Frequency of Low Vitamin D 3 Levels in Subjects with Parkinson ’ s Disease . A Study Conducted at PMCH , a Tertiary Care Hospital , Nawabshah

Background: Lack of serum vitamin D3 is related to PD (Parkinson’s disease). Currently a valid place for vitamin D3 deficiency in Parkinson disease (PD) has been anticipated. The aim of present research was to evaluate insufficiency of D3 (vitamin) in subjects with PD (Parkinson’s disease). Many of physiological functions connected with higher risk of illness are maintained by vitamin D, which also plays significant task in pathogenesis of calcium homeostasis and skeletal ailments. It forecasts hazard of persistent ailments like malignancy, CVS conditions, and T2DM. Continuous insufficiency of this vitamin may lead to PD. Method: This was a cross sectional study. Conducted at People’s Medical College Hospital, Nawabshah during period of Jan. 2014-Dec. 2016, the sample size of 243 subjects clinically diagnosed as PD was enlisted. Inclusion criteria were all male and female subjects aged >50 years, clinically diagnosed Parkinson’s disease enlisted in research. Results: In 151 (62.1%) subjects, vitamin D3 levels were <30 ng/ml while in 92 (37.9%) subjects, vitamin D3 values were normal (30 150 ng/ml) (p = 0.000). Conclusion: Considerably low levels of vitamin D3 were seen in Parkinson’s disease. Our information sustains a legitimate part of vitamin D insufficiency in PD.

(Cholecalciferol, Ergocalciferol) are essential compounds in our body [1].Parkinson's Disease is widespread neurological ailment of old age with unidentified cause.PD has great financial burden and social status of people universally.Uneven prevalence and incidence rates may be affected by ecological or hereditary components, approaches for case determination, diagnostic criterion, or age disseminations of investigation populaces may affect outcomes.Equivalence of existing researches is restricted [2].Vitamin D3 assumes a critical part in pathogenesis of skeletal ailments and calcium homeostasis [3].Vitamin D insufficiency likewise predicts expanded danger of other perpetual ailments, malignancy, [4], cardiovascular sicknesses [5] and DM (type 2) [6].Constantly deficient vitamin D values promote a constant loss of dopaminergic neurons and propose to assume a major part in the pathogenesis of PD [7].The epidemiological confirmation of a relationship among vitamin D and PD is, however, constrained to cross-sectional researches [8] [9] [10].
Studies had declared that in America (North), hundreds of populations who suffer from PD are vitamin D deficient.There is connection among PD and D3.These results have a strong correlation in old age peoples and fall risks and intimates additional search into the method essential for this connection [11].Subjects with PD have decreased vitamin D concentrations in relation to controls.PD is a noteworthy reason for incapacity in older people.Biological credibility and epidemiological information show that vitamin D inadequacy may add to PD progression [7].The recent research explored whether D3 level predicts Parkinson disease occurrence in populace of Pakistan where solar exposure is high from different zones of world.Vitamin D inadequacy had turned into universal issue in the older, kids and grown-ups [12] [13].Lack of vitamin D3 can occur from decreased solar contact [14].Altered bone mineralization and bony injury are associated with insufficiency leading to softening bony ailments (osteomalacia and rickets) [15] [16].This study will help in future to manage PD patients properly by reducing risk, treating and avoiding complications by giving additional supplements of vitamin D as a primary step by adding the basic element to diet and as drug.

Analyses of Different Correlations
The correlation of different variables assessed as shown in Table 2.We found that vitamin D3 levels (p = 0.000) were strongly correlated with age (p = 0.000), duration of PD (p = 0.000) these were statistically significant, and the analysis of other risk factors of PD were also assessed there was not significant correlation of various risk factors of PD and vitamin D deficiency like head injury (p = 0.017) alcohol (p = 0.358), smoking (p = 0.566), pesticide contact (p = 0.512), family history (p = 0.840) and BMI (p = 0.572) as shown in Table 2.The p-value of less than 0.05 was considered statistically significant.

Discussion
Pakistan is underdeveloped country with poor control on population growth and lack of resources.There is lot of hindrances in the health management parameters.Here we had carried out a research on PD and vitamin D3 level.PD is disease of old age.Sun exposure is easily available and prevalent throughout the country except few areas.There is poor concept of sunbath.Our male population remains outdoors most of daytime for earning purpose.Burka/Parda is common hindrances of females for sun exposure.Head injury, pesticide exposure, Advances in Parkinson's Disease emphatically connected with intellectual execution, especially with measuring its role in elderly populace [22].Many of studies (Cross Sectional) had shown the relationship of decreased levels of vitamin D with incident of PD also predicted increased hazard of PD [23].Vitamin D levels in high-risk group and matched controls (age, sex) did not differ, and it was suggested that there is no deficiency of vitamin D before diagnosis of PD [24].A majority of researches in established PD had shown lower vitamin D values as compared to fit controls [9].Serum values of vitamin D decrease as severity of disease increases [25] [26] as low levels of vitamin D3 were observed in subjects of PD in this study.
Nitric Oxide (free radical) can damage to cells, its synthesis is inhibited by vitamin D, and vitamin D3 also causes formation of glutathione (antioxidant) thus plays a neuro-protective role [27].It is assumed that vitamin D3 is involved in initiating the synthesis of N G F (nerve growth factor), Glial cell line derived factor and NT3 (Neurotrophin) and in this way is considered as Neurotrophic Factor [28] [29] [30].Peterson et al. in their research found strong relationship of automatic postural responses with serum vitamin D concentrations [31].Daily vitamin D3 supplements (1200 IU) for one year showed mild progression of disease and worsening of disease observed in those who did not receive increments.[32] As there were presence of more than one symptom of PD, VDD was more common as age of patient increases with more than one symptom.Patients with PD had limited outdoor activities so solar exposure is decreased this may contributes to decreasing levels of vitamin D even with incremental intake [33].Pakistan declaring Pakistani population a vitamin D deficient [49].Findings of above studies were considerably in contest with present study where we identified 151 (62.1%) subjects have vitamin D3 < 30 ng/ml.A narrowed danger of death in old age observed with high Vitamin D3 levels while others didn't benefit [50].Taking supplements are valuable or not still unclear [51].Increased danger of vitamin D deficiency observed in Blacks comparison to White populace [52].Further studies needed to find out reasons for these differences and clarify probable part of vitamin D in pathogenesis and clinical path of PD.

Frequency
a fat-soluble vitamin, has many biological consequences.It increases absorption of calcium, phosphate and magnesium in gut.Vitamin D3 and D2

A
sum of 243 diagnosed PD subjects from local community enrolled during 2014 to 2016 attending Department of Medicine, People's Medical University Hospital Nawabshah, Sindh, Pakistan.Sample size calculated by OpenEpi version 3, with population size 1.6 million, hypothesized percent frequency of outcome factor in PD 66/100,000, with confidence level 90% and margin of error 10%.Subjects with other neurodegenerative, thyroid ailments, and new change in life- Vitamin D deficiency is commonly associated in patients suffering from Parkinson's disease.As concluded in present research that as the age advances, risk of Parkinson's disease increases with simultaneous decrease in vitamin D level.As concluded in our study, 62.1% subjects of Parkinson's disease were vitamin D deficient.

Table 1 .
Frequency, percentage and chi-square values of study variables.

Table 2 .
Correlation of different variables in Parkinson's disease subjects.Correlations of low levels of Vitamin D levels with other variables of study.
smoking are common in comparison to alcoholism and obesity in PD.Due to lack of health education, most of time peoples ignore health issues.Currentlyan established role of vitamin D and PD was identified.We carried out a study in our population to check the presence of low levels of vitamin D3 in PD.There is A. A. Jamali et al.DOI: 10.4236/apd.2018.7100213 Advances in Parkinson's Disease vitamin D, there is hazard of developing PD; this hazard increases to twofold when there is deficiency of vitamin D [21].Vitamin D levels were low in subjects with PD and AD in comparison to the normal controls, [8] current study also determined insufficiency of vitamin D3 in 61.1% of PD subjects.25(OH)D3 Juan Wang et al. showed statistically a significant link among vitamin D values and sun exposure; and no involvement among serum vitamin D and daily Advances in Parkinson's Disease oral supplements of vitamin D. There study indicated that low values of this vitamin with reduced sun exposure are associated with increase hazard of PD [34], above associations of VDD and PD are evident in present study.Yoon JH et al. .A study demonstrated 66.32% of PD and 22.62% of healthy individuals had mild to moderate VDD (cutoff value < 30 ng/ml).Pakistani population in general had VDD and vitamin D supplementation assumed to be added after clinical Advances in Parkinson's Disease evaluation of population groups [47].Mansoor et al. elucidated that 56.9% men and 43.1% normal women had Vitamin D3 < 20 ng/ml [48].Sheikh et al. observed in 84.3% of tested healthy subjects (38 -55 years) in Karachi had 25(OH)D levels < 30 ng/ml suggesting extensive VDD prevalence throughout