Vitamin D deficiency among healthy infants and toddlers: A prospective study from Irbid, Jordan

Abdul‐Razzak, Khalid K.; Ajlony, Mohammed-Jafar A.; Khoursheed, Abeer M; Obeidat, Bayan A.

doi:10.1111/j.1442-200x.2011.03388.x

Cited by 28 publications

(26 citation statements)

References 31 publications

(73 reference statements)

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“…(17) Decreased sun exposure and sunscreen use are both established risk factors for vitamin D deficiency. (26, 36) However, these factors were not predictors of 25(OH)D concentration in our study or the study conducted by Gordon et al . (17) This may be due to the relatively small proportion of non-AA subjects in this study, as seasonal variation and sun exposure have greater effects on those with less skin pigmentation.…”

Section: Discussioncontrasting

confidence: 89%

“…(14–18, 20, 21, 23, 26, 33) One reason for this could be the small proportion of our sample that was <12 months of age (7%), the age until which breastfeeding is recommended and thus an age group especially susceptible to vitamin D deficiency if not receiving supplementation. In our sample, children ≥13 months of age had lower 25(OH)D levels than infants <13 months of age, perhaps due to switching from supplemented infant formulas to table foods and independent feeding, as is expected around 1 year of age.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of 25-Hydroxyvitamin D Concentrations in Infants and Toddlers

Michel

Olabopo

Wang

et al. 2015

CNF

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Background Resurgence of rickets and recognition of excessive prevalence of hypovitaminosis D among all age groups in the western hemisphere have refocused attention on vitamin D nutrition. Objective To examine the prevalence of hypovitaminosis D [25-hydroxyvitamin D [25(OH)D] <30ng/mL] and characterize the determinants of 25(OH)D concentrations in 8- to 24-month-old healthy infants and toddlers living in Pittsburgh, Pennsylvania. Methods Serum 25(OH)D concentrations were measured and dietary intake of vitamin D, mode of feeding, summertime sun exposure characteristics, and skin color (sun-reactive skin type and melanin index) were assessed. Results A total of 111 healthy 8- to 24-month-old children (mean age [±SD] 14.4 [±3.5] months; male, 51%; black, 67%) were studied. Serum 25(OH)D concentration was <30 ng/mL in 16% (n=18) of the children. Median (interquartile) 25(OH)D concentration was lower in children who were ≥ 13 months vs. <13 months of age [35 (31, 40.5) vs. 40 (35.8, 44.3) ng/mL, p=0.013]; with sun-reactive skin type IV and V vs. I, II, and III [36 (31, 41) vs. 44 (36.5, 48.5) ng/mL, p=0.001]; and examined during fall/winter vs. spring/summer [35.5 (32.5, 38.5) vs. 39 (32.5, 44) ng/mL, p=0.05]. Age and skin type were significant independent predictors of 25(OH)D. Conclusions Concentrations of 25(OH)D tend to be lower in infants and toddlers during fall/winter, and in children who are older (≥13 months vs. <13 months of age) and have darker skin tone. Benefits of enhancement of 25(OH)D concentrations during fall/winter and in children with higher sun-reactive skin type need further exploration.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Determinants of 25-Hydroxyvitamin D Concentrations in Infants and Toddlers

Michel

Olabopo

Wang

et al. 2015

CNF

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“…Our findings are in part explained by the relatively low mean 25(OH)D level of the group at study entry, but these are nevertheless reflective of circulating levels in the pediatric age groups from several nonwestern populations. Indeed, although the mean 25(OH)D at study entry was lower than the reported 25(OH)D that varied from 26 to 36 ng/mL in more than 2800 adolescents aged 12 to 19 years in the National Health and Nutrition Examination Survey (NHANES) study, it is, however, representative of vitamin D status in adolescents in some subgroups in the United States and in many countries in the Middle East and Asia . Indeed, a recent review, compiling information up to 2012, revealed that 30% to 75% of apparently healthy children and adolescents in the Middle East have serum 25(OH)D levels below 20 ng/mL .…”

Section: Discussionmentioning

confidence: 95%

Vitamin D3 Dose Requirement to Raise 25-Hydroxyvitamin D to Desirable Levels in Adolescents: Results from a Randomized Controlled Trial

