The association of vitamin D deficiency with psychiatric distress and violence behaviors in Iranian adolescents: the CASPIAN-III study

Association of vitamin D and functional dyspepsia: a case-control study

Background

Vitamin D plays a key role in responses of brain-gut axis. It has been suggested that functional dyspepsia (FD) may be associated with decreased levels of vitamin D. Hence this study wished to find the association between vitamin D in patients with FD.

Materials and methods

This case-control study was done at a tertiary care hospital with 150 cases and 150 controls. FD was diagnosed by the ROME IV criteria. Demographic profile and serum vitamin D levels including Perceived Stress Score (PSS) and salivary amylase were determined for both cases and controls.

Results

Majority of the FD cases were males (57.3%). Post-prandial distress syndrome represented the major type of FD cases (69.3%). A higher mean BMI was found among the control group (23.2 vs. 21.2, P<0.05) and higher percentage of obese individuals in the control group (42.7% vs. 29.3%, P= 0.05). Majority of the cases are from rural background (89.3% vs. 74%, P<0.001). Comparison of PSS showed that cases had significantly higher grades of PSS than control (P<0.001). However, no significant association was found in the levels of salivary amylase between the groups (P=0.728). Hypovitaminosis D (<30 ng/ml) was found significantly more among cases than controls (73.3% vs. 60%; P<0.05) with an odds ratio of 1.833 (CI 95%= 1.126-2.985). After adjustment of age, place of residence and BMI, vitamin D levels were significantly associated with FD in the regression analysis.

Conclusion

This study shows significant association of vitamin D deficiency in FD patients. It also opens up new avenues for further research into the role of vitamin D supplementation to further improve the management of such cases.

Is vitamin D supplementation program in Iranian schools effective in reducing adolescent depressive symptoms? Cost effectiveness study

PURPOSE

We aimed to assess the cost-effectiveness of the vitamin D supplementation program in Iranian adolescents reducing adolescent depressive Symptoms.

METHODS

In the current cost-effectiveness analysis, the viewpoint of Iran's Ministry of Health was selected. The target population was 1,519,762 Iranian high school students (733,657 girls and 786,105 boys). The total costs of the vitamin D supplementations program were based on the reports of the Nutrition Improvement Office of Iran's Ministry of Health and were adjusted to 2018. The variable of Quality-Adjusted Life Years (QALYs) was considered a suitable variable for estimating the effectiveness of vitamin D supplementation. We chose one year as the time horizon. A decision tree model was constructed in TreeAge Pro. The results of the cost-effectiveness analysis were reported in term of the Incremental Cost-Effectiveness Ratio (ICER).

RESULTS

The results of our study showed that the estimated cost per QALY gained of the vitamin D supplementation program is equal to 1528.6676 $, which indicates that vitamin D supplementation in adolescents(11-18Y) is a cost-effective and a dominant strategy in preventing depression through the cost-saving and QALYs increment compared to the no intervention. Sensitivity analysis showed that the possible variations in vitamin D supplement costs could not alter the results, and vitamin D supplementation may be a predominant and cost-effective strategy to prevent adulthood depression with a 100% probability.

CONCLUSION

The national program of vitamin D supplementation among Iranian adolescents was a cost-efficient strategy reducing adolescent depressive Symptoms through the cost-saving and QALYs increment compared to the no intervention.

Nutritional factors associated with aggression

Although the vast majority of patients in forensic psychiatry are treated using pharmacological agents, clinical and ethical concerns about their use have led to the consideration of alternative strategies to reduce aggression that is common in forensic psychiatric settings. One non-invasive and benign biologically-based treatment approach involves nutrition. This article provides a mini-review of the recent evidence on four salient nutritional factors associated with aggressive behavior, namely omega-3 fatty acids, vitamin D, magnesium, and zinc. The current evidence base indicates that lower omega-3 levels are associated with increased aggression. Although research on vitamin D and zinc in relation to aggressive behavior is more limited, there is initial evidence that they are negatively associated with aggression in healthy participants and in psychiatric samples. The relationship between magnesium and aggression varies depending on how magnesium is assessed. Findings from experimental trials reveal that nutritional intervention in the form of omega-3 supplementation has the potential to serve as an effective mode of treatment, with effects that can last beyond the intervention period. There is also support for the utility of nutrition to improve our understanding of how social processes are linked to aggression. In light of the nascent, but promising findings on the role of nutritional factors on aggressive behavior, directions for future research are discussed.

Vitamin D level in relation to depression symptoms during adolescence

BACKGROUND

This study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) and depression symptoms among adolescents in Kuwait, a country with a high prevalence of vitamin D deficiency.

