Is Vitamin D Deficiency the Invisible Part of the Iceberg in Preschool Children?

Year 2021, Volume: 7 Issue: 2, 124 - 130, 25.06.2020

Abdurrahman Ozdemir Aydın Varol Yakup Çağ Emine Dilek

Abstract

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.

Keywords

Vitamin D, children, preschool

References

• 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