Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet—a multivariable reanalysis
Nutritional rickets is believed to result from the interaction of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentration and dietary calcium intake, but this interaction has not been confirmed in children with rickets. Determining the vitamin D requirements to prevent nutritional rickets has b...
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| Veröffentlicht in: | The American journal of clinical nutrition 2021-07, Vol.114 (1), p.231-237 |
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| creator | Sempos, Christopher T Durazo-Arvizu, Ramón A Fischer, Philip R Munns, Craig F Pettifor, John M Thacher, Tom D |
| description | Nutritional rickets is believed to result from the interaction of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentration and dietary calcium intake, but this interaction has not been confirmed in children with rickets. Determining the vitamin D requirements to prevent nutritional rickets has been thwarted by inconsistent case definition, inadequate adjustment for calcium intake and other confounders, and 25(OH)D assay variability.
To model the 25(OH)D concentration associated with nutritional rickets in calcium-deprived Nigerian children, adjusted for confounding factors, and develop a general approach to define vitamin D status while accounting for calcium intake.
Logistic regression was used to model the association of serum 25(OH)D with having rickets adjusted for calcium intake in a reanalysis of a case-control study in Nigerian children. The matching variables age, sex, weight-for-age z score, and 4 additional significant variables were selected [religion, age began walking, phosphorus intake, and the 25(OH)D × calcium intake interaction] using a rigorous 7-step algorithm.
Cases had significantly (P < 0.0001) lower mean ± SD 25(OH)D than controls (33 ± 13 compared with 51 ± 16 nmol/L, respectively), whereas cases and controls had similarly (P = 0.81) low mean dietary calcium intakes (216 ± 88 and 213 ± 95 mg/d, respectively). There was a significant interaction between 25(OH)D and calcium intake [coefficient (95% CI): –0.0006 (–0.0009, –0.0002)]. Accordingly, as calcium intake increased from 130 to 300 mg/d, the adjusted odds of having rickets decreased dramatically with increasing 25(OH)D such that at 200 mg/d, the adjusted odds of having rickets at 47.5 nmol/L was 0.80, whereas it was 0.2 at 62.5 nmol/L. Moreover, at a calcium intake of 300 mg/d, the adjusted odds was 0.16 at a 25(OH)D concentration of 47.5 nmol/L and 0.02 at 62.5 nmol/L.
The vitamin D requirement to prevent nutritional rickets varies inversely with calcium intake and vice versa. Also, application of multivariable modeling is essential in defining vitamin D requirements. |
| doi_str_mv | 10.1093/ajcn/nqab048 |
| format | Article |
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To model the 25(OH)D concentration associated with nutritional rickets in calcium-deprived Nigerian children, adjusted for confounding factors, and develop a general approach to define vitamin D status while accounting for calcium intake.
Logistic regression was used to model the association of serum 25(OH)D with having rickets adjusted for calcium intake in a reanalysis of a case-control study in Nigerian children. The matching variables age, sex, weight-for-age z score, and 4 additional significant variables were selected [religion, age began walking, phosphorus intake, and the 25(OH)D × calcium intake interaction] using a rigorous 7-step algorithm.
Cases had significantly (P < 0.0001) lower mean ± SD 25(OH)D than controls (33 ± 13 compared with 51 ± 16 nmol/L, respectively), whereas cases and controls had similarly (P = 0.81) low mean dietary calcium intakes (216 ± 88 and 213 ± 95 mg/d, respectively). There was a significant interaction between 25(OH)D and calcium intake [coefficient (95% CI): –0.0006 (–0.0009, –0.0002)]. Accordingly, as calcium intake increased from 130 to 300 mg/d, the adjusted odds of having rickets decreased dramatically with increasing 25(OH)D such that at 200 mg/d, the adjusted odds of having rickets at 47.5 nmol/L was 0.80, whereas it was 0.2 at 62.5 nmol/L. Moreover, at a calcium intake of 300 mg/d, the adjusted odds was 0.16 at a 25(OH)D concentration of 47.5 nmol/L and 0.02 at 62.5 nmol/L.
