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Gan Y, You S, Ying J, Mu D. The Association between Serum Vitamin D Levels and Urinary Tract Infection Risk in Children: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2690. [PMID: 37375601 DOI: 10.3390/nu15122690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The association between serum vitamin D levels and urinary tract infection (UTI) in children is unclear. We undertook a systematic review and meta-analysis to evaluate the relationships between different vitamin D levels and the likelihood of UTI in children. Online databases, including Web of Science, PubMed, Embase, and Cochrane Library, were searched up to 6 February 2023 for studies based on the inclusion criteria. Weighted mean difference (WMD) and Odds Ratios (ORs), along with their 95% confidence intervals (CI), were calculated, and the random-effects model was used for analysis. Twelve case-control studies and one cross-sectional study (839 children with UTI and 929 controls) were included. We found that children with UTI had lower levels of serum vitamin D than healthy controls (WMD: -7.730, 95% CI: -11.57, -3.89; p < 0.001). Low vitamin D levels were significantly associated with UTI in children (OR: 2.80; 95% CI: 1.55, 5.05; p = 0.001). The likelihood of children having a UTI significantly increased when their serum vitamin D level was less than 20 ng/mL (OR: 5.49, 95% CI: 1.12, 27.04; p = 0.036). Therefore, vitamin D level, especially when less than 20 ng/mL, is a risk factor in UTI.
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Affiliation(s)
- Yan Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Siyi You
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610041, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610041, China
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2
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Stounbjerg NG, Mølgaard C, Cashman KD, Michaelsen KF, Damsgaard CT. Vitamin D status of 3-year-old children in Denmark: determinants and associations with bone mineralisation and blood lipids. Eur J Nutr 2023; 62:1441-1451. [PMID: 36637493 DOI: 10.1007/s00394-023-03084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE Low vitamin D status is a global problem and has been associated with reduced skeletal and cardiometabolic health. However, evidence in young children is lacking. We, therefore, aimed to characterise vitamin D status in toddlers, identify its determinants, and explore if vitamin D status was associated with bone mineralisation and lipid profile. METHODS We used cross-sectional data from 3-year-old children (n = 323) living in Denmark (latitude: 55°N). Bone mineralisation (n = 108) was measured by DXA. Blood samples were analysed for serum 25-hydroxyvitamin D (s-25(OH)D) by LC-MS/MS, triacylglycerol, and total, low- and high density lipoprotein cholesterol. RESULTS Mean ± SD s-25(OH)D was 69 ± 23 nmol/L, but varied with season. During winter, 38% had inadequate s-25(OH)D (< 50 nmol), whereof 15% had deficiency (< 30 nmol/L); these numbers were only 7 and 1% during summer. In terms of status determinants, supplement use (66% were users) was associated with s-25(OH)D (P < 0.001), whereas dietary vitamin D intake (median [25-75th percentile] of 1.3 [0.9-1.9] µg/d), sex, parental education, BMI, and physical activity were not. There were no associations between s-25(OH)D and blood lipids or bone measurements, using either unadjusted or adjusted regression models. CONCLUSION More than 1/3 of Danish toddlers had inadequate vitamin D intake during winter, but acceptable mean vitamin D status. In addition to season, supplement use was the main determinant of vitamin D status, which was, however, not associated with bone mineralisation or lipid profile. The results support recommendations of vitamin D supplements during winter at northern latitudes, but potential health effects need further investigation.
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Affiliation(s)
- Nanna G Stounbjerg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg, Denmark.
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg, Denmark
| | - Kevin D Cashman
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg, Denmark
| | - Camilla T Damsgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg, Denmark
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Zhao Y, Qin R, Hong H, Lv H, Ye K, Wei Y, Zheng W, Qi H, Ni Y, Zhang L, Yang G, Liu G, Wu A. Is vitamin D deficiency influenced by obesity during the first 5 years of life? A cross-sectional multicenter study. Food Sci Nutr 2022; 11:1084-1095. [PMID: 36789058 PMCID: PMC9922117 DOI: 10.1002/fsn3.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
Evidence on the association of 25-hydroxyvitamin D (25[OH]D) and obesity during the first 5 years of life is limited in China. The objective of this study was to examine the associations between weight, weight for age z score (ZWAZ), weight for length/height z score (ZWHZ), and body mass index for age z score (ZBMI) and 25(OH)D. This was a large population-based cross-sectional multicenter study in which the children aged 0-5 years were recruited from 12 children's healthcare centers by a stratified cluster random-sampling method in 10 cities of the Jiangsu province, China. The 25(OH)D concentration was determined by ELISA. A total of 5289 children were investigated. For 0-71 months children with obesity and nonobesity, the prevalence of vitamin D deficiency was 36.0% and 29.8%, and the 25(OH)D level was 59.8 and 64.0 nmol/L, respectively, and there were all significant difference. Compared with children with nonobesity, children with obesity had higher risk of vitamin D deficiency (OR [95% CI]: 1.33 [1.02, 1.72], p < .05), and had lower 25(OH)D level (β = -3.84, 95% CI = -7.58, -0.09, p < .05). The results for children aged 24-71 months were similar to those for children aged 0-71 months. However, no significant difference was observed in children aged 0-23 months. Vitamin D deficiency was observed in children with greater adiposity during the first 5 years of life. However, the results mainly came from those in the age group of 2 to 5 years instead of the first 2 years in their lives.
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Affiliation(s)
- Yan Zhao
- Department of Clinical NutritionJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Rui Qin
- Department of Child Health Care, Jiangsu Women and Children Health Hospital, Women and Child Branch Hospital of Jiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hong Hong
- Department of Child Health CareDrum Tower Maternity and Child Health Care InstituteNanjingChina
| | - Heyu Lv
- Department of Child Health CareJiangning Maternity and Child Health Care InstituteNanjingChina
| | - Kan Ye
- Department of Child Health CareSuzhou Municipal HospitalSuzhouChina
| | - Yarong Wei
- Department of Child Health CareWuxi Maternity and Child Health Care HospitalWuxiChina
| | - Wen Zheng
- Department of Child Health CareYancheng Maternity and Child Health Care InstituteYanchengChina
| | - Hongxia Qi
- Department of Child Health CareXuzhou Children's HospitalXuzhouChina
| | - Yufei Ni
- Department of Child Health CareNantong Maternity and Child Health Care HospitalNantongChina
| | - Li Zhang
- Department of Child Health CareHuai'an Maternity and Child Health Care HospitalHuai'anChina
| | - Guoqiang Yang
- Department of Child Health CareKunshan Maternity and Child Health Care InstituteKunshanChina
| | - Guoqin Liu
- Department of Child Health CareDafeng Maternity and Child Health Care HospitalDafengChina
| | - Aiping Wu
- Department of Child Health CareXinghua Maternity and Child Health Care HospitalXinghuaChina
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Trollfors B. Ethnicity, gender and seasonal variations all play a role in vitamin D deficiency. Acta Paediatr 2022; 111:1596-1602. [PMID: 35472253 DOI: 10.1111/apa.16372] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022]
Abstract
AIM (1) To explore the adherence of recommendations of vitamin D supplementation to children aged 0-4 years. (2) To compare serum levels of vitamin D in children and adolescents aged 0-17 years originating from different parts of the world. (3) To compare levels between boys and girls and (4) To determine seasonal variation. METHODS A review of vitamin D levels in children with parents from different parts of the world was conducted. 2502 children aged 0-17 years were included between 22 January 2004 and 17 May 2021. RESULTS Fifty-nine of 363 children aged 0-4 years received the recommended vitamin D supplementation. Children from all parts of the world had lower levels of serum 25(OH)D than Swedish children. Girls from the Indian subcontinent, Middle East and Africa had the lowest levels of s-25(OH)D. Seasonal variation with higher levels during the summer was seen in children from Sweden, the rest of Europe, Russia and Latin America. Overall prevalence of vitamin D deficiency (≤25 nmol/L) was 928/2198 (42%) in children not receiving supplementation. Seven children had clinical rickets. CONCLUSION Adherence of giving children aged 0-4 years the recommended vitamin D supplementation was very low. Vitamin D deficiency is common in immigrant children of all ages in Sweden.
