Prevalence of vitamin d deficiency and its association with recurrent respiratory infections in children: a hospital-based cross-sectional observational study.

Dr. Dharavath Devendar; Dr Muthyapu Shravan; Dr Naga Nayak J

doi:10.51168/pv11zr80

Authors

Dr. Dharavath Devendar Assistant Professor, Department of Paediatrics, Government Medical College, Kamareddy, Telangana, India. Author
Dr. Muthyapu Shravan Assistant Professor, Department of Paediatrics, Government Medical College, Kamareddy, Telangana, India. Author
Dr. Naga Nayak.J Assistant Professor, Department of ENT/Otorhinolaryngology, Government Medical College, Kamareddy, Telangana, India Author

DOI:

https://doi.org/10.51168/pv11zr80

Keywords:

Vitamin D deficiency, recurrent respiratory infections, children, 25-hydroxyvitamin D, sunlight exposure, nutritional status

Abstract

Background

Vitamin D deficiency is a common pediatric nutritional problem and has been linked to impaired innate immune responses and recurrent respiratory morbidity. Children with inadequate sunlight exposure, poor nutritional status, and repeated respiratory illness require focused assessment of vitamin D status.

Objectives

To estimate the prevalence of vitamin D deficiency among children and to evaluate its association with recurrent respiratory infections

Methods

This hospital-based cross-sectional observational study included 100 children evaluated in the Department of Pediatrics, Government Medical College, Kamareddy, Telangana, India, from February 2025 to January 2026. Demographic and clinical variables, nutritional status, sunlight exposure, respiratory infection profile, hospitalization history, and serum 25-hydroxyvitamin D [25(OH)D] levels were recorded. Vitamin D deficiency was defined as serum 25(OH)D <20 ng/mL. Categorical associations were examined using Chi-square tests, and crude odds ratios (ORs) with 95% confidence intervals (CIs) were estimated; no multivariable adjustment was performed.

Results

The mean age was 7.8 +/- 3.4 years, and 56.0% were males. The mean serum vitamin D level was 18.6 +/- 7.4 ng/mL. Vitamin D deficiency was present in 62.0% of children, while recurrent respiratory infections (RRIs) were documented in 51.0%. RRIs occurred in 64.5% of vitamin D-deficient children compared with 28.9% of non-deficient children. Vitamin D deficiency was associated with higher odds of RRI (crude OR 4.46, 95% CI 1.86-10.68; p=0.001). The distribution of RRI differed significantly across vitamin D categories (Pearson chi-square=14.21, df=3; p=0.003). Low sunlight exposure and underweight status were also significantly associated with RRI in crude analyses.

Conclusion

Vitamin D deficiency was highly prevalent among children and showed a significant association with recurrent respiratory infections.

Recommendations

Routine nutritional assessment, sunlight exposure counselling, and targeted vitamin D screening should be considered in children with recurrent respiratory morbidity.

Author Biographies

Dr. Dharavath Devendar, Assistant Professor, Department of Paediatrics, Government Medical College, Kamareddy, Telangana, India.

is an Assistant Professor in the Department of Paediatrics, Government Medical College, Kamareddy, Telangana, India. He holds MBBS and MD Paediatrics qualifications. His academic and clinical interests include paediatric medicine, child health, medical education, and clinical research. He is actively involved in undergraduate teaching, patient care, and academic activities in the field of paediatrics.
Dr. Muthyapu Shravan, Assistant Professor, Department of Paediatrics, Government Medical College, Kamareddy, Telangana, India.

is an Assistant Professor in the Department of Paediatrics, Government Medical College, Kamareddy, Telangana, India. He holds MBBS and MD Paediatrics qualifications. His areas of interest include paediatric clinical practice, child health, medical teaching, and research. He is engaged in clinical care, academic teaching, and scholarly activities related to paediatrics.
Dr. Naga Nayak.J, Assistant Professor, Department of ENT/Otorhinolaryngology, Government Medical College, Kamareddy, Telangana, India

is an Assistant Professor in the Department of ENT/Otorhinolaryngology, Government Medical College, Kamareddy, Telangana, India. He completed his MBBS and MS in ENT/Otorhinolaryngology and is actively involved in undergraduate medical teaching, clinical training, and patient care in the field of ear, nose, throat, and head and neck disorders. His academic interests include clinical otorhinolaryngology, otological disorders, rhinology, laryngology, and ENT-related surgical practice. He is committed to evidence-based clinical care, academic development, and medical research in otorhinolaryngology.

