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Prevalence of Vitamin D Deficiency Among Healthy Infants and Toddlers
Catherine M. Gordon, MD, MSc;
Henry A. Feldman, PhD;
Linda Sinclair, BA;
Avery LeBoff Williams, BA;
Paul K. Kleinman, MD;
Jeannette Perez-Rossello, MD;
Joanne E. Cox, MD
Arch Pediatr Adolesc Med. 2008;162(6):505-512.
Objectives To determine the prevalence of vitamin D deficiency and to examine whether 25-hydroxyvitamin D (25OHD) concentration varies as a function of skin pigmentation, season, sun exposure, breastfeeding, and vitamin D supplementation.
Design Cross-sectional sample.
Setting Urban primary care clinic.
Participants Healthy infants and toddlers (N = 380) who were seen for a routine health visit.
Outcome Measures Primary outcomes were serum 25OHD and parathyroid hormone levels; secondary measures included data on sun exposure, nutrition, skin pigmentation, and parental health habits. Wrist and knee radiographs were obtained for vitamin D–deficient participants.
Results The prevalence of vitamin D deficiency ( 20 ng/mL) was 12.1% (44 of 365 participants), and 146 participants (40.0%) had levels below an accepted optimal threshold (30 ng/mL). The prevalence did not vary between infants and toddlers or by skin pigmentation. There was an inverse correlation between serum 25OHD and parathyroid hormone levels (infants: r = –0.27, P < .001; toddlers: r = –0.20, P = .02). In multivariable models, breastfeeding without supplementation among infants and lower milk intake among toddlers were significant predictors of vitamin D deficiency. In vitamin D–deficient participants, 3 participants (7.5%) exhibited rachitic changes on radiographs, whereas 13 (32.5%) had evidence of demineralization.
Conclusions Suboptimal vitamin D status is common among otherwise healthy young children. Predictors of vitamin D status vary in infants vs toddlers, information that is important to consider in the care of these young patients. One-third of vitamin D–deficient participants exhibited demineralization, highlighting the deleterious skeletal effects of this condition.
Author Affiliations: Divisions of Adolescent Medicine (Dr Gordon and Mss Sinclair and Williams) and Endocrinology (Drs Gordon and Feldman), Clinical Research Program (Dr Feldman), Department of Radiology (Drs Kleinman and Perez-Rossello), and Division of General Pediatrics (Dr Cox), Children's Hospital Boston, Boston, Massachusetts.
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Vitamin D Deficiency in Young Children
JWatch General 2008;2008:6-6.
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