Serum calcium level among school-going adolescent girls in Bangladesh and their correlation with vitamin D level
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262602Keywords:
Adolescent girls, Serum calcium, Vitamin DAbstract
Background: Calcium and vitamin D are essential for bone health during adolescence, a period of rapid bone mass accrual. Adolescent girls in Bangladesh are at increased risk of deficiency due to dietary factors and limited sunlight exposure. This study evaluated serum calcium levels among urban and rural school-going adolescent girls and examined the association between serum calcium and vitamin D status.
Methods: This cross-sectional study was conducted at the Department of Biochemistry, Sylhet MAG Osmani Medical College, Sylhet, from July 2017 to December 2018 among 140 school-going adolescent girls aged 10–19 years (70 urban, 70 rural). Sociodemographic, anthropometric, dietary and lifestyle data were collected using structured questionnaires. Data were analyzed using SPSS version 26.
Results: Urban girls had significantly higher mean serum calcium levels than rural girls (9.12±0.48 vs. 8.86±0.52 mg/dl; p=0.003) but lower vitamin D levels (19.4±7.2 vs. 22.8±8.1 ng/ml; p=0.010). Low serum calcium was observed in 11% of urban and 24% of rural girls. Vitamin D deficiency was more prevalent among urban girls (55.7%) than rural girls (40.0%). Vitamin D status was significantly associated with serum calcium levels (p=0.012), with sufficient vitamin D linked to normal serum calcium. Rural girls had greater sunlight exposure (43.8±18.7 vs. 21.6±12.4 min/day; p<0.001).
Conclusions: Hypocalcemia and vitamin D deficiency are common among Bangladeshi adolescent girls, with significant urban–rural differences. Improved nutrition, dietary counselling and promotion of outdoor activities are needed.
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References
Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423-78. DOI: https://doi.org/10.1016/S0140-6736(16)00579-1
Sîrbe C, Rednic S, Grama A, Pop TL. An update on the effects of vitamin D on the immune system and autoimmune diseases. Int J Mol Sci. 2022;23(17):9784. DOI: https://doi.org/10.3390/ijms23179784
Dowdy JC, Sayre RM, Holick MF. Holick's rule and vitamin D from sunlight. The Journal of steroid biochemistry and molecular biology. 2010;121(2):328-30. DOI: https://doi.org/10.1016/j.jsbmb.2010.04.002
Shlisky J, Mandlik R, Askari S, Abrams S, Belizan JM, Bourassa MW, et al. Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes. 2022. DOI: https://doi.org/10.1111/nyas.14758
Bromage S, Ahmed T, Fawzi WW. Calcium deficiency in Bangladesh: burden and proposed solutions for the first 1000 days. Food Nutr. 2016;37(4):475-93. DOI: https://doi.org/10.1177/0379572116652748
Blum LS, Khan R, Sultana M, Soltana N, Siddiqua Y, Khondker R, et al. Using a gender lens to understand eating behaviours of adolescent females living in low‐income households in Bangladesh. Mat Child Nut. 2019;15(4):12841.
Akter R, Sugino H, Akhter N, Brown CL, Thilsted SH, Yagi N. Micronutrient adequacy in the diet of reproductive-aged adolescent girls and adult women in rural Bangladesh. Nutrients. 2021;13(2):337. DOI: https://doi.org/10.3390/nu13020337
Khan MN, Muhtasim MF, Al Persi A, Hoq MA, Alim NE, Hossain MS, et al. Prevalence and Seasonal Variations of Vitamin D Deficiency in the Southeastern Region of Bangladesh. Bangladesh J Nucl Med. 2025;28(1):114-8. DOI: https://doi.org/10.3329/bjnm.v28i1.79538
Siddiqee MH, Bhattacharjee B, Siddiqi UR, Rahman MM. High burden of hypovitaminosis D among the children and adolescents in South Asia: a systematic review and meta-analysis. Journal of Health, Population and Nutrition. 2022;17;41(1):10. DOI: https://doi.org/10.1186/s41043-022-00287-w
Hossain ME, Shahrukh S, Hossain SA. Chemical fertilizers and pesticides: impacts on soil degradation, groundwater and human health in Bangladesh. InEnvironmental degradation: challenges and strategies for mitigation 2022;28 (pp. 63-92). Cham: Springer International Publishing. DOI: https://doi.org/10.1007/978-3-030-95542-7_4
