Advertisement

European Journal of Nutrition

, Volume 57, Issue 2, pp 783–794 | Cite as

Low vitamin D deficiency in Irish toddlers despite northerly latitude and a high prevalence of inadequate intakes

  • Carol ní Chaoimh
  • Elaine K. McCarthy
  • Jonathan O’B. Hourihane
  • Louise C. Kenny
  • Alan D. Irvine
  • Deirdre M. Murray
  • Mairead E. Kiely
Original Contribution

Abstract

Purpose

While reports of inadequate vitamin D intakes among young children are widespread, data on the prevalence of vitamin D deficiency are inconsistent. We aimed to quantify vitamin D intake and serum 25-hydroxyvitamin D [25(OH)D] concentrations in children aged 2 years in the prospective Cork BASELINE Birth Cohort Study.

Methods

Serum 25(OH)D was analysed using UPLC-MS/MS in 741 children living in Cork, Ireland (51°N). Two-day weighed food diaries were collected in 467 children, and 294 provided both a blood sample and a food diary.

Results

Mean (SD) 25(OH)D concentrations were 63.4 (20.4) nmol/L [winter: 54.5 (19.9), summer: 71.2 (17.5)]. The prevalence of vitamin D deficiency (<30 nmol/L) was 4.6, and 26.7% were <50 nmol/L [45.2% during winter (November–April) and 10.4% in summer (May–October)]. With a mean (SD) vitamin D intake of 3.5 (3.1) µg/day, 96% had intakes below 10 µg/day, the current IOM estimated average requirement and the SACN safe intake value for this age group. After adjustment for season, vitamin D intake (µg/day) was associated with higher 25(OH)D concentrations [adjusted estimate (95% CI) 2.5 (1.9, 3.1) nmol/L]. Children who did not consume vitamin D-fortified foods or supplements had very low vitamin D intakes (1.2 (0.9) µg/day), and during winter, 12 and 77% were <30 and <50 nmol/L, respectively, compared with 6 and 44% of fortified food consumers.

Conclusion

There was a high prevalence of low vitamin D status during winter, especially among children who did not consume fortified foods or nutritional supplements. Our data indicate the need for dietary strategies to increase vitamin D intakes in this age group. This report provides further evidence that DRVs for vitamin D should be based on experimental data in specific population groups and indicates the need for dose–response RCTs in young children.

Keywords

Vitamin D intake 25-Hydroxyvitamin D Fortified foods Supplements Young children 

Notes

Acknowledgements

The National Children’s Research Centre is the primary funding source for the Cork BASELINE Birth Cohort Study. Additional support came from a grant from the UK Food Standards Agency to J.O’B.H., A.D.I. and D.M.M. and from Danone Nutricia Early Life Nutrition to M.K. This work and C. ní C. are supported by a grant to M.K. from the European Commission (ODIN, grant 613977 Food based solutions for optimal vitamin D nutrition and health through the life-cycle). None of the funding agencies had a role in the design, analysis or writing of this article.

The authors would like to thank Darina Sheehan, Emma Cobbe and the rest of the Cork BASELINE Birth Cohort Study research team and also the families for their dedication and continued support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics statement

Research objectives and measurements in the Cork BASELINE Birth Cohort Study were conducted according to the guidelines laid down by the Declaration of Helsinki, and ethical approval was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals, ref ECM 5 (9) 01/07/2008. The study is registered with the United States National Institutes of Health Clinical Trials Registry (http://www.clinicaltrials.gov), ID: NCT01498965.

