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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Kanit Reesukumal, Kotchamol Manonukul, Orathai Jirapongsananuruk, Wijittra Krobtrakulchai, Sithikan Hanyongyuth, Somruedee Chatsiricharoenkul, Busadee Pratumvinit

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

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

Methods

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

Results

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

Conclusion

The prevalence of hypovitaminosis D in healthy Thai children is very high, despite their exposure to sunlight, and that prevalence increases in children with a high BMI percentile. As a result, a formal recommendation for vitamin D supplementation in Thai children should be considered.
Literature
1.
Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158(6):531–7.CrossRefPubMed
2.
Basile LA, Taylor SN, Wagner CL, Quinones L, Hollis BW. Neonatal vitamin D status at birth at latitude 32 degrees 72’: evidence of deficiency. J Perinatol. 2007;27(9):568–71.CrossRefPubMed
3.
Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398–417.CrossRefPubMed
4.
Grant WB. An ecologic study of dietary and solar ultraviolet-B links to breast carcinoma mortality rates. Cancer. 2002;94(1):272–81.CrossRefPubMed
5.
6.
Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500–3.CrossRefPubMed
7.
Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296(23):2832–8.CrossRefPubMed
8.
Ginde AA, Mansbach JM, Camargo Jr CA. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384–90.CrossRefPubMedPubMedCentral
9.
Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91(5):1255–60.CrossRefPubMed
10.
Zittermann A. Vitamin D, and disease prevention with special reference to cardiovascular disease. Prog Biophys Mol Biol. 2006;92(1):39–48.CrossRefPubMed
11.
12.
Rovner AJ, O’Brien KO. Hypovitaminosis D among healthy children in the United States: a review of the current evidence. Arch Pediatr Adolesc Med. 2008;162(6):513–9.CrossRefPubMed
13.
Janjai S, Kirdsiri K, Masiri I, Nunez M. An investigation of solar erythemal ultraviolet radiation in the tropics: a case study at four stations in Thailand. Int J Climatol. 2010;30(12):1893–903.
14.
15.
Lund C, Browder N. The estimation of areas of burns. Surg Gynaecol Obstet. 1944;79:352–8.
16.
Khor GL, Chee WS, Shariff ZM, Poh BK, Arumugam M, Rahman JA, et al. High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia. BMC Public Health. 2011;11:95.CrossRefPubMedPubMedCentral
17.
McCarthy HD, Cole TJ, Fry T, Jebb SA, Prentice AM. Body fat reference curves for children. Int J Obes (Lond). 2006;30(4):598–602.CrossRef
18.
19.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.CrossRefPubMed
20.
Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014;144:138–45.CrossRefPubMed
21.
Sahu M, Bhatia V, Aggarwal A, Rawat V, Saxena P, Pandey A, et al. Vitamin D deficiency in rural girls and pregnant women despite abundant sunshine in northern India. Clin Endocrinol (Oxf). 2009;70(5):680–4.CrossRef
22.
Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007;92(6):2130–5.CrossRefPubMed
23.
Gilbert-Diamond D, Baylin A, Mora-Plazas M, Marin C, Arsenault JE, Hughes MD, et al. Vitamin D deficiency and anthropometric indicators of adiposity in school-age children: a prospective study. Am J Clin Nutr. 2010;92(6):1446–51.CrossRefPubMedPubMedCentral
24.
Flores M, Macias N, Lozada A, Sanchez LM, Diaz E, Barquera S. Serum 25-hydroxyvitamin D levels among Mexican children ages 2 y to 12 y: a national survey. Nutrition. 2013;29(5):802–4.CrossRefPubMed
25.
