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Indian endocrinologists warn of vitamin D deficiency

BMJ 2003; 326 doi: (Published 04 January 2003) Cite this as: BMJ 2003;326:12

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Vitamin D deficiency may be mediating rotavirus diarrhoea

The rotavirus diarrhoea is widely prevalent in India (Jain et al,
2001 and Parashar et al, 2003). Winter (Aggarwal et al, 1988), Weaning
(Motarjemi et al, 1993) and Weakening (Anderson and Weber, 2004) are major
confounders of this diarrhoea. The risk factors related with the winter
and thereby low exposures to the Sun are poorly understood. A functional
NSP4 enterotoxin peptide secreted from rotavirus-infected intestinal cells
causes intracellular calcium mobilization that leads to the diarrhoea
(Zhang et al, 2000). Effect of vitamin D in prevention of the bone calcium
mobilization is well known (Abrams, 2001) and monitoring of the calcium
mobilization and interaction with the NSP4 enterotoxin peptide in the
intestinal cells is obviously expected. This area is yet to be explored.

Dr Kochupillai has suggested health education about exposure to sunlight
and fortification of dairy products with vitamin D as simple preventive
measures for vitamin D deficiency in India. His statements are based upon
clinical experience and limited studies. He put forward that vitamin D
deficiency is widespread in northern India (Mudur, 2003). It is also
mentioned that a survey by paediatricians at New Delhi’s Kasturba Hospital
earlier last year showed the presence of rickets among city children. The
winter peak of incidence of rotavirus diarrhoea shown by Aggarwal et al,
1988 also happens to be in the same city. Mudur, 2003 also mentions that
over 50% of healthy people surveyed in studies by Dr Ambrish Mithal have
poor vitamin D levels. Marshall et al, 2003 have pointed out that assuming
by Indian scientist that a lowered serum level of 25-hydroxyvitamin D (25-
D) as a sole indicator of an inadequate level of Vitamin D intake is not
correct and 1,25-dihydroxyvitamin D (1,25-D) should be assayed. However,
he has not denied clinical picture presented by Indian authors. Summarily, the status of Vitamin D might mediate the
rotavirus diarrhoea; an important point to be
considered in the future laboratory and
epidemiological studies.


Abrams SA. Calcium turnover and nutrition through the life cycle.
Proc Nutr Soc. 2001 May;60(2):283-9.

Aggarwal P, Srivastav VK, Singh M, Khanna KK. Rotavirus shown to be
the main cause of acute childhood diarrhoea in a New Delhi hospital with a
high prevalence in winter. J Diarrhoeal Dis Res. 1988 Mar;6(1):39-40.

Anderson EJ, Weber SG. Rotavirus infection in adults. Lancet Infect
Dis. 2004 Feb;4(2):91-9.

Jain V, Parashar UD, Glass RI, Bhan MK. Epidemiology of rotavirus in
India. Indian J Pediatr. 2001 Sep;68(9):855-62.

Motarjemi Y, Kaferstein F, Moy G, Quevedo F. Contaminated weaning
food: a major risk factor for diarrhoea and associated malnutrition. Bull
World Health Organ. 1993;71(1):79-92.

Mudur Ganapati. Indian endocrinologists warn of vitamin D deficiency.
BMJ 2003; 326:12 (4 January).

Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global
illness and deaths caused by rotavirus disease in children. Emerg Infect
Dis. 2003 May;9(5):565-72.

Trevor G Marshall, Frances E. Marshall. Vitamin D may be Harmful in
Rheumatic Disease. BMJ 2003; (13 January).Rapid response.

Zhang M, Zeng CQ, Morris AP, Estes MK. A functional NSP4 enterotoxin
peptide secreted from rotavirus-infected cells. J Virol. 2000

Competing interests:
None declared

Competing interests: No competing interests

13 March 2004
Rajendra P Deolankar
Assistant Director
National Institute of Virology, Pune 411 001, India