Vitamin D status and its determinants during autumn in children at northern latitudes: a cross-sectional analysis from the optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study

Abstract

Sufficient summer/autumn vitamin D status appears important to mitigate winter nadirs at northern latitudes. We conducted a cross-sectional study to evaluate autumn vitamin D status and its determinants in 782 Danish 8-11-year-old children (55°N) using baseline data from the Optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study, a large randomised controlled trial. Blood samples and demographic and behavioural data, including 7-d dietary recordings, objectively measured physical activity, and time spent outdoors during school hours, were collected during September-November. Mean serum 25-hydroxyvitamin D (25(OH)D) was 60·8 (SD 18·7) nmol/l. Serum 25(OH)D levels ≤50 nmol/l were found in 28·4 % of the children and 2·4 % had concentrations <25 nmol/l. Upon multivariate adjustment, increasing age (per year) (β −2·9; 95 % CI −5·1, −0·7 nmol/l), female sex (β −3·3; 95 % CI −5·9, −0·7 nmol/l), sampling in October (β −5·2; 95 % CI −10·1, −0·4 nmol/l) and November (β −13·3; 95 % CI −17·7, −9·1), and non-white ethnicity (β −5·7; 95 % CI −11·1, −0·3 nmol/l) were negatively associated with 25(OH)D (all P < 0·05). Likewise, immigrant/descendant background was negatively associated with 25(OH)D, particularly in females (β −16·3; 95 % CI −21·9, −10·7) (P < 0·001) (P interaction = 0·003). Moderate-to-vigorous physical activity (MVPA) (min/d) (β 0·06; 95 % CI 0·01, 0·12), outdoor walking during school hours (min/week) (β 0·4; 95 % CI 0·1, 0·6) and intake of vitamin D-containing supplements ≥3 d/week (β 8·7; 95 % CI 6·4, 11·0) were positively associated with 25(OH)D (all P < 0·05). The high proportion of children with vitamin D status below the recommended sufficiency level of 50 nmol/l raises concern as levels expectedly drop further during winter months. Frequent intake of vitamin D supplements was strongly associated with status. MVPA and outdoor activity during school hours should be investigated further in interventions to improve autumn vitamin D status in children at northern latitudes. Key words: Vitamin D: Children: Northern latitudes: DeterminantsDeterminants of vitamin D status are complex to evaluate but require attention as vitamin D deficiency has been found to occur commonly among, for example, healthy European children and adolescents (1) , and as vitamin D facilitates intestinal Ca absorption and optimal bone health (2,3) . Vitamin D plays a particularly crucial role during childhood growth stages, when accumulation of skeletal Ca increases vastly (4) . The vitamin D metabolite 25-hydroxyvitamin D (25(OH)D) has a half-life of 2-3 weeks, and currently serves as a suitable marker of vitamin D status (5) . Although different cut-off levels are advocated (6) , the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has recently re-established the recommendation of a 25(OH)D concentration >50 nmol/l (20 ng/ml) to indicate sufficiency (1) . Severe vitamin D deficiency during childhood, established by ESPGHAN as ...

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