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Prevalence of risk of deficiency and inadequacy of 25-hydroxyvitamin D in US children: NHANES 2003–2006

  • Vytas P. Karalius , Daniel Zinn , James Wu , Guichan Cao , Carla Minutti , Amy Luke , Holly Kramer EMAIL logo and Ramon Durazo-Arvizu
Published/Copyright: March 12, 2014
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 27 Issue 5-6

Abstract

Aim: To assess prevalence and population estimates of increased risk of 25-hydroxyvitamin D [25(OH)D] deficiency and inadequacy in US children based on the current Institute of Medicine Committee to Review Dietary References Intakes for Vitamin D and Calcium guidelines.

Methods: The analysis was limited to a nationally representative sample of non-institutionalized US children and adolescents aged 6–18 years who participated in the National Health and Nutrition Examination Survey completed in 2003–2006 and had complete data on 25(OH)D measurements (n=2877). The 25(OH)D levels were adjusted for assay drift and prevalence, and population estimates of increased risk of 25(OH)D deficiency (<12 ng/mL), risk of inadequacy (<16 ng/mL), and adequacy (>20 ng/mL) were calculated.

Results: Overall, 4.61% of children and adolescents are at increased risk of deficiency (population estimate 2.5 million) and 10.3% are at risk of inadequacy (population estimate 5.5 million) based on the Institute of Medicine guidelines.

Conclusion: Approximately 10.3% of US children aged 6–18 years (population estimate 5.5 million) have 25(OH)D levels <16 ng/mL.

Keywords: deficiency; IOM guidelines; prevalence; supplementation; vitamin D
Corresponding author: Holly Kramer, MD, MPH, Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, 2160 S First Avenue, Maywood, IL 60153, USA, Phone: +1-708-327-9039, Fax: +1-708-327-9007, E-mail:

Acknowledgments

This paper reflects the authors’ findings and conclusions and does not necessarily reflect the official opinions of Loyola University Chicago.

Conflict of interest statement

None of the authors has a financial or other relationship that might signify a conflict of interest.

References

1. Norman AW. A vitamin D nutritional cornucopia: new insights concerning the serum 25-hydroxyvitamin D stats of the US population. Am J Clin Nutr 2008;88:1455–6.10.3945/ajcn.2008.27049Search in Google Scholar

2. Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr 2008;88:491S–9S.10.1093/ajcn/88.2.491SSearch in Google Scholar

3. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M, et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398–417.10.1542/peds.2007-1894Search in Google Scholar

4. Michos ED. Vitamin D deficiency and the risk of incident type 2 diabetes. Future Cardiol 2009;5:15–8.10.2217/14796678.5.1.15Search in Google Scholar

5. Melamed ML, Astor B, Michos ED, Hostetter TH, Powe NR, et al. 25-hydroxyvitamin D levels, race, and the progression of kidney disease. J Am Soc Nephrol 2009;20:2631–9.10.1681/ASN.2009030283Search in Google Scholar

6. Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008;168:1629–37.10.1001/archinte.168.15.1629Search in Google Scholar

7. Reis AF, Hauache OM, Velho G. Vitamin D endocrine system and the genetic susceptibility to diabetes, obesity and vascular disease. A review of evidence. Diabetes Metab 2005;31:318–25.10.1016/S1262-3636(07)70200-8Search in Google Scholar

8. Ginde AA, Liu MC, Camargo CA, Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004. Arch Intern Med 2009;169:626–32.10.1001/archinternmed.2008.604Search in Google Scholar PubMed PubMed Central

9. Howe WR, Dellavalle R. Vitamin D deficiency. N Engl J Med 2007;357:1981; author reply 1981–2.10.1056/NEJMc072359Search in Google Scholar PubMed

10. Pilz S, Tomaschitz A, Ritz E, Pieber TR. Vitamin D status and arterial hypertension: a systematic review. Nat Rev Cardiol 2009;6:621–30.10.1038/nrcardio.2009.135Search in Google Scholar PubMed

11. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503–11.10.1161/CIRCULATIONAHA.107.706127Search in Google Scholar

12. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266–81.10.1056/NEJMra070553Search in Google Scholar

13. MacLean HJ, Freedman MS. Multiple sclerosis: following clues from cause to cure. Lancet Neurol 2009;8:6–8.10.1016/S1474-4422(08)70272-2Search in Google Scholar

