The Convergence of Two Epidemics: Vitamin D Deficiency in Obese School-aged Children

Created October 2017

Journal of Pediatric Nursing, Vol 38, Jan–Feb 2018, Pages 20–26, https://doi.org/10.1016/j.pedn.2017.10.005

Linda Cheng,

Highlights

• Obesity is a strong risk factor for vitamin D deficiency.

• Vitamin D deficiency in obese children is predictive of metabolic syndrome.

• The pediatric nurse should prevent, screen for, assess for, treat, and counsel on VDD.

Unfortunately, the publication is not very up-to-date * No recommendation for time in the sun * No mention that other forms of Vitamin D bioavailable Vitamin D * No mention that most countries still do not fortify milk or other foods * No mention that low-fat milk has 2.5X less bio-available Vitamin D * No mention of increased needs for high risk categories such as dark skin * No change of Vitamin D dose with age (age 1-18) * 600 IU up to age 18 for any normal weight * 1200-1800 IU for age 18 - if obese - independent of actual weight * Recommends Vitamin D2 and well as D3 * Considers sufficient vitamin D level to be just 20 ng/mL --- 1. # Items in both categories Obesity and Infant-Child are listed here: {category} 1. # Items in both categories Obesity and Youth are listed here: {category}

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Problem: Vitamin D deficiency (VDD) and obesity are two interrelated global epidemics that affect school-aged children. This article will review the relationship between VDD and obesity in school-aged children and implications it has for the pediatric nurse (PN).

Eligibility criteria: Original articles of studies, review articles and meta-analyses were selected from the past 5 years and pooled for review. These included obese school-aged children who had vitamin D insufficiency. The latest guidelines concerning the issue were also included.

Sample: Children 6–12 years of age with obesity and vitamin D insufficiency.

Results: This review strongly implies obesity in children being a strong risk factor for VDD. Prevention of VDD starts with lifestyle changes and adequate dietary intake of fortified foods and current screening recommendations for VDD are inconsistent. Vitamin D supplementation is recommended with inadequate intake or deficient serum 25-hydroxyvitamin D levels or signs of hypocalcemia. Supplementation doses differ based on whether VDD is being prevented or being treated and in obese children, the Endocrine Society recommends a dose that is two to three times higher than for normal weight children. Subclinical signs and symptoms of VDD include musculoskeletal pain, fractures, reduced bone density and reduced immunity.

Conclusions: Whereas obesity is a strong risk factor for VDD, more research is needed to clarify the role of VDD as a risk factor for obesity.

Implications: The PN plays an essential role in preventing, screening for, assessing for, treating and counseling on VDD in obese school-aged children.

Tags: Infant-Child Obesity Youth