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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
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.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
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
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effect of Routine Vitamin D Supplementation on the Physical Growth of Exclusively Breastfed Infants at Six Months of Age: An Observational Study
Correspondence Address :
Ved Pratap Tiwari,
D701, Marvel Isola, Pune-411060, Maharashtra, India.
E-mail: vpt5411@gmail.com
Introduction: Vitamin D is essential for bone mineral metabolism and for the growth and development of the skeleton. The American Academy of Paediatrics and the Indian Academy of Paediatrics recommend the administration of 400 IU per day of oral Vitamin D to all infants in the first year of life. The authors hypothesised that routine supplementation of 400 IU of Vitamin D to exclusively breastfed infants would result in better physical growth.
Aim: To examine the effect of routine vitamin D supplementation (400 IU/day) on the weight, length, and head circumference of term, exclusively breastfed infants at six months of age.
Materials and Methods: An observational study was conducted at Department of Paediatrics, Smt. Kashibai Navale Medical College, Pune, Maharashtra, India, from November 2018 to March 2020, comparing the weight, length, and head circumference at birth and at six months of age for 111 exclusively breastfed term, appropriate for gestational age, healthy infants who were not supplemented with oral Vitamin D (Group-I) with 111 infants who were supplemented with 400 IU of oral Vitamin D daily (Group-II). Infants who presented at the Paediatric Out-Patient Department of SKNMC, Pune at around six months of age were enrolled in the study. Birth data and anthropometry at birth were recorded from available medical records. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Quantitative data were presented with the mean and standard deviation. Comparison among the study groups was done using an unpaired t-test as per the results of the normality test. Association among the study groups was assessed with the help of a Student’s t-test. A p-value of <0.001 was considered statistically significant.
Results: The mean birth weight, length, and head circumference of infants who were not supplemented with vitamin D (Group-I) were 2907.57±250.18 gm, 53.34±1.47 cm, 35.99±1.067 cm, respectively, and those who were supplemented (Group-II) were 2901.08±231.63 gm, 53.75±1.51 cm, and 35.85±1.09 cm, which were comparable in both groups. At six months, the mean weight, length, and head circumference in Group-I and Group-II were 7211.08±626.39 gm, 70.25±1.58 cm, 43.82±1.19 cm, and 7973.87±532.31 gm, 70.90±1.75 cm, and 45.01±1.34 cm, respectively. There was an increase in anthropometric parameters in both groups. The increase was greater in Group-II than in Group-I and was statistically significant (p<0.001).
Conclusion: Infants supplemented with vitamin D (400 IU/day) demonstrated better physical growth in terms of higher anthropometric values.
Growth parameters, Infant growth, Newborn, Sunshine vitamin
Despite India being a tropical country, there are numerous reports suggesting a high prevalence of Vitamin D Deficiency, especially in pregnant women and infants (1),(2),(3). Infants born to Vitamin D-deficient mothers have been shown to have low birth weight and significantly lower growth in the first year of life (4),(5). It is well known that Vitamin D deficiency leads to stunting and growth failure, but whether supplementation of Vitamin D improves physical growth is controversial (6),(7).
Vitamin D is critical for bone mineral metabolism and the growth and development of the skeleton (8),(9). Infancy is the most rapid period of skeletal growth and mineral accumulation, so the growth changes can be better appreciated. The American Academy of Paediatrics since 2008 and the Indian Academy of Paediatrics since 2017 have recommended routine administration of 400 IU per day of oral Vitamin D to all breastfed infants from the first few days of life until the end of the first year (10),(11). This recommendation was purely based on the high prevalence of Vitamin D deficiency and the higher incidence of rickets in infants.
Vitamin D affects growth by promoting adequate bone mineralisation and macronutrient metabolism through the regulation of the cell cycle and cell proliferation (12). Few studies have reported better physical growth with Vitamin D supplementation in children with vitamin D deficiency, but weather routine supplementation has the same effect is not known (13),(14).
The present study only included term, appropriate for gestational age, exclusively breastfed infants, thus making it a more homogeneous cohort. Physical growth during infancy depends on intrauterine nutrition and postnatal nutrition. By including only term and appropriate for gestational age infants, the effect of intrauterine nutritional factors affecting growth was minimised.
The aim of the present study was to determine the effect of routine oral Vitamin D supplementation of 400 IU/day on physical growth, specifically weight, height, and head circumference of exclusively breastfed term infants.