14. Andiran N, Celik N, Akca H, Dogan G. Vitamin D deficiency in children and adolescents. J Clin Res Pediatr Endocrinol 2012;4:25–9.10.4274/jcrpe.574Search in Google Scholar PubMed PubMed Central

15. Buyukinan M, Ozen S, Kokkun S, Saz EU. The relation of vitamin D deficiency with puberty and insulin resistance in obese children and adolescents. J Pediatr Endocrinol Metab 2012;25:83–7.10.1515/jpem-2011-0426Search in Google Scholar PubMed

16. Alemzadeh R, Kichler J, Babar G, Calhoun M. Hypovitaminosis D in obese children and adolescents: Relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism 2008;57:183–91.10.1016/j.metabol.2007.08.023Search in Google Scholar PubMed

17. Martini LA, Wood RJ. Vitamin D status and the metabolic syndrome. Nutr Rev 2006;64:479–86.10.1111/j.1753-4887.2006.tb00180.xSearch in Google Scholar PubMed

18. Bischoff-Ferrari HA. Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Adv Exp Med Biol 2008; 624:55–71.10.1007/978-0-387-77574-6_5Search in Google Scholar PubMed

19. Pilz S, Dobnig H, Winklhofer-Roob B, Riedmüller G, Fischer JE, et al. Low serum levels of 25-hydroxyvitamin D predict fatal cancer in patients referred to coronary angiography. Cancer Epidemiol Biomarkers Prev 2008;17:1228–33.10.1158/1055-9965.EPI-08-0002Search in Google Scholar PubMed

20. Chen P, Hu P, Xie D, Qin Y, Wang F, et al. Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat 2010;121:469–77.10.1007/s10549-009-0593-9Search in Google Scholar PubMed

21. Stolzenberg-Solomon RZ, Jacobs EJ, Arslan AA, Qi D, Patel AV, et al. Circulating 25-hydroxyvitamin D and risk of pancreatic cancer: Cohort consortium vitamin D pooling project of rarer cancers. Am J Epidemiol 2010;172:81–93.10.1093/aje/kwq120Search in Google Scholar PubMed PubMed Central

22. Yin L, Grandi N, Raum E, Haug U, Arndt V, et al. Meta-analysis: serum vitamin D and breast cancer risk. Eur J Cancer 2010;46:2196–205.10.1016/j.ejca.2010.03.037Search in Google Scholar PubMed

23. Gahche J, Bailey R, Burt V, Hughes J, Yetley E, et al. Dietary supplement use among U.S. adults has increased since NHANES III (1988–1994). NCHS Data Brief 2011;61:1–8.Search in Google Scholar

24. Hollis BW. Measuring 25-hydroxyvitamin D in a clinical environment: challenges and needs. Am J Clin Nutr 2008;88:507S–10S.10.1093/ajcn/88.2.507SSearch in Google Scholar PubMed

25. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academies Press (US), 2011.Search in Google Scholar

26. National Center for Health Statistics. Revised analytical note for NHANES 2000–2006 and NHANES III (1988–1994) 25-hydroxyvitamin D analysis (revised November 2010). Available at: http://www.cdc.gov.archer.luhs.org/nchs/data/nhanes/nhanes3/VitaminD_analyticnote.pdf2010. Accessed August 1, 2013.Search in Google Scholar

27. Yetley EA, Pfeiffer CM, Schleicher RL, Phinney KW, Lacher DA, et al. NHANES monitoring of serum 25-hydroxyvitamin D: a roundtable summary. J Nutr 2010;140:2030S–45S.10.3945/jn.110.121483Search in Google Scholar PubMed PubMed Central

28. Curtin LR, Mohadjer LK, Dohrmann SM, Montaquila JM, Kruszon-Moran D, et al. The national health and nutrition examination survey: sample design, 1999–2006. Vital Health Stat 2012;2:1–2.Search in Google Scholar

29. Centers for Disease Control and Prevention, National Center for Health Statistics. National health and nutrition examination survey. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed 19 July, 2012.Search in Google Scholar

30. Taylor CL, Carriquiry AL, Bailey RL, Sempos CT, Yetley EA. Appropriateness of the probability approach with a nutrient status biomarker to assess population inadequacy: a study using vitamin D. Am J Clin Nutr 2013;97:72–8.10.3945/ajcn.112.046094Search in Google Scholar PubMed PubMed Central

31. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, et al. CDC growth charts: United States. Adv Data 2000;314:1–27.Search in Google Scholar

32. Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. The maternal and child health bureau, health resources and services administration and the department of health and human services. Pediatrics 1998;102:E29.10.1542/peds.102.3.e29Search in Google Scholar PubMed

33. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30.10.1210/jc.2011-0385Search in Google Scholar PubMed

34. U.S. Census Bureau. 2012. “State Characteristics: Vintage 2011.” Table for Estimates of the Resident Population by Selected Age Groups for the United States, States, and Puerto Rico: July 1, 2011. http://www.census.gov/popest/data/state/asrh/2011/index.html. Accessed August 1, 2013.Search in Google Scholar

35. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004. Pediatrics 2009;124: e362–70.10.1542/peds.2009-0051Search in Google Scholar PubMed PubMed Central

36. Weng FL, Shults J, Leonard MB, Stallings VA, Zemel BS. Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents. Am J Clin Nutr 2007;86:150–8.10.1093/ajcn/86.1.150Search in Google Scholar PubMed

37. Olson ML, Maalouf NM, Oden JD, White PC, Hutchison MR. Vitamin D deficiency in obese children and its relationship to glucose homeostasis. J Clin Endocrinol Metab 2012;97:279–85.10.1210/jc.2011-1507Search in Google Scholar PubMed PubMed Central

38. Zhu Z, Zhan J, Shao J, Chen W, Chen L, et al. High prevalence of vitamin D deficiency among children aged 1 month to 16 years in hangzhou, china. BMC Public Health 2012;12:126.10.1186/1471-2458-12-126Search in Google Scholar PubMed PubMed Central

39. Rajakumar K, Fernstrom JD, Holick MF, Janosky JE, Greenspan SL. Vitamin D status and response to vitamin D(3) in obese vs. non-obese African American children. Obesity (Silver Spring) 2008;16:90–5.10.1038/oby.2007.23Search in Google Scholar PubMed

40. Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008; 122:1142–52.10.1542/peds.2008-1862Search in Google Scholar PubMed

Received: 2013-6-14
Accepted: 2013-12-2
Published Online: 2014-3-12
Published in Print: 2014-5-1

©2014 by Walter de Gruyter Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Original articles
  3. Assessment of hearing in children with type 1 diabetes mellitus
  4. Insulin resistance and lipid profiles in HIV-infected Thai children receiving lopinavir/ritonavir-based highly active antiretroviral therapy
  5. Increased hunger and speed of eating in obese children and adolescents
  6. Glucagon and insulin cord blood levels in very preterm, late preterm and full-term infants
  7. Thyroid function in late preterm infants in relation to mode of delivery and respiratory support
  8. Prevalence of vitamin D deficiency and its related factors in children and adolescents living in North Khorasan, Iran
  9. Asymmetric dimethyl L-arginine, nitric oxide and cardiovascular disease in adolescent type 1 diabetics
  10. A combined nutritional-behavioral-physical activity intervention for the treatment of childhood obesity – a 7-year summary
  11. The effect of earlier puberty on cardiometabolic risk factors in Afro-Caribbean children
  12. Prevalence of risk of deficiency and inadequacy of 25-hydroxyvitamin D in US children: NHANES 2003–2006
  13. Serum uric acid: relationships with biomarkers in adolescents and changes over 1 year
  14. Psychological impact on parents of children with congenital adrenal hyperplasia: a study from Sri Lanka
  15. Investigation of adropin and leptin levels in pediatric obesity-related nonalcoholic fatty liver disease
  16. Diseases accompanying congenital hypothyroidism
  17. Molecular diagnosis of a Chinese pedigree with α-mannosidosis and identification of a novel missense mutation
  18. Are the characteristics of thyroid cancer different in young patients?
  19. Unsaturated fatty acids and insulin resistance in childhood obesity
  20. Effect of genetic subtypes and growth hormone treatment on bone mineral density in Prader-Willi syndrome
  21. KCNJ11 gene mutation analysis on nine Chinese patients with type 1B diabetes diagnosed before 3 years of age
  22. Prevalence and risk factors of metabolic syndrome in school adolescents of northeast China
  23. Patient reports
  24. A novel activating ABCC8 mutation underlying neonatal diabetes mellitus in an infant presenting with cerebral sinovenous thrombosis
  25. Endocrinological anomalies in a patient with 12q14 microdeletion syndrome. Completing phenotype of this exceptional short stature condition
  26. Acute mental status change as the presenting feature of adrenal insufficiency in a patient with autoimmune polyglandular syndrome type II and stroke
  27. Effect of ethosuximide on cortisol metabolism in the treatment of congenital adrenal hyperplasia
  28. Absence of WNT4 gene mutation in a patient with MURCS association
  29. Identification of a novel insulin receptor gene heterozygous mutation in a patient with type A insulin resistance syndrome
  30. Adrenal insufficiency in association with congenital nephrotic syndrome: a case report
  31. Diabetic lipemia presenting as eruptive xanthomas in a child with autoimmune polyglandular syndrome type IIIa
  32. A case report of nephrogenic diabetes insipidus with idiopathic Fanconi syndrome in a child who presented with vitamin D resistant rickets
  33. Letter to the Editor
  34. Hyperbilirubinemia in neonates of diabetic mothers: an indirect biomarker of organ damage?
https://doi.org/10.1515/jpem-2013-0246
Keywords for this article
deficiency; IOM guidelines; prevalence; supplementation; vitamin D

