Vitamin D status and its predictors among pre-school children in Adelaide

Adverse childhood experiences, individual-level risk and protective factors, and recent drug use in a community sample of Nigerian women

Adverse childhood experiences (ACEs) are associated with a wide range of health problems and health-compromising behaviors, including drug use, but are understudied in sub-Saharan Africa. Further, some data suggest that some types of ACEs are more strongly associated with outcomes than others. We investigated associations between different types of ACEs and recent drug use among 2,011 women living in Katsina State, Nigeria. This community-based survey included questions on ACE exposure, modifiable individual-level risk and promotive factors, and past-year drug use. Tobacco, cannabis, and the nonmedical use of cough syrup with codeine and tramadol were the most frequently used drugs. Logistic regressions revealed that across most drugs, ACEs reflecting abuse, neglect, and household dysfunction, but not community violence, increased the likelihood of drug use, odds ratios (ORs) = 1.30-3.10. Ease of access to drugs, ORs = 1.33-2.98, and personal religiosity, ORs = 1.19-2.27, also enhanced the risk of drug use, and higher depressive affect was associated with codeine, OR = 1.27, and tramadol use, ORs = 2.42. Practicing religious rites, ORs = 0.38-0.70; disapproval of drug use, ORs = 0.36-0.57; and perceived harm from drug use, ORs = 0.54-0.71, reduced the likelihood of drug use. Efforts to prevent abuse, neglect, and household dysfunction; reduce access to drugs; treat depression; and increase disapproval and harm associated with drug use may reduce drug use in the context of ACE exposure.

Predictors of substance use disorder symptoms among women in Katsina State, Nigeria

BACKGROUND

Problems associated with substance use are on the rise among women in northern Nigeria, creating a need to understand factors contributing to this trend.

METHOD

Data on substance use, symptoms of substance use disorder (SUD) using DSM-5 criteria, and risk and protective factors associated with SUD symptoms, including adverse childhood experiences (ACE), were collected in a community-based study of young adult women (M age = 25.76, SD = 4.71 years) from Katsina State.

RESULTS

The analytic sample included 360 women with valid SUD symptom data. SUD symptoms were correlated in expected directions with the majority of risk and protective factors, including ACE. A hierarchical linear regression analysis predicting SUD symptoms revealed that age, ACE, and peer drug use were uniquely associated with higher levels of SUD symptoms; more education and endorsing a positive relationship with parents was associated with fewer SUD symptoms. Notably, ACE remained a unique contributor to SUD symptom totals in the context of protective factors and additional risk factors, although the association of ACE and SUD symptoms was attenuated.

CONCLUSIONS

These data illustrate the enduring impact of ACE on risk for SUD symptoms in women, and the protective role that a positive relationship with parents may play in reducing this risk. Further, these patterns of findings reveal the utility of assessing risk and protective factors across multiple life domains to gain a comprehensive picture of risk for SUD symptoms in women.

Vitamin D status of 3-year-old children in Denmark: determinants and associations with bone mineralisation and blood lipids

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 [25-75^th 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.

Predictors of Vitamin D Insufficiency in Children and Adolescents With Alopecia Areata

Introduction: Limited data regarding predictors of vitamin D deficiency in US children exist. We aimed to identify predictors of vitamin D insufficiency among children with alopecia areata.

Methods: The medical records of 439 pediatric patients diagnosed with alopecia areata (AA) between January 2015 and December 2017 were reviewed. Those with 25-hydroxyvitamin D levels and no documented vitamin supplementation, chronic illness, or other autoimmune comorbidities other than AA were included. Demographic data, Fitzpatrick skin type, and the month of blood collection were recorded. Monthly UV index information from Philadelphia, PA corresponding to the month of blood collection was also collected.

Results: Within our cohort, 60.4% of patients had insufficient vitamin D levels, of which 38.2% were deficient. The mean age was nine years old. In multivariate analyses, higher Fitzpatrick skin type, non-summer season, and non-White race were associated with vitamin D insufficiency, while the monthly UV index was inversely associated.

Discussion/Conclusion: Higher Fitzpatrick skin type, non-summer season, and non-White race may be associated with vitamin D insufficiency in US pediatric patients. Larger studies are warranted to replicate our findings and fully evaluate predictors of pediatric vitamin D deficiency in the US.

