Can vitamin D level influence the academic performance of medical students?

Anitha Oommen; Wala Ibrahim Alzahrani

doi:10.4103/jnsm.jnsm_156_21

REVIEW ARTICLE

Year : 2022 | Volume : 5 | Issue : 4 | Page : 319-321

Can vitamin D level influence the academic performance of medical students?

Anitha Oommen¹, Wala Ibrahim Alzahrani²
¹ Department of Anatomy, College of Medicine, Northern Border University, Arar, Saudi Arabia
² Department of Clinical Nutrition, College of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia

Date of Submission	16-Dec-2021
Date of Decision	12-Jul-2022
Date of Acceptance	11-Sep-2022
Date of Web Publication	12-Oct-2022

Correspondence Address:
Anitha Oommen
Northern Border University, Arar
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnsm.jnsm_156_21

Abstract

Vitamin D deficiency is common in many Western countries and also in Saudi Arabia. The cognitive effect of Vitamin D has been a subject of debate over the years. Studies in elderly people who had low levels of Vitamin D showed a cognitive decline over 6 years. Even though there is awareness about Vitamin D deficiency among medical students, only few of them are serious about taking care of it. Medical students are known to have excessive stress, which can affect their cognitive function. Researchers have reported that Vitamin D administration has improved cognitive function in the elderly. Sixty articles were collected from PubMed, Google Scholar, Directory of Open Access, and Research Gate relating to Vitamin D, of which 30 relevant articles were chosen to study the possible role of Vitamin D in neuroprotection and cognitive function.

Keywords: Academic performance, cognitive function, Vitamin D deficiency

How to cite this article:
Oommen A, Alzahrani WI. Can vitamin D level influence the academic performance of medical students?. J Nat Sci Med 2022;5:319-21

How to cite this URL:
Oommen A, Alzahrani WI. Can vitamin D level influence the academic performance of medical students?. J Nat Sci Med [serial online] 2022 [cited 2023 Mar 23];5:319-21. Available from: https://www.jnsmonline.org/text.asp?2022/5/4/319/358407

Introduction

The academic performance of students is dependent on their lifestyle, nutrition, psychological factors, self-esteem, and health awareness.^[1],[2] The role of Vitamin D in human health and disease cannot be overemphasized as Vitamin D deficiency can cause rickets in children and osteomalacia in adolescents and adults. Researchers have reported a high prevalence of Vitamin D deficiency among young people in Saudi Arabia.^[3],[4] Experimental studies in animal models have demonstrated the neuroprotective and immunomodulatory effects of Vitamin D.^[5] Studies have shown that Vitamin D levels and also Vitamin B levels can have beneficial effects on cognitive functions in the elderly^[6],[7],[8]

Methods

Sixty articles relating to Vitamin D were collected from PubMed, Google Scholar, Directory of Open Access, and ResearchGate. Articles which were not related to the cognitive effects of Vitamin D and the effects of Vitamin D on brain development were excluded from the study. Thirty relevant articles, which showed a correlation between Vitamin D level and brain development as well as the influence of Vitamin D level on the development of neurodegenerative diseases were chosen for this review. The hypothesis that Vitamin D helps in cognitive function, thereby improving academic performance, is examined in detail in this study.

Discussion

A systematic review which examined the association between Vitamin D level and cognitive performance showed inconclusive results. The researchers suggested that it could have been due to the types of cognitive tasks used in the studies.^[9] The need to standardize the methods which are used to evaluate Vitamin D status and the neuropsychiatric assessment of participants to study the relationship between Vitamin D deficiency, and its effects on cognitive functions, is highlighted by researchers.^[10] Even though there is strong evidence that Vitamin D is involved in brain development and brain functions, it is difficult to demonstrate the cognitive or behavioral effects of low levels of Vitamin D.^[11]

Studies conducted on medical students have shown that the level of stress is more in female students when compared to males.^[12] The increased stress can reduce academic ability, and grade point averages.^[13] A study done on older adults showed that Vitamin D deficiency was associated with low mood and some level of cognitive impairment.^[14] Animal experiment studies have concluded that Vitamin D deficiency can alter brain development which can affect synaptic function in the adult brain.^[15] According to researchers, Vitamin D acts by changing gene expression through Vitamin D response elements.^[16]