References

  1. 1.
    Cashman KD, Kiely M (2014) Recommended dietary intakes for vitamin D: where do they come from, what do they achieve and how can we meet them? J Hum Nutr Diet 27(5):434–442. doi: 10.1111/jhn.12226 CrossRefGoogle Scholar
  2. 2.
    Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, WashingtonGoogle Scholar
  3. 3.
    Scientific Advisory Committee on Nutrition. Report on Vitamin D and Health (2016) Published online at http://www.sacn.gov.uk/pdf. Accessed 1 July 2016
  4. 4.
    EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) (2016) Scientific opinion on Dietary Reference Values for vitamin D. EFSA Journal 2016; volume (issue):NNNN, 179 pp. doi: 10.2903/j.efsa.2016
  5. 5.
    NORDEN Nordic Nutrition Recommendations, 5th Edition (NNR5)–Vitamin D (2013). http://www.slv.se/en-gb/Startpage-NNR/Public-consultation11/. Accessed Aug 2013
  6. 6.
    German Nutrition Society (2012) New reference values for vitamin D. Ann Nutr Metab 60(4):241–246. doi: 10.1159/000337547 CrossRefGoogle Scholar
  7. 7.
    Carriquiry AL (1999) Assessing the prevalence of nutrient inadequacy. Public Health Nutr 2(1):23–33CrossRefGoogle Scholar
  8. 8.
    Lennox A, Sommerville J, Ong K, Henderson H, Allen R (2011) Diet and Nutrition Survey of Infants and Young Children (DNSIYC). Public Health, EnglandGoogle Scholar
  9. 9.
    Bates B, Lennox A, Prentice A, Bates C, Page P, Nicholson S, Swan G (2014) National Diet and Nutrition Survey. Results from years 1–4 (combined) of the rolling programme (2008/2009–2011/2012)Google Scholar
  10. 10.
    Black LJ, Walton J, Flynn A, Kiely M (2014) Adequacy of vitamin D intakes in children and teenagers from the base diet, fortified foods and supplements. Public Health Nutr 17(4):721–731. doi: 10.1017/s1368980013000359 CrossRefGoogle Scholar
  11. 11.
    Hennessy A, Browne F, Kiely M, Walton J, Flynn A (2016) The role of fortified foods and nutritional supplements in increasing vitamin D intake in Irish preschool children. Eur J Nutr. doi: 10.1007/s00394-016-1171-7 Google Scholar
  12. 12.
    Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, Sempos CT, Picciano MF (2010) Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr 140(4):817–822. doi: 10.3945/jn.109.118539 CrossRefGoogle Scholar
  13. 13.
    Vatanparast H, Calvo MS, Green TJ, Whiting SJ (2010) Despite mandatory fortification of staple foods, vitamin D intakes of Canadian children and adults are inadequate. J Steroid Biochem Mol Biol 121(1–2):301–303. doi: 10.1016/j.jsbmb.2010.03.079 CrossRefGoogle Scholar
  14. 14.
    Kiely M, Black LJ (2012) Dietary strategies to maintain adequacy of circulating 25-hydroxyvitamin D concentrations. Scand J Clin Lab Invest Suppl 243:14–23. doi: 10.3109/00365513.2012.681893 Google Scholar
  15. 15.
    Looker AC, Johnson CL, Lacher DA, Pfeiffer CM, Schleicher RL, Sempos CT (2011) Vitamin D status: United States, 2001–2006. NCHS Data Brief 59:1–8Google Scholar
  16. 16.
    Whiting SJ, Langlois KA, Vatanparast H, Greene-Finestone LS (2011) The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. Am J Clin Nutr 94(1):128–135. doi: 10.3945/ajcn.111.013268 CrossRefGoogle Scholar
  17. 17.
    El Hayek J, Pham TT, Finch S, Hazell TJ, Jean-Philippe S, Vanstone CA, Agellon S, Rodd C, Rauch F, Weiler HA (2013) Vitamin D status in Montreal preschoolers is satisfactory despite low vitamin D intake. J Nutr 143(2):154–160. doi: 10.3945/jn.112.169144 CrossRefGoogle Scholar
