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Published in: International Journal of Diabetes in Developing Countries 1/2017

01-03-2017 | Original Article

Vitamin D deficiency and the associated factors in children with type 1 diabetes mellitus in southern Iran

Authors: Forough Saki, Gholamhossein Ranjbar Omrani, Yasna Pouralborz, Mohammad Hossein Dabbaghmanesh

Published in: International Journal of Diabetes in Developing Countries | Issue 1/2017

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Abstract

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disorder caused by destruction of beta cells of the pancreas. Several reports have suggested a connection between vitamin D deficiency and T1DM and the possible role of dietary vitamin D supplementation in reducing the risk of T1DM. There is little knowledge about the prevalence of vitamin D deficiency among Iranian children with T1DM. Serum 25-hydroxy vitamin D (25OHD) was assayed by high performance liquid chromatography in 8–18-year-old diabetic patients referred to pediatric diabetes clinics in Shiraz, Iran, during a period of 14 months. The age of the onset of T1DM, daily insulin usage, weight, height, and BMI of each patient were recorded along with levels of physical activity and sun exposure. The patients’ body composition was determined by DEXA and used in further analysis. This study was conducted on 39 diabetic boys and 46 diabetic girls aged 12.4 ± 4.2 years. Mean serum 25(OH)D3 was 18 ± 12.2 ng/dl. Serum levels of 25(OH)D3 were higher in boys than girls. 7.7 % of the boys and 30.4 % of the girls had severe vitamin D deficiency. There was a negative correlation between the age of the onset of T1DM and serum concentration of 25(OH)D3 (p = 0.006, r = −0.17). Girls with T1DM showed a higher prevalence of severe vitamin D deficiency than boys with T1DM. Moreover, vitamin D deficiency was more prevalent in individuals with earlier onset of the disease and in those with higher fat mass index.
Literature
1.
go back to reference Dahlquist G. Environmental risk factors in human type 1 diabetes—an epidemiological perspective. Diabetes Metab Rev. 1995;11(1):37–46.CrossRefPubMed Dahlquist G. Environmental risk factors in human type 1 diabetes—an epidemiological perspective. Diabetes Metab Rev. 1995;11(1):37–46.CrossRefPubMed
2.
go back to reference Barrett JC, Clayton DG, Concannon P, Akolkar B, Cooper JD, Erlich HA, et al. Genome-wide association study and meta-analysis find that over 40 loci affect risk of type 1 diabetes. Nat Genet. 2009;41(6):703–7.CrossRefPubMedPubMedCentral Barrett JC, Clayton DG, Concannon P, Akolkar B, Cooper JD, Erlich HA, et al. Genome-wide association study and meta-analysis find that over 40 loci affect risk of type 1 diabetes. Nat Genet. 2009;41(6):703–7.CrossRefPubMedPubMedCentral
3.
go back to reference Karvonen M, Tuomilehto J, Libman I, LaPorte R. A review of the recent epidemiological data on the worldwide incidence of type 1 (insulin-dependent) diabetes mellitus. World Health Organization DIAMOND project group. Diabetologia. 1993;36(10):883–92.CrossRefPubMed Karvonen M, Tuomilehto J, Libman I, LaPorte R. A review of the recent epidemiological data on the worldwide incidence of type 1 (insulin-dependent) diabetes mellitus. World Health Organization DIAMOND project group. Diabetologia. 1993;36(10):883–92.CrossRefPubMed
4.
go back to reference Zhang J, Li W, Liu J, Wu W, Ouyang H, Zhang Q, et al. Polymorphisms in the vitamin D receptor gene and type 1 diabetes mellitus risk: an update by meta-analysis. Mol Cell Endocrinol. 2012;355(1):135–42.CrossRefPubMed Zhang J, Li W, Liu J, Wu W, Ouyang H, Zhang Q, et al. Polymorphisms in the vitamin D receptor gene and type 1 diabetes mellitus risk: an update by meta-analysis. Mol Cell Endocrinol. 2012;355(1):135–42.CrossRefPubMed
5.
