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Vitamin D Abnormalities: More Common in US Children with T1D than in Healthy Children

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DOI: 10.4236/jdm.2014.44045    3,630 Downloads   4,176 Views  

ABSTRACT

Background: Pediatric patients with type 1 diabetes (T1D) have increased risk for low bone mineral density, which may be due in part to low 25-hydroxyvitamin D levels. Vitamin D levels are influenced by sunlight exposure and thus display geographical variation. We hypothesize that the prevalence of 25-hydroxyvitamin D deficiency (<20 ng/mL) and insufficiency (20 - 29 ng/mL) in children with T1D living in the United States is higher than in healthy children and that diabetes duration, HbA1c, and insulin dose/kg are inversely associated with 25-hydroxyvitamin D levels. Methods: Medical records of patients with T1D being followed in Tennessee were reviewed for demographics, medical information, and 25-hydroxyvitamin D levels during the previous 2 years. Control subjects were obtained from a de-identified database of healthy pediatric subjects living in a similar geographical area. Chi squared tests and multivariable linear regression were performed. Results: Children and adolescents with T1D (n = 276; median age 14 years) have a significantly higher percentage of vitamin D deficiency and insufficiency compared with healthy pediatric controls (n = 100; median age 11.2 years) (68% versus 44%; p < 0.001). The median 25-hydroxyvitamin D level is 24 ng/mL versus 31 ng/mL, respectively. After adjusting for age, race, gender, UV light exposure, BMI, and multivitamin supplementation, children and adolescents with T1D have a serum 25-hydroxyvitamin D level 6.7 ng/mL lower than the control population [CI(4.11, 9.21), p < 0.0001]. Within the T1D population, there is no clear association between diabetes duration, HbA1c, or insulin dose/kg and 25-hydroxyvitamin D levels. Conclusions: There is an increased prevalence of 25-hydroxyvitamin D deficiency and insufficiency in US. children with T1D compared with geographically similar children without diabetes. Further research is needed to determine whether decreased serum 25-hydroxyvitamin D can be alleviated via dietary or behavioral modifications in this population.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Sheedy, C. , Xu, M. , Saville, B. and Simmons, J. (2014) Vitamin D Abnormalities: More Common in US Children with T1D than in Healthy Children. Journal of Diabetes Mellitus, 4, 324-333. doi: 10.4236/jdm.2014.44045.

References

[1] Tuominen, J.T., Impivaara, O., Puukka, P. and Ronnemaa, T. (1999) Bone Mineral Density in Patients with Type 1 and Type 2 Diabetes. Diabetes Care, 22, 1196-1200.
http://dx.doi.org/10.2337/diacare.22.7.1196
[2] Pinheiro, M.M., Castro, C.M. and Szejnfeld, V.L. (2006) Low Femoral Bone Mineral Density and Quantitative Ultrasound Are Risk Factors for New Osteoporotic Fracture and Total and Cardiovascular Mortality: A 5-Year Population-Based Study of Brazilian Elderly Women. The Journals of Gerontology: Series A, 61, 196-203. http://dx.doi.org/10.1093/gerona/61.2.196
[3] Maser, R.E., Kolm, P., Modlesky, C.M., Beck, T.J. and Lenhard, M.J. (2012) Hip Strength in Adults with Type 1 Diabetes Is Associated with Age at Onset of Diabetes. Journal of Clinical Densitometry, 15, 78-85. http://dx.doi.org/10.1016/j.jocd.2011.08.004
[4] Xing, Y. and Morgan, S.L. (2013) Celiac Disease and Metabolic Bone Disease. Journal of Clinical Densitometry, 16, 439-444. http://dx.doi.org/10.1016/j.jocd.2013.08.012
[5] Vestergaard, P. and Mosekilde, L. (2003) Hyperthyroidism, Bone Mineral, and Fracture Risk—A Meta-Analysis. Thyroid, 13, 585-593. http://dx.doi.org/10.1089/105072503322238854
[6] Kositsawat, J., Freeman, V.L., Gerber, B.S. and Geraci, S. (2010) Association of A1c Levels with Vitamin D Status in US Adults: Data from the National Health and Nutrition Examination Survey. Diabetes Care, 33, 1236-1238. http://dx.doi.org/10.2337/dc09-2150
[7] Holick, M.F. (2006) High Prevalence of Vitamin D Inadequacy and Implications for Health. Mayo Clinic Proceedings, 81, 353-373. http://dx.doi.org/10.4065/81.3.353
[8] Kumar, J., Muntner, P., Kaskel, F.J., Hailpern, S.M. and Melamed, M.L. (2009) Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: NHANES 2001-2004. Pediatrics, 124, e362-e370. http://dx.doi.org/10.1542/peds.2009-0051
[9] Svoren, B.M., Volkening, L.K., Wood, J.R. and Laffel, L.M.B. (2009) Significant Vitamin D Deficiency in Youth with Type 1 Diabetes Mellitus. The Journal of Pediatrics, 154, 132-134.
