Vitamin D, Exercise and Body Composition in Young Children and Adolescents

Chapter

Abstract

Vitamin D is now more correctly categorized as a seco-steroid prohormone, rather than as a nutrient or a vitamin. The primary function of vitamin D is thought to be the maintenance of calcium and phosphate homeostasis and skeletal integrity throughout life. Although persistent severe vitamin D deficiency results in the bone disease rickets in children and osteomalacia in adults, low vitamin D status can influence musculoskeletal health at any age. Numerous epidemiological studies suggest that vitamin D deficiency and/or insufficiency are global problems for growing children and adolescents. An adequate vitamin D status in children and adolescents is associated with higher levels of lean body mass and muscle strength levels. On the contrary, vitamin D deficiency in children and adolescents is associated with elevation of PTH level, increased bone remodelling rates and a reduction in bone mass. Thus, avoiding vitamin D deficiency by ensuring an adequate supply throughout childhood and adolescence might enhance physical growth and bone mass accretion, which ultimately could reduce the risk of osteoporotic fracture later in life. Furthermore, in recent years, the positive association of vitamin D status with many non-skeletal metabolic processes such as antiproliferative, differentiation and immunosuppressive effects has been related to a decreased risk of chronic diseases such as cardiovascular diseases, various types of cancers and type 1 diabetes. However, this review focuses on the importance of vitamin D status in body composition and bone growth in children and adolescents.

Keywords

Vitamin D deficiency Body composition Bone mass accretion Children and adolescents 

Abbreviations

aBMD

Areal bone mineral density

AI

Adequate intake

ANZBMS

Australia and New Zealand Bone and Mineral Society

BA

Bone area

BMC

Bone mineral content

BMI

Body mass index

DRI

Dietary reference intake

1,25(OH)D

1,25-dihydroxyvitamin D

DXA

Dual-photon energy X-ray absorptiometry

EAR

Estimated average requirement

FBM

Fat body mass

25(OH)D

25-hydroxyvitamin D

LBM

Lean body mass

LS

Lumbar spine

MED

Minimal erythemal dose

PA

Physical activity

PTH

Parathyroid hormone

UV

Ultraviolet

Notes

Acknowledgements

Sincere appreciation and gratitude is extended to Professor Dr. David Fraser for his excellent mentorship and his critical comments and intellectual thoughts shared throughout this chapter preparation.