METHODS

A school based cross-sectional study was conducted on randomly selected 704 adolescents in middle schools. Data on depression symptoms were collected using the Children's Depression Inventory (CDI). Data on covariates were collected from the parents by self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were analyzed in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem mass spectrometry.

RESULTS

Of 704 adolescents, 94 (13.35%; 95%CI:10.35-17.06%) had depression symptom (a score of 19 or more on the CDI). There was no significant difference in the median CDI score between different vitamin D status (p = 0.366). There was also no significant correlation between serum 25(OH)D concentration and CDI score (Spearman's rank correlation = 0.01; p = 0.825).There was no significant association between 25(OH)D and depression symptoms whether 25(OH)D was fitted as a continuous variable (crude odds ratio (OR) 0 .99 [95%CI: 0.98, 1.01], p = 0.458 and adjusted OR 1.01 [95%CI: 0.99, 1.02], p = 0.233), categorical variable as per acceptable cut-of points (crude analysis p = 0.376 and adjusted analysis p = 0.736), or categorical variable as quartiles (crude analysis p = 0.760 and adjusted analysis p = 0.549).

CONCLUSION

Vitamin D status does not seem to be associated with depression symptoms among adolescents in our setting. Nevertheless, it is important to have sufficient vitamin D levels during adolescence for several other health benefits.

Vitamin a deficiency and sleep disturbances related to autism symptoms in children with autism spectrum disorder: a cross-sectional study

Background

Vitamin A deficiency (VAD) and sleep disturbances have been reported in children with autism spectrum disorder (ASD). The influence of vitamin A (VA) levels on sleep regulation and sleep disturbances in ASD has garnered concern. The present study aimed to characterize the association of VA levels with sleep disturbances in children with ASD.

Methods

This cross-sectional study compared children with ASD (n = 856) to typically developing children (TDC; n = 316). We used the Children’s Sleep Habits Questionnaire to assess sleep disturbances, Childhood Autism Rating Scale to evaluate the severity of autism symptoms, and Autism Behavior Checklist and Social Responsiveness Scale to assess autism behaviors. Serum VA levels were estimated using high-performance liquid chromatography. Multivariable linear regression and two-way analysis of variance were performed to investigate if VAD was related to sleep disturbances in children with ASD.

Results

Children with ASD had lower serum VA levels and a higher prevalence of sleep disturbances than TDC did. The incidence of VAD in ASD children with sleep disturbances was higher, and the symptoms more severe than those without sleep disturbances and TDC. Interestingly, the interaction between VAD and sleep disturbances was associated with the severity of autism symptoms.

Conclusion

VAD and sleep disturbances are associated with the core symptoms of ASD in children. Regular monitoring of sleep and VA levels may be beneficial for children with ASD.

Trial registration

Chinese Clinical Trial Registry, registration number: ChiCTR-ROC-14005442, registration date: December 9th 2014.

The Influence of Vitamin D Intake and Status on Mental Health in Children: A Systematic Review

A potential role of vitamin D in some components of mental health is currently suggested, but the analyses are conducted mainly for adults, while for young individuals mental health is especially important, due to its lifelong effects. The aim of the study was to analyze the association between vitamin D intake or status and mental health in children within a systematic review of literature, including both intervention and observational studies. The literature search was conducted according to the PRISMA guidelines and it covered peer-reviewed studies included in databases of PubMed and Web of Science until October 2019. The studies presenting either vitamin D intake, or vitamin D status in human subjects were allowed (excluding subjects with intellectual disabilities, eating disorders and neurological disorders), while for mental health the various methods of assessment and wide scope of factors were included. The bias was assessed using the Newcastle-Ottawa Scale (NOS). The review was registered in the PROSPERO database (CRD42020155779). A number of 7613 studies after duplicate removing were extracted by two independent researchers, followed by screening and assessment for eligibility, conducted by two independent researchers in two steps (based on title and abstract). Afterwards, the full texts were obtained and after reviewing, a number of 24 studies were included. The synthetic description of the results was prepared, structured around exposure (vitamin D supplementation/status) and outcome (components of mental health). The included studies were conducted either in groups of healthy individuals, or individuals with mental health problems, and they assessed following issues: behavior problems, violence behaviors, anxiety, depressive symptoms/depression, aggressive disorder, psychotic features, bipolar disorder, obsessive compulsive disorder, suicidal incident, as well as general patterns, as follows: mental health, level of distress, quality of life, well-being, mood, sleep patterns. The vast majority of assessed studies, including the most prominent ones (based on the NOS score) supported potential positive influence of vitamin D on mental health in children. As a limitation of the analysis, it should be indicated that studies conducted so far presented various studied groups, outcomes and psychological measures, so more studies are necessary to facilitate comparisons and deepen the observations. Nevertheless, vitamin D intake within a properly balanced diet or as a supplementation, except for a safe sun exposure, should be indicated as an element supporting mental health in children, so it should be recommended to meet the required 25(OH)cholecalciferol blood level in order to prevent or alleviate mental health problems.