Vitamin D deficiency in a population of migrant children: an Italian retrospective cross-sectional multicentric study

BACKGROUND

Vitamin D is a hot topic in the scientific community. Its deficiency and the implications for the children's health became increasingly discussed during the last 20 years. The main aim of this retrospective study was to determinate the prevalence of vitamin D metabolism disorders in a population of adopted children and their risk factors.

METHODS

We gathered data from 2140 children observed in five different National Working Group for the Migrant Children of the Italian Society of Pediatrics centers, variously located in Italy. Serum 25-hydroxy (OH)-D concentration was used to determine every child's vitamin D status, defined as severely deficient (serum 25-OH-D < 10 ng/ml), moderately deficient (serum 25-OH-D {≥10 ng/ml U < 20 ng/ml}), mildly deficient (serum 25-OH-D {≥20 ng/ml U < 30 ng/ml}) and normal (serum 25-OH-D ≥ 30 ng/ml).

RESULTS

Mean value of serum 25-OH-D was 22.7 ng/ml (SD ± 12.1). Vitamin D status was deemed as normal in 483 (22.6%) children, mildly deficient in 718 (33.6%) children, moderately deficient in 730 (34.1%) children and severely deficient in 209 (9.8%) children.

CONCLUSIONS

A very high percentage of migrant children is affected by hypovitaminosis D, with a strong association with age, geographic origin, season of blood sample collection and time spent in Italy after the arrival. This finding highlights the need for corrective measures. However, these measures cannot be applied without increasing the access of migrant populations to healthcare services.

Obesity in young children and its relationship with diagnosis of asthma, vitamin D deficiency, iron deficiency, specific allergies and flat-footedness: A systematic review and meta-analysis

There is evidence that a number of medical conditions and co-morbidities are associated with obesity in young children. This review explored whether there is evidence of associations with other conditions or co-morbidities. Observational studies of young children (mean age < 10 years) were identified using electronic searches of five databases (MEDLINE, Embase, CINAHL, AMED and SPORTDiscus). Of 27 028 studies screened, 41 (comprising 44 comparisons) met the inclusion criteria. These studies provided data on five distinct diseases/conditions: asthma (n = 16), vitamin D deficiency (n = 10), iron deficiency (n = 10), allergies (n = 4) and flat-footedness (n = 4). Thirty-two studies were appropriate for meta-analysis using random-effects models, and revealed obesity was significantly associated with having asthma (OR 1.5, 95% CI 1.3-1.7), vitamin D deficiency (OR 1.9, 95% CI 1.4-2.5) and iron deficiency (OR 2.1, 95% CI 1.4-3.2). Heterogeneity (I2 ) ranged from 57% to 61%. Narrative synthesis was conducted for all studies. There was no evidence of a consistent association between obesity in young children and eczema, dermatitis or rhinitis due to the low number of studies. However, there was an association with flat-footedness. These results have implications for health policy and practice and families. Further research leading to a greater understanding of the associations identified in this review is suggested.

Sampling: how to select participants in my research study?

Background

In this paper, the basic elements related to the selection of participants for a health research are discussed. Sample representativeness, sample frame, types of sampling, as well as the impact that non-respondents may have on results of a study are described. The whole discussion is supported by practical examples to facilitate the reader's understanding.

Objective

To introduce readers to issues related to sampling.

Serum Vitamin D Levels in Children with Recurrent Respiratory Infections and Chronic Cough

OBJECTIVES

To evaluate serum vitamin D levels in cases of recurrent respiratory infections and chronic cough and to investigate the effect of vitamin D therapy on recurrence of the diseases.

METHODS

This prospective observational study was performed by comparing serum vitamin D levels in children with recurrent respiratory infections, chronic cough and healthy children. One-hundred-one children with chronic cough, ninety-eight children with recurrent respiratory infections and one-hundred-twenty-four healthy children were enrolled in the study. A structured questionnaire was completed to collect data on demography, diet, duration of breastfeeding, vitamin D supplementation and family history for allergic diseases. In patients with low serum vitamin D levels (<20 ng/ml), vitamin D therapy was administered in addition to conventional treatment for the diseases. Patients were followed up for 6 mo and their complaints were evaluated.

