Indian Journal of Occupational and Environmental Medicine Medknow Publications ISSN: 0973-2284 EISSN: 1998-3670 Vol. 11, Num. 2, 2007, pp. 83-85

Indian Journal of Occupational and Environmental Medicine, Vol. 11, No. 2, May-August, 2007, pp. 83-85

Brief Communications

Incidence of vitamin B12 / D3 deficiency among company executives

Gulvady, Chaitanya; Pingle, Shyam; Shanbhag, Shrinivas

Reliance Industries Ltd., Reliance Centre, Walchand Hirachand Marg, Ballard Pier, Mumbai - 400 001
Correspondence Address:Reliance Industries Ltd., Reliance Centre, Walchand Hirachand Marg, Ballard Pier, Mumbai - 400 001, chaitanya.gulvady@ril.com

Code Number: oe07018

Abstract

The present cross-sectional and interventional study was carried out to assess the incidence of vitamin B12 / vitamin D deficiency in male office executives in the tropical city of Mumbai, India. A total of 75 senior executives were surveyed and subjected to analysis of blood levels of vitamin D (25 Hydroxy Cholecalciferol) by RIA method and vitamin B12 by CLIA method. The same was performed in a reputed analytical laboratory with NABL accreditation. History of smoking, exposure to sunlight, exercise, dietary habits, consumption of vitamin supplements, medication etc. was obtained. The results revealed 65% executives with vitamin B12 deficiency (less than 193 pg/ml) and 28% executives with vitamin D deficiency (less than 7.6 ng/ml). The prevalence of low levels of vitamin B12 is lower (58%) in those who give history of regular exercise than others. The prevalence of vitamin D deficiency is lower (25%) in those who give history of regular exercise than in others (46.2%). Prevalence of vitamin D deficiency is higher (47%) in those whose workday day started earlier than in those whose workday started later (12%). In the second phase of the survey, 58 executives with low B12/ D3 values, were given vitamin B12/D3 oral supplements for a period of three months along with counseling for lifestyle modification. A modified questionnaire was then circulated and the subjects analyzed for B12/D3 values. Significant improvements in serum B12 and D3 values were seen after the oral therapy, sun exposure and dietary modifications.

Keywords: Alfacalcidol, mecobalamine

Introduction

• Vague complaints of unexplained pain in upper and lower limbs were encountered among senior executives in our company, who worked long hours in air-conditioned offices and in spite of living in a city with a tropical climate, were barely exposed to sunlight. ^[1]
• The aim of the survey was to assess the incidence of vitamin B12 and D3 deficiency among these executives.
• The second part of the survey aimed to observe the effectiveness of oral supplements of B12/D3. ^[2]
• The human daily requirement of Vitamin B12 is about 5 mcg

Adequate amounts of vitamin D3 can be obtained by sun exposure of as little as exposure of face and hands to ambient sunlight for twenty minutes thrice a week.

Materials and Methods

• 86 male senior executives- response rate-89%.
• Age: 40 to 68 years.
• H/o mode of travel to office, sun film on car windowpanes, duration of hours spent in office.
• Variables: Physical exercises - indoor or outdoor, smoking, alcohol consumption, history of abdominal surgery, medications esp H2 receptor blockers and PPI′s
• Informed consent obtained.
• Blood samples collected at the worksite itself.
• D3 - Analyzed by radioimmunoassay (RIA- BioSource Europe SA, Belgium)
• B12 - Analyzed by chemiluminiscent enzyme immunoassay (CLIA) (Immulite 2000 - solid phase, competitive CLIA).

• Treatment for three months: Tab Mecobalamine 1 OD / Tab Alfacalcidol 25 mg 1 OD.
• Dietary modification advised.
• Increased sun exposure.
• Modified questionnaire: 58 subjects with low values of vit B12 and/or D3,
• Blood samples were analyzed for B12/D3 levels.

Results

• All subjects traveled to office in cars with sun film on windowpanes and spent 9-10 hours at work, indoors in an office building, which has sunscreens on window panels.
• 65% of executives had vitamin B12 deficiency (< 193 pg/ml) and 29% were in the range of 194 to 500 pg/ml [Figure - 1].
• 28% of the subjects had vitamin D deficiency (< 7.6 ng/ml) and 55% were in the range of 7.6 to 30 ng/ml.
• Deficient vitamin B12 values were found in 49 subjects of which 70% were vegetarians and 30% non vegetarians, (who consumed non veg food occasionally) [Figure - 2].
• Prevalence of vitamin D deficiency is higher in those whose workday started earlier (47%) than in those whose day started later (12%) [Figure - 3].
• Of the subjects who consumed alcohol, 55.81% were found to be deficient in vitamin B12. Alcohol is known to retard the absorption of vitamin B12.
• Of those who did no physical exercises.58.4% were grossly deficient in vitamin D whereas 41.6% had values between 7.6 to 20 ng. All of them were deficient in vitamin B12.
• Of the vitamin D deficient subjects, 32% did not exercise at all, 47% did Indoor exercises thus hardly exposing themselves to sunlight [Figure - 4].
• Of the subjects who had complained of pain in limbs, 52% were found to B12 deficient. 20% subjects were deficient in vitamin D whilst 28% had low values of < 20 ng/ml.
• Of the total sample size of 84,there were 17 smokers, of which 13 were deficient in vitamin B12.
• There was no subject with any kind of abdominal surgery. Of the group there were 10 suffering from hypertension and 8 from diabetes.

• 47 subjects took oral B12 supplements and all showed improvement in their serum B12 values [Table - 1]. Of the 30% who remained deficient, 17% had not taken the full-prescribed treatment.
• 45 subjects took oral D3 supplements and all showed improvement in their serum vitamin D3 values [Table - 2].
• 36 subjects increased their duration of sun exposure and 86% showed improvement in serum vitamin D3 values. 38% increased from deficient to normal whilst 47% showed improvement from their lower normal values. 13% subjects showed reduction in their D3 values but of these 11% subjects had not taken oral Supplements of D3.
• 11 vitamin B12 deficient subjects reduced their consumption of alcohol and of these 81% subjects have shown improvement in their serum B12 values with oral supplements of B12.
• Of the 14 subjects who had reported complaints of pain in the limbs and who had taken vitamin B12/D3 supplements, 78% subjects reported improvement in their symptoms.

• In spite of living in tropical climates with abundant sunlight, vitamin D3 deficiency is evident in the urban Indian population as a corporate lifestyle disorder. Office executives especially, are not exposed to sunlight due to changing lifestyles, long working hours and the modern environment. ^[3]
• Incidence of vitamin B12 deficiency is observed to be high, probably due to predominantly vegetarian diets and insufficient consumption of dairy products, poultry and meat.
• Effectiveness of oral supplementation of B12/D3 is demonstrated by the results of the second phase of the survey. ^[4] Increase in sun exposure, dietary modification and reduction in alcohol consumption were also effective. Office executives need to exercise outdoors and thus increase their exposure to sunlight to facilitate vitamin D absorption.
• Serum vitamin B12/ D3 analysis is being made part of the annual check up for all Reliance employees.
• Intervention measures to bolster B12/D3 values among employees by diet modification and increased sun exposure have been instituted at all company establishments.

Acknowledgement

References

Copyright 2007 - Indian Journal of Occupational and Environmental Medicine

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