Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey
Alkim Oden Akman,
Leyla Tumer, Alev Hasanoglu, Mustafa Ilhan, Banu Caycı,
Corresponding Author
Alkim Oden Akman
Pediatrics Department
Alkim Oden Akman, MD, Department of Pediatrics, Gazi University Hospital, Ankara, Turkey. Email: [email protected]Search for more papers by this authorBanu Caycı
Medical Biochemistry Department, Gazi University Hospital, Ankara, Turkey
Search for more papers by this authorAlkim Oden Akman,
Leyla Tumer, Alev Hasanoglu, Mustafa Ilhan, Banu Caycı,
Corresponding Author
Alkim Oden Akman
Pediatrics Department
Alkim Oden Akman, MD, Department of Pediatrics, Gazi University Hospital, Ankara, Turkey. Email: [email protected]Search for more papers by this authorBanu Caycı
Medical Biochemistry Department, Gazi University Hospital, Ankara, Turkey
Search for more papers by this authorAbstract
Background: The aim of this study was to establish the frequencies of vitamin D deficiency and insufficiency among healthy children aged 1–16 years and also to determine the factors affecting the levels of vitamin D in Turkey.
Methods: A total of 849 healthy individuals whose ages ranged from 1 to 16 years were included in the study. Serum 25(OH)D, calcium, phosphorous and alkaline phosphatase l levels were measured at the end of the winter period. The approximate daily calcium intake was calculated by using a 1-week diet history.
Results: We determined that the prevalence of vitamin D deficiency (<20 ng/mL) was 8% and that of vitamin D insufficiency (20–29 ng/mL) was 25.5% in the population investigated. The average daily intake of calcium was especially low in the >8-year-old age group (<1300 mg/day).
Conclusion: Vitamin D insufficiency was found to be very common in the population investigated. The daily calcium intake was below the adequate levels especially in school children. Vitamin D supplementation after the first year of life could be beneficial especially for school children and adolescents. The government must develop public policies for the fortification of milk, milk products, and fruit juices with vitamin D.
References
- 1 Hatun S, Ozkan B, Orbak Z et al. Vitamin D deficiency in early infancy. J. Nutr. 2005; 135: 279–82.
- 2 Gultekin A, Özalp I, Hasanoglu A, Unal A. Serum-25-hydroxycholecalciferol levels in children and adolescents. Turk. J. Pediatr. 1987; 29: 155–62.
- 3 Olmez D, Bober E, Buyukgebiz A, Cimrin D. The frequency of vitamin D insufficiency in healthy female adolescents. Acta Paediatr. 2006; 95: 1266–9.
- 4 Budak N, Cicek B, Sahin S, Tutus A. Bone mineral density and serum 25-hydroxyvitamin D level: is there any difference according to the dressing style of the female university students. Int. J. Food Sci. Nutr. 2004; 55: 569–75.
- 5 Atli T, Gullu S, Uysal AR, Erdogan G. The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population. Arch. Gerontol. Geriatr. 2005; 40(1): 53–60.
- 6 Kimball S, Fuleihan Gel H, Vieth R. Vitamin D: a growing perspective. Crit. Rev. Clin. Lab. Sci. 2008; 45: 339–414.
- 7 Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 2002; 30: 771–7.
- 8 Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am. J. Clin. Nutr. 2008; 87: 1080S–6S.
- 9 El-Hajj Fuleihan G, Vieth R. Vitamin D insufficiency and musculoskeletal health in children and adolescents. International Congress Series 1297, 2007: p. 91–10
- 10 Fischer PR, Thacher TD, Pettifor JM. Pediatric vitamin D and calcium nutrition in developing countries. Rev. Endocr. Metab. Disord. 2008; 9: 181–92.
- 11 Centers for Disease Control and Prevention. Vitamin D expert panel meeting. 2001: Atlanta, Georgia [Cited 1 November 2011]. Available from URL: http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/Vitamin_D_Expert_Panel_Meeting.pdf
- 12 Hochberg Z, Bereket A, Davenport M et al. Consensus development for the supplementation of vitamin D in childhood and adolescence. Horm. Res. 2002; 58(1): 39–51.
- 13 Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008; 122: 1142–52.
- 14 Wharton B, Bishop N. Rickets. Lancet 2003; 362(9393): 1389–400.
- 15 Greer FR, Krebs NF. Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics 2006; 117(2): 578–85.
- 16 William B, Grant MFH. Benefits and requirements of vitamin D for optimal health: a review. Altern. Med. Rev. 2005; 10: 94–111.
- 17 Davies JH, Evans BA, Gregory JW. Bone mass acquisition in healthy children. Arch. Dis. Child. 2005; 90: 373–8.
- 18 Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am. J. Clin. Nutr. 2004; 79: 362–71.
- 19 Holick MF. Vitamin D: a millennium perspective. J. Cell. Biochem. 2003; 88: 296–307.
- 20
How to define normal values for serum concentrations of 25-hydroxyvitamin D? An overview. In: P Feldman,
Francis H Glourieux,
J Wesley Pike (editors). Vitamin D, 2nd
edn.
Elsevier Academic Press, Burlington, 2005; 1019–28.
