Research Article
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Bir halk sağlığı sorunu: çocuk sağlığı izleminde D vitamini

Year 2021, Volume: 14 Issue: 1, 63 - 70, 04.01.2021
https://doi.org/10.31362/patd.753792

Abstract

Amaç: D vitamini güneş ışığı altında deride sentezlenen bir hormondur. Eksikliği ve yetersizliği çocukları etkileyen evrensel bir sorundur. Sağlıklı büyüme ve gelişme için gereklidir. Birçok sistemi etkileyen düzenleyici rolü vardır. Eksiklik eşik değerinin belirlenmesinde parathormon ile olan ilişkisi önemlidir. Bu yazıda amaç, ülkemiz için yakın geçmişte belirlenen eşik değerler göz önüne alınarak hastanemize başvuran çocuklardaki D vitamini eksikliği sıklığının belirlenmesidir.
Yöntem: Çalışmaya katılan ve bilinen kronik sağlık sorunu olmayan çocuklara ait kayıtlar hastane bilgi sistemi üzerinden retrospektif olarak tarandı. Yaş, cinsiyet, parathormon (PTH), kalsiyum (Ca), fosfor (P), alkalen fosfataz (ALP), 25(OH)D düzeyleri kayıt altına alındı. Yaş grupları, cinsiyet, mevsimler dikkate alınarak istatistik paket programıyla analiz edilip sunuldu.
Bulgular: Çalışmaya yaşları 1-17 arasında değişen 229’u (%45,6) erkek, 273’ü (%54,4) kız, 502 sağlıklı çocuk katıldı. Uzman kuruluşlarının önerileri dikkate alındığında D vitamini eksikliği (25 (OH)D <12 ng/ml) oranı %26,7(n=134) idi. Katılımcıların %47,2’sinde “yeterlilik” söz konusu idi.
Sonuç: İlimiz Kuzey Yarımküre’nin ılıman iklim kuşağında yer almasına rağmen hastanemize başvuran sağlıklı çocuk nüfusun %50’sinden fazlasında D vitamini eksikliği veya yetersizliği mevcuttur. Güneş maruziyetinin arttırılması, destek tedavilerinin uygulanması ile bu sorunun çözülmesinde gereklidir. Yaşamın ilk bir yılında uygulanan ve aile sağlığı merkezleri tarafından yürütülen D vitamini destek programı bu yaş grubunda başarılı sonuçlar sağlamıştır. Benzer bir uygulamanın diğer yaş grupları için de yararlı olacağı düşünülmektedir.

ABSTRACT
Objective: Vitamin D is a hormone, synthesized in the skin under the direct sunlight. Deficiency of vitamin D is a significant global problem in children. It is necessary for well growing up and development. It acts as a regulator in many systems. Its relationship with parathormone is important to detect the cut off value of deficiency. The aim of this article is to determine the prevalence of vitamin D deficiency in children in our province by considering the recently established threshold values for our country.
Methods: The records of children who were known to have no chronic disease, were retrospectively reviewed through the hospital information system. Age, sex, parathormone (PTH), calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), 25(OH)D levels were recorded. The data were analyzed and presented with statistical package program considering age, gender and seasons.
Results: Five hundred and two children aged 1 to 17 years enrolled in the study. Considering recommendations of authorities, the rate of vitamin D deficiency was 26.7% (n = 134). Sufficiency was detected in the 47.2% of the participants.
Conclusion: Although our city is located in the temperate zone of the Northern Hemisphere, more than 50% of the study population had vitamin D deficiency or insufficiency. Supplementation treatments and increasing sun exposure are necessary to solve this problem. The vitamin supplementation in the first year of life, has provided successful outcomes in this age group. A similar practice is thought to be beneficial for other age groups.
Key Words: Child health; Vitamin D; Deficiency; Insufficiency