Association of Vitamin D Concentrations with subjective health complaints in children and adolescents: the CASPIAN-V study

BACKGROUND

Vitamin D deficiency (VDD) is recognized as a global pandemic. Identification, any association between VDD and subjective health complaints (SHC), can be helpful to realize critical mechanisms and improve psychological and somatic symptoms. Given few studies published on this issue and the importance of its clarification, the main objective of this study was to examine the association between VDD and the SHC in children and adolescents.

METHODS

In this national cross-sectional study, 2596 Iranian children and adolescents aged 8-18 years were included. Data on SHC, anthropometric indices, physical activity, and serum levels of vitamin D were collected. Logistic regression models (crude, adjusted) were applied to examine the association between the VDD and the SHC. Statistical analysis was performed using STATA version 11. P-values< 0.05 were considered as statistically significant.

RESULTS

Serum levels of vitamin D in approximately 70% of Iranian children and adolescents were lower than 30 ng/mL. Among the SHC, irritability (40.9%) and feeling anxiety (33.7%) were the most prevalent ones. Multiple complaints in students with the VDD was 2.5 times greater than those with sufficient vitamin D concentrations (p <  0.001). Compared to the reference group, the strongest association was found between vitamin D status and difficulties in getting to sleep (OR: 2.5, 95%CI: 1.18, 3.53, p <  0.001).

CONCLUSION

VDD was observed in the considerable percentage of the study population. There were no significant differences between the two gender groups. In addition, there were significant associations between vitamin D status and most of the somatic and psychological symptoms, particularly for getting to sleep. It seems national interventional programs for vitamin D supplementation or food fortifications can be helpful.

Assessing the Evidence of Micronutrients on Depression among Children and Adolescents: An Evidence Gap Map

There is some evidence indicating that nutrition may have the ability to prevent, treat, and/or influence the severity of depression. The aims of this evidence gap map (EGM) are to provide an overview and to determine evidence gaps in the existing research on micronutrients and their impact on depression among children and adolescents. We conducted a comprehensive search in multiple databases of primary and secondary literature assessing the impact of micronutrients on depression-related outcomes such as unipolar depression, major depressive disorders, dysthymia, acute depression, and mood disorders. Abstracts and full-text articles were dual-screened based on predefined eligibility criteria. A total of 30 primary research publications were included in the EGM. About 47% of included studies focused on late adolescents (15-19 y), ∼40% on early adolescents (10-14 y), and ∼13% on children aged 6-9 y. Among the included studies, 8 studies examined a single micronutrient intervention and 22 studies examined micronutrient concentrations (either intake or serum), and their impact on depression. The most frequently studied micronutrients were vitamin D (n = 8), zinc (n = 8), iron (n = 6), folate (n = 7), and vitamin B-12 (n = 5). More longitudinal studies and trials are needed to determine the role of micronutrients in the etiology and treatment of depression among children and adolescents.

The Effects of Vitamin D Supplementation on Lipid and Inflammatory Profile of Healthy Adolescent Boys: A Randomized Controlled Trial

Background: Deficiency of vitamin D, an anti-inflammatory micronutrient with some favorable effects on lipid profiles, has been found to be highly prevalent in adolescents. We aimed to investigate the effect of a school-based vitamin D supplementation regimen on the correction of vitamin D deficiency as well as lipid and inflammatory profiles of healthy adolescent boys. Methods: In this randomized single-blind placebo-controlled trial, seventy-one healthy adolescent boys (age 17 years old) were recruited from one high school in Tehran, Iran, and randomly assigned to two groups. The supplement group received vitamin D pearls at a dose of 50,000 IU monthly for 6 months, this dose is indeed defined by the Ministry of Health in Iran for a potential national school-based vitamin D supplementation program. The other group was given placebo pearls for the same duration. Before and after the treatment, the serum levels of 25-hydroxy vitamin D (25(OH) D), parathyroid hormone (PTH), retinol, lead (Pb), the lipid profile and the inflammatory biomarkers were measured and compared. Results: Between-groups statistical analysis showed that a dose (50,000 IU/month) vitamin D significantly increased the serum levels of 25-hydroxyvitamin D (25 (OH) D) (p < 0.001) and decreased serum levels of PTH (p = 0.003). No significant change was observed in serum levels of retinol and Pb. Between-group analysis revealed that the serum levels of TG (P = 0.001) decreased while an increase in serum levels of HDL (p = 0.021) was observed (p < 0.05). Both the within- and between-group analysis showed that serum tumor necrosis factor receptor 2 (TNFR2) concentration declined while serum interleukin-10 (IL-10) increased in response to vitamin D supplementation (p < 0.05). Conclusion: A supplementation regimen of (50,000 IU/month) vitamin D in a context with high rates of vitamin deficiency has shown positive impacts on the serum vitamin D, lipid profile and inflammatory biomarkers in healthy adolescent boys.

