Vitamin D deficiency in children living in Jeddah, Saudi Arabia

Clinical Characteristics and Outcomes of Limb Fractures in Saudi Children

BACKGROUND

 Children's bones are at high risk of fracture as they grow. The clinical characteristics of fractures in children differ from those in adults. Studying fractures in healthy children is critical for identifying cases of fragility fractures. The aim of this study was to assess the clinical characteristics of limb fractures as well as clinical indicators of fracture healing outcomes in healthy Saudi children seen in an emergency room.

METHODS

A retrospective review of the treatment course of all pediatric fractures and related factors treated at King Abdullah Specialist Children's Hospital (KASCH) in Riyadh between 2016 and 2018 was conducted. Children with a primary bone disorder or chronic comorbidities known to affect bone health were excluded.

RESULTS

 The study included 143 patients (mean age ± SD = 8.23 + 3.76 years), and 71% (n = 102) were males. Motor vehicle accidents (MVAs) were the most common mechanism of injury, accounting for 50 (35%) cases, followed by fall injuries, sports injuries, and pedestrian accidents at 45 (31.4%), 16 (11.2%), and 13 (9.1%), respectively. A total of 178 fractures were reported, with the femur (n = 75, 42.1%) being the most common of the reported fracture sites, followed by the forearm (n = 44, 24.7%). The most common type of fracture was transverse fracture (n = 96, 54% of patients). Vitamin D levels were measured in 53/143 cases. Of these, vitamin D deficiency was found in 38 (71.7%) patients. The average time for fracture healing was 32.9 ± 30.2 weeks. The mechanisms of injury, including MVAs and sports injuries, as well as femur and forearm fractures, were clinical factors that were independently associated with a longer duration of fracture healing time (p < 0.001), but age, gender, and vitamin D status were not associated with that outcome.

CONCLUSION

 MVAs and fall injuries were the most common causes of fracture in our patients. MVAs and sports injuries were associated with prolonged healing time. Large prospective, multicenter, or field studies may be required to further explore clinical characteristics, outcomes, and environmental factors.

Seasonal Variations in 25-Hydroxyvitamin D Levels among Pediatric Patients Attending the Healthcare Centre

Vitamin D plays an essential role in maintaining bone density, building the immune system, and regulating cell growth alongside other key biological functions. Limited data are available about the seasonal variation in vitamin D levels in the pediatric population in Saudi Arabia. This study aimed to investigate the seasonal influence on the pediatric circulating levels of 25(OH)D. A total of 1790 pediatric outpatients who visited the University healthcare centre were included in this study. Overall, there was a noticeably high prevalence (69%) of both combined 25(OH)D deficiency and insufficiency. The highest mean serum concentration of 25(OH)D was recorded in summer (29 ng/mL) and autumn (27 ng/mL). The deficient and insufficient categories were predominant, accounting for 33% and 36%, respectively. Comparable patterns were recorded during autumn, winter, and spring. Interestingly, the 25(OH)D level was significantly associated with the four seasons (p = 0.001), with females having a higher prevalence of 25(OH)D deficiency in the spring and summer than males. Furthermore, only in autumn and winter, we found a significant association between gender and 25(OH)D status (p < 0.001 for both). Another association between nationality and the circulating levels 25(OH)D was found during autumn and winter (p < 0.001 and p = 0.01), respectively. In all seasons, age had a negative impact on serum (OH)D levels. However, this relationship was statistically significant (p < 0.05) only in summer, autumn, and winter. Gender was a significant predictor, with 25(OH)D levels in autumn and winter and an odds ratio of 1.67 in autumn and 2 in winter, indicating that being men had a positive influence on circulating 25(OH)D levels. There were highly significant differences in 25(OH)D concentrations among different age categories. The Saudi population experiences low levels of vitamin D, particularly in autumn and winter periods. This study showed that seasonality, age category, nationality, and gender influence vitamin D status, suggesting the need for tailored intervention and monitoring of 25(OH)D status to reach adequate levels of vitamin D. Healthcare practitioners and policymakers may consider the interplay between age, nationality, gender, and seasonal variations when addressing vitamin D status and a targeted supplementation approach for high-risk groups that may develop health issues.

Relationship of Vitamin-D Deficiency with Kidney Disease in Patients with Type-2 Diabetes Mellitus (T2DM) in the Makkah Region: A Cross-Sectional Study

Aim

Vitamin D deficiency is linked with type 2 diabetes mellitus (T2DM) and the occurrence of complications in patients with type 2 diabetes mellitus. None of the studies have focused on the association between vitamin D levels in patients with type 2 diabetes mellitus and diabetic nephropathy (DN) in the Makkah region, Saudi Arabia. Hence, the purpose of this study is to investigate the relationship of vitamin D with kidney disease in patients with T2DM in the Makkah region, of Saudi Arabia.

Materials and Methods

This descriptive cross-sectional study was conducted at different hospitals in the Makkah region on T2DM patients from 2021 to 2022. In total, 328 patients with confirmed diabetes were enrolled in this study. T2DM patients over the aged>18 to 92 years were included in the study. General laboratory characteristics of the study population were measured, including fasting blood sugar, HbA1C (Glycated hemoglobin), vitamin D, kidney function (BUN-Blood urea nitrogen and creatinine), and lipid profiles (cholesterol, triglycerides, LDL-Low density lipoprotein, and HDL-High density lipoprotein).

Results

46.6% (n=153) of participants had normal serum vitamin D levels. Insufficient and deficient serum vitamin D level were observed in 43.9% (n=144) and 9.5% (n=31) of participants, respectively. Of the participants, 25.9% (n=85) had good glycemic control (<7.0%). Moderate and poor glycemic control were observed in 39.9% (n=131) and 34.1% (n=112) of the participants, respectively. A significant negative correlation (p<0.5) was found between vitamin D levels and kidney function test results (blood urea nitrogen and serum creatinine levels). An inverse relationship was observed between HbA1c levels and vitamin D deficiency.

