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Ahamed F, Jaiswal A, Sahoo S, Ghosh T, Kaur A, Rehman T, Goswami K. Impact of supplementation with iron-folic acid (IFA) and vitamin D 3 compared with IFA alone on haemoglobin levels in elderly people with mild-to-moderate anaemia: protocol for the double-blind, randomised, placebo-controlled Iron and vitamin D trial in Elderly Anemia (IDEA). BMJ Open 2024; 14:e080303. [PMID: 38626969 PMCID: PMC11029202 DOI: 10.1136/bmjopen-2023-080303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Anaemia in the elderly is often difficult to treat with iron supplementation alone as prevalence of anaemia of chronic disease (ACD) alone or mixed with iron-deficiency anaemia (IDA) is high in this age group. Hepcidin remains high in ACD, preventing utilisation of iron for heme synthesis. Vitamin D3 has shown hepcidin suppression activity in both in vitro and in vivo studies. As there is no study assessing the effect of iron-folic acid (IFA) with vitamin D3 on haemoglobin levels in the elderly in India, we want to conduct this study to estimate the impact of supplementation of a therapeutic package of IFA and vitamin D3 on haemoglobin levels in the elderly with mild-to-moderate anaemia in comparison with IFA only. The study will also assess the impact of the proposed intervention on ferritin, hepcidin, 25-hydroxyvitamin D, C reactive protein (CRP) and parathyroid hormone (PTH) levels. METHODS AND ANALYSIS This study is a community-based, double-blind, placebo-controlled, randomised trial. The study will be done in the Kalyani municipality area. Individuals aged ≥60 years with mild-to-moderate anaemia and normal vitamin D3 levels will be randomised into the intervention (IFA and vitamin D3 supplementation) group or the control group (IFA and olive oil as placebo). All medications will be self-administered. Follow-up will be done on a weekly basis for 12 weeks. The calculated sample size is 150 in each arm. Block randomisation will be done. The primary outcome is change in haemoglobin levels from baseline to 12 weeks. Secondary outcome is change in serum ferritin, 25-hydroxyvitamin D, hepcidin, CRP and PTH levels from baseline to 12 weeks. ETHICS AND DISSEMINATION Ethical approval from the Institutional Ethics Committee of All India Institute of Medical Sciences Kalyani has been obtained (IEC/AIIMS/Kalyani/Meeting/2022/03). Written informed consent will be obtained from each study participant. The trial results will be reported through publication in a reputable journal and disseminated through health talks within the communities. TRIAL REGISTRATION NUMBER CTRI/2022/05/042775. PROTOCOL VERSION Version 1.0.
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Affiliation(s)
- Farhad Ahamed
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences-Kalyani, Kalyani, West Bengal, India
| | - Abhishek Jaiswal
- Community Medicine, ESIC Medical College and Hospital Faridabad, Faridabad, Haryana, India
| | - Sibasish Sahoo
- Department of Biochemistry, All India Institute of Medical Sciences-Kalyani, Kalyani, West Bengal, India
| | - Tandra Ghosh
- Department of Physiology, All India Institute of Medical Sciences-Kalyani, Kalyani, West Bengal, India
| | - Amandeep Kaur
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences-Kalyani, Kalyani, West Bengal, India
| | - Tanveer Rehman
- Regional Medical Research Centre Bhubaneswar, Bhubaneswar, Orissa, India
| | - Kalyan Goswami
- Department of Biochemistry, All India Institute of Medical Sciences-Kalyani, Kalyani, West Bengal, India
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Suhaimi NA, Loh SP, Ab Manan N, Zalbahar N, Mohamad Alwi MN, Ahmad Fuzi SF. An 8-Week Vitamin D3-Fortified Fruit Drink Supplementation Increases Serum Ferritin Concentration: A Randomized Controlled Trial in Malaysian Women With Low Iron Stores. J Acad Nutr Diet 2024:S2212-2672(24)00092-3. [PMID: 38408566 DOI: 10.1016/j.jand.2024.02.013] [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: 06/07/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND There is limited randomized controlled trial evidence to support the association between vitamin D deficiency and anemia risk, highlighting the necessity for further investigations into the role of vitamin D in influencing iron status. OBJECTIVE The aim of this study was to determine the effect of vitamin D3-fortified fruit drink consumption (4,000 IU) on vitamin D and iron status biomarkers among iron-deficient women (serum ferritin of <20 μg/L [to convert μg/L ferritin to ng/mL, multiply by 1]). DESIGN An 8-week double-blind randomized controlled trial was conducted. SUBJECTS/SETTING A total of 45 healthy, nonpregnant, nonlactating subjects aged 18 through 40 years (mean [SD] 25.3 [4.6] years) were included in the study, excluding those who donated blood 6 months prior, regularly consumed nutritional supplements, or had gastrointestinal or iron metabolic disorders. INTERVENTION Subjects were randomly assigned to receive either vitamin D3-fortified fruit drink or a placebo. MAIN OUTCOME MEASURES Measurements of 25-hydroxyvitamin D (25[OH]D), serum ferritin, high-sensitivity C-reactive protein, and full blood count concentrations were obtained at baseline, interim, and post intervention. STATISTICAL ANALYSES A mixed model, repeated measures analysis of variance was used to analyze the intervention effect. RESULTS Attrition rate for the study was 13%, with 6 dropouts, and 39 subjects completed the study. Daily consumption of vitamin D3-fortified fruit drink in the intervention group resulted in significant increases in 25(OH)D and serum ferritin concentrations compared with the placebo group. The intervention group showed significantly higher mean (SD) changes (Δ) in both 25(OH)D (Δ 76.4 [30.2] nmol/L [to convert nmol/L 25(OH)D to ng/mL, multiply by .4] vs Δ -1.3 [10.7] nmol/L; P = .001) and serum ferritin concentrations (Δ 2.2 [4.2] μg/L vs Δ -0.3 [3.4] μg/L; P = .048) between baseline and post intervention. The other iron status biomarkers were not affected by the intervention. CONCLUSIONS Our study found that daily vitamin D3-fortified fruit drink supplementation for 8 weeks effectively improved 25(OH)D and iron stores, indicated by increased serum ferritin concentrations, in iron-deficient women. Further research is needed to evaluate its safety, efficacy, feasibility, and optimal food fortification in diverse populations.
