Impact of Deficiency of Serum Vitamin D3, Serum Zinc, Serum Iron and its Outcome in Community Acquired Pneumonia in Children in a Tertiary Healthcare Center of Central India: A Crosssectional Study

Abstract

Background: In regions like Central India, where malnutrition and micronutrient deficiencies are endemic, children are at a heightened risk of developing severe forms of CAP. Socioeconomic constraints, poor dietary diversity, limited access to healthcare, and lack of awareness contribute to a high prevalence of subclinical and overt deficiencies of vitamin D3, zinc, and iron. In tertiary healthcare centers, where patients often present with complicated or advanced stages of illness, assessing the nutritional and micronutrient status of paediatric patients with CAP can provide valuable insights into the underlying risk factors influencing disease severity and recovery outcomes.

Aim and Objectives: 1. to determine the correlation between vitamin D3, serum zinc, serum iron & Its severity and outcome in community acquired pneumonia in children.2. To estimate the levels of serum vitamin D3, serum zinc, serum iron in community acquired pneumonia in children.

Methodology: Study Design: Cross sectional study.

Study Setting: Paeditrics department of GMC Nagpur, Maharashtra.

Study Population: Patients aged 2 months up to 60 months who suffered CAP according to WHO criteria, clinically and radio logically (chest x-ray) confirmed case of community acquired pneumonia. Patients were clinically classified according to the severity of pneumonia.

Study Period: from October 2023 to March 2025.

Sample Size = 65

Results: High prevalence of vitamin D3 deficiency was observed in 42 cases (64.6%), followed by iron deficiency in 39 cases (60.0%) and zinc deficiency in 36 cases (55.4%). Furthermore, multiple micronutrient deficiencies were identified in 28 children (43.1%). The highest proportion of cases (14; 21.5%) occurred in the 13–24-month age group, followed by 13 cases (20.0%) in the 37–48- month group, 12 cases (18.5%) in the 2–6-month group, and 11 cases (16.9%) in the 49–60-month group. The 7–12- month group accounted for 9 cases (13.8%), while the lowest proportion was observed in the 25–36-month group, with 6 cases (9.2%). The prevalence of micronutrient deficiencies was substantially higher among ICU patients compared to those in the ward. Vitamin D3 deficiency was observed in 86.7% of ICU cases versus 58.0% of ward cases. Iron deficiency was also present in 86.7% of ICU patients compared to 52.0% in the ward. 35 (53.8%) were male and 30 (46.2%) were female. The overall prevalence of CAP was slightly higher in males (53.8%) than in females (46.2%). Vitamin D3 deficiency was present in 81.3% of severe cases versus 48.5% of pneumonia cases (p = 0.006). Serum iron deficiency occurred in 78.1% of severe cases compared with 42.4% of pneumonia cases (p = 0.004). Serum zinc deficiency was identified in 71.9% of severe cases versus 39.4% of pneumonia cases (p = 0.010). The multiple deficiency group recorded the highest mortality (17.9%) and the lowest recovery rate (53.6%).

Conclusions: The present study highlights a significant association between micronutrient deficiencies specifically vitamin D3, serum iron, and serum zinc and the incidence and severity of community-acquired pneumonia (CAP) in children aged 2 to 60 months.