Al-Shaar

Mneimneh

Nabulsi

et al. 2013

Journal of Bone and Mineral Research

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Several organizations issued recommendations on desirable serum 25-hydroxy vitamin D [25(OH)D] levels and doses of vitamin D needed to achieve them. Trials allowing the formulation of evidence-based recommendations in adolescents are scarce. We investigated the ability of two doses of vitamin D 3 in achieving recommended vitamin D levels in this age group. Post hoc analyses on data from a 1-year double-blind trial that randomized 336 Lebanese adolescents, aged 13 AE 2 years, to placebo, vitamin D 3 at 200 IU/ day (low dose), or 2000 IU/day (high dose). Serum 25(OH)D level and proportions of children achieving levels !20 ng/mL and 30 ng/ mL were determined. At baseline, mean 25(OH)D was 15 AE 7 ng/mL, 16.4 AE 7 ng/mL in boys, and 14 AE 8 ng/mL in girls, p ¼ 0.003, with a level !20 ng/mL in 18% and !30 ng/mL in 5% of subjects. At 1 year, mean levels were 18.6 AE 6.6 ng/mL in the low-dose group, 17.1 AE 6 ng/mL in girls, and 20.2 AE 7 ng/mL in boys, p ¼ 0.01, and 36.3 AE 22.3 ng/mL in the high-dose group, with no sex differences. 25(OH)D increased to !20 ng/mL in 34% of children in the low-dose and 96% in the high-dose group, being higher in boys in the lowdose arm only; it remained !30 ng/mL in 4% of children in the low-dose arm but increased to 64% in the high-dose arm. Baseline 25 (OH)D level, body mass index (BMI), and vitamin D dose assigned were the most significant predictors for reaching a 25(OH)D level !20 ng/mL and 30 ng/mL. A daily dose of 2000 IU raised 25(OH)D level !20 ng/mL in 96% of adolescents (98% boys versus 93% girls). Dose-response studies are needed to determine in a definitive manner the daily allowance of vitamin D for Middle Eastern adolescents with a similar profile.

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“…The overwhelming majority of studies revealed 25(OH)D levels in the low teens [25(OH)D 10−15 ng/ml], even considering population-based studies. Consistent predictors across these studies for lower values were age, albeit with differing findings, some studies showing older age to be a risk factor, 57 , 67 , 69 while others point to younger age, 41 , 42 , 77 female gender in adults 41 , 61 , 63 , 72 , 75 , 82 and children, 83 - 89 winter season, sunlight exposure and veiling, 40 , 41 , 44 , 56 , 60 , 63 , 66 , 75 , 78 , 81 , 90 , 92 except in some studies from gulf countries where summer registers lowest values in studies from the United Arab Emirates, 75 , 77 pollution, 43 low calcium or vitamin D dietary intake, 67 , 77 , 80 , 81 , 90 , 92 and exclusive breast feeding in infants 88 . Other predictors included high BMI and /or increased adiposity, 39 , 60 , 66 - 68 , 72 , 93 and lower SES status or educational level 44 , 60 , 64 , 68 , 80 , 83 .The impact of menopause was not consistent across studies, whereas premenopausal women had higher levels in the study from Saudi Arabia, 67 the opposite was found in UAE 77 Table 1.…”

Section: Magnitude Of the Problem And Predictors Of Low Vitamin D Statusmentioning

confidence: 99%

“…Two studies conducted in hospital based clinics in Amman, in toddlers and pre-school children, one in summer and the other in the winter, revealed that one-third of subjects had mean 25(OH)D levels below 20 ng/ml, 88 , 97 while a community based sample in 93 children mean age 60 mo, in the summer of 2007, revealed the proportion to be even higher at 82% 98 …”

Section: Magnitude Of the Problem And Predictors Of Low Vitamin D Statusmentioning

confidence: 99%

Hypovitaminosis D in the Middle East and North Africa

Bassil

Rahme²,

Hoteit³

et al. 2013

Dermato-Endocrinology

155

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Background: The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide. Aim: We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region. Methods: Medline, Pubmed and Embase search engines, entering keywords and concepts, combined with individual countries of interest, were used. Search was limited years 2000–2012; and review articles were used for the period preceding year 2000. Results: Rickets and osteomalacia still occur in this sunny region. Hypovitaminosis D prevails, with rates varying 30–90%, considering a desirable serum 25 hydroxy-vitamin D [25(OH)D] of 20 ng/ml. Advancing age, female gender, multi-parity, clothing style, season, socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults. Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children.. Associations with pain score and disease activity in rheumatologic disorders, viral load and interleukins in hepatitis C, BMI, lipids and insulin sensitivity, blood pressure, heart failure and mortality are described. Sun exposure in adults decreased prevalence of metabolic syndrome in one study. Few randomized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level, even with doses by far exceeding current recommendations. A trial in adolescent girls reveals substantial bone and lean mass increments. Conclusion: Hypovitaminosis D is prevalent in MENA. The lack of populations based studies, gaps in studies in infants, pre-pubertal children and pregnant women, hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often subclinical disease.

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Vitamin D deficiency among healthy infants and toddlers: A prospective study from Irbid, Jordan

Abstract: The prevalence of vitamin D deficiency is considered to be high among northern Jordanian infants and toddlers. Sun exposure of less than 30 min daily and exclusively breast-feeding are the main factors for developing vitamin D deficiency.

Cited by 28 publications

References 31 publications

Determinants of 25-Hydroxyvitamin D Concentrations in Infants and Toddlers

Determinants of 25-Hydroxyvitamin D Concentrations in Infants and Toddlers

Vitamin D3 Dose Requirement to Raise 25-Hydroxyvitamin D to Desirable Levels in Adolescents: Results from a Randomized Controlled Trial

Hypovitaminosis D in the Middle East and North Africa

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