European Journal of Pediatrics

, Volume 174, Issue 2, pp 183–190

High prevalence of vitamin D insufficiency/deficiency in Dutch multi-ethnic obese children

  • Nalini Radhakishun
  • Mariska van Vliet
  • Ines von Rosenstiel
  • Olivier Weijer
  • Michaela Diamant
  • Jos Beijnen
  • Dees Brandjes
Original Article

Abstract

Vitamin D insufficiency/deficiency is common among non-white children; however, little is known about the prevalence of vitamin D insufficiency/deficiency in non-white obese children living in the Netherlands. Therefore, a retrospective analysis was performed on data from multi-ethnic Dutch children and adolescents 6–18 years who visited the obesity outpatient clinic in 2012–2013. We performed anthropometric measurements, oral glucose tolerance test, and measured 25(OH)D and lipid levels. Vitamin D insufficiency was defined as 25(OH)D levels 37.5- <50 nmol/L and vitamin D deficiency as 25(OH)D <37.5 nmol/L. In total, data from 387 children were obtained (mean age 11.6 years, 41.1 % boys, 10.3 % Dutch native, 25.6 % Turkish, 24.5 % Moroccan, 7.5 % African Surinamese, and 7.0 % West African). The median 25(OH)D level was 34 (range 12–105) nmol/L. In total, 17.8 % were vitamin D sufficient, 24.5 % with vitamin D insufficiency, and 57.6 % with vitamin D deficiency. Obese ethnic children showed the highest (87.5 %) and normal weight white children showed the lowest (20.0 %) prevalence of vitamin D insufficiency/deficiency . Conclusion: Vitamin D insufficiency and deficiency is extremely prevalent in treatment-seeking obese ethnic children. However, there was no evidence of an effect of vitamin D status on various components of the metabolic syndrome in our cohort.

