Prevalence and Risk Factors for Hypovitaminosis D among Healthy Adolescents in Kota Bharu, Kelantan

Authors

DOI:

https://doi.org/10.15605/jafes.035.02.05

Keywords:

hypovitaminosis D, adolescents, nutritional rickets

Abstract

*Visual Abstracts prepared by Dr. Jerico Gutierrez

Objective. We aim to study the prevalence and risk factors of hypovitaminosis D among healthy adolescents in Kota Bharu, Kelantan based on the most recent Paediatric Consensus guideline.

Methodology. Ten public schools were selected from Kota Bharu, Kelantan. We analysed their demography (age, gender, ethnicity, income), measured their anthropometry (height, weight, BMI) and finally analysed their vitamin D and intact-
Parathyroid hormone levels.

Results. The prevalence of hypovitaminosis D was 16.9% among healthy teenagers with mean age of 15.9±1.39 years. Multivariate analysis showed female gender (adjusted OR, 95% CI): 23.7 (5.64, 100.3) and Chinese 0.24 (0.07, 0.84) were the significant predictors for hypovitaminosis D.

Conclusion. The prevalence of healthy adolescents with hypovitaminosis D in Kota Bharu, Kelantan was 16.9% using the most recent cut off value of 30 nmol/L from the global consensus 2016. Female and Malay were the significant risk factors associated with hypovitaminosis D. Higher cut off value would result in overestimation of prevalence rate of hypovitaminosis D.

Downloads

Download data is not yet available.

Author Biography

Suhaimi Hussain, Hospital University Science Malaysia

Paediatric Department

Senior Lecturer, Paediatrician, Paediatric Endocrinologist

 

References

Munns CF, Simm PJ, Rodda CP, et al. Incidence of vitamin D deficiency rickets among Australian children: An Australian Paediatric Surveillance Unit study. Med J Aust. 2012; 196(7):466-8. https://www.ncbi.nlm.nih.gov/pubmed/22509879. https://doi.org/10.5694/mja11.10662.

Dawodu A, Agarwal M, Sankarankutty M, Hardy D, Kochiyil J, Badrinath P. Higher prevalence of vitamin D deficiency in mothers of rachitic than nonrachitic children. J Paediatr. 2005;147(1):109-11. https://www.ncbi.nlm.nih.gov/pubmed/16027707. https://doi.org/10.1016/j.jpeds.2005.03.001.

Specker BL, Ho ML, Oestreich A, et al. Prospective study of vitamin D supplementation and rickets in China. J Pediatr. 1992;120(5):733-9. https://www.ncbi.nlm.nih.gov/pubmed/1578308. https://doi.org/10.1016/s0022-3476(05)80236-7.

Ward LM, Gaboury I, Ladhani M, Zlotkin S. Vitamin D deficiency rickets among children in Canada. Can Med Assoc J. 2007;177(2): 161-6. https://www.ncbi.nlm.nih.gov/pubmed/17600035. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913133. https://doi.org/10.1503/cmaj.061377.

Pike JW, Goozé LL, Haussler MR. Biochemical evidence for 1,25-dihydroxyvitamin D receptor macromolecules in parathyroid, pancreatic, pituitary, and placental tissues. Life Sci. 1980; 26(5):407–14. https://doi.org/10.1016/0024-3205(80)90158-7.

Mithal A, Wahl DA, Bonjour JP, et al. Global vitamin D status and determinants of hypovitaminosis D status. Osteoporosis Int. 2009;20(11):1807-20. https://www.ncbi.nlm.nih.gov/pubmed/19543765. https://doi.org/10.1007/s00198-009-0954-6.

Colston K, Hirt M, Feldman D. Organ distribution of the cytoplasmic 1,25-dihydroxycholecalciferol receptor in various mouse tissues. Endocrinology. 1980;107(6):1916–22. https://www.ncbi.nlm.nih.gov/pubmed/6253281. https://doi.org/10.1210/endo-107-6-1916.

Marwaha RK, Tandon N, Reddy DR, et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 2005;82(2):477-82. https://www.ncbi.nlm.nih.gov/pubmed/16087996. https://doi.org/10.1093/ajcn.82.2.477.

Angurana SK, Angurana RS, Mahajan G, Kumar N, Mahajan V. Prevalence of vitamin D deficiency in apparently healthy children in north India. J Pediatr Endocrinol Metab 2014; 27(11-12):1151-6. https://www.ncbi.nlm.nih.gov/pubmed/25006749. https://doi.org/10.1515/jpem-2013-0387.

Ritu G, Gupta A. Vitamin D deficiency in India: Prevalence, causalities and interventions. Nutrients. 2014;6(2):729-75. https://www.ncbi.nlm.nih.gov/pubmed/24566435. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942730. https://doi.org/10.3390/nu6020729.

Munns C, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clinical Endocrinol Metab. 2016;101(2):394-415. https://www.ncbi.nlm.nih.gov/pubmed/26745253. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880117. https://doi.org/10.1210/jc.2015-2175.