Conclusion

Nephropathy is more likely to develop in people with type 2 diabetes mellitus and vitamin D deficiency.

Vitamin D-A Risk Factor for Bone Fractures in Children: A Population-Based Prospective Case-Control Randomized Cross-Sectional Study

BACKGROUND

Vitamin D is an essential component in calcium metabolism. Seasonality, advanced age, sex, dark skin pigmentation, and limited exposure to sunlight were reported as causes of vitamin D deficiency. This study aims to determine whether children with lower levels of vitamin D suffer more fractures than those with sufficient levels.

MATERIALS AND METHODS

Our institution underwent a prospective case-control randomized cross-sectional single-blinded study that included 688 children. They were split into two groups: the study group and the control group. The study group received supplements of vitamin D and calcium for 6 months. Another reference cohort was observed, which comprised 889 patients in the pediatric ward for different respiratory or gastroenterological conditions without a history of fractures. This group was used for age-sex matching tests.

RESULTS

Logistic regression showed that with every one unit increase of vitamin D level, the chance of having a middle third fracture in both bones of the forearm decreased by 7% (OR 1.07); distal third fracture incidence decreased by 1.03 times; middle third radius fracture incidence decreased by 1.03 times; distal third radius fracture incidence decreased by 1.06 times. The risk of having a distal third both-bone forearm fracture increased by 1.06 times with every year of age. Comparing the healing process, we noticed an improvement in bony callus formation for patients in the study group.

CONCLUSIONS

Dosing the serum level of 25-OH-vitamin D should be taken into consideration for pediatric low-energy trauma fractures. Supplementing with vitamin D and calcium throughout childhood can be a solution for healthy bones. Our preliminary results show that the normal level of vitamin D in children should start at 40 ng/mL.

Media use, dietary intake, and diet quality of adolescents in Saudi Arabia

BACKGROUND

Excessive media use can affect diet of adolescents, but relevant data in Saudi Arabia are lacking. The present study aimed to explore the association between media use, dietary intake, and diet quality among adolescents.

METHODS

This cross-sectional study included data of 631 adolescents (ages 11-18 years) who were randomly recruited from 16 schools located in two main cities in the Western region of Saudi Arabia (Madinah and Jeddah). Envelopes including a questionnaire were sent home to collect sociodemographic data. Students then completed the short-form food frequency questionnaire to assess diet quality. Data on media use, anthropometrics, and 24-h dietary recalls were also collected.

RESULTS

A high proportion of adolescents (86.2%) exceeded media use recommendations of ≤2 h per day. Significantly higher proportions of younger adolescents, males, and non-Saudis reported media use within the recommendation compared to their peers. Media use predicted lower diet quality score (B = -0.67 [95% CI: -1.09 to -0.28]) and lower intake of calcium, zinc, vitamin D, and vitamin C (B = -104 [95% CI: -203 to -5.24], B = -2.13 [95% CI: -4.15 to -0.11], B = -23.5 [95% CI: -41.3 to -5.65], B = -24.0 [95% CI: -45.1 to -2.96], respectively).

CONCLUSION

Interventions to limit media use are urgently needed for adolescents in Saudi Arabia to improve diet quality and overall nutritional health.

IMPACT

Excessive media use can affect diet of adolescents, but relevant data are lacking in Saudi Arabia. The majority of adolescents exceed the recommendations for media use. Media use was negatively associated with diet quality and intake of calcium, zinc, vitamin D, and vitamin C. This study will inform public health entities and policy makers to draw evidence-based, culturally tailored recommendations and develop nutrition interventions to enhance diet quality and nutritional status of adolescents. Findings of this study highlight the urgency to develop intervention programs and policies that aim to limit media use among adolescents.

A Case Report of Rickets Due to Severe Nutritional Deficiencies

A 19-month-old boy presented to the general pediatric clinic with delayed development and multiple nutritional deficiencies, after being exclusively breastfed up to the age of nine months without vitamin D supplementation. Upon examination, imaging studies, and lab tests, the patient was diagnosed with nutritional rickets. The management included supplementation of cholecalciferol, ferrous sulfate, calcium carbonate, and multivitamin drops to support his diet, and was encouraged to follow a healthy balanced diet. Upon follow-up at the age of 20 months, the patient showed slight improvement and was able to walk, while at 22 months, the patient was developmentally up to age, and had a good appetite with a slight increase in weight. Despite the high incidence of nutritional deficiencies, there is still a lack of awareness and late presentations of such cases, which can lead to complications if not detected early. This case demonstrates the importance of prevention of similar cases by early education about adequate nutrition to the patients and caregivers and regular follow-ups with the general practitioner for early detection and early supplementation as required.

Association between serum vitamin D status and the anti-seizure treatment in Chinese children with epilepsy

Objective

To compare the serum 25-OH-VitD levels, the major marker of vitamin D (VitD) status, between healthy children and children with epilepsy before initiation of and during anti-seizure medications (ASMs) treatment and to evaluate the potential influence factors on 25-OH-VitD levels. Another major aim was to assess the potential role of VitD supplementation.

Methods

For comparison, we finally enrolled and collected data from 6,338 healthy children presenting to Health Care Department and 648 children visiting primary care pediatricians with symptoms of epilepsy in Children’s Hospital of Nanjing Medical University from January 2019 to June 2021. The demographic and biochemical characteristics of each child were extracted from the hospital information system.