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Affiliation(s)
- Birger Trollfors
- Department of Paediatrics Sahlgrenska University Hospital Gothenburg Sweden
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Individual participant data (IPD)-level meta-analysis of randomised controlled trials to estimate the vitamin D dietary requirements in dark-skinned individuals resident at high latitude. Eur J Nutr 2022; 61:1015-1034. [PMID: 34705075 PMCID: PMC8857035 DOI: 10.1007/s00394-021-02699-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/01/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT AND PURPOSE There is an urgent need to develop vitamin D dietary recommendations for dark-skinned populations resident at high latitude. Using data from randomised controlled trials (RCTs) with vitamin D3-supplements/fortified foods, we undertook an individual participant data-level meta-regression (IPD) analysis of the response of wintertime serum 25-hydroxyvitamin (25(OH)D) to total vitamin D intake among dark-skinned children and adults residing at ≥ 40° N and derived dietary requirement values for vitamin D. METHODS IPD analysis using data from 677 dark-skinned participants (of Black or South Asian descent; ages 5-86 years) in 10 RCTs with vitamin D supplements/fortified foods identified via a systematic review and predefined eligibility criteria. Outcome measures were vitamin D intake estimates across a range of 25(OH)D thresholds. RESULTS To maintain serum 25(OH)D concentrations ≥ 25 and 30 nmol/L in 97.5% of individuals, 23.9 and 27.3 µg/day of vitamin D, respectively, were required among South Asian and 24.1 and 33.2 µg/day, respectively, among Black participants. Overall, our age-stratified intake estimates did not exceed age-specific Tolerable Upper Intake Levels for vitamin D. The vitamin D intake required by dark-skinned individuals to maintain 97.5% of winter 25(OH)D concentrations ≥ 50 nmol/L was 66.8 µg/day. This intake predicted that the upper 2.5% of individuals could potentially achieve serum 25(OH)D concentrations ≥ 158 nmol/L, which has been linked to potential adverse effects in older adults in supplementation studies. CONCLUSIONS Our IPD-derived vitamin D intakes required to maintain 97.5% of winter 25(OH)D concentrations ≥ 25, 30 and 50 nmol/L are substantially higher than the equivalent estimates for White individuals. These requirement estimates are also higher than those currently recommended internationally by several agencies, which are based predominantly on data from Whites and derived from standard meta-regression based on aggregate data. Much more work is needed in dark-skinned populations both in the dose-response relationship and risk characterisation for health outcomes. TRAIL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews (Registration Number: CRD42018097260).
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Jackmann N, Gustafsson J, Harila‐Saari A, Ljungman G, Nezirevic Dernroth D, Frisk P, Mäkitie O. Prevalence of and factors influencing vitamin D deficiency in paediatric patients diagnosed with cancer at northern latitudes. Acta Paediatr 2021; 110:2252-2258. [PMID: 33528842 DOI: 10.1111/apa.15788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
AIM To investigate the prevalence of vitamin D deficiency among children with non-haematological malignancies and to explore possible causes of low vitamin D levels among these patients. METHODS We performed a cross-sectional study of 458 children diagnosed with solid tumours, brain tumours, non-Hodgkin lymphoma or Hodgkin disease at the University Children's Hospital, Uppsala, Sweden. Serum 25-hydroxyvitamin D and parathyroid hormone levels were measured in samples taken at the time of cancer diagnosis and related to clinical data. Vitamin D deficiency was defined as a 25-hydroxyvitamin D level below 50 nmol/L. RESULTS The prevalence rate of vitamin D deficiency among children with non-haematological malignancies was 41%. There was no association between sex or diagnosis and vitamin D status. Vitamin D deficiency was more common among school children than preschool children (51% vs. 24%). Older age, season outside summer, and a more recent calendar year were significant predictors of lower 25-hydroxyvitamin D. There was a significant, albeit weak, negative correlation between 25-hydroxyvitamin D and parathyroid hormone. CONCLUSION Vitamin D deficiency is common among children diagnosed with cancer, particularly among school-aged children diagnosed outside summer. The prevalence appears to be increasing, underlining the need for adequate replacement of vitamin D in these patients.
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Affiliation(s)
- Natalja Jackmann
- Department of Women's and Children's Health University Children's Hospital Uppsala Sweden
| | - Jan Gustafsson
- Department of Women's and Children's Health University Children's Hospital Uppsala Sweden
| | - Arja Harila‐Saari
- Department of Women's and Children's Health University Children's Hospital Uppsala Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health University Children's Hospital Uppsala Sweden
| | - Dzeneta Nezirevic Dernroth
- Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Per Frisk
- Department of Women's and Children's Health University Children's Hospital Uppsala Sweden
| | - Outi Mäkitie
- Department of Molecular Medicine and Surgery Karolinska Institute, and Clinical Genetics Karolinska University Hospital Stockholm Sweden
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Ulgen Temel E, Kocabay K, Ozkan A. Investigation of Vitamin D Deficiency in
Pre-School Children During Summer Season. EURASIAN JOURNAL OF FAMILY MEDICINE 2021. [DOI: 10.33880/ejfm.2021100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Vitamin D deficiency is an important public health problem, especially affecting children. The aim of our study is to evaluate the serum 25 (OH) vitamin D levels of children during the summer and to determine some features such as exposure to the sun, oral vitamin D supplementation, and to examine the parameters that affect serum vitamin D levels.
Methods: In our study, children aged between 12 and 83 months were included. A questionnaire was answered by families. In this cross-sectional study, serum 25 (OH) vitamin D levels of children and biochemical parameters were examined.
Results: The mean serum 25 (OH) vitamin D level was 27.0±12.4 ng/ml. Vitamin D deficiency was found 17%, and vitamin D insufficiency was 6%. The children that taking daycare indoors and body mass index <5th percentile had lower serum 25 (OH) vitamin D levels. Children between the ages of 12- 36 months and children with chronic diseases were found to have a shorter time to benefit from sunlight.
Conclusion: The rate of vitamin D deficiency and insufficiency (<20 ng/ml) in children were found at 23% in summer season. Families and caregivers should be informed about vitamin D and should be aware of safe sun exposure.
Keywords: Vitamin D, sunlight, summer, children, vitamin D deficiency
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Affiliation(s)
- Esra Ulgen Temel
- Department of Child Neurology, Faculty of Medicine, Gazi University
| | - Kenan Kocabay
- Department of Child Health and Diseases, Faculty of Medicine, Düzce University
| | - Aybars Ozkan
- Department of Pediatric Surgery, Sakarya University Medical Faculty Training and Research Hospital
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8
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Öhlund I, Lind T, Hernell O, Silfverdal SA, Liv P, Karlsland Åkeson P. Vitamin D status and cardiometabolic risk markers in young Swedish children: a double-blind randomized clinical trial comparing different doses of vitamin D supplements. Am J Clin Nutr 2020; 111:779-786. [PMID: 32140704 PMCID: PMC7138658 DOI: 10.1093/ajcn/nqaa031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Observational studies have linked low vitamin D status to unfavorable cardiometabolic risk markers, but double-blinded vitamin D intervention studies in children are scarce. OBJECTIVES The aim was to evaluate the effect of different doses of a vitamin D supplement on cardiometabolic risk markers in young healthy Swedish children with fair and dark skin. METHODS Cardiometabolic risk markers were analyzed as secondary outcomes of a double-blind, randomized, milk-based vitamin D intervention trial conducted during late fall and winter in 2 areas of Sweden (latitude 63°N and 55°N, respectively) in both fair- and dark-skinned 5- to 7-y-old children. During the 3-mo intervention, 206 children were randomly assigned to a daily milk-based vitamin D3 supplement of either 10 or 25 µg or placebo (2 µg; only at 55°N). Anthropometric measures, blood pressure, serum 25-hydroxyvitamin D [25(OH)D], total cholesterol, HDL cholesterol, apoA-I, apoB, and C-reactive protein (CRP) were analyzed and non-HDL cholesterol calculated at baseline and after the intervention. RESULTS At baseline, serum 25(OH)D was negatively associated with systolic and diastolic blood pressure (β = -0.194; 95% CI: -0.153, -0.013; and β = -0.187; 95% CI: -0.150, -0.011, respectively). At follow-up, there was no statistically significant difference in any of the cardiometabolic markers between groups. CONCLUSIONS We could not confirm any effect of vitamin D supplementation on serum lipids, blood pressure, or CRP in healthy 5- to 7-y-old children. The study was registered at clinicaltrials.gov (NCT01741324).
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Affiliation(s)
- Inger Öhlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden,Address correspondence to IO (e-mail: )
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Olle Hernell
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | | | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Jackmann N, Mäkitie O, Harila-Saari A, Gustafsson J, Nezirevic Dernroth D, Frisk P. Vitamin D status in children with leukemia, its predictors, and association with outcome. Pediatr Blood Cancer 2020; 67:e28163. [PMID: 31925904 DOI: 10.1002/pbc.28163] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Children and adolescents with leukemia are potentially at high risk of vitamin D inadequacy, which may have clinical relevance for skeletal morbidity, infections, and cancer outcome. This study aimed to evaluate vitamin D status at the time of diagnosis to investigate its predictors and association with overall survival in children with leukemia. PROCEDURE We included all 295 children and adolescents diagnosed with leukemia at our institution between 1990 and 2016 who had available serum sample from the time of diagnosis. We analyzed serum 25-hydroxyvitamin D and parathyroid hormone levels and correlated them with clinical data. RESULTS The 25-hydroxyvitamin D level was deficient (< 25 nmol/L), insufficient (25-50 nmol/L), sufficient (50-75 nmol/L), and optimal (> 75 nmol/L) in 6.4%, 26.8%, 39.7%, and 27.1% of the children, respectively. Older age and a more recent time of sampling (calendar year) predicted lower 25-hydroxyvitamin D level. In preschool children (age ≤6 years), lower 25-hydroxyvitamin D level was also associated with acute myeloid leukemia, and a 25-hydroxyvitamin D level < 50 nmol/L was associated with inferior overall survival. In school-aged children (age > 6 years), the 25-hydroxyvitamin D level showed significant seasonal variation. CONCLUSION It remains unclear whether vitamin D supplementation in pediatric leukemia patients will improve outcome.
