Skip to main content Accessibility help
×
Home

Prevalence and risk factors of vitamin D insufficiency and deficiency among 6–24-month-old underweight and normal-weight children living in an urban slum of Bangladesh

  • AM Shamsir Ahmed (a1) (a2), Tahmeed Ahmed (a2), Kurt Z Long (a2) (a3), Ricardo J Soares Magalhaes (a4) (a5), Md Iqbal Hossain (a2), Md Munirul Islam (a2), Mustafa Mahfuz (a2), SM Abdul Gaffar (a2), Atiya Sharmeen (a2), Rashidul Haque (a2), Richard L Guerrant (a6), William A Petri (a6) and Abdullah Al Mamun (a1) (a2)...

Abstract

Objective

We quantified the prevalence of vitamin D status in 6–24-month-old underweight and normal-weight children and identified the socio-economic and dietary predictors for status.

Design

Cross-sectional, baseline data from a nutritional intervention study were analysed. Multinomial logistic regression was used to estimate the odds of being vitamin D deficient or insufficient with the reference being vitamin D sufficient.

Setting

Urban slum area of Mirpur field site, Dhaka, Bangladesh.

Subjects

Underweight (weight-for-age Z-score <−2·00) and normal-weight (weight-for-age Z-score ≥−1·00) children aged 6–24 months.

Results

Among 468 underweight children, 23·1 % were sufficient, 42·3 % insufficient, 31·2 % deficient and 3·4 % severely vitamin D deficient. Among 445 normal-weight children, 14·8 % were sufficient, 39·6 % insufficient and 40·0 % deficient and 5·6 % severely deficient. With adjusted multinominal regression analysis, risk factors (OR (95 % CI)) for vitamin D deficiency in underweight children were: older age group (18–24 months old; 2·9 (1·5–5·7)); measurement of vitamin D status during winter (3·0 (1·4–6·4)) and spring (6·9 (3·0–16·1)); and maternal education (≥6 years of institutional education; 2·2 (1·0–4·9)). In normal-weight children, older age group (3·6 (1·2–10·6)) and living in the richest quintile (3·7 (1·1–12·5)) were found to be significantly associated with vitamin D insufficiency.

Conclusions

The study demonstrates a significant burden of vitamin D insufficiency and deficiency in both underweight and normal-weight children <2 years of age from an urban slum of Bangladesh. Identification of risk factors may help in mitigating the important burden in such children.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Prevalence and risk factors of vitamin D insufficiency and deficiency among 6–24-month-old underweight and normal-weight children living in an urban slum of Bangladesh
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Prevalence and risk factors of vitamin D insufficiency and deficiency among 6–24-month-old underweight and normal-weight children living in an urban slum of Bangladesh
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Prevalence and risk factors of vitamin D insufficiency and deficiency among 6–24-month-old underweight and normal-weight children living in an urban slum of Bangladesh
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: Email a.ahmed@uq.net.au

