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Open Access 01-12-2023 | Vitamin D Deficiency | Research

Vitamin D status in healthy Italian school-age children: a single-center cross-sectional study

Authors: Tiziana Galeazzi, Sara Quattrini, Dorina Pjetraj, Simona Gatti, Chiara Monachesi, Elisa Franceschini, Luisita Marinelli, Giulia N. Catassi, Elena Lionetti, Carlo Catassi

Published in: Italian Journal of Pediatrics | Issue 1/2023

Abstract

Background

Vitamin D is involved in calcium homeostasis and bone metabolism, although its extra-skeletal actions are also well-known. Low serum 25(OH)D levels are common both in adults and children worldwide.

Methods

The purpose of this cross-sectional study was to determine the distribution of 25(OH)D levels in a cohort of healthy Italian school-age children, aged 5–10 years, in relationship to determinants of vitamin D deficiency such as season, BMI, gender, age and ethnicity.

Results

The mean serum 25(OH) D level was 28.2 ng/mL; the prevalence of 25(OH)D sufficiency (> 30 ng/mL), insufficiency (20–30 ng/mL), deficiency (10–20 ng/mL) and severe deficiency (< 10 ng/mL) was 36%, 37%, 21% and 6% of the study-group population, respectively. The lower serum 25(OH)D values were observed during winter (21.6 ng/mL) and spring (22.9 ng/mL), as compared to summer (46.7 ng/mL) (p < 0.001). Higher BMI z-scores were associated with lower 25(OH)D level while no statistical difference was observed as related to gender and age groups.

Conclusions

Healthy Italian schoolchildren show low 25(OH)D levels, particularly during winter and spring time. Seasonality, ethnicity and overweight/obesity were confirmed to influence the vitamin D status, thus indicating the need for effective initiatives to support adequate vitamin D status in this population group.

Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I, Chiappini E, et al. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. Ital J Pediatr. 2018;44(1):51. https://doi.org/10.1186/s13052-018-0488-7.CrossRefPubMedPubMedCentral

Rewers M, Ludvigsson J. Environmental risk factors for type 1 diabetes. The Lancet. 2016;387:2340–8. https://doi.org/10.1016/S0140-6736(16)30507-4.CrossRef

Aranow C. Vitamin D and the Immune System. J Investig Med. 2011;59:881–6. https://doi.org/10.2310/JIM.0b013e31821b8755.CrossRefPubMedPubMedCentral

Lionetti E, Galeazzi T, Dominijanni V, Acquaviva I, Naspi Catassi G, Iasevoli M, et al. Lower Level of Plasma 25-Hydroxyvitamin D in Children at Diagnosis of Celiac Disease Compared with Healthy Subjects: A Case-Control Study. J Pediatr. 2021;228:132–7. https://doi.org/10.1016/j.jpeds.2020.08.089.CrossRefPubMed

Marino R, Misra M. Extra-Skeletal effects of vitamin D. Nutrients. 2019;11:1460–83. https://doi.org/10.3390/nu11071460.CrossRefPubMedPubMedCentral

Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016;101:394–415. https://doi.org/10.1210/jc.2015-2175.CrossRefPubMedPubMedCentral

Antonucci R, Locci C, Clemente MG, Chicconi E, Antonucci L. Vitamin D deficiency in childhood: old lessons and current challenges. J Ped Endocrinol Metab. 2018;31:247–60. https://doi.org/10.1515/jpem-2017-0391.CrossRef

Polzonetti V, Pucciarelli S, Vincenzetti S, Polidori P. Dietary Intake of vitamin D from Dairy Products Reduces the Risk of Osteoporosis. Nutrients. 2020;10:1743–58. https://doi.org/10.3390/nu12061743.CrossRef

Webb AR, Engelsen O. Ultraviolet Exposure Scenarios: Risks of Erythema from Recommendations on Cutaneous vitamin D Synthesis. In Sunlight, vitamin D and Skin Cancer, Reichrath, J., Ed. Springer New York, New York, NY, 2008, vol. 624, pp. 72–85. https://doi.org/10.1007/978-0-387-77574-6_6.