Quality of life and mental health in adolescent users of oral contraceptives. Results from the nationwide, representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

Objective

Using data from the nationwide, cross-sectional KiGGS (German Health Interview and Examination Survey for Children and Adolescents) study, we investigated whether hormonal contraception in adolescents aged 15 to 17 years was linked to health-related quality of life and mental health problems.

Methods

Study participants had undergone standardized recordings of blood pressure and measurements of serum 25-hydroxyvitamin D [25(OH)D]. Quality of life was assessed by self- and parent-rated KINDL-R questionnaires, whereas mental health problems were screened by means of the Strengths and Difficulties Questionnaire (SDQ).

Results

Self-rated quality of life was similar between users (n = 522) and non-users (n = 1173, 69.2%) of oral contraceptives (69.2 ± 11.2 vs. 69.2 ± 11.0, p = 0.943), as was the parent-rated version (72.9 ± 10.6 vs. 72.9 ± 10.5, p = 0.985). Likewise, no significant differences were observed between the two groups with respect to both self- (10.9 ± 4.4 vs. 10.8 ± 4.6, p = 0.732) and parent-rated SDQ scores (7.2 ± 4.8 vs. 7.0 ± 4.6. p = 0.390). However, serum 25(OH)D (59.5 ± 32.9 vs. 46.1 ± 28.0 nmol/L, p < 0.001) and mean arterial blood pressure (88.2 ± 7.4 vs. 86.5 ± 7.7 mmHg, p < 0.001) were significantly higher in users than in non-users. There was a trend towards a higher rate of psychotropic drug prescription in participants taking oral contraceptive pills as compared to those not receiving hormonal contraception (17.8% vs. 14.4%, p = 0.052). A series of linear regression models with either KINDL-R or SDQ as dependent variable confirmed that there were no associations between components of mental well-being and contraceptive drug use, irrespective of whether self- or parent-ratings were included in these models.

Conclusions

In a large, representative sample of German adolescents, exposure to exogenous contraceptive hormones was associated with higher arterial blood pressure and serum 25(OH)D concentration, whereas hormonal contraception was not linked to health-related quality of life or mental well-being.

The association between 25-hydroxyvitamin D levels and children's sleep-wake patterns: a prospective cohort study

OBJECTIVE

To explore the association between vitamin D in cord blood or in venous blood and children's sleep-wake patterns at two years of age.

METHODS

Data were from 209 children in a birth cohort, Shanghai Sleep Birth Cohort Study (SSBC). 25-Hydroxyvitamin D (25(OH)D) was assessed in cord blood and venous blood samples at two years of age by electrochemiluminescence immunoassay. Children's sleep-wake patterns were measured with the Brief Infant Sleep Questionnaire (BISQ) and Acti-Watch at two years of age.

RESULTS

The prevalence of vitamin D deficiency (defined as <50 nmol/L) was 50.4% in cord blood and 28% at two years of age. The cord blood 25(OH)D level was not significantly associated with children's sleep at two years of age. Children with 25(OH)D deficiency at two years old had shorter reported and actigraphic night sleep duration (NSD) and total sleep duration (TSD) than those with normal 25(OH)D concentration. 25(OH)D level at two years old was positively associated with night and total sleep duration (β_reported-NSD = 0.6, p = 0.011; β_reported-TSD = 0.6, p = 0.029; β_{actigraphic-NSD} = 0.82, p = 0.003; β_{actigraphic-TSD} = 0.78, p = 0.006), but was not associated with daytime sleep duration. There was no significant association between 25(OH)D level with night waking duration and midpoint of sleep either measured subjectively or objectively.

CONCLUSION

We found that not cord blood 25(OH)D level but two-year-old 25(OH)D level was associated with children's sleep-wake patterns at two years of age. These findings suggest more attention should be paid to the assessment of 25(OH)D levels in children with short sleep duration.