Keywords

Vitamin D Calcitriol Pediatric obesity Ethnic groups Prevalence 

Abbreviations

25(OH)D

25-Dihydroxyvitamin D3

ALT

Alanine aminotransferase

BMI

Body Mass Index

HDL

High-density lipoprotein

HOMA-IR

Homeostasis model assessment for insulin resistance

IFG

Impaired fasting glucose

IGM

Impaired glucose metabolism

IGT

Impaired glucose tolerance

IR

Insulin resistance

LDL

Low-density lipoprotein

SD

Standard deviation

T2DM

Type 2 diabetes mellitus

WC

Waist circumference

Z-BMI

Body Mass Index standard deviation score for age and sex

Z-WC

Waist circumference standard deviation score for age and sex

References

  1. 1.
    Alemzadeh R, Kichler J, Babar G, Calhoun M (2008) Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism 57(2):183–191PubMedCrossRefGoogle Scholar
  2. 2.
    Aypak C, Turedi O, Yuce A (2014) The association of vitamin D status with cardiometabolic risk factors, obesity and puberty in children. Eur J Pediatr 173(3):367–373. doi:10.1007/s00431-013-2177-2 PubMedCrossRefGoogle Scholar
  3. 3.
    Bhan I, Powe CE, Berg AH, Ankers E, Wenger JB, Karumanchi SA, Thadhani RI (2012) Bioavailable vitamin D is more tightly linked to mineral metabolism than total vitamin D in incident hemodialysis patients. Kidney Int 82(1):84–89PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Brouwers HF, Verburg AD, Looij BJ, Jansen EJ (2010) Rickets in the Benelux. A case report of two Indian immigrants. Acta Orthopaedia Belg 76(6):850–853Google Scholar
  5. 5.
    Creo AL, Rosen JS, Ariza AJ, Hidaka KM, Binns HJ (2013) Vitamin D levels, insulin resistance, and cardiovascular risks in very young obese children. J Pediatr Endocrinol Metab 26(1–2):97–104PubMedGoogle Scholar
  6. 6.
    De Luca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80(6):1689S–1696SGoogle Scholar
  7. 7.
    De Man SA, Andre JL, Bachmann H, Grobbee DE, Ibsen KK, Laaser U, Lippert P, Hofman A (1991) Blood pressure in childhood: pooled findings of six European studies. J Hypertens 9(2):109PubMedCrossRefGoogle Scholar
  8. 8.
    Dijksman T, van Doorn K (2011) A girl with bowed legs. Ned Tijdschr Geneeskd 155(26):A2345PubMedGoogle Scholar
  9. 9.
    Earthman C, Beckman L, Masodkar K, Sibley S (2012) The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes 36(3):387–396CrossRefGoogle Scholar
  10. 10.
    Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124(6):869–871PubMedCrossRefGoogle Scholar
  11. 11.
    Fredriks AM, van Buuren S, Fekkes M, Verloove-Vanhorick SP, Wit JM (2005) Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice? Eur J Pediatr 164(4):216–222PubMedCrossRefGoogle Scholar
  12. 12.
    Fredriks AM, Van Buuren S, Wit JM, Verloove-Vanhorick SP (2000) Body index measurements in 1996-7 ‚ compared with 1980. Arch Dis Child 82(2):107–112Google Scholar
  13. 13.
    Gerasimidis K, Shepherd S, Rashid R, Edwards CA, Ahmed F (2014) Group and individual agreement between field and dual x-ray absorptiometry-based body composition techniques in children from standard schools and a sports academy. J Acad Nutr Diet 114(1):91–98PubMedCrossRefGoogle Scholar
  14. 14.
    Gonzalez-Gross M, Valtuena J, Breidenassel C, Moreno LA, Ferrari M, Kersting M, De Henauw S, Gottrand F, Azzini E, Widhalm K (2012) Vitamin D status among adolescents in Europe: the healthy lifestyle in Europe by nutrition in adolescence study. Synthesis 15:18Google Scholar
  15. 15.
    Gonzalez-Molero I, Rojo-Martinez G, Morcillo S, Gutierrez C, Rubio E, Perez-Valero V, Esteva I, de Adana MR, Almaraz M, Colomo N (2013) Hypovitaminosis D and incidence of obesity: a prospective study. Eur J Clin Nutr 67(6):680–682PubMedCrossRefGoogle Scholar
  16. 16.
    Hintzpeter B, Scheidt-Nave C, Muller MJ, Schenk L, Mensink GB (2008) Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 138(8):1482–1490PubMedGoogle Scholar
  17. 17.
    Huibers MH, Visser DH, Deckers MM, van Schoor NM, van Furth AM, Wolf BH (2014) Vitamin D deficiency among native Dutch and first- and second-generation non-Western immigrants. Eur J Pediatr 173(5):583–588. doi:10.1007/s00431-013-2198-x PubMedGoogle Scholar
  18. 18.
    Lenders CM, Feldman HA, Von Scheven E, Merewood A, Sweeney C, Wilson DM, Lee PD, Abrams SH, Gitelman SE, Wertz MS (2009) Relation of body fat indexes to vitamin D status and deficiency among obese adolescents. Am J Clin Nutr 90(3):459–467PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH (1988) Low circulating vitamin D in obesity. Calcif Tissue Int 43(4):199–201PubMedCrossRefGoogle Scholar
  20. 20.
    Loomis WF (1967) Skin-pigment regulation of vitamin-D biosynthesis in man variation in solar ultraviolet at different latitudes may have caused racial differentiation in man. Science 157(3788):501–506PubMedCrossRefGoogle Scholar
  21. 21.
    Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R (1985) Homeostasis model assessment: insulin resistance and B-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419PubMedCrossRefGoogle Scholar
  22. 22.
