title: Hypovitaminosis D in Healthy Toddlers and Preschool Children from Western Saudi Arabia.
abstract: BACKGROUND
  Vitamin D deficiency is common in Saudi Arabia. No sufficient data are available on the vitamin D status of preschool children.
  
  
  OBJECTIVE
  To investigate the vitamin D status among toddlers and preschool children and to evaluate the factors associated with hypovitaminosis D in Western Saudi Arabia.
  
  
  METHODS
  A cross-sectional study was conducted on 503 preschool children in Makkah. The children were divided into two age categories: 1 - 3 years (toddlers) and 3 - 6 years (preschool). Sociodemographic factors, life-style factors, eating habits, body mass index (BMI), 25-(OH)-vitamin D3, parathyroid hormone, calcium, phosphorous, and alkaline phosphatase concentrations were determined.
  
  
  RESULTS
  Sixty-three % of children had a vitamin D deficiency. Vitamin D in toddlers was significantly higher than in preschool children. Vitamin D levels were negatively correlated with BMI (r = - 0.419, P < 0.001), and duration of breast feeding (r = - 0.270, P = 0.027), but a significant positive correlation with vitamin D intake (r = 0.335, P = 0.021), calcium intake (r = 0.25, P = 0.029), duration of formula feeding (r = 0.354, P = 0.019), and outdoor physical activity (r = 0.381, P = 0.011) was found. Multivariable predictors of hypovitaminosis D were preschool age (OR = 11, [95 % CI: 2.78 - 43.57], P < 0.001), outdoor physical inactivity (OR = 2.44, [95 % CI: 0.93 - 14.12], P < 0.001), obesity (OR = 2.3, [95 % CI: 1.25 - 7.08], P = 0.008), overweight (OR = 2.16, [95 % CI: 1.18 - 6.01], P = 0.039), inadequate vitamin D intake (OR = 1.65, [95 % CI: 1.12 - 2.53], P = 0.012), exclusive formula feeding (OR = 0.53, [95 % CI: 0.41 - 0.72], P < 0.001), and breast and formula feeding (OR = 0.62 [95 % CI: 0.39 - 0.88], P = 0.002).
  
  
  CONCLUSIONS
  Hypovitaminosis D is a public health concern, especially in preschool children. Possible determinants of low vitamin D status in preschool children in the Makkah region could be related to age, high BMI, inadequate vitamin D intake, exclusive breastfeeding, and outdoor physical inactivity.
authors.affiliation: 1 Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Osama A
authors.initials: OA
authors.lastname: Kensarah
authors.affiliation: 1 Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Abdelelah S
authors.initials: AS
authors.lastname: Jazar
authors.affiliation: 1 Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Firas S
authors.initials: FS
authors.lastname: Azzeh
mesh_terms: D015992:Body Mass Index; D001942:Breast Feeding; D002136:Calcium, Dietary / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula; D008019:Life Style; D008297:Male; D009765:Obesity / Q000453:epidemiology; D010290:Parents; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014807:Vitamin D / Q000008:administration & dosage; D014808:Vitamin D Deficiency / Q000453:epidemiology*
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D
keywords: hypovitaminosis D; nutrient adequacy ratio; preschool children