Incidence of Vitamin B12/D3 Deficiency Among Company

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• The human daily requirement of Chaitanya Gulvady, Abstract Vitamin B12 is about 5 mcg Shyam Pingle*, The present cross-sectional and interventional study was Shrinivas Shanbhag Reliance Industries carried out to assess the incidence of vitamin B12 / vitamin Adequate amounts of vitamin D3 can D deÞ ciency in male ofÞ ce executives in the tropical city Ltd., Reliance Centre, be obtained by sun exposure of as Walchand Hirachand of Mumbai, India. A total of 75 senior executives were little as exposure of face and hands to Marg, Ballard Pier, surveyed and subjected to analysis of blood levels of ambient sunlight for twenty minutes Mumbai - 400 001, vitamin D (25 Hydroxy Cholecalciferol) by RIA method and thrice a week. India, *Reliance vitamin B12 by CLIA method. The same was performed in Industries Ltd., a reputed analytical laboratory with NABL accreditation. MATERIALS AND METHODS Patalganga Works, B4 History of smoking, exposure to sunlight, exercise, dietary MIDC Industrial Area, habits, consumption of vitamin supplements, medication First phase questionnaire Patalganga, Rasayani, etc. was obtained. Raigad, Maharashatra, (included the following) India The results revealed 65% executives with vitamin B12 • 86 male senior executives- response deÞ ciency (less than 193 pg/ml) and 28% executives rate-89%. For correspondence: with vitamin D deÞ ciency (less than 7.6 ng/ml). The • Age: 40 to 68 years. Dr. Chaitanya Gulvady, prevalence of low levels of vitamin B12 is lower (58%) in • H/o mode of travel to office, sun Reliance Industries those who give history of regular exercise than others. film on car windowpanes, duration Ltd., Reliance Centre, The prevalence of vitamin D deÞ ciency is lower (25%) in of hours spent in office. Walchand Hirachand those who give history of regular exercise than in others • Variables: Physical exercises - Marg, Ballard Pier, (46.2%). Prevalence of vitamin D deÞ ciency is higher Mumbai - 400 001, indoor or outdoor, smoking, alcohol (47%) in those whose workday day started earlier than India. consumption, history of abdominal in those whose workday started later (12%). E-mail: chaitanya. surgery, medications esp H2 In the second phase of the survey, 58 executives [email protected] receptor blockers and PPI’s with low B12/ D3 values, were given vitamin B12/D3 • Informed consent obtained. oral supplements for a period of three months along • Blood samples collected at the with counseling for lifestyle modiÞ cation. A modiÞ ed worksite itself. questionnaire was then circulated and the subjects medknow.com). analyzed for B12/D3 values. SigniÞ cant improvements • D3 - Analyzed by radioimmunoassay in serum B12 and D3 values were seen after the oral (RIA- BioSource Europe SA, therapy, sun exposure and dietary modiÞ cations. Belgium) • B12 - Analyzed by chemiluminiscent enzyme immunoassay (CLIA) Key words: Alfacalcidol, mecobalamine This PDF is available for(Immulite free download 2000 - solid phase, from competitive CLIA). a site hosted by Medknow Publications (www. Second phase INTRODUCTION • Treatment for three months: Tab Mecobalamine 1 OD / Tab • Vague complaints of unexplained pain in upper and lower Alfacalcidol 25 mg 1 OD. limbs were encountered among senior executives in our • Dietary modification advised. company, who worked long hours in air-conditioned offices • Increased sun exposure. and in spite of living in a city with a tropical climate, were • Modified questionnaire: 58 subjects barely exposed to sunlight.[1] with low values of vit B12 and/or • The aim of the survey was to assess the incidence of D3, vitamin B12 and D3 deficiency among these executives. • Blood samples were analyzed for • The second part of the survey aimed to observe the B12/D3 levels. effectiveness of oral supplements of B12/D3.[2]