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Affiliation(s)
- Nursyafiqah Aqilah Suhaimi
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Su Peng Loh
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Norhafizah Ab Manan
- Department of Community Medicine, Faculty of Medicine, University of Cyberjaya, Selangor, Malaysia
| | - Nurzalinda Zalbahar
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Salma Faeza Ahmad Fuzi
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
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Silvestri R, Ipsiroglu OS. Behavioral sleep medicine-The need for harmonization of clinical best practice outcome measures in children and adolescents with intellectual or developmental disabilities and restless sleep. Front Psychiatry 2022; 13:1003019. [PMID: 36226108 PMCID: PMC9548631 DOI: 10.3389/fpsyt.2022.1003019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
In behavioral medicine, sleep disorders, insomnia in particular, may be considered comorbidities and precipitating factors to intellectual or developmental disabilities (IDD). Nevertheless, sleep alterations have often been neglected in favor of daytime features and symptoms, albeit simple behavioral nighttime observations may disclose hypermotor features that characterize restless sleep. The root of most hypermotor restlessness is linked to central iron deficiency. The latter is often exacerbated by vitamin D deficiency (VDD), which interferes with both dopaminergic and serotonergic mechanisms. In this way, an imbalance affecting daytime behavior and mood is created. Several sleep-related motor disorders such as bruxism, periodic and aperiodic leg movements, Restless Legs Syndrome (RLS), and Restless Sleep Disorder (RSD) are commonly seen in Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD). However, they are rarely diagnosed and often overlooked in affected children and adolescents. As a result, not only are these disorders not adequately addressed therapeutically, but their symptoms may be worsened by the side-effects of drugs used to contain disruptive daytime behavior, such as antipsychotics and antidepressants. In children with IDDs, obesity, inactivity and metabolic effects of antipsychotics often lead to Sleep Disordered Breathing (SDB), which is currently understood as an inflammatory state leading to "hyperactive" lethargy and further alterations of the hypoxic chain and vitamin D levels. Endorsing simple routine blood tests, including inflammatory markers such as C-reactive protein, ferritin, transferrin, and vitamin D levels, may favorably complement caregiver observations and ambulatory sleep recordings, leading to a sleep disorder diagnosis and consequent therapy. In fact, the treatment of SDB, RLS, and RSD has been copiously demonstrated to favorably impact vigilance, behavior, social competence, and academic skills in healthy and, to a greater extent, in IDD children. Thus, consulting and deliberating the root causes of functional and categorical diagnoses within a clinical framework may engender a more precise diagnosis and further benefit pediatric daytime and nighttime management of hyperactive behaviors.
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Affiliation(s)
- Rosalia Silvestri
- Department of Clinical and Experimental Medicine, Sleep Medicine Center, University of Messina, Azienda Ospedaliera Universitaria “Gaetano Martino”, Messina, Italy
| | - Osman S. Ipsiroglu
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- H-Behaviours Research Lab, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Is There An Association Between Vitamin B12 Level and Vitamin D Status in Children? J Pediatr Hematol Oncol 2022; 44:e677-e681. [PMID: 35319507 DOI: 10.1097/mph.0000000000002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Vitamin B12 (vit B12) or cobalamin is a water-soluble vitamin that acts as a coenzyme and is effective in the formation of a healthy nervous system and erythrocytes. In its deficiency, except fatigue and weakness, may cause serious signs and symptoms such as macrocytic anemia, cognitive-developmental delay, irreversible neurological damage. In this study, hemoglobin, leukocyte, thrombocyte, iron, iron-binding, ferritin, and vit B12 levels were evaluated retrospectively during the routine controls of 689 children 5 to 18 years old without any complaints. In addition, the relationship between serum 25-Hydroxyvitamin D (vit D) levels and vit B12 levels, which were evaluated in 487 of the cases, was investigated. Vit B12 deficiency was diagnosed in a total of 160 (23.2%) cases, 99 (24.4%) girls and 61 (21.4%) boys. Vit B12 level was significantly lower in children over 12 years old. Vitamin D deficiency was found to be 49.3% in 487 cases and was significantly higher in the group under 12 years and girls. The frequency of anemia was 7.2% in this group. There was a significant relationship between vit D deficiency and vit B12 deficiency. In conclusion, vit B12 deficiency is common in school-age children, especially in the adolescent age group. It should be known that vit D deficiency may also be present in vit B12 deficiency cases. More comprehensive studies are needed to reveal the relationship between B12 and vit D deficiency.
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Mogire RM, Muriuki JM, Morovat A, Mentzer AJ, Webb EL, Kimita W, Ndungu FM, Macharia AW, Cutland CL, Sirima SB, Diarra A, Tiono AB, Lule SA, Madhi SA, Prentice AM, Bejon P, Pettifor JM, Elliott AM, Adeyemo A, Williams TN, Atkinson SH. Vitamin D Deficiency and Its Association with Iron Deficiency in African Children. Nutrients 2022; 14:nu14071372. [PMID: 35405984 PMCID: PMC9002534 DOI: 10.3390/nu14071372] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Vitamin D regulates the master iron hormone hepcidin, and iron in turn alters vitamin D metabolism. Although vitamin D and iron deficiency are highly prevalent globally, little is known about their interactions in Africa. To evaluate associations between vitamin D and iron status we measured markers of iron status, inflammation, malaria parasitemia, and 25-hydroxyvitamin D (25(OH)D) concentrations in 4509 children aged 0.3 months to 8 years living in Kenya, Uganda, Burkina Faso, The Gambia, and South Africa. Prevalence of iron deficiency was 35.1%, and prevalence of vitamin D deficiency was 0.6% and 7.8% as defined by 25(OH)D concentrations of <30 nmol/L and <50 nmol/L, respectively. Children with 25(OH)D concentrations of <50 nmol/L had a 98% increased risk of iron deficiency (OR 1.98 [95% CI 1.52, 2.58]) compared to those with 25(OH)D concentrations >75 nmol/L. 25(OH)D concentrations variably influenced individual markers of iron status. Inflammation interacted with 25(OH)D concentrations to predict ferritin levels. The link between vitamin D and iron status should be considered in strategies to manage these nutrient deficiencies in African children.
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Affiliation(s)
- Reagan M. Mogire
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- KEMRI-Wellcome Trust Research Programme-Accredited Research Centre, Open University, P.O. Box 230, Kilifi 80108, Kenya
- Correspondence: (R.M.M.); (S.H.A.); Tel.: +254-709-983274 (R.M.M.); +254-709-983000 (S.H.A.)
| | - John Muthii Muriuki
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Alireza Morovat
- Department of Clinical Biochemistry, Oxford University Hospitals, Oxford OX3 9DU, UK;
| | - Alexander J. Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK;
- Li Ka Shing Centre for Health Information and Discovery, Big Data Institute, University of Oxford, Oxford OX3 7LF, UK
| | - Emily L. Webb
- Medical Research Council (MRC) International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (E.L.W.); (S.A.L.)
| | - Wandia Kimita
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Francis M. Ndungu
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Alex W. Macharia
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Clare L. Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa;
| | - Sodiomon B. Sirima
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Amidou Diarra
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Alfred B. Tiono
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Swaib A. Lule
- Medical Research Council (MRC) International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (E.L.W.); (S.A.L.)