  18. 18.
    Mortensen C, Damsgaard CT, Hauger H, Ritz C, Lanham-New SA, Smith TJ, Hennessy Á, Dowling K, Cashman KD, Kiely M, Mølgaard C (2016) Estimation of the dietary requirement for vitamin D in white children aged 4–8 y: a randomized, controlled, dose–response trial. Am J Clin Nutr. doi: 10.3945/ajcn.116.136697 Google Scholar
  19. 19.
    Kenny LC, Black MA, Poston L, Taylor R, Myers JE, Baker PN, McCowan LM, Simpson NA, Dekker GA, Roberts CT, Rodems K, Noland B, Raymundo M, Walker JJ, North RA (2014) Early pregnancy prediction of preeclampsia in nulliparous women, combining clinical risk and biomarkers: the Screening for Pregnancy Endpoints (SCOPE) international cohort study. Hypertension 64(3):644–652. doi: 10.1161/hypertensionaha.114.03578 CrossRefGoogle Scholar
  20. 20.
    O’Donovan SM, Murray DM, Hourihane JO, Kenny LC, Irvine AD, Kiely M (2015) Cohort profile: the Cork BASELINE Birth Cohort Study: babies after SCOPE: evaluating the longitudinal impact on neurological and nutritional endpoints. Int J Epidemiol 44(3):764–775. doi: 10.1093/ije/dyu157 CrossRefGoogle Scholar
  21. 21.
    Holland B, Welch A, Unwin ID, Buss DH, Paul A, Southgate D (1995) McCance and Widdowson’s the composition of foods, 5th edn. HMSO, LondonGoogle Scholar
  22. 22.
    Black LJ, Ireland J, Møller A, Roe M, Walton J, Flynn A, Finglas PM, Kiely M (2011) Development of an on-line Irish food composition database for nutrients. J Food Comp and Anal 24(7):1017–1023. doi: 10.1016/j.jfca.2011.01.015 CrossRefGoogle Scholar
  23. 23.
    Irish Universities Nutrition Alliance (2012) National Preschool Nutrition Survey. http://www.iuna.net. Accessed May 2013
  24. 24.
    Krebs-Smith SM, Kott PS, Guenther PM (1989) Mean proportion and population proportion: two answers to the same question? J Am Diet Assoc 89(5):671–676Google Scholar
  25. 25.
    Wright CM, Williams AF, Elliman D, Bedford H, Birks E, Butler G, Sachs M, Moy RJ, Cole TJ (2010) Using the new UK-WHO growth charts. BMJ 340:c1140CrossRefGoogle Scholar
  26. 26.
    SACN/RCPCH Expert Group (2012) Consideration of issues around the use of BMI centile thresholds for defining underweight, overweight and obesity in children aged 2–18 years in the UK. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/339411/SACN_RCPCH_defining_child_underweight__overweight_and_obesity_in_the_UK_2012.pdf. Accessed Aug 2013
  27. 27.
    Cashman KD, Kinsella M, Walton J, Flynn A, Hayes A, Lucey AJ, Seamans KM, Kiely M (2014) The 3 epimer of 25-hydroxycholecalciferol is present in the circulation of the majority of adults in a nationally representative sample and has endogenous origins. J Nutr 144(7):1050–1057. doi: 10.3945/jn.114.192419 CrossRefGoogle Scholar
  28. 28.
    EFSA Panel on Dietetic Products Nutrition and Allergies (2012) Scientific opinion on the tolerable upper intake level of vitamin D. EFSA J 10(7):2813Google Scholar
  29. 29.
    Norval M, Wulf HC (2009) Does chronic sunscreen use reduce vitamin D production to insufficient levels? Br J Dermatol 161(4):732–736. doi: 10.1111/j.1365-2133.2009.09332.x CrossRefGoogle Scholar
  30. 30.