References

  1. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387–91.PubMedCrossRefGoogle Scholar
  2. Bischoff HA, Stähelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003;18:343–51.PubMedCrossRefGoogle Scholar
  3. Boland R. Role of vitamin D in skeletal muscle function. Endocr Rev. 1986;7:434–48.PubMedCrossRefGoogle Scholar
  4. Boland R, de Boland AR, Marinissen MJ, Santillan G, Vazquez G, Zanello S. Avian muscle cells as targets for the secosteroid hormone 1,25-dihydroxy-vitamin D3. Mol Cell Endocrinol. 1995;114:1–8.PubMedCrossRefGoogle Scholar
  5. Chapuy MC, Arlot ME, Dobouef E. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992;4:245–52.Google Scholar
  6. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7:439–43.PubMedCrossRefGoogle Scholar
  7. Cheng S, Tylavsky F, Kroger H, Karkkainen M, Lyytikainen A, Koistinen A, Mahonen A, Alen M, Halleen J, Vaananen K, Lamberg-Allardt C. Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr. 2003;78:485–92.PubMedGoogle Scholar
  8. Clements MR. The problem of rickets in UK Asians. J Hum Nutr Diet. 1989;2:105–16.CrossRefGoogle Scholar
  9. Clements MR, Fraser DR. Vitamin D supply to the rat fetus and neonate. J Clin Invest. 1988;81:1768–73.PubMedCrossRefGoogle Scholar
  10. Clements MR, Johnson L, Fraser DR. A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature. 1987a;325:62–5.PubMedCrossRefGoogle Scholar
  11. Clements MR, Davies M, Fraser DR, Lumb GA, Mawer EB, Adams PH. Metabolic inactivation of vitamin D is enhanced in primary hyperparathyroidism. Clin Sci. 1987b;73:659–64.PubMedGoogle Scholar
  12. Daniels SR, Khoury PR, Morrison JA. The utility of body mass index as a measure of body fatness in children and adolescents: differences by race and gender. Pediatrics. 1997;99:804–7.PubMedCrossRefGoogle Scholar
  13. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE, Falconer G, Green CL. Rates of bone loss in postmenopausal women randomly assigned to one of two dosages of vitamin D. Am J Clin Nutr. 1995;61:1140–5.PubMedGoogle Scholar
  14. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337:670–6.PubMedCrossRefGoogle Scholar
  15. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713–6.PubMedCrossRefGoogle Scholar
  16. Docio S, Riancho JA, Perez A, Olmos JM, Amado JA, Gonzallez-Macias J. Seasonal deficiency of vitamin D in children: a potential target for osteoporosis preventing strategies. J Bone Miner Res. 1998;13:544–8.PubMedCrossRefGoogle Scholar
  17. Du X, Greenfield H, Fraser DR, Ge K, Trube A, Wang Y. Vitamin D deficiency and associated factors in adolescent girls in Beijing. Am J Clin Nutr. 2001;74:494–500.PubMedGoogle Scholar
  18. El-Hajj Fuleihan G, Nabulsi M, Choucair M, Salamoun M, Shahine CH, Kizirian A, Tannous R. Hypovitaminosis D in healthy schoolchildren. Pediatrics. 2001;107:E53.PubMedCrossRefGoogle Scholar
  19. El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, Choucair M, Arabi A, Vieth R. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006;91:405–12.PubMedCrossRefGoogle Scholar
  20. Foo LH, Zhang Q, Zhu K, Ma G, Greenfield H, Fraser DR. Influence of body composition, muscle strength, diet and physical activity on total body and forearm bone mass in Chinese adolescent girls. Br J Nutr. 2007;98:1281–7.PubMedGoogle Scholar
  21. Foo LH, Zhang Q, Zhu K, Ma G, Trube A, Greenfield H, Fraser DR. Relationship between vitamin D status, body composition and physical exercise of adolescent girls in Beijing. Osteoporos Int. 2009a;20:417–25.PubMedCrossRefGoogle Scholar
  22. Foo LH, Zhang Q, Zhu K, Ma G, Hu X, Greenfield H, Fraser DR. Low vitamin D status has an adverse influence on bone mass, bone turnover, and muscle strength in Chinese adolescent girls. J Nutr. 2009b;139:1002–7.PubMedCrossRefGoogle Scholar
  23. Fraser DR. Lancet. 1995;345:104–7.Google Scholar
  24. Fraser DR. Vitamin D-deficiency in Asia. J Steroid Biochem Mol Biol. 2004;89–90:491–5.PubMedCrossRefGoogle Scholar
  25. Fraser DR, Kodicek E. Unique biosynthesis by kidney of a biological active vitamin D metabolite. Nature. 1970;228:764–6.PubMedCrossRefGoogle Scholar
  26. Frost HM, Schonau E. The “muscle-bone unit” in children and adolescents: a 2000 overview. J Pediatr Endocrinol Metab. 2000;13:571–90.PubMedCrossRefGoogle Scholar
  27. Gannage-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res. 2000;15:1856–62.PubMedCrossRefGoogle Scholar
