Vitamin D deficiency in children and adolescents with obesity: a meta-analysis

Fiamenghi, Verônica Indicatti; Mello, Elza Daniel de

doi:10.1016/j.jped.2020.08.006

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Sumário

Review articles • J. Pediatr. (Rio J.) 97 (3) • May-Jun 2021 • https://doi.org/10.1016/j.jped.2020.08.006 copy

Vitamin D deficiency in children and adolescents with obesity: a meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the prevalence of vitamin D deficiency in obese children and adolescents when compared to eutrophic controls.

Methods

Systematic review with meta-analysis covering studies with patients aged 0–18 years old diagnosed with obesity and vitamin D deficiency and control group of eutrophic patients. The studies were retrieved in the PubMed, Embase, and LILACS databases in December 2019. The search used the terms “obesity” in combination with “pediatric population” and “vitamin D”.

Results

Through the search 3155 articles were retrieved; and after analysis, 20 studies were selected according to the study objectives. A total of 24,600 children and adolescents were included. Through meta-analysis, the relative risk for the association between obesity and vitamin D deficiency in the pediatric population was 1.41 (95% CI: 1.26–1.59) (I² = 89%, p < 0.01).

Conclusion

Children and adolescents with obesity have higher risk of vitamin D deficiency.

Keywords
Obesity; Vitamin D; Meta-analysis; Children; Adolescent

Study	Country	Study type	Age (years)	25(OH)D cutoff point (ng/mL)	Method for evaluation of 25(OH)D	Definition of obesity by BMI	Obese (n)	Vit D deficiency in obese (%)	Control (n)	Vit D deficiency in control (%)
Rajakumar et al.²⁰20 Rajakumar K, Fernstrom JD, Holick MF, Janosky JE, Greenspan SL. Vitamin D status and response to Vitamin D(3) in obese vs. non-obese African American children. Obesity (Silver Spring). 2008;16:90-95.	United States	Cross-sectional	6-10	<20	Immunoassay	>p95	21	57	20	40
Elizondo-Montemayor et al.²¹21 Elizondo-Montemayor L, Ugalde-Casas PA, Serrano-González M, Cuello-García CA, Borbolla-Escoboza JR. Serum 25-hydroxyvitamin d concentration, life factors and obesity in Mexican children. Obesity (Silver Spring). 2010;18:1805-1811.	Mexico	Cross-sectional	6-12	<20	Immunoassay	≥p95	99	27	99	13
Khor et al.²²22 Khor GL, Chee WS, Shariff ZM, Poh BK, Arumugam M, Rahman JA, et al. High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia. BMC Public Health. 2011;11:95.	Malaysia	Cross-sectional	7-12	<20	Immunoassay	≥p95	66	90	336	84
Rajakumar et al.²³23 Rajakumar K, de las Heras J, Chen TC, Lee S, Holick MF, Arslanian SA. Vitamin D status, adiposity, and lipids in Black American and Caucasian children. J Clin Endocrinol Metab. 2011;96:1560-1567.	United States	Cross-sectional	8-18	<20	Immunoassay	≥p95	112	65	125	47
Sacheck et al.²⁴24 Sacheck J, Goodman E, Chui K, Chomitz V, Must A, Economos C. Vitamin D deficiency, adiposity, and cardiometabolic risk in urban schoolchildren. J Pediatr. 2011;159:945-950.	United States	Cross-sectional	9-14	<20	Immunoassay	≥p95	65	80	198	71
Absoud et al.²⁵25 Absoud M, Cummins C, Lim MJ, Wassmer E, Shaw N. Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS One. 2011;6:.	England	Cross-sectional	4-18	<20	Immunoassay	≥p95	247	39	852	34
Olson et al.²⁶26 Olson ML, Maalouf NM, Oden JD, White PC, Hutchison MR. Vitamin D deficiency in obese children and its relationship to glucose homeostasis. J Clin Endocrinol Metab. 2012;97:279-285.	United States	Cross-sectional	6-16	<20	Immunoassay	≥p95	411	50	87	21
