FREQUENCY OF VITAMIN D DEFICIENCY IN CHILDREN: A SINGLE-CENTER CROSS-SECTIONAL STUDY IN ISTANBUL

Öz

Aim: Vitamin D deficiency is highly prevalent among children worldwide. This study aims to assess the frequency of vitamin D deficiency in children and how it varies according to gender, age, and season in Istanbul. Materials and methods: The study included 3096 children aged 0-18 admitted to the pediatric outpatient clinic in Istanbul. The serum 25 hydroxyvitamin D concentration was categorized into four groups: deficiency (<20 ng/mL), insufficiency (20–30 ng/mL), sufficiency (30-100 ng/mL), and toxicity (>100 ng/mL). Descriptive methods, Chi-square, Independent Samples T-Test, ANOVA, and correlation test were used in the statistical analysis of the data. Results: Of children, 52% were girls and 48% boys. The mean serum 25 hydroxyvitamin D concentration was 21.8 ± 15.8 ng/mL, and the frequency of vitamin D deficiency was 53.1%. There was a different distribution of vitamin D status between age groups. Vitamin D deficiency was more common in older children. There was also a significant difference between girls and boys in the frequency of vitamin D deficiency (57.6% versus 48.3%). The mean serum 25 hydroxyvitamin D concentration was significantly lower in winter and spring. A moderate negative correlation was found between age and serum 25 hydroxyvitamin D concentration (correlation coefficient:-0.36). Conclusion: This study showed that female sex, older children, and the winter/spring seasons were significantly associated with a higher frequency of vitamin D deficiency and a lower mean serum 25 hydroxyvitamin D concentration.

Anahtar Kelimeler

• Vitamin D deficiency
• children
• outpatient clinic
• frequency

Kaynakça

1. 1. Holick MF. Medical progress: Vitamin D deficiency. N. Engl. J. Med. 2007;357(3):266–281.
2. 2. Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 2011;96(7):1911–1930.
3. 3. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am. J. Clin. Nutr. 2004;80(6 Suppl):1678–1688.
4. 4. Huh SY, Gordon CM. Vitamin D deficiency in children and adolescents: Epidemiology, impact and treatment. Rev. Endocr. Metab. Disord. 2008:161–70.
5. 5. Holick MF. Vitamin D: Important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South. Med. J. 2005;98(10):1024–1027.
6. 6. Sahin ON, Serdar M, Serteser M, Unsal I, Ozpinar A. Vitamin D levels and parathyroid hormone variations of children living in a subtropical climate: A data mining study. Ital. J. Pediatr. 2018;44(1):1–7.
7. 7. Coşkun C, Şahin K. Correlation between vitamin D level and platelet indices in children aged 0-18 years. Haseki Tip Bul. 2018;56(2):153–157.
8. 8. Türe E, Müderrisoğlu S, Acı R, Çubukçu M, Erdem MA. Evaluation of Vitamin D Levels in Adolescents and Children According to Age, Sex and Seasonal Charesteristics. Ankara Med. J. 2020;20(2):380–386.