go back to reference Bajpai A, Bardia A, Mantan M, Hari P, Bagga A. Non-azotemic refractory rickets in Indian children. Indian Pediatr. 2005;42(1):23–30.PubMed Bajpai A, Bardia A, Mantan M, Hari P, Bagga A. Non-azotemic refractory rickets in Indian children. Indian Pediatr. 2005;42(1):23–30.PubMed
6.
go back to reference Elidrissy A-WT, editor Vitamin D-deficiency rickets in Saudi Arabia. Nestle nutrition workshop series (USA); 1991. Elidrissy A-WT, editor Vitamin D-deficiency rickets in Saudi Arabia. Nestle nutrition workshop series (USA); 1991.
7.
go back to reference Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78(12):1463–70.CrossRefPubMed Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78(12):1463–70.CrossRefPubMed
8.
go back to reference Majid Molla A, Badawi MH, Al-Yaish S, Sharma P, RS e-S, AM M. Risk factors for nutritional rickets among children in Kuwait. Pediatr Int. 2000;42(3):280–4.CrossRefPubMed Majid Molla A, Badawi MH, Al-Yaish S, Sharma P, RS e-S, AM M. Risk factors for nutritional rickets among children in Kuwait. Pediatr Int. 2000;42(3):280–4.CrossRefPubMed
9.
go back to reference Das G, Crocombe S, McGrath M, Berry JL, Mughal MZ. Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch Dis Child. 2006;91(7):569–72.CrossRefPubMed Das G, Crocombe S, McGrath M, Berry JL, Mughal MZ. Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch Dis Child. 2006;91(7):569–72.CrossRefPubMed
10.
go back to reference Dawodu A, Khadir A, Hardy D, Varady E. Nutritional rickets in the United Arab Emirates: an unresolved cause of childhood morbidity. Middle East Paediatr. 2002;7(1):12–5. Dawodu A, Khadir A, Hardy D, Varady E. Nutritional rickets in the United Arab Emirates: an unresolved cause of childhood morbidity. Middle East Paediatr. 2002;7(1):12–5.
11.
go back to reference Kamal M, Abbasy AJ, Muslemani AA, Bener A. Effect of nicotinamide on newly diagnosed type 1 diabetic children. Acta Pharmacol Sin. 2006;27(6):724–7.CrossRefPubMed Kamal M, Abbasy AJ, Muslemani AA, Bener A. Effect of nicotinamide on newly diagnosed type 1 diabetic children. Acta Pharmacol Sin. 2006;27(6):724–7.CrossRefPubMed
12.
go back to reference Mrena S, Savola K, Kulmala P, Reijonen H, Ilonen J, Akerblom HK, et al. Genetic modification of risk assessment based on staging of preclinical type 1 diabetes in siblings of affected children. J Clin Endocrinol Metab. 2003;88(6):2682–9.CrossRefPubMed Mrena S, Savola K, Kulmala P, Reijonen H, Ilonen J, Akerblom HK, et al. Genetic modification of risk assessment based on staging of preclinical type 1 diabetes in siblings of affected children. J Clin Endocrinol Metab. 2003;88(6):2682–9.CrossRefPubMed
13.
go back to reference Stene LC, Joner G. Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study. Am J Clin Nutr. 2003;78(6):1128–34.PubMed Stene LC, Joner G. Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study. Am J Clin Nutr. 2003;78(6):1128–34.PubMed
14.
16.
go back to reference Bizzarri C, Pitocco D, Napoli N, Di Stasio E, Maggi D, Manfrini S, et al. No protective effect of calcitriol on beta-cell function in recent-onset type 1 diabetes: the IMDIAB XIII trial. Diabetes Care. 2010;33(9):1962–3.CrossRefPubMedPubMedCentral Bizzarri C, Pitocco D, Napoli N, Di Stasio E, Maggi D, Manfrini S, et al. No protective effect of calcitriol on beta-cell function in recent-onset type 1 diabetes: the IMDIAB XIII trial. Diabetes Care. 2010;33(9):1962–3.CrossRefPubMedPubMedCentral
17.