High dose vitamin D supplementation is associated with an improvement in serum markers of liver function

Limited studies have examined the effects of vitamin D on liver enzymes in patients with liver disease but none has explored its effects in the healthy subjects. The aim of present study was to evaluate the effects of a high dose vitamin D supplementation on measures of liver function. A total of 988 adolescent girls were recruited; all were assessed for liver function tests (LFTs) including alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (ϒGT), alkaline phosphatase (ALP), total bilirubin, direct bilirubin, albumin, and total protein before and after supplementation with 50,000 IU cholecalciferol perls. Significant reductions were observed for AST, ALT, direct bilirubin, total bilirubin, LDH, and ϒGT at the end of supplementation, only in the group with abnormal reference value. Serum levels of total protein and albumin were higher at the end of follow up in the group with abnormal value. No significant change was obtained for LFTs in the group with normal value. Our findings suggest that vitamin D supplementation may improve markers of liver function in adolescents with abnormal LFTs. More randomized controlled trial with longer follow-up time will be required. © 2019 BioFactors, 45(3):335-342, 2019.

Evaluation of the serum prooxidant-antioxidant balance before and after vitamin D supplementation in adolescent Iranian girls

PURPOSE

Oxidative stress is caused by an imbalance between the antioxidant defenses and pro-oxidant production in favor of pro-oxidant production. Vitamin D has the potential for both pro- and anti-oxidative effects. The aim of this study was to assess the effect of high dose vitamin D supplementation on the prooxidant-antioxidant balance (PAB) in Iranian girls attending High School.

MATERIALS AND METHODS

A total of 464 girls aged 12-18 years were asked to take vitamin D capsules containing 50000IU vitamin D₃ once a week for a period of 9 weeks. All variables were determined at baseline and after 9 weeks of intervention. Fasting blood samples were taken from all subjects. The serum levels of 25OHD were measured using an electrochemiluminescence method. Serum PAB levels were determined using an ELISA reader at a wavelength of 450 nm.

RESULTS

Vitamin D supplementation was associated with an increase in serum PAB (P < 0.001) and a reduction in serum LDL-C (P < 0.001), total cholesterol (P < 0.001) and HDL-C (P < 0.01) serum levels in Iranian adolescent girls. The results obtained from the current study show that there were significant improvements in weight (P < 0.001), BMI (P < 0.001) and FBG (P = 0.02) in adolescent girls who had 50-74.9 nmol/L serum 25OHD levels compared to <50 nmol/L ones after the vitamin D supplementation. There was no significant association between the serum PAB and all biochemical factors (P > 0.05 for all variables).

CONCLUSIONS

The results showed that vitamin D supplementation has increased the PAB levels in teenage girls.

Effect of Vitamin D Supplement on Mood Status and Inflammation in Vitamin D Deficient Type 2 Diabetic Women with Anxiety: A Randomized Clinical Trial

Background:

Vitamin D plays an important role in nervous health and depression. Vitamin D deficiency and anxiety affect diabetic status. The purpose of this study was to determine the effect of vitamin D supplementation on anxiety, depression, and inflammation in diabetic women with anxiety.

Methods:

In this randomized controlled trial, totally 51 women with type 2 diabetes (T2DM) and vitamin D deficiency were randomly allocated to receive one oral pearl of 50,000 IU vitamin D3 (26 women) or a placebo (25 women) fortnightly for 16 weeks. Anthropometric indices, sun exposure, dietary intake, depression, anxiety, and stress scores and biochemical biomarkers including high sensitivity C-reactive protein (hs-CRP) and interleukin-10 (IL-10) were measured at the baseline and after 16-week supplementation.

Results:

Mean ± SD age of participant was 47.43 ± 9.57 years old. Baseline values were not different between the groups. Anxiety score changes were significantly lower in vitamin D group than the controls (P = 0.001). Within group comparison indicated that depression in supplement group with lower vitamin D levels was significantly reduced. Serum hs-CRP reduced (P = 0.01), while IL-10 concentrations increased (P = 0.04) in the intervention group.

Conclusions:

Vitamin D supplementation can improve mood status and anti-inflammatory biomarkers in female diabetics with anxiety and vitamin D deficiency.

Are gastrointestinal and sleep problems associated with behavioral symptoms of autism spectrum disorder?

