Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Aug 2018

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
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Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
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Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : OC18 - OC21 Full Version

Association of Obesity with Vitamin-D Deficiency and Anaemia: A Cross-sectional Study

Published: November 1, 2023 | DOI:
S Deepak Bhat, Swati Hegde, N Srikanth

1. Intern, Department of General Medicine, Ramaiah Medical College, Bengaluru, Karnataka, India. 2. Associate Professor, Department of General Medicine, ESIC MC and PGIMSR, Rajajinagar, Bengaluru, Karnataka, India. 3. Associate Professor, Department of General Medicine, Ramaiah Medical College, Bengaluru, Karnataka, India.

Correspondence Address :
Dr. Swati Hegde,
#24/1, 2nd Cross, ISEC Main Road, Nagarbhavi, Bengaluru-560072, Karnataka, India.


Introduction: Obesity is a growing health concern, especially in developing countries like India. Overweight and obesity are considered risk factors for numerous diseases, including micronutrient deficiencies. However, there is a lack of data on the association between vitamin-D status and anaemia in obesity. Therefore, this study was conducted in an urban setting where obesity is more prevalent.

Aim: To investigate the association between increased Body Mass Index (BMI) and vitamin-D deficiency and anaemia.

Materials and Methods: This cross-sectional observational study included 62 healthy overweight or obese adults from Ramaiah Medical College and Hospitals in Bengaluru, South India, from December 2021 to February 2022. Anthropometric measurements were taken, and blood investigations were conducted to estimate vitamin-D levels and haemoglobin levels. Pearson’s chi-square test was used to determine associations between the two groups.

Results: The study included (62) healthy adults, of whom 28 subjects (45.1%) were classified as obese (BMI ≥25 kg/m2) and 34 subjects (54.9%) were classified as overweight (BMI 23-24.9 kg/m2). There were 22 males and 40 females, with a mean age of 48.5 years. Vitamin-D deficiency was observed in 50 patients (80.6%). The prevalence of vitamin-D deficiency was higher in the obese group (n=23, 82.1%) compared to the overweight group (n=27, 79.4%), although this difference was not statistically significant. Anaemia was present in 14 patients (22.6%). Overweight males were more likely to be anaemic. Anaemia was observed more frequently in elderly overweight and obese patients and was statistically significant (p-value=0.039).

Conclusion: Vitamin-D deficiency and anaemia were seen as common problems in apparently healthy individuals with high BMI. This is a health concern that needs to be addressed, and early screening and appropriate treatment can help improve the quality of life.


Haemoglobin, Hypertension, Nutrition, Obesity, Screening

The prevalence of obesity is increasing in India and ranges from 13-50% in urban areas (1). Obesity is an established risk factor for diabetes, hypertension, and cardiovascular disorders. Once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low and middle-income countries, particularly in urban settings. Obesity has become a prime concern faced by many individuals these days due to changes in lifestyle, stressful working conditions, and increased consumption of foods with low nutritional value. As physicians, our interactions with patients having obesity have increased, making it important to study the various consequences of obesity.

Vitamin-D has gained more importance in recent years. It has a proven role in the homeostasis of calcium and phosphorus. Vitamin-D deficiency has been implicated in various metabolic disorders, including diabetes, as an immunomodulator, in various malignancies, cognitive dysfunctions, depression, and others. There is consistent association in the published literature between obesity and lower serum 25-hydroxyvitamin-D (25D) concentrations (2),(3),(4),(5). One of the endocrine derangements seen in obesity is hyperparathyroidism, believed to be secondary to low Vitamin-D (2). In a large study among Bangladeshi overweight and obese adults, Vitamin-D deficiency was seen in 72.6% (3).

Obesity, being an inflammatory state, also has varied effects on haematological parameters. It has been linked to iron deficiency. Obesity results in increased cytokines like Interleukin-6 (IL-6), leading to increased expression of hepcidin and subsequent reduced absorption of iron. Hepcidin may be directly secreted by adipocytes. Obesity is also associated with leucocytosis and increased platelet count (6). The association between obesity and anaemia is a subject of debate.

There are many studies on anaemia in obesity among school children, adolescents, and women (7),(8),(9). However, very few studies have focused on vitamin-D deficiency and anaemia in obesity among adults. In this study, authors hypothesise that obese individuals are more likely to be anaemic and vitamin-D deficient. The aim of this study was to investigate the association between increased BMI and vitamin-D deficiency and anaemia.