18.
go back to reference Saki F, Ranjbar Omrani G, Dabbaghmanesh M. Comparison between BMI and Inverted BMI in Evaluating Metabolic Risk and Body Composition in Iranian Children. Int J Pediatr. 2016;4(4):1625–36. Saki F, Ranjbar Omrani G, Dabbaghmanesh M. Comparison between BMI and Inverted BMI in Evaluating Metabolic Risk and Body Composition in Iranian Children. Int J Pediatr. 2016;4(4):1625–36.
19.
go back to reference Bener A, Alsaied A, Al-Ali M, Al-Kubaisi A, Basha B, Abraham A, et al. High prevalence of vitamin D deficiency in type 1 diabetes mellitus and healthy children. Acta Diabetol. 2009;46(3):183–9.CrossRefPubMed Bener A, Alsaied A, Al-Ali M, Al-Kubaisi A, Basha B, Abraham A, et al. High prevalence of vitamin D deficiency in type 1 diabetes mellitus and healthy children. Acta Diabetol. 2009;46(3):183–9.CrossRefPubMed
20.
go back to reference Karamizadeh Z, Kamali Sarvestani E, Saki F, Karamifar H, Amirhakimi GH, Namavar Shooshtarian MH, et al. Investigation of osteopontin levels and genomic variation of osteopontin and its receptors in type 1 diabetes mellitus. J Endocrinol Investig. 2013;36(11):1090–3. Karamizadeh Z, Kamali Sarvestani E, Saki F, Karamifar H, Amirhakimi GH, Namavar Shooshtarian MH, et al. Investigation of osteopontin levels and genomic variation of osteopontin and its receptors in type 1 diabetes mellitus. J Endocrinol Investig. 2013;36(11):1090–3.
21.
go back to reference Gomez JM, Maravall FJ, Soler J, Fernandez-Castaner M. Body composition assessment in type 1 diabetes mellitus patients over 15 years old. Horm Metab Res. 2001;33(11):670–3.CrossRefPubMed Gomez JM, Maravall FJ, Soler J, Fernandez-Castaner M. Body composition assessment in type 1 diabetes mellitus patients over 15 years old. Horm Metab Res. 2001;33(11):670–3.CrossRefPubMed
22.
go back to reference Jeddi M, Dabbaghmanesh MH, Ranjbar Omrani G, Ayatollahi SM, Bagheri Z, Bakhshayeshkaram M. Body composition reference percentiles of healthy Iranian children and adolescents in southern Iran. Arch Iran Med. 2014;17(10):661–9.PubMed Jeddi M, Dabbaghmanesh MH, Ranjbar Omrani G, Ayatollahi SM, Bagheri Z, Bakhshayeshkaram M. Body composition reference percentiles of healthy Iranian children and adolescents in southern Iran. Arch Iran Med. 2014;17(10):661–9.PubMed
23.
go back to reference Samsell L, Regier M, Walton C, Cottrell L. Importance of android/gynoid fat ratio in predicting metabolic and cardiovascular disease risk in normal weight as well as overweight and obese children. J Obes. 2014;2014:846578.CrossRefPubMedPubMedCentral Samsell L, Regier M, Walton C, Cottrell L. Importance of android/gynoid fat ratio in predicting metabolic and cardiovascular disease risk in normal weight as well as overweight and obese children. J Obes. 2014;2014:846578.CrossRefPubMedPubMedCentral
24.
go back to reference Danne T, Kordonouri O, Enders I, Weber B. Factors influencing height and weight development in children with diabetes. Results of the Berlin Retinopathy Study. Diabetes Care. 1997;20(3):281–5.CrossRefPubMed Danne T, Kordonouri O, Enders I, Weber B. Factors influencing height and weight development in children with diabetes. Results of the Berlin Retinopathy Study. Diabetes Care. 1997;20(3):281–5.CrossRefPubMed
25.
go back to reference Abd-Allah SH, Pasha HF, Hagrass HA, Alghobashy AA. Vitamin D status and vitamin D receptor gene polymorphisms and susceptibility to type 1 diabetes in Egyptian children. Gene. 2014;536(2):430–4.CrossRefPubMed Abd-Allah SH, Pasha HF, Hagrass HA, Alghobashy AA. Vitamin D status and vitamin D receptor gene polymorphisms and susceptibility to type 1 diabetes in Egyptian children. Gene. 2014;536(2):430–4.CrossRefPubMed
26.