10.

Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, et al. Vitamin D in the Healthy European Paediatric Population. J Ped Gastroenterol Nutr. 2013;56:692–701. https://doi.org/10.1097/MPG.0b013e31828f3c05.CrossRef

11.

Holick MF, Vitamin D. Status: Measurement, Interpretation, and Clinical Application. Ann Epidemiol. 2009;19:73–8. https://doi.org/10.1016/j.annepidem.2007.12.001.CrossRefPubMed

12.

Zerwekh JE. The measurement of vitamin D: analytical aspects. Ann Clin Biochem. 2004;41:272–81. https://doi.org/10.1258/0004563041201464.CrossRefPubMed

13.

Scientific Advisory Committee on Nutrition. Vitamin D and health. 2016. 1–304. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf.

14.

European Food Safety Authority (EFSA) Panel on Dietetic Products Nutrition and Allergies. Dietary reference values for vitamin D. EFSA J. 2016, 14. e04547–1000.

15.

New reference values for vitamin D. German Nutrition Society. Ann Nutr Metab. 2012;60:241–6.

16.

Evaluation of dietary reference values for vitamin D. Health Council of the Netherlands, 2012/15E, Health Council of the Netherlands, The Hague. Available at: https://www.healthcouncil.nl/documents/advisory-reports/2012/09/26/evaluation-of-the-dietary-reference-values-for-vitamin-d.

17.

Lamberg-Allardt C, Brustad M, Meyer HE, Steingrimsdottir L. Vitamin D a systematic literature review for the 5th edition of the nordic nutrition recommendations. Food Nutr Res. 2013;57:22671–702. https://doi.org/10.3402/fnr.v57i0.22671.CrossRef

18.

Draft vitamin D and Health report. Scientific Advisory Committee on Nutrition (SACN), 2015. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/447402/Draft_SACN_Vitamin_D_and_Health_Report.pdf

19.

Nair R, Maseeh A. Vitamin D: The ‘sunshine’ vitamin. J Pharmacol Pharmacother. 2012;3(2):118–26. https://doi.org/10.4103/0976-500X.95506.CrossRefPubMedPubMedCentral

20.

Linden MA, de ON Freitas RGB, Hessel G, Marmo DB, Bellomo-Brandão MÂ. Definition of vitamin D deficiency in schoolchildren: systematic review with meta-analysis. Arq Gastroenterol. 2019;56:425–30. https://doi.org/10.1590/s0004-2803.201900000-64.CrossRefPubMed

21.

Vierucci F, Del Pistoia M, Fanos M, Erba P, Saggese G. Prevalence of hypovitaminosis D and predictors of vitamin D status in Italian healthy adolescents. Ital J Pediatr. 2014;40:54–67. https://doi.org/10.1186/1824-7288-40-54.CrossRefPubMedPubMedCentral

22.

Franchi B, Piazza M, Sandri M, Tenero L, Comberiati P, Boner AL, Capristo C. 25-hydroxyvitamin D serum level in children of different ethnicity living in Italy. Eur J Pediatr. 2015;174:749–57. https://doi.org/10.1007/s00431-014-2451-y.CrossRefPubMed

23.

Gatti S, Lionetti E, Balanzoni L, Verma AK, Galeazzi T, Gesuita R, et al. Celiac Screening Team; Increased Prevalence of Celiac Disease in School-age Children in Italy. Clin Gastroenterol Hepatol. 2020;18:596–603. https://doi.org/10.1016/j.cgh.2019.06.013.CrossRefPubMed

24.

de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7. https://doi.org/10.2471/blt.07.043497.CrossRefPubMedPubMedCentral

25.