Many children with autism spectrum disorder (ASD) suffer from concurrent medical symptoms, including gastrointestinal (GI) and sleeping problems. However, there is limited information on the correlation between co-morbidities and autistic behavioral symptoms. In this study, we estimated the prevalence of GI and sleep problems in Chinese ASD children, examined the impacts of GI and sleep problems on autistic behavioral symptoms, and investigated the factors associated with GI and sleep problems. The survey included 169 ASD and 172 healthy children. Data regarding demographic characteristics, GI symptoms, sleep disturbances and behavioral symptoms were collected through questionnaires. GI and sleep problems were prevalent in Chinese ASD children. Moreover, ASD children with GI symptoms reported more severe ASD core symptoms than others. Autistic children's GI symptoms were associated with maternal sleep problems during pregnancy, child's 0-6 month food sources and picky eating. ASD children with sleep disturbances had lower performance in daily living skills, social cognition, social communication and intellectual development than ASD children without sleep disturbances. Sleep disturbances were associated with extra nutrient supply during lactation and feeding, and child's picky eating. Autistic children with GI or/and sleep problems may represent clinically relevant subtypes of ASD, for which targeted treatments may be needed.

Serum Transaminase Concentrations and the Presence of Irritable Bowel Syndrome Are Associated with Serum 25-Hydroxy Vitamin D Concentrations in Adolescent Girls Who Are Overweight and Obese

Background/Aims: Vitamin D deficiency has become endemic globally and its etiology is complex. Few studies have investigated the determinants of serum 25-hydroxy vitamin D (25-OH D). The aim of this study was to investigate the association between lifestyle patterns, liver functional tests (LFTs), and the presence of irritable bowel syndrome (IBS) with serum 25-OH D in apparently healthy girls. Methods: This cross-sectional study was undertaken in 965 adolescent girls aged 12–18 years. IBS was diagnosed using the Rome III questionnaire. An electrochemiluminescence method was used to measure serum 25-OH D. LFTs were measured using commercial kits and an auto analyzer. Linear regression and univariate analyses were performed to determine the association between continuous and categorical variables with serum 25-OH D respectively. Results: Serum 25-OH D was significantly higher in normal weight subjects compared to either overweight or obese subjects (9.5 ± 7.02 vs. 7.9 ± 5.7 ng/mL, p = 0.03). Physical activity level was positively associated with serum 25-OH D in overweight and obese subjects (β = 0.15, p < 0.05). An inverse relationship was found between the presence of IBS and 25-OH D in both normal (β = –1.95, p < 0.05), overweight and obese subjects (β = –1.83, p < 0.05). Serum alanine transaminase (ALT; β = –0.19, p < 0.05) and aspartate transaminase (β = –0.17, p < 0.05) were inversely associated with serum 25-OH in overweight and obese subjects. Conclusions: Individuals with IBS had significantly lower serum 25-OH D concentrations. In addition, there was an inverse association between serum ALT and 25-OH D. Prospective studies, and perhaps interventional trials, will be required to clarify these associations.

Vitamin D Status, Cardiometabolic, Liver, and Mental Health Status in Obese Youth Attending a Pediatric Weight Management Center

BACKGROUND

Vitamin D (VitD) deficiency and obesity are reaching epidemic proportions in North America, particularly in those with comorbid conditions such as diabetes or liver disease. The study objective was to determine the prevalence of suboptimal vitD status and interrelationships with anthropometric, cardiometabolic, liver, mental health, and lifestyle (sleep/screen time) parameters in an ambulatory population of children with obesity.

METHODS

Children (2-18 years) attending a pediatric weight management clinic (n = 217) were retrospectively reviewed. Variables studied included anthropometric (weight, height, body mass index, waist circumference), vitD (serum 25-hydroxyvitamin D), cardiometabolic (systolic blood pressure, diastolic blood pressure, glucose, insulin, homeostasis model assessment for insulin resistance, triglyceride, high-density lipoprotein, low-density lipoprotein, total cholesterol), liver enzymes (alanine aminotransferase, gamma-glutamyl transferase), and mental health (number, diagnosis) parameters.

RESULTS

Suboptimal vitD status (25-hydroxyvitamin D <75 nmol/L was present in 76% of children with obesity (12.0 ± 2.9 years). Blood pressure categorized as prehypertension, stage I hypertension, and stage II hypertension was present in 14%, 25%, and 7% of children, respectively. Mental health diagnoses including anxiety, attention-deficit hyperactivity disorder, mood disorders, and learning disabilities/developmental delays occurred in 18%, 17%, 10%, and 15%, of children, respectively. Waist circumferences >100 cm were associated with lower vitD levels (58 ± 18 vs 65 ± 17 nmol/L; P = 0.01). VitD status ≥50 nmol/L was associated with lower insulin (15.8 [11.7-23.1] mU/L vs 21.1 [14.3-34.2] mU/L; P < 0.01) and homeostasis model assessment for insulin resistance (3.5 [2.5-4.9] vs 4.8 [3.1-6.9]; P < 0.01) values and systolic blood pressure percentiles (73.0 ± 25.8 vs 80.6 ± 17.0; P = 0.04).

