Published online August 3, 2009
PEDIATRICS Vol. 124 No. 3 September 2009, pp. e362-e370 (doi:10.1542/peds.2009-0051)
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ARTICLE

Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: NHANES 2001–2004

Juhi Kumar, MD, MPHa, Paul Muntner, PhDb, Frederick J. Kaskel, MD, PhDa, Susan M. Hailpern, DrPH, MSc and Michal L. Melamed, MD, MHSd,e

a Children's Hospital at Montefiore and Departments of
d Medicine and Epidemiology
e Population Health, Albert Einstein College of Medicine, Bronx, New York
b Department of Medicine, Mount Sinai School of Medicine, New York, New York
c Northrop Grumman and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVES: To determine the prevalence of 25-hydroxyvitamin D (25[OH]D) deficiency and associations between 25(OH)D deficiency and cardiovascular risk factors in children and adolescents.

METHODS: With a nationally representative sample of children aged 1 to 21 years in the National Health and Nutrition Examination Survey 2001–2004 (n = 6275), we measured serum 25(OH)D deficiency and insufficiency (25[OH]D <15 ng/mL and 15–29 ng/mL, respectively) and cardiovascular risk factors.

RESULTS: Overall, 9% of the pediatric population, representing 7.6 million US children and adolescents, were 25(OH)D deficient and 61%, representing 50.8 million US children and adolescents, were 25(OH)D insufficient. Only 4% had taken 400 IU of vitamin D per day for the past 30 days. After multivariable adjustment, those who were older (odds ratio [OR]: 1.16 [95% confidence interval (CI): 1.12 to 1.20] per year of age), girls (OR: 1.9 [1.6 to 2.4]), non-Hispanic black (OR: 21.9 [13.4 to 35.7]) or Mexican-American (OR: 3.5 [1.9 to 6.4]) compared with non-Hispanic white, obese (OR: 1.9 [1.5 to 2.5]), and those who drank milk less than once a week (OR: 2.9 [2.1 to 3.9]) or used >4 hours of television, video, or computers per day (OR: 1.6 [1.1 to 2.3]) were more likely to be 25(OH)D deficient. Those who used vitamin D supplementation were less likely (OR: 0.4 [0.2 to 0.8]) to be 25(OH)D deficient. Also, after multivariable adjustment, 25(OH)D deficiency was associated with elevated parathyroid hormone levels (OR: 3.6; [1.8 to 7.1]), higher systolic blood pressure (OR: 2.24 mmHg [0.98 to 3.50 mmHg]), and lower serum calcium (OR: –0.10 mg/dL [–0.15 to –0.04 mg/dL]) and high-density lipoprotein cholesterol (OR: –3.03 mg/dL [–5.02 to –1.04]) levels compared with those with 25(OH)D levels ≥30 ng/mL.

CONCLUSIONS: 25(OH)D deficiency is common in the general US pediatric population and is associated with adverse cardiovascular risks.

Key Words: rickets • vitamin D • cardiovascular risk factors • obesity • racial disparities

Abbreviations: 25(OH)D—25-hydroxyvitamin D • PTH—parathyroid hormone • NHANES—National Health and Nutrition Examination Survey • PIR—poverty/income ratio • CRP—C-reactive protein • HDL—high-density lipoprotein • ACR—albumin/creatinine ratio

Accepted Apr 13, 2009.


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