go back to reference Azab SF, Saleh SH, Elsaeed WF, Abdelsalam SM, Ali AA, Esh AM. Vitamin D status in diabetic Egyptian children and adolescents: a case-control study. Ital J Pediatr. 2013;39:73.CrossRefPubMedPubMedCentral Azab SF, Saleh SH, Elsaeed WF, Abdelsalam SM, Ali AA, Esh AM. Vitamin D status in diabetic Egyptian children and adolescents: a case-control study. Ital J Pediatr. 2013;39:73.CrossRefPubMedPubMedCentral
27.
go back to reference Bener A, Alsaied A, Al-Ali M, Hassan AS, Basha B, Al-Kubaisi A, et al. Impact of lifestyle and dietary habits on hypovitaminosis D in type 1 diabetes mellitus and healthy children from Qatar, a sun-rich country. Ann Nutr Metab. 2008;53(3–4):215–22.CrossRefPubMed Bener A, Alsaied A, Al-Ali M, Hassan AS, Basha B, Al-Kubaisi A, et al. Impact of lifestyle and dietary habits on hypovitaminosis D in type 1 diabetes mellitus and healthy children from Qatar, a sun-rich country. Ann Nutr Metab. 2008;53(3–4):215–22.CrossRefPubMed
28.
go back to reference Bin-Abbas BS, Jabari MA, Issa SD, Al-Fares AH, Al-Muhsen S. Vitamin D levels in Saudi children with type 1 diabetes. Saudi Med J. 2011;32(6):589–92.PubMed Bin-Abbas BS, Jabari MA, Issa SD, Al-Fares AH, Al-Muhsen S. Vitamin D levels in Saudi children with type 1 diabetes. Saudi Med J. 2011;32(6):589–92.PubMed
29.
go back to reference Franchi B, Piazza M, Sandri M, Mazzei F, Maffeis C, Boner AL. Vitamin D at the onset of type 1 diabetes in Italian children. Eur J Pediatr. 2014;173(4):477–82.CrossRefPubMed Franchi B, Piazza M, Sandri M, Mazzei F, Maffeis C, Boner AL. Vitamin D at the onset of type 1 diabetes in Italian children. Eur J Pediatr. 2014;173(4):477–82.CrossRefPubMed
30.
31.
go back to reference Giarratana N, Penna G, Amuchastegui S, Mariani R, Daniel KC, Adorini L. A vitamin D analog down-regulates proinflammatory chemokine production by pancreatic islets inhibiting T cell recruitment and type 1 diabetes development. J Immunol. 2004;173(4):2280–7.CrossRefPubMed Giarratana N, Penna G, Amuchastegui S, Mariani R, Daniel KC, Adorini L. A vitamin D analog down-regulates proinflammatory chemokine production by pancreatic islets inhibiting T cell recruitment and type 1 diabetes development. J Immunol. 2004;173(4):2280–7.CrossRefPubMed
32.
go back to reference Pozzilli P, Manfrini S, Crino A, Picardi A, Leomanni C, Cherubini V, et al. Low levels of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 in patients with newly diagnosed type 1 diabetes. Horm Metab Res. 2005;37(11):680–3.CrossRefPubMed Pozzilli P, Manfrini S, Crino A, Picardi A, Leomanni C, Cherubini V, et al. Low levels of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 in patients with newly diagnosed type 1 diabetes. Horm Metab Res. 2005;37(11):680–3.CrossRefPubMed
33.
go back to reference Dutta D, Maisnam I, Shrivastava A, Sinha A, Ghosh S, Mukhopadhyay P, et al. Serum vitamin-D predicts insulin resistance in individuals with prediabetes. Indian J Med Res. 2013;138(6):853–60.PubMedPubMedCentral Dutta D, Maisnam I, Shrivastava A, Sinha A, Ghosh S, Mukhopadhyay P, et al. Serum vitamin-D predicts insulin resistance in individuals with prediabetes. Indian J Med Res. 2013;138(6):853–60.PubMedPubMedCentral
34.
