1. 1. Veerendrakumar C.M.MD.,DNBAssociate ProfessorDept of OBG,VIMS,BellaryThursday, December 22, 2011 dr.veerendrakumar cm 1
2. 2. Vitamin D & Iron Deficiency:Deadly Duo Alien + PredatorThursday, December 22, 2011 dr.veerendrakumar cm2
3. 3. Vitamin D vitamin or Hormone ??("sunshine" vitamin) Vitamin D is a fat-soluble vitamin. Fat-soluble vitamins are stored in the bodys fatty tissue Very few foods naturally contain vitamin D.Thursday, December 22, 2011 dr.veerendrakumar cm 3
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6. 6. Contents Vitamin D status & Deficiency Recap Clinical Data Health Implications Iron Deficiency Anemia status in India Vitamin D Deficiency & Iron Deficiency Anemia: is there a Link ? Prevalence Mechanistic Evidence Clinical Evidence SummaryThursday, December 22, 2011 dr.veerendrakumar cm6
7. 7. Vitamin D Vitamin D is found in the following foods: Dairy products Cheese Butter Cream Fortified milk (all milk in the U.S. is fortified with vitamin D) Fatty fish (such as tuna, salmon, and mackerel) Oysters Fortified breakfast cereals, margarine, and soy milkThursday, December 22, 2011 dr.veerendrakumar cm 7
8. 8. 10 to 15 minutes of sunshine three times weekly is enough to produce the bodys requirement of vitamin D. The sun needs to shine on the skin of your face, arms, back, or legs (without sunscreen). Skin that is exposed to sunshine indoors through a window will not produce vitamin D. Cloudy days, shade, and having dark-colored skin also cut down on the amount of vitamin D the skin makes.Thursday, December 22, 2011 dr.veerendrakumar cm8
9. 9. RDA 9 - 70 years: 600 IU (15 mcg/day) Safe upper limit - 4,000 IU/day for children 9 years and older, adults, and pregnant and breast-feeding teens and women One microgram of cholecalciferol (D3) is the same as 40 IU of vitamin D.Thursday, December 22, 2011 dr.veerendrakumar cm9
10. 10. The greater absorption of iron in vivo from ferrous ascorbate [Fe(HL)2] as compared with ferrous sulfate has been ascribed both to retardation or prevention of Fe(II) oxidation by ascorbate and to the existence of Fe(II) as a chelate with ascorbate. Pharm Weekbl Sci 1984 Dec 14;6(6):245-8.Thursday, December 22, 2011 dr.veerendrakumar cm10
11. 11. Ascorbic acid (AA), is the most efficient enhancer of non-heme iron absorption when its stability in the food vehicle is ensured. The number of studies investigating the effect of AA on ferrous sulfate absorption far outweighs that of other iron fortificants. The promotion of iron absorption in the presence of AA is more pronounced in meals containing inhibitors of iron absorption. Meals containing low to medium levels of inhibitors require the addition of AA at a molar ratio of 2:1 (e.g., 20 mg AA: 3 mg iron). Int J Vitam Nutr Res. 2004 Nov;74(6):403-19.Thursday, December 22, 2011 dr.veerendrakumar cm 11
12. 12. Pregnancy -The most dangerous journey ofmankindThursday, December 22, 2011 dr.veerendrakumar cm 12
13. 13. ANEMIA 40-90% WOMEN AFFECTED RESPONSIBLE FOR 65% MATERNAL DEATHS (FOGSI- WHO 1996) CHRONIC MORBIDITYThursday, December 22, 2011 dr.veerendrakumar cm 13
14. 14. Eradicating anemia can save at least200 mothers a day!Thursday, December 22, 2011 dr.veerendrakumar cm 14
15. 15. Public Health Significance WHO 2008Prevalence of anemia (%) Public health significance < 04.9 No PH problem05.0 19.9 Mild20.0 39.9 Moderate> 40.0 SevereThursday, December 22, 2011 dr.veerendrakumar cm15
16. 16. Silver shinesGold glitters But Iron strengthens! Thursday, December 22, 2011 dr.veerendrakumar cm 16
17. 17. Patients have a right to Normal Hb and Receive safe and efficient treatment; It is the physicians responsibility to ensure this and, Where possible, avoid blood transfusion.Thursday, December 22, 2011 dr.veerendrakumar cm17
18. 18. Anemia is on the increase!! Economy is better More women are educated, empowered Tons of iron tablets distributed Fancy iron preparations flood the market Antenatal clinics are running full !Iron is not reaching its destination!Thursday, December 22, 2011 dr.veerendrakumar cm 18
19. 19. Are we producinga defective generation?Thursday, December 22, 2011 dr.veerendrakumar cm 19
20. 20. More doctors are finally testing patients for vitamin Ddeficiencies Upwards of 70 percent of American adults are vitamin D deficient or insufficient," said cardiologist James OKeefe of St. Lukes Mid-America Vitamin D prevents heart disease, too Vitamin D is essential for activating immune system functionThursday, December 22, 2011 dr.veerendrakumar cm20
21. 21. Vitamin D: Optimum statusIdeal >30 ng/mlAcceptable20-30 ng/mlInsufficient10-20 ng/mlDeficient