References

1. 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 Clin Endocrinol Metab. 2011;96(7):1911-1930.doi:10.1210/jc.2011-0385.https://doi.org/10.1210/jc.2011-0385

2. Gupta P, Dabas A, Seth A, Bhatia VL, Khadgawat R, Kumar P, et al. Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets. Indian Pediatr. 2022;59(2):142-158. doi:10.1007/s13312-022-2448-y. PMID:34969941.https://doi.org/10.1007/s13312-022-2448-y

3. Rana G, Abraham RA, Sachdev HS, Nair KM, Kumar GT, Agarwal P, et al. Prevalence and correlates of vitamin D deficiency among children and adolescents from a nationally representative survey in India. Indian Pediatr. 2023;60(3):202-206.doi:10.1007/s13312-023-2835-1.https://doi.org/10.1007/s13312-023-2835-1

4. 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(2):167-173. doi:10.1007/s12291-014-0428-2.https://doi.org/10.1007/s12291-014-0428-2

5. Kapil U, Pandey RM, Sharma B, Ramakrishnan L, Sharma N, Singh G, et al. Prevalence of Vitamin D Deficiency in Children (6-18 years) Residing in Kullu and Kangra Districts of Himachal Pradesh, India. Indian J Pediatr. 2018;85(5):344-350. doi:10.1007/s12098-017-2577-9.https://doi.org/10.1007/s12098-017-2577-9

6. Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr. 2004;58(4):563-567. doi:10.1038/sj.ejcn.1601845.

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

7. McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, Rosenberg AM. Vitamin D deficiency in young children with severe acute lower respiratory infection. Pediatr Pulmonol. 2009;44(10):981-988. doi:10.1002/ppul.21089.

https://doi.org/10.1002/ppul.21089

8. Roth DE, Shah R, Black RE, Baqui AH. Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh. Acta Paediatr. 2010;99(3):389-393. doi:10.1111/j.1651-2227.2009.01594.x.

https://doi.org/10.1111/j.1651-2227.2009.01594.x

9. Dabrowska-Leonik N, Bernatowska E, Pac M, Filipiuk W, Mulawka J, Pietrucha B, et al. Vitamin D deficiency in children with recurrent respiratory infections, with or without immunoglobulin deficiency. Adv Med Sci. 2018;63(1):173-178. doi:10.1016/j.advms.2017.08.001.https://doi.org/10.1016/j.advms.2017.08.001

10. Ozdemir B, Koksal BT, Karakas NM, Tekindal MA, Ozbek OY. Serum Vitamin D Levels in Children with Recurrent Respiratory Infections and Chronic Cough. Indian J Pediatr. 2016;83(8):777-782. doi:10.1007/s12098-015-2010-1.

https://doi.org/10.1007/s12098-015-2010-1

11. Jaybhaye AP, Sangle AL, Ugra D, Chittal RY. A Hospital-Based Study of Vitamin D Levels in Children With Recurrent Respiratory Infections. Cureus. 2022;14(8):e27864. doi:10.7759/cureus.27864.https://doi.org/10.7759/cureus.27864

12. Jat KR. Vitamin D deficiency and lower respiratory tract infections in children: a systematic review and meta-analysis of observational studies. Trop Doct. 2017;47(1):77-84. doi:10.1177/0049475516644141.

https://doi.org/10.1177/0049475516644141

13. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583. doi:10.1136/bmj.i6583.https://doi.org/10.1136/bmj.i6583

14. Jolliffe DA, Camargo CA Jr, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, et al. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol. 2021;9(5):276-292. doi:10.1016/S2213-8587(21)00051-6.

https://doi.org/10.1016/S2213-8587(21)00051-6