go back to reference Dutta D, Choudhuri S, Mondal SA, Mukherjee S, Chowdhury S. Urinary albumin: creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D. J Diabetes. 2014;6(4):316–22.CrossRefPubMed Dutta D, Choudhuri S, Mondal SA, Mukherjee S, Chowdhury S. Urinary albumin: creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D. J Diabetes. 2014;6(4):316–22.CrossRefPubMed
35.
go back to reference Dutta D, Mondal SA, Choudhuri S, Maisnam I, Hasanoor Reza AH, Bhattacharya B, et al. Vitamin-D supplementation in prediabetes reduced progression to type 2 diabetes and was associated with decreased insulin resistance and systemic inflammation: an open label randomized prospective study from eastern India. Diabetes Res Clin Pract. 2014;103(3):e18–23.CrossRefPubMed Dutta D, Mondal SA, Choudhuri S, Maisnam I, Hasanoor Reza AH, Bhattacharya B, et al. Vitamin-D supplementation in prediabetes reduced progression to type 2 diabetes and was associated with decreased insulin resistance and systemic inflammation: an open label randomized prospective study from eastern India. Diabetes Res Clin Pract. 2014;103(3):e18–23.CrossRefPubMed
36.
go back to reference Neyestani TR, Hajifaraji M, Omidvar N, Eshraghian MR, Shariatzadeh N, Kalayi A, et al. High prevalence of vitamin D deficiency in school-age children in Tehran, 2008: a red alert. Public Health Nutr. 2012;15(2):324–30.CrossRefPubMed Neyestani TR, Hajifaraji M, Omidvar N, Eshraghian MR, Shariatzadeh N, Kalayi A, et al. High prevalence of vitamin D deficiency in school-age children in Tehran, 2008: a red alert. Public Health Nutr. 2012;15(2):324–30.CrossRefPubMed
37.
go back to reference Razzaghy-Azar M, Shakiba M. Assessment of vitamin D status in healthy children and adolescents living in Tehran and its relation to iPTH, gender, weight and height. Ann Hum Biol. 2010;37(5):692–701.CrossRefPubMed Razzaghy-Azar M, Shakiba M. Assessment of vitamin D status in healthy children and adolescents living in Tehran and its relation to iPTH, gender, weight and height. Ann Hum Biol. 2010;37(5):692–701.CrossRefPubMed
38.
go back to reference Ataie-Jafari A, Rahmat AB, Abbasi F, Cheong Loke S, Qorbani M, Larijani B. Vitamin D status and associated factors in recent-onset type 1 diabetic children in Iran. J Diabetes Metab Disord. 2012;11(1):12.CrossRefPubMedPubMedCentral Ataie-Jafari A, Rahmat AB, Abbasi F, Cheong Loke S, Qorbani M, Larijani B. Vitamin D status and associated factors in recent-onset type 1 diabetic children in Iran. J Diabetes Metab Disord. 2012;11(1):12.CrossRefPubMedPubMedCentral
39.
go back to reference Alagol F, Shihadeh Y, Boztepe H, Tanakol R, Yarman S, Azizlerli H, et al. Sunlight exposure and vitamin D deficiency in Turkish women. J Endocrinol Investig. 2000;23(3):173–7.CrossRef Alagol F, Shihadeh Y, Boztepe H, Tanakol R, Yarman S, Azizlerli H, et al. Sunlight exposure and vitamin D deficiency in Turkish women. J Endocrinol Investig. 2000;23(3):173–7.CrossRef
41.
go back to reference Saki F, Dabbaghmanesh MH, Omrani GR, Bakhshayeshkaram M. Vitamin D deficiency and its associated risk factors in children and adolescents in southern Iran. Public Health Nutr. 2015;8:1–6.CrossRef Saki F, Dabbaghmanesh MH, Omrani GR, Bakhshayeshkaram M. Vitamin D deficiency and its associated risk factors in children and adolescents in southern Iran. Public Health Nutr. 2015;8:1–6.CrossRef
42.
