Journal List > J Nutr Health > v.52(6) > 1142010

J Nutr Health. 2019 Dec;52(6):552-558. Korean.
Published online Dec 26, 2019.  https://doi.org/10.4163/jnh.2019.52.6.552
© 2019 The Korean Nutrition Society
Association between vitamin D deficiency and anemia among Korean adolescent girls and young women
Haeun Jang, Seonghee Park and Kyong Park
Department of Food and Nutrition, Yeungnam University, Gyeongsan, Gyeongbuk 38541, Korea.

To whom correspondence should be addressed. tel: +82-053-810-2879, Email: kypark@ynu.ac.kr
Received Aug 30, 2019; Revised Nov 26, 2019; Accepted Dec 10, 2019.

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

Purpose

Although vitamin D deficiency is common among Korean adolescent girls and young women, few studies have explored the potential health effects of vitamin D deficiency in this vulnerable population. This study examined the association between vitamin D deficiency and anemia in Korean adolescent girls and young women.

Methods

The data from the Korea National Health and Nutrition Examination Survey 2008 ~ 2014 were used. A total of 3,643 girls and adult women aged 12 to 29 who provided all the information (including serum 25-hydroxy vitamin D, hemoglobin, and/or serum ferritin) needed for the analysis were included in the analysis. Demographic, lifestyle, and health data were obtained through survey questionnaires. Anemia and iron deficiency anemia were defined according to the World Health Organization cut-offs. Multivariable logistic regression, and restricted cubic spline regression were used in the analysis.

Results

In fully adjusted logistic regression models, the vitamin D deficiency was significantly associated with higher prevalences of anemia (odds ratio (OR): 1.61, 95% confidence interval (CI): 1.04 ~ 2.49) and iron deficiency anemia (OR: 1.43, 95% CI: 1.01 ~ 2.03). In a cubic spline regression model, we observed a dose-response relationship between serum 25(OH)D concentration and anemia, and this linear relationship was also clearly observed between serum 25(OH)D concentration and iron deficiency anemia.

Conclusion

Vitamin D deficiency may be associated with a higher prevalence of iron deficiency anemia and anemia in adolescent girls and young women. Alternatively, vitamin D deficiency may be a concurrent event for patients with anemia, which we cannot distinguish in this cross-sectional study. Further studies are needed to verify the causality in this population of low vitamin D levels.

Keywords: vitamin D; anemia; iron-deficiency anemia; adolescents; women

Figures


Fig. 1
Odds ratios (95% confidence intervals) for the non-linear relationship between serum 25-hydroxy vitamin D (25(OH)D) concentration and prevalence of (A) anemia and (B) iron deficiency anemia in adolescent girls and young women, evaluated with restricted cubic splines. The model was adjusted for age (continuous), obesity status (obese and non-obese), smoking status (smokers and non-smokers), alcohol consumption (drinkers and non-drinkers), household income (low, mid ~ low, mid ~ high, and high), and physical activity (low, mid, and high). Solid lines, OR; dashed lines, 95% CI.
Click for larger imageDownload as PowerPoint slide

Tables


Table 1
Demographic and lifestyle characteristics of participants according to the serum 25-hydroxy vitamin D (25(OH)D) concentration
Click for larger image


Table 2
Odds ratio and 95% confidence intervals of anemia and iron deficiency anemia according to the serum 25-hydroxy vitamin D (25(OH)D) concentration
Click for larger image

Notes

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (grant number: NRF-2017R1A1A3A04069759). The founding sponsor had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