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa;
| | - Andrew M. Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia;
| | - Philip Bejon
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - John M. Pettifor
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, R68 Old Potchefstroom Road, Bertsham, Johannesburg 2050, South Africa;
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Adebowale Adeyemo
- Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20891-5635, USA;
| | - Thomas N. Williams
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College, London SW7 2NA, UK
| | - Sarah H. Atkinson
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (R.M.M.); (S.H.A.); Tel.: +254-709-983274 (R.M.M.); +254-709-983000 (S.H.A.)
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AL-Zuhairy SH, Darweesh MA, Othman MAM, AL-Zuhairy NALHS. Vitamin D deficiency in young children with iron deficiency in Misan province, Iraq. J Med Life 2022; 15:387-391. [PMID: 35449997 PMCID: PMC9015167 DOI: 10.25122/jml-2021-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess vitamin D status and its association with iron status in young Iraqi children. A total of 95 infants and toddlers with iron deficiency (ages ranging from 6 to 24 months) and an equal number of 95 healthy subjects with normal hemoglobin (Hb) and sufficient ferritin level with matching age were included as a control group. A specially designed questionnaire was used to collect data. The cases were classified into iron deficiency (ID) and iron deficiency anemia (IDA) according to hemoglobin and ferritin levels. The cases and control groups were subdivided into vitamin insufficiency (VDI), vitamin D deficiency (VDD), and vitamin D sufficiency groups according to 25-hydroxyvitamin D [25(OH)D] levels. Young children with IDA have significantly lower serum levels of 25(OH) D compared with ID and control groups (p<0.05). According to iron status, VDI and VDD were present in 20% and 70% of IDA, 25.7% and 60%of ID, and 26.3% and 30.5% of control groups, respectively, with a significant difference in vitamin D level (p<0.05) among studied groups. A significant positive correlation (p=0.000) was found between serum ferritin level and 25(OH) D level in studied patients. Young children with severe iron deficiency have a higher prevalence of vitamin D deficiency, and there was a significant positive correlation between serum ferritin level and 25(OH) D levels among studied children.
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Affiliation(s)
- Salah Hashim AL-Zuhairy
- Department of Pediatrics, College of Medicine, University of Misan, Amarah, Iraq,Corresponding Author: Salah Hashim AL-Zuhairy, Department of Pediatrics, College of Medicine, University of Misan, Amarah, Iraq. E-mail:
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The Role of Vitamin D in Sleep Disorders of Children and Adolescents: A Systematic Review. Int J Mol Sci 2022; 23:ijms23031430. [PMID: 35163353 PMCID: PMC8835880 DOI: 10.3390/ijms23031430] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023] Open
Abstract
This review investigates the association between vitamin D and sleep disorders. Vitamin D is an essential nutrient known to play an important role in the growth and bone health of the human body, but it also appears to play a role in sleep. The goal of our review is to examine the association between vitamin D and sleep disorders in children and adolescents. We summarize the evidence about the role and the mechanism of action of vitamin D in children and adolescents with sleep disorders such as insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and other sleep disorders. Systematic electronic database searches were conducted using Pubmed and Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The studies that met the established inclusion criteria were analyzed and compared. Results suggest a strict relationship between vitamin D deficiency in children and sleep disorders. There is evidence that vitamin D is implicated in the different neurochemical mechanisms involved in sleep regulation and mainly in the serotonergic and dopaminergic pathways. This might be responsible for the association of vitamin D deficiency and restless sleep, sleep hyperhidrosis, OSA, and RLS.
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Mansourian M, Rafie N, Khorvash F, Hadi A, Arab A. Are serum vitamin D, calcium and phosphorous associated with restless leg syndrome? A systematic review and meta-analysis. Sleep Med 2020; 75:326-334. [PMID: 32950014 DOI: 10.1016/j.sleep.2020.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/29/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is hypothesized that vitamin D deficiency, and calcium/phosphate imbalance could be involved in the pathophysiology of restless leg syndrome (RLS). This systematic review and meta-analysis of observational studies were carried out to reach a firm conclusion regarding the possible association between vitamin D, calcium and phosphorous levels with RLS in end-stage renal disease (ESRD) patients, other comorbidities and healthy population. METHODS PubMed, Scopus, ISI Web of Science, and Cochrane's library were systematically searched up to June 2020. Quality assessment of the included observational studies was performed using Newcastle-Ottawa Quality Assessment Scale. Statistical analyses were done using STATA 11.2. A P-value <0.05 were considered statistically significant. RESULTS A total of 36 studies involving 9590 participants were included in this systematic review and meta-analysis. We found that serum vitamin D level is significantly lower (WMD -3.39 ng/mL; 95% CI, -5.96 to -0.81; P = 0.010; I2 = 86.2%) and phosphorous (SMD 0.19; 95% CI, 0.04-0.34; P = 0.011; I2 = 83.6%) is significantly higher in RLS individuals compared to the non-RLS individuals. However, the mean difference of serum calcium was not significant in comparison between RLS and control groups (SMD -0.01; 95% CI, -0.19 to 0.18; P = 0.957; I2 = 89.2%). CONCLUSION Results revealed a significant association between serum vitamin D and phosphorous with RLS. However, further prospective cohort studies and clinical trials are needed for better understanding of the relationship between these variables.
