Abstract
Background: The data on the prevalence of vitamin D deficiency (VDD) in apparently healthy children from India is limited.
Objective: To assess the prevalence of VDD in apparently healthy children.
Design: Prospective study.
Setting and subjects: Apparently healthy children from the age groups of 3 months–12 years, from the upper socioeconomical status (USES), attending the outpatient department (OPD) of a private pediatric hospital in Chandigarh, India, for minor ailments were enrolled over a period of 6 months (March–August 2013).
Methods: Plasma levels of 25-hydroxyvitamin D [25(OH)D] were measured by competitive electrochemiluminescence immunoassay.
Results: In total, 338 children (188 boys, 150 girls) with mean age of 3.31 years were enrolled. The percentages of children with deficient, insufficient, and sufficient levels of 25(OH)D were 40.24%, 25.44%, and 34.32%, respectively. Clinical signs of VDD were seen in only 8.53% of the children. The mean (±SD) levels of 25(OH)D were 27.48 (15.99) ng/mL. On univariate analysis, deficient levels of 25(OH)D were associated with relatively younger age group, female sex, failure to thrive, exclusive breastfeeding, inadequate sun exposure, and no vitamin D supplements.
Conclusion: A high prevalence of clinical and biochemical VDD was noted in apparently healthy children belonging to the USES.
References
1. Rathi N, Rathi A. Vitamin D and child health in the 21st century. Indian Pediatr 2011;48:619–25.10.1007/s13312-011-0107-9Search in Google Scholar PubMed
2. Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, et al. Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008;168:1340–9.10.1001/archinte.168.12.1340Search in Google Scholar PubMed
3. Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, et al. Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol 2010;126:52–8, e5.10.1016/j.jaci.2010.03.043Search in Google Scholar PubMed PubMed Central
4. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266–81.10.1056/NEJMra070553Search in Google Scholar PubMed
5. McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, et al. Vitamin D deficiency in young children with severe acute lower respiratory infection. Pediatr Pulmonol 2009;44:981–8.10.1002/ppul.21089Search in Google Scholar PubMed
6. Ginde AA, Camargo CA Jr., Shapiro NI. Vitamin D insufficiency and sepsis severity in emergency department patients with suspected infection. Acad Emerg Med 2011;18:551–4.10.1111/j.1553-2712.2011.01047.xSearch in Google Scholar PubMed
7. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 2004;158:531–7.10.1001/archpedi.158.6.531Search in Google Scholar PubMed
8. Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, et al. Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med 2008;162:505–12.10.1001/archpedi.162.6.505Search in Google Scholar PubMed PubMed Central
9. Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, et al. Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013;56:692–701.10.1097/MPG.0b013e31828f3c05Search in Google Scholar PubMed
10. Marwaha RK, Tandon N, Reddy DR, Aggarwal R, Singh R, et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 2005;82:477–82.10.1093/ajcn/82.2.477Search in Google Scholar
11. Tiwari L, Puliyel JM. Vitamin D level in slum children of Delhi. Indian Pediatr 2004;41:1076–7.Search in Google Scholar
12. Puri S, Marwaha RK, Agarwal N, Tandon N, Agarwal R, 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;99:876–82.10.1017/S0007114507831758Search in Google Scholar PubMed
13. Habibesadat S, Ali K, Shabnam JM, Arash A. Prevalence of vitamin D deficiency and its related factors in children and adolescents living in North Khorasan, Iran. J Pediatr Endocrinol Metab 2014;27:431–6.10.1515/jpem-2013-0198Search in Google Scholar PubMed
14. Bairwa M, Rajput M, Sachdeva S. Modified Kuppuswamy’s socioeconomic scale: social researcher should include updated income criteria, 2012. Indian J Community Med 2013;38:185–6.10.4103/0970-0218.116358Search in Google Scholar PubMed PubMed Central
15. Kumar N, Gupta N, Kishore J. Kuppuswamy’s socioeconomic scale: updating income ranges for the year 2012. Indian J Public Health 2012;56:103–4.10.4103/0019-557X.96988Search in Google Scholar PubMed
16. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, et al. Estimates of optimal vitamin D status. Osteoporos Int 2005;16:713–6.10.1007/s00198-005-1867-7Search in Google Scholar PubMed
17. Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr 2005;135:317–22.10.1093/jn/135.2.317Search in Google Scholar PubMed
18. Gannage-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;15:1856–62.10.1359/jbmr.2000.15.9.1856Search in Google Scholar PubMed
19. Fuleihan GE, Deeb M. Hypovitaminosis D in a sunny country. N Engl J Med 1999;340:1840–1.10.1056/NEJM199906103402316Search in Google Scholar PubMed
20. Saintonge S, Bang H, Gerber LM. Implications of a new definition of vitamin D deficiency in a multiracial us adolescent population: the National Health and Nutrition Examination Survey III. Pediatrics 2009;123:797–803.10.1542/peds.2008-1195Search in Google Scholar PubMed
21. Mansbach JM, Ginde AA, Camargo CA Jr. Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics 2009;124:1404–10.10.1542/peds.2008-2041Search in Google Scholar PubMed PubMed Central
22. Gessner BD, Plotnik J, Muth PT. 25-hydroxyvitamin D levels among healthy children in Alaska. J Pediatr 2003;143:434–7.10.1067/S0022-3476(03)00410-4Search in Google Scholar
23. Flores M, Macias N, Lozada A, Sanchez LM, Diaz E, et al. Serum 25-hydroxyvitamin D levels among Mexican children ages 2 y to 12 y: a national survey. Nutrition 2013;29:802–4.10.1016/j.nut.2012.12.024Search in Google Scholar PubMed
24. Laillou A, Wieringa F, Tran TN, Van PT, Le BM, et al. Hypovitaminosis D and mild hypocalcaemia are highly prevalent among young vietnamese children and women and related to low dietary intake. PLoS One 2013;8:e63979.10.1371/journal.pone.0063979Search in Google Scholar PubMed PubMed Central
25. Vatanparast H, Nisbet C, Gushulak B. Vitamin D insufficiency and bone mineral status in a population of newcomer children in Canada. Nutrients 2013;5:1561–72.10.3390/nu5051561Search in Google Scholar PubMed PubMed Central
26. Jin HJ, Lee JH, Kim MK. The prevalence of vitamin D deficiency in iron-deficient and normal children under the age of 24 months. Blood Res 2013;48:40–5.10.5045/br.2013.48.1.40Search in Google Scholar PubMed PubMed Central
