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BRIEF RESEARCH ARTICLE
Year : 2021  |  Volume : 65  |  Issue : 3  |  Page : 294-297  

Effect of vitamin-D supplementation on self-perceived health-related quality of life in postmenopausal women in Ludhiana, Punjab


1 Assistant Professor, Department of Community Medicine, Malankara Orthodox Syrian Church Medical College, Ernakulam, Kerala, India
2 Professor and Head of Department, Department of Community and Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
3 Professor and Head of Department, Department of Community Medicine, Believers Church Medical College, Tiruvalla, Kerala, India

Date of Submission08-Mar-2021
Date of Decision12-Mar-2021
Date of Acceptance19-Apr-2021
Date of Web Publication22-Sep-2021

Correspondence Address:
Nimila Elsa Mathews
Department of Community Medicine, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam - 682 311, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_226_21

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   Abstract 


Postmenopausal women are routinely prescribed calcium and Vitamin-D supplements in view of their increased risk of osteoporosis and fractures. A community-based interventional study was undertaken to determine the effect of Vitamin-D supplementation on self-perceived health-related quality of life in 290 postmenopausal women over 6 months in 2015. Vitamin D (60,000 IU) was supplemented for 8 weeks. The CDC-Health-Related Quality-of-Life Questionnaire -14 was administered to the subjects at baseline and post intervention. The pre and postintervention responses were compared using Chi-square test and paired t-test as appropriate. There was a significant improvement in their overall general health status. Mean systolic blood pressure (BP) was reduced by 3.0% (P = 0.0705) and the mean diastolic BP by 3.2% (P = 0.0419). Post supplementation, high serum Vitamin-D levels was observed in 6.5% of the 92 subjects tested. Prescribing Vitamin D to postmenopausal women without checking the serum levels prior to supplementation may occasionally lead to toxicity.

Keywords: Health-related quality of life, postmenopausal women, Vitamin-D supplementation


How to cite this article:
Mathews NE, Sengupta P, Benjamin AI. Effect of vitamin-D supplementation on self-perceived health-related quality of life in postmenopausal women in Ludhiana, Punjab. Indian J Public Health 2021;65:294-7

How to cite this URL:
Mathews NE, Sengupta P, Benjamin AI. Effect of vitamin-D supplementation on self-perceived health-related quality of life in postmenopausal women in Ludhiana, Punjab. Indian J Public Health [serial online] 2021 [cited 2021 Dec 2];65:294-7. Available from: https://www.ijph.in/text.asp?2021/65/3/294/326391



Vitamin D is produced endogenously in the skin when exposed to ultraviolet B radiation. Seafood (salmon, mackerel, and herring) and fish liver oils are a rich source of Vitamin D3.[1] Food fortification with Vitamin D is practiced in industrialized countries, but such programs are practically nonexistent in most low-income countries. Hence, sunlight still continues to be the main source of Vitamin D for majority of the populations of the world.[2]

Vitamin-D synthesis is affected by multiple factors such as geographical location, atmospheric pollution, sunlight exposure, clothing, melanin pigmentation, and aging.[1] Biochemically, Vitamin-D deficiency has been defined as 25(OH) D <20 ng/ml; Vitamin-D insufficiency as 21–29 ng/ml, and Vitamin-D sufficiency as >30 ng/ml.[1],[3] Vitamin-D deficiency has been widely reported in India (both rural and urban), in all age groups including toddlers, schoolchildren, adolescent girls, pregnant women, and postmenopausal women.[4],[5] Postmenopausal women frequently present with generalized aches and pains. Calcium and Vitamin-D supplements are routinely prescribed to them. The effect of Vitamin-D supplementation on general well-being and quality of life in postmenopausal women, if any, is not well-documented.

This community-based interventional study was carried out from June to December 2015 to determine the effect of Vitamin-D supplementation on the self-perceived health-related quality of life among postmenopausal women. As per the departmental database, there were 820 postmenopausal women in the study area. In the absence of quality of life data in postmenopausal women in this region, presuming 50% of them will have symptoms of ill health, the minimum sample size at 95% confidence limit and 10% allowable error is 262. Allowing for 10% loss to follow-up, 290 women were selected by systematic random sampling. Subjects on calcium or Vitamin-D supplements at present or within the past 3 months, those with terminal illness, history of heart disease/stroke, chronic liver disease/renal failure, and current treatment for cancer were excluded from the study. Menopause was defined as cessation of menstruation for 12 months. At induction, the subjects were interviewed and demographic data, information regarding lifestyle, dietary practices, history of any drug intake, and chronic diseases was obtained. Height, weight, body mass index, and blood pressure (BP) of each individual were recorded using portable electronic scales/monitors, as per the WHO-STEPS methodology.[6]