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

References

  • KAYNAKLAR 1. Antonucci R, Locci C, Clemente MG, Chicconi E, Antonucci L. Vitamin D deficiency in childhood: old lessons and current challenges. J Pediatr Endocrinol Metab 2018;31:247-260 doi: 10.1515/jpem-2017-0391. 2. Holick M, Mclaughin JA, Doppelt SH. Science 1981;211:590-593. 3. Bikle DD. Vitamin D: an ancient Hormone. Exp Dermatol 2011;20:7-13. doi: 10.1111/j.1600-0625.2010.01202.x. 4. Atapattu N, Shaw N, Hogler W. Relationship between serum 25- hydroxyvitamin D and parathyroid hormone in the search for a biochemical definition of vitamin D deficiency in children. Pediatr Res 2013;74:552-556 doi: 10.1038/pr.2013.139. 5. Şahin Ö N, Serdar M, Serteser M, Ünsal İ, Özpınar A. Vitamin D levels and parathyroid hormone variations of children living in a subtropical climate: a data mining study. Ital J Pediatr 2018;44:40 doi:10.1186/s13052-018-0479-8 6. Hatun S, Bereket A, Ozkan B, Coşkun T, Köse R, Çalıkoğlu AS. Free vitamin D supplementation for every infant in Turkey. Arch Dis Child 2007;92:373-374. doi: 10.1136/adc.2006.113829. 7. Reeve LE, Chesney RW, DeLuca HF. Vitamin D of human milk identification of biologically active form. Am J Clin Nutr 1982;36:122-126. doi: 10.1093/ajcn/36.1.122. 8. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398-417. doi: 10.1542/peds.2007-1894. 9. Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab 2016;101:394-415. 10. T.C. Sağlık Bakanlığı, Halk Sağlığı Müdürlüğü . Çocuklarda D Vitamini Kullanımı Önergesi. erişim: at: https://hsgm.saglik.gov.tr/tr/cocukergen-yayınlar. erişim tarihi: 10 Ekim 2019 11. Kang JI, Lee YS, Han YJ, Kong KA, Kim HS. The serum level of 25-hydroxyvitamin D for maximal suppression of parathyroid hormone in children: the relationship between 25- hydroxyvitamin D and parathyroid hormone. Korean J Pediatr 2017;60:45-49. doi: 10.3345/kjp.2017.60.2.45 12. Hill KM, McCabe GP, McCabe LD, Gordon CM, Abrams SA, Weawer CM. An inflection point of serum 25-hydroxyvitamin D for maximal suppression of parathyroid hormone is not evident from multi-site pooled data in children and adolescents. J Nutr 2010;140:1983-1988. doi: 10.3945/jn.110.124966. 13. T.C. Meteoroloji Genel Müdürlüğü. Hava durumu raporları [Meteoroloji Genel Müdürlüğü internet sitesi] Erişim: https://www.mgm.gov.tr/veridegerlendirme/il-ve-ilceler-istatistik.aspx?m=AMASYA Erişim tarihi: 23 Eylül 2019 14. T.C. Amasya Valiliği. Coğrafi konum. [Amasya Valiliği internet sitesi].Available at http://www.amasya.gov.tr/cografi-konum. Erişim tarihi: Eylül 2019 15. Tarhan S, Sarı A. Model selection for global and diffuse radiation over the Central Black Sea (CBS) region of Turkey. Energy Conversion and Management 2005;46:605-613 16. Janssen MJ, Wielders JP, Bekker CC, Boesten LSM, Buijs MM , Heijboer AC, van der Horst FAL, Loupatty FJ, van den Ouweland JMW. Multicenter comparison study of current methods to measure 25-hydroxyvitamin D in serum. Steroids. 2012;77:1366-1372 doi: 10.1016/j.steroids.2012.07.013. 17. Akman AO, Tümer L, Hasanoğlu A, İlhan M, Çaycı B. Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int. 2011;53: 968-973. 10.1111/j.1442-200X.2011.03486.x 18. Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol. 20017;103:620-625. 10.1016/j.jsbmb.2006.12.076 19. Kroll MH, Bi C, Garber CC,et al. Temporal Relationship between Vitamin D Status and Parathyroid Hormone in the United States. PLoS ONE, 2015; 10: e0118108. doi:10.1371/journal. pone.0118108 20. Holick MF. The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Aspects Med 2008; 29:361-8 doi: 10.1016/j.mam.2008.08.008. 21. Sankar J, Ismail J, Das R, Dev N, Chitkara A, Sankar MJ. Effect of Severe Vitamin D Deficiency at Admission on Shock Reversal in Children With Septic Shock: A Prospective Observational Study. J Intensive Care Med. 2019;34:397-403 doi: 10.1177/0885066617699802. 22. Seo JH, Chung HJ, Kim HJ, et al. Increasing vitamin D deficiency in children from 1995 to 2011.Turk J Pediatr. 2016;58:616-622. doi: 10.24953/turkjped.2016.06.007. 23. Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary reference intakes for calcium and vitamin D.Washington, DC: National Academies Press. 2011. 24. Saggese G, Vierucci F, Boot AM, et al. Vitamin D in childhood and adolescence: an expert position statement. Eur J Pediatr.2015;174:565-576. doi: 10.1007/s00431-015-2524-6. 25. Steingri msdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G, Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake, JAMA 2005;294:2336-2341. doi: 10.1001/jama.294.18.2336. 26. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 1995;61:638S–645S doi: 10.1093/ajcn/61.3.638S.

