Is Vitamin D Deficiency the Invisible Part of the Iceberg in Preschool Children?
Is Vitamin D Deficiency the Invisible Part of the Iceberg in Preschool Children?
Introduction: Vitamin D deficiency continues to be a serious public health problem in all age groups in Turkey. The aim of this prospective study was to evaluate the vitamin D status in preschool children after the initiation of support programs and to determine risk factors for vitamin D deficiency. Materials and Methods: The study included 135 preschool children, >24 months to <84 months of age, who presented to the pediatric clinic between January and September 2018. The demographics, risk factors, diet, and daily vitamin D intake were recorded. Serum levels of 25(OH)D, calcium, phosphorus, and alkaline phosphatase were measured. Serum 25(OH)D levels were evaluated in relation to several risk factors including age, gender, body mass index, number of siblings, socioeconomic status, education level of the family, vitamin D intake during pregnancy and infancy, daily sunlight exposure, and season of presentation. Results: The mean 25(OH)D level was 19.6±8.5 ng/mL. According to the vitamin D levels, more than half of the children had vitamin D deficiency (n=31, 23%) or insufficiency (n=42, 31.1%). Significantly lower 25(OH)D levels were found in children with low socioeconomic status (p=0.01), a low maternal education level (p=0.02), low regular vitamin D intake during infancy (p=0.04), less daily sunlight exposure (p=0.03), and in those who presented in winter (p=0.01). Laboratory parameters did not differ significantly across the vitamin D deficient, insufficient, and sufficient groups. Conclusion: Despite the current preventive strategies and supplementation programs, vitamin D deficiency continues to be an important problem not only for risk groups but also for preschool children.
___
- 1. Holick MF, Chen TC. Vitamin D deficiency: a worldwide
problem with health consequences. Am J Clin Nutr 2008;87:
1080-6
- 2.Palacios C, Gonzales L. Is vitamin D deficiency a major global
public health problem? J Steroid Biochem Mol Biol 2014;144:
138-45
- 3.Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M.
Vitamin D deficiency in children and its management: Review
of current knowledge and recommendations. Pediatrics 2008;
122:398-417
- 4.Liang Ke, Mason RS, Kariuki M, Mpofu E, E Brock K. Vitamin D
status and hypertension: a review. Integrated Blood Pressure
Control 2015;8:13-35
- 5.Schlög M, Holick MF. Vitamin D and neurocognitive function.
Clinical Interventions in Aging 2014; 9:559-68
- 6.Aranow C. Vitamin D and the Immune System. J Investig Med
2011;59:881-6
- 7.Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D:An Evidence-Based Review. J Am Board Fam Med 2009;
22:698-706
- 8.Hatun S, Ozkan B, Bereket A. Vitamin D deficiency and
prevention: Turkish experience. Acta Paediatr 2011; 100:1195-9
- 9.Ozdemir AA, Ercan Gündemir Y, Küçük M, Yıldıran Sarıcı D,
Elgörmüş Y, Cag Y, et al. Vitamin D Deficiency in Pregnant
Women and Their Infants. J Clin Res Pediatr Endocrinol
2018;10:44-50
- 10.Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006;95:194-8
- 11.Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono
K, et al. Global Consensus Recommendations on Prevention
and Management of Nutritional Rickets. J Clin Endocrinol
Metab 2016; 101:394-415
- 12.Mansbach JM, Ginde AA, Camargo Jr CA. Serum 25-
Hydroxyvitamin D Levels Among US Children Aged 1to 11
Years: Do Children Need More Vitamin D? Pediatrics
2009;124:1404-10
- 13.Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, Perez-Rossello J, et al. Prevalence of Vitamin D Deficiency
Among Healthy Infants and Toddlers. Arch Pediatr Adolesc
Med 2008; 162:505-12
- 14.Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I,
Chiappini E, et al. Vitamin D in pediatric age: consensus of the
Italian Pediatric Society and the Italian Society of Preventive
and Social Pediatrics, jointly with the Italian Federation of
Pediatricians. Ital J Pediatr 2018;44:51
- 15.Zhao X, Xiao J, Liao X, Cai L, Xu F, Chen D, et al. Vitamin D
Status among Young Children Aged 1-3 Years: A Cross-
Sectional Study in Wuxi, China. PLoS One 2015; 10 (10):
e0141595
- 16.Surve S, Chauhan S, Amdekar Y, Joshi B. Vitamin D deficiency in Children: An update on its Prevalence, Therapeutics and Knowledge gaps. Indian J Nutri 2017;4:167
- 17.Hatun S, Islam O, Cizmecioglu F, Kara B, Babaoğlu K, Berk F,
et al. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr 2005;135:218-22
- 18.Olmez D, Bober E, Buyukgebiz A, Cimrin D. The frequency of
vitamin D insufficiency in healthy female adolescents. Acta
Paediatr 2006;95:1266-9
- 19.Arıca V, Arıca S, Gücük S, Edirne T. Level of serum 25-OHD in healthy children aged 0-36 months in Van. Turk Arch Ped
2010; 45:286-90
- 20. Andıran N, Çelik N, Akça H, Doğan G. Vitamin D deficiency in
children and adolescents. J Clin Res Pediatr Endocrinol 2012;
4(1):25-9
- 21. Doğan N, Aydoğdu Çolak A, Güden N, Üstüner F. Vitamin D
deficiency in children in Aegean region in Turkey. Cumhuriyet
Medical Journal 2015;37(1):17-22
- 22. Demiral Başar M, Sırmagül SB. Endokrin Polikliniğine Başvuran Çocuklarda D Vitamini Düzeyleri. J Curr Pediatr 2016;14:60-6
- 23. Karagüzel G, Dilber B, Çan G, Ökten A, Değer O, Holick MF.
Seasonal vitamin D status of healthy schoolchildren and
predictors of low vitamin D status. J Pediatr Gastroenterol Nutr
2014;58:654-60
- 24.Erol M, Yiğit Ö, Küçük SH, Bostan Gayret Ö. Vitamin D
Deficiency in Children and Adolescents in Bağcılar, İstanbul. J
Clin Res Pediatr Endocrinol 2015;7:134-9
- 25.Vandevijvere S, Amsalkhir S, Van Oyen H, Moreno-Reyes R.
High prevalence of vitamin D deficiency in pregnant women:
a national cross-sectional survey. PLoS One 2012; 7(8): e43868
- 26.El Koumi MA, Ali YF, Abd El Rahman RN. Impact of maternal
vitamin D status during pregnancy on the prevalence of
neonatal vitamin D deficiency. Turk J Pediatr 2013;55:371-7
- 27.Andiran N, Yordam N, Ozön A. Risk factors for vitamin D
deficiency in breast-fed newborns and their mothers.
Nutrition 2002;18:47-50