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ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 4  |  Page : 324-328  

Comparison of Vitamin D status in obese and nonobese children: A hospital-based prospective cohort study


1 Division of Neonatology, Department of Pediatrics, KEM Hospital, Pune, Maharashtra, India
2 Department of Pediatrics, GMC, Jammu, Jammu and Kashmir, India
3 Department of Pediatrics, SKNMC, Pune, Maharashtra, India

Date of Submission17-Jul-2018
Date of Acceptance16-Jan-2019
Date of Web Publication8-Jul-2019

Correspondence Address:
Anumodan Gupta
Division of Neonatology, Department of Pediatrics, KEM Hospital, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_115_18

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  Abstract 


Objectives: The objective of this study is to compare the Vitamin D3 level in obese children in a tertiary care center in Jammu (Jammu and Kashmir), India, and to find the association between Vitamin D3 levels and the comorbidities of obesity. Materials and Methods: Twenty obese children and 20 controls were included in the study group. Obesity defined by international obesity task force (criteria) Questionnaires Form and anthropomorphic data were collected on patients, and fasting blood glucose, lipids, liver function tests, renal function test and 25-hydroxyvitamin D (25-OHD) were measured. Results: The levels of 25-OHD in the obese group were significantly lower than those of the control group (χ = 0.000). About 80% of obese children and 10% of controls were Vitamin D deficient; similarly, 20% of obese children and 35% of controls had Vitamin D insufficiency. There was no statistical significant difference of mean serum Vitamin D level between male and female children in both cases and controls. Calorie intake (P = 0.11), serum cholesterol, and triglycerides were significantly raised among the obese group with the mean (152.70 ± 18.85) than in the control group (134.65 ± 15.27) (P = 0.002). There was no significant association of 25 (OH) Vitamin D3 level with the other comorbidities of obesity such as deranged blood sugar, liver function tests, and lipid profile. Conclusion: Vitamin D deficiency is significantly more prevalent in obese children and showed a linear relationship, but we were unable to find any significant statistical association between 25 (OH) Vitamin D3 levels with the comorbidities of obesity.

Keywords: 25(OH), alanine transaminase, obese, serum cholesterol, triglycerides, Vitamin D3


How to cite this article:
Gupta A, Harish R, Saini A. Comparison of Vitamin D status in obese and nonobese children: A hospital-based prospective cohort study. Med J DY Patil Vidyapeeth 2019;12:324-8

How to cite this URL:
Gupta A, Harish R, Saini A. Comparison of Vitamin D status in obese and nonobese children: A hospital-based prospective cohort study. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Oct 21];12:324-8. Available from: http://www.mjdrdypv.org/text.asp?2019/12/4/324/262224




  Introduction Top


Obesity in children is a complex disorder. Many factors, including genetics, environment, metabolism, lifestyle, and eating habits, are believed to play a role in the development of obesity. Among the obese children, so many comorbidities are associated, and one of them is Vitamin D deficiency (VDD). It is a major health problem in both the developed and developing countries across the globe. In India, despite ample sunlight (required for the synthesis of Vitamin D endogenously), VDD prevalence has been documented to be in the range of 50%–90% among all the age groups.[1] Scientific evidence reveals that, in addition to skeletal disorders, Vitamin D is also associated with the risk of cardiovascular diseases, obesity, hypertension, and diabetes mellitus.[2],[3],[4] The factors responsible for VDD can be skin complexion, poor sunlight exposure, vegetarian food habits, and lower intake of Vitamin D fortified foods.[3],[4],[5],[6],[7],[8],[9] In India, there is a paucity of study regarding the correlation of VDD and obesity as both are endemic in our country but should be recognized as major health issue. Hence, this study was planned as no such study was conducted to study the Vitamin D status of obese children in the Jammu region of India.


  Materials and Methods Top


This study was designed to compare 25 (OH) Vitamin D3 level in obese children with nonobese controls in a tertiary care center in the age group of 2- to 18-year-old children from November 1, 2013, to October 31, 2014. The sample size of 40 was calculated by taking prevalence of vitamin D deficiency in obese children as 84%[1] with margin of error 5% and 95% confidence interval. Children between 2 to 18 years, attending paediatric outpatient department were subjected to screening for obesity using reference body mass index (BMI) charts designed by international obesity task force. Equal number of age and sex matched non-obese children were selected as controls. Children on anticonvulsants, antidepressants, or on Vitamin D or calcium supplementation were excluded. So were children with chronic diseases, genetic disorders, malabsorption disorders, and obesity syndromes such as Laurence-Moon-Biedl Syndrome.