CONCLUSIONS

Children with obesity had a high prevalence of vitD deficiency, particularly those at risk for hypertension, reduced insulin sensitivity, and central obesity.

High-dose vitamin D supplementation is associated with an improvement in several cardio-metabolic risk factors in adolescent girls: a nine-week follow-up study

Background Vitamin D deficiency is a prevalent and important global health problem. Because of its role in growth and development, vitamin D status is likely to be particularly important in adolescent girls. Here, we explored the effects of high-dose vitamin D supplementation on cardio-metabolic risk factors. Methods We have examined the effects of vitamin D supplementation on cardio-metabolic risk factors in 988 healthy adolescent girls in Iran. Fasting blood samples and anthropometric measurements were obtained at baseline and after supplementation with high-dose vitamin D. All individuals took a capsule of 50,000 IU vitamin D/week for nine weeks. The study was completed by 940 participants. Results The prevalence of vitamin D deficiency was 90% at baseline, reducing to 16.3% after vitamin D supplementation. Vitamin supplementation was associated with a significant increase in serum concentrations of 25 (OH) vitamin D and calcium. There were significant reductions in diastolic blood pressure, heart rate, waist circumference and serum fasting blood glucose, total- and low-density lipoprotein-cholesterol after the nine-week period on vitamin D treatment, but no significant effects were observed on body mass index, systolic blood pressure or serum high-density lipoprotein cholesterol and triglyceride. Conclusion Vitamin D supplementation had beneficial effects on cardio-metabolic profile in adolescent girls.

Vitamin D and mental health in children and adolescents

While vitamin D is known to be relevant for bone health, evidence has recently accumulated for an impact on mental health. To identify the potential benefits and limitations of vitamin D for mental health, an understanding of the physiology of vitamin D, the cut-off values for vitamin D deficiency and the current status of therapeutic trials is paramount. Results of a systematic PUBMED search highlight the association of vitamin D levels and mental health conditions. Here, we focus on children and adolescents studies as well as randomized controlled trials on depression in adults. 41 child and adolescent studies were identified including only 1 randomized controlled and 7 non-controlled supplementation trials. Overall, results from 25 cross-sectional studies as well as from 8 longitudinal studies suggest a role of vitamin D in the pathogenesis of mental disorders in childhood and adolescence. Findings from supplementation trials seem to support this hypothesis. However, randomized controlled trials in adults revealed conflicting results. Randomized controlled trials in childhood and adolescents are urgently needed to support the potential of vitamin D as a complementary therapeutic option in mental disorders. Study designs should consider methodological challenges, e.g., hypovitaminosis D at baseline, appropriate supplementation doses, sufficient intervention periods, an adequate power, clinically validated diagnostic instruments, and homogenous, well-defined risk groups.

Vitamin D status in pediatric irritable bowel syndrome

Importance

Irritable bowel syndrome (IBS) is associated with significant morbidity in children and adolescents, and the therapeutic efficacy of available treatment options is limited. The role of vitamin D supplementation in pediatric IBS is unclear as the vitamin D status of pediatric patients with IBS is unknown. Equally, the relationship of vitamin D status with psychosomatic symptoms in children and adolescents is unclear.

Aim

To characterize the vitamin D status of pediatric patients with IBS using a case-control study design.

Hypothesis

Serum 25-hydroxyvitamin D [25(OH)D] concentration will be similar between patients with IBS and controls.

Subjects and methods

A retrospective case-controlled study of 116 controls (age 14.6 ± 4.3 y), female (n = 67; 58%) and 55 subjects with IBS (age 16.5 ± 3.1y), female (n = 44; 80%). Overweight was defined as BMI of ≥85^th but <95^th percentile, and obesity as BMI ≥95^th percentile. Vitamin D deficiency was defined as 25(OH)D of <50 nmol/L, while seasons of vitamin D draw were categorized as summer, winter, spring, and fall. Major psychosomatic manifestations included in the analysis were depression, anxiety, and migraine.