The vitamin D requirement to prevent nutritional rickets varies inversely with calcium intake and vice versa. Also, application of multivariable modeling is essential in defining vitamin D requirements.</description><identifier>ISSN: 0002-9165</identifier><identifier>EISSN: 1938-3207</identifier><identifier>DOI: 10.1093/ajcn/nqab048</identifier><identifier>PMID: 33742199</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>25-Hydroxyvitamin D ; Adolescent ; Age ; Algorithms ; Calciferol ; Calcium ; Calcium (dietary) ; Calcium, Dietary - administration & dosage ; case-control ; Child ; Child Nutritional Physiological Phenomena ; Child, Preschool ; Children ; Diet ; Dietary intake ; Female ; Humans ; Infant ; Kidney stones ; logistic regression ; Male ; metabolic bone disorders ; multivariable modeling ; Multivariate Analysis ; Nigeria ; Nutrient deficiency ; nutrition ; Phosphorus ; Regression models ; Rickets ; Rickets - prevention & control ; VDSP ; Vitamin D ; Vitamin D - analogs & derivatives ; Vitamin D - blood ; Vitamin D Standardization Program</subject><ispartof>The American journal of clinical nutrition, 2021-07, Vol.114 (1), p.231-237</ispartof><rights>2021 American Society for Nutrition.</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.</rights><rights>Copyright American Society for Clinical Nutrition, Inc. Jul 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-b32b2a74222186a6315949844739fc7b42d08faefe9a970b4d24cc552fe9870a3</citedby><cites>FETCH-LOGICAL-c436t-b32b2a74222186a6315949844739fc7b42d08faefe9a970b4d24cc552fe9870a3</cites><orcidid>0000-0003-1324-3282</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33742199$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sempos, Christopher T</creatorcontrib><creatorcontrib>Durazo-Arvizu, Ramón A</creatorcontrib><creatorcontrib>Fischer, Philip R</creatorcontrib><creatorcontrib>Munns, Craig F</creatorcontrib><creatorcontrib>Pettifor, John M</creatorcontrib><creatorcontrib>Thacher, Tom D</creatorcontrib><title>Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet—a multivariable reanalysis</title><title>The American journal of clinical nutrition</title><addtitle>Am J Clin Nutr</addtitle><description>Nutritional rickets is believed to result from the interaction of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentration and dietary calcium intake, but this interaction has not been confirmed in children with rickets. Determining the vitamin D requirements to prevent nutritional rickets has been thwarted by inconsistent case definition, inadequate adjustment for calcium intake and other confounders, and 25(OH)D assay variability.
To model the 25(OH)D concentration associated with nutritional rickets in calcium-deprived Nigerian children, adjusted for confounding factors, and develop a general approach to define vitamin D status while accounting for calcium intake.
Logistic regression was used to model the association of serum 25(OH)D with having rickets adjusted for calcium intake in a reanalysis of a case-control study in Nigerian children. The matching variables age, sex, weight-for-age z score, and 4 additional significant variables were selected [religion, age began walking, phosphorus intake, and the 25(OH)D × calcium intake interaction] using a rigorous 7-step algorithm.
Cases had significantly (P < 0.0001) lower mean ± SD 25(OH)D than controls (33 ± 13 compared with 51 ± 16 nmol/L, respectively), whereas cases and controls had similarly (P = 0.81) low mean dietary calcium intakes (216 ± 88 and 213 ± 95 mg/d, respectively). There was a significant interaction between 25(OH)D and calcium intake [coefficient (95% CI): –0.0006 (–0.0009, –0.0002)]. Accordingly, as calcium intake increased from 130 to 300 mg/d, the adjusted odds of having rickets decreased dramatically with increasing 25(OH)D such that at 200 mg/d, the adjusted odds of having rickets at 47.5 nmol/L was 0.80, whereas it was 0.2 at 62.5 nmol/L. Moreover, at a calcium intake of 300 mg/d, the adjusted odds was 0.16 at a 25(OH)D concentration of 47.5 nmol/L and 0.02 at 62.5 nmol/L.