Ross AC, Manson JE, Abrams SA, 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(1):53-8. https://www.ncbi.nlm.nih.gov/pubmed/21118827. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046611. https://doi.org/10.1210/jc.2010-2704.

Al-Sadat N, Majid HA, Sim PY, et al. Vitamin D deficiency in Malaysian adolescents aged thirteen years: Findings from the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). BMJ Open. 2016;18(6):e010689. https://www.ncbi.nlm.nih.gov/pubmed/27540095. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013370. https://doi.org/10.1136/bmjopen-2015-010689.

Holick MF, Schnoes HK, DeLuca HF. Identification of 1,25-dihydroxycholecalciferol, a form of vitamin D3 metabolically active in the intestine. Proc Natl Acad Sci U S A. 1971;68(4):803-4. https://www.ncbi.nlm.nih.gov/pubmed/4323790. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC389047. https://doi.org/10.1073/pnas.68.4.803.

Holick MF, Schnoes HK, DeLuca HF, Suda T, Cousins RJ. Isolation and identification of 1,25 dihydroxycholecalciferol. A metabolite of vitamin D active in intestine. Biochemistry. 1971;10(14):2799–804.

https://www.ncbi.nlm.nih.gov/pubmed/4326883. https://doi.org/10.1021/bi00790a023.

Jones G, Strugnell SA, DeLuca HF. Current understanding of the molecular actions of vitamin D. Physiol Rev. 1998;78(4):1193–231. https://www.ncbi.nlm.nih.gov/pubmed/9790574. https://doi.org/10.1152/physrev.1998.78.4.1193.

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(2):373-8. https://www.ncbi.nlm.nih.gov/pubmed/2839537. https://doi.org/10.1210/jcem-67-2-373.

Agarwal KS, Mughal MZ, Upadhyay P, Berry JL, Mawer EB, Puliyel JM. The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child. 2002; 87(2):111-3. https://www.ncbi.nlm.nih.gov/pubmed/12138058. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719192. https://doi.org/10.1136/adc.87.2.111.

Harris SS, Dawson-Hughes B. Seasonal changes in plasma 25-hydroxyvitamn D concentrations of young American black and white women. Am J Clin Nutr. 1998;67(6):1232-6. https://www.ncbi.nlm.nih.gov/pubmed/9625098. https://doi.org/10.1093/ajcn/67.6.1232.

Petersen B, Wulf HC, Triguero-Mas M, et al. Sun and ski holidays improve vitamin D status, but are associated with high levels of DNA damage. J Invest Dermatol. 2014; 134(11):2806-13. https://www.ncbi.nlm.nih.gov/pubmed/24844860. https://doi.org/10.1038/jid.2014.223.

Richter K, Breitner S, Webb A, et al. Influence of external, intrinsic and individual behaviour variables on serum 25(OH)D in a German survey. J Photochem Photobiol B. 2014; 140C:120-9. https://www.ncbi.nlm.nih.gov/pubmed/25116947. https://doi.org/10.1016/j.jphotobiol.2014.07.018.

Terushkin V, Bender A, Psaty EL, Engelsen O, Wang SQ, Halpern AC. Estimated equivalency of Vitamin D production from natural sun exposure versus oral vitamin D supplementation across Seasons at two US latitudes. J Am Acad Dermatol. 2010; 62(6):929.e1-9. https://www.ncbi.nlm.nih.gov/pubmed/20363523. https://doi.org/10.1016/j.jaad.2009.07.028.

Holick MF. McCollum Award Lecture, 1994: Vitamin D-new horizons for the 21th century. Am J Clin Nutr. 1994;60(4):619-30. https://www.ncbi.nlm.nih.gov/pubmed/8092101. https://doi.org/10.1093/ajcn/60.4.619.

Bodekær M, Petersen B, Thieden E, et al. UVR exposure and vitamin D in a rural population. A study of outdoor working farmers, their spouses and children. Photochem Photobiol Sci. 2014; 13(11):1598-1606. https://doi.org/10.1039/C4PP00188E.

Kift R, Berry JL, Vail A, Durkin MT, Rhodes LE, Webb AR. Lifestyle factors including less cutaneous sun exposure contribute to starkly lower vitamin D levels in U.K. South Asians compared with the white population. Br J Dermatol. 2013;169(6):1272-8. https://www.ncbi.nlm.nih.gov/pubmed/23855783. https://doi.org/10.1111/bjd.12518.

Thieden E, Philipsen PA, Heydenreich J, Wulf CH. UV radiation exposure related to age, sex, occupation, and sun behavior based on time-stamped personal dosimeter readings. Arch Derm. 2004;140(2):197-203. https://www.ncbi.nlm.nih.gov/pubmed/14967793. https://doi.org/10.1001/archderm.140.2.197.

