CORRESPONDENCE Prevalence of Vitamin D Deficiency in Children (6–18 years) Residing in Kullu and Kangra Districts of Himachal Pradesh, India: Correspondence To the Editor: We read with interest the article on the preva- lence of vitamin D deficiency in children residing at high altitudes in the recent issue of your esteemed journal and found it very useful [1]. Despite formal guidelines on vitamin D supplementation for Indian children, most of the children are deficient [2]. Authors rightly stated that we are facing an unrecognized and untreated pandemic of Vitamin D deficien- cy for which there are no well-defined diagnostic/therapeutic endpoints. The magnitude of this pandemic is defined by prev- alence based upon certain cut-offs which themselves are in a gray zone. A recently published review of guidelines [3] sug- gests that all except the Endocrine Society Clinical Practice Guideline [4] agreed upon cut-off of 20 ng/ml as sufficient and same cut-off has been endorsed by Indian Academy of Pediatrics (IAP) [2]. The cut-off of 20 ng/mL is more appro- priate as it coincides with the level that would cover the needs of 97.5% of the population [2]. Defining a standard cut-off is very necessary as increasing the cut-off will greatly affect the prevalence rate of insufficiency and will increase the treatment rate. So, to ensure uniformity it will be useful to have data from this study on vitamin D deficiency using 12 mg/ml as the cut-off. Beyond the age of 1 y, IAP recommends routine supple- mentation of 600 IU vitamin D/day for every child, but author excluded children on vitamin D supplementation. What was the rationale for exclusion of children on supplementation when it is a routine recommendation and the majority of the population is supposed to follow it? Also, it will be prudent to know, how many children were on vitamin D supplementation who got excluded. It will help in understanding the actual coverage of the recommendation and formulating better poli- cy for its implementation. The previous similar study of the author showed preva- lence as 93% [5]. Other studies also showed that the preva- lence of vitamin D deficiency is high altitude areas is very high [6]. But for the current study, they assumed prevalence as low as 25%. What was the rationale for assuming such a low prevalence? The results of this, as well as previous studies on this as- pect, show that vitamin D deficiency is an important public health problem in hilly as well as plain regions. With prior knowledge and experience, we know that food fortification is the most convenient and cheapest method to halt this pandem- ic. However, Indian guidelines did not pay much attention to it [2]. Based on current as well as previous studies, there is an urgent need to consider vitamin D fortification while keeping the diverse dietary, social, economic, cultural and religious practices in mind in India. In our scenario, fortification of staple foods, such as wheat flour, rice flour, and rice, maybe more viable strategies. It is high time for the researchers to agree on a single well defined scientific cut-off as well as for the administrators to make policies for food fortification and get implemented. Jogender Kumar 1 and Arushi Yadav 2 1 Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and 2 Department of Radiodiagnosis, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. E-mail: jogendrayadv@gmail.com References 1. Kapil U, Pandey RM, Sharma B, et al. Prevalence of vitamin D defi- ciency in children (6–18 years) residing in Kullu and Kangra districts of Himachal Pradesh, India. Indian J Pediatr. 2018;85:344–50. 2. Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, et al; From Indian Academy of Pediatrics ‘Guideline for Vitamin D and Calcium in Children’ Committee. Prevention and treatment of vita- min D and calcium deficiency in children and adolescents: Indian academy of pediatrics (IAP) guidelines. Indian Pediatr. 2017;54:567–73. 3. Randev S, Kumar P, Guglani V. Vitamin D supplementation in child- hood - a review of guidelines. Indian J Pediatr. 2018;85:194–201. 4. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30. 5. Kapil U, Pandey RM, Goswami R, et al. Prevalence of vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India. Indian J Endocrinol Metab. 2017;21:178–83. 6. Hirschler V, Maccallini G, Molinari C, Aranda C; San Antonio de losCobres study group. Low vitamin D concentrations among indig- enous Argentinean children living at high altitudes. Pediatr Diabetes. 2013;14:203–10. The Indian Journal of Pediatrics https://doi.org/10.1007/s12098-018-2742-9