Results

Serum 25-OH-VitD levels in 648 children with epilepsy were significantly lower than those of 6,338 healthy children (P &lt; 0.0001), and the percentage of VitD insufficiency and deficiency status in pediatric patients was 49.19%. Of note, the serum 25-OH-VitD levels in children with newly diagnosed epilepsy before receiving any ASMs treatment were also significantly lower than those in healthy controls. Interestingly, ASMs therapy, alone or in combination, did not consistently reduce baseline serum VitD levels in children with epilepsy. The lower serum VitD levels in pediatric patients than those in healthy children might be related to the disease itself, rather than the ASMs treatment. As expected, VitD supplementation substantially increased the serum 25-OH-VitD levels (P &lt; 0.0001). More critically, children with epilepsy receiving VitD supplementation achieved good seizure control in our study.

Significance

In this retrospective study, the childhood epilepsy before initiation of and during ASMs treatment decreased the serum 25-OH-VitD concentrations, suggesting a clear association between epileptic disease and the risk of VitD deficiency. ASMs coadministration and long-term valproic acid treatment did not worse VitD-deficiency status, but in the small group receiving VitD supplementation, there was a significant improvement in reduction of seizure frequency. Therefore, pediatric clinicians are urged to raise public awareness of epilepsy-associated VitD deficiency.

Vitamin D and iron deficiencies among Saudi children and adolescents: A persistent problem in the 21st century

BACKGROUND

Although several studies have reported on the prevalence of micronutrients in Saudi Arabia, most frequently vitamin D and iron, they are either old or hospital- or primary health care center-based. The objectives of our study were to provide more updated data on the prevalence rate of micronutrients deficiency among the Saudi general pediatric population and to determine if there is an association between micronutrients deficiency and undernutrition.

METHODS

The present study is part of a cross-sectional mass screening study, "Exploring the Iceberg of Celiacs in Saudi Arabia" conducted among school-aged children (6-16 years) in 2014-2015. A sample of 7,931 children aged 6-16 years was randomly selected. We identified thin children [body mass index (BMI) z-score <-2 SD, for age and gender], using the WHO reference 2007. A case-control study was performed, where the sera of 182 thin children (cases) and 393 normal BMI children (controls) were tested for levels of iron, ferritin, vitamin D, zinc, selenium, and copper.

RESULTS

The prevalence of thinness was 3.5%. The two most common micronutrients deficient among Saudi children with normal BMI were iron (20%) and vitamin D (78%). Vitamin D levels were significantly higher among boys as compared to girls (39.6 nmol/L vs. 31.15 nmol/L; P < 0.001). Deficiency of copper, zinc, and selenium occurred in 0.25%, 1%, and 7.4% of the children with normal BMI. Comparisons between the cases and controls did not show statistically significant differences.

CONCLUSION

Vitamin D and iron deficiencies are still common forms of malnutrition in the Saudi community, that have remained unchanged over the past 20-30 years, while the intake of trace elements (zinc, copper, and selenium) is adequate as evident by normal serum levels in the vast majority of the investigated children. We could not observe a correlation between undernutrition and micronutrient deficiencies.

Nutrient intake and gender differences among Saudi children

Dietary surveillance is necessary to determine community needs for nutrition interventions. Yet, the nutrient intake of Saudi children has not been previously investigated. The objective of the present study is to evaluate dietary data of Saudi children and investigate gender differences in nutrient intake. In this cross-sectional study, dietary data of 424 Saudi children (6–12 years of age) were collected using telephone-administered single 24-h dietary recall. Three 24-h dietary recalls were collected from a subsample of 168 children (39⋅6 %) and compared with the Dietary Recommended Intakes (DRIs). Nutrient intakes and proportions of children meeting the DRI requirements were similar and did not vary by children's gender. Over two-thirds of the children had an adequate usual intake of vitamin B12, and over half had adequate intakes (AIs) of vitamin C and phosphorus. On the other hand, our data indicated that low proportions of children consumed adequate usual intakes of magnesium and vitamin E. Over half of the children in our sample met the AI for sodium and vitamin D. Only small proportions of children met the AI for calcium, potassium and fibre. Cholesterol and saturated fat intake exceeded the limits of 300 mg and 10 % of total energy intake by 13⋅7 % (n 23) and 80⋅4 % (n 135) of the sample, respectively. Suboptimal intake of several micronutrients was observed among children, suggesting an urgent need to identify barriers to high-quality diet and to develop evidence-based interventions to promote optimal dietary efficacy for children in Saudi Arabia.

Use of continuous glucose monitoring trend arrows in the younger population with type 1 diabetes

Early control of glycaemia is key to reduce vascular complications in individuals with Type 1 diabetes. Therefore, encouraging children and adolescents with T1DM to take responsibility for controlling glucose levels is an important yet a challenging task. The rapid expansion of continuous glucose monitoring (CGM) systems has allowed for more comprehensive analysis of glycaemia in T1D. Moreover, CGM devices have the ability to calculate rate of change in glucose levels and display the information as trend arrows. In turn, this can help to take evasive actions to return glucose levels to near physiological glycaemia, which can be highly motivating for young people with T1DM. In the absence of standardised, evidence-based guidance, this consensus document, generated by experts from the Arab Society of Paediatric Endocrinology and Diabetes and international advisors, summarises recent literature on the use of trend arrows in young people with T1DM. The use of trend arrows in different CGM systems is reviewed and their clinical significance is highlighted. Adjusting insulin doses according to trend arrows is discussed while also addressing special situations, such as exercise, fasting, nocturnal hypoglycaemia and menstruation. Adequate understanding of trend arrows should facilitate optimisation of glycaemic control in the T1D population.

Vitamin D status in preschool children in Algeria

It is well established today that an optimal vitamin D intake plays a crucial role in the constitution of optimal osseous mass during childhood, and hence in the prevention of the osteoporosis in adults. The prevalence of the vitamin D deficiency is increasing globally and Algeria is no exception in this regard. Our study is the first to be carried out with healthy children of preschool age in North Africa.

AIMS

The study aimed to evaluate the vitamin D status of a pediatric population, during all four seasons of the year, living in the north of Algeria, as well as to estimate the prevalence of vitamin D deficiency, identifying the potential risk factors.

