Low Levels of 25-hydroxyvitamin D in the Pediatric Populations: Prevalence and Clinical Outcomes

Authors and Disclosures

Michal L Melamed, MD, MHS^†
Assistant Professor of Medicine & Epidemiology & Population Health, Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullman 615/Belfer 1008, Bronx, NY 10461, USA Tel.: +1 718 430 2304 Fax: +1 718 430 8963 michal.melamed@einstein.yu.edu

Juhi Kumar, MD, MPH
Departments of Medicine & Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA and Departments of Pediatrics & Public Health, Weill Cornell Medical College, NY, USA Tel.: +1 646 962 2037 Fax: +1 646 962 0246 juk2013@med.cornell.edu

†Author for correspondence
Assistant Professor of Medicine & Epidemiology & Population Health, Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullman 615/Belfer 1008, Bronx, NY 10461, USA Tel.: +1 718 430 2304 Fax: +1 718 430 8963 michal.melamed@einstein.yu.edu

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Executive Summary

• There are few natural dietary sources of vitamin D.

• Vitamin D deficiency, defined variously as less than 15 ng/ml or less than 20 ng/ml, is common in the US pediatric population.

• Risk factors for vitamin D deficiency include darker skin, older age, less milk drinking, less sun exposure, sunscreen use and no vitamin D supplement use.

• Vitamin D deficiency can cause rickets, a disease seen in toddlers and adolescents characterized commonly by bone pain, epiphyseal swelling and bowed legs, and less commonly by hypocalcemic seizures, infections and cardiomyopathy.

• Studies of vitamin D supplementation suggest higher growth velocity in children.

• Animal and adult studies are suggestive that low vitamin D levels may be a factor in the development of hypertension; further studies are needed in children.

• There is observational evidence suggesting a link between low vitamin D levels and both Type 1 diabetes mellitus, potentially immunologically mediated, and Type 2 diabetes mellitus, potentially through muscle, adipose tissue or direct islet cell effects.

• Low vitamin D levels and intake have been associated with lower HDL levels, higher triglycerides, infections, asthma and allergic rhinitis.

• Most of the data in this review are observational in nature and there is a need for randomized clinical trials to test these associations.