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Affiliation(s)
- Natalja Jackmann
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
| | - Outi Mäkitie
- Department of Molecular Medicine and Surgery, Karolinska Institute, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Arja Harila-Saari
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
| | - Jan Gustafsson
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
| | - Dzeneta Nezirevic Dernroth
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Frisk
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
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McClorry S, Slupsky CM, Lind T, Karlsland Åkeson P, Hernell O, Öhlund I. Effectiveness of vitamin D supplementation in Swedish children may be negatively impacted by BMI and serum fructose. J Nutr Biochem 2019; 75:108251. [PMID: 31707286 DOI: 10.1016/j.jnutbio.2019.108251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/29/2019] [Accepted: 09/13/2019] [Indexed: 12/29/2022]
Abstract
In regions where sunlight exposure is limited, dietary vitamin D intake becomes important for maintaining status. However, Swedish children have been shown to have deficient or marginal status during the winter months even if the recommended dietary intake is met. Since low vitamin D status has been associated with several disease states, this study investigated the metabolic changes associated with improved vitamin D status due to supplementation. During the 3 winter months, 5-7-year-old children (n=170) in northern (Umeå, 63° N) and southern (Malmö, 55° N) Sweden were supplemented daily with 2 (placebo), 10 or 25 μg of vitamin D. BMI-for-age z-scores (BAZ), S-25(OH)D concentrations, insulin concentrations and the serum metabolome were assessed at baseline and follow-up. S-25(OH)D concentrations increased significantly in both supplementation groups (P<.001). Only arginine and isopropanol concentrations exhibited significant associations with improvements in S-25(OH)D. Furthermore, the extent to which S-25(OH)D increased was correlated with a combination of baseline BAZ and the change in serum fructose concentrations from baseline to follow up (P=.012). In particular, the change in S-25(OH)D concentrations was negatively correlated (P=.030) with the change in fructose concentrations for subjects with BAZ ≥0 and consuming at least 20 μg vitamin D daily. These results suggest that although the metabolic changes associated with improved vitamin D status are small, the effectiveness of dietary supplementation may be influenced by serum fructose concentrations.
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Affiliation(s)
- Shannon McClorry
- Department of Nutrition and Technology, University of California, Davis, CA, USA.
| | - Carolyn M Slupsky
- Department of Nutrition and Technology, University of California, Davis, CA, USA; Department of Food Science and Technology, University of California, Davis, CA, USA.
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden,.
| | - Pia Karlsland Åkeson
- Faculty of Medicine, Department of Clinical Sciences, Pediatrics, Lund University, Malmö/Lund, Sweden.
| | - Olle Hernell
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden,.
| | - Inger Öhlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden,.
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Midtbø LK, Nygaard LB, Markhus MW, Kjellevold M, Lie Ø, Dahl L, Kvestad I, Frøyland L, Graff IE, Øyen J. Vitamin D status in preschool children and its relations to vitamin D sources and body mass index-Fish Intervention Studies-KIDS (FINS-KIDS). Nutrition 2019; 70:110595. [PMID: 31739173 DOI: 10.1016/j.nut.2019.110595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/21/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aims of this study were to determine vitamin D status (serum 25-hydroxyvitamin D3 [s-25(OH)D3]) and examine possible associations between vitamin D status and vitamin D-rich dietary sources, sun exposure, and body mass index in preschool children ages 4 to 6 y. METHODS This is a cross-sectional study based on baseline data (collected in January-February 2015) from the two-armed randomized controlled trial Fish Intervention Studies-KIDS (FINS-KIDS) conducted in Bergen, Norway. S-25(OH)D3 concentration was determined by liquid chromatography-tandem mass spectrometry. Information regarding habitual dietary intake, recent sun vacations, and body mass index were assessed with questionnaires answered by the children's caregivers. RESULTS The children (n = 212) had a mean (standard deviation) s-25(OH)D3 of 60.7 (13.8) nmol/L; 18.9% had s-25(OH)D3 ≤50 nmol/L. In logistic regression models, non-overweight versus overweight status was inversely associated with s-25(OH)D3 ≤50 nmol/L (odds ratio: 0.41; 95% confidence interval, 0.18-0.95; P = 0.037). Non-sun versus sun vacations were associated with s-25(OH)D3 ≤75 nmol/L (odds ratio: 5.33; 95% confidence interval, 1.93-14.77; P = 0.001). CONCLUSIONS The majority of the preschool children (81%) had s-25(OH)D3 >50 nmol/L. Children with overweight status had an increased risk of s-25(OH)D3 ≤50 nmol/L, and children who had not been on sun vacations were at a greater risk of s-25(OH)D3 ≤75 nmol/L.
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Affiliation(s)
| | | | | | | | - Øyvind Lie
- Institute of Marine Research, Bergen, Norway; Directorate of Fisheries, Bergen, Norway
| | | | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | | | - Ingvild Eide Graff
- Institute of Marine Research, Bergen, Norway; NORCE Norwegian Research Centre, Bergen, Norway
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Hoevenaar-Blom MP, Wielders JP, Groeneveld H, de Leeuw E, Schmits RJ, Pepermans C, Pasker-de Jong PC, Hogeman PH. Prevalence and determinants of vitamin D deficiency in infants and toddlers in the Netherlands: a pilot study. Ann Clin Biochem 2019; 56:613-618. [PMID: 31154805 DOI: 10.1177/0004563219857772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Little is known of the vitamin D status of young infants and toddlers and its determinants in West Europe. The prevalence and determinants of vitamin D deficiency of children aged 6–48 months in the centre of the Netherlands (52°N) is investigated. Methods In a cross-sectional population study, randomly recruited infants and toddlers ( n = 150) were studied using an online questionnaire and a physical examination either in late summer ( n = 52) or in late winter ( n = 98). Vitamin D analysis was performed by capillary blood sampling using dried bloodspots plus LC-MS/MS. Results In late winter, 32% of the children were vitamin D deficient (<50 nmol/L 25OH vitamin D3) with 5% severely deficient (<25 nmol/L). In late summer, 2% were deficient. The odds of vitamin D deficiency were higher in children aged 24–48 months, for those not using formula milk and those not adhering to the supplementation guidelines. Conclusion One-third of Dutch infants and toddlers were found to be vitamin D deficient in late winter. Suggested strategies for raising the vitamin D status may include improving the adherence to supplementation, a sensible sun exposure or the use of fortified foods. Special attention is needed for the children aged 24–48 months.
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Affiliation(s)
| | - Jos Pm Wielders
- 2 Department of Clinical Chemistry, Meander Medical Center, Amersfoort, the Netherlands
| | - Henk Groeneveld
- 3 Department of Youth Health Care, Public Health Services Region, Utrecht, the Netherlands
| | - Elly de Leeuw
- 4 Department of Public Health, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ruben Jh Schmits
- 3 Department of Youth Health Care, Public Health Services Region, Utrecht, the Netherlands.,4 Department of Public Health, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carolien Pepermans
- 3 Department of Youth Health Care, Public Health Services Region, Utrecht, the Netherlands
| | | | - Paul Hg Hogeman
- 1 Department of Pediatrics, Meander Medical Center, Amersfoort, the Netherlands
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Georgieva V, Kamolvit W, Herthelius M, Lüthje P, Brauner A, Chromek M. Association between vitamin D, antimicrobial peptides and urinary tract infection in infants and young children. Acta Paediatr 2019; 108:551-556. [PMID: 30003595 DOI: 10.1111/apa.14499] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 12/31/2022]
Abstract
AIM Vitamin D stimulates production of the endogenous antimicrobial peptides cathelicidin and β-defensin-2, which are expressed in the urinary tract. We investigated vitamin D status and levels of cathelicidin and β-defensin-2 and their association with urinary tract infection (UTI). METHODS The study included 120 children under three years of age: 76 children with UTIs and 44 otherwise healthy children with congenital hydronephrosis. Serum 25-hydroxycholecalciferol levels were measured by direct competitive electro-chemiluminescence immunoassay, and plasma cathelicidin and β-defensin-2 concentrations were analysed by enzyme-linked immunosorbent assay. RESULTS We found that vitamin D insufficiency and deficiency are prevalent in young children (21%). Serum vitamin D levels negatively correlated with age and were significantly lower in girls. Levels of vitamin D positively correlated with levels of cathelicidin but not with β-defensin-2. Low concentrations of vitamin D were associated with UTIs in girls, but we did not see any correlation with the recurrence of infection at one-year follow-up. CONCLUSION Vitamin D deficiency is common and may prove to be a risk factor for UTIs especially in girls. We hypothesise that adequate supplementation with vitamin D may become a way to prevent first-time UTIs.
