Risk Factors For Hypovitaminosis Research Articles

Prevalence and Risk Factors of Vitamin D, Calcium and Phosphate Deficiency among Apparently Healthy Children Aged 6-24 Months in a Semi-urban Community in Southwest, Nigeria.

Adequate levels of calcium, phosphate and Vitamin D are essential for bone physiology and growth, as well as preventing some common childhood illnesses. This study aimed to determine the prevalence of the deficiencies of these nutrients and factors affecting their serum levels in Nigerian children. This was a cross-sectional study that involved 220 apparently healthy children aged 6-24 months in Ikenne Local Government Area of Ogun State, Nigeria. Serum calcium and phosphate were assayed using the calorimetric method, while Vitamin D (25-OH Vitamin D) was assayed with ELISA. The mean (±standard deviation [SD]) serum Vitamin D level was 55.07 ± 16.53 ng/ml, while the mean (±SD) serum calcium and phosphate were 2.27 ± 0.13 mmol/l and 1.28 ± 0.18 mmol/l, respectively. Eleven (5%) of the children had hypovitaminosis D, 23 (10.5%) had hypocalcaemia and 12 (5.5%) had hypophosphataemia. Factors found to be significantly associated with hypovitaminosis D included low consumption of milk and the use of a hijab veil, while malnutrition (both undernutrition and overnutrition) was significantly associated with hypocalcaemia. The prevalence levels of hypovitaminosis D and hypophosphataemia were low, while hypocalcaemia was more common. Low milk consumption and use of a hijab veil were risk factors for hypovitaminosis D, while malnutrition was a risk factor for hypocalcaemia. Malnourished children, especially overnourished ones, should be routinely screened for hypocalcaemia because of its high prevalence among them.

A Multiregional Survey of Serum Vitamin D Levels among apparently healthy Nigerians – Prevalence and Risk Factors of Hypovitaminosis D

Globally, Hypovitaminosis D has been reported across age groups, with predisposing factors such as black race, older age, inactivity, diet, lack of vitamin D supplementation, indoor-outdoor lifestyle, winter/ wet season and sociocultural/socioeconomic factors. Vitamin D is an essential fat-soluble vitamin with a significant contribution to human health. The optimal level of serum vitamin D for adults' general health may be between 75 and 100 nmol/L, while there are sparse outcome data to help define a healthy or optimal level in children. In spite of the consideration for a serum vitamin D level below 25nmol/l as the lowest cutoff for vitamin D status, there are pieces of evidence that rickets can occur in infants and young children with a serum vitamin D concentration that is higher than 25nmol/l. 
 The study aimed to determine the prevalence and risk factors of hypovitaminosis D among apparently healthy Nigerian hospital workers and patients' caregivers and possibly provide a rationale for clinical supplementation.
 It was a descriptive, cross-sectional multicentre study conducted in 198 participants from the three geopolitical zones of the country between January 2019 and March 2019. A multistage sampling method was used to select the geopolitical zones and tertiary hospitals in the country while a simple random sampling method was used to select the participants from each zones. Serum vitamin D level was determined by Calbiotech Inc, kit.
 Over 68% of the participants had sufficient serum vitamin D levels while 30.8% had low levels, with the latter constituting the prevalence of hypovitaminosis D in this study. Only one participant had a toxic serum level of vitamin D.
 This study shows that about a third of the sample population had Hypovitaminosis D. This suggests a need for routine vitamin D estimation and supplementation accordingly among blacks.

Principaux facteurs de l’hypovitaminose D chez des enfants âgés de 6 à 12 ans non supplémentés dans un milieu urbain à Alger