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Affiliation(s)
- Marjan Mansourian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Rafie
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amir Hadi
- Halal Research Center of IRI, FDA, Tehran, Iran.
| | - Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Vitamin D3 supplementation for 8 weeks leads to improved haematological status following the consumption of an iron-fortified breakfast cereal: a double-blind randomised controlled trial in iron-deficient women. Br J Nutr 2019; 121:1146-1157. [PMID: 30819262 DOI: 10.1017/s0007114519000412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The effect of 38 µg (1500 IU) daily vitamin D3 supplementation, consumed with an Fe-fortified breakfast cereal for 8 weeks, on haematological indicators in Fe-deficient female subjects was investigated. Fifty Fe-deficient subjects (plasma ferritin concentration <20 µg/l; mean age: 27·4 (sd 9·4) years) were randomised to consume an Fe-fortified breakfast cereal containing 9 mg of Fe daily, with either a vitamin D3 supplement or placebo. Blood samples were collected at baseline, interim (4 weeks) and post-intervention (8 weeks) for measurement of Fe and vitamin D status biomarkers. The effect of intervention was analysed using mixed-model repeated-measures ANOVA. Significant increases were observed in two main haematological indices: Hb concentration and haematocrit level from baseline to post-intervention in the vitamin D group but not in the placebo group. The increase from baseline to post-intervention in Hb concentration in the vitamin D group (135 (sd 11) to 138 (sd 10) g/l) was significantly higher compared with the placebo group (131 (sd 15) to 128 (sd 13) g/l) (P=0·037). The increase in haematocrit level from baseline to post-intervention was also significantly higher in the vitamin D group (42·0 (sd 3·0) to 43·8 (sd 3·4) %) compared with the placebo group (41·2 (sd 4·3) to 40·7 (sd 3·6) %) (P=0·032). Despite the non-significant changes in plasma ferritin concentration, this study demonstrates that 38 µg supplemental vitamin D, consumed daily, with Fe-fortified breakfast cereal led to improvement in Hb concentration and haematocrit levels in women with low Fe stores. These findings may have therapeutic implications in the recovery of Fe status in Fe-deficient populations at a healthcare level.
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Deane S, Schroth RJ, Sharma A, Rodd C. Combined deficiencies of 25-hydroxyvitamin D and anemia in preschool children with severe early childhood caries: A case-control study. Paediatr Child Health 2018; 23:e40-e45. [PMID: 29769814 PMCID: PMC5951085 DOI: 10.1093/pch/pxx150] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Severe early childhood caries (S-ECC) is common and has adverse affects on children's health. Children with S-ECC have been shown to have anemia or vitamin D deficiency. No studies have assessed the presence of combined deficiencies with S-ECC. The purpose of our study was to examine whether those with S-ECC had a higher prevalence of combined anemia and low 25-hydroxyvitamin D (25(OH)D) compared to controls. Covariates associated with elevated parathyroid hormone (PTH), previously noted in S-ECC, were examined. METHODS This is a re-analyses of a previously described cross-sectional case-control study; data were collected between 2009 and 2011. Children with S-ECC were recruited on the day of dental surgery and controls from the community. Blood was drawn for complete blood count, ferritin, 25(OH)D and PTH. Families completed a questionnaire. RESULTS A total of 266 children participated (S-ECC n=144); the mean age was 40.8 ± 14.1 months. Children with S-ECC were more likely to have low 25(OH)D, hemoglobin, elevated PTH or iron-deficiency anemia compared to controls. Significant differences between groups were seen for a combined deficiency of low hemoglobin (<110 g/L) and 25(OH)D < 50 nmol/L; controls 0/114 versus S-ECC 15/140 (P<0.001). In an adjusted regression model, PTH was negatively associated with 25(OH)D (P<0.001) and higher income (P<0.02); it was positively associated with less regular milk consumption (P=0.001). CONCLUSIONS Combined deficiencies of vitamin D and anemia are more prevalent in children with S-ECC; the etiology remains unclear. A detailed diet history is key in those with S-ECC to assess risks for deficiencies.
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Affiliation(s)
- Shannon Deane
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Robert J Schroth
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
- Department of Preventive Dental Science, College of Dentistry, University of Manitoba, Winnipeg, Manitoba
| | - Atul Sharma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba
| | - Celia Rodd
- Section of Pediatric Endocrinology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
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11
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Murphy HJ, Cahill JB, Twombley KE, Kiger JR. Early Continuous Renal Replacement Therapy Improves Nutrition Delivery in Neonates During Extracorporeal Life Support. J Ren Nutr 2017; 28:64-70. [PMID: 28964639 DOI: 10.1053/j.jrn.2017.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Optimizing nutrition in neonatal patients as soon as possible after extracorporeal life support (ECLS) initiation is imperative as malnutrition can worsen both short- and long-term outcomes. Fluid restriction, used to manage the fluid overload that commonly complicates neonatal ECLS, severely impairs nutrition delivery. Continuous renal replacement therapy (CRRT) can be used to help manage fluid overload. We hypothesize that early CRRT utilization ameliorates the need for fluid restriction and allows providers to prescribe higher parenteral nutrition (PN) volumes leading to better nutrition delivery. DESIGN The design of the study was a retrospective chart review, and the setting was a single, level III neonatal intensive care unit. SUBJECTS Neonatal patients (n = 42) treated with ECLS between January 1, 2008, and December 31, 2013. INTERVENTIONS Comparisons were made between 2 groups: neonates who received ECLS without early CRRT initiation (group 1; n = 23) and with early CRRT initiation (group 2; n = 19). MAIN OUTCOME MEASURES The main outcome measures were goal total fluid intake, prescribed PN volume, protein, glucose infusion rate, intralipid, and kilocalories. RESULTS Infants who received early CRRT were prescribed higher mean total fluid intake goals (group 1: 99 mL/kg/day vs. group 2: 119 mL/kg/day, P < .001) and higher mean volumes of PN (group 1: 61 mL/kg/day vs. group 2: 81 mL/kg/day, P < .001) over the first 72 hours of ECLS compared with infants who did not receive early CRRT. Early CRRT receivers also were prescribed greater mean amounts of protein during the first 72 hours of ECLS (group 1: 2.7 g/kg/day vs. group 2: 3 g/kg/day, P = 0.03). There were no significant changes noted in prescribed glucose infusion rates, intralipid, or total kilocalories. CONCLUSIONS Institution of early CRRT in neonates on ECLS allows for administration of greater volumes of PN with improved protein delivery. This study characterizes one benefit of early CRRT initiation in neonates on ECLS and suggests these patients could experience improved nutritional outcomes.
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Affiliation(s)
- Heidi J Murphy
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
| | - John B Cahill
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Katherine E Twombley
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - James R Kiger
- Division of Neonatal Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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12
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Uwaezuoke SN. Vitamin D deficiency and anemia risk in children: a review of emerging evidence. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:47-55. [PMID: 29388633 PMCID: PMC5774601 DOI: 10.2147/phmt.s129362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There has been renewed scientific interest in the sequelae of vitamin D deficiency, given the emerging evidence on the diverse biologic functions of vitamin D, besides its fundamental role in bone and mineral metabolism. For the past decade, the evidence in the medical literature pointing to a relationship between anemia risk and vitamin D deficiency has been accumulating. This paper critically reviews the current evidence linking vitamin D deficiency to anemia risk in children. The synthesized evidence indicates that the studies, which were preponderantly conducted among the adult population, not only reported a bidirectional relationship between vitamin D deficiency and anemia but also showed a racial effect. In studies conducted among children, similar results were reported. Although the causal association of vitamin D deficiency with anemia risk (especially iron-deficiency anemia) remains debatable, the noncalcemic actions of the vitamin and its analogs hold prospects for several novel clinical applications. There is, however, unanimity in many reports suggesting that vitamin D deficiency is directly associated with anemia of chronic disease or inflammation. Despite the advances in unraveling the role of vitamin D in iron homeostasis, further research is still required to validate causality in the relationship between vitamin D deficiency and anemia, as well as to determine its optimal dosing, the ideal recipients for therapeutic intervention, and the preferred analogs to administer.