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Affiliation(s)
- V Georgieva
- Department of Clinical Science, Intervention and Technology Division of Paediatrics Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - W Kamolvit
- Department of Microbiology, Tumour and Cell Biology Division of Clinical Microbiology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - M Herthelius
- Department of Clinical Science, Intervention and Technology Division of Paediatrics Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - P Lüthje
- Department of Microbiology, Tumour and Cell Biology Division of Clinical Microbiology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - A Brauner
- Department of Microbiology, Tumour and Cell Biology Division of Clinical Microbiology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - M Chromek
- Department of Clinical Science, Intervention and Technology Division of Paediatrics Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
- Department of Clinical Sciences Lund Division of Paediatrics Lund University Lund Sweden
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14
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Sun behaviour and physical activity associated with autumn vitamin D status in 4–8-year-old Danish children. Public Health Nutr 2018; 21:3158-3167. [DOI: 10.1017/s1368980018002094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo explore determinants of serum 25-hydroxyvitamin D (s-25(OH)D) during autumn in young, Caucasian children not consuming vitamin D-fortified foods or supplements, and explore differences in sun behaviours between pre-school and school children.DesignIn September–October, s-25(OH)D was measured by LC–MS/MS; physical activity, sun behaviours and vitamin D intake were assessed with questionnaires.SettingBaseline data from the ODIN Junior trial at 55°N.SubjectsChildren aged 4–8 years (n130), of whom 96% gave blood samples.ResultsMean s-25(OH)D was 56·8 (sd12·5) nmol/l and positively associated with fat-free mass index (P=0·014). Children being active 6–7 h/week had 5·6 (95% CI 1·1, 10·0) nmol/l higher s-25(OH)D than less active children (P=0·014). Children seeking shade sometimes or rarely/never had 7·0 (95% CI 1·2, 12·9;P=0·018) and 7·2 (95% CI 0·8, 13·6;P=0·028) nmol/l higher s-25(OH)D, respectively, than children always/often seeking shade. Pre-school children had more sun-safe behaviour than school children in terms of use of a hat, sunscreen and sunscreen sun protection factor (P<0·05). In school but not pre-school children, using a hat rarely/never was associated with 12·1 (95% CI 2·5, 21·7;P=0·014) nmol/l higher s-25(OH)Dv. always/often (Pinteraction=0·019). Vitamin D intake was not associated with s-25(OH)D (P=0·241).ConclusionsPhysical activity and sun behaviours are associated with s-25(OH)D in young children. Identifying factors influencing autumn s-25(OH)D is relevant to optimize levels before sun exposure diminishes. Strategies to reduce risk of inadequacy should consider risk of skin cancer and sunburn, and could include fortification and/or vitamin D supplementation.
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15
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Vitamin D Intervention and Bone: A Randomized Clinical Trial in Fair- and Dark-skinned Children at Northern Latitudes. J Pediatr Gastroenterol Nutr 2018; 67:388-394. [PMID: 29851760 DOI: 10.1097/mpg.0000000000002031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate vitamin D status and effects of vitamin D intervention on bone mineral density (BMD) and content (BMC) in children with fair and dark skin in Sweden during winter. METHODS In a 2-center prospective double-blinded randomized intervention study 5- to 7-year-old children (n = 206) with fair and dark skin in Sweden (55°N-63°N) received daily vitamin D supplements of 25 μg, 10 μg, or placebo (2 μg) during 3 winter months. We measured BMD and BMC for total body (TB), total body less head (TBLH), femoral neck (FN), and spine at baseline and 4 months later. Intake of vitamin D and calcium, serum 25-hydroxy vitamin D (S-25[OH]D), and related parameters were analyzed. RESULTS Despite lower S-25(OH)D in dark than fair-skinned children, BMD of TB (P = 0.012) and TBLH (P = 0.002) and BMC of TBLH (P = 0.04) were higher at baseline and follow-up in those with dark skin. Delta (Δ) BMD and BMC of TB and TBLH did not differ between intervention and placebo groups, but FN-BMC increased more among dark-skinned children in the 25 μg (P = 0.038) and 10 μg (P = 0.027) groups compared to placebo. We found no associations between Δ S-25(OH)D, P-parathyroid hormone, P-alkaline phosphatase, and Δ BMD and BMC, respectively. CONCLUSIONS BMD and BMC remained higher in dark- than fair-skinned children despite lower vitamin D status. Even though no difference in general was found in BMD or BMC after vitamin D intervention, the increase in FN-BMC in dark-skinned children may suggest an influence on bone in those with initially insufficient vitamin D status.
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16
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Hauger H, Mølgaard C, Mortensen C, Ritz C, Frøkiær H, Smith TJ, Hart K, Lanham-New SA, Damsgaard CT. Winter Cholecalciferol Supplementation at 55°N Has No Effect on Markers of Cardiometabolic Risk in Healthy Children Aged 4-8 Years. J Nutr 2018; 148:1261-1268. [PMID: 29917069 DOI: 10.1093/jn/nxy080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background Low serum 25-hydroxyvitamin D [25(OH)D] has been associated with unfavorable cardiometabolic risk profiles in many observational studies in children, but very few randomized controlled trials have investigated this. Objective We explored the effect of winter-time cholecalciferol (vitamin D3) supplementation on cardiometabolic risk markers in young, white, 4- to 8-y-old healthy Danish children (55°N) as part of the pan-European ODIN project. Methods In the ODIN Junior double-blind, placebo-controlled, dose-response trial, 119 children (mean ± SD age: 6.7 ± 1.5 y; 36% male; 82% normal weight) were randomly allocated to 0, 10 or 20 µg/d of vitamin D3 for 20 wk (October-March). Cardiometabolic risk markers including BMI-for-age z score (BMIz), waist circumference, systolic and diastolic blood pressure, serum triglycerides and cholesterol (total, LDL, HDL, and total:HDL), plasma glucose and insulin, and whole-blood glycated hemoglobin were measured at baseline and endpoint as secondary outcomes together with serum 25(OH)D. Intervention effects were evaluated in linear regression models as between-group differences at endpoint adjusted for baseline value of the outcome, and additionally for age, sex, baseline serum 25(OH)D, BMIz, time since breakfast, and breakfast content. Results Mean ± SD serum 25(OH)D was 56.7 ± 12.3 nmol/L at baseline and differed between groups at endpoint with concentrations of 31.1 ± 7.5, 61.8 ± 10.6, and 75.8 ± 11.5 nmol/L in the 0-, 10-, and 20 µg/d groups, respectively (P < 0.0001). Vitamin D3 supplementation had no effect on any of the cardiometabolic risk markers in analyses adjusted for baseline value of the outcome (all P ≥ 0.05), and additional covariate adjustment did not change the results notably. Conclusions Preventing the winter decline in serum 25(OH)D with daily vitamin D3 supplementation of 10 or 20 µg had no cardiometabolic effects in healthy 4- to 8-y-old Danish children. This trial was registered at www.clinicaltrials.gov as NCT02145195.
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Affiliation(s)
- Hanne Hauger
- Departments of Nutrition, Exercise and Sports and Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Christian Mølgaard
- Departments of Nutrition, Exercise and Sports and Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Charlotte Mortensen
- Departments of Nutrition, Exercise and Sports and Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Christian Ritz
- Departments of Nutrition, Exercise and Sports and Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Hanne Frøkiær
- Departments of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Taryn J Smith
- Departments of Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Kathryn Hart
- Departments of Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Susan A Lanham-New
- Departments of Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Camilla T Damsgaard
- Departments of Nutrition, Exercise and Sports and Veterinary and Animal Sciences, University of Copenhagen, Denmark
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Jerome SP, Sticka KD, Schnurr TM, Mangum SJ, Reynolds AJ, Dunlap KL. 25(OH)D levels in trained versus sedentary university students at 64° north. Int J Circumpolar Health 2018; 76:1314414. [PMID: 28452288 PMCID: PMC5497540 DOI: 10.1080/22423982.2017.1314414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE 25-hydroxyvitamin D (25[OH]D) deficiency is associated with compromised bone mineralisation, fatigue, suppressed immune function and unsatisfactory skeletal muscle recovery. We investigated the risk of 25(OH)D insufficiency or deficiency in endurance athletes compared to sedentary non-athletes living at 64° north. METHODS University student-athletes (TS) and sedentary students (SS) volunteered to participate in this study. TS engaged in regular exercise while SS exercised no more than 20 minutes/week. Metabolic Equivalent of Task (MET) scores for participants were determined. Vitamin D intake was assessed using the National Cancer Institute's 24-hour food recall (ASA24). Fasting plasma 25(OH)D levels were quantified via enzyme-linked immunosorbent assay. RESULTS TS reported higher activity levels than SS as assessed with MET-minutes/week and ranking of physical activity levels (p < 0.05). The reported mean daily intake of vitamin D was higher in TS compared to SS (p < 0.05) while 25(OH)D plasma levels were lower in TS than in SS (p < 0.05). In total, 43.8% of the TS were either insufficient (31.3%) or deficient (12.5%) in 25(OH)D, while none of the SS were insufficient and 13.3% were deficient. CONCLUSION TS are at increased risk of 25(OH)D insufficiency or deficiency compared to their sedentary counterparts residing at the same latitude, despite higher vitamin D intake.