Introduction. Hypovitaminosis D is a global public health problem. It affects children of all ages. Objective. To determine the risk factors of hypovitaminosis D in children. Population and methods. Cross-sectional study of non-supplemented children (n=123), 54 girls, and 69 boys, aged between 6-12 years. The thresholds were defined as adequacy 30 ng/mL, and deficiency 10 ng/mL. Seasons, daily sunshine duration, gender, exogenous Vit. D intakes, phototype, and body mass index (BMI) were analysed. The study was carried out during 12 months (January 2018-January 2019) with samples taken during the four seasons. Results. The median age was 8.16 ±1.82 years. Hypovitaminosis D was noted in 79.6% versus 20.4% adequacy. The average BMI was 16.80 ± 3.29kg/m2 [11.89 -30.70]. Vit. D daily intakes < 400 IU/d was noted in 52.9% of children, 75.6% of them were insufficiently exposed to sun. After multivariate analysis, and adjustment, the influencing factors were seasons (pa <0,0001, OR=11.22), and sun exposure (pa <0,001, OR=3.56). The lowest rates were present in winter, and when sunshine was < 30 min/d. There was a significant negative correlation between Vit. D values and parathormone (PTH) rate (p <0,001, r= -0.49). Conclusion. There is a high prevalence of hypovitaminosis D in scholar age children. Sun exposure could be insufficient in this urban city. Children should have adequate outdoor activities with sunlight, according to Word Health Organization (WHO) recommendations. Vit.D supplementation should be intensified, especially in winter, and diet should be enriched in Vit. D

Prevalence and Risk Factors for Hypovitaminosis D among Healthy Adolescents in Kota Bharu, Kelantan.

ObjectiveWe aim to study the prevalence and risk factors of hypovitaminosis D among healthy adolescents in Kota Bharu, Kelantan based on the most recent Paediatric Consensus guideline.MethodologyTen public schools were selected from Kota Bharu, Kelantan. We analysed their demography (age, gender, ethnicity, income), measured their anthropometry (height, weight, BMI) and finally analysed their vitamin D and intactParathyroid hormone levels.ResultsThe prevalence of hypovitaminosis D was 16.9% among healthy teenagers with mean age of 15.9±1.39 years. Multivariate analysis showed female gender (adjusted OR, 95% CI): 23.7 (5.64, 100.3) and Chinese 0.24 (0.07, 0.84) were the significant predictors for hypovitaminosis D.ConclusionThe prevalence of healthy adolescents with hypovitaminosis D in Kota Bharu, Kelantan was 16.9% using the most recent cut off value of 30 nmol/L from the global consensus 2016. Female and Malay were the significant risk factors associated with hypovitaminosis D. Higher cut off value would result in overestimation of prevalence rate of hypovitaminosis D.

Prevalence and Risk Factors of Hypovitaminosis D in Nigerian Children with Sickle Cell Anaemia

Background: Vitamin D deficiency (VDD) has been linked to some acute and chronic bone disorders that commonly complicate sickle cell anaemia (SCA) in children. Some of these bone diseases include chronic pain, reduced bone density and fractures. Despite Nigeria having the highest number of children with SCA in the world, there is a paucity of data on vitamin D status and the associated risk factors in affected children. Objective: To determine the prevalence and risk factors for hypovitaminosis D in children with sickle cell anaemia in steady-state. Methods: A total of 174 children with sickle cell anaemia aged one to eighteen years were recruited at the Sickle Cell Foundation Centre, Lagos. Baseline sociodemographic, clinical, anthropometric and laboratory parameters (serum 25-hydroxyvitamin D, corrected serum calcium and alkaline phosphatase) were recorded. Results: The prevalence of vitamin D insufficiency and deficiency were 12.6 % and 72.5% respectively. Children below six years of age were less likely to have hypovitaminosis D compared to the older age groups (p = 0.017). The mean serum corrected calcium was lowest in subjects with vitamin D deficiency (p >0.001). Age and hypocalcaemia are independent predictors of hypovitaminosis D. Conclusion: There is a high prevalence of vitamin D deficiency among children with sickle cell anaemia. Children aged below six years and with those with hypocalcaemia had higher odds of hypovitaminosis D.