    McKinney K, Breitkopf CR, Berenson AB (2008) Association of race, body fat and season with vitamin D status among young women: a cross-sectional study. Clin Endocrinol 69(4):535–541CrossRefGoogle Scholar
  23. 23.
    Meulmeester J, Van den Berg H, Wedel M, Boshuis P, Hulshof K, Luyken R (1990) Vitamin D status, parathyroid hormone and sunlight in Turkish, Moroccan and Caucasian children in The Netherlands. Eur J Clin Nutr 44(6):461–470PubMedGoogle Scholar
  24. 24.
    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):398–417PubMedCrossRefGoogle Scholar
  25. 25.
    NGHS Coordinating Center (1998) NHLBI Growth and Health Study (NGHS) data monitoring report. Maryland Medical Research, BaltimoreGoogle Scholar
  26. 26.
    Olson ML, Maalouf NM, Oden JD, White PC, Hutchison MR (2011) Vitamin D deficiency in obese children and its relationship to glucose homeostasis. J Clin Endocrinol Metab 97(1):279–285PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Pettifor JM (2004) Nutritional rickets: deficiency of vitamin D, calcium, or both? Am J Clin Nutr 80(6):1725S–1729SPubMedGoogle Scholar
  28. 28.
    Powe CE, Ricciardi C, Berg AH, Erdenesanaa D, Collerone G, Ankers E, Wenger J, Karumanchi SA, Thadhani R, Bhan I (2011) Vitamin D-binding protein modifies the vitamin D-bone mineral density relationship. J Bone Miner Res 26(7):1609–1616PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Radhakishun NNE, van Vliet M, Poland DCW, Weijer O, Beijnen JH, Brandjes DPM, Diamant M, von Rosenstiel IA (2014) Efficacy and tolerability of a high loading dose (25000 IU weekly) vitamin D3 supplementation in vitamin D deficient obese childrenGoogle Scholar
  30. 30.
    Rajakumar K, de Las Heras J, Chen TC, Lee S, Holick MF, Arslanian SA (2011) Vitamin D status, adiposity, and lipids in black American and Caucasian children. J Clin Endocrinol Metab 96(5):1560–1567PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Reis JP, von Muhlen D, Miller ER, Michos ED, Appel LJ (2009) Vitamin D status and cardiometabolic risk factors in the United States adolescent population. Pediatrics 124(3):e371–e379PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Sartorio A, Del Col A, Agosti F, Mazzilli G, Bellentani S, Tiribelli C, Bedogni G (2006) Predictors of non-alcoholic fatty liver disease in obese children. Eur J Clin Nutr 61(7):877–883PubMedCrossRefGoogle Scholar
  33. 33.
    Schulpen TW (1982) Once again, rickets in the Netherlands. Ned Tijdschr Geneeskd 126(14):610–613PubMedGoogle Scholar
  34. 34.
    Schwartz JB, Lai J, Lizaola B, Kane L, Markova S, Weyland P, Terrault NA, Stotland N, Bikle D (2014) A comparison of measured and calculated free 25(OH) vitamin D levels in clinical populations. J Clin Endocrinol Metab 99(5):1631–1637PubMedCrossRefGoogle Scholar
  35. 35.
    Sluyter JD, Schaaf D, Scragg RK, Plank LD (2010) Prediction of fatness by standing 8-electrode bioimpedance: a multiethnic adolescent population. Obesity 18(1):183–189PubMedCrossRefGoogle Scholar
  36. 36.
    Stanley T, Bredella MA, Pierce L, Misra M (2013) The ratio of parathyroid hormone to vitamin D Is a determinant of cardiovascular risk and insulin sensitivity in adolescent girls. Metab Syndr Relat Disord 11(1):56–62PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Tanner T (1962) Growth at adolescence: with a general consideration of the effects of hereditary and environmental factors upon growth and maturation from birth to maturity, 2nd edn. Blackwell Scientific, OxfordGoogle Scholar
  38. 38.
    Van der Meer I, Middelkoop B, Boeke A, Lips P (2011) Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview. Osteoporos Int 22(4):1009–1021PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Wang L, Song Y, Manson JE, Pilz S, Marz W, Michaelsson K, Lundqvist A, Jassal SK, Barrett-Connor E, Zhang C (2012) Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 5(6):819–829PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350(23):2362–2374PubMedCrossRefGoogle Scholar
  41. 41.
    Williams DM, Fraser A, Lawlor DA (2011) Associations of vitamin D, parathyroid hormone and calcium with cardiovascular risk factors in US adolescents. Heart 97(4):315–320PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    World Health Organization (1987) Measuring obesity: classification and description of anthropometric data. Report on a WHO consultation of the epidemiology of obesity. Warsaw 21–23 October 1987. Copenhagen: WHO, 1989. Nutrition Unit document, EUR/ICP /NUT 123Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Nalini Radhakishun
    • 1
    • 2
  • Mariska van Vliet
    • 1
  • Ines von Rosenstiel
    • 1
  • Olivier Weijer
    • 1
  • Michaela Diamant
    • 2
  • Jos Beijnen
    • 3
  • Dees Brandjes
    • 4
  1. 1.Department of PediatricsSlotervaart HospitalAmsterdamThe Netherlands
  2. 2.Diabetes Center, Department of Internal MedicineVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Pharmacy & PharmacologySlotervaart HospitalAmsterdamThe Netherlands
  4. 4.Department of Internal MedicineSlotervaart HospitalAmsterdamThe Netherlands

Personalised recommendations