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Affiliation(s)
- Scott P Jerome
- a Department of Chemistry and Biochemistry , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Kendra D Sticka
- a Department of Chemistry and Biochemistry , University of Alaska Fairbanks , Fairbanks , AK , USA.,b College of Health , University of Alaska Anchorage , Anchorage , AK , USA
| | - Theresia M Schnurr
- a Department of Chemistry and Biochemistry , University of Alaska Fairbanks , Fairbanks , AK , USA.,c Novo Nordisk Research Foundation Center for Basic Metabolic Research , University of Copenhagen , Copenhagen , Denmark
| | - Sally J Mangum
- d Department of Family Medicine , Pacific Northwest University of Health Sciences , Yakima , WA , USA
| | - Arleigh J Reynolds
- e Department of Veterinary Medicine , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Kriya L Dunlap
- a Department of Chemistry and Biochemistry , University of Alaska Fairbanks , Fairbanks , AK , USA.,f Institute of Arctic Biology , University of Alaska Fairbanks , Fairbanks , AK , USA
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18
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Gyll J, Ridell K, Öhlund I, Karlsland Åkeson P, Johansson I, Lif Holgerson P. Vitamin D status and dental caries in healthy Swedish children. Nutr J 2018; 17:11. [PMID: 29338758 PMCID: PMC5771062 DOI: 10.1186/s12937-018-0318-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/04/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Johanna Gyll
- Department of Odontology, Section of Paediatric Dentistry, Faculty of Medicine, Umeå University, 90185, Umeå, Sweden
| | - Karin Ridell
- Department of Paediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Inger Öhlund
- Department of Clinical Sciences/Section of Paediatric Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Pia Karlsland Åkeson
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Malmö, Sweden
| | - Ingegerd Johansson
- Department of Odontology/Section of Cariology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Pernilla Lif Holgerson
- Department of Odontology, Section of Paediatric Dentistry, Faculty of Medicine, Umeå University, 90185, Umeå, Sweden.
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19
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Öhlund I, Lind T, Hernell O, Silfverdal SA, Karlsland Åkeson P. Increased vitamin D intake differentiated according to skin color is needed to meet requirements in young Swedish children during winter: a double-blind randomized clinical trial. Am J Clin Nutr 2017; 106:105-112. [PMID: 28615261 DOI: 10.3945/ajcn.116.147108] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Dark skin and low exposure to sunlight increase the risk of vitamin D insufficiency in children.Objective: The aim of the study was to evaluate the amount of vitamin D needed to ascertain that most children >4 y of age attain sufficient serum 25-hydroxyvitamin D [S-25(OH)D; i.e., ≥50 nmol/L] during winter regardless of latitude and skin color.Design: In a longitudinal, double-blind, randomized, food-based intervention study, 5- to 7-y-old children from northern (63°N) and southern (55°N) Sweden with fair (n = 108) and dark (n = 98) skin were included. Children, stratified by skin color by using Fitzpatrick's definition, were randomly assigned to receive milk-based vitamin D3 supplements that provided 2 (placebo), 10, or 25 μg/d during 3 winter months.Results: Mean daily vitamin D intake increased from 6 to 17 μg and 26 μg in the intervention groups supplemented with 10 and 25 μg, respectively. In the intention-to-treat analysis, 90.2% (95% CI: 81.1%, 99.3%) of fair-skinned children randomly assigned to supplementation of 10 μg/d attained sufficient concentrations, whereas 25 μg/d was needed in dark-skinned children to reach sufficiency in 95.1% (95% CI: 88.5%, 100%). In children adherent to the study product, 97% (95% CI: 91.3%, 100%) and 87.9% (95% CI: 76.8%, 99%) of fair- and dark-skinned children, respectively, achieved sufficient concentrations if supplemented with 10 μg/d. By using 95% prediction intervals for 30 and 50 nmol S-25(OH)D/L, intakes of 6 and 20 μg/d are required in fair-skinned children, whereas 14 and 28 μg/d are required in children with dark skin.Conclusion: Children with fair and dark skin require vitamin D intakes of 20 and 28 μg/d, respectively, to maintain S-25(OH)D ≥50 nmol/L, whereas intakes of 6 and 14 μg/d, respectively, are required to maintain concentrations ≥30 nmol/L during winter. This trial was registered at clinicaltrials.gov as NCT01741324.
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Affiliation(s)
- Inger Öhlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden; and
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden; and
| | - Olle Hernell
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden; and
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A Validation Study of an Interviewer-Administered Short Food Frequency Questionnaire in Assessing Dietary Vitamin D and Calcium Intake in Swedish Children. Nutrients 2017; 9:nu9070682. [PMID: 28665354 PMCID: PMC5537797 DOI: 10.3390/nu9070682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 12/14/2022] Open
Abstract
Vitamin D and calcium are essential nutrients with a range of biological effects of public health relevance. This study aimed to validate a short food frequency questionnaire (SFFQ) against a three-day food record (3D record), assessing the intake of vitamin D and calcium in Swedish children during wintertime. In a double-blinded, randomized food-based intervention study on the effect of feeding different daily doses of vitamin D supplement to 5–7-year-old children (n = 85), 79 (93%) participants completed SFFQ1 at baseline and SFFQ2 after the intervention, and 72 were informed to fill in a 3D record. The 28 (39%) children who completed the 3D record were included in this validation study. The baseline level of serum-25 hydroxy vitamin D [S-25(OH)D] was used as a biomarker. The correlation between all three instruments were moderate to strong. SFFQ2 and the 3D record correlated moderately to S-25(OH)D. Bland-Altman analysis showed that SFFQ2 overestimated vitamin D intake by on average 0.6 μg/day, (limits of agreement (LOA) 5.7 and −4.6 μg/day), whereas the intake of calcium was underestimated by on average 29 mg/day, (LOA 808 and −865 mg/day). Finally, the validity coefficient calculated for vitamin D using the method of triad was high (0.75). In conclusion, this SFFQ, assessed by a dietician, is a valid tool to assess dietary vitamin D and calcium intake in groups of young children.
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Common genetic variants are associated with lower serum 25-hydroxyvitamin D concentrations across the year among children at northern latitudes. Br J Nutr 2017; 117:829-838. [DOI: 10.1017/s0007114517000538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractIn a longitudinal study including 642 healthy 8–11-year-old Danish children, we investigated associations between vitamin D dependent SNP and serum 25-hydroxyvitamin D (25(OH)D) concentrations across a school year (August–June). Serum 25(OH)D was measured three times for every child, which approximated measurements in three seasons (autumn, winter, spring). Dietary and supplement intake, physical activity, BMI and parathyroid hormone were likewise measured at each time point. In all, eleven SNP in four vitamin D-related genes: Cytochrome P450 subfamily IIR1 (CYP2R1); 7-dehydrocholesterol reductase/nicotinamide adenine dinucleotide synthetase-1(DHCR7/NADSYN1); group-specific complement (GC); and vitamin D receptor were genotyped. We found minor alleles of CYP2R1 rs10500804, and of GC rs4588 and rs7041 to be associated with lower serum 25(OH)D concentrations across the three seasons (all P<0·01), with estimated 25(OH)D differences of −5·8 to −10·6 nmol/l from major to minor alleles homozygosity. In contrast, minor alleles homozygosity of rs10741657 and rs1562902 in CYP2R1 was associated with higher serum 25(OH)D concentrations compared with major alleles homozygosity (all P<0·001). Interestingly, the association between season and serum 25(OH)D concentrations was modified by GC rs7041 (Pinteraction=0·044), observed as absence of increase in serum 25(OH)D from winter to spring among children with minor alleles homozygous genotypes compared with the two other genotypes of rs7041 (P<0·001). Our results suggest that common genetic variants are associated with lower serum 25(OH)D concentrations across a school year. Potentially due to modified serum 25(OH)D response to UVB sunlight exposure. Further confirmation and paediatric studies investigating vitamin D-related health outcomes of these genotypic differences are needed.
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Shinde NK, Kumar P, Dabla PK, Jhanwar P, Chadha R, Choudhury SR. Assessment of Nutritional Status of Patients of Congenital Pouch Colon Following Definitive Surgery. J Indian Assoc Pediatr Surg 2017; 22:13-18. [PMID: 28082770 PMCID: PMC5217132 DOI: 10.4103/0971-9261.194613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To assess the nutritional status in 31 patients of congenital pouch colon (CPC) who had undergone definitive surgery and closure of a protective stoma, if any, at least 1 year earlier and were below 14 years age. Materials and Methods: The clinical history, demographic details, anthropometric measurements, and results of hematological and biochemical tests were recorded. In addition to collective data, analysis was also performed after grouping by age, subtype of CPC (Types I/II and Types III/IV CPC), and in Types I/II CPC patients, by whether the colonic pouch had been completely excised or else a segment preserved by tubular colorraphy (TC). Results: Severe fecal incontinence (FI) was common (64.52%). Anthropometry showed a significant malnutrition in 53.85–95.45% patients, especially stunting which was most prevalent in the 0–5 years age-group. Serum Vitamin B12, folate, and Vitamin D were lower than normal in 38.71%, 22.58%, and 74.19% patients, respectively, without statistically significant difference among the various groups studied. Patients with Types I/II CPC had a statistically significant higher incidence of anemia, low serum ferritin, and severe FI than patients with Types III/IV CPC. Patients with Types I/II CPC, managed by excision of the colonic pouch, had a higher incidence of severe FI, wasting, and thinness than those undergoing TC. Conclusions: On follow-up of the patients of CPC, anthropometry shows a high incidence of malnutrition, especially stunting in the 0–5 years age-group. There is an adequate adaptation of fluid-electrolyte homeostasis. Although Types I/II CPC patients have a significantly higher incidence of anemia and severe FI than Types III/IV CPC patients, long-term anthropometric parameters are similar. In Types I/II CPC, preservation of the colonic pouch by TC offers long-term benefit.