Informed consent was taken for interview, data collection, and laboratory investigation. Predesigned and pretested pro forma was used to collect the data where patient's dietary history (By Dietary Recall Method), time spent for outdoor activities, type of clothing, etc., collected, and patients were subjected to appropriate laboratory tests.

A thorough physical examination was done. Height and weight of each patient were taken. Height was measured (to nearest mm) using stadiometer. Participants were weighed in kilograms using a weigh scale with light clothing. BMI (wt (kg)/ht (m 2) was calculated and his/her BMI percentiles were obtained from the WHO age- and gender-specific BMI charts. Sexual maturity rating was taken according to Tanner staging in pubertal age group children. Blood pressure (BP) was measured and was defined as per the recommendation by the fourth report on Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (Revised) 2005. BP tables with systolic and diastolic values for the 50th, 90th, 95th, and 99th percentiles by age and sex and height percentile were used. Laboratory parameters were studied by withdrawing 5 ml of blood by venepuncture using sterile technique.

The metabolic parameters tested were as follows: fasting blood glucose (glucose oxidase method), renal, liver function tests, calcium/phosphate, and lipid profile by spectrophotometry and Vitamin D by electrochemiluminescence. Vitamin D status in relation to 25 (OH) D Levels: Deficiency (<20 ng/ml), Insufficiency (21–29 ng/ml), sufficiency (>30 ng/ml) and toxicity (>50 ng/ml). The cutoff value in the present study was based on the recommendations by the US Endocrine Society.

Statistical methods applied

Data were analyzed using SPSS 21, IBM, Armonk, NY, United States of America. Vitamin D level presented as mean and standard deviation, and the difference in mean among the groups was assessed by use of t-test to analyze intergroup difference. P < 0.05 was considered as statistically significant.


  Results Top


There was no statistically significant difference in the mean age and sex. BMI was significantly higher among the obese children than the control, the mean value being 27.36 ± 4.22 kg/m2 in obese children and 13.45 kg/m 2 in controls. All the confounders such as outdoor exposure time, physical activity, and screen time were comparable between the two groups. The durations of physical activity among the obese and non-obese children were 1.65 ± 0.58 h/week and 1.95 ± 0.66 h/week, respectively. There was no statistically significant difference found in physical activity between the two groups (P = 0.139) [Table 1]. Obese children had significantly higher calorie consumption. There was no significant difference between the daily calcium and phosphate intake between obese and control groups. Serum cholesterol and triglycerides were significantly raised among the obese group with the mean (152.70 ± 18.85) than in the control group (134.65 ± 15.27), P < 0.002 (highly significant). While the high density lipoprotein (HDL) and low density lipoprotein (LDL) were within normal limits in both the groups, with no significant difference among them, the obese children had higher levels of both HDL and LDL (49.70 ± 11.56 and 86.45 ± 9.56 respectively in obese, compared to corresponding values of 45.55 ± 8.99 and 80.70 ± 11.37 in non-obese). There were 80% obese children and 10% controls who were Vitamin D deficient (P < 0.000). Twenty percent and 35% had Vitamin D insufficiency. None of the obese children had sufficient Vitamin D levels, and out of 20 controls, 55% had sufficient Vitamin D levels [Table 2]. There was no statistical difference between Vitamin D-insufficient group and Vitamin D-deficient population under study for BMI and BP. The mean cholesterol was higher in Vitamin D-deficient groups. Mean dietary calcium and phosphorous intake was lower among the Vitamin D-deficient population though not significant. Physical activity, outdoor exposure, and screen time were comparable between two groups. The HDL and LDL were comparable in both obese and nonobese groups. The alkaline phosphate levels are lower in Vitamin D insufficiency group with the mean level of 203.00 ± 77.92 iu/l as compared to 258.31 ± 58.6 iu/l in Vitamin D-deficient group. Serum sodium and potassium levels are comparable to each of the other groups [Table 3].
Table 1: Baseline characteristics of study population

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Table 2: Vitamin D status of the study population

