Pediatr Gastroenterol Hepatol Nutr.  2013 Dec;16(4):254-260.

Subclinical Vitamin D Insufficiency in Korean School-aged Children

• Han SW
• Kang HR
• Kim HG
• Kim JH
• Uhm JH
• Seo JY

Abstract

PURPOSE
Recently, vitamin D insufficiency has increased and has been correlated to growth and puberty in children. This study was conducted to find the prevalence of subclinical vitamin D insufficiency and its influence on school-aged children in Korea.
METHODS
The subjects of this study were 397 children aged 7 to 15 years who had been tested for 25-OH vitamin D3 among the outpatients of the Department of Pediatrics in Eulji General Hospital from March 2007 to February 2011. Data for age, sex, comorbidities, serum 25-OH vitamin D3, height, weight, body mass index (BMI), and sunlight exposure time were collected before and after 3 months of vitamin D administration, retrospectively.
RESULTS
Vitamin D insufficiency was present in 343 (86%) of the subjects. In the vitamin D insufficient group, chronological age was 8.96+/-1.72 years, mean height (z-score [z]) was 0.51+/-1.26, mean BMI (z) was 0.81+/-2.20, and bone age was 10.26+/-1.75 years. In the vitamin D sufficient group, chronological age was 9.61+/-1.77 years, mean height (z) was-0.66+/-0.98, mean BMI (z) was-0.01+/-1.16, and bone age was 9.44+/-2.12 years. A paired t-test showed that three months after vitamin D administration, the mean 25-OH vitamin D3 level in the insufficient group increased to 24.38 +/-10.03 ng/mL and mean BMI (z) decreased to 0.67+/-1.06.
CONCLUSION
In Korean school-aged children, vitamin D insufficiency were relatively higher and may be closely related with higher BMI. Insufficient rise of the level of vitamin D after supplementation suggest the new supplementation guidelines, especially for Korean children.

Keyword

Vitamin D; 25 Hydroxy vitamin D3; Vitamin D insufficiency; Child; Body mass index

MeSH Terms

Adolescent
Body Mass Index
Body Weight
Child*
Cholecalciferol
Comorbidity
Hospitals, General
Humans
Korea
Outpatients
Pediatrics
Prevalence
Puberty
Retrospective Studies
Sunlight
Vitamin D*
Vitamins*
Cholecalciferol
Vitamin D
Vitamins

Figure

• 

  Fig. 1 The level of 25-OH vitamin D3 according to the age.

• 

  Fig. 2 Comparison of the characteristics before and after vitamin D administration.

Reference

1. Holick MF. Vitamin D: a millenium perspective. J Cell Biochem. 2003; 88:296–307.

2. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006; 81:353–373.

3. Kang B, Jung SY, Kim SK, Lee JE, Son BK, Kwon YS. Clinical features of seizures related to rickets in breastfed children. J Korean Child Neurol Soc. 2012; 20:179–187.

4. Cho HM, Choi CS, Sun GK, Kim EY, Kim KS, Kim YW. Two cases of rickets that developed as a result of by diet restriction due to atopic dermatitis. Korean J Pediatr Gastroenterol Nutr. 2006; 9:284–290.

5. Huh SY, Gordon CM. Vitamin D deficiency in children and adolescents: epidemiology, impact and treatment. Rev Endocr Metab Disord. 2008; 9:161–170.

6. Hatun S, Islam O, Cizmecioglu F, Kara B, Babaoglu K, Berk F, et al. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr. 2005; 135:218–222.

7. Rovner AJ, O'Brien KO. Hypovitaminosis D among healthy children in the United States: a review of the current evidence. Arch Pediatr Adolesc Med. 2008; 162:513–519.

8. Goldner WS, Stoner JA, Thompson J, Taylor K, Larson L, Erickson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obes Surg. 2008; 18:145–150.

9. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006; 84:18–28.

10. Yoon JH, Park CS, Seo JY, Choi YS, Ahn YM. Clinical characteristics and prevalence of vitamin D insufficiency in children less than two years of age. Korean J Pediatr. 2011; 54:298–303.

11. Kim MJ, Na B, No SJ, Han HS, Jeong EH, Lee W, et al. Nutritional status of vitamin D and the effect of vitamin D supplementation in Korean breast-fed infants. J Korean Med Sci. 2010; 25:83–89.

12. Yang HR, Seo JW, Kim YJ, Kim JY, Ryoo E, Sim JG, et al. Recent concepts on vitamin D in children and adolescents. Korean J Pediatr. 2009; 52:1082–1089.

13. Shin YH, Kim KE, Lee C, Shin HJ, Kang MS, Lee HR, et al. High prevalence of vitamin D insufficiency or deficiency in young adolescents in Korea. Eur J Pediatr. 2012; 171:1475–1480.

14. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004; 158:531–537.

15. Abrams SA. Dietary guidelines for calcium and vitamin D: a new era. Pediatrics. 2011; 127:566–568.

16. Neyestani TR, Hajifaraji M, Omidvar N, Eshraghian MR, Shariatzadeh N, Kalayi A, et al. High prevalence of vitamin D deficiency in school-age children in Tehran, 2008: a red alert. Public Health Nutr. 2012; 15:324–330.

17. 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; 86:150–158.

18. Hickey L, Gordon CM. Vitamin D deficiency: new perspectives on an old disease. Curr Opin Endocrinol Diabetes. 2004; 11:18–25.

19. Lips P, Duong T, Oleksik A, Black D, Cummings S, Cox D, et al. A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab. 2001; 86:1212–1221.

20. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011; 96:643–651.

21. Villamor E, Marin C, Mora-Plazas M, Baylin A. Vitamin D deficiency and age at menarche: a prospective study. Am J Clin Nutr. 2011; 94:1020–1025.

22. Kremer R, Campbell PP, Reinhardt T, Gilsanz V. Vitamin D status and its relationship to body fat, final height, and peak bone mass in young women. J Clin Endocrinol Metab. 2009; 94:67–73.

23. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000; 72:690–693.

24. 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.

25. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96:1911–1930.

26. Harkness LS, Cromer BA. Vitamin D deficiency in adolescent females. J Adolesc Health. 2005; 37:75.

27. Vashi PG, Lammersfeld CA, Braun DP, Gupta D. Serum 25-hydroxyvitamin D is inversely associated with body mass index in cancer. Nutr J. 2011; 10:51.

28. Viljakainen HT, Natri AM, Kärkkäinen M, Huttunen MM, Palssa A, Jakobsen J, et al. A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res. 2006; 21:836–844.

29. 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. 1678S–1688S.