Predicting vitamin D deficiency through parathormone in the children of a small city located in the warm climate belt of northern hemisphere

Year 2020, Volume: 3 Issue: 4, 389 - 394, 22.10.2020

Gökçe Celep , Zeynep Durmaz

https://doi.org/10.32322/jhsm.766043

Cited By: 1

Abstract

ÖZ
Amaç: Bu çalışmanın amacı bir grup sağlıklı çocukta parathormon (PTH), kalsiyum (Ca), fosfor (P), D vitamini düzeylerini ortaya koymak ve “D vitamini eksikliği” ile “yetersizliği” tanıları için düzey saptamaktır.
Yöntem: Çalışmaya bilinen kronik sağlık sorunu olmayan 543 çocuk katıldı. PTH, Ca, P, 25(OH)D düzeyleri, kan örneğinin alındığı mevsim, yaş, cinsiyet ve sağlık durumuna ait veriler hastane kayıt sisteminden geriye dönük olarak elde edildi. Değişkenler arasındaki ilişkiler metinde ayrıntılı olarak tanımlanan istatistiksel yöntemlerle değerlendirildi.
Bulgular: PTH yükselmesini tetikleyen en düşük PTH değeri 13.6 ng/ml olarak saptandı. Farklı yaş grupları için 25(OH)D düzeyi persentil değerleri hesaplandı. Yaş, PTH ve mevsimin D vitamini düzeylerine katkısı olduğu lojistik regresyon analizleri ile gösterildi.
Sonuç: Yaşanılan yerin rakımı ve enlemi Güneş’in Zenith açısını etkilediğinden D vitamini durumunda önemli bir değişkendir. Destek ve tedavi yaklaşımında yaş, cinsiyet ve mevsimler dikkate alınmalıdır.
Anahtar sözcükler: D vitamini eksikliği, 25(OH)D, PTH, enlem, çocuk

ABSTRACT
Aim: The aim of this study is to analyse the serum levels of parathormone (PTH), calcium (Ca), phosphorus (P), vitamin D and define a cut off value for vitamin D deficiency and insufficiency in a sample of healthy children.
Methods: A total of 543 healthy children enrolled to this study. The data of PTH, Ca, P, 25(OH)D levels, season of blood sample collection, age, sex and health status were collected from the hospital record system retrospectively. The relationships between these variables were defined by statistical analyses and explained in detail in the text.
Results: The inflection point that triggered PTH rise was 13.6 ng/ml. The percentile values of 25(OH)D for different age groups were reported. Logistic regression analyses pointed that age, PTH and seasons contributed to vitamin D status.
Conclusion: The habitat is a significant variable for vitamin D status because altitude and latitude affect solar Zenith angle. Age, gender and seasonal variations must be taken in consideration when recommending supplementation.
Keywords: Vitamin D deficiency, 25 (OH)D, PTH, latitude, child

