February 2011, Volume 61, Issue 2

Letter to the Editor

The impact of atmospheric pollution on vitamin D status

Madam, air pollution, an emerging environmental issue around the globe, has been attributed to cause 2.4 million deaths yearly1 owing to its adverse health effects such as, cardiopulmonary diseases, allergies and inflammations. Data from Pakistan suggests high levels of air pollution in major cities of Pakistan, with Karachi ranking as the most polluted mega-city in terms of total suspended particles (TSP) and the fourth most polluted mega-city in the world in terms of multi-pollutant index.2
Atmospheric pollution consists of particulate-matters, ozone, carbon-monoxide, sulphurdioxide, etc; ozone adsorbing and reducing effective UVB levels, hence increasing the risk of vitamin D deficiency (VDD). Studies from India3 and west have shown similar trend of lower serum vitamin D levels in individuals residing in high polluted areas as compared to those in lesser polluted areas.
This finding is of immense significance since Vitamin-D plays a key role in enhancing immune system, fighting cancers, diabetes control, and bone development4 in the body. Sunlight is the main source of vitamin D; therefore, people who do not receive adequate sunlight might be at higher risk of developing VDD. Studies done in our country have revealed VDD prevalence of 70% in healthy population of Karachi  and 48-58% in hospitalized patients.5
We can, therefore, imply that air pollution might be playing a role in VDD, in our country, along with other factors, such as high melanin, clothing, pardah, inadequate sun exposure. Awareness among the general population in this regard and atmospheric pollution control measures need to be implemented in order to safeguard general health of people living in polluted areas.
Quratulain Humayun, Romaina Iqbal
Aga Khan University Hospital, Karachi.


1.Air quality and health, fact sheet N 313. World Health Organization; August 2008. (Online) (Cited 2010 July 2). Available from URL: http://www.who.int/entity/quantifying_ehimpacts/countryprofilesebd.xls.
2.Gurjar BR, Butler TM, Lawrence MG, Lelieveld J. Evaluation of emissions and air quality in megacities. Atmos Env 2008; 42: 1593-606.
3.Agarwal KS, Mughal MZ, Upadhyay P, Berry JL, Mawer EB, Puliyel JM 2002 The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child 2002; 87: 111-3.
4.Rockett KA, Brookes R, Udalova I, Vidal V, Hill AV, Kwiatkowski D. 1,25-Dihydroxyvitamin D3 induces nitric oxide synthase and suppresses growth of Mycobacterium tuberculosis in a human macrophage-like cell line. Infect Immun 1998; 66: 5314-21.
5.Zuberi LM, Habib A. Vitamin D Deficiency in ambulatory patients. J Pak Med Assoc 2008; 58: 482-4.

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