  28. Gessner BD, Plotnik J, Muth PT. 25-hydroxyvitamin D levels among healthy children in Alaska. J Pediatr. 2003;143:434–7.PubMedCrossRefGoogle Scholar
  29. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531–7.PubMedCrossRefGoogle Scholar
  30. Grant CC, Wall CR, Crengle S, Scragg R. Vitamin D deficiency in early childhood: prevalent in the sunny South Pacific. Public Health Nutr. 2009;12:1893–901.PubMedCrossRefGoogle Scholar
  31. Guillemant J, Cabrol S, Allemandou A, Peres G, Guillemant S. Vitamin D dependent seasonal variation of PTH in growing male adolescents. Bone. 1995;17:513–6.PubMedCrossRefGoogle Scholar
  32. Guillemant J, Le HT, Maria A, Allemandou A, Pérès G, Guillemant S. Wintertime vitamin D deficiency in male adolescents: effect on parathyroid function and response to vitamin D3 supplements. Osteoporos Int. 2001;12:875–9.PubMedCrossRefGoogle Scholar
  33. Guillemant J, LeTaupin HT, Taright N, Alemandou A, Peres G, Guillemant S. Vitamin D status during puberty in French healthy male adolescents. Osteoporos. Int. 1999;10:222–5.PubMedCrossRefGoogle Scholar
  34. Haapasalo H, Kannus P, Sievänen H, Pasanen M, Uusi-Rasi K, Heinonen A, Oja P, Vuori I. Effect of long-term unilateral activity on bone mineral density of female junior tennis players. J Bone Miner Res. 1998;13:310–9.PubMedCrossRefGoogle Scholar
  35. Hatun S, Islam O, Cizmecioglu F, Kara B, Babaoglu K, Berk F, Gokalp AS. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J Nutr. 2005;135:218–22.PubMedGoogle Scholar
  36. Heaney RP. The Vitamin D requirement in health and disease. J Steroid Biochem Mol Biol. 2005;97:13–9.PubMedCrossRefGoogle Scholar
  37. Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Marcus R, Matkovic V, Weaver C. Peak bone mass. Osteoporos Int. 2000;11:985–1009.PubMedCrossRefGoogle Scholar
  38. Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142–6.Google Scholar
  39. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80:S1678–88.Google Scholar
  40. Hollis BW. Assessment of vitamin D nutritional and hormonal status: what to measure and how to do it. Calcif Tissue Int. 1996;58:4–5.PubMedGoogle Scholar
  41. Ilich JZ, Badenhop NE, Jelic T, Clairmont AC, Nagode LA, Matkovic V. Calcitriol and bone mass accumulation in females during puberty. Calcif Tissue Int. 1997;61:104–9.PubMedCrossRefGoogle Scholar
  42. Institute of Medicine. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary reference intakes: calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press; 1997.Google Scholar
  43. Jones G, Strugnell SA, DeLuca HF. Current understanding of the molecular action of vitamin D. Physiol Rev. 1998;78:1193–231.PubMedGoogle Scholar
  44. Jones G, Blizzard C, Riley MD, Parameswaran V, Greenaway TM, Dwyer T. Vitamin D levels in prepubertal children in Southern Tasmania: prevalence and determinants. Eur J Clin Nutr. 1999;53:824–9.PubMedCrossRefGoogle Scholar
  45. Jones G, Dwyer T. Bone mass in prepubertal children: gender differences and the role of physical activity and sunlight exposure. J Clin Endocrinol Metab. 1998;83:4274–9.PubMedCrossRefGoogle Scholar
  46. Jones G, Dwyer T, Hynes KL, Parameswaran V, Greenaway TM. Vitamin D insufficiency in adolescent males in Southern Tasmania: prevalence, determinants, and relationship to bone turnover markers. Osteoporos Int. 2005;16:636–41.PubMedCrossRefGoogle Scholar
  47. Kremer R, Campbell PP, Reinhardt T, Gilsanz V. Vitamin D status and its relationship to body fat, final height, and peak bone mass in young women. J Clin Endocrinol Metab. 2009;94:67–73.PubMedCrossRefGoogle Scholar
  48. Kristinsson JO, Valdimarsson O, Sigurdsson G, Franzson L, Olafsson I, Steingrimsdottir L. Serum 25-hydroxyvitamin D levels and bone mineral density in 16-20 years-old girls: lack of association. J Intern Med. 1998;243:381–8.PubMedCrossRefGoogle Scholar
  49. Lapatsanis D, Moulas A, Cholevas V, Soukakos P, Papadopoulou ZL, Challa A. Vitamin D: a necessity for children and adolescents in Greece. Calcif Tissue Int. 2005;77:348–55.PubMedCrossRefGoogle Scholar
  50. Lehtonen-Veromaa M, Möttönen T, Irjala K, Kärkkäinen M, Lamberg-Allardt C, Hakola P, Viikari J. Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls. Eur J Clin Nutr. 1999;53:746–51.PubMedCrossRefGoogle Scholar
  51. Lehtonen-Veromaa MK, Mottonen TT, Nuotio IO, Irjala KM, Leino AE, Viikari JS. Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study. Am J Clin Nutr. 2002a;76:1446–53.PubMedGoogle Scholar