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Affiliation(s)
- Samuel N Uwaezuoke
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka.,Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
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13
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Akkermans MD, Eussen SR, van der Horst-Graat JM, van Elburg RM, van Goudoever JB, Brus F. A micronutrient-fortified young-child formula improves the iron and vitamin D status of healthy young European children: a randomized, double-blind controlled trial. Am J Clin Nutr 2017; 105:391-399. [PMID: 28052885 DOI: 10.3945/ajcn.116.136143] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 12/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) and vitamin D deficiency (VDD) are common among young European children because of low dietary intakes and low compliance to vitamin D supplementation policies. Milk is a common drink for young European children. Studies evaluating the effect of milk fortification on iron and vitamin D status in these children are scarce. OBJECTIVE We aimed to investigate the effect of a micronutrient-fortified young-child formula (YCF) on the iron and vitamin D status of young European children. DESIGN In this randomized, double-blind controlled trial, healthy German, Dutch, and English children aged 1-3 y were allocated to receive either YCF (1.2 mg Fe/100 mL; 1.7 μg vitamin D/100 mL) or nonfortified cow milk (CM) (0.02 mg Fe/100 mL; no vitamin D) for 20 wk. Blood samples were taken before and after the intervention. The primary and secondary outcomes were change from baseline in serum ferritin (SF) and 25-hydroxyvitamin D [25(OH)D], respectively. ID was defined as SF <12 μg/L in the absence of infection (high-sensitivity C-reactive protein <10 mg/L) and VDD as 25(OH)D <50 nmol/L. Statistical adjustments were made in intention-to-treat analyses for sex, country, age, baseline micronutrient status, and micronutrient intake from food and supplements (and sun exposure in the case of vitamin D outcomes). RESULTS The study sample consisted of 318 predominantly Caucasian (∼95%) children. The difference in the SF and 25(OH)D change between the treatment groups was 6.6 μg/L (95% CI: 1.4, 11.7 μg/L; P = 0.013) and 16.4 nmol/L (95% CI: 9.5, 21.4 nmol/L; P < 0.001), respectively. The probability of ID (OR 0.42; 95% CI:0.18, 0.95; P = 0.036) and VDD (OR 0.22; 95% CI: 0.01, 0.51; P < 0.001) after the intervention was lower in the YCF group than in the CM group. CONCLUSION Micronutrient-fortified YCF use for 20 wk preserves iron status and improves vitamin D status in healthy young children in Western Europe. This trial was registered at www.trialregister.nl as NTR3609.
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Affiliation(s)
- Marjolijn D Akkermans
- Department of Pediatrics, Juliana Children's Hospital/Haga Teaching Hospital, The Hague, Netherlands;
| | | | | | - Ruurd M van Elburg
- Danone Nutricia Research, Utrecht, Netherlands.,Department of Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; and
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; and.,Department of Pediatrics, VU University Medical Center, Amsterdam, Netherlands
| | - Frank Brus
- Department of Pediatrics, Juliana Children's Hospital/Haga Teaching Hospital, The Hague, Netherlands
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14
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Nielsen NO, Bjerregaard P, Rønn PF, Friis H, Andersen S, Melbye M, Lundqvist M, Cohen AS, Hougaard DM, Jørgensen ME. Associations between Vitamin D Status and Type 2 Diabetes Measures among Inuit in Greenland May Be Affected by Other Factors. PLoS One 2016; 11:e0152763. [PMID: 27073876 PMCID: PMC4830590 DOI: 10.1371/journal.pone.0152763] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/18/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Epidemiological studies have provided evidence of an association between vitamin D insufficiency and type 2 diabetes. Vitamin D levels have decreased among Inuit in Greenland, and type 2 diabetes is increasing. We hypothesized that the decline in vitamin D could have contributed to the increase in type 2 diabetes, and therefore investigated associations between serum 25(OH)D3 as a measure of vitamin D status and glucose homeostasis and glucose intolerance in an adult Inuit population. METHODS 2877 Inuit (≥18 years) randomly selected for participation in the Inuit Health in Transition study were included. Fasting- and 2hour plasma glucose and insulin, C-peptide and HbA1c were measured, and associations with serum 25(OH)D3 were analysed using linear and logistic regression. A subsample of 330 individuals who also donated a blood sample in 1987, were furthermore included. RESULTS After adjustment, increasing serum 25(OH)D3 (per 10 nmol/L) was associated with higher fasting plasma glucose (0.02 mmol/L, p = 0.004), 2hour plasma glucose (0.05 nmol/L, p = 0.002) and HbA1c (0.39%, p<0.001), and with lower beta-cell function (-1.00 mmol/L, p<0.001). Serum 25(OH)D3 was positively associated with impaired fasting glycaemia (OR: 1.08, p = 0.001), but not with IGT or type 2 diabetes. CONCLUSIONS Our results did not support an association between low vitamin D levels and risk of type 2 diabetes. Instead, we found weak positive associations between vitamin D levels and fasting- and 2hour plasma glucose levels, HbA1c and impaired fasting glycaemia, and a negative association with beta-cell function, underlining the need for determination of the causal relationship.
