Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors

Anna Lee; Se Hwi Kim; Chung Mo Nam; Young-Jin Kim; Soo-Ho Joo; Kyoung-Ryul Lee

doi:10.3343/lmo.2016.6.2.70

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Lee, Kim, Nam, Kim, Joo, and Lee: Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors

Original Article

Clinical Chemistry

Laboratory Medicine Online 2016; 6(2): 70-78.

Published online: 1 April 2016

DOI: https://doi.org/10.3343/lmo.2016.6.2.70

Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors

Anna Lee, M.D.¹, Se Hwi Kim, M.S.², Chung Mo Nam, Ph.D.³, Young-Jin Kim, M.D.¹, Soo-Ho Joo, M.D.¹, Kyoung-Ryul Lee, M.D.¹

¹Seoul Medical Science Institute, Yongin, Korea.

²Department of Biostatistics and Computing, The Graduate School of Yonsei University, Seoul, Korea.

³Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Anna Lee. Seoul Medical Science Institute, A-dong, 27F, Heungdeok IT valley, 13 Heungduk 1-ro, Giheung-gu, Yongin 16954, Korea. Tel: +82-2-330-2012, Fax: +82-2-790-6509, anlee@scllab.co.kr

Received 25 June 2015 Revised 13 November 2015 Accepted 16 November 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The objective of this study was to assess the serum 25-hydroxyvitamin D (25OHD) status and evaluate the associated factors in a Korean pediatric population aged 0-18 yr.

Methods

Serum 25OHD levels were retrospectively analyzed in 13,236 Korean children and adolescents. 25OHD tests by chemiluminescent immunoassay were requested from 332 medical institutions nationwide in Korea between January 2014 and December 2014. Prevalence of vitamin D deficiency (VDD) and insufficiency (VDI) and the associated factors were analyzed. VDD and VDI were defined as serum 25OHD levels of <20.0 ng/mL and 20.0-29.9 ng/mL, respectively.

Results

The 25OHD levels negatively correlated with age (r=-0.4033, P<0.001). Overall, 79.8% boys and 83.8% girls had hypovitaminosis D (VDI or VDD). The Odds ratios (ORs) of being in the VDD/VDI category as against the reference category of VDS (vitamin D sufficiency) were as follows: increase in age by 1 yr (OR=1.42/1.25, all P<0.001); girls (OR=1.32/1.16, P<0.001/P=0.004) compared to boys, spring (OR=1.61/1.80), fall (OR=1.31/1.28), and winter (OR=1.44/2.03, all P<0.001) compared to summer season; living in urban areas (OR=1.23, P<0.001) compared to rural areas.

Conclusions

VDD and VDI are highly prevalent in children and adolescents in Korea. Serum 25OHD levels decreased significantly according to increasing age. Winter and spring seasons, increasing age, female sex, and living in urban areas are the factors associated with a high risk of VDD or VDI.

Keywords: 25-hydroxyvitamin D, Vitamin D deficiency, Vitamin D insufficiency, Hypovitaminosis D, Children, Adolescents

Figures and Tables

Fig. 1

Prevalence of vitamin D deficiency (<20 ng/mL), insufficiency (20-29.9 ng/mL), and sufficiency (≥30 ng/mL) among the study population. (A) By sex. (B) By age. (C) By month. (D) By season. Season was defined as spring (Mar-May), summer (Jun-Aug), fall (Sep-Nov), and winter (Dec-Feb). (E) By region groups. The urban area includes Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan, and Gyeonggi-do. The rural area includes Gangwon-do, Chungcheongbuk-do, Chungcheongnam-do, Jeollabuk-do, Jeollanam-do, Gyeongsangbuk-do, Gyeongsangnam-do, and Jeju-do.

Abbreviation: 25OHD, 25-hyrdoxyvitamin D.

Fig. 2

Distribution of mean serum 25-hydroxyvitamin D (25OHD) levels and mean ages according to regions. (A) Mean serum 25OHD levels by regions. Mean 25OHD levels were stratified to 15-<17, 17-<19, 19-<21, 21-<23, and 23-25 ng/mL. (B) Mean ages according to regions.

