Main Article Content

Mehwish Arif Butt
Asma Arman
Tahir Ansari


OBJECTIVE: To determine the frequency of 25-hydroxy vitamin-D deficiency in Patients with multiple sclerosis (MS).

METHODS: This cross-sectional study was conducted at Civil Hospital Karachi, Pakistan from January to December 2019. One hundred and sixty five diagnosed cases of MS of either gender, aging 20-55 years, not taking vitamin-D supplements, steroids and could go outside in the sun were selected through non-probability consecutive sampling technique. Patients having history of rickets, parathyroid disease, chronic liver or renal diseases were excluded. Blood sample was taken to measure 25-hydroxyl vitamin D3 levels. A level of <20 ng/ml was considered as vitamin-D deficient. Logistic regression analysis was used to identify determinants.

RESULTS: Out of 165 MS patients, 106 (64.24%) were females, 66 (40%) had income between PKR 10000-25000, 51 (30.9%) were illiterate and 12 (7.3%) had graduate level education. Majority (n=101; 61.21%) had relapsing-remitting MS. Mean age of enrolled participants was 32.92±8.19 years and mean duration of MS was 2.17±0.84 years. Ninety-nine (60%) patients had history of adequate sun exposure. Vitamin-D deficiency in MS patients was 55 (33.3%). Female patients with MS had 2.9 times more likely to be vitamin-D deficient compared to male patients (95% CI: 1.3-6.5). Vitamin-D deficiency In MS patients having no or primary level education patients was recorded in 38 (69.1%) patients as compared to 17 (31.9%) case having secondary or higher education (p-value=0.046).

CONCLUSION: Vitamin-D deficiency is common in MS patients. Female and less educated MS patients are at a higher risk of being vitamin-D deficient.

Article Details

How to Cite
Butt, M., A. Arman, and T. Ansari. “FREQUENCY OF 25-HYDROXY VITAMIN D DEFICIENCY IN PATIENTS WITH MULTIPLE SCLEROSIS”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 14, no. 1, Mar. 2022, doi:10.35845/kmuj.2022.22039.
Original Articles


1. Voet S, Prinz M, van Loo G. Microglia in central nervous system inflammation and multiple sclerosis pathology. Trends Mol Med 2019;25(2):112-23.
2. Kocovska E, Gaughran F, Krivoy A, Meier UC. Vitamin-D deficiency as a potential environmental risk factor in multiple sclerosis, schizophrenia, and autism. Front Psychiatry 2017;8:47.
3. Runia TF, Hop WC, de Rijke YB, Buljevac D, Hintzen RQ. Lower serum vitamin D levels are associated with a higher relapse risk in multiple sclerosis. Neurology 2012;79(3):261-6.
4. Thouvenot E, Orsini M, Daures JP, Camu W. Vitamin D is associated with degree of disability in patients with fully ambulatory relapsing-remitting multiple sclerosis. Eur J Neurol 2015;22(3):564-9.
5. Mansouri B, Asadollahi S, Heidari K, Fakhri M, Assarzadegan F, Nazari M, et al. Risk factors for increased multiple sclerosis susceptibility in the Iranian population. J Clin Neurosci 2014;21(12):2207-11.
6. Harandi AA, Shahbeigi S, Pakdaman H, Fereshtehnejad SM, Nikravesh E, Jalilzadeh R. Association of serum 25(OH) vitamin D3 concentration with severity of multiple sclerosis. Iran J Neurol 2012;11(2):54-8.
7. Smolders J, Menheere P, Kessels A, Damoiseaux J, Hupperts R. Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis. Mult Scler 2008;14(9):1220-4.
8. Pierrot-Deseilligny C, Souberbielle JC. Vitamin D and multiple sclerosis: an update. Mult Scler Relat Disord 2017;14:35-45.
9. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17(2):162-73.
10. Riaz H, Finlayson AE, Bashir S, Hussain S, Mahmood S, Malik F, et al. Prevalence of Vitamin D deficiency in Pakistan and implications for the future. Expert Rev Clin Pharmacol 2016;9(2):329-38.
11. Bouillon R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol 2017;13(8):466-79.
12. Ferre L, Sferruzza G, Mascia E, Clarelli F, Dalla Costa G, Radaelli M, et al. Baseline vitamin D levels and multiple sclerosis activity in relapsing remitting patients treated with fingolimod. Neurol Sci 2016;39(8):1467-70.
13. Shah Z, Wasay M, Chaudhry BZ, Fredrikson S. Multiple sclerosis in Pakistan: Current status and future perspective. J Neurol Sci 2020:418:117066.
14. Raja V, Afzal N, Roy N, ur Rehman J, Avinash BK. Frequency of Vitamin D Deficiency Among Patients of Multiple Sclerosis in Pakistan. J Med Health Studies 2020;1(1):17-22.
15. Siddiqee MH, Bhattacharjee B, Siddiqi UR, Meshbah ur Rahman M. High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis. BMC Public Health 2021;21(1):2-18.
16. Shamsi U, Azam I, Shamsi A, Shamsi D, Callen D. Frequency and determinants of vitamin D deficiency among premenopausal and postmenopausal women in Karachi Pakistan. BMC Womens Health 2021;21(1):2-8.
17. Syed F, Latif MSZ, Ahmed I, Bibi S, Ullah S, Khalid N. Vitamin D deficiency in Pakistani population: critical overview from 2008 to 2018. Nutrition Food Science 2020;50(1):105-15.
18. Vorobeychik G, Black D, Cooper P, Cox A. Multiple sclerosis and related challenges to young women's health: Canadian expert review. Neurodegener Dis Manag 2020;10(2s):1-13.
19. Goulden R, Ibrahim T, Wolfson C. Is high socioeconomic status a risk factor for multiple sclerosis? A systematic review. Eur J Neurol 2015;22(6):899-911.
20. Bjørnevik K, Riise T, Cortese M, Holmøy T, Kampman MT, Magalhaes S, et al. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study. Mult Scler 2016;22(1):104-11.
21. Bartosik-Psujek H, Psujek M. Vitamin D as an immune modulator in multiple sclerosis. Neurol Neurochir Pol 2019;53(2):113-22.
22. Smolders J, Torkildsen Ø, Camu W, Holmøy T. An update on vitamin D and disease activity in multiple sclerosis. CNS Drugs 2019;33(12):1187-99.
23. Sternberg Z. Cardiovascular autonomic dysfunction: link between multiple sclerosis osteoporosis and neurodegeneration. Neuromolecular Med 2018;20(1):37-53.