References

Hide All
1. Holick, MF (2007) Vitamin D deficiency. N Engl J Med 357, 266281.
2. Hewison, M (2011) Vitamin D and innate and adaptive immunity. Vitam Horm 86, 2362.
3. Hewison, M (2012) Vitamin D and immune function: autocrine, paracrine or endocrine? Scand J Clin Lab Invest Suppl 243, 92102.
4. Holick, MF (2012) The D-lightful vitamin D for child health. JPEN J Parenter Enteral Nutr 36, 1 Suppl., 9S19S.
5. Lucas, RM, McMichael, AJ, Armstrong, BK et al. (2008) Estimating the global disease burden due to ultraviolet radiation exposure. Int J Epidemiol 37, 654667.
6. Calvo, MS, Whiting, SJ & Barton, CN (2005) Vitamin D intake: a global perspective of current status. J Nutr 135, 310316.
7. Arabi, A, El Rassi, R & El-Hajj Fuleihan, G (2010) Hypovitaminosis D in developing countries – prevalence, risk factors and outcomes. Nat Rev Endocrinol 6, 550561.
8. Oren, Y, Shapira, Y, Agmon-Levin, N et al. (2010) Vitamin D insufficiency in a sunny environment: a demographic and seasonal analysis. Isr Med Assoc J 12, 751756.
9. van Schoor, NM & Lips, P (2011) Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 25, 671680.
10. Agarwal, KS, Mughal, MZ, Upadhyay, P et al. (2002) The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child 87, 111113.
11. Atiq, M, Suria, A, Nizami, SQ et al. (1998) Vitamin D status of breastfed Pakistani infants. Acta Paediatr 87, 737740.
12. Bhalala, U, Desai, M, Parekh, P et al. (2007) Subclinical hypovitaminosis D among exclusively breastfed young infants. Indian Pediatr 44, 897901.
13. Combs, GF Jr, Hassan, N, Dellagana, N et al. (2008) Apparent efficacy of food-based calcium supplementation in preventing rickets in Bangladesh. Biol Trace Elem Res 121, 193204.
14. Roth, DE, Shah, MR, Black, RE et al. (2010) Vitamin D status of infants in northeastern rural Bangladesh: preliminary observations and a review of potential determinants. J Health Popul Nutr 28, 458469.
15. Roth, DE, Shah, R, Black, RE et al. (2010) Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh. Acta Paediatr 99, 389393.
16. Tiwari, L & Puliyel, JM (2004) Vitamin D level in slum children of Delhi. Indian Pediatr 41, 10761077.
17. Wayse, V, Yousafzai, A, Mogale, K et al. (2004) Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 58, 563567.
18. Fischer, PR, Rahman, A, Cimma, JP et al. (1999) Nutritional rickets without vitamin D deficiency in Bangladesh. J Trop Pediatr 45, 291293.
19. Atiq, M, Suria, A, Nizami, SQ et al. (1998) Maternal vitamin-D deficiency in Pakistan. Acta Obstet Gynecol Scand 77, 970973.
20. Combs, GF & Hassan, N (2005) The Chakaria food system study: household-level, case–control study to identify risk factor for rickets in Bangladesh. Eur J Clin Nutr 59, 12911301.
21. Andiran, N, Celik, N, Akca, H et al. (2012) Vitamin D deficiency in children and adolescents. J Clin Res Pediatr Endocrinol 4, 2529.
22. Andiran, N, Yordam, N & Ozon, A (2002) Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition 18, 4750.
23. Gharaibeh, MA & Stoecker, BJ (2009) Assessment of serum 25(OH)D concentration in women of childbearing age and their preschool children in Northern Jordan during summer. Eur J Clin Nutr 63, 13201326.
24. Grant, CC, Wall, CR, Crengle, S et al. (2009) Vitamin D deficiency in early childhood: prevalent in the sunny South Pacific. Public Health Nutr 12, 18931901.
25. Hintzpeter, B, Scheidt-Nave, C, Muller, MJ et al. (2008) Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 138, 14821490.
26. Mansbach, JM, Ginde, AA & Camargo, CA Jr (2009) Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics 124, 14041410.
27. Prentice, A (2008) Vitamin D deficiency: a global perspective. Nutr Rev 66, 10 Suppl. 2, S153S164.
28. Zhu, Z, Zhan, J, Shao, J et al. (2012) High prevalence of vitamin D deficiency among children aged 1 month to 16 years in Hangzhou, China. BMC Public Health 12, 126.
29. The MAL-ED Network Investigators (2014) The MAL-ED study: a multinational and multidisciplinary approach to understand the relationship between enteric pathogens, malnutrition, gut physiology, physical growth, cognitive development, and immune responses in infants and children up to 2 years of age in resource-poor environments. Clin Infect Dis 59, Suppl. 4, S193S206.