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Affiliation(s)
- Nand Kishor Shinde
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Praveen Jhanwar
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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Ekbom K, Marcus C. Vitamin D deficiency is associated with prediabetes in obese Swedish children. Acta Paediatr 2016; 105:1192-7. [PMID: 26871588 PMCID: PMC5071714 DOI: 10.1111/apa.13363] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 01/31/2023]
Abstract
AIM Low vitamin D levels have been associated with obesity and living in areas that lack sunshine, such as northern Europe. The aim of this study was to investigate the vitamin D status of a group of obese children in Sweden and to investigate the associations between vitamin D status and markers of glucose metabolism and metabolic risk markers. METHODS This was a prospective cross-sectional study of 202 obese children between 4.5 and 17.9 years of age who had been referred to the National Childhood Obesity Centre at Karolinska University Hospital, Stockholm. We examined age, gender, 25-hydroxyvitamin D (25(OH)D), f-glucose, f-insulin and metabolic risk markers. Vitamin D deficiency was defined as less than 30 25(OH)D nmol/L. Children with and without a vitamin D deficiency were compared. RESULTS Just over a third (33.2%) of our study population had vitamin D levels <30 nmol/L 25(OH)D. A significant interaction effect was found between age and 25(OH)D. An association was also found between low 25(OH)D levels and impaired fasting glycaemia (IFG) independent of age and season. CONCLUSION Low vitamin D levels were common among obese adolescents living in Sweden and were strongly associated with age and associated with a higher risk of IFG.
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Affiliation(s)
- Kerstin Ekbom
- Division of Pediatrics Department of Clinical Science Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Claude Marcus
- Division of Pediatrics Department of Clinical Science Intervention and Technology Karolinska Institutet Stockholm Sweden
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Roh YE, Kim BR, Choi WB, Kim YM, Cho MJ, Kim HY, Park KH, Kim KH, Chun P, Kim SY, Kwak MJ. Vitamin D deficiency in children aged 6 to 12 years: single center's experience in Busan. Ann Pediatr Endocrinol Metab 2016; 21:149-154. [PMID: 27777907 PMCID: PMC5073161 DOI: 10.6065/apem.2016.21.3.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study investigated the prevalence and risk factors associated with vitamin D deficiency in children. METHODS We analyzed the medical records of 330 patients from the age of 6 to 12, who visited the endocrinology clinic of the Department of Pediatrics at Pusan National University Hospital, from September, 2013 to May, 2014. According to their serum 25-hydroxyvitamin D (25(OH)D) levels, the patients were grouped into either the deficiency group (25(OH)D<20 ng/mL), or the sufficiency group (25(OH)D≥20 ng/mL). The differences between the 2 groups were compared. RESULTS There were 195 patients (59.1%) who had vitamin D deficiency. Their mean serum 25(OH)D level was 14.86±3.20 ng/mL. The differences in sex, age, and pubertal status between the 2 groups were not statistically significant. Weight standard deviation score (SDS), and body mass index SDS, were significantly higher in the vitamin D deficiency group (P=0.002 for each), compared to the sufficiency group. Compared with Autumn, both Spring (odds ratio [OR], 9.7; 95% confidence interval [CI], 4.3-22.0), and Winter (OR, 5.9; 95% CI, 3.5-10.0), were risk factors for vitamin D deficiency. In multiple logistic regression analysis, only seasonal differences have been confirmed to have an effect on vitamin D deficiency. CONCLUSION Vitamin D deficiency in children aged 6 to 12 years is very common. Spring and Winter are the most important risk factors for vitamin D deficiency. We suggest that it is necessary to supplement the guideline for the vitamin D intake according to our situation.
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Affiliation(s)
- Young Eun Roh
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Bo Ryung Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Won Bok Choi
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young Mi Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Min-Jung Cho
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kwang Hoon Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Peter Chun
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Su Young Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Min Jung Kwak
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Serum Vitamin D Depends Less on Latitude Than on Skin Color and Dietary Intake During Early Winter in Northern Europe. J Pediatr Gastroenterol Nutr 2016; 62:643-9. [PMID: 26628439 DOI: 10.1097/mpg.0000000000001028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate if dietary vitamin D intake is adequate for sufficient vitamin D status during early winter in children living in Sweden, irrespective of latitude or skin color. METHODS As part of a prospective, comparative, 2-center intervention study in northern (63°N) and southern (55°N) Sweden, dietary intake, serum 25-hydroxyvitamin D (S-25(OH) D), associated laboratory variables, and sociodemographic data were studied in 5 to 7-year-old children with fair and dark skin in November and December. RESULTS Two hundred six children with fair/dark skin were included, 44/41 and 64/57 children in northern and southern Sweden, respectively. Dietary vitamin D intake was higher in northern than southern Sweden (P = 0.001), irrespective of skin color, partly due to higher consumption of fortified foods, but only met 50-70% of national recommendations (10 μg/day). S-25(OH) D was higher in northern than southern Sweden, in children with fair (67 vs 59 nmol/L; P < 0.05) and dark skin (56 vs 42 nmol/L; P < 0.001). S-25(OH) D was lower in dark- than fair-skinned children at both sites (P < 0.01), and below 50 nmol/L in 40 and 75% of dark-skinned children in northern and southern Sweden, respectively. CONCLUSIONS Insufficient vitamin D status was common during early winter in children living in Sweden, particularly in those with dark skin. Although, higher dietary vitamin D intake in northern than southern Sweden attenuated the effects of latitude, a northern country of living combined with darker skin and vitamin D intake below recommendations are important risk factors for vitamin D insufficiency.
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Vitamin D status among indigenous Mayan (Kekchi) and Afro-Caribe (Garifuna) adolescents from Guatemala: a comparative description between two ethnic groups residing on the Rio Dulce at the Caribbean coast in Izabal Province, Guatemala. Public Health Nutr 2016; 20:1729-1737. [PMID: 27029545 DOI: 10.1017/s1368980016000598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess vitamin D status and the influence of risk factors such as skin pigmentation and time spent outdoors on hypovitaminosis D among Guatemalan Kekchi and Garifuna adolescents. DESIGN Cross-sectional study, with convenient sampling design. Blood samples, anthropometric and behavioural data were all collected during the dry season. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by RIA. SETTING Communities of Rio Dulce and Livingston, Izabal Province, Caribbean coast of Guatemala, with latitude and longitude of 15°49'N and 88°45'W for Livingston and 15°46'N and 88°49'W for Rio Dulce, respectively. SUBJECTS Eighty-six adolescents, divided evenly by sex and ethnicity, with mean age of 14 years. RESULTS Mean (sd) 25(OH)D value was 27·8 (7·2) ng/ml for the total group, with 25·8 (5·9) and 29·8 (7·9) ng/ml, respectively, in Kekchis and Garifunas (P=0·01). Use of vitamin D supplementation, clothing practices and sun protection were not statistically different between groups. Skin area exposed on the day of data collection ranged from 20·0 % minimum to 49·4 % maximum, with mean (sd) exposure of 32·0 (8.5) %. With univariate regression analysis, age (P=0·034), sex (P=0·044), ethnicity (P=0·010), time spent outdoors (P=0·006) and percentage skin area exposed (P=0·001) were predictive. However, multivariate analysis indicated that only sex (P=0·034) and percentage skin area exposed (P=0·044) remained as predictors of 25(OH)D. CONCLUSIONS Despite residing in an optimal geographic location for sunlight exposure, nearly 65 % of study adolescents were either insufficient or deficient in vitamin D. Correction and long-term prevention of this nutritional problem may be instrumental in avoiding adverse effects in adulthood attributed to low 25(OH)D during adolescence.