    Cashman KD, Fitzgerald AP, Kiely M, Seamans KM (2011) A systematic review and meta-regression analysis of the vitamin D intake-serum 25-hydroxyvitamin D relationship to inform European recommendations. Br J Nutr 106(11):1638–1648. doi: 10.1017/s0007114511005058 CrossRefGoogle Scholar
  31. 31.
    Grant CC, Wall CR, Crengle S, Scragg R (2009) Vitamin D deficiency in early childhood: prevalent in the sunny South Pacific. Public Health Nutr 12(10):1893–1901. doi: 10.1017/s1368980009004820 CrossRefGoogle Scholar
  32. 32.
    Mansbach JM, Ginde AA, Camargo CA Jr (2009) Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics 124(5):1404–1410. doi: 10.1542/peds.2008-2041 CrossRefGoogle Scholar
  33. 33.
    Absoud M, Cummins C, Lim MJ, Wassmer E, Shaw N (2011) Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS ONE 6(7):e22179. doi: 10.1371/journal.pone.0022179 CrossRefGoogle Scholar
  34. 34.
    Davies PS, Bates CJ, Cole TJ, Prentice A, Clarke PC (1999) Vitamin D: seasonal and regional differences in preschool children in Great Britain. Eur J Clin Nutr 53(3):195–198CrossRefGoogle Scholar
  35. 35.
    Maguire JL, Lebovic G, Kandasamy S, Khovratovich M, Mamdani M, Birken CS, Parkin PC (2013) The relationship between cow’s milk and stores of vitamin D and iron in early childhood. Pediatrics 131(1):e144–e151. doi: 10.1542/peds.2012-1793 CrossRefGoogle Scholar
  36. 36.
    Black LJ, Walton J, Flynn A, Cashman KD, Kiely M (2015) Small increments in vitamin D intake by Irish adults over a decade show that strategic initiatives to fortify the food supply are needed. J Nutr 145(5):969–976. doi: 10.3945/jn.114.209106 CrossRefGoogle Scholar
  37. 37.
    Spiro A, Buttriss JL (2014) Vitamin D: an overview of vitamin D status and intake in Europe. Nutr Bull/BNF 39(4):322–350. doi: 10.1111/nbu.12108 CrossRefGoogle Scholar
  38. 38.
    Hogler W (2015) Complications of vitamin D deficiency from the foetus to the infant: one cause, one prevention, but who’s responsibility? Best Pract Res Clin Endocrinol Metab 29(3):385–398. doi: 10.1016/j.beem.2015.03.003 CrossRefGoogle Scholar
  39. 39.
    Food Safety Authority of Ireland (FSAI) (2007) Recommendations for a national policy on vitamin D supplementation for infants in Ireland. https://www.fsai.ie/workarea/downloadasset.aspx?id=1222. Accessed Jan 2013
  40. 40.
    European Commission (2007) Orientation paper on setting maximum and minimum amounts for vitamins and minerals in foodstuffs. SANCO/E4/FDA/bs D/540510. European Commission Health and Consumer Protection Directorate-General, Brussels, BelgiumGoogle Scholar
  41. 41.
    Madsen KH, Rasmussen LB, Andersen R, Molgaard C, Jakobsen J, Bjerrum PJ, Andersen EW, Mejborn H, Tetens I (2013) Randomized controlled trial of the effects of vitamin D-fortified milk and bread on serum 25-hydroxyvitamin D concentrations in families in Denmark during winter: the VitmaD study. Am J Clin Nutr 98(2):374–382. doi: 10.3945/ajcn.113.059469 CrossRefGoogle Scholar
  42. 42.
    Piirainen T, Laitinen K, Isolauri E (2007) Impact of national fortification of fluid milks and margarines with vitamin D on dietary intake and serum 25-hydroxyvitamin D concentration in 4-year-old children. Eur J Clin Nutr 61(1):123–128. doi: 10.1038/sj.ejcn.1602506 CrossRefGoogle Scholar
  43. 43.
    Maguire Jl BCSKM et al (2013) Modifiable determinants of serum 25-hydroxyvitamin d status in early childhood: opportunities for prevention. JAMA Pediatr 167(3):230–235. doi: 10.1001/2013.jamapediatrics.226 CrossRefGoogle Scholar