RESULTS

Mean serum 25(OH) vitamin D level in the recurrent respiratory infections group was 11.97 ± 4.04 ng/ml, chronic cough group was 13.76 ± 4.81 ng/ml and control group was 31.91 ± 18.79 ng/ml. Comparison of serum 25(OH) vitamin D levels between the study groups revealed a statistically significant difference (p < 0.05). 25(OH)D deficiency in children was associated with increased frequency of recurrent respiratory infections and chronic cough.

CONCLUSIONS

To conclude, administration of supplementary vitamin D may be useful in the treatment and preventation of recurrent respiratory infections and chronic cough.

Complementary Serologic Investigations in Children with Celiac Disease Is Unnecessary during Follow-Up

OBJECTIVES

To determine the frequency of nutritional deficiencies and thyroid dysfunction in children with celiac disease (CD) and during follow-up after initiation of a gluten-free diet. Laboratory investigations of hemoglobin, ferritin, calcium, folate, vitamin B12, vitamin D, and thyroid function are regularly ordered in children with CD despite sufficient evidence for these.

STUDY DESIGN

Between 2009 and 2014, test results of hemoglobin, ferritin, folate, vitamin B12, calcium, vitamin D (25[OH]D), free thyroxin, and thyroid stimulating hormone of children with CD regularly seen at the Leiden University Medical Center were investigated. Laboratory reference ranges were used to define abnormal results. Pearson χ(2) test for trend, unpaired t test, and 1-way ANOVA were used for statistical analysis.

RESULTS

Of the 182 children evaluated, 119 were newly diagnosed. On average, 17% of results per year were missing because of incomplete blood investigations. Iron deficiency (28%) and iron deficiency anemia (9%) were found at the time of diagnosis of CD. Folate (14%), vitamin B12 (1%), and vitamin D deficiencies (27%) were also seen. No hypocalcemia or thyroid dysfunction was found. At follow-up, iron deficiency, iron deficiency anemia, and folate and vitamin D deficiency were observed in 8%, 2%, 3%, and 25% of patients, respectively. Vitamin B12 deficiency, hypocalcemia, and thyroid disease were not found.

CONCLUSIONS

Complementary blood investigations are relevant at the time of diagnosis of CD but have little diagnostic yield during follow-up visits once the patient is placed on a gluten-free diet. Thus, we recommend that these variables only be assessed on indication, such as fatigue or abnormal growth.

Hypovitaminosis D in healthy children in Central Thailand: prevalence and risk factors

Background

There are limited data regarding the prevalence and risk factors relating to hypovitaminosis D in children of Thailand, a tropical country with abundant sunlight. The objective of this study was to assess the prevalence of hypovitaminosis D and examine factors associated with hypovitaminosis D in school-aged children in Bangkok, Thailand – a centrally located capital city.

Methods

This cross-sectional study evaluated 159 healthy children (33.3% boys and 66.7% girls), aged 6 to 12 years, in Bangkok, Thailand (located at 13.45°N). Fasting plasma samples were examined for total 25-hydroxyvitamin D [25(OH)D] using electrochemiluminescence immunoassay. Demographic characteristics (age, sex, household income), past medical history (birth weight, allergic diseases, hospitalization), amount of sun exposure, anthropometric data, and selected biochemical tests were used to investigate for factors associated with hypovitaminosis D.

Results

Overall, the mean ± SD level of plasma 25(OH)D was 64.0 ± 15.1 nmol/L. Hypovitaminosis D (< 75 nmol/L) was presented in 79.2% of subjects. Of these, the prevalence of vitamin D insufficiency and vitamin D deficiency were 59.7% and 19.5%, respectively. In univariate analysis, children with hypovitaminosis D (< 75 nmol/L) had a higher mean body mass index (BMI) percentile than the vitamin D-sufficient group (56.7 ± 33.9 vs. 42.6 ± 36.0; P-value = 0.04). Plasma PTH levels in the children with hypovitaminosis D were significantly higher than in the children with normal levels of vitamin D (4.34 ± 1.38 vs 3.78 ± 1.25 pmol/L; P-value = 0.04). In multivariate analysis, high BMI percentile and high PTH concentration were the parameters associated with 25(OH)D level < 75 nmol/L.

Conclusion

The prevalence of hypovitaminosis D in healthy Thai children is very high, despite their exposure to sunlight, and that prevalence increases in children with a high BMI percentile. As a result, a formal recommendation for vitamin D supplementation in Thai children should be considered.