Sources of vitamin D and determinants of serum 25-hydroxyvitamin D in Finnish adolescents

Sonja Soininen, Aino-Maija Eloranta, Ursula Schwab, Timo A Lakka, Sonja Soininen, Aino-Maija Eloranta, Ursula Schwab, Timo A Lakka

Abstract

Purpose: To study the intake and sources of vitamin D and determinants of serum 25-hydroxyvitamin D (S-25(OH)D) in Finnish adolescents.

Methods: We studied 265 adolescents (117 girls) aged 15-17 years attending 8-year examinations of the PANIC Study, assessed diet using food records and other lifestyle factors by questionnaires, and analyzed S-25(OH)D by chemiluminescence immunoassay and determinants of S-25(OH)D using multivariate linear regression.

Results: Mean (standard deviation) of total vitamin D intake from food and supplements was 19.2 (13.1) µg/d, and that of dietary vitamin D intake was 9.9 (5.4) µg/d. Milk fortified with vitamin D was the main dietary source of vitamin D, providing 45% of daily intake. Altogether, 29% of the adolescents used no vitamin D supplements and 25% did not meet the recommended total vitamin D intake of 10 µg/d. Mean (standard deviation) of S-25(OH)D was 62.0 (18.8) nmol/l, and S-25(OH)D was < 50 nmol/l in 29.5% of the adolescents. Vitamin D intake from supplements was the main determinant of S-25(OH)D (β = 0.465, p < 0.001), followed by consumption of milk products (β = 0.251, p < 0.001), consumption of meat products (β = 0.179, p = 0.002), travels to sunny countries (β = 0.178, p = 0.002), and average daylight time (β = 0.162, p = 0.004).

Conclusion: Most of the adolescents had vitamin D intake at the recommended level, although a fourth did not meet the recommended total vitamin D intake of 10 µg/d and almost a third had S-25(OH)D < 50 nmol/l. More attention should be paid to the sufficient intake of vitamin D in adolescents who do not use vitamin D supplements or fortified milk products.

Trial registration: ClinicalTrials.gov: NCT01803776, registered March 3, 2013.

Keywords: 25-Hydroxyvitamin D; Adolescents; Diet; Fortification; Supplements; Vitamin D.

Conflict of interest statement

The authors declare that they have no conflicts of interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Distribution of serum 25-hydroxyvitamin D (25(OH)D) concentration