The CDC-Health-Related Quality-of-Life Questionnaire (CDC HRQOL-14) includes questions on general health perception, number of physically and mentally unhealthy days in a month, activity limitation, and number of days with symptoms such as pain, depression or anxiety, sleeplessness, and vitality. This was administered to the participants by the researcher before and after intervention and both the responses were compared. All participants were supplemented with Vitamin D 60,000 IU weekly for 8 weeks. Compliance was encouraged through weekly reinforcement by personal visits and monitored by keeping a record of the empty sachets. We also estimated the serum Vitamin-D level of randomly selected 92 subjects who completed the study to assess the endpoint effects of the routine Vitamin-D supplementation. This was done to see if the current practice of prescribing Vitamin-D supplements, without prior estimation of the Vitamin-D level, is beneficial or increases the risk of toxicity. The approval for this study was granted by the research and ethics committee (BFUHS/2014/P-Th/8980 dated September 19, 2014). The study processes were explained to the participants, and informed consent was obtained.

Out of the 290 women enrolled, 271 successfully completed the study. The mean age was 56.5 ± 10.01 years (95% confidence interval [CI] 55.36–57.76). According to the Modified B.G Prasad's classification, most of the women (32.8%) were Class II (upper middle), followed by 25.8% women in Class III (lower middle), 22.8% in Class IV (upper lower), and 14.0% in Class I (upper class). The mean duration of menopause was 11.45 years with a standard deviation of 9.84 (95% CI: 10.27–12.62). Most of the women had attained menopause for ≥15 years. Hypertension (31.7%) was the most common chronic disease reported, followed by arthritis (19.5%) and diabetes mellitus (16.9%). The percentage of women who had both hypertension and diabetes was 4.4%. Almost half of the subjects (51.3%) did not give any history of chronic disease. BP of all the subjects was recorded and it was seen that 185/271 subjects had hypertension (including already diagnosed cases) as per the JNC-7 criteria. Thus, the prevalence of hypertension among postmenopausal women in this study was 68.2%.

Among the participants, 76.8% were vegetarians. The consumption of milk and milk products (in ml/day) was found to be generally low in the subjects with only 23.2% of women taking more than 250 ml of milk and milk products in a day. With regard to physical activity, 91.1% of participants were found to be sedentary and 8.8% were moderately active. Among the participants, 4.8% were underweight, 34.7% were normal, 35.1% were pre-obese, and 25.4% were obese.

The self-perceived general health status reported by the study subjects has shown significant improvement (P = 0.0000). The percentage of women who reported that their health status was excellent/very good increased from 2.2% to 24% post intervetion [Table 1].
Table 1: Self-reported general health status (n=271)

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Pain, depression, and tension/anxiety had significantly decreased in the study subjects following the intervention (P ≤ 0.001). Although sleeplessness had reduced in the subjects, this was not statistically significant (P = 0.1261). An overall improvement in vitality/energy levels was reported which was highly significant (P = 0.0000) [Figure 1].
Figure 1: Comparison of Symptom days (n= 271).

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A reduction in the mean systolic BP by 3.0% (P = 0.0705) and mean diastolic BP by 3.2% (P = 0.0419) was observed following the intervention.

Out of the 92 subjects whose serum Vitamin-D levels were checked, 65.2% had sufficient levels (>30 ng/ml), while 28.2% remained either deficient (<20 ng/ml) or insufficient (21–29 ng/ml) and 6.5% had their levels falling into the high range (>100 ng/ml).

The prevalence of hypertension among postmenopausal women in our study was alarmingly high (68.2%). In a study done in China, the prevalence of hypertension among postmenopausal women was seen to be 62.4%.[7] Another study done in Delhi reported 39.6% hypertension among urban postmenopausal women and 56% among rural postmenopausal women.[8] Our subjects reported a significant improvement in their general health status following Vitamin-D supplementation. Pain, depression, tension/anxiety, and sleeplessness were observed to decrease in the subjects and overall improvement in vitality/energy levels was reported. In a study from the Philippines, 76 patients who were Vitamin-D deficient were prescribed Vitamin-D supplements for 8 weeks and the effect on health-related quality of life was determined. Physical well-being, social and family well-being, emotional well-being, functional well-being, and total HRQoL scores all increased significantly from baseline after 8 weeks (P < 0.0001).[9] Huang et al. observed that Vitamin-D supplementation in Vitamin-D-deficient or insufficient patients resulted in improvement in pain, sleep, and QoL except for role functioning and emotional QoL relative to baseline.[10] The present study reflected similar results as evidenced by the significant improvement in the HRQoL of patients from baseline to 8 weeks, although other factors that might have contributed in the patients' improved HRQoL scores cannot be totally ruled out.