Vitamin D and Brain Development

Vitamin D is important in the early years of brain development.^[17] Schwarzenberg et al. were the first researchers who reported the accumulation of Vitamin D in the posterior pituitary, brain, and spinal cord. This led to the investigation of a neural role for Vitamin D, and several animal studies have highlighted the biological activity of Vitamin D within the central nervous system. In schizophrenia, the hippocampus shows changes and it is suggested that an interplay of genetic and environmental factors during brain development negatively affects brain development. Low levels of Vitamin D during the development of the brain have been postulated as a causative factor for schizophrenia and it is used as a developmental model in schizophrenia research.^[18] Vitamin D receptors start functioning from the 12^th day of gestation, which coincides with the development of dopamine neurons. Dopamine is a neurotransmitter that is affected in mental disorders such as schizophrenia and depression. Vitamin D also modulates nerve growth factors which are essential for the growth of cholinergic forebrain neurons.^[19] Experimental studies have shown that Vitamin D helps in neuronal differentiation and reduces apoptosis in the hippocampus, which is involved in language and memory.^[20],[21]

Vitamin D Deficiency and Parkinson's Disease

Studies have shown that Vitamin D is associated with verbal fluency and verbal memory in Parkinson's disease.^[22] Some researchers have reported a higher prevalence of Vitamin D deficiency and insufficiency in Parkinson's disease.^[23] One alpha-hydroxylase is the enzyme that converts Vitamin D to its active form and it is expressed in the substantia nigra of the midbrain. It was suggested that Vitamin D can cause dysfunction or cell death in substantia nigra.^[24]

Vitamin D Deficiency and Depression

Depression is defined as a mood disorder that causes a persistent feeling of sadness and loss of interest. The underlying cause of depression remains unknown, and it is likely that several different mechanisms are involved. A systematic review of observational studies and randomized control trials showed that low Vitamin D level is associated with depression, and they highlighted the need for randomized controlled trials of Vitamin D to find out whether this association is causal.^[25] A group of researchers who did research on health science university students in Saudi Arabia reported a significant relationship between Vitamin D deficiency and depression.^[26]

Vitamin D Deficiency and Fatigue

Fatigue is defined as extreme tiredness resulting from mental or physical exertion or illness. It has been reported that Vitamin D deficiency is associated with fatigue, headache, and musculoskeletal pain and weakness. In a double-blind randomized placebo-controlled trial, the researchers found that administration of a single dose of oral 100,000 IU of Vitamin D3 is a cost-effective treatment strategy for healthy adults who report fatigue. Vitamin D increases mitochondrial oxidative phosphorylation in the muscle of individuals with low Vitamin D levels, thereby leading to a decrease in fatigue.^[27]

Vitamin D and Alzheimer's Disease

Alzheimer's disease (AD) is a neurodegenerative disease characterized by loss of memory and cognitive function. Studies have shown that patients with AD have Vitamin D deficiency. Genetic studies have shown the protein link between Vitamin D and AD. Vitamin D is used for AD due to its receptor in the central nervous system.^[28]

Since medical students have a better knowledge regarding nutrients and their effect on health, they are expected to be role models of healthy eating patterns. However, the stress of medical studies can have a negative impact on their dietary patterns.^[29] Poor dietary habits can result in anemia, reduced physical ability, and decreased immune response, which in turn can lead to fatigue, lethargy, and a decrease in cognitive function.^[30] Considering the role of Vitamin D in brain development and brain function and its use in the treatment of fatigue and neurodegenerative diseases like AD, there is a possibility that treating Vitamin D deficiency in medical students may improve their cognitive function, which in turn leads to better academic performance.

Conclusion

From the available literature, it is evident that Vitamin D helps in neuronal differentiation and reduces apoptosis in the hippocampus, which in turn helps in language development and memory. According to some researchers, the administration of Vitamin D has helped in improving neurodegenerative diseases such as Parkinson's disease and AD. Since medical students have a lot of stress and fatigue due to their academic workload, it is important to monitor their Vitamin D levels so that their cognitive function can be improved, which in turn can help in their academic performance.

Strengths of the study

Although Vitamin D deficiency is a major health problem in many Western countries as well as in the Middle East, its impact on cognitive function in university students has not been looked into. Hence, we have made an attempt to highlight its importance.

Limitations of the study

There is a paucity of literature regarding the correlation between Vitamin D deficiency and the academic performance of medical students.

Recommendation

The authors would like to recommend in-depth prospective studies to find out the cognitive effects of Vitamin D.

Acknowledgment

The authors are grateful for the grant awarded by Northern Border University for the ongoing research undertaken by the authors entitled “Role of Vitamin D in the Academic Performance of Female Medical Students and Applied Medical Sciences Students in Saudi Arabia” with decision no (12/42/H), which has led to writing this review article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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