References

    1. Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. Horm Res Paediatr. 2016;85:83–106. doi: 10.1159/000443136.
    1. Lamberg-Allardt C, Brustad M, Meyer HE, Steingrimsdottir L. Vitamin D-a systematic literature review for the the 5th edition of the Nordic Nutrition Recommendations. Food Nutr Res. 2013 doi: 10.3402/fnr.v57i0.22671.
    1. Lips P, Cashman KD, Lamberg-Allardt C, et al. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol. 2019;180:P23–P54. doi: 10.1530/EJE-18-0736.
    1. Harel Z, Cromer B, DiVasta AD, et al. Recommended vitamin D intake and management of low vitamin D status in adolescents: a position statement of the society for adolescent health and medicine. J Adolesc Heal. 2013;52:801–803. doi: 10.1016/j.jadohealth.2013.03.022.
    1. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–1930. doi: 10.1210/jc.2011-0385.
    1. Institute of Medicine . Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academies Press; 2011.
    1. Nordic Council of Ministers . Integrating nutrition and physical activity. 5. Copenhagen: Nordic Council of Ministers; 2014. Nordic nutrition recommendations.
    1. Scientific Advisory Committee on Nutrition (2016) Vitamin D and health. . (Accessed 7 Apr 2022)
    1. Bresson JL, Burlingame B, Dean T, et al. Dietary reference values for vitamin D. EFSA J. 2016 doi: 10.2903/j.efsa.2016.4547.
    1. Vitamin D Standardization program (VDSP) Binkley N, Sempos CT. Standardizing vitamin D assays: the way forward. J Bone Miner Res. 2014;29:1709–1714. doi: 10.1002/jbmr.2252.
    1. Kiely M, Cashman KD. Summary outcomes of the ODIN project on food fortification for vitamin D deficiency prevention. Int J Environ Res Public Health. 2018;15:2342. doi: 10.3390/ijerph15112342.
    1. National Nutrition Council (2010) VRN D-vitamiinityöryhmän raportti huhtikuu 2010. (Report of vitamin D working group, in Finnish.) Available at: . Accessed 29 Aug 2022
    1. National Nutrition Council . Finnish nutrition recommendations 2014. Helsinki: Juvenes Oy; 2014.
    1. Soininen S, Eloranta A-M, Lindi V, et al. Determinants of serum 25-hydroxyvitamin D concentration in Finnish children: the physical activity and nutrition in children (PANIC) study. Br J Nutr. 2016;25:1–12. doi: 10.1017/S0007114515005292.
    1. Jääskeläinen T, Itkonen ST, Lundqvist A, et al. The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data. Am J Clin Nutr. 2017;105:1512–1520. doi: 10.3945/ajcn.116.151415.
    1. Raulio S, Erlund I, Männistö S, et al. Successful nutrition policy: improvement of vitamin D intake and status in Finnish adults over the last decade. Eur J Public Health. 2017;27:268–273. doi: 10.1093/eurpub/ckw154.
    1. Raulio S, Tapanainen H, Valsta L, et al. FinRavinto 2017-tuloksia: D-vitamiinin saanti ja seerumipitoisuus aikuisilla. Suom Lääkäril–Finlands läkartidning. 2021;76:2578–2582.
    1. Skaffari E, Korkalo L, Vepsäläinen H, et al (2019) Päiväkoti-ikäisten lasten ruokavalio -raportti. In: Helsingin Yliop. . (Accessed 7 Apr 2022)
    1. Rosendahl J, Fogelholm M, Pelkonen A, et al. A history of cow’s milk allergy is associated with lower vitamin D status in schoolchildren. Horm Res Paediatr. 2017;88:244–250. doi: 10.1159/000478779.
    1. Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103:1033–1044. doi: 10.3945/ajcn.115.120873.
    1. Munasinghe LL, Yuan Y, Willows ND, et al. Vitamin D deficiency and sufficiency among Canadian children residing at high latitude following the revision of the RDA of vitamin D intake in 2010. Br J Nutr. 2017;117:457–465. doi: 10.1017/S0007114517000320.
    1. Lakka TA, Lintu N, Väistö J, et al. A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC Study. Diabetologia. 2020;63:2270–2281. doi: 10.1007/s00125-020-05250-0.
    1. Sallinen T, Viitasalo A, Lintu N, et al. The effects of an 8-year individualised lifestyle intervention on food consumption and nutrient intake from childhood to adolescence: the PANIC Study. J Nutr Sci. 2022;11:e40. doi: 10.1017/jns.2022.13.
    1. Ministry of Social Affairs and Health (2005) Recommendations for physical activity in early childhood education. Handbooks of the Ministry of Social Affairs and Health, Helsinki (In Finnish)
    1. National Nutrition Council . Finnish nutrition recommendations. Helsinki: Edita Prima Oy; 2005.
    1. Rastas M, Seppänen R, Knuts L, et al. Nutrient composition of foods. Helsinki, Finland: Publications of the Social Insurance Institution; 1997.