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Affiliation(s)
- Nina O Nielsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Greeenland Centre for Health Research, University of Greenland, Nuuk, Greenland
| | - Pernille F Rønn
- Steno Diabetes Centre, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marika Lundqvist
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Arieh S Cohen
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - David M Hougaard
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Centre, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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15
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Iron and Vitamin D Deficiency in Healthy Young Children in Western Europe Despite Current Nutritional Recommendations. J Pediatr Gastroenterol Nutr 2016; 62:635-42. [PMID: 26488124 DOI: 10.1097/mpg.0000000000001015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Iron deficiency (ID) and vitamin D deficiency (VDD) are the 2 most common micronutrient deficiencies in young children worldwide and may lead to impaired neurodevelopment and rickets, respectively. Risk factors for ID and VDD differ between populations. The objective of this study was to determine the prevalence of and risk factors for ID and VDD in 12- to 36-month-old children in Western Europe. METHODS This study took place in Germany, the Netherlands, and the United Kingdom from 2012 to 2014. A venous blood sample was taken to establish iron and vitamin D status. ID was defined as serum ferritin <12 μg/L in the absence of infection (high sensitivity C-reactive protein <10 mg/L). VDD was defined as serum 25-hydroxyvitamin D <50 nmol/L (20 ng/mL). Furthermore, parents were asked to fill out a questionnaire regarding their child's demographic- and socioeconomic characteristics, food intake, sun exposure, and medical history. RESULTS In 325 children (white race 95%, boys 56%, mean age 20.7 months) the overall prevalence of ID and VDD was 11.8% and 22.8%, respectively. The use of primarily cow's milk as major type of milk was associated with ID (odds ratio [OR] 3.20, 95% confidence interval [CI] 1.12-8.53) and VDD (OR 7.17, 95% CI 3.10-16.57). The use of vitamin D supplements (OR 0.20, 95% CI 0.07-0.56) was associated with a lower prevalence of VDD. CONCLUSION Despite current nutritional recommendations, ID and VDD are common in healthy young white children. Health programs focusing on adequate iron and vitamin D intake at an early age should be implemented to prevent deficiencies.
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16
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Suh YJ, Lee JE, Lee DH, Yi HG, Lee MH, Kim CS, Nah JW, Kim SK. Prevalence and Relationships of Iron Deficiency Anemia with Blood Cadmium and Vitamin D Levels in Korean Women. J Korean Med Sci 2016; 31:25-32. [PMID: 26770034 PMCID: PMC4712576 DOI: 10.3346/jkms.2016.31.1.25] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/02/2015] [Indexed: 12/22/2022] Open
Abstract
Anemia, iron deficiency (ID), and iron deficiency anemia (IDA) are common disorders. This study was undertaken to determine the prevalence of anemia, ID, and IDA in Korean females. We examined the associations between IDA, heavy metals in blood, vitamin D level and nutritional intakes. The study was performed using on data collected from 10,169 women (aged ≥ 10 yr), including 1,232 with anemia, 2,030 with ID, and 690 with IDA during the fifth Korea National Health and Nutrition Examination Survey (KNHANES V; 2010-2012). Prevalence and 95% confidence intervals were calculated, and path analysis was performed to identify a multivariate regression model incorporating IDA, heavy metals in blood, vitamin D level, and nutritional intakes. The overall prevalence of anemia, ID and IDA was 12.4%, 23.11%, and 7.7%, respectively. ID and IDA were more prevalent among adolescents (aged 15-18 yr; 36.5% for ID; 10.7% for IDA) and women aged 19-49 yr (32.7% for ID; 11.3% for IDA). The proposed path model showed that IDA was associated with an elevated cadmium level after adjusting for age and body mass index (β=0.46, P<0.001). Vitamin D levels were found to affect IDA negatively (β=-0.002, P<0.001). This study shows that the prevalence of anemia, ID, and IDA are relatively high in late adolescents and women of reproductive age. Path analysis showed that depressed vitamin D levels increase the risk of IDA, and that IDA increases cadmium concentrations in blood. Our findings indicate that systematic health surveillance systems including educational campaigns and well-balanced nutrition are needed to control anemia, ID, and IDA.
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Affiliation(s)
- Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Korea
| | - Ji Eun Lee
- Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea
| | - Dae Hyung Lee
- Future Strategy Team, Inha University Hospital, Incheon, Korea
| | - Hyeon Gyu Yi
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Moon Hee Lee
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Chul Soo Kim
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Jeung Weon Nah
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea
| | - Soon Ki Kim
- Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea
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17
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Chandyo RK, Henjum S, Ulak M, Thorne-Lyman AL, Ulvik RJ, Shrestha PS, Locks L, Fawzi W, Strand TA. The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal. Eur J Clin Nutr 2015; 70:456-62. [PMID: 26626049 PMCID: PMC4827010 DOI: 10.1038/ejcn.2015.199] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 12/02/2022]
Abstract
Background/Objectives: Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal. Subjects/Methods: In a cross-sectional survey, we randomly selected 500 mother–infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein. Results: The altitude-adjusted prevalence of anemia was 49% among infants 2–6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7–12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 μg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations. Conclusions: Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.
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Affiliation(s)
- R K Chandyo
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - S Henjum
- Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - M Ulak
- Department of Child Health, Institute of Medicine, Kathmandu, Nepal
| | - A L Thorne-Lyman
- WorldFish, Malaysia, Bayan Lepas, Malaysia.,Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - R J Ulvik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - P S Shrestha
- Department of Child Health, Institute of Medicine, Kathmandu, Nepal
| | - L Locks
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - W Fawzi
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.,Department of Epidemiology and Global Health and Population, Harvard School of Public Health
| | - T A Strand
- Centre for International Health, University of Bergen, Bergen, Norway.,Innlandet Hospital Trust, Lillehammer, Norway
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18
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Wang J, Wang H, Chang S, Zhao L, Fu P, Yu W, Man Q, Scherpbier R, Pan L, Duan Y, Yin SA. The Influence of Malnutrition and Micronutrient Status on Anemic Risk in Children under 3 Years Old in Poor Areas in China. PLoS One 2015; 10:e0140840. [PMID: 26488490 PMCID: PMC4619061 DOI: 10.1371/journal.pone.0140840] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition and anemia affect large numbers of young children living in poor areas of China. Multi-micronutrient deficiencies may be related to the prevalence of anemia in different populations, and identifying the risk factors that render children susceptible to anemia is the first step in combating anemia effectively. METHODS In this cross-sectional study, a total of 1370 children under 3 years old were selected based on probability proportional to size sampling principles from poor counties of China. Basic characteristics data were collected by questionnaire; then anthropometrics and hemoglobin were measured in the field and anemia prevalence evaluated. Venous blood was drawn from children aged 12-35 months (N = 553) to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia. RESULTS Among children aged 0-35 months, the prevalence of stunting, low body weight and wasting was 17.5%, 8.6% and 5.1%, respectively, and 25.6% of the children were affected by anemia, with more anemic infants and younger children than older children (P <0.01). There were 26.5%, 12.8%, 14.1% and 20.0% of the children aged 12-35 months affected by iron deficiency, vitamin D deficiency, folic acid deficiency and vitamin B12 deficiency, respectively. For children aged 0-11 months who were breastfed, the mothers' anemic status was the only factor associated with the child's anemia (OR = 2.6; 95% CI: 1.2-5.4, P < 0.05). For children aged 12-35 months, multivariate logistic regression indicated that anemia was significantly associated with iron and vitamin B12 deficiency (OR = 5.3; 95% CI: 1.9-14.5, P < 0.01) and monotonous diet (OR = 2.3; 95% CI: 1.1-4.7, P < 0.05) after adjusting for age and gender. CONCLUSION The prevalence of anemia was higher in children under 2 years old and requires urgent intervention. An effective intervention strategy should include iron and vitamin B12 supplements, improving dietary diversity and controlling breastfeeding mothers' anemia.