  52. Lehtonen-Veromaa M, Mottonen T, Nuotio I, Irjala K, Viikari J. The effect of conventional vitamin D(2) supplementation on serum 25(OH)D concentration is weak among peripubertal Finnish girls: a 3-y prospective study. Eur J Clin Nutr. 2002b;56:431–7.PubMedCrossRefGoogle Scholar
  53. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001;22:477–501.PubMedCrossRefGoogle Scholar
  54. Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone. 2002;30:771–7.PubMedCrossRefGoogle Scholar
  55. Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS, Siervogel RM. Childhood body composition in relation to body mass index. Pediatrics. 2001;107:344–50.PubMedCrossRefGoogle Scholar
  56. Menendez C, Lage M, Peino R, Baldelli R, Concheiro P, Diéguez C, Casanueva FF. Retinoic acid and vitamin D(3) powerfully inhibit in vitro leptin secretion by human adipose tissue. J Endocrinol. 2001;170:425–31.PubMedCrossRefGoogle Scholar
  57. Outila TA, Karkkainen MU, Lamberg-Allardt CJ. Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr. 2001;74:206–10.PubMedGoogle Scholar
  58. Prentice A, Parsons TJ, Cole TJ. Uncritical use of bone mineral density in absorptiometry may lead to size-related artifacts in the identification of bone mineral determinants. Am J Clin Nutr. 1994;60:837–42.PubMedGoogle Scholar
  59. Puri S, Marwaha RK, Agarwal N, Tandon N, Agarwal R, Grewal K, Reddy DH, Singh S. Vitamin D status of apparently healthy schoolgirls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr. 2008;99:876–82.PubMedCrossRefGoogle Scholar
  60. Rockell JE, Green TJ, Skeaff CM, Whiting SJ, Taylor RW, Williams SM, Parnell WR, Scragg R, Wilson N, Schaaf D, Fitzgerald ED, Wohlers MW. Season and ethnicity are determinants of serum 25-hydroxyvitamin D concentrations in New Zealand children aged 5-14 y. J Nutr. 2005;135:2602–8.PubMedGoogle Scholar
  61. Saggese G, Baroncelli GI, Bertelloni S. Puberty and bone development. Best Pract Res Clin Endocrinol Metab. 2002;16:53–64.PubMedCrossRefGoogle Scholar
  62. Slemenda CW, Peacock M, Hui S, Zhou LL, Johnston CC. Genetic determinants of bone mass in adult women: a revaluation of the twin model and the potential importance of gene interaction on heritability estimates. J Bone Miner Res. 1997;12:676–82.PubMedCrossRefGoogle Scholar
  63. Stein EM, Laing EM, Hall DB, Hausman DB, Kimlin MG, Johnson MA, Modlesky CM, Wilson AR, Lewis RD. Serum 25-hydroxyvitamin D concentrations in girls aged 4-8 y living in the southeastern United States. Am J Clin Nutr. 2006;83:75–81.PubMedGoogle Scholar
  64. Vieth R. Vitamin D supplementation, 25-dihydroxyvitamin D levels, and safety. Am J Clin Nutr. 1999;69:842–56.PubMedGoogle Scholar
  65. Viljakainen HT, Natri AM, Kärkkäinen M, Huttunen MM, Palssa A, Jakobsen J, Cashman KD, Mølgaard C, Lamberg-Allardt C. 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.PubMedCrossRefGoogle Scholar
  66. Ward KA, Das G, Berry JL, Roberts SA, Rawer R, Adams JE, Mughal Z. Vitamin D status and muscle function in post-menarchal adolescent girls. J Clin Endocrinol Metab. 2009;94:559–63.PubMedCrossRefGoogle Scholar
  67. Weaver CM, Fleet JC. Vitamin D requirements: current and future. Am J Clin Nutr. 2004;80:S1735–9.Google Scholar
  68. Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988;67:373–8.PubMedCrossRefGoogle Scholar
  69. Weisberg P, Scanlon KS, Li R, Cogswell ME. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr. 2004;80:S1697–705.Google Scholar
  70. Wells JCK, Coward WA, Cole TJ, Davies PS. The contribution of fat and fat-free tissue to body mass index in contemporary children and the reference child. Int J Obes Relat Metab Disord. 2002;26:1323–8.PubMedCrossRefGoogle Scholar
  71. Weng FL, Shults J, Leonard MB, Stallings VA, Zemel BS. Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents. Am J Clin Nutr. 2007;86:150–8.PubMedGoogle Scholar
  72. Willett AM. Vitamin D status and its relationship with parathyroid hormone and bone mineral status in older adolescents. Proc Nutr Soc. 2005;64:193–203.PubMedCrossRefGoogle Scholar
  73. Working Group of the Australia and New Zealand Bone and Mineral Society (ANZBMS). Vitamin D and adult bone health in Australia and New Zealand: a position statement. MJA. 2005;182:281–5.Google Scholar
  74. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–3.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Program of Nutrition, School of Health SciencesUniversiti Sains MalaysiaKubang Kerian, KelantanMalaysia

Personalised recommendations