10.1016/B978-012252687-9/50065-6 Google Scholar
- 21 Pettifor JM. Rickets and vitamin D deficiency in children and adolescents. Endocrinol. Metab. Clin. North Am. 2005; 34: 537–53, vii.
- 22 Bischoff-Ferrari HA, Glovannucci E, Wilett 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(1): 18–28.
- 23 Weaver CM, Fleet JC. Vitamin D requirements: current and future. Am. J. Clin. Nutr. 2004; 80(6 Suppl.): 1735S–9S.
- 24 Holick MF. Vitamin D Status: measurement, interpretation, and clinical application. Ann. Epidemiol. 2009; 19: 73–8.
- 25 Zerwekh JE. Blood biomarkers of vitamin D status. Am. J. Clin. Nutr. 2008; 87(4): 1087S–91S.
- 26 Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am. J. Clin. Nutr. 1999; 69(5): 842–56.
- 27 Calvo MS, Whiting SJ, Barton CN. Vitamin D fortification in the United States and Canada: current status and data needs. Am. J. Clin. Nutr. 2004; 80(6 Suppl.): 1710S–6S.
- 28 Holick MF. The vitamin D epidemic and its health consequences. J. Nutr. 2005; 135: 2739S–48S.
- 29 Hatun S, Bereket A, Ozkan B, Coskun T, Kose R, Calioglu AS. Free vitamin D supplementation for every infant in Turkey. Arch. Dis. Child. 2007; 92: 373–4.
- 30 Ozkan B, Doneray H, Karacan M et al. Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur. J. Pediatr. 2009; 168(1): 95–100.
- 31 Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J. Am. Coll. Nutr. 2003; 22(2): 142–6.
- 32 Theintz G, Buchs B, Rizzoli R et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J. Clin. Endocrinol. Metab. 1992; 75(4): 1060–5.
- 33 Vitamin D. In: Institute of Medicine, F.a.N.B.D.R.I.F.C. (ed). Phosphorus, Magnesium, Vitamin D, and Fluoride. National Academy Press, Washington, DC, 1997; 250–87.
- 34 Tobiume H, Kanzaki S, Hida S et al. Serum bone alkaline phosphatase isoenzyme levels in normal children and children with growth hormone (GH) deficiency: a potential marker for bone formation and response to GH therapy. J. Clin. Endocrinol. Metab. 1997; 82(7): 2056–61.
- 35 Dori N, Levi L, Stan T, Sukhotnik I, Shaoul R. Transient hyperphosphatasemia in children revisited. Pediatr. Int.2010 Dec; 52(6): 866–71
- 36 Leary NO, Pembroke A, Duggan PF. Single stable reagent (Arsenazo Ill) for optically robust measurement of calcium in serum and plasma. Clin. Chem. 1992; 38: 904–8.
- 37 Cerdà JMEaV. Flow analysis techniques for phosphorus: an overview. Talanta 2005; 66: 307–31.
- 38 Kennedy JW, Carey RN, Coolen RB et al. Evaluation of Precision Performance of Clinical Chemistry Device; Approved Guideline (EP5-A). The National Committee for Clinical Laboratory Standards, Wayne, PA, 1999.
- 39 Neyestani TR, Gharavi A, Kalayi A. Determination of serum 25-hydroxy cholecalciferol using high-performance liquid chromatography: a reliable tool for assessment of vitamin D status. Int J Vitam Nutr Res 2007; 77: 341–6.
- 40 Hatun S, Islam O, Cizmecioglu F et al. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J. Nutr. 2005; 135(2): 218–22.
- 41 Akman AO. 1-16 Yaş ArasıÇocuklarda D Vitamini Düzeyi ve Buna Etki Eden Faktörlerin Belirlenmesi (Thesis). Ankara, Gazi University School of Medicine Department of Pediatrics, 2009.
- 42 Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J. Clin. Endocrinol. Metab. 1988; 67: 373–8.
- 43 Lapatsanis D, Moulas A, Cholevos V, Soukakos P, Popadopoulou ZL, Chalia A. Vitamin D: a necessity for children and adolescents in Greece. Calcif. Tissue Int. 2005; 77: 348–55.
- 44 El-Hajj Fuleihan G, Nabulsi M, Choucair M et al. Hypovitaminosis D in healthy schoolchildren. Pediatrics 2001; 107(4): E53.
- 45 Stein EM, Laing EM, Hall DB et al. Serum 25-hydroxyvitamin D concentrations in girls aged 4–8 y living in the southeastern United States. Am. J. Clin. Nutr. 2006; 83(1): 75–81.
- 46 Weaver C. Vitamin D and calcium metabolism in adolescents. International Congress Series, 2006(1297): p. 32–8.
- 47 Peacey SR. Routine biochemistry in suspected vitamin D deficiency. J. R. Soc. Med. 2004; 97: 322–5.
- 48 Smith GR, Collinson PO, Kiely PD. Diagnosing hypovitaminosis D: serum measurements of calcium, phosphate, and alkaline phosphatase are unreliable, even in the presence of secondary hyperparathyroidism. J. Rheumatol. 2005; 32: 684–9.
- 49 Dahifar H, Faraji A, Ghorbani A, Yassobi S. Impact of dietary and lifestyle on vitamin D in healthy student girls aged 11–15 years. J. Med. Invest. 2006; 53(3-4): 204–8.
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