Results

More than 50% of IBS subjects had vitamin D deficiency at a cut-off point of <50 nmol/L (53% vs. 27%, p = 0.001); and >90% of IBS subjects had vitamin D deficiency at a cut-off point of <75 nmol/L (93% vs. 75%, p = 0.006). IBS subjects had significantly lower mean 25(OH)D: 53.2 ± 15.8 nmol/L vs. 65.2 ± 28.0 nmol/L, p = 0.003; and albumin: 6.2 ± 0.6 vs. 6.5 ± 0.6 μmol/L, p = 0.0.01. IBS subjects with migraine had significantly lower mean 25(OH)D concentration compared to controls (p = 0.01). BMI z-score was similar between the controls and IBS subjects (0.5 ± 1.4 vs. 1.2 ± 2.9, p = 0.11).

Conclusions

Pediatric patients with IBS had significantly lower 25(OH)D concentration compared to controls despite having similar mean BMI values as controls. Only 7% of the children and adolescents with IBS were vitamin D sufficient, and >50% of the subjects with IBS had vitamin D deficiency. This is a much higher prevalence of vitamin D deficiency compared to IBD and other malabsorption syndromes. Monitoring for vitamin D deficiency should be part of the routine care for patients with IBS. Randomized control trials are warranted to determine the role of adjunctive vitamin D therapy in pediatric IBS.

Association of circulating 25-hydroxyvitamin D with mental well-being in a population-based, nationally representative sample of German adolescents

OBJECTIVE

Numerous studies have linked vitamin D to health-related quality of life (hrQoL) in chronically ill adults or elderly subjects. The aim of this study was to evaluate the association between 25-hydroxyvitamin D (25(OH)D) and hrQoL in a population-based sample of German adolescents.

METHODS

A total of n = 5066 study participants from the nationwide, representative German Health Interview and Examination Survey for Children and Adolescents (Kinder- und Jugendgesundheitssurvey) aged 11-17 years were included in this post hoc analysis. HrQoL was measured using the well-validated self- and parent-rated Children's Quality of Life questionnaires (KINDL-R), while the level of distress was assessed using the self- and proxy version of the Strengths and Difficulties Questionnaire (SDQ). Serum 25(OH)D concentrations were determined using a commercially available chemiluminescence immunoassay.

RESULTS

Bivariate analyses demonstrated a significant positive association between 25(OH)D and hrQoL for both self- [estimate (E) = 0.82, 95 % confidence interval (95 % CI) 0.35-1.30, p = 0.001] and parent ratings (E = 1.33, 95 % CI 0.83-1.83, p < 0.001). In addition, we found negative correlations between 25(OH)D and self- (E = -0.34, 95 % CI -0.58 to -0.11, p = 0.005) and parent-reported total SDQ scores (E = -0.70, 95 % CI -1.03 to -0.37, p < 0.001). Generalized linear models adjusted for age, sex, body mass index, systolic blood pressure, migration background, socio-economic status, and sedentary screen time confirmed that 25(OH)D independently and significantly predicted better hrQoL (p ≤ 0.004).

CONCLUSIONS

These findings linking 25(OH)D to better well-being in a nationally representative sample of German children and adolescents suggest beneficial effects of vitamin D on mental health. However, recommendations for vitamin supplementation in healthy children and adolescents are not warranted from our data.

Nutrient Intake and Depression Symptoms in Spanish Children: The ANIVA Study

The aim of this study was to examine the relationship between nutritional intake and depressive symptoms in Valencian schoolchildren. The ANIVA (Antropometria y Nutricion Infantil de Valencia) study is a descriptive cross-sectional study. During academic year 2013–2014, 710 schoolchildren aged 6–9 years were selected from eleven primary schools in Valencia (Spain). Children’s dietary intake was measured on three-day food records, completed by parents/guardians; children completed the 20-item Center for Epidemiologic Studies Depression Scale for Children (CES-DC) Questionnaire to measure depressive symptoms. Weight, height, and body mass index (BMI), and z-scores were evaluated in all subjects. Nutrient adequacy was assessed using Spanish dietary recommended intakes (DRIs); 20.70% of the sample presented depressive symptoms. We identified a positive association between children with depressive symptoms and non-depressive symptoms for thiamin, vitamin K, and bromine (p < 0.05), and a negative association for protein, carbohydrates, pantothenic acid, biotin, vitamin B₁₂ and E, zinc, manganese, cobalt, and aluminum (p < 0.05). Statistically significant differences were found between both groups according to the DRIs for intakes of total energy (p = 0.026), fiber (p < 0.001), vitamin C (p < 0.001), vitamin E (p = 0.004), magnesium (p = 0.018), and iron (p = 0.013). Our results demonstrated that carbohydrates were the most closely associated factor with depressive symptoms, and highlight the potential significant public health implications of inadequate nutritional intake on schoolchildren’s mental health.