The vitamin D requirement to prevent nutritional rickets varies inversely with calcium intake and vice versa. Also, application of multivariable modeling is essential in defining vitamin D requirements.</description><subject>25-Hydroxyvitamin D</subject><subject>Adolescent</subject><subject>Age</subject><subject>Algorithms</subject><subject>Calciferol</subject><subject>Calcium</subject><subject>Calcium (dietary)</subject><subject>Calcium, Dietary - administration & dosage</subject><subject>case-control</subject><subject>Child</subject><subject>Child Nutritional Physiological Phenomena</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Diet</subject><subject>Dietary intake</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Kidney stones</subject><subject>logistic regression</subject><subject>Male</subject><subject>metabolic bone disorders</subject><subject>multivariable modeling</subject><subject>Multivariate Analysis</subject><subject>Nigeria</subject><subject>Nutrient deficiency</subject><subject>nutrition</subject><subject>Phosphorus</subject><subject>Regression models</subject><subject>Rickets</subject><subject>Rickets - prevention & control</subject><subject>VDSP</subject><subject>Vitamin D</subject><subject>Vitamin D - analogs & derivatives</subject><subject>Vitamin D - blood</subject><subject>Vitamin D Standardization Program</subject><issn>0002-9165</issn><issn>1938-3207</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkbuOEzEUhi0EYsNCR40sUUDBsL7NxSVartIKCqC2PJ4zrIPHTnwJpOMF6HhCngRHCRQIicqW_Z3_HPtD6D4lTymR_EKvjb_wWz0SMdxAKyr50HBG-ptoRQhhjaRde4bupLQmhDIxdLfRGee9YFTKFfr-HmJZMGub6_0Uw9f9zma9WI-f4wjbYiMs4HPCOeBNhF3dY19ytNkGrx2O1nyGel0L3tpPEK322FxbN0XwOHissQtfGqOdsbXLZCH__PZD46W4bHe64qOD2kjXrH2y6S66NWuX4N5pPUcfX774cPm6uXr36s3ls6vGCN7lZuRsZLo-gTE6dLrjtJVCDkL0XM6mHwWbyDBrmEFq2ZNRTEwY07asHgw90fwcPT7mbmLYFkhZLTYZcE57CCUp1hJe0zouK_rwL3QdSqzzHqiWE0bb_kA9OVImhpQizGoT7aLjXlGiDprUQZM6aar4g1NoGReY_sC_vVTg0REIZfO_qO5IQv2vnYWokrHgDUzVnclqCvbfhb8AYZ6y1A</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Sempos, Christopher T</creator><creator>Durazo-Arvizu, Ramón A</creator><creator>Fischer, Philip R</creator><creator>Munns, Craig F</creator><creator>Pettifor, John M</creator><creator>Thacher, Tom D</creator><general>Elsevier Inc</general><general>Oxford University Press</general><general>American Society for Clinical Nutrition, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T7</scope><scope>7TS</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1324-3282</orcidid></search><sort><creationdate>202107</creationdate><title>Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet—a multivariable reanalysis</title><author>Sempos, Christopher T ; Durazo-Arvizu, Ramón A ; Fischer, Philip R ; Munns, Craig F ; Pettifor, John M ; Thacher, Tom D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-b32b2a74222186a6315949844739fc7b42d08faefe9a970b4d24cc552fe9870a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>25-Hydroxyvitamin D</topic><topic>Adolescent</topic><topic>Age</topic><topic>Algorithms</topic><topic>Calciferol</topic><topic>Calcium</topic><topic>Calcium (dietary)</topic><topic>Calcium, Dietary - administration & dosage</topic><topic>case-control</topic><topic>Child</topic><topic>Child Nutritional Physiological Phenomena</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Diet</topic><topic>Dietary intake</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Kidney stones</topic><topic>logistic regression</topic><topic>Male</topic><topic>metabolic bone disorders</topic><topic>multivariable modeling</topic><topic>Multivariate Analysis</topic><topic>Nigeria</topic><topic>Nutrient deficiency</topic><topic>nutrition</topic><topic>Phosphorus</topic><topic>Regression models</topic><topic>Rickets</topic><topic>Rickets - prevention & control</topic><topic>VDSP</topic><topic>Vitamin D</topic><topic>Vitamin D - analogs & derivatives</topic><topic>Vitamin D - blood</topic><topic>Vitamin D Standardization