http://dx.doi.org/10.1016/j.jpeds.2008.07.015
[10] Janner, M., Ballinari, P., Mullis, P.E. and Fluck, C.E. (2010) High Prevalence of Vitamin D Deficiency in Children and Adolescents with Type 1 Diabetes. Swiss Medical Weekly, 140, Article ID: w13091.
[11] Mutlu, A., Mutlu, G.Y., Ozsu, E., Cizmecioglu, F.M. and Hatun, S. (2011) Vitamin D Deficiency in Children and Adolescents with Type 1 Diabetes. Journal of Clinical Research in Pediatric Endocrinology, 3, 179-183.
[12] Thnc, O., Cetinkaya, S., Kizilgün, M. and Aycan, Z. (2011) Vitamin D Status and Insulin Requirements in Children and Adolescent with Type 1 Diabetes. Journal of Pediatric Endocrinology and Metabolism, 24, 1037-1041.
[13] Kaur, H., Donaghue, K.C., Chan, A.K., Benitez-Aguirre, P., Hing, S., Lloyd, M., et al. (2011) Vitamin D Deficiency Is Associated with Retinopathy in Children and Adolescents with Type 1 Diabetes. Diabetes Care, 34, 1400-1402. http://dx.doi.org/10.2337/dc11-0103
[14] Bener, A., Alsaied, A., Al-Ali, M., Al-Kubaisi, A., Basha, B., Abraham, A., et al. (2009) High Prevalence of Vitamin D Deficiency in Type 1 Diabetes Mellitus and Healthy Children. Acta Diabetologica, 46, 183-189. http://dx.doi.org/10.1007/s00592-008-0071-6
[15] Greer, R.M., Portelli, S.L., Hung, B.S., Cleghorn, G.J., McMahon, S.K., Batch, J.A., et al. (2013) Serum Vitamin D Levels Are Lower in Australian Children and Adolescents with Type 1 Diabetes than in Children without Diabetes. Pediatric Diabetes, 14, 31-41.
http://dx.doi.org/10.1111/j.1399-5448.2012.00890.x
[16] Thorsen, S.U., Mortensen, H.B., Cartensen, B., Fenger, M., Thuesen, B.H., Husemoen, L.L., et al. (2013) No Difference in Vitamin D Levles between Children Newly Diagnosed with Type 1 Diabetes and Their Healthy Siblings: A 13-Year Nationwide Danish Study. Diabetes Care, 36, e157-e158.
http://dx.doi.org/10.2337/dc13-0342
[17] Bierschenk, L., Alexander, J., Wasserfall, C., Haller, M., Schatz, D. and Atkinson, M. (2009) Vitamin D Levels in Subjects with and without Type 1 Diabetes Residing in a Solar Rich Environment. Diabetes Care, 32, 1977-1979. http://dx.doi.org/10.2337/dc09-1089
[18] Yeshayahu, Y., Sochett, E.B., Deda, L., Sud, S. and Mahmud. F.H. (2012) Type 1 Diabetes as a Risk Factor for Impaired Vitamin D Status in a Multi-Ethnic Cohort of Canadian Adolescents. Canadian Journal of Diabetes, 36, 314-319. http://dx.doi.org/10.1016/j.jcjd.2012.10.002
[19] Simmons, J., Sheedy, C., Lee, H., Koh, S., Alvarez, J., Koyama, T., et al. (2013) Prevalence of 25-Hydroxyvitamin D Deficiency in Child and Adolescent Patients Undergoing Hematopoietic Cell Transplantation Compared with a Healthy Population. Pediatric Blood & Cancer, 60, 2025-2030.