A public health problem: vitamin D status in child health follow up

Year 2021, Volume: 14 Issue: 1, 63 - 70, 04.01.2021
https://doi.org/10.31362/patd.753792

Abstract

Project Number

Yok

References

  • KAYNAKLAR 1. Antonucci R, Locci C, Clemente MG, Chicconi E, Antonucci L. Vitamin D deficiency in childhood: old lessons and current challenges. J Pediatr Endocrinol Metab 2018;31:247-260 doi: 10.1515/jpem-2017-0391. 2. Holick M, Mclaughin JA, Doppelt SH. Science 1981;211:590-593. 3. Bikle DD. Vitamin D: an ancient Hormone. Exp Dermatol 2011;20:7-13. doi: 10.1111/j.1600-0625.2010.01202.x. 4. Atapattu N, Shaw N, Hogler W. Relationship between serum 25- hydroxyvitamin D and parathyroid hormone in the search for a biochemical definition of vitamin D deficiency in children. Pediatr Res 2013;74:552-556 doi: 10.1038/pr.2013.139. 5. Şahin Ö N, Serdar M, Serteser M, Ünsal İ, Özpınar A. Vitamin D levels and parathyroid hormone variations of children living in a subtropical climate: a data mining study. Ital J Pediatr 2018;44:40 doi:10.1186/s13052-018-0479-8 6. Hatun S, Bereket A, Ozkan B, Coşkun T, Köse R, Çalıkoğlu AS. Free vitamin D supplementation for every infant in Turkey. Arch Dis Child 2007;92:373-374. doi: 10.1136/adc.2006.113829. 7. Reeve LE, Chesney RW, DeLuca HF. Vitamin D of human milk identification of biologically active form. Am J Clin Nutr 1982;36:122-126. doi: 10.1093/ajcn/36.1.122. 8. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398-417. doi: 10.1542/peds.2007-1894. 9. Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab 2016;101:394-415. 10. T.C. Sağlık Bakanlığı, Halk Sağlığı Müdürlüğü . Çocuklarda D Vitamini Kullanımı Önergesi. erişim: at: https://hsgm.saglik.gov.tr/tr/cocukergen-yayınlar. erişim tarihi: 10 Ekim 2019 11. Kang JI, Lee YS, Han YJ, Kong KA, Kim HS. The serum level of 25-hydroxyvitamin D for maximal suppression of parathyroid hormone in children: the relationship between 25- hydroxyvitamin D and parathyroid hormone. Korean J Pediatr 2017;60:45-49. doi: 10.3345/kjp.2017.60.2.45 12. Hill KM, McCabe GP, McCabe LD, Gordon CM, Abrams SA, Weawer CM. An inflection point of serum 25-hydroxyvitamin D for maximal suppression of parathyroid hormone is not evident from multi-site pooled data in children and adolescents. J Nutr 2010;140:1983-1988. doi: 10.3945/jn.110.124966. 