    1. National Institute for Health and Welfare, Nutrition Unit. In: Fineli. Finnish food Compos. database. . (Accessed 7 Apr 2022)
    1. Ministry of Agriculture and Forestry of Finland Maa-ja metsätalousministeriön asetus rasvattoman homogenoidun maidon D-vitaminoinnista. Available online: . (In Finnish, Accessed 29 Aug 2022)
    1. Saari A, Sankilampi U, Hannila M-L-L, et al. New Finnish growth references for children and adolescents aged 0 to 20 years: length/height-for-age, weight-for-length/height, and body mass index-for-age. Ann Med. 2011;43:235–248. doi: 10.3109/07853890.2010.515603.
    1. Fitzpatrick TB. The validity and practicality of sunreactive skin types I through VI. Arch Dermatol. 1988;124:869–871. doi: 10.1001/archderm.124.6.869.
    1. Vitamin D Standardization-Certification Program (VDSCP) | CDC. . (Accessed 7 Apr 2022)
    1. Krebs-Smith SM, Kott PS, Guenther PM. Mean proportion and population proportion: two answers to the same question? J Am Diet Assoc. 1989;89:671–676. doi: 10.1016/S0002-8223(21)02224-0.
    1. Warensjö Lemming E, Petrelius Sipinen J, Nyberg G, et al. Vitamin D status and associations with diet, objectively measured physical activity patterns and background characteristics among adolescents in a representative national cross-sectional survey. Public Health Nutr. 2022 doi: 10.1017/S1368980022000222.
    1. Itkonen ST, Andersen R, Björk AK, et al. Vitamin D status and current policies to achieve adequate vitamin D intake in the Nordic countries. Scand J Public Health. 2021;49:616–627. doi: 10.1177/1403494819896878.
    1. Warensjö Lemming E, Moraeus L, Petrelius Sipinen J, Lindroos AK (2013) Riksmaten ungdom 2016–2017. Närningsintag och närningsstatus bland ungdomar i Sverige (in Swedish with English abstract)
    1. Valsta L, Kaartinen N, Tapanainen H, et al. Ravitsemus Suomessa–nutrition in Finland. Helsinki: THL; 2018.
    1. Kumar J, Muntner P, Kaskel FJ, et al. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004. Pediatrics. 2009;124:e362–e370. doi: 10.1542/peds.2009-0051.
    1. Petersen RA, Damsgaard CT, Dalskov SM, et al. 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. Br J Nutr. 2016;115:239–250. doi: 10.1017/S000711451500433X.
    1. Absoud M, Cummins C, Lim MJ, et al. Prevalence and predictors of vitamin D insufficiency in children: a great britain population based study. PLoS ONE. 2011 doi: 10.1371/journal.pone.0022179.
    1. Hansen L, Tjønneland A, Køster B, et al. Vitamin D status and seasonal variation among danish children and adults: a descriptive study. Nutrients. 2018 doi: 10.3390/nu10111801.
    1. Taylor CL, Patterson KY, Roseland JM, et al. Including food 25-hydroxyvitamin D in intake estimates may reduce the discrepancy between dietary and serum measures of vitamin D status. J Nutr. 2014;144:654–659. doi: 10.3945/jn.113.189811.
    1. Itkonen S, Erkkola M, Lamberg-Allardt C. Vitamin D fortification of fluid milk products and their contribution to vitamin D intake and vitamin D status in observational studies—a review. Nutrients. 2018;10:1054. doi: 10.3390/nu10081054.
    1. Tolppanen AM, Fraser A, Fraser WD, Lawlor DA. Risk factors for variation in 25-hydroxyvitamin D(3) and D(2) concentrations and vitamin D deficiency in children. J Clin Endocrinol Metab. 2012;97:1202–1210. doi: 10.1210/jc.2011-2516.
    1. Dong Y, Pollock N, Stallmann-Jorgensen IS, et al. Low 25-hydroxyvitamin D levels in adolescents: race, season, adiposity, physical activity, and fitness. Pediatrics. 2010;125:1104–1111. doi: 10.1542/peds.2009-2055.
    1. Vierucci F, Del Pistoia M, Fanos M, et al. Prevalence of hypovitaminosis D and predictors of vitamin D status in Italian healthy adolescents. Ital J Pediatr. 2014 doi: 10.1186/1824-7288-40-54.
    1. Abbas MA. Physiological functions of vitamin D in adipose tissue. J Steroid Biochem Mol Biol. 2017;165:369–381. doi: 10.1016/j.jsbmb.2016.08.004.
    1. Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–693. doi: 10.1093/ajcn/72.3.690.
    1. Voortman T, van den Hooven EH, Heijboer AC, et al. Vitamin D deficiency in school-age children is associated with sociodemographic and lifestyle factors. J Nutr. 2015;145:791–798. doi: 10.3945/jn.114.208280.
    1. Engelsen O. The relationship between ultraviolet radiation exposure and vitamin D status. Nutrients. 2010;2:482–495. doi: 10.3390/nu2050482.

Source: PubMed

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