Ciresi A, Cicciò F, Giordano C. High prevalence of hypovitaminosis D in Sicilian children affected by growth hormone deficiency and its improvement after 12 months of replacement treatment. J Endocrinol Invest. 2014;37:631–8. https://doi.org/10.1007/s40618-014-0084-7.CrossRefPubMed

26.

Slater J, Larcombe L, Green C, Slivinski C, Singer M, Denechezhe L, et al. Dietary intake of vitamin D in a northern Canadian Dené First Nation community. Int J Circumpolar Health. 2013;5:20723–31. https://doi.org/10.3402/ijch.v72i0.20723.CrossRef

27.

Cashman KD, Dowling KG, Škrabáková Z, Gonzalez-Gross M, Valtueña J, De Henauw S, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103:1033–44. https://doi.org/10.3945/ajcn.115.120873.CrossRefPubMedPubMedCentral

28.

Castiglione D, Platania A, Conti A, Falla M, D’Urso M, Marranzano M. Dietary Micronutrient and Mineral Intake in the Mediterranean Healthy Eating, Ageing, and Lifestyle (MEAL) Study. Antioxidants (Basel). 2018;23:79–96. https://doi.org/10.3390/antiox7070079.CrossRef

29.

García-Dorta A, Medina-Vega L, Villacampa-Jiménez JJ, Hernández-Díaz M, Bustabad-Reyes S, González-Dávila E, et al. Baseline Levels of vitamin D in a Healthy Population from a Region with High Solar Irradiation. Nutrients. 2021;13:1647–59. https://doi.org/10.3390/nu13051647.CrossRefPubMedPubMedCentral

30.

González-Gross M, Valtueña J, Breidenassel C, Moreno LA, Ferrari M, Kersting M, HELENA Study Group, et al. Vitamin D status among adolescents in Europe: the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Br J Nutr. 2012;107:755–64. https://doi.org/10.1017/S0007114511003527.CrossRefPubMed

31.

Manios Y, Moschonis G, Lambrinou CP, Tsoutsoulopoulou K, Binou P, Karachaliou A, et al. A systematic review of vitamin D status in southern European countries. Eur J Nutr. 2018;57:2001–36. https://doi.org/10.1007/s00394-017-1564-2.CrossRefPubMed

32.

Manios Y, Moschonis G, Hulshof T, Bourhis AS, Hull GLJ, Dowling KG, et al. Prevalence of vitamin D deficiency and insufficiency among schoolchildren in Greece: the role of sex, degree of urbanisation and seasonality. Br J Nutr. 2017;118:550–8. https://doi.org/10.1017/S0007114517002422.CrossRefPubMed

33.

Chlebna-Sokół D, Konstantynowicz J, Abramowicz P, Kulik-Rechberger B, Niedziela M, Obuchowicz A, et al. Evidence of a significant vitamin D deficiency among 9–13-year -old Polish children: results of a multicentre study. Eur J Nutr. 2019;58:2029–36. https://doi.org/10.1007/s00394-018-1756-4.CrossRefPubMed

34.

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:e22179–85. https://doi.org/10.1371/journal.pone.0022179.CrossRefPubMedPubMedCentral

35.

Petersen R, Damsgaard C, Dalskov SM, Sørensen L, Hjorth M, Ritz C, et al. Vitamin D status and its determinants during autumn in children at northern latitudes: a cross-sectional analysis from the optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study. Br J Nutr. 2016;115:239–50. https://doi.org/10.1017/S000711451500433X.CrossRefPubMed

36.

Soininen S, Eloranta AM, Lindi V, Venäläinen T, Zaproudina N, Mahonen A, Lakka TA. Determinants of serum 25-hydroxyvitamin D concentration in Finnish children: the Physical Activity and Nutrition in Children (PANIC) study. Br J Nutr. 2016;115:1080–91. https://doi.org/10.1017/S0007114515005292.CrossRefPubMed

37.

