Institute of Nutrition and Food Science

Effects of Vitamin-D 3 Supplement on the Cognitive Status in Patient with Systemic Lupus Erythematosus with Neuropsychiatric Phenomenon

2026-04-19T06:32:39Z

Effects of Vitamin-D 3 Supplement on the Cognitive Status in Patient with Systemic Lupus Erythematosus with Neuropsychiatric Phenomenon Sultana, Nasreen Systemic Lupus Erythematosus (SLE) is a complicated autoimmune illness that affects several organ systems, including the central nervous system. Neuropsychiatric (NP) SLE (NPSLE) is characterized by neurological and psychiatric symptoms such as cognitive dysfunction, mood problems, and seizures, and has been linked to severe impairments in memory, attention, and executive functioning can lead to altered brain perfusion. Vitamin D3 has shown promise in neuro-protection and cognitive improvement, which may benefit NPSLE patients. This study investigates the effects of Vitamin D3 supplementation on cognitive function and brain perfusion in NPSLE patients. Material & Methods This randomized controlled trial (RCT) included NPSLE patients (N=72), divided into an intervention group (n=34) receiving Vitamin D3 supplementation, and a control group (n=38) without supplementation. Baseline and six-month evaluations of serum Vitamin D levels, Mini-Mental State Examination (MMSE) scores, and brain perfusion using Single-photon emission computed tomography (SPECT) imaging (Z-scores) were conducted at National Institute of Nuclear Medicine & Allied Science (NINMAS), Dhaka. The intervention group received 40,000 IU of Vitamin D3/week for six weeks, followed by a maintenance dose of 2000 IU/day for three months, along with standard SLE management. Both verbal and written informed consent was obtained, and adherence was encouraged through weekly reminders via text or calls. After six months, outcomes were analyzed to assess the impact of Vitamin D3 on cognitive function and brain perfusion in NPSLE patients. xv Results Baseline characteristics (age, gender, BMI, and waist-to-hip ratio/WHR) were indifferent (P>0.05) between groups (Control vs. cases). No significant differences (P>0.05) were found between groups in age (28.24±7.18 vs. 26.32±7.94,), gender distribution (predominantly female), BMI (19.0±1.4 vs.19.2±2.0,), and waist-to-hip ratio (0.78±0.11 vs. 0.76±0.10). Moreover, at baseline, vitamin D levels were low and similar across both groups (14.5±5.3 ng/ml vs. 16.2±4.9, p=0.173). After the study period, a significant (p<0.001) increase in vitamin D3 levels (28.3±5.3 ng/ml) was observed in the intervention group as compared to controls (15.1±3.4 ng/ml), indicating effective supplementation. Moreover, at baseline, MMSE scores were similar (24.1±1.7 vs. 24.3±1.5) between groups (P=0.677) while at the end line, the intervention group (26.5±1.4) showed a significant improvement in MMSE scores than control (23.8±2.25; p<0.001). This suggests a positive effect of Vitamin D3 supplementation on cognitive function. Brain perfusion was analyzed using SPECT imaging techniques (Z-scores), and at baseline, abnormal perfusion was prevalent in both groups (81.6% vs. 88.2%, P=.522), primarily in the frontal, parietal lobes, and precuneus regions (z-score: 1.4 vs. 1.46, P=0.549). This baseline homogeneity indicates effective randomization and establishes comparable initial conditions between the study groups. However, at the end line, mean z-scores were insignificantly (P=.457) higher in the control group (n=13, z-scores=1.84) than intervention group (n=21, z- scores=1.66) while 65.8% (n=25) of the Brain SPECT of the controls were not available at end line, as compared to cases (n=13). On top of that, significant between-group differences emerged in performing perfusion test results (Fisher’s exact test= 6.997, p = 0.028) when considered comparison in missing cases between groups, which indicates among available controls (n=13), eleven xvi showed abnormal brain perfusion. Furthermore, the intervention group demonstrated distinct patterns of perfusion compared to controls, suggesting a potential effect of Vitamin D3 supplementation on cerebral perfusion parameters. These findings suggest that despite the study groups (intervention vs. control) exhibited indifferent (all P>0.05) vitamin D3 levels, MMSE scores, and perfusion characteristics at the baseline, significant differences emerged between groups especially in the MMSE-scores (small effect size, Partial eta squared=.460 for MMSE between case and. control) attributable to the effective vitamin D3 supplementation (High effect size, Partial eta squared=.714 for Vitamin D, Case vs. control) following the intervention period (6-months). Conclusion Vitamin D3 supplementation led to substantial improvements in serum vitamin D levels, cognitive function (MMSE scores), and brain perfusion in the intervention group. These findings support the potential role of Vitamin D3 as an adjunctive therapy in NPSLE, enhancing cognitive performance and cerebral perfusion. Further studies are recommended to validate these results and assess the long-term benefits of Vitamin D3 in managing NPSLE-related cognitive impairment This thesis is submitted for the degree of Doctor of Philosophy.