83 Indian Journal of Occupational and Environmental Medicine - August 2007 - Volume 11 - Issue 2

83 CMYK Gulvady C, et al.: Incidence of vitamin B12 / D3 defi ciency

RESULTS vitamin D whilst 28% had low values of < 20 ng/ml. • Of the total sample size of 84,there were 17 smokers, of First phase of survey which 13 were deficient in vitamin B12. • All subjects traveled to office in cars with sun film on • There was no subject with any kind of abdominal surgery. windowpanes and spent 9-10 hours at work, indoors in an Of the group there were 10 suffering from hypertension office building, which has sunscreens on window panels. and 8 from diabetes. • 65% of executives had vitamin B12 deficiency (< 193 pg/ml) and 29% were in the range of 194 to 500 pg/ml [Figure 1]. Second phase of survey • 28% of the subjects had vitamin D deficiency (< 7.6 ng/ml) • 47 subjects took oral B12 supplements and all showed and 55% were in the range of 7.6 to 30 ng/ml. improvement in their serum B12 values [Table 1]. Of the • Deficient vitamin B12 values were found in 49 subjects of 30% who remained deficient, 17% had not taken the full- which 70% were vegetarians and 30% non vegetarians, (who prescribed treatment. consumed non veg food occasionally) [Figure 2]. • 45 subjects took oral D3 supplements and all showed • Prevalence of vitamin D deficiency is higher in those whose improvement in their serum vitamin D3 values [Table 2]. workday started earlier (47%) than in those whose day • 36 subjects increased their duration of sun exposure and started later (12%) [Figure 3]. 86% showed improvement in serum vitamin D3 values. • Of the subjects who consumed alcohol, 55.81% were found 38% increased from deficient to normal whilst 47% showed to be deficient in vitamin B12. Alcohol is known to retard improvement from their lower normal values. 13% subjects the absorption of vitamin B12. showed reduction in their D3 values but of these 11% • Of those who did no physical exercises.58.4% were grossly subjects had not taken oral Supplements of D3. deficient in vitamin D whereas 41.6% had values between • 11 vitamin B12 deficient subjects reduced their 7.6 to 20 ng. All of them were deficient in vitamin B12. consumption of alcohol and of these 81% subjects have • Of the vitamin D deficient subjects, 32% did not exercise shown improvement in their serum B12 values with oral at all, 47% did Indoor exercises thus hardly exposing supplements of B12. themselves to sunlight [Figure 4]. • Of the 14 subjects who had reported complaints of pain in • Of the subjects who had complained of pain in limbs, 52% the limbs and who had taken vitamin B12/D3 supplements, were found to B12 deficient. 20% subjects were deficient in 78% subjects reported improvement in their symptoms.

47% 65%

medknow.com). 28%

12%

This PDF is available for free download from Figure 1: Prevalence rates of vit B12 /D3 deÞ ciencies Figure 3: Relationship of work schedule with vitamin D3 deÞ ciency a site hosted by Medknow Publications (www.

47%

32% 30%

70% 9% 12%

Figure 2: Relationship of diet with vit B12 deÞ ciency Figure 4: Relationship of exercise with vitamin D deÞ ciency

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84 CMYK Gulvady C, et al.: Incidence of vitamin B12 / D3 defi ciency

Table 1: Prevalence rates of vitamin B12 Table 2: Prevalence rates of vitamin D3 Serum vitamin <193 194-500 501-983 Vitamin D ng/ml <7.6% 7.7 to 30% 31 to 75% B Levels pg/ml % pg/ml % pg/ml % Pre 46.5 49 4.5 Pre 85 15 0 Post D3 supplements 2 80 18 Post oral B12 supplements 30 61.5 8.5

Pre Supplement Vitamin D3 Pre Supplement Vitamin B12 Prevalence Rates Prevalence Rates

15 % (194-500 pg/ml) 4.5% (31-75 ng/ml)

46.5% (<7.6 ng/ml)

49% 85% (< 193 pg/ml) (7.7-30 ng/ml)

Post Supplement Vitamin B12 Post Supplement Vitamin D3 Prevalence Rates Prevalence Rates (31-75 ng/ml) 2% (< 7.6 ng/ml) 8.5% (>500 pg/ml) 18% 30% (<193 pg/ml)

80% (7.7-30 ng/ml) 61.5% (194-500 pg/ml)

Statistical analysis • Intervention measures to bolster B12/D3 values among • In spite of living in tropical climates with abundant employees by diet modification and increased sun exposure sunlight, vitamin D3 deficiency is evident in the urban have been instituted at all company establishments. Indian population as a corporate lifestyle disorder. Office executives especially, are not exposed to sunlight due to ACKNOWLEDGEMENT changing lifestyles, long working hours and the modern environment.[3] Reliance Industries Ltd., Hemang Gor and Kadar Shaikh. • Incidence of vitamin B12 deficiency is observed to be high, probably due to predominantly vegetarian diets and REFERENCES insufficient consumption of dairy products, poultry andmedknow.com). meat. 1. Boyles S. Lack of Vitamin D Linked to Pain: WebMD Medical News • Effectiveness of oral supplementation of B12/D3 is 2003. 2. Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician demonstrated by the results of the second phase of the 2003;67:979-86. survey.[4] Increase in sun exposure, dietary modification 3. Available from: http://www.vitaminind.ucr.edu/nutri.html: University of and reduction in alcohol consumption were also effective. California: Nutritional Aspects of Vitamin D: 6/2/2005. Office executives needThis to exercisePDF outdoorsis available and thus for4. Kuzminski free AM, download Del Giacco EJ, Allen from RH, Stabler SP, Lindenbaum J. increase their exposure to sunlight to facilitate vitamin Effective treatment for cobalamin deÞ ciency with oral cobalamin. Blood 1998;92:1191-8. D absorption. a site hosted by Medknow Publications (www. • Serum vitamin B12/ D3 analysis is being made part of the annual check up for all Reliance employees. Source of Support: Nil, Confl ict of Interest: None declared.

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