Joshi K, Bhatia V, Singh N, Ramesh V. Vitamin D nutrition of healthy schoolchildren from North India. International J Pediat Endocrinol. 2015;28(1):65. DOI: https://doi.org/10.1186/1687-9856-2015-S1-P65
Patil S, Joglekar C, Desai M, Yadav A, Sonawane S, Chavan R, et al. Nutritional status and psychological impairment in rural adolescent girls: Pilot data from “KOKAN” region of western India. Front Publ Health. 2018;6:160. DOI: https://doi.org/10.3389/fpubh.2018.00160
Saggese G, Vierucci F, Boot AM, Czech-Kowalska J, Weber G, Camargo Jr CA, et al. Vitamin D in childhood and adolescence: an expert position statement. European J Pediat. 2015;174(5):565-76. DOI: https://doi.org/10.1007/s00431-015-2524-6
Duncan CN, Vrooman L, Apfelbaum EM, Whitley K, Bechard L, Lehmann LE. 25-hydroxy vitamin D deficiency following pediatric hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2011;17(5):749-53. DOI: https://doi.org/10.1016/j.bbmt.2010.10.009
Oyibo I, Oyibo PG, Osie-Efetie B. Prevalence and predictors of hypocalcaemia among adolescent girls in rural public secondary schools in South-South Nigeria. Ethiopian J Heal Sci. 2021;31(6):1185. DOI: https://doi.org/10.4314/ejhs.v31i6.13
Omidvar N, Neyestani TR, Hajifaraji M, Eshraghian MR, Rezazadeh A, Armin S, et al. Calcium intake, major dietary sources and bone health indicators in Iranian primary school children. Iranian J Pediat. 2015;25(1):177. DOI: https://doi.org/10.5812/ijp.177
Baliga SS, Naik VA, Mallapur MD. Nutritional status of adolescent girls residing in rural area: A community-based cross-sectional study. J Scient Soc. 2014;41(1):22-5. DOI: https://doi.org/10.4103/0974-5009.126712
Das S, Hasan MM, Mohsin M, Jeorge DH, Rasul MG, Khan AR, et al. Sunlight, dietary habits, genetic polymorphisms and vitamin D deficiency in urban and rural infants of Bangladesh. Scient Rep. 2022;12(1):3623. DOI: https://doi.org/10.1038/s41598-022-07661-y
Mahfuz M, Alam MA, Das S, Fahim SM, Hossain MS, Petri Jr WA, et al. Daily supplementation with egg, cow milk and multiple micronutrients increases linear growth of young children with short stature. J Nutr. 2020;150(2):394-403. DOI: https://doi.org/10.1093/jn/nxz253
Saha A, Shakur MS, Laila R, Shakur S, Shomik MS, Habib RB. Assessment of risk factors associated with vitamin D status among children of an urban and a rural areas of Bangladesh: Risk factors for vitamin D status. Bangladesh Med Res Coun. 2020;46(2):134-41. DOI: https://doi.org/10.3329/bmrcb.v46i2.49024
Harinarayan CV, Akhila H, Shanthisree E. Modern india and dietary calcium deficiency—half a century nutrition data—retrospect–introspect and the road ahead. Front Endocrinol. 2021;12:583654. DOI: https://doi.org/10.3389/fendo.2021.583654
Al-Ajlan BY, Freije A, Allehdan S, Perna S. Prevalence and risk factors for vitamin D deficiency in children and adolescents in the kingdom of Bahrain. Nutrients. 2023;15(3):494. DOI: https://doi.org/10.3390/nu15030494
Kahwati LC, LeBlanc E, Weber RP, Giger K, Clark R, Suvada K, et al. Screening for vitamin D deficiency in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(14):1443-63. DOI: https://doi.org/10.1001/jama.2020.26498
Mustafa A, Shekhar C. Concentration levels of serum 25-Hydroxyvitamin-D and vitamin D deficiency among children and adolescents of India: a descriptive cross-sectional study. BMC Pediat. 2021;21(1):334. DOI: https://doi.org/10.1186/s12887-021-02803-z
Blum LS, Khan R, Sultana M, Soltana N, Siddiqua Y, Khondker R, et al. Using a gender lens to understand eating behaviours of adolescent females living in low‐income households in Bangladesh. Mat Child Nutr. 2019;15(4):12841. DOI: https://doi.org/10.1111/mcn.12841
Keats EC, Rappaport AI, Shah S, Oh C, Jain R, Bhutta ZA. The dietary intake and practices of adolescent girls in low-and middle-income countries: a systematic review. Nutrients. 2018;10(12):1978. DOI: https://doi.org/10.3390/nu10121978
Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis Int. 2016;27(4):1281-386. DOI: https://doi.org/10.1007/s00198-015-3440-3
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