Evaluation of Nutritional and Developmental Consequences and Renal Function of Children who Recovered from Hypernatremia

2026-04-19T04:15:12Z

Evaluation of Nutritional and Developmental Consequences and Renal Function of Children who Recovered from Hypernatremia Huq, Sayeeda Hypernatremia (HN), defined as high sodium in the blood (≥145 μmol/L), is a serious complication of diarrheal diseases in children. However, clinical manifestations are usually observed in children in developing countries at the level of 150 μmol/L The primary cause of HN is excessive water loss relative to sodium loss. The resulting hyperosmolality can lead to neuronal cell shrinkage, causing brain injury, including widespread cerebral hemorrhage, thrombosis, subdural effusion, and permanent neurological deficits. Retrospective study conducted in icddr,b showed that 2.4-5.1% children with diarrhea had hypernatremia and case fatality ranges from 15-9%(Chisti et al., 2016).Deaths are often attributed to the severe effects of HN on the brain or to rapid rehydration, which can result in cerebral edema. A prospective observational study was conducted at Dhaka Hospital of icddr,b from August 2013 to October 2015. In total, 259 children under five years old were enrolled. After treatment, 224 children were successfully discharged. The death rate was 13.5%, with neurological sequelae in 29.9%, acute kidney injury in 32.4%, and severe malnutrition in 44% of the children. However, post hypernatremia impact in long term on morbidity, nutritional status, cognitive development, and renal function is largely unknown. Therefore, it is imperative to evaluate nutritional status, growth, cognitive development, and renal function in long term among children recovered from hypernatremia. vi Methodology: This Observational longitudinal study was conducted among children under five years of age who had hypernatremia and participated in the prospective observational study conducted from August 2013 to October 2015. The original study aimed to investigate neurologic complications and developmental consequences in children with hypernatremia. The sample size is based on 224 children who successfully recovered from the initial hypernatremia study. Accounting for a 25% attrition rate, the sample size was estimated to be 168. However, due to dropouts during follow-up, 143 children were successfully followed up in the present study. The study lasted from March 2016 to March 2017, and children were examined at the Dhaka Hospital of icddr, b. All children were brought to Dhaka Hospital inpatient ward for a complete physical, nutritional, neurological, and cognitive assessment. A spot urine analysis was also performed to evaluate their kidney function. Upon arrival, each child's weight, height, and mid-upper arm circumference (MUAC) were measured using standard procedures. Data were collected using pre-designed and pre-tested Case Report Forms (CRFs), which included the child’s medical records, exact address, socio-demographic information, family status, living conditions, history of illness, and immunization status. Cognitive, motor and neuropsychological development were assessed by a trained psychologist using standard procedures. Two different tools were used depending on the child's age. The Bayley Scales of Infant Development-III (BSID-III) was used for children under 36 months, while the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) was used for children older than 36 months. Motor function was assessed using the Movement Assessment Battery for Children-II (MABC-II). A spot urine sample was collected from each child for vii microscopic examination, and the protein-to-creatinine ratio was calculated to detect potential glomerular damage. Results: Of the 224 recovered hypernatremia children, 143 (64%) parents consented to participate in this study. The mean age of the children was 35 ± 8 months, and 59% were male. Mean± SD of weight and height of the study participants were 12.4 ±3.1 kg and 89.5 ±7.5 cm, respectively. Malnutrition was not significant in this study population. After stratified by two age groups, children aged up to 36 months and those older than 36 months, Median (IQR) of family income, 13000(10000,20000) vs. 11500 (8000,18000); maternal, 7(4,10) vs. 8(5,10); and paternal, 6(4, 9) vs. 8(1,10) education levels were comparable. Around 50% of the study children commonly presented with upper respiratory infections. After 12 months of recovering from hypernatremia, half of the children had an increased protein-to- creatinine ratio. Children with mild hypernatremia were more likely to have raised urinary Pr/Cr ratio, though none presented with any evidence of urinary problems or glomerular damage. Eighty-six percent (86%) of the children from better socioeconomic status were less likely to have a high Pr/Cr ratio in comparison with their poorest counterparts (p=<0.001). Children under 36 months are twice more likely to have raised urinary Pr/Cr compared to those more than 36 months; 2.31(1.06, 5.02); p-0.035. The mean cognitive score improved significantly at 12 months’ post-recovery (86.1± 16.3; p=0.002), as well as the motor and language composite score; 83. ±15.7, and 80.9± 13.8 respectively. These developmental scores were similar between male and female participants. viii However, 10% of the children showed poor cognitive performance (<69) after 12 months. After adjusting for age and weight-for-age Z-scores (WAZ), composite scores of cognitions and socioemotional domain of development showed a significant difference between baseline and end-line assessment (p=0.002 and p=0.013, respectively). On the other hand, after 12 months’ children mostly presented with average IQ. The mean Movement Assessment score indicated that children are at risk of movement difficulties during the post-hypernatremia recovery period. Conclusion: Long-term evaluation of children's nutritional status and renal function recovered from hypernatremia did not reveal any significant clinical abnormalities. However, developmental assessments indicated that most children exhibited average neurocognitive development and IQ. Further studies are required to validate the spot urine method against the gold standard 24-hour urine collection method for assessing proteinuria in post-hypernatremia children. This thesis is submitted for the degree of Doctor of Philosophy.

