Prevalence and Risk Factors for Vitamin C Deficiency in North and South India: A Two Centre Population Based Study in People Aged 60 Years and Over

Abstract

BackgroundStudies from the UK and North America have reported vitamin C deficiency in around 1 in 5 men and 1 in 9 women in low income groups. There are few data on vitamin C deficiency in resource poor countries.ObjectivesTo investigate the prevalence of vitamin C deficiency in India.DesignWe carried out a population-based cross-sectional survey in two areas of north and south India. Randomly sampled clusters were enumerated to identify people aged 60 and over. Participants (75% response rate) were interviewed for tobacco, alcohol, cooking fuel use, 24 hour diet recall and underwent anthropometry and blood collection. Vitamin C was measured using an enzyme-based assay in plasma stabilized with metaphosphoric acid. We categorised vitamin C status as deficient (<11 µmol/L), sub-optimal (11–28 µmol/L) and adequate (>28 µmol/L). We investigated factors associated with vitamin C deficiency using multivariable Poisson regression.ResultsThe age, sex and season standardized prevalence of vitamin C deficiency was 73.9% (95% confidence Interval, CI 70.4,77.5) in 2668 people in north India and 45.7% (95% CI 42.5,48.9) in 2970 from south India. Only 10.8% in the north and 25.9% in the south met the criteria for adequate levels. Vitamin C deficiency varied by season, and was more prevalent in men, with increasing age, users of tobacco and biomass fuels, in those with anthropometric indicators of poor nutrition and with lower intakes of dietary vitamin C.ConclusionsIn poor communities, such as in our study, consideration needs to be given to measures to improve the consumption of vitamin C rich foods and to discourage the use of tobacco.

Use of Cooking Fuels and Cataract in a Population-Based Study: The India Eye Disease Study

“…GSH and ascorbate are the principal lens antioxidants and protect the nuclear lens proteins from the highly reactive hydroxl radical generated by redox active metals, principally iron (Fu et al 1998; Garner et al 2000; Truscott 2005). Plasma ascorbate concentrations and dietary intakes of vitamin C were very low in our study population (Ravindran et al 2011). The association with nuclear cataract in women may be explained by increased exposure to redox active metals through combustion of biomass fuels and inadequate antioxidant protection by vitamin C. We found no effect modification of biomass fuel use by plasma ascorbate deficiency.…”

Association of plasma vitamin C concentration to total and cause-specific mortality: a 16-year prospective study in China

“…A summary of micronutrients intake across eight European countries showed that the proportion of vitamin C intake under EAR ranged from 8% to 13% in Poland, lower in UK and other countries 27. In contrast, the prevalence of vitamin C deficiency was much higher in low-income and middle-income countries such as India where it is reported as 74% in northern India and 46% in southern India 14. In our study in rural China, the overall prevalence of vitamin C deficiency was 21%, ranging from 5% in winter to 35% in spring.…”

Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections

“…Currently, the most commonly used vitamin C cutoff levels are approximately ≤23-28 µmol/L for hypovitaminosis C and ≤11 µmol/L for deficiency [58]. The evidence indicates that vitamin C insufficiency or deficiency is common in low and middle-income countries (e.g., Mexico, Brazil, India), and not uncommon in high income countries (e.g., US, Singapore, New Zealand), particularly in at-risk subpopulations [53,[59][60][61][62][63][64][65][66][67]. Furthermore, the WHO and the Food and Agriculture Organization (FAO) of the United Nations have described that, based on blood markers, vitamin A and iron deficiencies are widespread and of significant global concern [46, 49,50].…”