30. Ahmed, T, Mahfuz, M, Islam, MM et al. (2014) The MAL-ED cohort study in Mirpur, Bangladesh. Clin Infect Dis 59, Suppl. 4, S280S286.
31. The DHS Program (2008) DHS Model Questionnaires. http://www.measuredhs.com/What-We-Do/Survey-Types/DHS-Questionnaires.cfm#CP_JUMP_16179 (accessed March 2013).
32. Wallace, AM, Gibson, S, de la Hunty, A et al. (2010) Measurement of 25-hydroxyvitamin D in the clinical laboratory: current procedures, performance characteristics and limitations. Steroids 75, 477488.
33. Wahed, MA, Alvarez, JO, Khaled, MA et al. (1995) Comparison of the modified relative dose response (MRDR) and the relative dose response (RDR) in the assessment of vitamin A status in malnourished children. Am J Clin Nutr 61, 12531256.
34. Tomkins, A (1981) Nutritional status and severity of diarrhoea among pre-school children in rural Nigeria. Lancet 1, 860862.
35. National Institute of Population Research and Training, Mitra and Associates, & ICF International (2013) Bangladesh Demographic and Health Survey 2011. Dhaka and Calverton, MD: NIPORT, Mitra and Associates, and ICF International.
36. World Health Organization (20009) Global Prevalence of Vitamin A Deficiency in Populations At Risk 1995–2005. WHO Global Database on Vitamin A Deficiency. Geneva: WHO.
37. Brown, KH, Rivera, JA, Bhutta, Z et al. (2004) International Zinc Nutrition Consultative Group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull 25, 1 Suppl. 2, S99S203.
38. Lips, P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22, 477501.
39. Need, AG, O’Loughlin, PD, Morris, HA et al. (2008) Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J Bone Miner Res 23, 18591863.
40. Bischoff-Ferrari, HA, Giovannucci, E, Willett, WC et al. (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84, 1828.
41. Kuchuk, NO, Pluijm, SM, van Schoor, NM et al. (2009) Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons. J Clin Endocrinol Metab 94, 12441250.
42. Clemens, TL, Adams, JS, Henderson, SL et al. (1982) Increased skin pigment reduces the capacity of skin to synthesise vitamin D3 . Lancet 1, 7476.
43. Nair, R & Maseeh, A (2012) Vitamin D: the ‘sunshine’ vitamin. J Pharmacol Pharmacother 3, 118126.
44. Matsuoka, LY, Wortsman, J, Dannenberg, MJ et al. (1992) Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3 . J Clin Endocrinol Metab 75, 10991103.
45. Roth, DE, Al Mahmud, A, Raqib, R et al. (2013) Randomized placebo-controlled trial of high-dose prenatal third-trimester vitamin D3 supplementation in Bangladesh: the AViDD trial. Nutr J 12, 47.
46. Kazemi, A, Sharifi, F, Jafari, N et al. (2009) High prevalence of vitamin D deficiency among pregnant women and their newborns in an Iranian population. J Womens Health (Larchmt) 18, 835839.
47. Sedrani, SH, Abanmy, A, Slaman, H et al. (1992) Vitamin D status of Saudis: seasonal variations. Are Saudi children at risk of developing vitamin D deficiency rickets? Saudi Med J 13, 430433.
48. Islam, MZ, Lamberg-Allardt, C, Karkkainen, M et al. (2002) Vitamin D deficiency: a concern in premenopausal Bangladeshi women of two socio-economic groups in rural and urban region. Eur J Clin Nutr 56, 5156.
49. Bhaskaram, P (2002) Micronutrient malnutrition, infection, and immunity: an overview. Nutr Rev 60, 5 Pt 2, S40S45.
50. Winichagoon, P (2008) Coexistence of micronutrient malnutrition: implication for nutrition policy and programs in Asia. Asia Pac J Clin Nutr 17, Suppl. 1, 346348.

Keywords

Prevalence and risk factors of vitamin D insufficiency and deficiency among 6–24-month-old underweight and normal-weight children living in an urban slum of Bangladesh

  • AM Shamsir Ahmed (a1) (a2), Tahmeed Ahmed (a2), Kurt Z Long (a2) (a3), Ricardo J Soares Magalhaes (a4) (a5), Md Iqbal Hossain (a2), Md Munirul Islam (a2), Mustafa Mahfuz (a2), SM Abdul Gaffar (a2), Atiya Sharmeen (a2), Rashidul Haque (a2), Richard L Guerrant (a6), William A Petri (a6) and Abdullah Al Mamun (a1) (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed