Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Seasonal Changes in Vitamin D Levels of Healthy Children in Mid-Latitude, Asian Urban Area

  • Won, Jong Woo (Department of Pediatrics, Korea University Medical Center) ;
  • Jung, Seong Kwan (Department of Pediatrics, Woorisoa Children's Hospital) ;
  • Jung, In Ah (Department of Pediatrics, Woorisoa Children's Hospital) ;
  • Lee, Yoon (Department of Pediatrics, Korea University Medical Center)
  • Received : 2020.08.24
  • Accepted : 2020.10.25
  • Published : 2021.03.15
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Abstract

Purpose: This study aimed to investigate the seasonal changes in vitamin D levels in a healthy pediatric population living in mid-latitude East Asian urban areas. Methods: A pediatric population was selected from single secondary hospital visitors. Clinical data and serum vitamin D levels were collected retrospectively. Statistical analyses were performed based on the month of the blood sampling date, subject age, and vitamin D supplementation history. The data were categorized into three subgroups based on serum vitamin D levels-adequate (≥30 ng/mL), insufficient (20-29 ng/mL), and deficient (<20 ng/mL). Results: Of the 481 patients, 172 had vitamin D supplementation history. More than 70% of the total study population had inadequate vitamin D levels (<30 ng/mL). The non-supplemented group and the supplemented group showed significantly uneven monthly distribution of the adequate, insufficient, and deficient subgroups. Only the non-supplemented group showed significantly different average vitamin D levels in the summer months compared to the winter months. In the non-supplemented group, vitamin D levels were the lowest in March, the highest in August and September. Significant relevance was noted between vitamin D supplementation status and vitamin D serum level in February and March. There was no significant difference between different age groups in terms of the distribution of vitamin D levels. Conclusion: Currently-widespread vitamin D replacement methods seem to have some effect on increasing the overall serum vitamin D levels, specifically during late winter when natural serum vitamin D levels plunge. However, they are unable to fully compensate the seasonal fluctuation.

Keywords

References

  1. Aggarwal R, Akhthar T, Jain SK. Coronary artery disease and its association with Vitamin D deficiency. J Midlife Health 2016;7:56-60.
  2. Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, et al. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012;7:155-72. https://doi.org/10.1007/s11657-012-0093-0
  3. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398-417. https://doi.org/10.1542/peds.2007-1894
  4. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81:353-73. https://doi.org/10.4065/81.3.353
  5. Hansen KE, Jones AN, Lindstrom MJ, Davis LA, Engelke JA, Shafer MM. Vitamin D insufficiency: disease or no disease? J Bone Miner Res 2008;23:1052-60. https://doi.org/10.1359/jbmr.080230
  6. Huh SY, Gordon CM. Vitamin D deficiency in children and adolescents: epidemiology, impact and treatment. Rev Endocr Metab Disord 2008;9:161-70. https://doi.org/10.1007/s11154-007-9072-y
  7. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006;84:18-28. https://doi.org/10.1093/ajcn/84.1.18
  8. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81. https://doi.org/10.1056/NEJMra070553
  9. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet 1998;351:805-6. https://doi.org/10.1016/S0140-6736(05)78933-9
  10. Nair R, Maseeh A. Vitamin D: the "sunshine" vitamin. J Pharmacol Pharmacother 2012;3:118-26. https://doi.org/10.4103/0976-500X.95506
  11. Kang JI, Lee YS, Han YJ, Kong KA, Kim HS. The serum level of 25-hydroxyvitamin D for maximal suppression of parathyroid hormone in children: the relationship between 25-hydroxyvitamin D and parathyroid hormone. Korean J Pediatr 2017;60:45-9. https://doi.org/10.3345/kjp.2017.60.2.45
  12. Leary PF, Zamfirova I, Au J, McCracken WH. Effect of latitude on vitamin D levels. J Am Osteopath Assoc 2017;117:433-9.
  13. Bikle DD. Vitamin D and the skin: physiology and pathophysiology. Rev Endocr Metab Disord 2012;13:3-19. https://doi.org/10.1007/s11154-011-9194-0
  14. Costanzo PR, Elias NO, Kleiman Rubinsztein J, Garcia Basavilbaso NX, Piacentini R, Salerni HH. [Ultraviolet radiation impact on seasonal variations of serum 25-hydroxy-vitamin D in healthy young adults in Buenos Aires]. Medicina (B Aires) 2011;71:336-42.
  15. Choi HS. Vitamin d status in Korea. Endocrinol Metab (Seoul) 2013;28:12-6. https://doi.org/10.3803/EnM.2013.28.1.12
  16. Stagi S, Pelosi P, Strano M, Poggi G, Manoni C, de Martino M, et al. Determinants of vitamin D levels in Italian children and adolescents: a longitudinal evaluation of cholecalciferol supplementation versus the improvement of factors influencing 25(OH)D status. Int J Endocrinol 2014;2014:583039. https://doi.org/10.1155/2014/583039
  17. Ala-Houhala M, Koskinen T, Koskinen M, Visakorpi JK. Double blind study on the need for vitamin D supplementation in prepubertal children. Acta Paediatr Scand 1988;77:89-93. https://doi.org/10.1111/j.1651-2227.1988.tb10604.x
  18. Schou AJ, Heuck C, Wolthers OD. Vitamin D supplementation to healthy children does not affect serum osteocalcin or markers of type I collagen turnover. Acta Paediatr 2003;92:797-801. https://doi.org/10.1080/08035250310002984
  19. El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, et al. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab 2006;91:405-12. https://doi.org/10.1210/jc.2005-1436
  20. Viljakainen HT, Natri AM, Karkkainen M, Huttunen MM, Palssa A, Jakobsen J, et al. A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res 2006;21:836-44. https://doi.org/10.1359/jbmr.060302
  21. Maalouf J, Nabulsi M, Vieth R, Kimball S, El-Rassi R, Mahfoud Z, et al. Short- and long-term safety of weekly high-dose vitamin D3 supplementation in school children. J Clin Endocrinol Metab 2008;93:2693-701. https://doi.org/10.1210/jc.2007-2530
  22. Park CY, Hill KM, Elble AE, Martin BR, DiMeglio LA, Peacock M, et al. Daily supplementation with 25㎍ cholecalciferol does not increase calcium absorption or skeletal retention in adolescent girls with low serum 25-hydroxyvitamin D. J Nutr 2010;140:2139-44. https://doi.org/10.3945/jn.110.124891
  23. Molgaard C, Larnkjaer A, Cashman KD, Lamberg-Allardt C, Jakobsen J, Michaelsen KF. Does vitamin D supplementation of healthy Danish Caucasian girls affect bone turnover and bone mineralization? Bone 2010;46:432-9. https://doi.org/10.1016/j.bone.2009.08.056
  24. Aguirre Castaneda R, Nader N, Weaver A, Singh R, Kumar S. Response to vitamin D3 supplementation in obese and non-obese Caucasian adolescents. Horm Res Paediatr 2012;78:226-31. https://doi.org/10.1159/000343446
  25. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96:53-8. https://doi.org/10.1210/jc.2010-2704
  26. Golden NH, Abrams SA; Committee on Nutrition. Optimizing bone health in children and adolescents. Pediatrics 2014;134:e1229-43. https://doi.org/10.1542/peds.2014-2173
  27. Yoon JH, Park CS, Seo JY, Choi YS, Ahn YM. Clinical characteristics and prevalence of vitamin D insufficiency in children less than two years of age. Korean J Pediatr 2011;54:298-303. https://doi.org/10.3345/kjp.2011.54.7.298
  28. Cho HM, Choi CS, Sun GK, Kim EY, Kim KS, Kim YW. Two cases of rickets that developed as a result of by diet restriction due to atopic dermatitis. Korean J Pediatr Gastroenterol Nutr 2006;9:284-90. https://doi.org/10.5223/kjpgn.2006.9.2.284
  29. Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc 2011;86:50-60. https://doi.org/10.4065/mcp.2010.0567
  30. Wang LL, Wang HY, Wen HK, Tao HQ, Zhao XW. Vitamin D status among infants, children, and adolescents in southeastern China. J Zhejiang Univ Sci B 2016;17:545-52. https://doi.org/10.1631/jzus.B1500285
  31. Gonzalez-Parra E, Avila PJ, Mahillo-Fernandez I, Lentisco C, Gracia C, Egido J, et al. High prevalence of winter 25-hydroxyvitamin D deficiency despite supplementation according to guidelines for hemodialysis patients. Clin Exp Nephrol 2012;16:945-51. https://doi.org/10.1007/s10157-012-0642-2
  32. Kashi Z, Saeedian Fs, Akha O, Gorgi Ma, Emadi Sf, Zakeri H. Vitamin D deficiency prevalence in summer compared to winter in a city with high humidity and a sultry climate. Endokrynol Pol 2011;62:249-51.
  33. Shoben AB, Kestenbaum B, Levin G, Hoofnagle AN, Psaty BM, Siscovick DS, et al. Seasonal variation in 25-hydroxyvitamin D concentrations in the cardiovascular health study. Am J Epidemiol 2011;174:1363-72. https://doi.org/10.1093/aje/kwr258
  34. Sochorova L, Hanzlikova L, Cerna M, Vosatkova M, Grafnetterova AP, Fialova A, et al. Assessment of vitamin D status in Czech children. Cent Eur J Public Health 2018;26:260-4. https://doi.org/10.21101/cejph.a5386
  35. Niculescu DA, Capatina CAM, Dusceac R, Caragheorgheopol A, Ghemigian A, Poiana C. Seasonal variation of serum vitamin D levels in Romania. Arch Osteoporos 2017;12:113. https://doi.org/10.1007/s11657-017-0407-3
  36. Pittaway JK, Ahuja KD, Beckett JM, Bird ML, Robertson IK, Ball MJ. Make vitamin D while the sun shines, take supplements when it doesn't: a longitudinal, observational study of older adults in Tasmania, Australia. PLoS One 2013;8:e59063. https://doi.org/10.1371/journal.pone.0059063
  37. Mazzoleni S, Magni G, Toderini D. Effect of vitamin D3 seasonal supplementation with 1500 IU/day in north Italian children (DINOS study). Ital J Pediatr 2019;45:18. https://doi.org/10.1186/s13052-018-0590-x
  38. Holmlund-Suila E, Viljakainen H, Hytinantti T, Lamberg-Allardt C, Andersson S, Makitie O. High-dose vitamin d intervention in infants--effects on vitamin d status, calcium homeostasis, and bone strength. J Clin Endocrinol Metab 2012;97:4139-47. https://doi.org/10.1210/jc.2012-1575
  39. Gallo S, Comeau K, Vanstone C, Agellon S, Sharma A, Jones G, et al. Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: a randomized trial. JAMA 2013;309:1785-92. https://doi.org/10.1001/jama.2013.3404

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