title: Anaemia, lead poisoning and vitamin D deficiency in low-income children: do current screening recommendations match the burden of illness?
abstract: OBJECTIVE
  Low-income children are routinely screened for anaemia and elevated blood lead levels (EBLL) but not for vitamin D deficiency. We sought to determine the relative prevalence of and the relationship among vitamin D deficiency, anaemia and EBLL among healthy low-income paediatric clinic patients.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Paediatric outpatient clinic in an urban safety net hospital in a northern US state.
  
  
  METHODS
  Healthy toddlers and children under 6 years of age (n 127) who were seen for a routine well child check-up (WCC).
  
  
  RESULTS
  The prevalence of vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) < 30 ng/ml) was 62 %; the prevalence of vitamin D deficiency (25(OH)D < 20 ng/ml) was 29 %. These rates were far higher than those for anaemia (Hb < 11·0 g/dl) at 10 %, EBLL (Pb > 9 μg/dl) at 1 % or even mildly EBLL (Pb 5-9 μg/dl) at 4 % (range: 1-11). There was no relationship among any of the following: vitamin D status, anaemia or EBLL. The vast majority of children with vitamin D deficiency had both normal Hb (86 %) and Pb level (100 %). After controlling for child's age, gender and race/ethnicity, there was no association between Hb (continuous, g/dl) and vitamin D deficiency (adjusted OR (aOR) = 0·97, 95 % CI 0·64, 1·47; P = 0·88). The only significant predictor of vitamin D deficiency was increasing age in years (aOR = 1·39, 95 % CI 1·03, 1·86; P = 0·03). None of these associations changed materially when deficiency was defined as <15 ng/ml.
  
  
  CONCLUSIONS
  Vitamin D deficiency was far more common than anaemia or EBLL, and Hb and Pb status were not predictors of vitamin D status.
authors.affiliation: Department of Pediatrics, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN 55415, USA. kerse003@umn.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Kersey
authors.forename: Ming
authors.initials: M
authors.lastname: Chi
authors.forename: Diana B
authors.initials: DB
authors.lastname: Cutts
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000740:Anemia / Q000097:blood / Q000453:epidemiology*; D002675:Child, Preschool; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006887:Hydroxycholecalciferols / Q000097:blood / Q000172:deficiency*; D007223:Infant; D007855:Lead Poisoning / Q000097:blood / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011203:Poverty; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology*
chemical_list: D006887:Hydroxycholecalciferols