title: Vitamin D status and predictors of hypovitaminosis D in Italian children and adolescents: a cross-sectional study.
abstract: Hypovitaminosis D affects children and adolescents all around the world. Italian data on vitamin D status and risk factors for hypovitaminosis D during pediatric age are lacking. Six hundred fifty-two children and adolescents (range 2.0-21.0 years) living in the northwestern area of Tuscany were recruited at the Department of Pediatrics, University Hospital Pisa. None of them had received vitamin D supplementation in the previous 12 months. 25-hydroxyvitamin D (25-OH-D) and parathyroid hormone (PTH) levels were analyzed in all subjects. Severe vitamin D deficiency was defined as serum levels of 25-OH-D<25.0 nmol/L (10.0 ng/mL) and vitamin D deficiency a<50.0 nmol/L (20.0 ng/mL). Serum 25-OH-D levels of 50.0-74.9 nmol/L (20.0-29.9 ng/mL) indicated vitamin D insufficiency, whereas 25-OH-D levels ≥ 75.0 nmol/L (30.0 ng/mL) were considered sufficient. Hypovitaminosis D was defined as 25-OH-D levels<75.0 nmol/L (30.0 ng/mL). The median serum 25-OH-D level was 51.8 nmol/L, range 6.7-174.7 (20.7 ng/mL, range 2.7-70.0), with a prevalence of vitamin D deficiency, insufficiency, and sufficiency of 45.9, 33.6, and 20.5 %, respectively. The prevalence of severe vitamin D deficiency was 9.5 %. Adolescents had lower median 25-OH-D levels (49.8 nmol/L, range 8.1-174.7; 20.0 ng/mL, range 3.2-70.0) than children (55.6 nmol/L, range 6.8-154.6; 22.3 ng/mL, range 2.7-61.9, p=0.006). Non-white individuals (n=37) had median serum 25-OH-D levels in the range of deficiency (28.2 nmol/L, range 8.1-86.2; 11.3 ng/mL, range 3.2-34.5), with 36/37 having hypovitaminosis D. Logistic regression showed significant increased risk of hypovitaminosis D in the following: blood samples taken in winter (odds ratio (OR) 27.20), spring (OR 26.44), and fall (OR 8.27) compared to summer; overweight (OR 5.02) and obese (OR 5.36) subjects compared to individuals with normal BMI; low sun exposure (OR 8.64) compared to good exposure, and regular use of sunscreens (OR 7.06) compared to non-regular use. Gender and place of residence were not associated with vitamin D status. The 25-OH-D levels were inversely related to the PTH levels (r=-0.395, p<0.0001). Sixty-three out of the 652 (9.7 %) subjects showed secondary hyperparathyroidism.
  
  
  CONCLUSIONS
  Italian children and adolescents who were not receiving vitamin D supplementation had high prevalence of hypovitaminosis D. Careful identification of factors affecting vitamin D status is advisable to promptly start vitamin D supplementation in children and adolescents.
authors: Francesco
authors: F
authors: Vierucci
authors: Marta
authors: M
authors: Del Pistoia
authors: Margherita
authors: M
authors: Fanos
authors: Martina
authors: M
authors: Gori
authors: Giorgia
authors: G
authors: Carlone
authors: Paola
authors: P
authors: Erba
authors: Gabriele
authors: G
authors: Massimetti
authors: Giovanni
authors: G
authors: Federico
authors: Giuseppe
authors: G
authors: Saggese
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood*; D015995:Prevalence; D044469:Racial Groups; D012016:Reference Values; D012307:Risk Factors; D012621:Seasons; D013473:Sunscreening Agents / Q000008:administration & dosage; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D013473:Sunscreening Agents; D014807:Vitamin D; C104450:25-hydroxyvitamin D
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