Articles in the same Issue

  1. Frontmatter
  2. Original articles
  3. Assessment of hearing in children with type 1 diabetes mellitus
  4. Insulin resistance and lipid profiles in HIV-infected Thai children receiving lopinavir/ritonavir-based highly active antiretroviral therapy
  5. Increased hunger and speed of eating in obese children and adolescents
  6. Glucagon and insulin cord blood levels in very preterm, late preterm and full-term infants
  7. Thyroid function in late preterm infants in relation to mode of delivery and respiratory support
  8. Prevalence of vitamin D deficiency and its related factors in children and adolescents living in North Khorasan, Iran
  9. Asymmetric dimethyl L-arginine, nitric oxide and cardiovascular disease in adolescent type 1 diabetics
  10. A combined nutritional-behavioral-physical activity intervention for the treatment of childhood obesity – a 7-year summary
  11. The effect of earlier puberty on cardiometabolic risk factors in Afro-Caribbean children
  12. Prevalence of risk of deficiency and inadequacy of 25-hydroxyvitamin D in US children: NHANES 2003–2006
  13. Serum uric acid: relationships with biomarkers in adolescents and changes over 1 year
  14. Psychological impact on parents of children with congenital adrenal hyperplasia: a study from Sri Lanka
  15. Investigation of adropin and leptin levels in pediatric obesity-related nonalcoholic fatty liver disease
  16. Diseases accompanying congenital hypothyroidism
  17. Molecular diagnosis of a Chinese pedigree with α-mannosidosis and identification of a novel missense mutation
  18. Are the characteristics of thyroid cancer different in young patients?
  19. Unsaturated fatty acids and insulin resistance in childhood obesity
  20. Effect of genetic subtypes and growth hormone treatment on bone mineral density in Prader-Willi syndrome
  21. KCNJ11 gene mutation analysis on nine Chinese patients with type 1B diabetes diagnosed before 3 years of age
  22. Prevalence and risk factors of metabolic syndrome in school adolescents of northeast China
  23. Patient reports
  24. A novel activating ABCC8 mutation underlying neonatal diabetes mellitus in an infant presenting with cerebral sinovenous thrombosis
  25. Endocrinological anomalies in a patient with 12q14 microdeletion syndrome. Completing phenotype of this exceptional short stature condition
  26. Acute mental status change as the presenting feature of adrenal insufficiency in a patient with autoimmune polyglandular syndrome type II and stroke
  27. Effect of ethosuximide on cortisol metabolism in the treatment of congenital adrenal hyperplasia
  28. Absence of WNT4 gene mutation in a patient with MURCS association
  29. Identification of a novel insulin receptor gene heterozygous mutation in a patient with type A insulin resistance syndrome
  30. Adrenal insufficiency in association with congenital nephrotic syndrome: a case report
  31. Diabetic lipemia presenting as eruptive xanthomas in a child with autoimmune polyglandular syndrome type IIIa
  32. A case report of nephrogenic diabetes insipidus with idiopathic Fanconi syndrome in a child who presented with vitamin D resistant rickets
  33. Letter to the Editor
  34. Hyperbilirubinemia in neonates of diabetic mothers: an indirect biomarker of organ damage?
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