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Videhult FK, Öhlund I, Hernell O, West CE. Body mass but not vitamin D status is associated with bone mineral content and density in young school children in northern Sweden. Food Nutr Res 2016; 60:30045. [PMID: 26945233 PMCID: PMC4779328 DOI: 10.3402/fnr.v60.30045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 12/13/2022] Open
Abstract
Background High latitude of residence where sun exposure is limited affects vitamin D status. Although vitamin D levels have been associated with poor bone health, cut-off values for optimising bone health are yet to be decided. Objective To assess vitamin D intake and status among young school children living at latitude 63–64 °N, in northern Sweden and to examine the association between vitamin D status and bone mineral content (BMC) and bone mineral density (BMD). Design In a cross-sectional study, diet was assessed by a 4-day food diary and a food frequency questionnaire in 8- to 9-year-old children (n=120). Energy, vitamin D, and calcium intakes were calculated. Physical activity was assessed using a pedometer for 7 days. Serum 25-hydroxyvitamin D (S-25[OH]D) levels were analysed by high-pressure liquid chromatography-atmospheric pressure chemical ionisation-mass spectrometry (n=113). BMC and BMD were assessed by dual energy X-ray absorptiometry scan. Height and weight were measured by standard procedures and BMI z-score was calculated using WHO AnthroPlus programme. Results The majority of children, 91%, did not reach the recommended vitamin D intake of 7.5 µg/day and 50% had insufficient S-25[OH]D levels defined as <50 nmol/l. The highest concentrations of S-25[OH]D were observed during the summer months (p=0.01). Body mass (p<0.01) but not S-25[OH]D was associated with measures of BMC and BMD. Furthermore, boys had higher total BMC (p=0.01), total body less head BMC (p=0.02), fat free mass (p<0.01), and a higher degree of physical activity (p=0.01) compared to girls. Conclusions Body mass was related to BMC and BMD measures in a population of prepubertal school children living at high latitudes in Sweden. Despite insufficient S-25[OH]D levels and low vitamin D intake, this did not appear to affect bone parameters. Prospective studies with repeated assessment of vitamin D status are needed to examine cut-off values for optimising bone health.
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Affiliation(s)
- Frida K Videhult
- Pediatrics, Department of Clinical Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden;
| | - Inger Öhlund
- Pediatrics, Department of Clinical Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Olle Hernell
- Pediatrics, Department of Clinical Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Christina E West
- Pediatrics, Department of Clinical Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
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Thorisdottir B, Gunnarsdottir I, Steingrimsdottir L, Palsson GI, Birgisdottir BE, Thorsdottir I. Vitamin D Intake and Status in 6-Year-Old Icelandic Children Followed up from Infancy. Nutrients 2016; 8:75. [PMID: 26861385 PMCID: PMC4772039 DOI: 10.3390/nu8020075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 12/17/2022] Open
Abstract
High serum 25-hydroxyvitamin D (25(OH)D) levels have been observed in infants in Nordic countries, likely due to vitamin D supplement use. Internationally, little is known about tracking vitamin D status from infancy to childhood. Following up 1-year-old infants in our national longitudinal cohort, our aims were to study vitamin D intake and status in healthy 6-year-old Icelandic children (n = 139) and to track vitamin D status from one year of age. At six years, the mean 25(OH)D level was 56.5 nmol/L (SD 17.9) and 64% of children were vitamin D sufficient (25(OH)D ≥ 50 nmol/L). A logistic regression model adjusted for gender and breastfeeding showed that higher total vitamin D intake (Odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.08–1.49), blood samples collected in summer (OR = 8.88, 95% CI = 1.83–43.23) or autumn (OR = 5.64, 95% CI = 1.16–27.32) compared to winter/spring, and 25(OH)D at age one (OR = 1.02, 95% CI = 1.002–1.04) were independently associated with vitamin D sufficiency at age six. The correlation between 25(OH)D at age one and six was 0.34 (p = 0.003). Our findings suggest that vitamin D status in infancy, current vitamin D intake and season are predictors of vitamin D status in early school age children. Our finding of vitamin D status tracking from infancy to childhood provides motivation for further studies on tracking and its clinical significance.
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Affiliation(s)
- Birna Thorisdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland and Landspitali University Hospital, Reykjavik 101, Iceland.
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland and Landspitali University Hospital, Reykjavik 101, Iceland.
| | - Laufey Steingrimsdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland and Landspitali University Hospital, Reykjavik 101, Iceland.
| | - Gestur I Palsson
- Children's Hospital, Landspitali University Hospital, Reykjavik 101, Iceland.
| | - Bryndis E Birgisdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland and Landspitali University Hospital, Reykjavik 101, Iceland.
| | - Inga Thorsdottir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland and Landspitali University Hospital, Reykjavik 101, Iceland.
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Abstract
BACKGROUND Vitamin D deficiency is prevalent in the pediatric population and multiple risk factors have been identified. Low vitamin D levels can result in poor bone mineralization and have been associated with a significantly higher risk of forearm fracture in children. Vitamin D deficiency has also been associated with pediatric critical illness. The purpose of this study was to determine whether children undergoing vertical expandable prosthetic titanium rib (VEPTR) treatment have low vitamin D levels. METHODS Patients undergoing VEPTR treatment at a single institution were prospectively enrolled (VEPTR). All patients either had a diagnosis of thoracic insufficiency syndrome (TIS), or were at risk of developing TIS secondary to progressive scoliosis or chest wall deformity. Exclusion criteria were patients with rickets and patients receiving vitamin D supplementation at the time of VEPTR insertion. A group of healthy children who presented with fractures during the winter season were used as controls (FX). Vitamin D status and risk factors for vitamin D deficiency were evaluated. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OH-D) <20 ng/mL and vitamin D insufficiency as serum 25-OH-D between 20 and 29 ng/mL. RESULTS Twenty-eight VEPTR and 25 FX patients were compared. The average age was 8.6 years in the VEPTR group and 9.1 years in the FX group. Twenty VEPTR patients (71%) and 19 FX patients (76%) demonstrated low vitamin D levels. The average 25-OH-D level was 27.3 ng/mL in the VEPTR group and 25.4 ng/mL in the FX group. Patient characteristics and vitamin D levels were similar between the groups. No association was found between vitamin D status and sex, race, obesity, or multivitamin use. CONCLUSIONS Low vitamin D levels are common in children undergoing VEPTR treatment. In our series, the prevalence of vitamin D deficiency in this patient population was similar to reported rates in the general pediatric population. Vitamin D status should be routinely monitored in children undergoing VEPTR treatment and supplementation should be initiated if necessary.
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Vitamin D status and its determinants during autumn in children at northern latitudes: a cross-sectional analysis from the optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study. Br J Nutr 2015; 115:239-50. [PMID: 26563915 DOI: 10.1017/s000711451500433x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sufficient summer/autumn vitamin D status appears important to mitigate winter nadirs at northern latitudes. We conducted a cross-sectional study to evaluate autumn vitamin D status and its determinants in 782 Danish 8-11-year-old children (55°N) using baseline data from the Optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study, a large randomised controlled trial. Blood samples and demographic and behavioural data, including 7-d dietary recordings, objectively measured physical activity, and time spent outdoors during school hours, were collected during September-November. Mean serum 25-hydroxyvitamin D (25(OH)D) was 60·8 (sd 18·7) nmol/l. Serum 25(OH)D levels ≤50 nmol/l were found in 28·4 % of the children and 2·4 % had concentrations <25 nmol/l. Upon multivariate adjustment, increasing age (per year) (β -2·9; 95 % CI -5·1, -0·7 nmol/l), female sex (β -3·3; 95 % CI -5·9, -0·7 nmol/l), sampling in October (β -5·2; 95 % CI -10·1, -0·4 nmol/l) and November (β -13·3; 95 % CI -17·7, -9·1), and non-white ethnicity (β -5·7; 95 % CI -11·1, -0·3 nmol/l) were negatively associated with 25(OH)D (all P<0·05). Likewise, immigrant/descendant background was negatively associated with 25(OH)D, particularly in females (β -16·3; 95 % CI -21·9, -10·7) (P<0·001) (P interaction=0·003). Moderate-to-vigorous physical activity (MVPA) (min/d) (β 0·06; 95 % CI 0·01, 0·12), outdoor walking during school hours (min/week) (β 0·4; 95 % CI 0·1, 0·6) and intake of vitamin D-containing supplements ≥3 d/week (β 8·7; 95 % CI 6·4, 11·0) were positively associated with 25(OH)D (all P<0·05). The high proportion of children with vitamin D status below the recommended sufficiency level of 50 nmol/l raises concern as levels expectedly drop further during winter months. Frequent intake of vitamin D supplements was strongly associated with status. MVPA and outdoor activity during school hours should be investigated further in interventions to improve autumn vitamin D status in children at northern latitudes.
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Effects of school meals with weekly fish servings on vitamin D status in Danish children: secondary outcomes from the OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) School Meal Study. J Nutr Sci 2015; 4:e26. [PMID: 26495118 PMCID: PMC4611087 DOI: 10.1017/jns.2015.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 09/30/2014] [Accepted: 06/02/2015] [Indexed: 01/14/2023] Open
Abstract
Children's vitamin D intake and status can be optimised to meet recommendations. We investigated if nutritionally balanced school meals with weekly fish servings affected serum 25-hydroxyvitamin D (25(OH)D) and markers related to bone in 8- to 11-year-old Danish children. We conducted an explorative secondary outcome analysis on data from 784 children from the OPUS School Meal Study, a cluster-randomised cross-over trial where children received school meals for 3 months and habitual lunch for 3 months. At baseline, and at the end of each dietary period, 25(OH)D, parathyroid hormone (PTH), osteocalcin (OC), insulin-like growth factor-1 (IGF-1), bone mineral content (BMC), bone area (BA), bone mineral density (BMD), dietary intake and physical activity were assessed. School meals increased vitamin D intake by 0·9 (95 % CI 0·7, 1·1) μg/d. No consistent effects were found on 25(OH)D, BMC, BA, BMD, IGF-1 or OC. However, season-modified effects were observed with 25(OH)D, i.e. children completing the school meal period in January/February had higher 25(OH)D status (5·5 (95 % CI 1·8, 9·2) nmol/l; P = 0·004) than children completing the control period in these months. A similar tendency was indicated in November/December (4·1 (95 % CI –0·12, 8·3) nmol/l; P = 0·057). However, the effect was opposite in March/April (–4·0 (95 % CI –7·0, –0·9) nmol/l; P = 0·010), and no difference was found in May/June (P = 0·214). Unexpectedly, the school meals slightly increased PTH (0·18 (95 % CI 0·07, 0·29) pmol/l) compared with habitual lunch. Small increases in dietary vitamin D might hold potential to mitigate the winter nadir in Danish children's 25(OH)D status while higher increases appear necessary to affect status throughout the year. More trials on effects of vitamin D intake from natural foods are needed.