Turer et al.²⁷27 Turer CB, Lin H, Flores G. Prevalence of vitamin D deficiency among overweight and obese US children. Pediatrics. 2013;131:e152-61.	United States	Cross-sectional	6-18	<20	Immunoassay	≥p95	2478	37	9814	22
Bellone et al. ²⁸28 Bellone S, Esposito S, Giglione E, Genoni G, Fiorito C, Petri A, et al. Vitamin D levels in a paediatric population of normal weight and obese subjects. J Endocrinol Invest. 2014;37:805-809.	Italy	Cross-sectional	Pediatric patients	<20	Immunoassay	>p95	444	44	113	31
Dyląg et al.¹⁸18 Dyląg H, Rowicka G, Strucińska M, Riahi A. Assessment of vitamin D status in children aged 1–5 with simple obesity. Rocz Panstw Zakl Hig. 2014;65:325-330.	Poland	Cross-sectional	1-5	<20	Immunoassay	≥p97	50	42	50	22
Zhang et al.¹²12 Zhang HQ, Teng JH, Li Y, Li XX, He YH, He X, et al. Vitamin D status and its association with adiposity and oxidative stress in schoolchildren. Nutrition. 2014;30:1040-1044.	China	Cross-sectional	7-11	<20	Chromatography	≥p95	164	69	1324	55
Huang et al.¹⁴14 Huang K, Jiang YJ, Fu JF, Liang JF, Zhu H, Zhu ZW, et al. The relationship between serum 25-hydroxyvitamin D and glucose homeostasis in obese children and adolescents in Zhejiang, China. Endocr Pract. 2015;21:1117-1124.	China	Cross-sectional	6-16	<12	Immunoassay	≥p95	348	18	445	6
Jari et al.¹⁵15 Jari M, Qorbani M, Moafi M, Motlagh ME, Keikha M, Ardalan G, et al. Association of 25-hydroxy vitamin D levels with indexes of general and abdominal obesity in Iranian adolescents: the CASPIAN-III study. J Res Med Sci. 2015;20:122-126.	Iran	Cross-sectional	10-18	<10	Immunoassay	≥p95	104	41	986	40
Al-Sadat et al.¹⁶16 Al-Sadat N, Majid HA, Sim PY, Su TT, Dahlui M, Abu Bakar MF, et al. Vitamin D deficiency in Malaysian adolescents aged 13 years: findings from the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). BMJ Open. 2016;6:.	Malaysia	Cross-sectional	12-13	<15	Immunoassay	≥p95	116	88	1234	78
Wang et al.¹⁷17 Wang L, Wang H, Wen H, Tao H, Zhao X. Relationship between HOMA-IR and serum vitamin D in Chinese children and adolescents. J Pediatr Endocrinol Metab. 2016;29:777-781.	China	Cross-sectional	8-18	<12	-	≥p95	103	4	175	3
Wakayo et al.¹³13 Wakayo T, Whiting SJ, Belachew T. Vitamin D deficiency is associated with overweight and/or obesity among schoolchildren in Central Ethiopia: a cross-sectional study. Nutrients. 2016;8:190.	Ethiopia	Cross-sectional	11-18	<20	Chromatography	Unavailable	18	77	156	39
Moore et al.²⁹29 Moore CE, Liu Y. Low serum 25-hydroxyvitamin D concentrations are associated with total adiposity of children in the United States: National Health and Examination Survey 2005 to 2006. Nutr Res. 2016;36:72-79.	United States	Cross-sectional	6-18	<20	-	≥p95	582	56	1900	40
Barja-Fernandez et al.³⁰30 Barja-Fernández S, Aguilera CM, Martínez-Silva I, Vazquez R, Gil-Campos M, Olza J, et al. 25-Hydroxyvitamin D levels of children are inversely related to adiposity assessed by body mass index. J Physiol Biochem. 2018;74:111-118.	Spain	Cross-sectional	2-18	<20	Immunoassay	≥p95	176	79	295	108
Durá-Travé et al.¹⁹19 Durá-Travé T, Gallinas-Victoriano F, Chueca-Guindulain MJ, Berrade-Zubiri S, Moreno-Gónzalez P, Malumbres-Chacón M. Prevalence of hypovitaminosis D and associated factors in Spanish population of school children and adolescents. Aten Primaria. 2018;50:422-429.	Spain	Cross-sectional	3.1-15.4	<20	Immunoassay	>p97	119	32	459	57
Shulhai et al.³¹31 Shulhai AM, Pavlyshyn H, Shulhai O. Peculiarities of the prevalence and risk factors for vitamin D deficiency in overweight and obese adolescents in Ukraine. Arch Balk Med Union. 2019;54:57-63.	Ukraine	Cross-sectional	12-17	<20	Immunoassay	>p95	78	60	131	84

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[1] * Corresponding author. vfiamenghi@hcpa.edu.br