Program</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sempos, Christopher T</creatorcontrib><creatorcontrib>Durazo-Arvizu, Ramón A</creatorcontrib><creatorcontrib>Fischer, Philip R</creatorcontrib><creatorcontrib>Munns, Craig F</creatorcontrib><creatorcontrib>Pettifor, John M</creatorcontrib><creatorcontrib>Thacher, Tom D</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of clinical nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sempos, Christopher T</au><au>Durazo-Arvizu, Ramón A</au><au>Fischer, Philip R</au><au>Munns, Craig F</au><au>Pettifor, John M</au><au>Thacher, Tom D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet—a multivariable reanalysis</atitle><jtitle>The American journal of clinical nutrition</jtitle><addtitle>Am J Clin Nutr</addtitle><date>2021-07</date><risdate>2021</risdate><volume>114</volume><issue>1</issue><spage>231</spage><epage>237</epage><pages>231-237</pages><issn>0002-9165</issn><eissn>1938-3207</eissn><abstract>Nutritional rickets is believed to result from the interaction of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentration and dietary calcium intake, but this interaction has not been confirmed in children with rickets. Determining the vitamin D requirements to prevent nutritional rickets has been thwarted by inconsistent case definition, inadequate adjustment for calcium intake and other confounders, and 25(OH)D assay variability.
To model the 25(OH)D concentration associated with nutritional rickets in calcium-deprived Nigerian children, adjusted for confounding factors, and develop a general approach to define vitamin D status while accounting for calcium intake.
Logistic regression was used to model the association of serum 25(OH)D with having rickets adjusted for calcium intake in a reanalysis of a case-control study in Nigerian children. The matching variables age, sex, weight-for-age z score, and 4 additional significant variables were selected [religion, age began walking, phosphorus intake, and the 25(OH)D × calcium intake interaction] using a rigorous 7-step algorithm.
Cases had significantly (P < 0.0001) lower mean ± SD 25(OH)D than controls (33 ± 13 compared with 51 ± 16 nmol/L, respectively), whereas cases and controls had similarly (P = 0.81) low mean dietary calcium intakes (216 ± 88 and 213 ± 95 mg/d, respectively). There was a significant interaction between 25(OH)D and calcium intake [coefficient (95% CI): –0.0006 (–0.0009, –0.0002)]. Accordingly, as calcium intake increased from 130 to 300 mg/d, the adjusted odds of having rickets decreased dramatically with increasing 25(OH)D such that at 200 mg/d, the adjusted odds of having rickets at 47.5 nmol/L was 0.80, whereas it was 0.2 at 62.5 nmol/L. Moreover, at a calcium intake of 300 mg/d, the adjusted odds was 0.16 at a 25(OH)D concentration of 47.5 nmol/L and 0.02 at 62.5 nmol/L.
The vitamin D requirement to prevent nutritional rickets varies inversely with calcium intake and vice versa. Also, application of multivariable modeling is essential in defining vitamin D requirements.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33742199</pmid><doi>10.1093/ajcn/nqab048</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1324-3282</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | 25-Hydroxyvitamin D Adolescent Age Algorithms Calciferol Calcium Calcium (dietary) Calcium, Dietary - administration & dosage case-control Child Child Nutritional Physiological Phenomena Child, Preschool Children Diet Dietary intake Female Humans Infant Kidney stones logistic regression Male metabolic bone disorders multivariable modeling Multivariate Analysis Nigeria Nutrient deficiency nutrition Phosphorus Regression models Rickets Rickets - prevention & control VDSP Vitamin D Vitamin D - analogs & derivatives Vitamin D - blood Vitamin D Standardization Program |
| title | Serum 25-hydroxyvitamin D requirements to prevent nutritional rickets in Nigerian children on a low-calcium diet—a multivariable reanalysis |
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