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      Prevalence of Vitamin D Deficiency and Calcium Homeostasis in Saudi Children

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          Abstract

          Objective:

          Vitamin D deficiency (VDD) and vitamin D insufficiency (VDI) are significant health problems all over the world. The aim of this study was to determine the prevalence of VDD and VDI in children and adolescents residing in 8 provinces in the Kingdom of Saudi Arabia and to also investigate calcium homeostasis in these subjects.

          Methods:

          A cross-sectional study was conducted in 2110 participants aged between 6 and 15 years. Information on socio-demographic status, anthropometric measurements, knowledge about vitamin D, color of the skin, dietary intake, sun exposure experience, smoking, and physical activity were collected through a questionnaire given to the parents of all subjects. The subjects were divided into three groups as vitamin D deficient, vitamin D insufficient, and vitamin sufficient according to their blood level of vitamin D [VDD ≤25 nmol/L (25 hydroxy vitamin D), VDI >25-50 nmol/L, and VDS >50 nmol/L].

          Results:

          VDD was highly prevalent in this group of children. 95.3 of the subjects had either VDD (45.5%) or VDI (49.9%). The prevalence rate of VDD combined with VDI was higher in females (97.8%) compared to males (92.8%) (p<0.001). Only 1.6% had significant hypocalcaemia. Children with dark skin had lower concentrations of vitamin D and higher concentrations of parathormone. A positive correlation was observed between 25 hydroxy vitamin D level and serum calcium, inorganic phosphate, and alkaline phosphatase concentrations.

          Conclusion:

          The results showed a high prevalence of VDD and VDI in Saudi children with significantly higher prevalence in girls. These findings necessitate the set-up of a national program for vitamin D supplementation and health education for this vulnerable group.

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          Most cited references30

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          Resurrection of vitamin D deficiency and rickets.

          The epidemic scourge of rickets in the 19th century was caused by vitamin D deficiency due to inadequate sun exposure and resulted in growth retardation, muscle weakness, skeletal deformities, hypocalcemia, tetany, and seizures. The encouragement of sensible sun exposure and the fortification of milk with vitamin D resulted in almost complete eradication of the disease. Vitamin D (where D represents D2 or D3) is biologically inert and metabolized in the liver to 25-hydroxyvitamin D [25(OH)D], the major circulating form of vitamin D that is used to determine vitamin D status. 25(OH)D is activated in the kidneys to 1,25-dihydroxyvitamin D [1,25(OH)2D], which regulates calcium, phosphorus, and bone metabolism. Vitamin D deficiency has again become an epidemic in children, and rickets has become a global health issue. In addition to vitamin D deficiency, calcium deficiency and acquired and inherited disorders of vitamin D, calcium, and phosphorus metabolism cause rickets. This review summarizes the role of vitamin D in the prevention of rickets and its importance in the overall health and welfare of infants and children.
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            Vitamin D deficiency in children and its management: review of current knowledge and recommendations.

            Given the recent spate of reports of vitamin D deficiency, there is a need to reexamine our understanding of natural and other sources of vitamin D, as well as mechanisms whereby vitamin D synthesis and intake can be optimized. This state-of-the-art report from the Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society was aimed to perform this task and also reviews recommendations for sun exposure and vitamin D intake and possible caveats associated with these recommendations.
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              IOM committee members respond to Endocrine Society vitamin D guideline.

              In early 2011, a committee convened by the Institute of Medicine issued a report on the Dietary Reference Intakes for calcium and vitamin D. The Endocrine Society Task Force in July 2011 published a guideline for the evaluation, treatment, and prevention of vitamin D deficiency. Although these reports are intended for different purposes, the disagreements concerning the nature of the available data and the resulting conclusions have caused confusion for clinicians, researchers, and the public. In this commentary, members of the Institute of Medicine committee respond to aspects of The Endocrine Society guideline that are not well supported and in need of reconsideration. These concerns focus on target serum 25-hydroxyvitamin D levels, the definition of vitamin D deficiency, and the question of who constitutes a population at risk vs. the general population.
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                Author and article information

                Journal
                J Clin Res Pediatr Endocrinol
                J Clin Res Pediatr Endocrinol
                JCRPE
                Journal of Clinical Research in Pediatric Endocrinology
                Galenos Publishing
                1308-5727
                1308-5735
                December 2016
                1 December 2016
                : 8
                : 4
                : 461-467
                Affiliations
                [1 ] King Abdulaziz Medical City in Jeddah, King Saud bin Abdulaziz University for Health Sciences, Department of Pediatrics, Chemistry Laboratory, Community Medicine, Jeddah, Saudi Arabia
                [2 ] King Abdulaziz University Hospital, Clinic of Family and Community Medicine, Jeddah, Saudi Arabia
                [3 ] University of Alexandria Faculty of Medicine, Department of Pediatrics, Alexandria, Egypt
                [4 ] King Abdulaziz Medical City-Central, King Saud bin Abdulaziz University for Health Sciences, Department of Medicine, Chmistry Laboratory, Riyadh, Saudi Arabia
                [5 ] King Abdulaziz University Hospital, King Abdullah International Medical Research Center, Al Hasa, Saudi Arabia
                [6 ] Imam Abdulrahman AlFaisal Hospital, Clinic of Family Medicine, Dammam, Saudi Arabia
                Author notes
                * Address for Correspondence: King Abdulaziz Medical City in Jeddah, King Saud bin Abdulaziz University for Health Sciences, Department of Pediatrics, Chemistry Laboratory, Community Medicine, Jeddah, Saudi Arabia E-mail: shaikham@ 123456ngha.med.sa
                Article
                1871
                10.4274/jcrpe.3301
                5198006
                27476528
                cdfed845-92d4-46a7-8f03-da767248942d
                © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 April 2016
                : 30 July 2016
                Categories
                Original Article

                Pediatrics
                vitamin d,vitamin d deficiency,vitamin d insufficiency,parathyroid hormone levels,calcium,inorganic phosphate

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