[20] Harris, P.A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N. and Conde, J.G. (2009) Research Electronic Data Capture (REDCap)—A Metadata-Driven Methodology and Workflow Process for Providing Translational Research Informatics Support. Journal of Biomedical Informatics, 42, 377-381.
http://dx.doi.org/10.1016/j.jbi.2008.08.010
[21] Drake, M.T., Maurer, M.J., Link, B.K., Habermann, T.M., Ansell, S.M., Micallef, I.N., et al. (2010) Vitamin D Insufficiency and Prognosis in Non-Hodgkin’s Lymphoma. Journal of Clinical Oncology, 28, 1101-1108. http://dx.doi.org/10.1200/JCO.2010.28.6674
[22] Holick, M.F., Binkley, N.C., Bischoff-Ferrari, H.A., Gordon, C.M., Hanley, D.A., Heaney, R.P., et al. (2011) Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96, 1911-1930.
http://dx.doi.org/10.1210/jc.2011-0385
[23] (2013) Center, National Oceanic and Atmospheric Administration (NOAA) Climate Prediction.
ftp://ftp.cpc.ncep.noaa.gov/long/uv/cities
[24] Vierucci, F., Del Pistoia, M., Fanos, M., Gori, M., Carlone, G., Erba, P., et al. (2013) Vitamin D Status and Predictors of Hypovitaminosus D in Italian Children and Adolescents: A Cross-Sectional Study. European Journal of Pediatrics, 172, 1607-1617. http://dx.doi.org/10.1007/s00431-013-2119-z
[25] Nesby-O’Dell, S., Scanlon, K.S., Cogswell, M.E., Gillespie, C., Hollis, B.W., Looker, A.C., et al. (2002) Hypovitaminosis D Prevalence and Determinants among African American and White Women of Reproductive Age: Third National Health and Nutrition Examination Survey, 1988-1994. American Journal of Clinical Nutrition, 76, 187-192.
[26] Turer, C.B., Lin, H. and Flores, G. (2013) Prevalence of Vitamin D Deficiency among Overweight and Obese US Children. Pediatrics, 131, e152-e161. http://dx.doi.org/10.1542/peds.2012-1711
[27] Ladhani, S., Srinivasan, L., Buchanan, C. and Allgrove, J. (2004) Presentation of Vitamin D Deficiency. Archives of Disease in Childhood, 89, 781-784. http://dx.doi.org/10.1136/adc.2003.031385
[28] Mansbach, J.M., Ginde, A.A. and Camargo, C.A. (2009) Serum 25-Hydroxyvitamin D Levels among US Children Aged 1 to 11 Years: Do Children Need More Vitamin D? Pediatrics, 124, 1404-1410. http://dx.doi.org/10.1542/peds.2008-2041
[29] Tangpricha, V., Pearce, E.N., Chen, T.C. and Holick, M.F. (2002) Vitamin D Insufficiency among Free-Living Healthy Young Adults. The American Journal of Medicine, 112, 659-662.