Suarez-Martinez EB, Perez CM, Cruz SK, Khorsandi S, Chardon C, Ferder L. Importance of vitamin D and vitamin D levels status in Puerto Ricans. J Health Care Poor Underserved. 2013;24(4 Suppl):38–47.PubMedPubMedCentral
26.
Rojroongwasinkul N, Kijboonchoo K, Wimonpeerapattana W, Purttiponthanee S, Yamborisut U, Boonpraderm A, et al. SEANUTS: the nutritional status and dietary intakes of 0.5-12-year-old Thai children. Br J Nutr. 2013;3(110 Supp):S36–44.CrossRef
27.
Houghton LA, Gray AR, Harper MJ, Winichagoon P, Pongcharoen T, Gowachirapant S, et al. Vitamin D Status among Thai School Children and the Association with 1,25-Dihydroxyvitamin D and Parathyroid Hormone Levels. PLoS One. 2014;9(8):e104825.CrossRefPubMedPubMedCentral
28.
Chokephaibulkit K, Saksawad R, Bunupuradah T, Rungmaitree S, Phongsamart W, Lapphra K, et al. Prevalence of vitamin D deficiency among perinatally HIV-infected Thai adolescents receiving antiretroviral therapy. Pediatr Infect Dis J. 2013;32(11):1237–9.CrossRefPubMed
29.
Krobtrakulchai W, Praikanahok J, Visitsunthorn N, Vichyanond P, Manonukul K, Pratumvinit B, et al. The effect of vitamin d status on pediatric asthma at a university hospital. Thailand Allergy Asthma Immunol Res. 2013;5(5):289–94.CrossRefPubMed
30.
Nakavachara P, Viprakasit V. Children with hemoglobin E/beta-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(10):1683–8.CrossRefPubMed
31.
Rockell JE, Green TJ, Skeaff CM, Whiting SJ, Taylor RW, Williams SM, et al. Season and ethnicity are determinants of serum 25-hydroxyvitamin D concentrations in New Zealand children aged 5–14 y. J Nutr. 2005;135(11):2602–8.PubMed
32.
Absoud M, Cummins C, Lim MJ, Wassmer E, Shaw N. Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS One. 2011;6(7):e22179.CrossRefPubMedPubMedCentral
33.
Alemzadeh R, Kichler J, Babar G, Calhoun M. Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism. 2008;57(2):183–91.CrossRefPubMed
34.
Rodriguez-Rodriguez E, Navia-Lomban B, Lopez-Sobaler AM, Ortega RM. Associations between abdominal fat and body mass index on vitamin D status in a group of Spanish schoolchildren. Eur J Clin Nutr. 2010;64(5):461–7.CrossRefPubMed
35.
Zhou SJ, Skeaff M, Makrides M, Gibson R. Vitamin D status and its predictors among pre-school children in Adelaide. J Paediatr Child Health. 2014; doi: 10.1111/jpc.12770.
36.
Earthman CP, Beckman LM, Masodkar K, Sibley SD. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes (Lond). 2012;36(3):387–96.CrossRef
37.
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
38.
Konradsen S, Ag H, Lindberg F, Hexeberg S, Jorde R. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index. Eur J Nutr. 2008;47(2):87–91.CrossRefPubMed
39.
Chung IH, Kim HJ, Chung S, Yoo EG. Vitamin D deficiency in Korean children: prevalence, risk factors, and the relationship with parathyroid hormone levels. Ann Pediatr Endocrinol Metab. 2014;19(2):86–90.CrossRefPubMedPubMedCentral
40.
Cheng S, Tylavsky F, Kroger H, Karkkainen M, Lyytikainen A, Koistinen A, et al. Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr. 2003;78(3):485–92.PubMed
41.
Karaguzel G, Dilber B, Can G, Okten A, Deger O, Holick MF. Seasonal vitamin D status of healthy schoolchildren and predictors of low vitamin D status. J Pediatr Gastroenterol Nutr. 2014;58(5):654–60.CrossRefPubMed
42.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84(1):18–28.PubMed
Metadata
Title
Hypovitaminosis D in healthy children in Central Thailand: prevalence and risk factors
Authors
Kanit Reesukumal
Kotchamol Manonukul
Orathai Jirapongsananuruk
Wijittra Krobtrakulchai
Sithikan Hanyongyuth
Somruedee Chatsiricharoenkul
Busadee Pratumvinit
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1588-6

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