Material and Methods

This was a cross-sectional observational study conducted at Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India between December 2021 and February 2022. The study was approved by the Institutional Ethics Committee (IEC) (MS Ramaiah Medical College) (ref no.: MSRMC/EC/AP-05/02-2021).

Inclusion criteria: All individuals aged 18 years or older with a BMI of 23 kg/m2 or higher (according to the consensus guidelines for the Asian population (10)) who were attending the hospital for routine executive health check-ups. Patients with diabetes and hypertension under treatment were also included. Sixty-two patients who met the inclusion criteria were enrolled in the study.

Exclusion criteria: Patients who had recently received any vitamin supplements, individuals with chronic liver or kidney disease, and those on medications that affect bone metabolism were excluded. Additionally, individuals with recent major surgery, a history of blood loss, pregnant or lactating females were also excluded from the study.

Sample size: Based on a study by Kannan U and Achuthan A, it was observed that the correlation between Body Mass Index (BMI) and haemoglobin level was r=-0.27 for BMI >23 kg/m2, r=0.171 for BMI 18.5-23 kg/m2, and r=0.965 for BMI <18.5 kg/m2 (7). For the present study, expecting similar results with 80% power, 95% confidence level, and considering a population correlation coefficient of r=0.58, a minimum of 56 subjects were required. This was calculated using nMaster 2.0 software developed by CMC Vellore to calculate sample size. Final sample size was 62 patients.

After obtaining written informed consent, relevant medical history including dietary history was recorded. Anthropometric measurements were taken. Height was measured using a wall-mounted stadiometer, weight was measured using calibrated electronic weighing scales, and BMI was calculated as weight in kilograms divided by height in meters squared. According to the consensus guidelines for Asian Indians, a BMI of 23 to 24.9 kg/m2 was considered overweight and a BMI of 25 kg/m2 or higher was considered obese (10). Only overweight or obese individuals were included in the study.

Vitamin-D levels were measured using the Chemiluminescence immunoassay method. Individuals with Vitamin-D levels <30 ng/mL were considered deficient (11). Individuals with and without Vitamin-D deficiency were compared. Complete haemogram was measured using the automated method with the Beckman Coulter DxH 800 USA machine. According to the World Health Organisation (WHO) criteria, females with haemoglobin levels <12 g/dL and males with haemoglobin levels <13 g/dL were considered anaemic (12).

Statistical Analysis

All quantitative variables such as age, weight, height, etc., were expressed using descriptive statistics like mean and standard deviation. All qualitative or categorical variables were analysed using frequency and percentage. Pearson’s chi-square test was used to find associations between the two groups. A p-value of <0.05 was considered significant. All statistical analyses were performed using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) software version 18.0 (IBM SPSS Statistics, Somers NY, USA).


In this study, 62 adults with a high BMI presenting to a tertiary care urban hospital for a general health check-up were included. Among them, 28 subjects (45.1%) were obese with a BMI of ≥25 kg/m2, and the remaining 34 (54.9%) were overweight (BMI 23-24.9 kg/m2). There were 22 males and 40 females with a mean age of 48.565±12.35 years (Table/Fig 1).

The average Vitamin-D levels were 23.3±14.890 ng/mL. Vitamin-D deficiency was observed in 50 (80.6%) patients. Among them, 29 (46.8%) subjects had Vitamin-D deficiency (<20 ng/mL), and 21 (33.8%) had Vitamin-D insufficiency (20-30 ng/mL) according to the Clinical Practice Guidelines of the Endocrine Society, 2011 (11). Anaemia was present in 14 (22.6%) patients.

As shown in (Table/Fig 2), the patients with Vitamin-D deficiency were analysed and there was no statistically significant difference with respect to age, gender, and dietary habits. The presence of Vitamin-D deficiency was higher in obese individuals (23, 82.1%) compared to overweight individuals (27, 79.4%), though not statistically significant. Patients with a history of hypertension were found to have a lower incidence of Vitamin-D deficiency compared to non hypertensives. However, no difference was observed in patients with or without diabetes.

Anaemia was observed in 14 (22.5%) of the apparently healthy individuals in this study, which was high for an urban setting. Overweight males were more affected, though not statistically significant. Anaemia was observed more in elderly (>60 years) overweight and obese patients, and it was statistically significant (p-value=0.039). Additionally, it was observed that anaemia was more common in diabetics (p-value=0.006) and hypertensives (p-value=0.007) (Table/Fig 3).