Keywords

vitamin D deficiency,, 25(OH)D,, PTH, latitude, child

Project Number

Yok

References

• Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 1995; 6: 638–45.
• Wahl DA, Cooper C, Ebeling PR, et al. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012; 7: 155–72.
• Grant WB, Strange RC, Garland CF. Sunshine is good medicine: the health benefits of ultraviolet-B induced vitamin D production. J Cosmet Dermatol 2003; 2: 86–98.
• Reeve LE, Chesney RW, DeLuca HF. Vitamin D of human milk identification of biologically active form. Am J Clin Nutr 1982; 36: 122-6.
• Wang TJ, Zhang F, Richards JB, et al. Common genetic determinants of vitamin D insufficiency: a genome-wide association study. Lancet 2010; 376: 180–8.
• Antonucci R, Locci C, Clemente MG, Chicconi E, Antonucci L. Vitamin D deficiency in childhood: old lessons and current challenges. J Pediatr Endocrinol Metab 2018; 31: 247–60.
• Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 2005; 294: 2336–41.
• Bikle D. Vitamin D: an ancient hormone. Exp Dermatol 2011; 20: 7-13.
• Atapattu N, Shaw N, Hogler W. Relationship between serum 25- hydroxyvitamin D and parathyroid hormone in the search for a biochemical definition of vitamin D deficiency in children. Pediatr Res 2013; 74: 552-6.
• Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J 2005; 98: 1024–7.
• Holick MF. The vitamin D deficiency pandemic and consequences for non-skeletal health: mechanisms of action. Mol Aspects Med 2008; 29: 361–8.
• Sankar J, Ismail J, Das R, Dev N, Chitkara A, Sankar J. Effect of severe vitamin D deficiency at admission on shock reversal in children with septic shock: A prospective observational study. J Intensive Care Med 2017; 20: 1-7
• Enko D, Fridrich L, Rezanka E, et al. 25-hydroxy-vitamin D status: limitations in comparison and clinical interpretation of serum-levels across different assay methods. Clin Lab 2014; 60: 1541–50.
• Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab 2016; 101: 394–415.
• Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M, Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008; 122: 398–417.
• Braeger C, Campoy C, Colomb V, et al. ESPGHAN Committee on Nutrition. Vitamin D in the healthy European paediatric population. JPGN 2013; 56: 692–701.
• Hill KM, McCabe GP, McCabe LD, Gordon CM, Abrams SA, Weaver CM. An inflection point of serum 25-hydroxyvitamin D for maximal suppression of parathyroid hormone is not evident from multi-site pooled data in children and adolescents. J Nutr 2010; 140: 1983-8.
• Akman AO, Tümer L, Hasanoğlu A, İlhan M, Çaycı B. Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int 2011; 53: 968–73.
• Şahin ÖN, Serdar M, Serteser M, Ünsal İ, Özpınar A. Vitamin D levels and parathyroid hormone variations of children living in a subtropical climate: a data mining study. Ital J Pediatr 2018; 44: 40.
• Erkuran N, Gücük S. Relationship between vitamin D levels and demographic factors and life style characteristics of 18-49 age women. Euras J Fam Med 2017; 6: 35-42.
• Seo JH, Chung HJ, Kim HJ, et al. Increasing vitamin D deficiency in children from 1995 to 2011.Turk J Pediatr 2016; 58: 616-22.
• Location. (Amasya Valiliği web site). Available at http://www.amasya.gov.tr/cografi-konum. Accessed in September 2018.
• Tarhan S, Sarı A. Model selection for global and diffuse radiation over the Central Black Sea (CBS) region of Turkey. Energy Conversion and Management 2005; 46: 605-13.
• Hatun S, Ozkan B, Bereket A. Vitamin D deficiency and prevention: Turkish experience. Acta Pediatr 2011; 100: 1195-9.
• Wimalawansa SJ. Non-musculoskeletal benefits of vitamin D. J Steroid Biochem Mol Biol 2018; 175:60-81.
• Kroll MH, Bi C, Garber CC, et al. Temporal relationship between vitamin D status and parathyroid hormone in the United States. PLoS ONE 2015; 10: e0118108.
• Kang JI, Lee YS, Han YJ, Kong KA, Kim HS. The serum level of 25-hydroxyvitamin D for maximal suppression of parathyroid hormone in children: the relationship between 25- hydroxyvitamin D and parathyroid hormone. Korean J Pediatr 2017; 60: 45-9.
• Crews BO, Moore J, Dietzen DJ. Circulating intact parathyroid hormone is suppressed at 25-hydroxyvitamin D concentrations >25 nmol/L in children. J Pediatr Endocrinol Metab 2014; 27: 657-60.
• Harkness L, Cromer B. Low levels of 25-hydroxy vitamin D are associated with elevated parathyroid hormone in healthy adolescent females. Osteoporos Int 2005; 16: 109-13.