An observational study was conducted at Department of Paediatrics, Smt. Kashibai Navale Medical College, Pune, Maharashtra, India from November 2018 to March 2020 after obtaining ethical clearance from the Institutional Ethical Clearance Committee (IEC No.-Institutional Ethical committee letter No- SKNMC/Ethics/app/2018/53 dated 5th October 2018) to compare growth parameters (weight, length, and head circumference) of exclusively breastfed, term, healthy infants who were not supplemented with routine oral Vitamin D (Group-I) with exclusively breastfed, term, healthy infants who were being supplemented with 400 IU of oral Vitamin D daily (Group-II). Informed written consent from parents for their infants to participate in the study was obtained after providing them with detailed information.
Sample size calculation: It was performed using online software (Epitools). For the calculation, the study’s power (1-beta) was set at 95%, and the confidence level was taken as 0.95. The assumed baseline of sufficient Vitamin D levels in the control group was 5% (as multiple studies have reported vitamin D deficiency in neonates from 90-96%); and the odds ratio was taken as 5 [15-17]. A total of 222 subjects (111 in each group) were included in the study.
Inclusion criteria: All exclusively breastfed, Infants who were born term and appropriate for gestational age and who did not receive oral supplementation for more than seven days in the last six months were included in Group-I. Term-born infants (born on or after 37 completed weeks) and appropriate for gestational age (Birth weight ≥2.5 kg) at around six months of age (5 months and 20 days to 6 months and 10 days) who were started on oral vitamin D supplementation in the first week of life and continued it (without a break for more than three days at a stretch) were included in the case group of the study (Group-II).
Exclusion criteria: Infants who were on exclusively formula feed or mixed (breastfeed and formula) feed, infants with significant perinatal history, infants with a history of hospitalisation for more than three days, or who had signs of rickets were excluded from the study.
Study Procedure
Infants who reported to the well-baby clinic or the OPD of study Institute of SKNMC, Pune at around six months of age were enrolled in the study. Birth data and anthropometry at birth were recorded from available medical records (Neonatal Discharge card, Immunisation card, or any other available medical record). Weight was measured to the nearest 10 grams using a calibrated electronic weighing machine (TM-5S Digital Baby Weighing Scale from Techocare). Length was measured to the nearest 0.5 cm using an infantometer (Acromedicare), and head circumference was measured to the nearest 0.5 cm by a non expansible measuring tape.
Statistical Analysis
Quantitative data were presented using the mean and Standard Deviation (SD). Comparison among the study groups was performed using an unpaired t-test based on the results of the normality test. Association among the study groups was assessed using a Student’s t-test, with a p-value of <0.001 being considered statistically significant.
Both groups were comparable in terms of variables such as maternal age, gestational age, number of pregnancies, and interpregnancy intervals (Table/Fig 1). There were 73 male infants and 38 female infants in Group-I, compared to 67 male infants and 44 female infants in Group-II (Table/Fig 2).
The mean birth weight of infants who were not supplemented with vitamin D (Group-I) was 2907.57±250.18 grams, and those who were subsequently supplemented (Group-II) was 2901.08±231.63 grams, which was comparable in both groups (p=0.841). At six months, the mean weight in Group-I and Group-II was 7211.08±626.39 grams and 7973.87±532.31 grams, respectively, and the difference was statistically significant (p<0.001**).
The mean head circumference of infants who were not supplemented with Vitamin D (Group-I) was 35.99±1.067 cm, and those who were subsequently supplemented (Group-II) was 35.85±1.09 cm, which was comparable in both groups (p=0.325). At six months, the mean head circumference in Group-I and Group-II was 43.82±1.19 cm and 45.01±1.34 cm, respectively, and the difference was statistically significant (p<0.001**).
The mean length of infants who were not supplemented with Vitamin D (Group-I) was 53.34±1.47 cm, and those who were subsequently supplemented was 53.75±1.51 cm, which was comparable in both groups (p=0.469). At six months, the mean length in Group-I and Group-II was 70.25±1.58 cm and 70.90±1.75 cm, respectively, and the difference was statistically significant (p=0.004*) (Table/Fig 3).
There was an increase in anthropometric parameters in both groups. The increase was greater in Group-II than in Group-I. The mean increase in weight was 4303.51±385.51 grams in Group-I compared to 5072.79±393.55 grams in Group-II. The mean increase in length was 16.92±1.14 cm and 17.69±1.49 cm, respectively, in Group-I and Group-II. The mean increase in head circumference from birth was 7.83±0.76 cm in Group-I and 9.16±0.92 cm in Group-II (Table/Fig 4).
