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Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: NHANES 2001-2004 - pdf of published report attached
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Download the PDF Here
Pediatrics Aug 3 2009
Juhi Kumar, MD, MPHa, Paul Muntner, PhDb, Frederick J. Kaskel, MD, PhDa, Susan M. Hailpern, DrPH, MSc and Michal L. Melamed, MD, MHSd,e
aChildren's Hospital at Montefiore and
Departments ofdMedicine and Epidemiology and
ePopulation Health, Albert Einstein College of Medicine, Bronx, New York;
bDepartment of Medicine, Mount Sinai School of Medicine, New York, New York;
cNorthrop Grumman and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
"We describe the prevalence of vitamin D deficiency in the US pediatric population using a large nationally representative database. In addition we also showed an association between deficiency and cardiovascular risk factors such as blood pressure and HDL levels.....Nine percent of children had 25(OH)D levels _15 ng/mL, representing 7.6 million US children and adolescents with 25(OH)D deficiency. Sixtyone percent of the children had 25(OH)D levels between 15 and 29 ng/mL, representing 50.8 million US children and adolescents with 25(OH)D insufficiency....after multivariable adjustment, children and adolescents with vitamin D insufficiency and deficiency were more likely to have PTH levels >65 pg/mL and hypertension....After multivariable adjustment, children and adolescents with 25(OH)D insufficiency had lower levels of total cholesterol and HDL cholesterol and higher diastolic blood pressures and were more likely to have elevated PTH levels than their counterparts with 25(OH)D >30 ng/mL. Children with 25(OH)D deficiency had lower serum calcium and HDL cholesterol levels and higher systolic blood pressure than those with 25(OH)D levels >30 ng/mL after multivariable adjustment....Consistent with other studies, nonwhite race/ethnicity was a very strong predictor of 25(OH)D deficiency"
ABSTRACT
Objectives - To determine the prevalence of 25-hydroxyvitamin D (25[OH]D) deficiency and associations between 25(OH)D deficiency and cardiovascular risk factors in children and adolescents.
Methods - With a nationally representative sample of children aged 1 to 21 years in the National Health and Nutrition Examination Survey 2001-2004 (n = 6275), we measured serum 25(OH)D deficiency and insufficiency (25[OH]D <15 ng/mL and 15-29 ng/mL, respectively) and cardiovascular risk factors.
Results -
Overall, 9% of the pediatric population, representing 7.6 million US children and adolescents, were 25(OH)D deficient and 61%, representing 50.8 million US children and adolescents, were 25(OH)D insufficient. Only 4% had taken 400 IU of vitamin D per day for the past 30 days.
After multivariable adjustment, those who were older (odds ratio [OR]: 1.16 [95% confidence interval (CI): 1.12 to 1.20] per year of age), girls (OR: 1.9 [1.6 to 2.4]), non-Hispanic black (OR: 21.9 [13.4 to 35.7]) or Mexican-American (OR: 3.5 [1.9 to 6.4]) compared with non-Hispanic white, obese (OR: 1.9 [1.5 to 2.5]), and those who drank milk less than once a week (OR: 2.9 [2.1 to 3.9]) or used >4 hours of television, video, or computers per day (OR: 1.6 [1.1 to 2.3]) were more likely to be 25(OH)D deficient.
Those who used vitamin D supplementation were less likely (OR: 0.4 [0.2 to 0.8]) to be 25(OH)D deficient.
Also, after multivariable adjustment, 25(OH)D deficiency was associated with elevated parathyroid hormone levels (OR: 3.6; [1.8 to 7.1]), higher systolic blood pressure (OR: 2.24 mmHg [0.98 to 3.50 mmHg]), and lower serum calcium (OR: -0.10 mg/dL [-0.15 to -0.04 mg/dL]) and high-density lipoprotein cholesterol (OR: -3.03 mg/dL [-5.02 to -1.04]) levels compared with those with 25(OH)D levels ≥30 ng/mL.
Conclusions- 25(OH)D deficiency is common in the general US pediatric population and is associated with adverse cardiovascular risks.