Prevalence and risk factors of hypovitaminosis D in pregnant Spanish women

The hypovitaminosis D epidemic is a global health problem. Our aim was to assess the prevalence and potential risk factors of hypovitaminosis D among pregnant women on the eastern Mediterranean coast. Cross-sectional analysis involved 793 healthy pregnant women (35.3 ± 5.0 years) participating in ECLIPSES, a multicenter randomized trial. Socio-demographic, obstetric, anthropometric, lifestyle, dietary variables and blood draw was collected in the first trimester. Vitamin D deficiency was identified in 50.2% and insufficiency in 30.3% of pregnant women. The mean vitamin D level in the overall sample was 33.9 nmol/L (SD, 17.0). Multivariable logistic regression analysis applying AIC-based backward selection identified excess weight during the 1st trimester (BMI ≥ 25 kg/m2) (OR = 1.950, 95% CI = 1.409, 2.699), Arab ethnic group/dark skin colour (OR = 4.005, 95% CI = 2.488, 6.447), winter/spring (OR = 4.319, 95% CI = 3.112, 5.994), and consumption of milk (OR = 0.754, 95% CI = 0.572, 0.993) and yogurt (OR = 0.635, 95% CI = 0.436, 0.922) as independent risk factors for vitamin D deficiency. All of these factors (except yogurt consumption) and physical activity were independently associated with vitamin D deficiency/insufficiency risk in the final multivariable model (all p < 0.05). All these factors and social class were the most important determinants of circulating 25(OH)D concentrations. Our results confirm a high prevalence of vitamin D deficiency and insufficiency among pregnant women from the eastern Mediterranean coast.

Risk Factors of Hypovitaminosis D in HIV-Infected Patients on Suppressive Antiretroviral Therapy.

Low serum vitamin D levels are very common in human immunodeficiency virus (HIV)-infected patients. In our cross-sectional study, we investigated the association between 25-hydroxyvitamin D (25(OH)D) levels and serum inflammation markers [C-reactive protein (CRP), white blood cells (WBC), D-dimers, platelet count (PLT)] in 148 HIV-infected patients on combined antiretroviral therapy [28 on tenofovir alafenamide (TAF)] and 40 healthy controls. The controls were significantly older (56.6 ± 19.1 years for HIV(-) vs. 45.1 ± 11.8 years for HIV(+); p = .001) and more females were observed in this group (65% for HIV(-) vs. 16.7% for HIV(+); p = .001). The vitamin D serum level was comparable in the two studied groups (74.2 ± 35.9 nmol/L for HIV(+) vs. 78.0 ± 27.6 nnmol/L for HIV(-), p = .545). In HIV-infected group, a significant positive correlation between CD4+ cell percentage and vitamin D level was observed (r = 0.17; p = .036). Furthermore, the significant negative correlation between vitamin D level and CD8+ cell percentage, PLT, CRP, and D-dimers was seen. In univariate analysis, only TAF use and AIDS status was associated with vitamin D level deficiency. No other antiretroviral (ARV) drug nor gender or smoking had influence on vitamin D serum level. In multivariate analysis, only AIDS status and CRP level were correlated with vitamin D level (slope estimate = 11.6 and p = .032 and slope estimate = -0.83 and p = .002; respectively). In summary, we report that low vitamin D level may be associated with high CRP level in HIV-infected patients on suppressive antiretroviral therapy, especially in AIDS phase. More larger studies are required to assess our observation concerning TAF use and vitamin D level in HIV-positive patients.

Vitamin D Status of Epileptic Children in India: A Prospective Cross-Sectional Study from a Tertiary Care Centre

AbstractVitamin D deficiency is prevalent all over the world, especially in tropical countries. In epileptics, antiepileptic drugs (AED) and associated comorbidities further impact vitamin D status. The aim of this study is to estimate the prevalence of 25(OH) vitamin D deficiency in epileptic children and evaluate probable risk factors. A cross-sectional study of 200 children between 1 and 18 years of age on AED was undertaken in the pediatric neurology clinic of a tertiary care center of Northern India. In all children, serum 25(OH) vitamin D levels, calcium, phosphorus, and alkaline phosphatase were estimated. The deficiency levels of vitamin D were categorized as: deficiency &lt;20 ng/mL, insufficiency 20 to 30 ng/mL, and sufficiency &gt;30 ng/mL. The potential risk factors for hypovitaminosis D, including type of epilepsy, AED regimen (specific medications, polytherapy vs. monotherapy), cerebral palsy, ambulatory status, intellectual disability, body mass index, gender, and vegetarianism were examined. Among the 200 enrolled children (60% boys), 106/200 (53%) were vitamin D deficient. There was no significant relation of vitamin D levels with gender, type of epilepsy, neurological deficit, and type of AED. An inverse relationship of higher phenytoin doses during monotherapy associated with lower vitamin D levels in monotherapy was found, thereby suggesting adverse effect of high doses of phenytoin on vitamin D levels. VDD is common among epileptic children on AED therapy. Vitamin D deficiency is common prevalent among epileptic children on AED therapy, and its detection and treatment correction should be an integral part of epilepsy management.

Epidemiology and risk factors of hypovitaminosis D in a cohort of internationally adopted children: a retrospective study

BackgroundPredictors of hypovitaminosis D were extensively studied in the adult population, leading to an approximately complete understanding of them, while there is a lack of studies in the pediatric population, especially in migrant and internationally adopted children.In this retrospective study, we tried to identify the major laboratory predictors of hypovitaminosis D in a cohort of internationally adopted children.MethodsData were extracted from the database of the “Ethnopediatrics Outpatient Clinic” of the “A. Gemelli” Foundation University Hospital in Rome, Italy. Our study included 873 children evaluated from March 2007 to May 2016. Analysis of variance, chi square test, t test and multivariate logistic regression were performed, a “p” value < 0.05 was considered significant, with a confidence interval of 95%.ResultsWe did not find any significant correlation between Vitamin D and Calcium, Phosphates or Magnesium levels within the population we examined. Moreover, parathyroid hormone is not a good predictor of Vitamin D Status.ConclusionsConsidering the strong influence Vitamin D status has not only on bone health, but also on general well-being, it is due to perform a vitamin D assessment as soon as possible, especially in internationally adopted children.

Vitamin D in the Middle East and North Africa

PurposeThe Middle East and North Africa (MENA) region registers some of the lowest serum 25‑hydroxyvitamin D [25(OH)D] concentrations, worldwide. We describe the prevalence and the risk factors for hypovitaminosis D, completed and ongoing clinical trials, and available guidelines for vitamin D supplementation in this region. MethodsThis review is an update of previous reviews published by our group in 2013 for observational studies, and in 2015 for randomized controlled trials (RCTs) from the region. We conducted a comprehensive search in Medline, PubMed, and Embase, and the Cochrane Library, using MeSH terms and keywords relevant to vitamin D, vitamin D deficiency, and the MENA region, for the period 2012–2017 for observational studies, and 2015–2017 for RCTs. We included large cross-sectional studies with at least 100 subjects/study, and RCTs with at least 50 participants per arm. ResultsWe identified 41 observational studies. The prevalence of hypovitaminosis D, defined as a 25‑hydroxyvitamin D [25(OH)D] level below the desirable level of 20 ng/ml, ranged between 12–96% in children and adolescents, and 54–90% in pregnant women. In adults, it ranged between 44 and 96%, and the mean 25(OH)D varied between 11 and 20 ng/ml. In general, significant predictors of low 25(OH)D levels were female gender, increasing age and body mass index, veiling, winter season, use of sun screens, lower socioeconomic status, and higher latitude.We retrieved 14 RCTs comparing supplementation to control or placebo, published during the period 2015-2017: 2 in children, 8 in adults, and 4 in pregnant women. In children and adolescents, a vitamin D dose of 1000–2000 IU/d was needed to maintain serum 25(OH)D level at target. In adults and pregnant women, the increment in 25(OH)D level was inversely proportional to the dose, ranging between 0.9 and 3 ng/ml per 100 IU/d for doses ≤2000 IU/d, and between 0.1 and 0.6 ng/ml per 100 IU/d for doses ≥3000 IU/d. While the effect of vitamin D supplementation on glycemic indices is still controversial in adults, vitamin D supplementation may be protective against gestational diabetes mellitus in pregnant women. In the only identified study in the elderly, there was no significant difference between 600 IU/day and 3750 IU/day doses on bone mineral density. We did not identify any fracture studies.The available vitamin D guidelines in the region are based on expert opinion, with recommended doses between 400 and 2000 IU/d, depending on the age category, and country. ConclusionHypovitaminosis D is prevalent in the MENA region, and doses of 1000–2000 IU/d may be necessary to reach a desirable 25(OH)D level of 20 ng/ml. Studies assessing the effect of such doses of vitamin D on major outcomes, and confirming their long term safety, are needed.

Pediatric Hypovitaminosis D: Molecular Perspectives and Clinical Implications.

Vitamin D, a secosteroid, is essential for the development and maintenance of healthy bone in both the adult and pediatric populations. Low level of 25-hydroxy vitamin D (25-(OH)-D) is highly prevalent in children worldwide and has been linked to various adverse health outcomes including rickets, osteomalacia, osteomalacic myopathy, sarcopenia, and weakness, growth retardation, hypocalcemia, seizure and tetany, autism, cardiovascular diseases, diabetes mellitus, cancers (prostate, colon, breast), infectious diseases (viral, tuberculosis), and autoimmune diseases, such as multiple sclerosis and Hashimoto’s thyroiditis. Risk factors for hypovitaminosis D are people with darker skin pigmentation, use of sunscreen, insufficient ultraviolet B exposure, prematurity, living in northern latitudes, malnutrition, obesity, exclusive breastfeeding, low maternal vitamin D level, certain medications, drinking unfortified cow’s milk, liver failure, chronic renal insufficiency, cystic fibrosis, asthma, and sickle cell hemoglobinopathy. This review highlights and summarizes the molecular perspectives of vitamin D deficiency and its potential adverse health outcomes in pediatric age groups. The recommended treatment regimen is beyond the scope of this review.

Vitamin D Status and Predictors of Hypovitaminosis D in Internationally Adopted Children.

ObjectivesTo evaluate vitamin D status in internationally adopted children at first medical evaluation in Italy and to identify possible risk factors for hypovitaminosis D in this population.Methods25-hydroxyvitamin D [25(OH)D] levels were analyzed in internationally adopted children consecutively recruited at one Italian Center between 2010 and 2014 as part of the first screening protocol. Demographic, clinical and laboratory data were prospectively collected. Serum 25(OH)D levels <10 ng/mL, <20 ng/mL, and <30 ng/mL were used to define severe vitamin D deficiency, vitamin D deficiency and hypovitaminosis D, respectively.Results962 internationally adopted children (median age: 5.47 years; IQR:3.14–7.93) were included in the study. Median 25(OH)D level was 22.0 ng/mL (IQR:15.0–30.0 ng/mL); 710/962 (73.8%) children showed hypovitaminosis D (<30 ng/mL), 388/962 (40.3%) had vitamin D deficiency (<20 ng/dL), and 92/962 (9.6%) had severe vitamin D deficiency (<10ng/mL). No case of clinical rickets was observed. Hypovitaminosis D was particularly frequent (>90%) in children adopted from Ethiopia, Peru, India, Bulgaria and Lithuania. At multivariate analysis an increased risk of hypovitaminosis D was found to be associated with: age ≥ 6 years, time spent in Italy ≥ 3 months, blood sample taken in winter, spring or fall, compared to summer. Gender, ethnicity/continent of origin, tubercular infection, intestinal parassitosis and BMI-z-score < -2 were not associated with vitamin D status.ConclusionHypovitaminosis D is common in internationally adopted children, from all ethnic group. The evaluation of serum 25(OH)D level could be useful early after the adoption to promptly start vitamin D supplementation/treatment if needed.

The Association of Gender, Age, Efavirenz Use, and Hypovitaminosis D Among HIV-Infected Adults Living in the Tropics.

Vitamin D, which is important for calcium homeostasis and bone metabolism, has several noncalcemic actions. Low vitamin D levels have been observed in HIV-infected patients from high latitudes, with consequently reduced bone mineral density (BMD), but data from the tropics are scarce. We aimed to determine the prevalence of and risk factors for hypovitaminosis D among HIV-infected patients in the tropics. This was a cross-sectional study to determine serum 25-hydroxyvitamin D [25(OH)D] levels in HIV-infected patients who attended our HIV clinic in Bangkok, Thailand from July 2010 to June 2011. Hypovitaminosis D was defined as vitamin D insufficiency and deficiency [25(OH)D 20-30 ng/ml and <20 ng/ml, respectively]. Hypovitaminosis D prevalence was calculated and risk factors were determined using multivariate logistic regression. A total of 673 HIV-infected adults were included. The median age was 41 years and 47% were females. The median body mass index (BMI) was 21.9 kg/m(2) and 93% were using antiretroviral therapy (ART), with a median (IQR) duration of 8.9 (5.0-10.4) years. Thirty-one percent were using efavirenz (EFV). The prevalence of vitamin D insufficiency and deficiency was 40.6% and 29.9%, respectively. In multivariate analysis, female gender [odds ratio: OR (95% confidence interval: 95% CI) 1.7 (1.2-2.3), p = 0.005], age >37 years [OR (95% CI) 1.6 (1.1-2.4), p = 0.01], and EFV use [OR (95% CI) 2.0 (1.3-3.2), p = 0.004] were independent predictors of hypovitaminosis D. Even in tropical areas where the sun is abundant, hypovitaminosis D is highly prevalent. Thus, treatment of low vitamin D in HIV-infected patients at high risk should not be ignored to prevent reductions in BMD and other hypovitaminosis D-related comorbidities.

Vitamin D Deficiency in Spinal Surgery: Can It Compromise the Outcome?

ow back pain is a problem that affects an ever-greater number of patients, and the volume of spinal fusion surL geries performed each year is constantly increasing. Although in most patients the surgery achieves a satisfactory outcome, there is a subpopulation that does not achieve a complete recovery. The causes of such failure can be easily identified in most of cases (e.g., pseudarthrosis); however, there are some patients who continue to complain of low back pain without a reasonable explanation. In those patients who experience a suboptimal outcome after spinal fusion surgery, several parameters may be considered, and serum Vitamin D concentration could be an important marker to investigate because of its importance in maintaining musculoskeletal health. This consideration can be crucial when a spinal fusion surgery is planned, especially in those patients with risk factors for hypovitaminosis D.

Risk Factors of Hypovitaminosis D in Adolescents, Shanghai, China: A Cross-Sectional Study

Abstract Background and Objectives: Hypovitaminosis D is prevalent worldwide. Accumulating researches suggested vitamin D deficiency is associated with obesity and dyslipidemia. But the relationship is still controversial. This study was aimed to evaluate the vitamin D status in Chinese adolescents, to find out the risk factors of hypovitaminosis D and its association with obesity. Methods: A cross-sectional survey of serum 25(OH)D, glycolipids, anthropometric measurements and life style investigation was done in 441 youths. The prevalence of hypovitaminosis D was determined. The influence factors of 25(OH)D concentration were analysed. Multi-variation logistic regression was utilized to find the risk factors of hypovitaminosis D. The association of vitamin D3 and the metabolic indice was analysed by gender. Results: The mean serum 25(OH)D concentration was 21.9 ± 8.1 ng/ml. Boys had higher 25(OH)D than girls (22.4 ± 8.1 ng/ml vs. 19.0 ng/ml (P25: 15.5 ng/ml, P75: 25.2 ng/ml), p<0.05). The prevalence of hypovitaminosis D was 42.4%. The prevalence of vitamin D deficiency in girls was significantly higher than in boys (55.4% vs. 39.8%, p<0.01). The mean concentration of 25(OH)D in winter was 19.6ng/ml, significantly lower than that in summer(25.6 ± 7.8 ng/ml, p<0.001). Significant differences were found in gender (p=0.005), age (p<0.001), BMI-SDS (p=0.003), WCSDS (p=0.005), seasons (p<0.001) and NAFLD ratios (p=0.018) among groups of vitamin D sufficiency, insufficiency and deficiency. The logistic regression suggested that female (OR=2.45, p=0.001), older ages (OR=1.29, p=0.011) and winter (OR=1.96, p=0.038) were risk factors of vitamin D deficiency. In male adolescents, HDL was protective factor of 25(OH)D concentrations (OR=0.22, p=0.009). BMI and WC were of no association with vitamin D. No relationship between 25(OH)D and metabolic indice or anthropometric measurements in girls was found. Conclusions: The vitamin D3 status in adolescents was very worrying. The risk factors of hypovitaminosis D were female, older ages and winter. 25(OH)D concentration had no relationship with BMI, WC, NAFLD in both genders.

Vitamin D insufficiency in the elderly orthopaedic patient: an epidemic phenomenon.

The purpose of this observational study was to evaluate serum levels of 25-OH-D of elderly patients presenting with orthopaedic illness. Furthermore, we enquired about potential confounders and risk factors of hypovitaminosis D in comorbidities and daily medication of the elderly. Vitamin D levels in 1,083 patients aged >70 years and admitted to an orthopaedic surgery department were measured. Univariate and multivariate analyses were used to assess risk factors for insufficient vitamin D levels. Overall, 86 % of patients had insufficient serum levels of 25-OH-D and >60 % were vitamin D deficient. Serum vitamin D levels were lower during winter and months with fewer sunshine hours. Patients presenting with obesity, hypertension and osteoporosis were more likely to have low vitamin D levels. We found a high prevalence of hypovitaminosis D in elderly, nonhospitalized orthopaedic patients. Given the well-known effects of vitamin D on bone metabolism and muscle health, as well as its nonskeletal effects, vitamin D insufficiency may have a negative impact.

Vitamin D status and predictors of hypovitaminosis D in Italian children and adolescents: a cross-sectional study

Hypovitaminosis D affects children and adolescents all around the world. Italian data on vitamin D status and risk factors for hypovitaminosis D during pediatric age are lacking. Six hundred fifty-two children and adolescents (range 2.0-21.0 years) living in the northwestern area of Tuscany were recruited at the Department of Pediatrics, University Hospital Pisa. None of them had received vitamin D supplementation in the previous 12 months. 25-hydroxyvitamin D (25-OH-D) and parathyroid hormone (PTH) levels were analyzed in all subjects. Severe vitamin D deficiency was defined as serum levels of 25-OH-D<25.0 nmol/L (10.0 ng/mL) and vitamin D deficiency a<50.0 nmol/L (20.0 ng/mL). Serum 25-OH-D levels of 50.0-74.9 nmol/L (20.0-29.9 ng/mL) indicated vitamin D insufficiency, whereas 25-OH-D levels ≥ 75.0 nmol/L (30.0 ng/mL) were considered sufficient. Hypovitaminosis D was defined as 25-OH-D levels<75.0 nmol/L (30.0 ng/mL). The median serum 25-OH-D level was 51.8 nmol/L, range 6.7-174.7 (20.7 ng/mL, range 2.7-70.0), with a prevalence of vitamin D deficiency, insufficiency, and sufficiency of 45.9, 33.6, and 20.5 %, respectively. The prevalence of severe vitamin D deficiency was 9.5 %. Adolescents had lower median 25-OH-D levels (49.8 nmol/L, range 8.1-174.7; 20.0 ng/mL, range 3.2-70.0) than children (55.6 nmol/L, range 6.8-154.6; 22.3 ng/mL, range 2.7-61.9, p=0.006). Non-white individuals (n=37) had median serum 25-OH-D levels in the range of deficiency (28.2 nmol/L, range 8.1-86.2; 11.3 ng/mL, range 3.2-34.5), with 36/37 having hypovitaminosis D. Logistic regression showed significant increased risk of hypovitaminosis D in the following: blood samples taken in winter (odds ratio (OR) 27.20), spring (OR 26.44), and fall (OR 8.27) compared to summer; overweight (OR 5.02) and obese (OR 5.36) subjects compared to individuals with normal BMI; low sun exposure (OR 8.64) compared to good exposure, and regular use of sunscreens (OR 7.06) compared to non-regular use. Gender and place of residence were not associated with vitamin D status. The 25-OH-D levels were inversely related to the PTH levels (r=-0.395, p<0.0001). Sixty-three out of the 652 (9.7 %) subjects showed secondary hyperparathyroidism. Italian children and adolescents who were not receiving vitamin D supplementation had high prevalence of hypovitaminosis D. Careful identification of factors affecting vitamin D status is advisable to promptly start vitamin D supplementation in children and adolescents.