There was no significant association between vitamin-D deficiency and anaemia among the study participants (p-value=0.82) (Table/Fig 4).


Obesity, anaemia, and vitamin-D deficiency are important health problems. Vitamin-D deficiency and anaemia were commonly observed in individuals with high BMI; however, there was no statistically significant difference between the overweight and obese groups.

In this study, vitamin-D deficiency was observed in 50 (80.6%) of apparently healthy South Indian urban patients with overweight and obesity. This could be due to sedentary and indoor jobs, leading to reduced exposure to sunlight among urban populations. According to a recent review, hospital-based studies in different parts of India and different population subsets showed a prevalence of vitamin-D deficiency ranging from 37-99% (13).

The mean level of 25 (OH) Vitamin-D was 23.357±14.890 ng/mL, which was much lower than the normal range (11). This finding was similar to another study by Parikh SJ et al., where the average 25 (OH)Vitamin-D levels in obese healthy subjects were 23.5±12.2 ng/mL, significantly lower (p-value<0.0001) than the non obese group (31±14.4 ng/mL) (2). In another study conducted on overweight and obese Bangladeshi adults, the mean serum 25 (OH)D level was 25.25±11.97 ng/mL (3).

Among those with vitamin-D deficiency, 46.8% had severe deficiency (<20 ng/mL), and 33.8% had insufficiency (20-30 ng/mL), which was slightly higher than that observed in a similar study by Paul AK et al., (3). Many observational studies and meta-analyses have found an inverse relationship between vitamin-D levels and BMI (2),(4). Various mechanisms have been described in the literature to explain this relationship, including volumetric dilution, sequestration of vitamin-D in adipose tissue, reduced hepatic metabolism due to fatty liver, or reduced sunlight exposure due to a sedentary lifestyle (5),(14). Whether vitamin-D deficiency is a cause or effect of obesity is still not clearly understood (14). In the present study, vitamin-D deficiency was more prevalent in obese individuals compared to overweight individuals; however, this difference was not statistically significant.

There was no statistically significant difference with respect to gender or age between the two groups. These findings were consistent with other similar studies (2),(15). A study by Poudel N et al., showed a higher incidence of vitamin-D deficiency in individuals aged over 60 years and in females (16). There was no significant difference in vitamin-D levels among the subjects with or without diabetes. This finding contrasts with another study by Hussain Gilani SY et al., where they concluded that obesity and diabetes were inversely related to vitamin-D levels (17). A pure vegetarian diet is deficient in vitamin-D and vitamin B12. Hence, the effect of diet on the presence of vitamin-D deficiency and anaemia was considered and studied. However, it was not found to be significant. The presence of diabetes or the type of diet did not significantly affect vitamin-D levels. However, it was observed that vitamin-D deficiency was more prevalent in non hypertensive individuals 30 (90.9%) compared to patients with hypertension 20 (69%). The reason could be that patients with hypertension were more conscious and made changes in their diet and lifestyle.

Anaemia was observed in 14 (22.5%) of the apparently healthy individuals in present study, which was high for an urban setting. This could be due to unhealthy eating habits leading to obesity as well as nutritional deficiencies. In a cross-sectional study by Arshad M et al., the prevalence of anaemia was 9.8% among morbidly obese individuals (18). In another study by Kannan U and Achuthan A, it was observed that overweight/obesity and increased waist circumference were inversely associated with anaemia (7). In the present study, overweight males were more affected, though not statistically significant. This finding was comparable to other similar studies (7). However, some studies have shown that obese individuals are less likely to be anaemic (8). Anaemia was observed more frequently in elderly patients aged >60 years. This could be due to other factors causing anaemia, which were not further investigated in the study. Anaemia was also significantly more prevalent in individuals with diabetes and hypertensive individuals. This could be explained by the fact that obesity, being a proinflammatory state, is a risk factor for both diabetes and hypertension.


The present study had a few limitations. A control group was not included. The results cannot be generalised as it was a single-centre study. Further investigations to evaluate the cause of anaemia were not conducted in this study. Larger randomised studies in the future may help establish the association of obesity with micronutrient deficiencies like vitamin-D, vitamin B12, and iron.


This study sheds light on the fact that vitamin-D deficiency and anaemia are common health problems in overweight and obese individuals. The presence of vitamin-D deficiency (80.6%) and anaemia (22.5%) was quite high in this study, which included healthy subjects with high BMI. Anaemia was more prevalent in the elderly with hypertension or diabetes. Hence, screening obese individuals in the community for anaemia and vitamin-D deficiency may help in early diagnosis and management. Obesity, being a modifiable risk factor, can be treated early to prevent many complications. Regardless of vitamin-D estimation, supplementation of vitamin-D may be beneficial in this subset of the population, especially in resource-limited settings.