Table 1

Characteristics and serum total 25-hyrdoxyvitamin D levels of participants (N=13,236)

	Number (%)	Age (Mean±SD)	25OHD (mean±SD, ng/mL)	P value
Overall	13,236 (100)	5.2±4.8	22.2±9.0
Sex				<0.001^*
Boys	6,583 (50.4)	5.0±4.6	22.9±9.1
Girls	6,482 (49.6)	5.5±4.9	21.6±8.8
Age group^†				<0.001^‡
Kindergarten or less	9,001 (69.4)	2.5±1.7	24.2±9.2
Elementary school	2,540 (19.6)	9.1±1.6	19.0±5.9
Junior high school	713 (5.5)	13.9±0.8	16.0±6.8
Senior high school	713 (5.5)	17.1±0.8	15.0±7.3
Season^§				<0.001^‡
Spring	3,399 (25.7)	5.5±4.9	21.6±8.4
Summer	2,897 (21.9)	5.1±4.8	23.2±10.2
Fall	2,997 (22.6)	5.1±4.7	22.3±9.2
Winter	3,943 (29.8)	5.2±4.6	22.0±8.3
Region^II				<0.001^*
Urban	8,461 (63.9)	5.3±4.8	22.0±9.0
Rural	4,775 (36.1)	5.1±4.7	22.7±9.0

^*Mann-Whitney U-test for 25OHD; ^†Participants were grouped according to age as kindergarten or less (age <7 yr), elementary school (age 7-12 yr), junior high school (age 13-15 yr), and senior high school (age 16-18 yr); ^‡Kruskal-Wallis test for 25OHD; ^§Seasons were defined as spring (March to May), summer (June to August), fall (September to November) and winter (December to February); ^∥Regions were categorized as rural and urban areas according to the locations of institutions of which 25OHD had been requested from. Urban area includes Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan, and Gyeonggi-do. Rural area includes Gangwon-do, Chungcheongbuk-do, Chungcheongnam-do, Jeollabuk-do, Jeollanam-do, Gyeongsangbuk-do, Gyeongsangnam-do, and Jeju-do.

Abbreviation: 25OHD, 25-hyrdoxyvitamin D.

Table 2

The factors associated with vitamin D deficiency (25OHD<20 ng/mL) or insufficiency (25OHD 20-29.9 ng/mL) against the reference category (vitamin D sufficiency, 25OHD ≥30ng/mL) on a multi-nominal logistic regression analysis (N=13,236)

Variables	Vitamin D deficiency		Vitamin D insufficiency
Variables	OR (95% CI)	P value	OR (95% CI)	P value
Age^*	1.42 (1.39-1.45)	< 0.001	1.25 (1.23-1.28)	< 0.001
Sex (vs. Boys)
Girls	1.32 (1.19-1.47)	< 0.001	1.16 (1.05-1.28)	0.004
Season^† (vs. Summer)
Spring	1.61 (1.38-1.87)	< 0.001	1.80 (1.56-2.09)	< 0.001
Fall	1.31 (1.13-1.52)	< 0.001	1.28 (1.11-1.48)	< 0.001
Winter	1.44 (1.24-1.66)	< 0.001	2.03 (1.77-2.33)	< 0.001
Region^‡ (vs. Rural)
Urban	1.23 (1.10-1.37)	< 0.001	1.04 (0.94-1.16)	0.4773

The reference group for each variable is given in parentheses. For example, the odds ratio for "girls (vs. boys)" is 1.32, which means that for girls, the odds of being in the 25OHD<20 vs. ≥30 ng/mL category are 1.32 times the odds for boys, assuming that all other variables in the model are held constant.

^*Age increase by one year;^†Seasons were defined as spring (March to May), summer (June to August), fall (September to November), and winter (December to February);^‡Regions were categorized as rural and urban areas according to the locations of institutions from where 25OHD had been requested from. Urban area includes Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan, and Gyeonggi-do. Rural area includes Gangwon-do, Chungcheongbuk-do, Chungcheongnam-do, Jeollabuk-do, Jeollanam-do, Gyeongsangbuk-do, Gyeongsangnam-do, and Jeju-do.

Abbreviations: 25OHD, 25-hyrdoxyvitamin D; OR, odds ratio; CI, confidence interval.

Notes

This article is available from http://www.labmedonline.org

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