Low Levels of 25-hydroxyvitamin D in the Pediatric Populations: Prevalence and Clinical Outcomes

Michal L Melamed; Juhi Kumar


Pediatr Health. 2010;4(1):89-97. 

In This Article

Risk Factors for Vitamin D Deficiency

There is little consensus regarding what constitutes vitamin D deficiency in children and adolescents.[21] Different authors have used different definitions of deficiency, including less than 10 ng/ml,[22–24] less than 15 ng/ml[11,25–27] and less than 20 ng/ml.[10,13,28] Most experts agree that whatever level one defines as deficiency, any 25(OH)D levels between the deficiency cut-off and 30 ng/ml constitutes vitamin D 'insufficiency'. Levels above 30 ng/ml are considered, at least in adults, to be associated with the best outcomes.[29]

Common risk factors for 25(OH)D deficiency include those outlined above, non-White ethnicity and obesity, as well as other risk factors outlined in Box 1. Risk factors can be divided into non-modifiable risk factors such as age and skin color, modifiable risk factors such as sunscreen use and low vitamin D intake, and non-patient factors such as living at high latitude and low altitude (further away from the sun). In our analysis of NHANES 2001–2004, we found that older age, female sex, non-White ethnicity, obesity, less frequent milk drinking, and watching over 4 h of television, video or computer per day were associated with 25(OH)D levels below 15 ng/ml.[15] Vitamin D supplement use was associated with a lower risk for deficiency.[15] A study from Japan revealed that limited exposure to sunlight and a limited diet were the primary causes amongst 31 confirmed cases of rickets.[30] Children with inflammatory bowel disease have also been shown to have a high prevalence of 25(OH)D deficiency with almost 35% of 130 patients having 25(OH)D levels below 15 ng/ml.[31] Children with cystic fibrosis also have a high prevalence of inadequate vitamin D levels, in one recent study, 95% had levels below 30 ng/ml.[32] Another study recently demonstrated that the prevalence of vitamin D deficiency has increased over the past 10 years in patients with chronic kidney disease.[33] In summary, certain patient groups are at higher risk of vitamin D deficiency.


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