http://dx.doi.org/10.1016/S0002-9343(02)01091-4
[30] Holick, M.F., Biancuzzo, R.M., Chen, T.C., Klein, E.K., Young, A., Bibuld, D., et al. (2008) Vitamin D2 Is as Effective as Vitamin D3 in Maintaining Circulating Concentrations of 25-Hydroxyvitamin D. The Journal of Clinical Endocrinology & Metabolism, 93, 677-681. http://dx.doi.org/10.1210/jc.2007-2308
[31] Kordonouri, O., Klinghammer, A., Lang, E.B., Gruters-Kieslich, A., Grabert, M. and Holl, R.W. (2002) Thyroid Autoimmunity in Children and Adolescents with Type 1 Diabetes: A Multicenter Survey. Diabetes Care, 25, 1346-1350. http://dx.doi.org/10.2337/diacare.25.8.1346
[32] Barera, G., Bonfanti, R., Viscardi, M., Bazzigaluppi, E., Calori, G., Meschi, F., et al. (2002) Occurrence of Celiac Disease after Onset of Type 1 Diabetes: A 6-Year Prospective Longitudinal Study. Pediatrics, 109, 833-838. http://dx.doi.org/10.1542/peds.109.5.833
[33] Barker, J.M., Ide, A., Hostetler, C., Yu, L., Miao, D., Fain, P.R., et al. (2005) Endocrine and Immunogenetic Testing in Individuals with Type 1 Diabetes and 21-Hydroxylase Autoantibodies: Addison’s Disease in a High-Risk Population. The Journal of Clinical Endocrinology & Metabolism, 90, 128-134. http://dx.doi.org/10.1210/jc.2004-0874
[34] Kota, S.K., Meher, L.K., Jammula, S., Kota, S.K. and Modi, K.D. (2012) Clinical Profile of Coexisting Conditions in Type 1 Diabetes Mellitus Patients. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 6, 70-76. http://dx.doi.org/10.1016/j.dsx.2012.08.006
[35] Lovas, K., Gjesdal, C.G., Christensen, M., Wolff, A.B., Alm?s, B., Svartberg, J., et al. (2009) Glucocorticoid Replacement Therapy and Pharmacogenetics in Addison’s Disease: Effects on Bone. European Journal of Endocrinology, 160, 993-1002. http://dx.doi.org/10.1530/EJE-08-0880
[36] Nadeem, M. and Roche, E.F. (2012) Bone Health in Children and Adolescent with Turner Syndrome. Journal of Pediatric Endocrinology and Metabolism, 25, 823-833. http://dx.doi.org/10.1515/jpem-2012-0088
[37] Dong, J.Y., Zhang, W., Chen, J.J., Zhang, Z.L., Han, S.F. and Qin, L.Q. (2013) Vitamin D Intake and Risk of Type 1 Diabetes: A Meta-Analysis of Observational Studies. Nutrients, 5, 3551-3562.
http://dx.doi.org/10.3390/nu5093551
[38] Zipitis, C.S. and Akobeng, A.K. (2008) Vitamin D Supplementation in Early Childhood and Risk of Type 1 Diabetes: A Systematic Review and Meta-Analysis. Archives of Disease in Childhood, 93, 512-517. http://dx.doi.org/10.1136/adc.2007.128579
[39] Munger, K.L., Levin, L., Massa, J., Horst, R., Orban, T. and Ascherio, A. (2013) Preclinical Serum 25-Hydroxyvitamin D Levels and Risk of Type 1 Diabetes in a Cohort of US Military Personnel. American Journal of Epidemiology, 177, 411-419. http://dx.doi.org/10.1093/aje/kws243
[40] Raab, J., Giannopoulou, E.Z., Schneider, S., Warncke, K., Krasmann, M., Winkler, C., et al. (2014) Prevalence of Vitamin D Deficiency in Pre-Type 1 Diabetes and Its Association with Disease Progression. Diabetologia, 57, 902-908. http://dx.doi.org/10.1007/s00125-014-3181-4
[41] Takiishi, T., Van Belle, T., Gysemans, C. and Mathieu, C. (2013) Effects of Vitamin D on Antigen-Specific and NonAntigen-Specific Immune Modulation: Relevance for Type 1 Diabetes. Pediatric Diabetes, 14, 81-89. http://dx.doi.org/10.1111/j.1399-5448.2012.00923.x
[42] Prietl, B., Treiber, G., Pieber, T.R. and Amrein, K. (2013) Vitamin D and Immune Function. Nutrients, 5, 2502-2521. http://dx.doi.org/10.3390/nu5072502

  
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