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A Review of the Current Evidence

Alisha J. Rovner, PhD; Kimberly O. O’Brien, PhD

Arch Pediatr Adolesc Med. 2008;162(6):513-519.

Objective  To review the published literature on serum 25-hydroxyvitamin D concentrations in US children.

Data Sources  Articles were identified by searching MEDLINE using 25-hydroxyvitamin D, vitamin D, hypovitaminosis D, vitamin D insufficiency, vitamin D deficiency, children, and adolescents as key words and by screening references from original studies.

Study Selection  Studies were included if they fulfilled the following a priori criteria: contained a well-defined sample of children, included only healthy children, presented data on serum 25-hydroxyvitamin D concentrations, were published in the past 10 years, and were conducted in the United States.

Data Extraction  Serum 25-hydroxyvitamin D concentrations and prevalence of low vitamin D status (hypovitaminosis D).

Data Synthesis  Fourteen articles fulfilled the criteria. There were no consistent definitions of hypovitaminosis D; values corresponding to vitamin D deficiency ranged from less than 5 ng/mL to less than 12 ng/mL, and those for vitamin D insufficiency ranged from less than 10 ng/mL to less than 32 ng/mL (to convert 25-hydroxyvitamin D concentrations to nanomoles per liter, multiply by 2.496). The following assays were used: radioimmunoassay (7 studies), competitive binding protein assay (3 studies), automated chemiluminescence protein-binding assay (3 studies), and enzyme-linked immunosorbent assay (1 study). Breastfed infants in winter who did not receive vitamin D supplementation were the most severely vitamin D deficient (78%). Estimates of the prevalence of hypovitaminosis D ranged from 1% to 78%. Older age, winter season, higher body mass index, black race/ethnicity, and elevated parathyroid hormone concentrations were associated with lower 25-hydroxyvitamin D concentrations.

Conclusion  Although overt vitamin D deficiency is no longer common in US children, lesser degrees of vitamin D insufficiency are widespread.

Author Affiliations: Division of Epidemiology, Statistics and Prevention, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland (Dr Rovner); and Division of Nutritional Sciences, Cornell University, Ithaca, New York (Dr O’Brien).

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