MATERIAL AND METHODS

This was an analytic and cross-sectional study carried out between March 2014 and March 2016 with healthy preschool infants from an urban environment in the town of Hussein Dey. A total of 1016 infants aged 9-72 months were included during this period. The consensual threshold value was 20ng/mL.

RESULTS

The sex ratio was of 1.47 (535 boys/481 girls) and the average age of the children was 36.5±1.79 months. The daily average calcium ratio was 395±23 mg/with food contributions in vitamin D at an estimated average of 164 UI/day (4.1μg/day). The average concentration of the total 25-OHD for all four seasons of the year was 18.6±10.4ng/mL with an average rate of parathyroid hormone (PTH) of 30.9±14.6pg/mL. There was a highly significant inverse correlation between the serum level of vitamin D and PTH (r=-0.57; P=0.0001), the point of inflection was situated at 34.1ng/mL. The prevalence of vitamin D deficiency follows a seasonal variation that is statistically significant (P=0.0001), and the prevalence is higher during the autumn-winter period. The risk factors identified by multiple logistic regression were autumn-winter season (OR: 7; 95% CI: 3-11; P=0.001), age less than 24 months (OR: 3.8; 95% CI: 3.4-4.4; P=0.0001), high body mass index (OR: 2; 95% CI: 1.2-3.2; P=0.3), darker skin pigmentation (OR: 2.8; 95% CI: 2.2-5.2; P=0.001), duration of sunlight exposure less than 15min (OR: 6.1; 95% CI: 3.6-10.2; P=0.0001), low socioeconomic status (OR: 3.9; 95% CI: 1.5-4.3; P=0.01), calcium intake lower than 500 mg/day (OR: 2.5; 95% CI: 1.8-6; P=0.001), and a weekly dietary intake of vitamin D lower than 200 UI (OR: 2.6; 95% CI: 1.6-4.2; P=0.02).

DISCUSSION

No studies have been conducted in north Africa or Algeria concerning healthy preschool children; however, this population has a rapid growth rate and deserves special attention. The prevalence of vitamin D deficiency in the children of this study was higher than that reported in studies of children of the same age living in Europe or America, despite the fact that Algeria is closer to the equator (36° latitude north).

CONCLUSION

The changes experienced by Algerian society and the shorter exposure of the population to the sun call for more efforts regarding the detection and treatment of vitamin D deficiency, as well as an update of the vitamin D supplementation schedule.

Inference of link among diabetes, obesity, and thyroid dysfunction in data from a clinic at Saudi Arabia

The clinical link among diabetes, obesity, and thyroid dysfunction is of interest. Hence, medical records of 601 patients with diabetes, obesity, and thyroid dysfunctions at the Abha Specialist Center and Military Diabetic Endocrine Center we used in this analysis. Approximately 28% of diabetic patients had thyroid dysfunction, and 12.4% were vitamin D deficient. The patients with thyroid dysfunction had significantly elevated triglyceride levels compared to the patients without thyroid dysfunction (173.6 vs. 128. p=0.009). Vitamin D deficient obese patients were significantly younger (33.99±10.69 vs. 43.68±14.42; p<0.001) and had significantly lower levels of HbA1c (5.73±1.16 vs. 6.83±2.08; p=0.014) and lower systolic BP (120.26±11.75 vs. 124.58±13.63; p=0.049) than non-vitamin D deficient obese patients. Vitamin D deficient thyroid patients had significantly lower diastolic BP (71.4±9.9 vs. 74.9±9.7; p=0.040) and higher HbA1c (8.7±3.6 vs. 6.4±1.7; p=0.003) in comparison to non-vitamin D deficient thyroid patients. Hence, analysis of metabolic disorders in these patients will help combat complications in these cases.

Advancements in SPR biosensing technology: An overview of recent trends in smart layers design, multiplexing concepts, continuous monitoring and in vivo sensing

Inspired by the rapid progress and existing limitations in surface plasmon resonance (SPR) biosensing technology, we have summarized the recent trends in the fields of both chip-SPR and fiber optic (FO)-SPR biosensors during the past five years, primarily regarding smart layers design, multiplexing, continuous monitoring and in vivo sensing. Versatile surface chemistries, biomaterials and nanomaterials have been utilized thus far to generate smart layers on SPR platforms and as such achieve oriented immobilization of bioreceptors, improved fouling resistance and sensitivity enhancement, collectively aiming to improve the biosensing performance. Furthermore, often driven by the desires for time- and cost-effective quantification of multiple targets in a single measurement, efforts have been made to implement multiplex bioassays on SPR platforms. While this aspect largely remains difficult to attain, numerous alternative strategies arose for obtaining parallel analysis of multiple analytes in one single device. Additionally, one of the upcoming challenges in this field will be to succeed in using SPR platforms for continuous measurements and in vivo sensing, and as such match up other biosensing platforms where these goals have been already conquered. Overall, this review will give insight into multiple possibilities that have become available over the years for boosting the performance of SPR biosensors. However, because combining them all into one optimal sensor is practically not feasible, the final application needs to be considered while designing an SPR biosensor, as this will determine the requirements of the bioassay and will thus help in selecting the essential elements from the recent progress made in SPR sensing.

Knowledge, attitude and practice of health care practitioners in Saudi Arabia, with regard to prevention of vitamin D deficiency in infancy

Objectives:

To understand the knowledge, attitude, and practice of healthcare practitioners in Saudi Arabia, with regard to vitamin D supplementation.

Methods:

A cross-sectional survey was conducted among healthcare practitioners in the Tabuk region of Saudi Arabia between January 2015 and December 2016. A questionnaire assessing knowledge, attitude and practice with regard to prevention of vitamin D deficiency was distributed to 100 healthcare practitioners.