References
1. Health Insurance Review and Assessment Service (KR). Vitamin D deficiency could be developed frequently during winter season because of short-term sun exposure Gangwon-do Province Health Insurance Review and Assessment service [Internet]. Wonju: Health Insurance Review and Assessment Service; 2016 [cited 2018 Oct 6].
2. Jung IK. Prevalence of vitamin D deficiency in Korea: results from KNHANES 2010 to 2011. J Nutr Health 2013;46(6):540–551.
3. Stagi S, Cavalli L, Iurato C, Seminara S, Brandi ML, de Martino M. Bone metabolism in children and adolescents: main characteristics of the determinants of peak bone mass. Clin Cases Miner Bone Metab 2013;10(3):172–179.
4. Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, et al. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 2016;27(4):1281–1386.
5. Carvalho C, Isakova T, Collerone G, Olbina G, Wolf M, Westerman M, et al. Hepcidin and disordered mineral metabolism in chronic kidney disease. Clin Nephrol 2011;76(2):90–98.
6. Van Assendelft O, Bakes-Martin RC, Bern C, Bowman BA, Clark LD, Grummer-Strawn L, et al. Recommendations to prevent and control iron deficiency in the United States [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 1998 [cited 2018 Aug 20].
7. Lee JO, Lee JH, Ahn S, Kim JW, Chang H, Kim YJ, et al. Prevalence and risk factors for iron deficiency anemia in the Korean population: results of the fifth Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2014;29(2):224–229.
8. Palaniswamy S, Hyppönen E, Williams DM, Jokelainen J, Lowry E, Keinänen-Kiukaanniemi S, et al. Potential determinants of vitamin D in Finnish adults: a cross-sectional study from the Northern Finland birth cohort 1966. BMJ Open 2017;7(3):e013161
9. Shirazi L, Almquist M, Malm J, Wirfält E, Manjer J. Determinants of serum levels of vitamin D: a study of life-style, menopausal status, dietary intake, serum calcium, and PTH. BMC Womens Health 2013;13:33
10. Touvier M, Deschasaux M, Montourcy M, Sutton A, Charnaux N, Kesse-Guyot E, et al. Determinants of vitamin D status in Caucasian adults: influence of sun exposure, dietary intake, sociodemographic, lifestyle, anthropometric, and genetic factors. J Invest Dermatol 2015;135(2):378–388.
11. van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ, et al. Potentially modifiable determinants of vitamin D status in an older population in the Netherlands: the Hoorn Study. Am J Clin Nutr 2007;85(3):755–761.
12. Rassouli A, Milanian I, Moslemi-Zadeh M. Determination of serum 25-hydroxyvitamin D(3) levels in early postmenopausal Iranian women: relationship with bone mineral density. Bone 2001;29(5):428–430.
13. Yoon JS, Song MK. Vitamin D intake, outdoor activity time and serum 25-OH vitamin D concentrations of Korean postmenopausal women by season and by age. Korean J Community Nutr 2015;20(2):120–128.
14. Holick MF, Siris ES, Binkley N, Beard MK, Khan A, Katzer JT, et al. Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005;90(6):3215–3224.
15. Liu BA, Gordon M, Labranche JM, Murray TM, Vieth R, Shear NH. Seasonal prevalence of vitamin D deficiency in institutionalized older adults. J Am Geriatr Soc 1997;45(5):598–603.
16. Lee JA, Hwang JS, Hwang IT, Kim DH, Seo JH, Lim JS. Low vitamin D levels are associated with both iron deficiency and anemia in children and adolescents. Pediatr Hematol Oncol 2015;32(2):99–108.
17. National Sleep Foundation (US). National sleep foundation recommends new sleep times [Internet]. Washington, D.C.: National Sleep Foundation; 2015 [cited 2019 Jun 18].
18. World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000.
19. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr 2018;61(5):135–149.
20. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary reference intakes for calcium and vitamin D. Washington, D.C.: National Academies Press; 2010.
21. World Health Organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations [Internet]. Geneva: World Health Organization; 2011 [cited 2019 Jan 10].
22. World Health Organization. Nutritional anaemias: tools for effective prevention and control [Internet]. World Health Organization; 2017 [cited 2018 Sep 28].
23. Munasinghe LL, Ekwaru JP, Mastroeni MF, Mastroeni SS, Veugelers PJ. The association of serum 25-hydroxyvitamin D concentrations with elevated serum ferritin levels in normal weight, overweight and obese Canadians. PLoS One 2019;14(3):e0213260
24. Larose TL, Chen Y, Camargo CA Jr, Langhammer A, Romundstad P, Mai XM. Factors associated with vitamin D deficiency in a Norwegian population: the HUNT Study. J Epidemiol Community Health 2014;68(2):165–170.
25. Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev 2015;16(4):341–349.
26. Huang YF, Tok TS, Lu CL, Ko HC, Chen MY, Chen SC. Relationship between being overweight and iron deficiency in adolescents. Pediatr Neonatol 2015;56(6):386–392.
27. Naude CE, Carey PD, Laubscher R, Fein G, Senekal M. Vitamin D and calcium status in South African adolescents with alcohol use disorders. Nutrients 2012;4(8):1076–1094.
28. Prentice A. Vitamin D deficiency: a global perspective. Nutr Rev 2008;66 10 Suppl 2:S153–S164.
29. Dong Y, Pollock N, Stallmann-Jorgensen IS, Gutin B, Lan L, Chen TC, et al. Low 25-hydroxyvitamin D levels in adolescents: race, season, adiposity, physical activity, and fitness. Pediatrics 2010;125(6):1104–1111.
30. BinSaeed AA, Torchyan AA, AlOmair BN, AlQadhib NS, AlSuwayeh FM, Monshi FM, et al. Determinants of vitamin D deficiency among undergraduate medical students in Saudi Arabia. Eur J Clin Nutr 2015;69(10):1151–1155.
31. Choi EY. 25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults. Asia Pac J Clin Nutr 2012;21(4):526–535.
32. Specker BL. Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res 1996;11(10):1539–1544.
33. Chowdhury R, Taneja S, Bhandari N, Strand TA, Bhan MK. Vitamin D deficiency and mild to moderate anemia in young North Indian children: a secondary data analysis. Nutrition 2019;57:63–68.
34. Atkinson MA, Melamed ML, Kumar J, Roy CN, Miller ER 3rd, Furth SL, et al. Vitamin D, race, and risk for anemia in children. J Pediatr 2014;164(1):153–158.e1.
35. Liu T, Zhong S, Liu L, Liu S, Li X, Zhou T, et al. Vitamin D deficiency and the risk of anemia: a meta-analysis of observational studies. Ren Fail 2015;37(6):929–934.
36. Reichel H, Koeffler HP, Norman AW. The role of the vitamin D endocrine system in health and disease. N Engl J Med 1989;320(15):980–991.
37. Norman AW. Minireview: vitamin D receptor: new assignments for an already busy receptor. Endocrinology 2006;147(12):5542–5548.
38. Blazsek I, Farabos C, Quittet P, Labat ML, Bringuier AF, Triana BK, et al. Bone marrow stromal cell defects and 1 alpha,25-dihydroxyvitamin D3 deficiency underlying human myeloid leukemias. Cancer Detect Prev 1996;20(1):31–42.
39. Icardi A, Paoletti E, De Nicola L, Mazzaferro S, Russo R, Cozzolino M. Renal anaemia and EPO hyporesponsiveness associated with vitamin D deficiency: the potential role of inflammation. Nephrol Dial Transplant 2013;28(7):1672–1679.
40. Shin JY, Shim JY. Low vitamin D levels increase anemia risk in Korean women. Clin Chim Acta 2013;421:177–180.
41. Blanco-Rojo R, Pérez-Granados AM, Toxqui L, Zazo P, de la Piedra C, Vaquero MP. Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food. Eur J Nutr 2013;52(2):695–703.
42. Ganz T. Systemic iron homeostasis. Physiol Rev 2013;93(4):1721–1741.