Abstract
Early-life vitamin D deficiency is associated with adverse child health outcomes, but the prevalence of vitamin D deficiency and its correlates in infants remains underexplored, particularly in sub-Saharan Africa. We aimed to investigate the prevalence of vitamin D deficiency and its correlates among young infants in South Africa. This study included 744 infants, aged 6–10 weeks from the Drakenstein Child Health Study, a population-based birth cohort. Infants were categorized into distinct categories based on serum 25(OH)D concentration level including deficient (<50 nmol/L), insufficient (50–74 nmol/L), and sufficient (≥75 nmol/L). Using multivariable Tobit and logistic regression models, we examined the correlates of serum 25(OH)D3 levels. The overall prevalence of vitamin D deficiency was 81% (95% confidence intervals (CI]) 78–83). Multivariable regression analysis showed that serum 25(OH)D3 concentration was independently associated with study site, socioeconomic status, and sex. Birth in winter and breastfeeding were the strongest predictors of lower serum 25(OH)D3 concentration levels. Compared to non-breastfed children, children breastfed were at higher risk of vitamin D deficiency (AOR, 1.96; 95% CI, 1.04–3.67) and breastfeeding for more than one month was associated with greater likelihood of vitamin D deficiency (AOR, 5.40; 95% CI, 2.37–12.32) and lower vitamin D concentrations (−16.22 nmol/L; 95% CI, −21.06, −11.39). Vitamin D deficiency in infants is ubiquitous, under-recognised, and strongly associated with season of birth and breastfeeding in this setting. Nutritional interventions with vitamin D supplementation in national health programs in low- and middle-income countries are urgently needed to improve early-life vitamin D status in infants.
Highlights
Vitamin D deficiency is a re-emerging public health problem in children across many low- and middle-income countries [1]
There is growing evidence to suggest that the impact of vitamin D deficiency in the first few years of life may extend to adulthood, when vitamin D deficiency is associated with cancer, cardiovascular disease, or infections including COVID-19 [9,10,11]
We investigated the prevalence of vitamin D deficiency in infants in the first two months of life and explored correlates with vitamin D concentrations and deficiency in a population-based birth cohort in South Africa
Summary
Vitamin D deficiency is a re-emerging public health problem in children across many low- and middle-income countries [1]. Vulnerability to vitamin D deficiency in early-life is commonly attributed to increased micronutrient requirements for child growth, bone development, inadequate nutrient intake, or limited exposure to sunlight [2]. In addition to increased risk of growth impairment and rickets in children, vitamin D deficiency has been associated with numerous other adverse child health outcomes such as respiratory tract infections [3,4,5], asthma, allergies [6,7], and type 1 diabetes mellitus [8]. Understanding the epidemiology of vitamin D deficiency in children, especially young infants, is key to the prevention of a broad range of diseases across the lifespan
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