Results:

There was a good understanding of the importance of vitamin D deficiency; and overall practices were good. The average knowledge score was 4.75/8 (range 2-7), largely due to 85% of recipients identifying sun exposure between 6-7 am as the optimal time. There was a lack of understanding also, that as little as 10 minutes exposure is of benefit.

Conclusion:

This study highlights the need for distribution of the recommendations for vitamin D supplementation in KSA, as widely as possible. This study suggests that healthcare practitioners understand the importance of correction of vitamin D deficiency. Deficiencies in knowledge with regard to sun exposure were identified. Dissemination of this information is, therefore, likely to impact significantly on the practice of a receptive clinical population.

Vitamin D status in diabetic children and adolescents

INTRODUCTION

Besides its role in calcium homeostasis, vitamin D (VD) has an important immuno-mudulation effect. However, its role in autoimmune diseases such as type 1 diabetes is under discussion. This study designed to investigate serum VD status in children and adolescents with and without diabetes.

MATERIALS AND METHODS

In a case-control study, 85 diabetic and 85 non-diabetic control (total 170) aged 1-15 yr. were enrolled. History of breast feeding and vitamin supplementation was obtained; growth indices and serum levels of Calcium, phosphorous, Alkaline-Phosphatase (ALP), Hemoglobin-A1c and VD were measured and analyzed.

RESULTS

The mean values for VD in case and control groups were 12.80 ± 10.59 and 15.85 ± 9.92 nmol/L, respectively (p = 0.057). Serum VD status in these two groups was sufficient in 5.88% and 9.41%, insufficient in 18% and 14%, and deficient in 75.29% and 76.74%, respectively. Compared to the controls, diabetics had more history of breast-feeding (62.35% vs. 42.35%; p = 0.017) and higher serum ALP levels (772.34 ± 309.89 vs. 657.99 ± 395.11 U/L; p = 0.032).

CONCLUSION

More frequency of breast-feeding, higher serum ALP and mildly lower serum level of VD in diabetics suggests a significant difference in VD status in diabetics compared to the healthy peers indicating a potential role of this deficiency in the disease process.

Prevalence of vitamin D deficiency in healthy Iranian children: A systematic review and meta-analysis

Background: Vitamin D deficiency is related to rickets in children, and it can increase the risk of osteoporosis in adulthood. The aim of our study was to estimate the prevalence of vitamin D deficiency among healthy Iranian children and adolescents. Vitamin D levels less than 20ng/ml and between 20 and 30ng/ml was considered as vitamin D deficiency and insufficiency, respectively. Methods: Relevant observational studies evaluating the prevalence of vitamin D deficiency through 1 January 1990 to 28 Dec 2016, were searched in several electronic databases including Iran-Medex, Scientific Information Database (SID), Irandoc, PubMed and NLM Gateway (for MEDLINE), Web of Science, and Scopus with no restriction on language. Only full-text articles were used for data extraction and synthesis after considering the inclusion/exclusion criteria. Results: 11 studies included; the data of four studies of Iranian newborns were withdrawn because of their high heterogeneity. The prevalence of vitamin D deficiency in Iranian boys and girls were 35% (CI 95% 34-37) and 61% (CI 95% 60-63), respectively. The prevalence of vitamin D insufficiency in Iranian children and adolescents was 31% (CI 95% 30-31). Conclusion: It seems that the prevalence of vitamin D deficiency is very high among Iranian children and adolescents. The present findings could provide practical information for healthcare decision makers.

Vitamin D status among adolescents in Kuwait: a cross-sectional study

OBJECTIVES

In Kuwait, as in many Arab states in the Gulf region, there are limited data on the prevalence of vitamin D deficiency among healthy adolescents. This study aimed to estimate the prevalence of vitamin D deficiency in a nationally representative sample of adolescents and investigate factors associated with vitamin D status.

METHODS

A cross-sectional study was conducted on 1416 adolescents aged 11-16 years, who were randomly selected from middle schools in all governorates of Kuwait. Data were collected from parents through self-administered questionnaire and from adolescents through face-to-face interview. Vitamin D was measured using liquid chromatography-tandem mass spectrometry. Logistic regression was used to investigate the independent factors associated with vitamin D status.

RESULTS

The prevalence of vitamin D deficiency was 81.21% (95% CI 71.61% to 90.81%), while severe deficiency was 39.48%. Only 3.60% of adolescents were vitamin D-sufficient. The prevalence of vitamin D deficiency was significantly higher among girls compared with boys (91.69% vs 70.32%; p<0.001). There was a significant inverse correlation between vitamin D and parathyroid hormone (Spearman correlation=-0.35; p<0.001). In the final model, gender, age, governorate, parental education, body mass index, vitamin D supplement and the number of times adolescents walk to schools per week were all significantly related to vitamin D deficiency.

CONCLUSION

High prevalence of vitamin D deficiency was noted among adolescents in Kuwait despite the abundant sunshine, which may reflect strong sun avoidance behaviour. Adequate outdoor daytime activities should be encouraged especially for girls. We call for locally tailored guidelines for vitamin D supplement in which girls should have a higher dose compared with boys.

Hypovitamininosis D in Childhood Cancer Survivors: Importance of Vitamin D Supplementation and Measurement Over Different Points of Time

This observational retrospective cross-sectional and case-controlled study measures levels of 25-hydroxy-vitamin D (25-OH-VD) in pediatric cancer survivors at different intervals and assesses the effect of 2 supplementation regimens over a period of 12 months. Sixty-eight patients were included in this quasi-experimental study, of which 32 were boys and 36 were girls. A control group of 30 healthy children were included. It was found that initial 25-OH-VD levels were insufficient (<30 ng/mL) in 61 patients (89.7%). Yet, no significant difference between the levels of 25-OH-VD in these patients as compared with the healthy control group was evidenced. However, 25-OH-VD levels were significantly higher at 18 months in patients who were supplemented with oral 50,000 IU/month vitamin D during the 12 months in comparison with patients supplemented with 1000 IU/day. Our findings indicate that pediatric cancer survivors who require frequent monitoring of their 25-OH-VD levels yielded better results when supplemented with higher doses of vitamin D over longer periods of time. A course of oral vitamin D supplementation regimen of 50,000 IU/month gave effective results with excellent compliance and no reports of any adverse or harmful effects.