  44. 44.
    Houghton LA, Gray AR, Szymlek-Gay EA, Heath AL, Ferguson EL (2011) Vitamin D-fortified milk achieves the targeted serum 25-hydroxyvitamin D concentration without affecting that of parathyroid hormone in New Zealand toddlers. J Nutr 141(10):1840–1846. doi: 10.3945/jn.111.145052 CrossRefGoogle Scholar
  45. 45.
    Hower J, Knoll A, Ritzenthaler KL, Steiner C, Berwind R (2013) Vitamin D fortification of growing up milk prevents decrease of serum 25-hydroxyvitamin D concentrations during winter: a clinical intervention study in Germany. Eur J Pediatr 172(12):1597–1605. doi: 10.1007/s00431-013-2092-6 CrossRefGoogle Scholar
  46. 46.
    Cashman KD, Kiely M, Kinsella M, Durazo-Arvizu RA, Tian L, Zhang Y, Lucey A, Flynn A, Gibney MJ, Vesper HW, Phinney KW, Coates PM, Picciano MF, Sempos CT (2013) Evaluation of Vitamin D Standardization Program protocols for standardizing serum 25-hydroxyvitamin D data: a case study of the program’s potential for national nutrition and health surveys. Am J Clin Nutr 97(6):1235–1242. doi: 10.3945/ajcn.112.057182 CrossRefGoogle Scholar
  47. 47.
    Kiely ME, Zhang JY, Kinsella M, Khashan AS, Kenny LC (2016) Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. Am J Clin Nutr 104(2):354–361. doi: 10.3945/ajcn.116.130419 CrossRefGoogle Scholar
  48. 48.
    Munns C, Zacharin MR, Rodda CP, Batch JA, Morley R, Cranswick NE, Craig ME, Cutfield WS, Hofman PL, Taylor BJ, Grover SR, Pasco JA, Burgner D, Cowell CT (2006) Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust 185(5):268–272Google Scholar
  49. 49.
    Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M (2008) Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 122(2):398–417. doi: 10.1542/peds.2007-1894 CrossRefGoogle Scholar
  50. 50.
    Drincic AT, Armas LA, Van Diest EE, Heaney RP (2012) Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring) 20(7):1444–1448. doi: 10.1038/oby.2011.404 CrossRefGoogle Scholar
  51. 51.
    Smith TJ, Tripkovic L, Damsgaard CT, Mølgaard C, Ritz C, Wilson-Barnes SL, Dowling KG, Hennessy Á, Cashman KD, Kiely M, Lanham-New SA, Hart KH (2016) Estimation of the dietary requirement for vitamin D in adolescents aged 14–18 y: a dose–response, double-blind, randomized placebo-controlled trial. Am J Clin Nutr. doi: 10.3945/ajcn.116.138065 Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Carol ní Chaoimh
    • 1
    • 2
  • Elaine K. McCarthy
    • 1
    • 2
  • Jonathan O’B. Hourihane
    • 2
    • 3
  • Louise C. Kenny
    • 2
    • 4
  • Alan D. Irvine
    • 5
    • 6
    • 7
  • Deirdre M. Murray
    • 2
    • 3
  • Mairead E. Kiely
    • 1
    • 2
  1. 1.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional SciencesUniversity College CorkCorkIreland
  2. 2.The Irish Centre for Fetal and Neonatal Translational Research (INFANT)University College CorkCorkIreland
  3. 3.Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
  4. 4.Department of Obstetrics and GynaecologyUniversity College CorkCorkIreland
  5. 5.Department of Clinical MedicineTrinity CollegeDublinIreland
  6. 6.Department of Paediatric DermatologyOur Lady’s Children’s HospitalDublinIreland
  7. 7.National Children’s Research CentreDublinIreland

Personalised recommendations