13. T.C. Meteoroloji Genel Müdürlüğü. Hava durumu raporları [Meteoroloji Genel Müdürlüğü internet sitesi] Erişim: https://www.mgm.gov.tr/veridegerlendirme/il-ve-ilceler-istatistik.aspx?m=AMASYA Erişim tarihi: 23 Eylül 2019 14. T.C. Amasya Valiliği. Coğrafi konum. [Amasya Valiliği internet sitesi].Available at http://www.amasya.gov.tr/cografi-konum. Erişim tarihi: Eylül 2019 15. Tarhan S, Sarı A. Model selection for global and diffuse radiation over the Central Black Sea (CBS) region of Turkey. Energy Conversion and Management 2005;46:605-613 16. Janssen MJ, Wielders JP, Bekker CC, Boesten LSM, Buijs MM , Heijboer AC, van der Horst FAL, Loupatty FJ, van den Ouweland JMW. Multicenter comparison study of current methods to measure 25-hydroxyvitamin D in serum. Steroids. 2012;77:1366-1372 doi: 10.1016/j.steroids.2012.07.013. 17. Akman AO, Tümer L, Hasanoğlu A, İlhan M, Çaycı B. Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int. 2011;53: 968-973. 10.1111/j.1442-200X.2011.03486.x 18. Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol. 20017;103:620-625. 10.1016/j.jsbmb.2006.12.076 19. Kroll MH, Bi C, Garber CC,et al. Temporal Relationship between Vitamin D Status and Parathyroid Hormone in the United States. PLoS ONE, 2015; 10: e0118108. doi:10.1371/journal. pone.0118108 20. Holick MF. The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Aspects Med 2008; 29:361-8 doi: 10.1016/j.mam.2008.08.008. 21. Sankar J, Ismail J, Das R, Dev N, Chitkara A, Sankar MJ. Effect of Severe Vitamin D Deficiency at Admission on Shock Reversal in Children With Septic Shock: A Prospective Observational Study. J Intensive Care Med. 2019;34:397-403 doi: 10.1177/0885066617699802. 22. Seo JH, Chung HJ, Kim HJ, et al. Increasing vitamin D deficiency in children from 1995 to 2011.Turk J Pediatr. 2016;58:616-622. doi: 10.24953/turkjped.2016.06.007. 23. Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary reference intakes for calcium and vitamin D.Washington, DC: National Academies Press. 2011. 24. Saggese G, Vierucci F, Boot AM, et al. Vitamin D in childhood and adolescence: an expert position statement. Eur J Pediatr.2015;174:565-576. doi: 10.1007/s00431-015-2524-6. 25. Steingri msdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G, Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake, JAMA 2005;294:2336-2341. doi: 10.1001/jama.294.18.2336. 26. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 1995;61:638S–645S doi: 10.1093/ajcn/61.3.638S.
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Details

Primary Language Turkish
Subjects Paediatrics
Journal Section Research Article
Authors

Gökçe Celep 0000-0001-6250-5096

Zeynep Durmaz 0000-0002-3260-0030

Project Number Yok
Publication Date January 4, 2021
Submission Date June 16, 2020
Acceptance Date August 28, 2020
Published in Issue Year 2021 Volume: 14 Issue: 1

Cite

AMA Celep G, Durmaz Z. Bir halk sağlığı sorunu: çocuk sağlığı izleminde D vitamini. Pam Med J. January 2021;14(1):63-70. doi:10.31362/patd.753792

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