Current Evidence on Vitamin D Deficiency and Metabolic Syndrome in Obese Children: What Does the Evidence from Saudi Arabia Tell Us?

Obesity and vitamin D deficiency represent major health problems among Saudi children, and have been linked to chronic diseases. Obese children are at risk of developing vitamin D deficiency, which appears to have negative influences on energy homeostasis, impeded bone mineralisation, insulin resistance and inflammation. Evidence supporting the association between vitamin D deficiency of obese children and metabolic syndrome has not specifically been studied in early childhood. The mechanisms through which vitamin D deficiency is associated with metabolic syndrome in obese children needs further elucidation. This commentary aims to (i) summarise current knowledge of the association between vitamin D deficiency and metabolic syndrome in obese children; and (ii) discuss current evidence for the association among Saudi Arabian children.

Knowledge, awareness, attitudes and sources of vitamin D deficiency and sufficiency in Saudi children

OBJECTIVES

To examine the awareness, knowledge, and attitudes regarding vitamin D and its sources among Saudi Arabian children. 

METHODS

One hundred patients (vitamin D-deficient children) and 100 healthy children participated in the study. Participants were interviewed separately on topics including their awareness, knowledge, and attitudes regarding vitamin D using multiple-choice, and short-answer questions. This prospective, cross-sectional study was performed on children and adolescents between January 2011 and December 2011 at the Security Forces Hospital, Riyadh, Saudi Arabia. 

RESULTS

Only 28% were aware of the sources of vitamin D, while 64% of healthy subjects were aware. Similarly, only 50% of patients and their parents knew of the health benefits of vitamin D, while 70% of healthy subjects had knowledge. Hence, our findings agree with previous findings that low levels of awareness and knowledge regarding vitamin D and its sources persist.  

CONCLUSION

Most vitamin D deficient cases were unaware of vitamin D sources. However, half of the patient/parents were aware of benefits of vitamin D. Hence, we recommend that an improved campaign for awareness, knowledge, and attitudes regarding vitamin D and its sources are needed.

Growth Profile and Its Association with Nutrient Intake and Dietary Patterns among Children and Adolescents in Hail Region of Saudi Arabia

Hail region of Saudi Arabia (KSA) has the highest adult obesity rates in the entire kingdom and limited information is available about the prevalence and patterns of growth markers. Therefore, it is important to monitor the growth trends to implement effective public health preventive strategies for the region. This study aims to estimate the prevalence of growth profile patterns (stunting, wasting, underweight, and overweight) and its associations with nutrient intake and dietary patterns among children and adolescents. A cross-sectional survey was conducted involving 1420 children and adolescents (2-18 years), selected using a multistage stratified random-sampling technique representing both female and male schools from Hail region, KSA. Growth profile z-scores were generated using 2006 and 2007 WHO growth standards. The overall prevalence of 4.73% moderate and 1.54% severe underweight; 6.65% moderate and 2.59% severe stunting; 6.34% moderate and 2.55% severe wasting was present in the study population. Stunting decreased as age progressed with concurrent increase in the prevalence of overweight and obesity. There was a significantly higher prevalence of overweight (18.55% versus 23.05%; P < 0.001) and obesity (8.7% versus 13.85%; P < 0.001) in adolescents than in school-age children with higher prevalence in females as compared to males. Both stunted and overweight/obesity groups had significantly lower mean intakes for critical micronutrients necessary for growth as compared to normal children.

Risk factors and predictors of uncontrolled hyperglycemia and diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus in Jeddah, western Saudi Arabia

BACKGROUND

Little is known about levels of glycemic control and risk factors for uncontrolled hyperglycemia in Saudi children with type 1 diabetes mellitus (T1DM). The aim of the present study was to identify levels of glycemic control, risk factors and predictors of uncontrolled hyperglycemia (HG) and diabetic ketoacidosis (DKA) in children with T1DM.

METHODS

A retrospective study was performed on Saudi children and adolescents with confirmed T1DM who were followed at the Pediatric Endocrinology Clinic of the Maternity and Children Hospital, Jeddah, from 2000 to 2014. Data collection included all possible factors that may be associated with uncontrolled T1DM. Patients were classified according to American Diabetes Association guidelines for target HbA1c levels per age group. Comparisons were made between well-controlled (WC) patients, HG patients, and DKA patients. Calculation of odds ratios and logistic regression allowed for estimation of the role of each risk factor in uncontrolled T1DM.

RESULTS

Only 31.2 % of children and adolescents with T1DM were well controlled. Better glycemic control was associated with age < 6 years, urban residence, and T1DM duration <5 years. Glycemic control was not affected by gender, insulin therapy, or comorbidities. The most significant independent predictors of hyperglycemia and DKA were poor compliance with a healthy lifestyle (adjusted hazards ratio [AHR] 28.94; 95 % confidence interval [CI] 8.37-100.04) and an excess intake of sweets (AHR 3.31; 95 % CI 1.54-7.11).

CONCLUSION

The most significant independent predictor for poor glycemic control (particularly DKA rather than hyperglycemia) in Saudi children and adolescents was poor compliance with a healthy lifestyle with an excessive intake of sweets.

Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients

Diabetes is a global endemic with rapidly increasing prevalence in both developing and developed countries. The American Diabetes Association has recommended glycated hemoglobin (HbA1c) as a possible substitute to fasting blood glucose for diagnosis of diabetes. HbA1c is an important indicator of long-term glycemic control with the ability to reflect the cumulative glycemic history of the preceding two to three months. HbA1c not only provides a reliable measure of chronic hyperglycemia but also correlates well with the risk of long-term diabetes complications. Elevated HbA1c has also been regarded as an independent risk factor for coronary heart disease and stroke in subjects with or without diabetes. The valuable information provided by a single HbA1c test has rendered it as a reliable biomarker for the diagnosis and prognosis of diabetes. This review highlights the role of HbA1c in diagnosis and prognosis of diabetes patients.

Knowledge, attitude, and practice of general practitioners in Dammam, Saudi Arabia towards Vitamin D supplementation to infants

Background:

With the report of high prevalence rate of Vitamin D deficiency in the literature since the 1980s, the condition can be considered an epidemic in Saudi Arabia. However, no specific steps have been taken by the Ministry of Health to tackle the problem. Moreover, little is known about general practitioners’ (GPs) knowledge, attitude, and practice (KAP) of Vitamin D supplementation for infants.

Objectives:

To measure the KAP of GPs, of Vitamin D supplementation for infants in Dammam, Saudi Arabia.

Materials and Methods:

This was a cross-sectional study of GPs practicing in primary healthcare centers in the Dammam area of Saudi Arabia. All the 110 GPs working in primary health centers (PHCs) in Dammam were invited to participate in the study. Data was collected with the help of a self-administered questionnaire. Data was analyzed using SPSS 20.0. Statistical analysis included descriptive analysis of all the variables, expressed as the mean (standard deviation [SD]) or the median if not normally distributed.

Results:

Ninety-three GPs working in the Dammam area participated in the study. Thirty percent had excellent knowledge of Vitamin D. Ninety two percent had a positive attitude toward Vitamin D supplementation and sixty percent regularly prescribed Vitamin D supplementation for infants.

Conclusion:

The majority of GPs had a positive attitude toward Vitamin D supplementation for infants. However, their knowledge and practice need improvement.

Posterior urethral valves: Metabolic consequences in a cohort of patients

BACKGROUND

Despite the improvements in diagnosis and management of posterior urethral valves (PUVs), about one third of patients develop chronic kidney disease (CKD). Children with PUVs might have abnormal calcium, phosphorus, vitamin D and parathyroid hormone levels, which could affect their bone growth and overall health.

OBJECTIVE

The aim was to determine the relationship between kidney function, vitamin D deficiency and secondary hyperparathyroidism in children with PUVs.

PATIENTS AND METHODS

Sixty-four children with PUVs were followed for a period of 3.64 ± 2.50 years after their initial presentation and management. Their laboratory parameters were compared with 20 age-, gender- and race-matched children in a control group, including: serum calcium, phosphorus, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D levels, and kidney function.

RESULTS

Children with PUVs had significantly lower estimated kidney function (P = 0.006) and vitamin D levels (P < 0.001) and higher iPTH levels (P = 0.042). There were no significant between-group differences in serum calcium, phosphorus, alkaline phosphatase, sodium, potassium, and bicarbonate levels. There was a strong correlation between the degree of vitamin D deficiency and hyperparathyroidism and the degree of kidney dysfunction (r = 0.52 and -0.52, respectively) in the PUV group. On a multivariate analysis, the kidney dysfunction was the only independent predictor of vitamin D deficiency (ρ = 0.271, P < 0.001), while kidney dysfunction, serum calcium and alkaline phosphatase were independent predictors for hyperparathyroidism (ρ = 0.925, P<0.001, ρ = 0.933, P<0.001 and ρ = 0.913, P < 0.001, respectively).

DISCUSSION

The prevalence of CKD in children with PUVs ranges from 30 to 60%. Patients with CKD are more likely to have vitamin D deficiency and display more-prominent hyperparathyroidism. Compared with a control group with normal kidney function, the present cohort had lower 25-hydroxyvitamin D and higher iPTH serum levels. Abnormal kidney function was a major predictor for both serum levels. In this cohort, there were no significant differences in serum calcium and phosphorus between children with PUVs and the control group, and also between those with and without CKD. On the contrary, vitamin D level decreased early in the disease and progressively declined thereafter, while iPTH was the opposite. These findings were comparable to previous studies. This study had some limitations because it was a single center cross-sectional non-randomized study. However, the findings in this study can be extrapolated to children with PUVs and CKD from other origins because the unit is considered as a referral center in the Middle East region.

CONCLUSION

Abnormal kidney function, vitamin D deficiency, and secondary hyperparathyroidism are prevalent in children with PUVs. Kidney function is the main determinant of vitamin D and parathyroid hormone levels. Efforts should be directed toward managing CKD, and controlling vitamin D deficiency and hyperparathyroidism in children after ablation of PUV.

Increasing trends and significance of hypovitaminosis D: a population-based study in the Kingdom of Saudi Arabia

Vitamin D deficiency is highly prevalent in Saudi Arabia, particularly among young women and is emerging as public health threat of epidemic proportions. Prevalence of severe hypovitaminosis D is expected to rise exponentially without primary intervention. This largest study encompasses extent of vitamin D deficiency and recommendations to reduce significant health care burden.

INTRODUCTION

The aim of the study was to determine the prevalence and significance of vitamin D deficiency in Saudi population and to help develop national consensus for its prevention, screening, and management.

METHODS

This was a retrospective observational study which involved 10,709 patients, recruited from the Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center (KFSH&RC), Saudi Arabia, over a period of 5 years. The endpoints included overall status of vitamin D level and severity of vitamin D deficiency. Serum measurements included 25 hydroxyvitamin D (25(OH)D), parathormone, calcium, phosphate, alkaline phosphatase, albumin levels, eGFR levels, bone mineral density.