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Table 3: Comparison of biochemical profile of obese children with Vitamin D insufficiency and deficiency

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  Discussion Top


The global escalation of childhood obesity is a major public health issue. Despite a known genetic contribution, the increase in pediatric obesity has been attributed mainly to diet and a sedentary lifestyle. In this prospective observational study to compare the Vitamin D levels in obese children and find any association between 25 (OH) Vitamin D3 levels with the comorbidities of obesity in a tertiary care center at Jammu, we found a high prevalence of VDD in obese children who were screened and subjected to analyses for Vitamin D level. The mean age in our study was 10.6 years which did not show any statistically significant difference between the two groups as it is anticipated due to age-matched controls. In an Indian study by Khadgawat et al., the mean age of obese population was 13 ± 3 years.[9] Thus, the mean age of our study population was comparable with other studies done previously.[10],[11] BMI as expected was significantly higher among the obese children than the control, the mean value being 27.36 ± 4.22 kg/m2 in obese children and 13.45 kg/m 2 in controls. In a preceding study, the mean BMI was 25.5 ± 4.8 kg/m2 in controls.[10] Other scholars also showed a mean BMI of 24.39 ± 3.24 kg/m2 in obese children and 16.30 ± 1.01 kg/m2 among controls, which is quite similar to our study.[11] There was no statistically significant difference in the systolic BP (SBP) (P = 0.197) and the diastolic BP (DBP) (P = 0.653). Similar observations have been reported by other studies Alfawaz and Abdel Megeid in their study found the mean SBP and DBP with a P = 0.003 and 0.09.[12] In the present study, mean blood sugar was comparable to other studies in obese population, and no statistically significant difference was found in the mean blood sugar between obese and nonobese groups with a mean of 92.05 ± 7.05 in obese group and 89.45 ± 10.55 in nonobese group. Triglycerides were significantly raised among the obese group with a mean of 152.70 ± 18.85 than in the control group with a mean of 134.65 ± 15.27, P = 0.002 (highly significant). Both HDL and LDL levels tended to be high in obese individuals compared to non-obese, however, these differences were statistically not significant. Similarly, another study found that a total of 36.11% had dyslipidemia.[13] In the present study, serum Vitamin D level between 20 and 30 ng/mlwasobservedin 20% of obese children and 80% had levels <20 ng/ml. Similarly, another author in American children found the 25(OH)D levels with median of 27 ng/ml in 197 of the 302 subjects (65.2%).[14] Another study by Indian scholar who studied 316 children of Andhra Pradesh found that 69.3% have Vitamin D <20 ng/ml.[15] Similarly, Abu Shady et al. also reported a statistically significant inverse association of serum Vitamin D with BMI.[16] In the present study, we could not find any significant association in Vitamin D levels with fasting blood sugar levels with a mean level of 92.00 ± 7.34 mg/dl in Vitamin D-deficient obese children and mean of 92.25 ± 6.70 mg/dl in Vitamin D-insufficient obese children. Similar findings were observed by another author who suggested that the insulin resistance appears to be decreased in type 2 diabetes mellitus patients who had received Vitamin D.[17] In the present study, we could not find any significant association in Vitamin D levels and lipids as the mean serum cholesterol was 152.93 ± 20.26 (mg/dl), and in Vitamin D-insufficient obese children, it was 151.75 ± 14.00 (mg/dl). Triglyceride, LDL cholesterol and HDL also had no significant relationship with Vitamin D levels. While Abu Shady et al. studying 215 Egyptian school children showed a statistically significant inverse association of serum Vitamin D with BMI, triglyceride, serum cholesterol, and LDLcholesterol and direct association with HDL cholesterol.[18] The variation in the observations of the present study with other studies could be due to the small study group in the present study.

There was no statistically significant difference in SBP and DBP when compared with Vitamin D-deficient/insufficient participants; no significant significance was found, while Burgaz et al. reported an inverse correlation of 25-hydroxy Vitamin D levels with SBP and DBP.[5] The absence of any significance between Vitamin D levels and BP in the present study can again be due to small study group. Similarly, we found no statistical significance while analyzing blood glucose, alkaline phosphatase levels, and serum electrolytes also. Hence to imply, while analyzing and comparing with other literatures, our study supports that early screening for VDD and its correction should be taken in early childhood to decrease the odds of getting innumerable complications associated with VDD in this part of region of India, but the results of our study should be read against the limitations of our study such as sample size was small, most of our samples were from urban population, and etiology of obesity in cases was not being matched. We did not consider factors such as history of use/no use of supplements in infancy and to further add on it was a hospital-based study, and serum parathyroid hormone level was not measured as facility for the same was not available in our institute.


