga Khan University and other health-care institutions in Karachi • Demographic characteristics of the two groups were determined using a questionnaire • Serum levels of 25(OH) vitamin D were determined using kit methods

Vitamin D status in terms of 25 Hydroxy vitamin D levels Deficient Insufficient Sufficient Toxic levels <20 ng/ml 20 -30 ng/ml >100 ng/ml

Results

Table 1: Demographic and clinical characteristics of Pakistani population of patients suffering from diabetes mellitus(n=111) and age-matched healthy controls(n=116) Variable Gender Males Females Age (Years) BMI (Kg/m 2) Waist Circumference (cm) Vitamin D levels (ng /ml) n(%) Mean ± SD 182(80. 2) 45(19. 8) 45. 5± 7. 8 26. 8± 5. 0 95. 8± 10. 2 18. 26± 13. 8

Vitamin D status in the study population 20 -30 ng/ml <20 ng/ml >30 ng/ml

Table 2: Frequency of ethnic groups in the study population Ethnicity n (%) Punjabi 25(11. 0) Sindhi 42(18. 5) Balochi 4(1. 8) Pathan 17(7. 5) Urdu 78(34. 4) Others 59(26. 0)

Table 3: Vitamin D status in different ethnic groups in the study population Ethnicity Vitamin D Deficient (<20 ng/ml) Vitamin D Insufficient (21 -30 ng/ml) Vitamin D Sufficient (>30 ng/ml) Punjabi 17(68. 0) 4(16. 0) Sindhi 19(47. 5) 11(27. 5) 10(25. 0) Balochi 3(75. 0) 1(25. 0) 0(0) Pathan 9(60. 0) 2(13. 3) 4(26. 6) Urdu 58(75. 3) 8(10. 3) 11(14. 2) Others 37(63. 7) 9(15. 5) 12(20. 6)

Figure 1: Mean ± SD serum levels of Vitamin D with respect to monthly household income Monthly Household Income

Table 4: Association of Vitamin D deficiency with monthly household income* Monthly household Crude OR (95% Cl) Adjusted OR (95% Cl) 1 income Adjusted OR (95% Cl)2 >Rs 50 000 1 1 1

Conclusion

• There is high prevalence of vitamin D deficiency (65%) in a hospitalbased Pakistani population • There is an association between monthly household income and vitamin D levels in this population • Odds of vitamin D deficiency were more than 2 -fold in the group having monthly household income less than Rs 50, 000 compared to the group with monthly house-hold income more than Rs 50, 000 • Odds remain nearly the same even when the model was adjusted for BMI or waist circumference

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