Anemia 1.9X more likely in white children having lowish vitamin D – Jan 2014

Vitamin D, Race, and Risk for Anemia in Children

The Journal of Pediatrics. Volume 164, Issue 1 , Pages 153-158.e1, January 2014
Portions of this study were presented as a poster at the Pediatric Academic Societies' Meeting, Denver, CO, April 30 - May 3, 2011.
Meredith A. Atkinson, MD, MHS , Michal L. Melamed, MD, MHS, Juhi Kumar, MD, MPH, Cindy N. Roy, PhD, Edgar R. Miller III, PhD, MD, Susan L. Furth, MD, PhD , Jeffrey J. Fadrowski, MD, MHS
Received 13 June 2013; received in revised form 24 July 2013; accepted 26 August 2013. published online 10 October 2013.

Objective: To examine the association between 25-hydroxyvitamin D [25(OH)D] deficiency and anemia in a cohort of otherwise-healthy children and to determine whether race modifies the association between 25(OH)D status and hemoglobin (Hgb).

Study design: Cross-sectional study of 10 410 children and adolescents ages 1-21 years from the 2001-2006 National Health and Nutrition Examination Survey. Anemia was defined as Hgb less than the 5th percentile for age and sex based on National Health and Nutrition Examination Survey III (1988-1994) data.

Results: Lower 25(OH)D levels were associated with increased risk for anemia;

  • <30 ng/mL, adjusted OR 1.93, 95% CI 1.21-3.08, P = .006, and
  • <20 ng/mL, OR 1.47, 95% CI 1.14-1.89, P = .004.

In linear regression, small but significant increases in Hgb were noted in the upper quartiles of 25(OH)D compared with the lowest quartile (<20 ng/mL) in the full cohort.
Results of race-stratified linear regression by 25(OH)D quartile in white children were similar to those observed in the full cohort, but in black children, an increase in Hgb in the upper 25(OH)D quartiles was only apparent compared with the lowest black race−specific quartile (<12 ng/mL).

Conclusion: 25(OH)D deficiency is associated with increased risk of anemia in healthy US children, but the 25(OH)D threshold levels for lower Hgb are lower in black children in comparison with white children.