9. 9. Demiral M, Sırmagül B, Kirel B. Endokrin polikliniğine başvuran çocuklarda d vitamini düzeyleri. Guncel Pediatr. 2016;14(2):60–66.
10. 10. Yetim A, Tıkız C, Baş F. Prevelance of vitamin D and B12 deficiency in adolescence. Çocuk Derg. 2017;17(1):24–29.
11. 11. Atasoy V, Ateş Altunbaş E, Set T. Evaluation of Vitamin D levels among overweight and obese children. Türkiye Aile Hekim. Derg. 2019;23(3):102–109.
12. 12. Naiboğlu E, Naiboğlu S, Turan E, Hasbal Akkuş C, Hatipoğlu S. Investigation of Vitamin B12 and Vitamin D Deficiency in Patients with Lower Respiratory Tract Infection in Child Clinic. Bakirkoy Tip Derg. / Med. J. Bakirkoy 2019;15(4):339–344.
13. 13. Doğan N, Colak AA, Güden N, Üstüner F. Vitamin D deficiency in children in Aegean Region in Turkey. Cumhur. Med. J. 2015;37(1):17–22.
14. 14. Ozhan B, Evrengul H, Yilmaz Agladioglu S, Umit Yasar S, Demir S. Vitamin D Status of Children in a University Hospital in West Turkey. Hong Kong Med. J. 2016;21:251–256.
15. 15. Bucak IH, Almis H. The Retrospective Analysis of Vitamin D Levels of Pediatric Patients in a Small City Center in Turkey. Sak. Med. J. 2016;6(3):136–140.
16. 16. Topal I, Mertoglu C, Arslan YK et al. Erzincan Bölgesindeki Çocukların D Vitamini Seviyelerinin Yaş, Cinsiyet ve Mevsimlere Göre Değerlendirilmesi. Firat Med J 2018;23(4):168–172.
17. 17. Acik S, Yakinci MC. Vitamin D Levels of Pediatric Intensive Care Patients. Konuralp Tıp Derg. 2018;10(3):326–332.
18. 18. Moore CE, Liu Y. Low serum 25-hydroxyvitamin D concentrations are associated with total adiposity of children in the United States: National Health and Examination Survey 2005 to 2006. Nutr. Res. 2016;36(1):72–79.
19. 19. Yang C, Mao M, Ping L, Yu D. Prevalence of vitamin D deficiency and insufficiency among 460,537 children in 825 hospitals from 18 provinces in mainland China. Medicine (Baltimore). 2020;99(44). doi:10.1097/MD.0000000000022463.
20. 20. Isa H, Almaliki M, Alsabea A, Mohamed A. Vitamin D deficiency in healthy children in Bahrain: Do gender and age matter? East. Mediterr. Heal. J. 2020;26(3):260–267.
21. 21. Beer RJ, Herrán OF, Villamor E. Prevalence and correlates of vitamin D deficiency in a tropical setting: results from a nationally representative survey. Am. J. Clin. Nutr. 2020;112(4):1088–1098.
22. 22. Kanike N, Hospattankar KG, Sharma A, Worley S, Groh-Wargo S. Prevalence of Vitamin D Deficiency in a Large Newborn Cohort from Northern United States and Effect of Intrauterine Drug Exposure. Nutrients 2020;12(7):1–9.
23. 23. Lee JM, Smith JR, Philipp BL et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin. Pediatr. (Phila). 2007;46(1):42–44.
24. 24. Merewood A, Mehta SD, Grossman X et al. Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers. Pediatrics 2010;125(4):640–647.
25. 25. Halicioglu O, Aksit S, Koc F et al. Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey. Paediatr. Perinat. Epidemiol. 2012;26(1):53–60.
26. 26. Chen Z, Lv X, Hu W et al. Vitamin D Status and Its Influence on the Health of Preschool Children in Hangzhou. Front. public Heal. 2021;9. doi:10.3389/FPUBH.2021.675403.
27. 27. Al-Sadat N, Majid HA, Sim PY et al. Vitamin D deficiency in Malaysian adolescents aged 13 years: findings from the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). BMJ Open 2016;6(8). doi:10.1136/BMJOPEN-2015-010689.
28. 28. Khor GL, Chee WSS, Shariff ZM et al. High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia. BMC Public Health 2011;11(95):1–8.
29. 29. Shaikh AMA, Abaalkhail B, Soliman A et al. Prevalence of vitamin d deficiency and calcium homeostasis in saudi children. JCRPE J. Clin. Res. Pediatr. Endocrinol. 2016;8(4):461–467.
30. 30. Levis S, Gomez A, Jimenez C et al. Vitamin D deficiency and seasonal variation in an adult south Florida population. J. Clin. Endocrinol. Metab. 2005;90(3):1557–1562.
31. 31. Gannagé-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: Relation to lifestyle and bone markers. J. Bone Miner. Res. 2000;15(9):1856–1862.
32. 32. van der Mei IAF, Ponsonby AL, Engelsen O et al. The high prevalence of vitamin D insufficiency across Australian populations is only partly explained by season and latitude. Environ. Health Perspect. 2007;115(8):1132–1139.
33. 33. Mishal AA. Effects of different dress styles on vitamin D levels in healthy young Jordanian women. Osteoporos. Int. 2001;12(11):931–935.
34. 34. Zhang H qi, Teng J hua, Li Y et al. Vitamin D status and its association with adiposity and oxidative stress in schoolchildren. Nutrition 2014;30(9):1040–1044.
35. 35. Turer CB, Lin H, Flores G. Prevalence of vitamin D deficiency among overweight and obese us children. Pediatrics 2013;131(1):152–61.
36. 36. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am. J. Clin. Nutr. 2000;72(3):690–693.
37. 37. Clemens TL, Henderson SL, Adams JS, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1982;319(8263):74–76.
38. 38. Weishaar T, Vergili JM. Vitamin D Status Is a Biological Determinant of Health Disparities. J. Acad. Nutr. Diet. 2013;113(5):643–651.
39. 39. Puri S, Marwaha RK, Agarwal N et al. Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: Relation to nutrition and lifestyle. Br. J. Nutr. 2008;99(4):876–882.