Vitamin D is an essential nutrient that plays a major role in skeletal health and bone mineralisation (18). In addition to its role in bone health, Vitamin D appears to influence the hepatic secretion of Insulin-like Growth Factor-1 (IGF-1) and Insulin-like Growth Factor-Binding Protein-3 (IGFBP-3) and the expression of IGF-1 receptors in various tissues (19),(20). Thus, an optimal level of vitamin D can promote good health and better physical growth (21).
In a prospective randomised trial, Lin CH et al., found that infants who were supplemented with oral Vitamin D of 400 IU/day had a significantly larger weight and head circumference at four months of age than the placebo group (p=0.014 and 0.020, respectively); however, there was no significant difference in body length at four months of age (p=0.653) (22).
In a randomised control trial by Ganmaa D et al., on Vitamin D supplementation and growth in urban Mongol school children between 12-15 years of age, it was found that those who were supplemented with 800 IU/day of vitamin D had 0.9 (±0.3 SE) cm greater increases in height compared to placebo-treated children. However, there was no significant difference in weight and body mass index (23).
A recent Cochrane systematic review on the effects of oral vitamin D supplementation on linear growth of children under the age of five years concluded that compared to placebo or no intervention, vitamin D supplementation (200 to 2000 IU daily; or up to 300,000 IU bolus at enrollment) may result in little or no difference in linear growth (length/height in cm) among children less than five years of age {Mean Difference (MD) 0.66, 95% Confidence Interval (CI) -0.37 to 1.68} (24).
Mugunthan S et al., in their prospective randomised controlled trial to observe the effect of vitamin D supplementation in vitamin D deficient children between 2 to 5 years of age, found that those supplemented with 400 IU/day of vitamin D and calcium for nine months had a better weight and height standard compared to those who were given only calcium. The mean weight standard deviation in the group supplemented with vitamin D and calcium increased from 0.39±0.02 to 1.54±0.02 kg, compared to 0.42±0.01 to 0.84±0.01 kg in the group that received only calcium. Similarly, the mean height standard deviation in the group supplemented with Vitamin D and calcium increased from 0.37±0.03 to 0.72±0.01 cm, compared to 0.03±0.02 to 0.37±0.07 cm in the group supplemented with only calcium. The increase was statistically significant in the group that received vitamin D and calcium both (p<0.01) (25).
Trilok-Kumar G et al., in their randomised controlled trial on the effects of vitamin D supplementation in infancy on growth, bone parameters, body composition, and gross motor development at age 3-6 years in low birthweight infants, reported an increase in weight, length, and mid-arm circumference at six months in those who were supplemented with Vitamin D. However, these increases in parameters were no longer evident at 3-6 years. The likely explanation given by them is varying beneficial and adverse situations in the intervening years of the children’s lives, resulting in a wash-out of differences between the groups. Furthermore, at later ages, a greater sample size is required than at earlier ages for evaluating identical differences in observed anthropometric units because anthropometric changes are less apparent at later ages (26).
Thamke R et al., in their randomised controlled trial on the effect of Vitamin D supplementation on anthropometric measures in exclusively breastfed infants, found better anthropometric parameters in those who were supplemented with routine vitamin D compared to placebo. A significant increase in weight and length was noted at 2.5, 3.5, 6, and 9 months in infants, who were supplemented with routine oral vitamin D (27).
Limitation(s)
The present study did not consider maternal nutritional status, serum Vitamin D levels, and diet during pregnancy and lactation, which can directly affect the physical growth of infants. Additionally, sun exposure in infants was not taken into account in the present study.
Infants who were supplemented with vitamin D (400 IU/day) showed better physical growth, as evidenced by higher anthropometric values. Physical growth during infancy depends on intrauterine nutrition and postnatal nutrition. Thus, an optimal level of vitamin D can promote good health and better physical growth.
DOI: 10.7860/JCDR/2024/67392.18961
Date of Submission: Sep 15, 2023
Date of Peer Review: Oct 31, 2023
Date of Acceptance: Dec 18, 2023
Date of Publishing: Jan 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• 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 CHECKING METHODS:
• Plagiarism X-checker: Sep 15, 2023
• Manual Googling: Dec 02, 2023
• iThenticate Software: Dec 15, 2023 (17%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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