Huibers MHW, Visser DH, Deckers MML, van Schoor NM, van Furth AM, Wolf BHM. Vitamin D deficiency among native Dutch and first- and second-generation non-Western immigrants. Eur J Pediatr. 2013;173:583–8. https://doi.org/10.1007/s00431-013-2198-x.CrossRefPubMed

38.

Farrar MD, Mughal MZ, Adams JE, Wilkinson J, Berry JL, Edwards L, Kift R, Marjanovic E, Vail A, Webb AR, Rhodes LE. Sun Exposure Behavior, Seasonal vitamin D Deficiency, and Relationship to Bone Health in Adolescents. J Clin Endocrinol Metab. 2016;101(8):3105–13.CrossRefPubMed

39.

Mark S, Lambert M, Delvin EE, O’Loughlin J, Tremblay A, Gray-Donald K. Higher vitamin D intake is needed to achieve serum 25(OH)D levels greater than 50 nmol/l in Québec youth at high risk of obesity. Eur J Clin Nutr. 2011;65:486–92. https://doi.org/10.1038/ejcn.2011.5.CrossRefPubMed

40.

Fu Z, Xu C, Shu Y, Xie Z, Lu C, Mo X. Serum 25-hydroxyvitamin D is associated with obesity and metabolic parameters in US children. Public Health Nutr. 2020;23:1214–22. https://doi.org/10.1017/S1368980019001137.CrossRefPubMed

41.

Cheng L. The Convergence of Two Epidemics: vitamin D Deficiency in Obese School-aged Children. J Pediatr Nurs. 2018;38:20–6. https://doi.org/10.1016/j.pedn.2017.10.005.CrossRefPubMed

42.

DongY, Pollock N, Stallmann-Jorgensen IG, Gutin B, Lan L, Chen TC, et al. Low 25-hydroxyvitamin D levels in adolescents: race, season, adiposity, physical activity, and fitness. Pediatrics. 2010;125:1104–1111. https://doi.org/10.1542/peds.2009-2055.

43.

Bischofova S, Dofkova M, Blahova J, Kavrik R, Nevrla J, Rehurkova I, Ruprich J. Dietary Intake of vitamin D in the Czech Population: A Comparison with Dietary Reference Values, Main Food Sources Identified by a Total Diet Study. Nutrients. 2018;7:1452–66. https://doi.org/10.3390/nu10101452.CrossRef

44.

Sette S, Le Donne C, Piccinelli R, Arcella D, Turrini A, Leclercq C. INRAN-SCAI 2005–6 Study Group. The third Italian National Food Consumption Survey, INRAN-SCAI 2005–06--part 1: nutrient intakes in Italy. Nutr Metab Cardiovasc Dis. 2011;21:922–32. https://doi.org/10.1016/j.numecd.2010.03.001.

45.

Martone D, Roccaldo R, Censi L, Toti E, Catasta G, D'Addesa D, Carletti C. ZOOM8 Study Group. Food consumption and nutrient intake in Italian schoolchildren: results of the ZOOM8 study. Int J Food Sci Nutr. 2013;64:700–5. https://doi.org/10.3109/09637486.2013.775226.

46.

Marrone G, Rosso I, Moretti R, Valent F, Romanello C. Is vitamin D status known among children living in Northern Italy?. Eur J Nutr. 2012;51:143–9. https://doi.org/10.1007/s00394-011-0200-9.

Title: Vitamin D status in healthy Italian school-age children: a single-center cross-sectional study
Authors: Tiziana Galeazzi
Sara Quattrini
Dorina Pjetraj
Simona Gatti
Chiara Monachesi
Elisa Franceschini
Luisita Marinelli
Giulia N. Catassi
Elena Lionetti
Carlo Catassi
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Vitamin D Deficiency
Published in: Italian Journal of Pediatrics / Issue 1/2023
Electronic ISSN: 1824-7288
DOI: https://doi.org/10.1186/s13052-023-01422-x

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Vitamin D status in healthy Italian school-age children: a single-center cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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