Parity and tanned white skin as novel predictors of vitamin D status in early pregnancy: a population‐based cohort study

In pregnancy, vitamin D insufficiency and deficiency, defined as serum 25-hydroxyvitamin D (25(OH)D) <50 nM, and <25 nM, respectively, may have adverse effects for both mother and child. Prevalence estimates, and identification of subgroups at special risk, may be useful for the planning of preventive strategies. To study the prevalence and risk factors of hypovitaminosis D in early pregnancy. In a cross-sectional study of 1348 women in early pregnancy from the Odense Child Cohort, Denmark, 25(OH)D was determined and correlated to demographic and lifestyle variables (age, nationality, skin tone, parity, prepregnancy body mass index (BMI), smoking and sun exposure), using multiple linear and logistic regression analyses for all year, or stratified for summer and winter. The risk of vitamin D insufficiency was expressed as odds ratios (OR) with 95% confidence intervals in brackets. The prevalence of vitamin D insufficiency and deficiency was estimated to 27·8% and 3·5% respectively. In adjusted analyses, vitamin D insufficiency was directly associated with winter season, OR = 1·89 (1·35-2·63); increasing prepregnancy BMI, OR = 1·06 (1·03-1·10); and smoking, OR = 2·7 (1·34-5·41); but was less frequent in nulliparous, OR = 0·47 (0·33-0·68) and tanned Caucasians, OR = 0·63 (0·41-0·97). Season-specific associations having parental origin from outside Europe in summer, OR = 4·13 (1·41-12·13); in winter smoking, OR = 3·15 (1·19-8·36); and prepregnancy BMI, OR = 1·12 (1·06-1·18). Vitamin D insufficiency was widespread in early pregnancy. Associations to smoking, prepregnancy BMI and origin outside Europe varied with season. Multiparity and not being tanned in Caucasians represent new risk factors of vitamin D insufficiency.

Prevalence and Risk Factors for Hypovitaminosis D in Young Patients With Inflammatory Bowel Disease

Vitamin D plays an important role in bone homeostasis. We aimed to report the prevalence of hypovitaminosis D in children with inflammatory bowel disease (IBD) and risk factors associated with low serum 25-hydroxyvitamin D (25OHD) concentration in children with IBD. Risk factors for deficiency of this vitamin are similar to those in healthy children, with the addition of higher erythrocyte sedimentation rate. Both patients with ulcerative colitis and Crohn disease are at risk for hypovitaminosis D.

Risk Factors for Hypovitaminosis D in Nondialyzed Chronic Kidney Disease Patients

Hypovitaminosis D is highly prevalent among patients with chronic kidney disease and has been associated with worse outcome even in the earlier stages of the disease. This study aimed to investigate the risk factors for hypovitaminosis D in nondialyzed patients with chronic kidney disease. This cross-sectional study included 120 patients with chronic kidney disease at stages 2 to 5 (62% male, age: 55.4 ± 11.3 year, estimated glomerular filtration rate: 35.1 ± 15 mL/minute, body mass index [BMI]: 27.1 ± 5.2 kg/m(2), 31% diabetics). Serum 25-hydroxivitamin D [25(OH)D] was measured by chemiluminescence. Subjective global assessment, total body fat (dual-energy X-ray absorptiometry), visceral and subcutaneous abdominal fat (computed tomography), and several laboratory parameters were assessed. Insufficiency of 25(OH)D (15 to 30 ng/mL) was observed in 55% and deficiency (<15 ng/mL) in 20% of the patients. Patients with diabetes, BMI ≥30 kg/m(2), and who had the blood collection during the winter or spring had lower levels of 25(OH)D. Serum 25(OH)D correlated inversely with parathyroid hormone, proteinuria, insulin resistance, leptin, and subcutaneous abdominal fat. The risk factors for hypovitaminosis D were diabetes (odds ratio: 3.8; 95% CI: 1.2 to 11.7; P = .022) and BMI ≥30 kg/m(2) (odds ratio: 4.3; 95% CI: 1.2 to 15.3; P = .018). In the logistic regression analysis adjusting for gender, skin color, and season of the year, diabetes and BMI ≥30 kg/m(2) were independently associated with hypovitaminosis D. Diabetes and obesity were the risk factors for hypovitaminosis D in nondialyzed patients with chronic kidney disease. Effective interventional protocols of vitamin D supplementation taking into account these risk factors are warranted for this population.