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Affiliation(s)
- Jie Wang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Wang
- Department of Population Research, China Population and Development Research Center, Beijing, China
| | - Suying Chang
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Liyun Zhao
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ping Fu
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wentao Yu
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingqing Man
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Robert Scherpbier
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Lili Pan
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yifan Duan
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shi-an Yin
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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19
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Kang YS, Kim JH, Ahn EH, Yoo EG, Kim MK. Iron and vitamin D status in breastfed infants and their mothers. KOREAN JOURNAL OF PEDIATRICS 2015; 58:283-7. [PMID: 26388892 PMCID: PMC4573441 DOI: 10.3345/kjp.2015.58.8.283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/11/2014] [Accepted: 10/21/2014] [Indexed: 12/28/2022]
Abstract
Purpose We assessed the relationships between iron and vitamin D statuses in breastfed infants and their mothers and evaluated the determinants of iron and vitamin D deficiencies in breastfed infants. Methods Seventy breastfed infants aged 4-24 months and their mothers participated in this study from February 2012 to May 2013. Complete blood counts, total iron binding capacity, and levels of C-reactive protein, iron, ferritin, calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D (25(OH)D) in infants and their mothers were measured. Results A history of maternal prepregnancy anemia was associated with lower ferritin and 25(OH)D levels in both infants and their mothers. The 25(OH)D level of infants correlated with maternal 25(OH) D levels. The independent risk factors for iron deficiency in breastfed infants were the duration of breastfeeding (odds ratio [OR], 6.54; 95% confidence interval [CI], 1.09-39.2; P=0.04) and infant body weight (OR, 2.65; 95% CI, 1.07-6.56; P=0.04). The determinants for vitamin D deficiency were the infant's age (OR, 0.15; 95% CI, 0.02-0.97; P=0.046) and maternal 25(OH)D level (OR, 0.74; 95% CI, 0.59-0.92; P=0.01). Conclusion A maternal history of prepregnancy anemia requiring iron therapy was associated with lower current ferritin and 25(OH)D levels in both infants and their mothers. Therefore, physicians should monitor not only iron but also vitamin D levels in infants who are breastfed by mothers who had prepregnancy anemia.
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Affiliation(s)
- Yu Sun Kang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Joon Hwan Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Hee Ahn
- Department of Obstetrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun-Gyong Yoo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Moon Kyu Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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20
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Chandyo RK, Ulak M, Adhikari RK, Sommerfelt H, Strand TA. Prevalence of Iron Deficiency and Anemia among Young Children with Acute Diarrhea in Bhaktapur, Nepal. Healthcare (Basel) 2015; 3:593-606. [PMID: 27417782 PMCID: PMC4939584 DOI: 10.3390/healthcare3030593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 06/26/2015] [Accepted: 07/14/2015] [Indexed: 11/21/2022] Open
Abstract
Iron deficiency anemia is still common in children under five years of age and may impair their growth and cognitive development. Diarrhea is the second most common reason for seeking medical care for young children in Nepal. However, neither screening programs nor effective preventive measures for anemia and iron deficiencies are in place among children with diarrhea in many developing countries. The aims of this study were to determine the prevalence of anemia and iron deficiency and explore their associations with clinical, socioeconomic, and anthropometric parameters in Nepalese children. This was a cross-sectional study based on 1232 children, six to 35 months old, with acute diarrhea participating in a zinc supplementation trial. The mean (SD) hemoglobin was 11.2 g/dL (1.2). Anemia was found in 493 children (40%); this estimate increased to 641 (52%) when we adjusted for the altitude of the study area (hemoglobin <11.3 g/dL). One in every three children had depleted iron stores and 198 (16%) of the children had both depleted iron stores and anemia, indicating iron deficiency anemia. The prevalence of anemia among children presenting with acute diarrhea was high but the degree of severity was mainly mild or moderate. Iron deficiency explained less than half of the total anemia, indicating other nutritional deficiencies inducing anemia might be common in this population.
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Affiliation(s)
- Ram K Chandyo
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
- Community Medicine Department, Kathmandu Medical College, Kathmandu University, Kathmandu P.O. Box 21266, Nepal.
| | - Manjeswori Ulak
- Department of Child Health, Institute of Medicine, Kathmandu P.O. Box 1524, Nepal.
| | - Ramesh K Adhikari
- Department of Pediatrics, Kathmandu Medical College, Kathmandu University, Kathmandu P.O. Box 21266, Nepal.
| | - Halvor Sommerfelt
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
| | - Tor A Strand
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
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The Role of 25-Hydroxy Vitamin D Deficiency in Iron Deficient Children of North India. Indian J Clin Biochem 2014; 30:313-7. [PMID: 26089618 DOI: 10.1007/s12291-014-0449-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
Extensive data from animal and human studies indicate a role of vitamin D in erythropoiesis. Iron and vitamin D deficiencies are implicated with adverse health effects in children even if they are asymptomatic. The potential relationship between the two remains poorly understood. A cross-sectional study was performed in the period from 1st May 2012 through 30th April 2013 and subjects were classified into vitamin D deficiency (VDD), vitamin D insufficiency (VDI) and vitamin D sufficiency (VDS) groups according to their 25(OH) D levels. A total of 263 children were included in the analysis. Anaemia was present in 66 % of 25(OH) D deficient subjects compared with 35 % in vitamin D sufficient individuals (p < 0.0001). The association of breast feeding and development of VDD was also significant (p < 0.05). Serum levels of 25(OH) D were found lower in female sex and if the analysis was performed in the winter/spring season. Physicians should therefore assess vitamin D levels in all anaemic children and ensure adequate supplementation to prevent deficiencies.