 Download the PDF from VitaminDWiki


  • Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics. 2009;124:e362–e370
  • Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281
  • Melamed ML, Astor B, Michos ED, Hostetter TH, Powe NR, Muntner P. 25-hydroxyvitamin D levels, race, and the progression of kidney disease. J Am Soc Nephrol. 2009;20:2631–2639
  • Reis JP, von Muhlen D, Miller ER, Michos ED, Appel LJ. Vitamin D status and cardiometabolic risk factors in the united states adolescent population. Pediatrics. 2009;124:e371–e379
  • Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab. 2009;94:26–34
  • Shroff R, Knott C, Rees L. The virtues of vitamin D—but how much is too much?. Pediatr Nephrol. 2010;25:1607–1620
  • Polhamus B, Dalenius K, Thompson D, Scanlon K, Borland E, Smith B, et al. Pediatric nutrition surveillance. Nutr Clin Care. 2003;6:132–134
  • Kendrick J, Targher G, Smits G, Chonchol M. 25-hydroxyvitamin D deficiency and inflammation and their association with hemoglobin levels in chronic kidney disease. Am J Nephrol. 2009;30:64–72
  • Kiss Z, Ambrus C, Almasi C, Berta K, Deak G, Horonyi P, et al. Serum 25(OH)-cholecalciferol concentration is associated with hemoglobin level and erythropoietin resistance in patients on maintenance hemodialysis. Nephron Clin Pract. 2011;117:c373–c378
  • Patel NM, Gutierrez OM, Andress DL, Coyne DW, Levin A, Wolf M. Vitamin D deficiency and anemia in early chronic kidney disease. Kidney Int. 2010;77:715–720
  • Meguro S, Tomita M, Katsuki T, Kato K, Oh H, Ainai A, et al. Plasma 25-hydroxyvitamin d is independently associated with hemoglobin concentration in male subjects with type 2 diabetes mellitus. Int J Endocrinol. 2011;2011:362981
  • Zittermann A, Jungvogel A, Prokop S, Kuhn J, Dreier J, Fuchs U, et al. Vitamin D deficiency is an independent predictor of anemia in end-stage heart failure. Clin Res Cardiol. 2011;100:781–788
  • Sim JJ, Lac PT, Liu IL, Meguerditchian SO, Kumar VA, Kujubu DA, et al. Vitamin D deficiency and anemia: a cross-sectional study. Ann Hematol. 2010;89:447–452
  • Perlstein TS, Pande R, Berliner N, Vanasse GJ. Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation. Blood. 2011;117:2800–2806
  • Centers for Disease Control and Prevention. Body mass index (BMI)-for-age charts for boys and girls aged 2 to 20 years. Updated 2001. Accessed October 19, 2012.
  • KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006;47:S1–S146
  • Patel KV, Longo DL, Ershler WB, Yu B, Semba RD, Ferrucci L, et al. Haemoglobin concentration and the risk of death in older adults: differences by race/ethnicity in the NHANES III follow-up. Br J Haematol. 2009;145:514–523
  • Robins EB, Blum S. Hematologic reference values for African American children and adolescents. Am J Hematol. 2007;82:611–614
  • Atkinson MA, Pierce CB, Zack RM, Barletta GM, Yadin O, Mentser M, et al. Hemoglobin differences by race in children with CKD. Am J Kidney Dis. 2010;55:1009–1017
  • Perry GS, Byers T, Yip R, Margen S. Iron nutrition does not account for the hemoglobin differences between blacks and whites. J Nutr. 1992;122:1417–1424
  • Reed WW, Diehl LF. Leukopenia, neutropenia, and reduced hemoglobin levels in healthy american blacks. Arch Intern Med. 1991;151:501–505
  • Pan WH, Habicht JP. The non-iron-deficiency-related difference in hemoglobin concentration distribution between blacks and whites and between men and women. Am J Epidemiol. 1991;134:1410–1416
  • Beutler E, West C. Hematologic differences between african-americans and whites: the roles of iron deficiency and alpha-thalassemia on hemoglobin levels and mean corpuscular volume. Blood. 2005;106:740–745
  • Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?. Blood. 2006;107:1747–1750
  • Centers for Disease Control and Prevention, National Center for Health Statistics. Revised analytical note for NHANES 200–2006 and NHANES III (1988-1994) 25-hydroxyvitamin D analysis (revised November 2010). Updated 2010. Accessed November/29, 2012.
  • Custer JW. Blood chemistries and body fluids. In: Custer JW, Rau RE editor. The Harriet Lane handbook. 18th ed.. Philadelphia (PA): Mosby Inc; 2009;p. 682
  • Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20:629–637
  • Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–612
  • Fadrowski JJ, Pierce CB, Cole SR, Moxey-Mims M, Warady BA, Furth SL. Hemoglobin decline in children with chronic kidney disease: baseline results from the chronic kidney disease in children prospective cohort study. Clin J Am Soc Nephrol. 2008;3:457–462
  • Baeke F, Gysemans C, Korf H, Mathieu C. Vitamin D insufficiency: implications for the immune system. Pediatr Nephrol. 2010;25:1597–1606
  • Adams JS, Hewison M. Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab. 2008;4:80–90
  • Lac PT, Choi K, Liu IA, Meguerditchian S, Rasgon SA, Sim JJ. The effects of changing vitamin D levels on anemia in chronic kidney disease patients: a retrospective cohort review. Clin Nephrol. 2010;74:25–32
  • Saab G, Young DO, Gincherman Y, Giles K, Norwood K, Coyne DW. Prevalence of vitamin D deficiency and the safety and effectiveness of monthly ergocalciferol in hemodialysis patients. Nephron Clin Pract. 2007;105:c132–c138
  • Kumar VA, Kujubu DA, Sim JJ, Rasgon SA, Yang PS. Vitamin D supplementation and recombinant human erythropoietin utilization in vitamin D-deficient hemodialysis patients. J Nephrol. 2011;24:98–105
  • Armas LA, Heaney RP. Vitamin D: the iceberg nutrient. J Ren Nutr. 2011;21:134–139
  • Alon DB, Chaimovitz C, Dvilansky A, Lugassy G, Douvdevani A, Shany S, et al. Novel role of 1,25(OH)(2)D(3) in induction of erythroid progenitor cell proliferation. Exp Hematol. 2002;30:403–409
  • Aucella F, Scalzulli RP, Gatta G, Vigilante M, Carella AM, Stallone C. Calcitriol increases burst-forming unit-erythroid proliferation in chronic renal failure. A synergistic effect with r-HuEpo. Nephron Clin Pract. 2003;95:c121–c127
  • Nemeth E. Targeting the hepcidin-ferroportin axis in the diagnosis and treatment of anemias. Adv Hematol. 2010;2010:750643
  • Roy CN, Andrews NC. Anemia of inflammation: the hepcidin link. Curr Opin Hematol. 2005;12:107–111
  • Carvalho C, Isakova T, Collerone G, Olbina G, Wolf M, Westerman M, et al. Hepcidin and disordered mineral metabolism in chronic kidney disease. Clin Nephrol. 2011;76:90–98
  • Gutierrez OM, Farwell WR, Kermah D, Taylor EN. Racial differences in the relationship between vitamin D, bone mineral density, and parathyroid hormone in the National Health and Nutrition Examination Survey. Osteoporos Int. 2011;22:1745–1753
  • Aloia JF, Chen DG, Chen H. The 25(OH)D/PTH threshold in black women. J Clin Endocrinol Metab. 2010;95:5069–5073
  • Michos ED, Reis JP, Post WS, Lutsey PL, Gottesman RF, Mosley TH, et al. 25-hydroxyvitamin D deficiency is associated with fatal stroke among whites but not blacks: the NHANES-III linked mortality files. Nutrition. 2012;28:367–371
  • Powe CE, Ricciardi C, Berg AH, Erdenesanaa D, Collerone G, Ankers E, et al. Vitamin D-binding protein modifies the vitamin D-bone mineral density relationship. J Bone Miner Res. 2011;26:1609–1616

See also VitaminDWiki

Items in both categories Iron and Infant-Child are listed here:

6899 visitors, last modified 21 Nov, 2018,
Printer Friendly Follow this page for updates