Misra A, Shrivastava U. Obesity and dyslipidemia in South Asians. Nutrients. 2013;5(7):2708-33. Available from: [crossref][PubMed]
Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, et al. The relationship between obesity and serum 1,25-dihydroxy vitamin-D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89(3):1196-99. Available from: [crossref][PubMed]
Paul AK, Kamrul-Hasan ABM, Chanda PK, Nandi DC. Vitamin-D status of overweight and obese Bangladeshi adults. J Family Med Prim Care. 2020;9(7):3444-49. Available from: [crossref][PubMed]
Karampela I, Sakelliou A, Vallianou N, Christodoulatos GS, Magkos F, Dalamaga M. Vitamin-D and Obesity: Current evidence and controversies. Curr Obes Rep. 2021;10(2):162-80. Doi: 10.1007/s13679-021-00433-1. [crossref][PubMed]
Bennour I, Haroun N, Sicard F, Mounien L, Landrier J-F. Vitamin-D and obesity/adiposity-A brief overview of recent studies. Nutrients. 2022;14(10):2049. Available from: [crossref][PubMed]
Purdy JC, Shatzel JJ. The hematologic consequences of obesity. Eur J Haematol [Internet]. 2021;106(3):306-19. Available from: [crossref][PubMed]
Kannan U, Achuthan A. Correlation of haemoglobin concentration with body mass index among medical students. Indian J Clin Anat Physiol. 2017;4(2):227-30.
Qin Y, Melse-Boonstra A, Pan X, Yuan B, Dai Y, Zhao J, et al. Anaemia in relation to body mass index and waist circumference among Chinese women. Nutr J. 2013;12(1):10. Available from: [crossref][PubMed]
Jeong J, Cho Y, Cho IY, Ahn J. Association between obesity and anaemia in a nationally representative sample of South Korean adolescents: A cross-sectional study. Healthcare (Basel). 2022;10(6):1055. Doi: 10.3390/healthcare10061055. [crossref][PubMed]
Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163-70.
Holick MF, Binkley NC, Bischoff Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of Vitamin-D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911 30. [crossref][PubMed]
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. WHO/NMH/NHD/MNM/11.1. Geneva: World Health Organization; 2011 ( [Date of accessed Sep 5, 2023].
Gupta S, Aparna P, Muthathal S, Nongkynrih B. Vitamin-D deficiency in India. J Family Med Prim Care. 2018;7(2):324-330. Available from: [crossref][PubMed]
Vranic´ L, Mikolaševic´ I, Milic´ S. Vitamin-D deficiency: Consequence or cause of obesity? Medicina (Kaunas). 2019;55(9):541. Available from: [crossref][PubMed]
Dog? an Y, Kara M, Culha MA, Özçakar L, Kaymak B. The relationship between vitamin-D deficiency, body composition, and physical/cognitive functions. Arch Osteoporos. 2022;17(1):66. Available from: [crossref][PubMed]
Poudel N, Dhakal SS, Sukhupayo R, Karki DB. Vitamin-D deficiency among patients visiting a tertiary care hospital: A descriptive cross-sectional study. A JNMA J Nepal Med Assoc. 2020;58(231): 839-42. vailable from:[crossref][PubMed]
Hussain Gilani SY, Bibi S, Siddiqui A, Ali Shah SR, Akram F, Rehman MU. Obesity and diabetes as determinants of vitamin-D deficiency. J Ayub Med Coll Abbottabad. 2019;31(3):432-35.
Arshad M, Jaberian S, Pazouki A, Riazi S, Rangraz MA, Mokhber S. Iron deficiency anaemia and megaloblastic anaemia in obese patients. Rom J Intern Med [Internet]. 2017;55(1):03-07. Available from:[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/63830.18692

Date of Submission: Feb 28, 2023
Date of Peer Review: May 15, 2023
Date of Acceptance: Sep 28, 2023
Date of Publishing: Nov 01, 2023

• Financial or Other Competing Interests: (Funded by Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India.)
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Mar 04, 2023
• Manual Googling: Jun 16, 2023
• iThenticate Software: Sep 25, 2023 (8%)

ETYMOLOGY: Author Origin


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