Vitamin-D status among adolescent attending in the Out Patient Department of Selected Tertiary Hospitals in Bangladesh

2026-03-03T08:32:21Z

Vitamin-D status among adolescent attending in the Out Patient Department of Selected Tertiary Hospitals in Bangladesh Jaiswal, Sanni Context/Background: Lack of vitamin D is a global issue that has been linked to a number of health problems. In Bangladesh, it is quite prevalent in all age categories, but it is particularly prevalent in children and adolescents of both sexes. Since vitamin D is produced by cutaneous synthesis when exposed to plenty of sunlight, the incidence of vitamin D insufficiency in Bangladesh is often disregarded. The objective of the current study was to assess the vitamin D status of adolescents attending in the outpatient department (OPD) of selected tertiary hospitals in Bangladesh, as well as the relationship between vitamin D status and dietary habits and socio-demographic traits. Techniques/Methods Two chosen hospitals' outpatient departments recruited adolescents (10–19 years old) for a cross-sectional survey. The study employed convenience sampling of 384 adolescents who came to these hospitals and their medical reports were available at the hospital. Vitamin D status was evaluated based on the medical reports. Alongside, dietary habits were recorded using the Food Frequency Questionnaire (FFQ). A multinomial logistic regression model was built to determine the predictors of the participants' vitamin D status. Results: More than 58% of the respondents were younger adolescents (aged 10-14 years) and around two-thirds were girls. It was discovered that 36.7% of the adolescents had inadequate amounts of vitamin D, and 32% were vitamin D deficient. Deficiency level was significantly higher among older adolescents (15-19 years of age). Girls were significantly more deficient 36.2% than boys 24.6%. In addition to other socio-demographic factors, mothers with low- paying jobs, mothers whose education level was primary/below or no institutional education, families with lower incomes, etc., had higher prevalence of vitamin D deficiency. Regarding dietary habits, the study found that respondents who regularly consumed foods high in vitamin D i.e. beef, fatty fish, egg, dairy, fortified oils, nuts, fruits and vegetables, Horlicks had lower rate of vitamin D deficiency. A multinomial logistic regression analysis showed 7 that the occupation level of the mother (service holder), the less frequent consumption of beef, dairy, fortified oil, and Horlicks (a nutritional supplement drink) as significant predictors for vitamin D deficiency. Conclusion: The present study found a positive impact of consumption of certain vitamin D-rich food items (beef, dairy, fortified oil, and Horlicks) on vitamin D levels of adolescents. Adolescents who consumed these items frequently had a lower risk of vitamin D deficiency than those who did so occasionally or never. Therefore, if any awareness programs or campaigns could be conducted for both parents and adolescents, it might be beneficial for reducing vitamin D deficiency. Additionally, if it's feasible, more study can be done to fortify food with vitamin D through further research. This thesis is submitted for the degree of Master of Philosophy.

