Vitamin D Deficiency Associated With Increased Incidence of Gastrointestinal and Ear Infections in School-age Children

Kathryn A. Thornton, DMD, MPH; Constanza Marín, RD; Mercedes Mora-Plazas, MSc, RD; Eduardo Villamor, MD, DrPH


Pediatr Infect Dis J. 2013;32(5):585-593. 

In This Article


The mean (± standard deviation) age of children at recruitment was 8.9 ± 1.6 years, and 52% of children were girls. The mean (± standard deviation) plasma concentration of 25(OH)D was 73.2 ± 19.8 nmol/L; 10.1% of children were vitamin D-deficient, whereas 46.7% of children were vitamin D-insufficient. Children contributed 62,642 days of observation with a median (interquartile range) 140 (91, 182) days per child; the distribution of total child-days did not vary significantly by vitamin D status. At baseline, vitamin D serostatus was inversely associated with female sex, age, body mass index-Z and single mother status (Table 1).

Children with VDD had higher rates of vomiting, diarrhea with vomiting and earache or ear discharge with fever than vitamin D-sufficient children (Table 2). Compared with children who were vitamin D-sufficient, those who were deficient had twice as many days with diarrhea and vomiting after adjustment for child's age, sex and household socioeconomic status (P = 0.009). In addition, vitamin D-deficient children had 2.4 times as many days with earache or ear discharge with fever compared with vitamin D-sufficient children (P = 0.008). This association was particularly strong among boys (adjusted IRR: 5.74; 95% CI: 2.32, 14.18) compared with girls (adjusted IRR: 1.09; 95% CI: 0.46, 2.60; P test for interaction with sex = 0.001).

We noted that vitamin D-insufficient (25(OH)D ≥50 and <75 nmol/L) children had lower rates of earache or ear discharge with fever and cough with fever, compared with children with 25(OH)D ≥75 nmol/L. The relation with cough and fever was mainly apparent in girls; vitamin D-insufficient girls reported 66% fewer days of cough with fever than girls who were vitamin D-sufficient (adjusted IRR: 0.34; 95% CI: 0.26, 0.43), whereas no significant association was observed in boys (adjusted IRR: 1.10; 95% CI: 0.81, 1.50; P test for interaction with sex < 0.0001).