go back to reference Reis JP, von Muhlen D, Miller 3rd ER, Michos ED, LJ A. Vitamin D status and cardiometabolic risk factors in the United States adolescent population. Pediatrics. 2009;124(3):e371–9.CrossRefPubMedPubMedCentral Reis JP, von Muhlen D, Miller 3rd ER, Michos ED, LJ A. Vitamin D status and cardiometabolic risk factors in the United States adolescent population. Pediatrics. 2009;124(3):e371–9.CrossRefPubMedPubMedCentral
43.
go back to reference Thnc O, Cetinkaya S, Kizilgun M, Aycan Z. Vitamin D status and insulin requirements in children and adolescent with type 1 diabetes. J Pediatr Endocrinol Metab. 2011;24(11–12):1037–41.PubMed Thnc O, Cetinkaya S, Kizilgun M, Aycan Z. Vitamin D status and insulin requirements in children and adolescent with type 1 diabetes. J Pediatr Endocrinol Metab. 2011;24(11–12):1037–41.PubMed
44.
go back to reference Daga RA, Laway BA, Shah ZA, Mir SA, Kotwal SK, Zargar AH. High prevalence of vitamin D deficiency among newly diagnosed youth-onset diabetes mellitus in north India. Arq Bras Endocrinol Metabol. 2012;56(7):423–8.CrossRefPubMed Daga RA, Laway BA, Shah ZA, Mir SA, Kotwal SK, Zargar AH. High prevalence of vitamin D deficiency among newly diagnosed youth-onset diabetes mellitus in north India. Arq Bras Endocrinol Metabol. 2012;56(7):423–8.CrossRefPubMed
45.
go back to reference Vitamin D supplement in early childhood and risk for type I (insulin-dependent) diabetes mellitus. The EURODIAB Substudy 2 Study Group. Diabetologia. 1999;42(1):51–4. Vitamin D supplement in early childhood and risk for type I (insulin-dependent) diabetes mellitus. The EURODIAB Substudy 2 Study Group. Diabetologia. 1999;42(1):51–4.
46.
go back to reference Jeddi M, Dabbaghmanesh MH, Ranjbar Omrani G, Ayatollahi SM, Bagheri Z, Bakhshayeshkaram M. Relative importance of lean and fat mass on bone mineral density in Iranian children and adolescents. Int J Endocrinol Metab. 2015;13(3):e25542.CrossRefPubMedPubMedCentral Jeddi M, Dabbaghmanesh MH, Ranjbar Omrani G, Ayatollahi SM, Bagheri Z, Bakhshayeshkaram M. Relative importance of lean and fat mass on bone mineral density in Iranian children and adolescents. Int J Endocrinol Metab. 2015;13(3):e25542.CrossRefPubMedPubMedCentral
47.
go back to reference Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690–3.PubMed Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690–3.PubMed
48.
go back to reference Tsuji K, Maeda T, Kawane T, Matsunuma A, Horiuchi N. Leptin stimulates fibroblast growth factor 23 expression in bone and suppresses renal 1alpha,25-dihydroxyvitamin D3 synthesis in leptin-deficient mice. J Bone Miner Res Off J Am Soc Bone Miner Res. 2010;25(8):1711–23.CrossRef Tsuji K, Maeda T, Kawane T, Matsunuma A, Horiuchi N. Leptin stimulates fibroblast growth factor 23 expression in bone and suppresses renal 1alpha,25-dihydroxyvitamin D3 synthesis in leptin-deficient mice. J Bone Miner Res Off J Am Soc Bone Miner Res. 2010;25(8):1711–23.CrossRef
Metadata
Title
Vitamin D deficiency and the associated factors in children with type 1 diabetes mellitus in southern Iran
Authors
Forough Saki
Gholamhossein Ranjbar Omrani
Yasna Pouralborz
Mohammad Hossein Dabbaghmanesh
Publication date
01-03-2017
Publisher
Springer India
Published in
International Journal of Diabetes in Developing Countries / Issue 1/2017
Print ISSN: 0973-3930
Electronic ISSN: 1998-3832
DOI
https://doi.org/10.1007/s13410-016-0499-0

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