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Yoo EH, Cho HJ. Prevalence of 25-hydroxyvitamin D deficiency in Korean patients with anemia. J Clin Lab Anal 2014; 29:129-34. [PMID: 24797104 DOI: 10.1002/jcla.21740] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 01/08/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We investigated the prevalence and risk factors for vitamin D deficiency in Korean patients with anemia. METHODS We included 200 anemic patients and 300 controls. Anemia was defined according to the WHO criteria. Serum 25-hydroxyvitamin D [25(OH)D] was measured using an electrochemiluminescence immunoassay. We compared serum 25(OH)D levels based on the presence and subtypes of anemia. RESULTS We found that 91% (182/200) and 87.3% (262/300) of patients exhibited 25(OH)D inadequacies (<20 ng/ml) in the anemic (median hemoglobin (Hb), 9.6 g/dl) and control groups (median Hb 13.8 g/dl), respectively. The prevalence of 25(OH)D deficiency (<12 ng/ml) was significantly higher in the anemic group than in the control group (52.5% (105/200) vs. 25% (75/300), P < 0.0001), with an odds ratio of 3.316 (95% CI, 2.265-4.854; P < 0.0001). The prevalence of 25(OH)D deficiency was not different among anemia subtypes. Female gender and high C-reactive protein (CRP) were associated with vitamin D deficiency in anemic group. CONCLUSIONS This study demonstrates that vitamin D deficiency is associated with anemia. Therefore, the measurement of serum 25(OH)D levels and appropriate vitamin D supplementation should be considered in anemic patients, particularly in females and patients with high CRP level.
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Affiliation(s)
- Eun-Hyung Yoo
- Department of Laboratory Medicine, Konyang University Hospital, Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Korea
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Nakavachara P, Viprakasit V. Children with hemoglobin E/β-thalassemia have a high risk of being vitamin D deficient even if they get abundant sun exposure: a study from Thailand. Pediatr Blood Cancer 2013; 60:1683-8. [PMID: 23733667 DOI: 10.1002/pbc.24614] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/02/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vitamin D is a key component in calcium homeostasis, bone mineralization and immune function, and people with a vitamin D deficiency may therefore be at higher risk of osteoporosis, osteopenia, delayed growth and fractures. Vitamin D deficiency is a known clinical complication of patients with β-thalassemia major; however, as yet there are limited data on the vitamin D status of patients with Hb E/β-thalassemia. Hb E/β-thalassemia is characterized by a wide clinical heterogeneity ranging from non-transfusion dependency to transfusion dependency. Because patients with Hb E/β-thalassemia are so clinically diverse, the prevalence of vitamin D deficiency might differ among Hb E/β-thalassemia patients. PROCEDURE We investigated the vitamin D status of 109 children with Hb E/β-thalassemia who attended the Pediatric Hematology Clinic at the Siriraj Hospital in Bangkok, Thailand, from April 2009 to March 2010. RESULTS Forty-nine of the children were classified as transfusion-dependent (TD) and the remainder (n = 60) as non-transfusion-dependent (NTD). Only 10.1% of the children in our study had normal vitamin D levels, despite Thailand's geographic position 15° N and 100° E and climate, which provides abundant sunlight exposure and therefore efficient vitamin D synthesis. In addition, NTD children were significantly more likely to be vitamin D deficient than TD children (P = 0.01). CONCLUSIONS Our results highlight the importance of monitoring serum vitamin D levels in children with Hb E/β-thalassemia regardless of their clinical severity or the amount of sunlight they are exposed to.
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Affiliation(s)
- Pairunyar Nakavachara
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Shin YH, Shin HJ, Lee YJ. Vitamin D status and childhood health. KOREAN JOURNAL OF PEDIATRICS 2013; 56:417-23. [PMID: 24244209 PMCID: PMC3827489 DOI: 10.3345/kjp.2013.56.10.417] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/20/2013] [Indexed: 02/06/2023]
Abstract
Vitamin D is an essential component of bone and mineral metabolism; its deficiency causes growth retardation and skeletal deformities in children and osteomalacia and osteoporosis in adults. Hypovitaminosis D (vitamin D insufficiency or deficiency) is observed not only in adults but also in infants, children, and adolescents. Previous studies suggest that sufficient serum vitamin D levels should be maintained in order to enhance normal calcification of the growth plate and bone mineralization. Moreover, emerging evidence supports an association between 25-hydroxyvitamin D (25[OH]D) levels and immune function, respiratory diseases, obesity, metabolic syndrome, insulin resistance, infection, allergy, cancers, and cardiovascular diseases in pediatric and adolescent populations. The risk factors for vitamin D insufficiency or deficiency in the pediatric population are season (winter), insufficient time spent outdoors, ethnicity (non-white), older age, more advanced stage of puberty, obesity, low milk consumption, low socioeconomic status, and female gender. It is recommended that all infants, children, and adolescents have a minimum daily intake of 400 IU (10 µg) of vitamin D. Since the vitamin D status of the newborn is highly related to maternal vitamin D levels, optimal vitamin D levels in the mother during pregnancy should be maintained. In conclusion, given the important role of vitamin D in childhood health, more time spent in outdoor activity (for sunlight exposure) and vitamin D supplementation may be necessary for optimal health in infants, children, and adolescents.
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Affiliation(s)
- Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Hye Jung Shin
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Jin HJ, Lee JH, Kim MK. The prevalence of vitamin D deficiency in iron-deficient and normal children under the age of 24 months. Blood Res 2013; 48:40-5. [PMID: 23589794 PMCID: PMC3624995 DOI: 10.5045/br.2013.48.1.40] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/24/2012] [Accepted: 02/13/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Iron and vitamin D deficiencies cause a variety of health issues in children, which might have long-lasting effects even in asymptomatic cases. The present study sought to elucidate the potential association between iron status and serum vitamin D levels in infants. METHODS We evaluated 102 infants aged 3-24 months who visited the CHA Bundang Medical Center from August 2010 to July 2011. Questionnaire and laboratory data were collected. The infants were classified into iron deficiency anemia (IDA), iron deficiency (ID), and normal groups according to hemoglobin (Hb) and ferritin levels. They were then classified into vitamin D deficiency (VDD), vitamin D insufficiency (VDI), and vitamin D sufficiency (VDS) groups according to 25-hydroxyvitamin D [25(OH)D] levels. RESULTS VDD was present in 67% of IDA, 53% of ID, and 29% of normal subjects. The proportion of breastfed infants was the highest in the IDA (97%) and VDD (96%) groups. The odds ratio for the likelihood of iron-deficient infants to have subnormal vitamin D levels was 4.115. There was a significant correlation between Hb and 25(OH)D levels. Plasma 25(OH)D levels were lower in the winter/spring. Body mass index values were higher in the IDA/ID groups. Iron, age, and season were predictors of 25(OH)D levels. CONCLUSION The prevalence of iron and vitamin D deficiency was high in breastfed infants. There was also a significant association between Hb and 25(OH)D levels in infants. Since all breastfed infants should receive vitamin D supplementation, there should also be concern about concurrent deficiencies in infants with IDA.
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Affiliation(s)
- Hyun Joo Jin
- Department of Pediatrics, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
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