27. Wagner CL, Greer FR. 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
28. Millen AE, Bodnar LM. Vitamin D assessment in population-based studies: a review of the issues. Am J Clin Nutr 2008;87:1102S–5S.10.1093/ajcn/87.4.1102SSearch in Google Scholar PubMed
29. Ward LM, Gaboury I, Ladhani M, Zlotkin S. Vitamin D-deficiency rickets among children in Canada. CMAJ 2007;177:161–6.10.1503/cmaj.061377Search in Google Scholar PubMed PubMed Central
30. Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 2004;58:563–7.10.1038/sj.ejcn.1601845Search in Google Scholar PubMed
31. Hollis BW, Roos BA, Draper HH, Lambert PW. Vitamin D and its metabolites in human and bovine milk. J Nutr 1981;111: 1240–8.10.1093/jn/111.7.1240Search in Google Scholar PubMed
32. Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol 2010;6:550–61.10.1038/nrendo.2010.146Search in Google Scholar PubMed
33. Jain V, Gupta N, Kalaivani M, Jain A, Sinha A, et al. Vitamin D deficiency in healthy breastfed term infants at 3 months and their mothers in India: seasonal variation and determinants. Indian J Med Res 2011;133:267–73.Search in Google Scholar
©2014 by De Gruyter
Articles in the same Issue
- Frontmatter
- Highlight: Cushing syndrome
- Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
- Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
- Cushing’s disease presenting as cholestatic hepatitis
- How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
- Review article
- Subclinical hypothyroidism in childhood and adolescense
- Original articles
- Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
- Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
- Measures of pituitary gland and stalk: from neonate to adolescence
- Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
- Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
- Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
- A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
- Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
- Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
- Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
- Long-term outcomes of pediatric Graves’ disease
- Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
- Vitamin D, parathormone, and insulin resistance in children born large for gestational age
- Prevalence of vitamin D deficiency in apparently healthy children in north India
- Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
- Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
- Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
- Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
- Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
- Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
- The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
- The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
- Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
- Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
- Patient reports
- Hereditary vitamin D rickets: a case series in a family
- Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
- Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
- Acquired hypothyroidism due to iodine deficiency in an American child
- Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
- Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
- Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
- Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
- Short communications
- Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
- Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
- Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
- Letter to the Editor
- And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?
Articles in the same Issue
- Frontmatter
- Highlight: Cushing syndrome
- Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
- Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
- Cushing’s disease presenting as cholestatic hepatitis
- How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
- Review article
- Subclinical hypothyroidism in childhood and adolescense
- Original articles
- Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
- Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
- Measures of pituitary gland and stalk: from neonate to adolescence
- Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
- Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
- Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
- A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
- Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
- Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
- Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
- Long-term outcomes of pediatric Graves’ disease
- Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
- Vitamin D, parathormone, and insulin resistance in children born large for gestational age
- Prevalence of vitamin D deficiency in apparently healthy children in north India
- Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
- Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
- Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
- Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
- Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
- Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
- The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
- The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
- Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
- Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
- Patient reports
- Hereditary vitamin D rickets: a case series in a family
- Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
- Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
- Acquired hypothyroidism due to iodine deficiency in an American child
- Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
- Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
- Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
- Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
- Short communications
- Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
- Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
- Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
- Letter to the Editor
- And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?