Dengue Viral Infection in Children: Epidemiological, Nutritional and Genomic Analysis

2026-03-03T08:17:44Z

Dengue Viral Infection in Children: Epidemiological, Nutritional and Genomic Analysis Ghosh, Kinkar Background: The epidemiology and genomic characteristics of dengue viral infection in children have been poorly explored in Bangladesh. The study aimed to delineate the epidemiological, nutritional, and genomic characteristics of the dengue viral infection in Bangladeshi children. Method: A cross-sectional study was carried out in the in-patient department of Bangladesh Shishu Hospital and Institute from June 2023 to May 2024. Children of age <18 years admitted with presumptive positive dengue infection and presumptive negative dengue infection (NS1 and/IgM negative) with features like dengue infection were enrolled in this study. A total of 722 presumptive dengue-positive children were included for epidemiological analysis, 349 children under the age of five for nutritional assessment; 104 dengue-positive children, and 50 dengue-negative children (from another group) for genomic analysis and concomitant viral infections respectively. MedCalc online tools and SPSS version 21 were used for genomic and statistical analysis. Results: Among 722 children, 600(83%) were from Dhaka City Corporation (494 and 106 were from North and South City Corporation respectively) and 122(17%) were from outside of Dhaka. The age group of <1 Year were 91(12%), 1- <5 Year 258(36%),5- <10 Year 238(33%) and > 10 Year 135(19%). Out of all, fever was the compulsory presenting complaint, and vomiting 355(49%), abdominal pain 192(27%), loose motion 135(19%), cough 49(7%), headache 30(4%), reluctant to feed 23(3%), bleeding 18(2%), convulsion 16(2%) were present. Among all 516(71%) presented with warning signs and 206(29%) without warning signs; 82(16%) children with warning signs and 23(11%) without warning signs were admitted to the intensive care unit. Reinfection was in 39(5.4%), a comorbid condition in 79(10%) and shock was the predominant complication. Among 349 under-five children, 7 (2%) were overweight, 178(51%) normal, 153(44%) moderately underweight, and 11(3%) severely underweight. Real-Time PCR results reveal that out of 104 positive cases, 96(92%) were true positive and 8(8%) were false positive. Among 50 negative cases 17(34%) were false negative and 33(66%) true negative. Real-time PCR of nasopharyngeal swabs reveals that 12(12%) had Flu or Respiratory Syncytial Virus (RSV) in true positive cases(n=103) and 5 (19%) in true negative cases(n=26). Circulating serotypes were DEN2 87% and DEN3 13%. Genomic footprint shows that DEN-2-2023 in Bangladesh was most similar to 2018 and DEN-3-2023 most similar to 2017. Conclusion: In children, DEN2 was the most predominant serotype in 2023 among children which might be responsible for more severe diseases. Concomitant viral infection could be an upcoming concern for the dengue outbreak. Authorities should prioritize the feasibility of using Real-time PCR for dengue screening in the coming years and a laboratory network system like COVID-19 should be considered. This thesis is submitted for the degree of Master of Philosophy.