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

European Journal of Pediatrics volume 172, pages 1607–1617 (2013)Cite this article

Abstract

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 as < 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. Conclusion 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.

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Abbreviations

25-OH-D:

25-hydroxyvitamin D

BMI:

body mass index

OR:

odds ratio

PTH:

parathyroid hormone

SPF:

sun protector factor

25-hydroxyvitamin D:

nmol/L = ng/mL × 2.496

Parathyroid hormone:

pg/mL = ng/L

Calcium:

mmol/L = mg/dL × 0.25

Phosphate:

mmol/L = mg/dL × 0.323

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The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Pediatric Unit, Department of Pediatrics, Santa Chiara University Hospital, Via Roma 67, 56126, Pisa, Italy

    Francesco Vierucci, Marta Del Pistoia, Margherita Fanos, Martina Gori, Giorgia Carlone, Giovanni Federico & Giuseppe Saggese

  2. Nuclear Medicine Unit, Santa Chiara University Hospital, Via Roma 67, 56126, Pisa, Italy

    Paola Erba

  3. Section of Psychiatry, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, Via Roma 67, 56126, Pisa, Italy

    Gabriele Massimetti

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  1. Francesco Vierucci
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  2. Marta Del Pistoia
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Correspondence to Francesco Vierucci.

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Vierucci, F., Del Pistoia, M., Fanos, M. et al. Vitamin D status and predictors of hypovitaminosis D in Italian children and adolescents: a cross-sectional study. Eur J Pediatr 172, 1607–1617 (2013). https://doi.org/10.1007/s00431-013-2119-z

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Keywords

  • Vitamin D deficiency
  • Vitamin D insufficiency
  • 25-hydroxivitamin D
  • Parathyroid hormone
  • Children
  • Adolescents