Diffy BL. Is casual exposure to summer sunlight effective at maintaining adequate vitamin D status? Photodermatol Photoimmunol Photomed. 2010;26(4):172-6. https://www.ncbi.nlm.nih.gov/pubmed/20626818. https://doi.org/10.1111/j.1600-0781.2010.00518.x.

Farrar MD, Kift R, Felton SJ, et al. Recommended summer sunlight exposure amounts fail to produce sufficient vitamin D status in UK adults of South Asian origin. Am J Clin Nutr. 2011; 94(5):1219-24. https://www.ncbi.nlm.nih.gov/pubmed/21918215. https://doi.org/10.3945/ajcn.111.019976.

Farrar MD, Webb AR, Kift R, et al. Efficacy of a dose range of simulated sunlight exposures in raising vitamin D status in South Asian adults: Implications for targeted guidance on sun exposure. Am J Clin Nutr. 2013;97(6):1210-6. https://www.ncbi.nlm.nih.gov/pubmed/23615828. https://doi.org/10.3945/ajcn.112.052639.

MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985;76(4):1536-8. https://www.ncbi.nlm.nih.gov/pubmed/2997282. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC424123. https://doi.org/10.1172/JCI112134.

Webb AR, Kift R, Durkin MT, et al. The role of sunlight exposure in determining the vitamin D status of the U.K. white adult population. Br J Dermatol. 2010;163(5):1050-5. https://www.ncbi.nlm.nih.gov/pubmed/20716215. https://doi.org/10.1111/j.1365-2133.2010.09975.x.

Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. 1995;61(3 Suppl):638S-645S. https://www.ncbi.nlm.nih.gov/pubmed/7879731. https://doi.org/10.1093/ajcn/61.3.638S.

Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142–52. https://www.ncbi.nlm.nih.gov/pubmed/18977996. https://doi.org/10.1542/peds.2008-1862.

Theintz G, Buchs B, Rizzoli R, et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: Evidence for a marked reduction after 16 years of age at the levels of lumbar spine and

femoral neck in female subjects. J Clin Endocrinol Metab. 1992;75(4):1060-5. https://www.ncbi.nlm.nih.gov/pubmed/1400871. https://doi.org/10.1210/jcem.75.4.1400871.

Ladhani S, Srinivasan L, Buchanan C, Allgrove J. Presentation of vitamin D deficiency. Arch Dis Child. 2004;89(8):781-4. https://www.ncbi.nlm.nih.gov/pubmed/15269083. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720051. https://doi.org/10.1136/adc.2003.031385.

Lulseged S. Severe rickets in a children’s hospital in Addis Ababa. Ethiop Med J. 1990; 28(4):175–81. https://www.ncbi.nlm.nih.gov/pubmed/2249677.

Thacher TD, Clark BL. Vitamin D insufficiency. Mayo Clin Proc. 2011; 86(1):50-60. https://www.ncbi.nlm.nih.gov/pubmed/21193656. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012634. https://doi.org/10.4065/mcp.2010.0567.

Khor GL, Chee WSS, Shariff ZM, et al. High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia. BMC Public Health. 2011;11:95. https://www.ncbi.nlm.nih.gov/pubmed/21310082. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045951. https://doi.org/10.1186/1471-2458-11-95.

Pérez-López FR, Pérez-Roncero G, López-Baena MT. Vitamin D and adolescent health. Adolesc Health Med Ther.2010; 1-8. https://www.ncbi.nlm.nih.gov/pubmed/28028383. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175574. https://doi.org/10.2147/AHMT.S7472.

Poh BK, Rojroongwasinkul N, Nguyen BKL, et al. 25-hydroxy-vitamin D demography and the risk of vitamin D insufficiency in the South East Asian Nutrition Surveys (SEANUTS). Asia PAC J Clin Nutr. 2016;25(3):538-48. https://www.ncbi.nlm.nih.gov/pubmed/27440689. https://doi.org/10.6133/apjcn.092015.02.

Hengist A, Perkin O, Gonzalez JT, et al. Mobilizing vitamin D from adipose tissue: The potential impact of exercise. Nutr Bull. 2019;(44).25-35. https://doi.org/10.1111/nbu.12369.

Pereira-Santos M, Costa PRF, Assis AMO, Santos CAST, Santos DB. Obesity and vitamin D deficiency: A systematic review and meta-analysis. Obes Rev. 2015;16(4):341–9. https://www.ncbi.nlm.nih.gov/pubmed/25688659. https://doi.org10.1111/obr.12239.

Pourshahidi LK. Vitamin D and obesity: current perspectives and future directions. Proc Nutr Soc. 2015; 74(2):115–24. https://doi.org/10.1017/S0029665114001578.

Published

2020-09-17

How to Cite

Hussain, S., & Elnajeh, M. (2020). Prevalence and Risk Factors for Hypovitaminosis D among Healthy Adolescents in Kota Bharu, Kelantan. Journal of the ASEAN Federation of Endocrine Societies, 35(2), 176–180. https://doi.org/10.15605/jafes.035.02.05

Issue

Section

Original Articles

Most read articles by the same author(s)