Although a reduction in both the mean systolic (3.0%) and diastolic BP (3.2%) was seen after 8 weeks, the reduction in diastolic BP was found to be statistically significant (P = 0.0419). A randomized, placebo-controlled study done in 148 elderly women showed that 800 IU of Vitamin D3 plus 1200 mg of calcium significantly reduced BP by 9.3% after 8 weeks, whereas treatment with 1200 mg of calcium alone reduced BP by only 4.0% (P = 0.02).[11] In another experiment that looked at the effects of Vitamin D on BP, the researchers assigned 250 people to receive either 1,000 IU/day, 2,000 IU/day, 4,000 IU/day of Vitamin D, or a placebo for 3 months. They found that for each 1ng/mL increase in plasma 25-hydroxyvitamin D, there was a significant 0.2 mmHg reduction in systolic pressure (P = 0.02), but there was no effect on diastolic pressure (P = 0.37).[12]

We observed that Vitamin-D supplementation proved to have a significant effect on the self-perceived overall general health status of postmenopausal women in this study. It also had a beneficial effect on symptoms such as pain, depression, tension/anxiety, and sleeplessness and an overall improvement in vitality/energy levels. A reduction in the mean systolic and diastolic BP of the participants was also noted. Serum Vitamin-D estimation of 92 subjects following supplementation for 8 weeks showed that while majority of the women had their levels in the normal range, 6.5% had high levels. The practice of routinely prescribing Vitamin D to postmenopausal women, assuming a high prevalence of Vitamin-D deficiency in this group, can occasionally lead to high serum VitaminD levels in a small proportion of the women, as is evident from this study.

This study has some potential limitations. We could not control for all potential confounders. Both pre and postintervention serum Vitamin-D levels of all the subjects could not be estimated due to financial constraints.

Vitamin D has a significant role to play in improving the quality of life in postmenopausal women. However, it is recommended that the baseline serum Vitamin-D levels be tested prior to supplementation and only those with suboptimal levels need to be supplemented as it may occasionally lead to high levels of serum Vitamin D. Vitamin-D supplementation also had an effect on BP in the study. A well-designed randomized controlled trial needs to be ideally done for further research in this area.

Acknowledgment

The authors would like to acknowledge the Indian Council of Medical Research, New Delhi, for supporting this study under the MD/MS Thesis grant (No. 3/2/2014/PG-Thesis-HRD-16).

Financial support and sponsorship

This study was financially supported by ICMR MD Thesis grant.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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WHO. STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance (STEPS). WHO. Available from: http://www.who.int/chp/steps/riskfactor/en/. [Last access on 2016 May 25].  Back to cited text no. 6
    
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Zhou Y, Zhou X, Guo X, Sun G, Li Z, Zheng L, et al. Prevalence and risk factors of hypertension among pre- and post-menopausal women: A cross-sectional study in a rural area of northeast China. Maturitas 2015;80:282-7.  Back to cited text no. 7
    
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Gupta N, Vibha, Khandekar J, Jain A, Gupta S. Hypertension and its risk factors among postmenopausal women in Delhi. Indian J Community Health 2014;26:412-6.  Back to cited text no. 8
    
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Wilson OT, Montano CN. The effect of Vitamin D supplementation on health – Related quality of life among patients with low Vitamin D. Endocr Rev 2013;34:254.  Back to cited text no. 9
    
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Huang W, Shah S, Long Q, Crankshaw AK, Tangpricha V. Improvement of pain, sleep, and quality of life in chronic pain patients with vitamin D supplementation. Clin J Pain 2013;29:341-7.  Back to cited text no. 10
    
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Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab 2001;86:1633-7.  Back to cited text no. 11
    
12.
Forman JP, Scott JB, Ng K, Drake BF, Suarez EG, Hayden DL, et al. Effect of vitamin D supplementation on blood pressure in blacks. Hypertension 2013;61:779-85.  Back to cited text no. 12
    


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