ABBREVIATIONS
25(OH)D-25-hydroxyvitamin D
PTH-parathyroid hormone
NHANES-National Health and Nutrition Examination Survey
PIR-poverty/income ratio
CRP-C-reactive protein
HDL-high-density lipoprotein
ACR-albumin/creatinine ratio
Vitamin D, known mainly for its role in calcium homeostasis, is now thought to be involved in various physiologic and pathologic processes in the human body.1,2 Rickets has reemerged in the United States in certain populations.3-9 25-Hydroxyvitamin D (25[OH]D) levels are the most commonly measured indicator of vitamin D status. Chronically low 25(OH)D levels, <15 ng/mL, considered by many to be 25(OH)D deficiency, may result in bone changes that are consistent with rickets. 10 In adults, the optimal level of 25(OH)D has been suggested to be >30 ng/mL, a level associated with maximal suppression of parathyroid hormone (PTH) and reduced fracture rates.11 Few studies have evaluated the prevalence of 25(OH)D deficiency in children and adolescents in the United States. One study showed that 52% of 307 Hispanic and black adolescents in Boston, Mass, had 25(OH)D levels _15 ng/mL. Another found that 48% of 23 white preadolescent girls in Maine had 25(OH)D levels <20 ng/mL.12,13 More recently, a study of vitamin D levels in presumably healthy toddlers and infants attending a pediatrics clinic found that 12.1% (44 of 365) of the children had levels <20 ng/mL, and 40% (146 of 365) had levels <30 ng/mL.14 Given the limited available data on the prevalence of 25(OH)D deficiency among children and adolescents in the United States, we examined the prevalence of 25(OH)D deficiency (<15 ng/mL)12,15-18 and insufficiency (15-29 ng/mL) in US children and adolescents. In addition, we studied risk factors for 25(OH)D deficiency, and, because of evidence linking low 25(OH)D levels with cardiovascular risk factors in adults, we studied this association in children and adolescents as well. To do so, we analyzed data on children and adolescents from the National Health and Nutrition Examination Survey (NHANES) 2001-2004.
RESULTS
Prevalence of 25(OH)D Deficiency
and Insufficiency
There were 9757 children in NHANES 2001-2004 included in the prevalence analyses. Nine percent of children had 25(OH)D levels <15 ng/mL, representing 7.6 million US children and adolescents with 25(OH)D deficiency. Sixtyone percent of the children had 25(OH)D levels between 15 and 29 ng/mL, representing 50.8 million US children and adolescents with 25(OH)D insufficiency
(Figs 1 and 2 and Table 1).
Factors Associated With 25(OH)D
Deficiency (25[OH]D Levels
<15 ng/mL)
Older children, girls, non-Hispanic blacks, Mexican Americans, other races, those born outside of the United States, those with a lower PIR, obese children, and those who spent more time watching television, playing video games, or using computers were more likely to have lower 25(OH)D levels (Table 2). In contrast, children who drank milk daily and those who took vitamin D supplements were less likely to have lower 25 (OH)D levels. These factors were associated with 25(OH)D deficiency after age, gender, and race/ethnicity adjustment and after multivariable adjustment (Table 3).
Association of 25(OH)D Deficiency
With Cardiovascular Risk Factors
Children and adolescents with lower 25(OH)D levels were more likely to have lower serum calcium and HDL cholesterol levels, diabetes mellitus, and elevated CRP and PTH levels (Table 2). After multivariable adjustment, children and adolescents with 25(OH)D insufficiency had lower levels of total cholesterol and HDL cholesterol and higher diastolic blood pressures and were more likely to have elevated PTH levels than their counterparts with 25(OH)D >30 ng/mL (Table 4). Participants with 25(OH)D insufficiency were less likely to have elevated CRP levels, a finding that did not maintain statistical significance when evaluating those with 25(OH)D deficiency. Children with 25(OH)D deficiency had lower serum calcium and HDL cholesterol levels and higher systolic blood pressure than those with 25(OH)D levels >30 ng/mL after multivariable adjustment (Table 4). In addition, after multivariable adjustment, children and adolescents with vitamin D insufficiency and deficiency were more likely to have PTH levels >65 pg/mL and hypertension (Table 4).
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