  Conclusion Top


Serum Vitamin D levels were lower in obese children and were found to be statistically significant. No statistical significance was established between VDD/insufficiency and comorbidities associated with obesity

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Harinarayan CV, Joshi SR. Vitamin D status in India – Its implications and remedial measures. J Assoc Physicians India 2009;57:40-8.  Back to cited text no. 1
    
2.
Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S, et al. Evidence for alteration of the Vitamin D-endocrine system in obese subjects. J Clin Invest 1985;76:370-3.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
    
4.
Ahonen MH, Tenkanen L, Teppo L, Hakama M, Tuohimaa P. Prostate cancer risk and prediagnostic serum 25-hydroxyvitamin D levels (Finland). Cancer Causes Control 2000;11:847-52.  Back to cited text no. 4
    
5.
Burgaz A, Orsini N, Larsson SC, Wolk A. Blood 25-hydroxyvitamin D concentration and hypertension: A meta-analysis. J Hypertens 2011;29:636-45.  Back to cited text no. 5
    
6.
Daniels SR. The consequences of childhood overweight and obesity. Future Child 2006;16:47-67.  Back to cited text no. 6
    
7.
Ganji V, Zhang X, Tangpricha V. Serum 25-hydroxyvitamin D concentrations and prevalence estimates of hypovitaminosis D in the U.S. Population based on assay-adjusted data. J Nutr 2012;142:498-507.  Back to cited text no. 7
    
8.
Rajakumar K, Holick MF, Jeong K, Moore CG, Chen TC, Olabopo F, et al. Impact of season and diet on Vitamin D status of African American and Caucasian children. Clin Pediatr (Phila) 2011;50:493-502.  Back to cited text no. 8
    
9.
Khadgawat R, Marwaha RK, Garg MK, Ramot R, Oberoi AK, Sreenivas V, et al. Impact of Vitamin D fortified milk supplementation on Vitamin D status of healthy school children aged 10-14 years. Osteoporos Int 2013;24:2335-43.  Back to cited text no. 9
    
10.
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;16:90-5.  Back to cited text no. 10
    
11.
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;18:1805-11.  Back to cited text no. 11
    
12.
Alfawaz HA, Abdel Megeid FY. Vitamin D deficiency in obese children and its relationship to the components of the metabolic syndrome. World Appl Sci J 2013;21:320-8.  Back to cited text no. 12
    
13.
Erol M, Bostan Gayret Ö, Hamilçıkan Ş, Can E, Yiǧit ÖL. Vitamin D deficiency and insulin resistance as risk factors for dyslipidemia in obese children. Arch Argent Pediatr 2017;115:133-9.  Back to cited text no. 13
    
14.
Johnson MD, Nader NS, Weaver AL, Singh R, Kumar S. Relationships between 25-hydroxyvitamin D levels and plasma glucose and lipid levels in pediatric outpatients. J Pediatr 2010;156:444-9.  Back to cited text no. 14
    
15.
Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D. Vitamin D status in Andhra Pradesh: A population based study. Indian J Med Res 2008;127:211-8.  Back to cited text no. 15
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16.
Abu Shady MM, Youssef MM, Salah El-Din EM, Abdel Samie OM, Megahed HS, Salem SM, et al. Predictors of serum 25-hydroxyvitamin D concentrations among a sample of Egyptian schoolchildren. ScientificWorldJournal 2016;2016:8175768.  Back to cited text no. 16
    
17.
Talaei A, Mohamadi M, Adgi Z. The effect of Vitamin D on insulin resistance in patients with type 2 diabetes. Diabetol Metab Syndr 2013;5:8.  Back to cited text no. 17
    
18.
Abu Shady MM, Youssef MM, Saleh El-Din EM, Abdel Samie OM, Megahed HS, Salem SM, et al. Predictors of serum 25-Hydroxyvitamin D concentrations among a sample of Egyptian schoolchildren. Sci World J 2016;2016:8175768.  Back to cited text no. 18
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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