Nano-emulsion versus Conventional Vitamin D - Indian Relevance and Evidence

In order to enable regular bone mineralization,vitamin D stimulates calcium absorption in the gut and maintains blood calcium levels. At the same time, compliance with therapies for bone health is still a major challenge. (1)

Need for Vitamin D supplementation in India

With around 85% of the Indian population suffering from varying degrees of vitamin D deficiency, vitamin D deficiency is a significant public health issue in India. According to studies, the 25(OH)D concentrations in subjects living in north India are generally lower than those in subjects living in south India, with an inverse correlation with latitude (r = -0.48; P< 0.0001). (2)

In practicality, majority of Indians cannot obtain enough vitamin D through sunlight, and the few (relatively) abundant dietary sources of vitamin D are also expensive and limited, especially for vegetarians given that the majority of Indians are vegetarians. (3) As a result, supplementation is necessary for many of us.

How much vitamin D is enough?

Over the past few years, there has been some debate regarding the required amount of vitamin D. The recommended daily intakes for vitamins are sometimes more a matter of opinion than of fact since rigorous and well-controlled dietary research in general population is sometimes lacking, or because they are extrapolated from studies in model systems.

The United States Endocrine Society's recommendations call for serum 25(OH)D concentrations of 30 ng/mL or greater as the ideal range for preventing damage to bone health or the metabolism of minerals. (4)

According to recent studies, maintaining blood levels of 25(OH) D between 30 and 50 ng/mL for an extended length of time is required to produce significant decreases in morbidities from a variety of communicable and non-communicable diseases. (4)

How supplementation helps in reaching the optimal dose of Vitamin D?

Because of its non-polar lipid characteristics and low solubility in the aqueous fluids of the digestive tract, vitamin D has poor bioavailability in its conventional forms. In recent years, it has been demonstrated that in vitro and in vivo experiments, vitamin D3 nanoemulsion formulations have higher bioavailability than coarse emulsion preparations. (5)

Nano-emulsion Vitamin D has Better Efficacy among Adults- Review of Indian Experience: In the first study of its kind in humans, R. K. Marwaha et al. used serum 25(OH)D, parathyroid hormone, and other biochemical parameters to evaluate the effectiveness of a nano-emulsion formulation of vitamin D3 with the traditional granular form in otherwise healthy adults who were vitamin D deficient. (5)

The study recruited a total of 180 healthy adults who were randomized to receive either micellised or conventional vitamin D3 at a monthly dose of 60 000 IU (1500 μg). After 6 months, participants in micellised group had an additional increase of 20·2 (95 % CI 14·0, 26·4) nmol/l in serum 25(OH)D levels (P <0·001). (5)

Nano-emulsion Vitamin D has Better Efficacy among Children- Review of Indian Experience: The same author conducted another non-randomized, pilot study in 180 healthy children, aged 13–14 years to assess the efficacy of micellised with conventionally used fat-soluble vitamin D3. The participants were divided into two groups where the former group was given 60,000 IU of fat-soluble vitamin D3/month with milk and the latter with 60,000 IU/month of water miscible vitamin D3 for 6 months. The study observed a significantly greater increase in the serum 25(OH)D levels in the micellised group as compared to the conventional fat-soluble group (31.8 ± 9.1 ng/mL vs. 23.7 ± 10.4 ng/mL; p<0.001). (6)

These results imply that supplementation with nano-emulsion vitamin D3 appears to be more effective in raising serum 25(OH)D levels than therapy with an equivalent amount of fat-soluble vitamin D3 in conventional granular form. Additionally, for healthy people, taking vitamin D supplements in these dose regimes is safe and is not linked to any negative consequences.

Vitamin D is not a panacea but may be a valuable, affordable, and adjuvant therapy for many diseases across different life stages, including pregnancy, childhood, and ageing. Although the rickets epidemic is over, vitamin D deficiency and insufficiency are still associated with numerous diseases that can affect people of all ages. Therapeutic goals are aimed at treating vitamin D insufficiency, its related morbidities, and sequels.

Vitamin D supplementation in the nano-emulsion form can be a practical and desirable option for supplying the balance of recommended daily amounts, reversing vitamin D insufficiency, and maintaining overall bone health.

References:

1. Peterlik M, Boonen S, Cross HS, Lamberg-Allardt C. Vitamin D and calcium insufficiency-related chronic diseases: an emerging worldwide public health problem. Int J Environ Res Public Health. 2009;6(10):2585-2607. doi:10.3390/ijerph6102585

2. Harinarayan CV, Akhila H, Shanthisree E. Modern India and Dietary Calcium Deficiency-Half a Century Nutrition Data-Retrospect-Introspect and the Road Ahead. Front Endocrinol (Lausanne). 2021;12:583654. Published 2021 Apr 6. doi:10.3389/fendo.2021.583654

3. G R, Gupta A. Vitamin D deficiency in India: prevalence, causalities, and interventions. Nutrients. 2014;6(2):729-775. Published 2014 Feb 21. doi:10.3390/nu6020729

4. Wimalawansa, Sunil. (2016). Extra-Skeletal benefits, Endocrine Functions, and Toxicity of Vitamin D. Journal of Endocrinology and Diabetes. 3. 1-5. 10.15226/2374-6890/3/3/00152.

5. Marwaha RK, Dev T, Mittal A, et al. A randomized controlled trial comparing the efficacy of micellised and fat-soluble vitamin D3 supplementation in healthy adults. Br J Nutr. 2019;121(8):859-865. doi:10.1017/S0007114518003215

6. Marwaha RK, Yenamandra VK, Ganie MA, et al. Efficacy of micellized vs. fat-soluble vitamin D3 supplementation in healthy school children from Northern India. J Pediatr Endocrinol Metab. 2016;29(12):1373-1377. doi:10.1515/jpem-2016-0191