RESULTS

A total of 10,709 patients were analyzed; 31.4 % were males and 68.6 % were females, with a preponderance of Saudis (68.5 %) compared to non-Saudis (31.5 %). The prevalence of vitamin D deficiency was 83.6 % (31.9 % severe, 32.0 % moderate, and 19.7 % mild), when cut points of less than 25, 50, and 75 nmol/l, respectively, were used. Mean serum 25(OH)D was 44.58 ± 34.80 standard deviation (SD) nmol/l. There was significant difference in severity of vitamin D deficiency stratified by age, gender, and nationality. More females had severe 25(OH)D deficiency compared to males (35.6 vs. 23.7 %, p < 0.000). Severe 25(OH)D deficiency was markedly high among adolescents as compared to other age groups (49.2 vs. 30.9 %, p < 0.000). More Saudis were found to be vitamin D deficient compared to non-Saudis (37.2 vs. 20.3 %, p < 0.000).

CONCLUSION

The prevalence of hypovitaminosis D is significantly high among Saudi population, especially among women, despite abundant sunshine. It is a major public health concern and requires a robust health policy for vitamin D supplementation and implementation of dietary public health measures. Vitamin D screening is strongly recommended at an earlier age especially among women and children.

Vitamin D status and its relationship with metabolic syndrome risk factors among adolescent girls in Boukan, Iran

OBJECTIVE

To investigate vitamin D status and its association with components of the metabolic syndrome (MetS) in adolescent girls attending high school in Boukan, Iran during winter 2012.

DESIGN

A cross-sectional study.

SETTING

High schools of Boukan city, Iran.

SUBJECTS

A sample of 216 girls aged 14-17 years was selected by multistage random sampling from four districts of Boukan. Weight, height, waist circumference, blood pressure, daily energy intake, physical activity and serum 25-hydroxyvitamin D (25(OH)D), fasting blood glucose, TAG and HDL-cholesterol levels of all participants were evaluated. Serum 25(OH)D level <20 ng/ml was defined as vitamin D deficiency.

RESULTS

Mean serum 25(OH)D was 7.26 (sd 2.81) ng/ml and 96 % of the participants had vitamin D deficiency. According to age-modified definitions of the National Cholesterol Education Program Adult Treatment Panel III, MetS was diagnosed in 10.6% of the participants. In multivariable regression analysis after adjustment for BMI, energy intake and physical activity level, serum 25(OH)D was inversely associated with fasting blood glucose (β = -0.143, P = 0.04). No significant relationship was found between serum 25(OH)D and other components of MetS.

CONCLUSIONS

The high prevalence of vitamin D deficiency warrants national polices and interventions towards improving this major health problem among adolescent girls. Low 25(OH)D level was significantly associated with increased fasting blood glucose. Prospective studies are needed to determine the effects of vitamin D deficiency on the development of MetS and related metabolic diseases in adolescent girls.

Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia)

The dual burden of malnutrition reportedly coexists in Malaysia; however, existing data are scarce and do not adequately represent the nutritional status of Malaysian children. The Nutrition Survey of Malaysian Children was carried out with the aim of assessing the nutritional status in a sample of nationally representative population of children aged 6 months to 12 years. A total of 3542 children were recruited using a stratified random sampling method. Anthropometric measurements included weight, height, mid-upper arm circumference, and waist and hip circumferences. Blood biochemical assessment involved analyses of Hb, serum ferritin, and vitamins A and D. Dietary intake was assessed using semi-quantitative FFQ, and nutrient intakes were compared with the Malaysian Recommended Nutrient Intakes (RNI). The prevalence of overweight (9·8 %) and obesity (11·8 %) was higher than that of thinness (5·4 %) and stunting (8·4 %). Only a small proportion of children had low levels of Hb (6·6 %), serum ferritin (4·4 %) and vitamin A (4·4 %), but almost half the children (47·5 %) had vitamin D insufficiency. Dietary intake of the children was not compatible with the recommendations, where more than one-third did not achieve the Malaysian RNI for energy, Ca and vitamin D. The present study revealed that overnutrition was more prevalent than undernutrition. The presence of high prevalence of vitamin D insufficiency and the inadequate intake of Ca and vitamin D are of concern. Hence, strategies for improving the nutritional status of Malaysian children need to consider both sides of malnutrition and also put emphasis on approaches for the prevention of overweight and obesity as well as vitamin D insufficiency.

Relationships between serum 25-hydroxyvitamin D and quantitative ultrasound bone mineral density in 0-6 year old children

The relationship between serum 25-hydroxyvitamin D and quantitative ultrasound bone mineral density in young children remains unclear. In addition, consensus has not been reached with regard to the concentration of 25(OH)D to define vitamin D deficiency for infants and children. In the present study, 203 children 0-6 years old were recruited in Shanghai, China. The concentrations of serum 25(OH)D, weight, length, and quantitative ultrasound bone mineral density (BMD) of left mid-tibia were determined. Low BMD was defined as <20th percentile of given age and sex. Low 25(OH)D was defined as 25(OH)D<20 ng/ml. The results showed that median serum 25(OH)D level was 19.0 ng/ml, and 58.6% had a serum 25(OH)D below 20 ng/ml. After adjusting for potential confounders, a linear relationship between serum 25(OH)D and BMD was observed. Serum 25(OH)D was positively associated with BMD (ß=323.3, 95% CI=201.0-445.7, p<0.001), and low 25(OH)D (<20 ng/ml) had a high risk for low BMD (OR=5.5, 95% CI=2.5-12). In addition, there is a nonlinear relationship between 25(OH)D and low BMD, and a threshold for 25(OH)D of 20 ng/ml existed for low BMD. The prevalence of low BMD was 47.1% in the group of 25(OH)D<20 ng/ml, much higher than 16.7% in the group of 25(OH)D ≥ 20 ng/ml (p<0.05). The results suggested that quantitative ultrasound BMD could be an indicator for vitamin D status in young children, and also provided further evidence to define vitamin D deficiency for infants and children.