Abstract
Background: Vitamin D insufficiency (defined as 25-hydroxyvitamin D [25(OH)D] concentrations <40 nmol/L) may be associated with subclinical adverse effects on bone mineralization. The current vitamin D status of children and adolescents in Canada has not been described. The purpose of this study was to describe the association between 25(OH)D serum concentration and dietary vitamin D intake, and other potential determinants of vitamin D status, among a sample of children and adolescents aged 2–16 years presenting to a pediatric emergency department in Edmonton, Alberta (latitude 52°N) at the end of winter.
Methods: In early April 2003, 90 patients between the ages of 2 and 16 years who presented to the pediatric emergency department in Edmonton volunteered to participate. All participants and/or parents or guardians completed questionnaires regarding potential risk factors for vitamin D insufficiency, detailed dietary assessments, and anthropometric measurements. Serum 25(OH)D concentrations were measured in 68 of 90 participants.
Results: The mean serum 25(OH)D concentration was 47.2 nmol/L (95% CI 43.8–50.8 nmol/L). 34% of participants had vitamin D insufficiency (<40 nmol/L) and 6% were deficient (<25 nmol/L). Boys and girls aged 9–16 years had a prevalence of insufficiency of 69% and 35% respectively, while boys and girls 2–8 years old had a prevalence of insufficiency of 22% and 8% respectively. Dietary vitamin D intake per kilogram body weight was the most important independent determinant of 25(OH)D concentration (r = 0.446, p<0.001). Vitamin D intake, age and male sex best predicted insufficiency. No subject was insufficient if they had an intake >0.45 mcg/kg/day.
Interpretation: Vitamin D insufficiency may be common among children and adolescents at the beginning of spring. The risk may be highest among older children because vitamin D intake does not adequately rise in proportion with increases in body mass. Further studies are needed to assess whether Canadian dietary vitamin D recommendations should be changed.
MeSH terms: Vitamin D, nutrition disorders, Canada, child, adolescent, vitamin D deficiency
Résumé
Contexte: L’insuffisance en vitamine D (définie dans cette étude comme les concentrations de 25-hydroxyvitamine D [25(OH)D] inférieures à 40 nmol/L) peut être associée à des effets subcliniques indésirables sur la minéralisation osseuse. Comme le statut actuel en vitamine D des enfants et des adolescents au Canada n’a pas encore été décrit, nous avons cherché à déterminer l’association entre la concentration sérique en 25(OH)D et l’apport en vitamine D dans l’alimentation, ainsi que d’autres déterminants possibles du statut en vitamine D, au sein d’un échantillon d’enfants et d’adolescents de 2 à 16 ans s’étant présentés au service d’urgences pédiatriques d’Edmonton (Alberta) (latitude 52°N) à la fin de l’hiver.
Méthode: Quatre-vingt-dix patients âgés de 2 à 16 ans s’étant présentés au service d’urgences pédiatriques d’Edmonton au début d’avril 2003 ont participé bénévolement à l’étude. Tous les participants et/ou leurs parents ou tuteurs ont rempli des questionnaires portant sur les facteurs de risque d’insuffisance en vitamine D et se sont soumis à des évaluations approfondies de leur alimentation et à des mesures anthropométriques. Les concentrations sériques en 25(OH)D ont été mesurées chez 68 des 90 participants.
Résultats: La concentration sérique moyenne en 25(OH)D était de 47,2 nmol/L (IC de 95 % =43,8–50,8 nmol/L). Trente-quatre p. cent des participants avaient une insuffisance en vitamine D (<40 nmol/L), et 6 % étaient carencés (<25 nmol/L). Les garçons et les filles de 9 à 16 ans affichaient des taux d’insuffisance de 69 % et de 35 % respectivement, contre 22 % et 8 % respectivement pour les garçons et les filles de 2 à 8 ans. L’apport alimentaire en vitamine D par kilogramme de poids était le principal déterminant indépendant de la concentration en 25(OH)D (r=0,446, p<0,001). L’apport en vitamine D, l’âge et le sexe masculin étaient les meilleurs prédicteurs d’insuffisance. Aucun sujet ayant un apport supérieur à 0,45 mcg/kg/jour n’a été considéré comme présentant une insuffisance.
Interprétation: L’insuffisance en vitamine D pourrait être commune chez les enfants et les adolescents au début du printemps. Les enfants pourraient présenter le risque le plus élevé, car leur apport en vitamine D n’augmente pas suffisamment en proportion de la croissance de leur masse corporelle. D’autres études sont nécessaires pour déterminer s’il faut modifier les recommandations canadiennes concernant l’apport alimentaire en vitamine D.
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