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Key Words
- 25(OH)D, 25-hydroxyvitamin D
- BA, bone area
- BMC, bone mineral content
- BMD, bone mineral density
- Children
- DXA, dual-energy X-ray absorptiometry
- IGF-1, insulin-like growth factor-1
- Nutrition
- OC, osteocalcin
- OPUS, Optimal well-being, development and health for Danish children through a healthy New Nordic Diet
- PTH, parathyroid hormone
- School meals
- Vitamin D
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Environmental factors in multiple sclerosis. Presse Med 2015; 44:e113-20. [PMID: 25744944 DOI: 10.1016/j.lpm.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 12/29/2022] Open
Abstract
Although multiple sclerosis (MS) is recognized as a disorder involving the immune system, the interplay of environmental factors and individual genetic susceptibility seems to influence MS onset and clinical expression, as well as therapeutic responsiveness. Multiple human epidemiological and animal model studies have evaluated the effect of different environmental factors, such as viral infections, vitamin intake, sun exposure, or still dietary and life habits on MS prevalence. Previous Epstein-Barr virus infection, especially if this infection occurs in late childhood, and lack of vitamin D (VitD) currently appear to be the most robust environmental factors for the risk of MS, at least from an epidemiological standpoint. Ultraviolet radiation (UVR) activates VitD production but there are also some elements supporting the fact that insufficient UVR exposure during childhood may represent a VitD-independent risk factor of MS development, as well as negative effect on the clinical and radiological course of MS. Recently, there has been a growing interest in the gut-brain axis, a bidirectional neuro-hormonal communication system between the intestinal microbiota and the central nervous system (CNS). Indeed, components of the intestinal microbiota may be pro-inflammatory, promote the migration of immune cells into the CNS, and thus be a key parameter for the development of autoimmune disorders such as MS. Interestingly most environmental factors seem to play a role during childhood. Thus, if childhood is the most fragile period to develop MS later in life, preventive measures should be applied early in life. For example, adopting a diet enriched in VitD, playing outdoor and avoiding passive smoking would be extremely simple measures of primary prevention for public health strategies. However, these hypotheses need to be confirmed by prospective evaluations, which are obviously difficult to conduct. In addition, it remains to be determined whether and how VitD supplementation in adult life would be useful in alleviating the course of MS, once this disease has already started. A better knowledge of the influence of various environmental stimuli on MS risk and course would certainly allow the development of add-on therapies or measures in parallel to the immunotherapies currently used in MS.
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Gasparetto M, Guariso G. Crohn's disease and growth deficiency in children and adolescents. World J Gastroenterol 2014; 20:13219-13233. [PMID: 25309059 PMCID: PMC4188880 DOI: 10.3748/wjg.v20.i37.13219] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 04/22/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Nutritional concerns, linear growth deficiency, and delayed puberty are currently detected in up to 85% of patients with Crohn’s disease (CD) diagnosed at childhood. To provide advice on how to assess and manage nutritional concerns in these patients, a Medline search was conducted using “pediatric inflammatory bowel disease”, “pediatric Crohn’s disease”, “linear growth”, “pubertal growth”, “bone health”, and “vitamin D” as key words. Clinical trials, systematic reviews, and meta-analyses published between 2008 and 2013 were selected to produce this narrative review. Studies referring to earlier periods were also considered if the data was relevant to our review. Although current treatment strategies for CD that include anti-tumor necrosis factor-α therapy have been shown to improve patients’ growth rate, linear growth deficiencies are still common. In pediatric CD patients, prolonged diagnostic delay, high initial activity index, and stricturing/penetrating type of behavior may cause growth deficiencies (in weight and height) and delayed puberty, with several studies reporting that these patients may not reach an optimal bone mass. Glucocorticoids and inflammation inhibit bone formation, though their impact on skeletal modeling remains unclear. Long-term control of active inflammation and an adequate intake of nutrients are both fundamental in promoting normal puberty. Recent evidence suggests that recombinant growth factor therapy is effective in improving short-term linear growth in selected patients, but is of limited benefit for ameliorating mucosal disease and reducing clinical disease activity. The authors conclude that an intense initial treatment (taking a “top-down” approach, with the early introduction of immunomodulatory treatment) may be justified to induce and maintain remission so that the growth of children with CD can catch up, ideally before puberty. Exclusive enteral nutrition has a key role in inducing remission and improving patients’ nutritional status.
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Seasonal vitamin D status of healthy schoolchildren and predictors of low vitamin D status. J Pediatr Gastroenterol Nutr 2014; 58:654-60. [PMID: 24787093 DOI: 10.1097/mpg.0000000000000274] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to assess seasonal prevalence of vitamin D deficiency according to sex and to determine the relations between serum levels of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) and sociodemographic characteristics in otherwise healthy schoolchildren during spring and autumn. METHODS In a cross-sectional study, 746 healthy students aged between 11 and 18 years were recruited during spring (n = 375) and autumn (n = 371). Sociodemographic data were collected by a questionnaire. Serum 25(OH)D, PTH, calcium, phosphate, and alkaline phosphatase were measured. Serum 25(OH)D levels were categorized as <50 nmol/L (vitamin D deficiency) and <25 nmol/L (severe deficiency). RESULTS Mean ± standard deviation 25(OH)D levels were 22.3 ± 10.5 nmol/L in girls and 28.5 ± 17.0 nmol/L in boys during spring (P < 0.001) and 36.5 ± 20.3 nmol/L in girls and 45.0 ± 18.5 nmol/L in boys during autumn (P < 0.001). The prevalence of vitamin D deficiency was 93% during spring and 71% during autumn. There was a negative correlation between 25(OH)D and PTH levels (P < 0.01). We determined a cutoff point of serum 25(OH)D in which the mean serum PTH concentration began to increase as 35.8 nmol/L (P < 0.0001). The age, sex, and calcium level were found to be independent predictors for vitamin D deficiency. CONCLUSIONS Vitamin D deficiency is prevalent among healthy schoolchildren. It is noteworthy that 25(OH)D levels were significantly lower in girls and during autumn. We recommend vitamin D supplementation for children in addition to more time spent for outdoor activities for sensible sunlight exposure.
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Insufficient autumn vitamin D intake and low vitamin D status in 7-year-old Icelandic children. Public Health Nutr 2014; 18:208-17. [PMID: 24476995 DOI: 10.1017/s1368980013003558] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim was to investigate autumn vitamin D intake and status in 7-year-old Icelanders, fitting BMI and cardiorespiratory fitness as predictors. DESIGN Three-day food records and fasting blood samples were collected evenly from September to November, and cardiorespiratory fitness was measured with an ergometer bike. Food and nutrient intakes were calculated, and serum 25-hydroxyvitamin D (s-25(OH)D) and serum parathyroid hormone were analysed. Suboptimal vitamin D status was defined s-25(OH)D <50 nmol/l, and deficient status as s-25(OH)D <25 nmol/l. SETTING School-based study in Reykjavik, Iceland in 2006. SUBJECTS Of the 7-year-olds studied (n 265), 165 returned valid intake information (62 %), 158 gave blood samples (60 %) and 120 gave both (45 %). RESULTS Recommended vitamin D intake (10 μg/d) was reached by 22·4 % of the children and 65·2 % had s-25(OH)D <50 nmol/l. Median s-25(OH)D was higher for children taking vitamin D supplements (49·2 nmol/l v. 43·2 nmol/l, respectively; P < 0·0 0 1). Median s-25(OH)D was lower in November (36·7 nmol/l) than in September (59·9 nmol/l; P < 0·001). The regression model showed that week of autumn accounted for 18·9 % of the variance in s-25(OH)D (P < 0·001), vitamin D intake 5·2 % (P < 0·004) and cardiorespiratory fitness 4·6 % (P < 0·005). CONCLUSIONS A minority of children followed the vitamin D recommendations and 65 % had suboptimal vitamin D status during the autumn. Week of autumn was more strongly associated with vitamin D status than diet or cardiorespiratory fitness, which associated with vitamin D status to a similar extent. These results demonstrate the importance of sunlight exposure during summer to prevent suboptimal vitamin D status in young schoolchildren during autumn in northern countries. An increased effort is needed for enabling adherence to the vitamin D recommendations and increasing outdoor activities for sunlight exposure.
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