Hypovitaminosis D in Healthy Toddlers and Preschool Children from Western Saudi Arabia

Abstract. Background: Vitamin D deficiency is common in Saudi Arabia. No sufficient data are available on the vitamin D status of preschool children. Aims: To investigate the vitamin D status among toddlers and preschool children and to evaluate the factors associated with hypovitaminosis D in Western Saudi Arabia. Methods: A cross-sectional study was conducted on 503 preschool children in Makkah. The children were divided into two age categories: 1 - 3 years (toddlers) and 3 - 6 years (preschool). Sociodemographic factors, life-style factors, eating habits, body mass index (BMI), 25-(OH)-vitamin D₃, parathyroid hormone, calcium, phosphorous, and alkaline phosphatase concentrations were determined. Results: Sixty-three % of children had a vitamin D deficiency. Vitamin D in toddlers was significantly higher than in preschool children. Vitamin D levels were negatively correlated with BMI (r = - 0.419, P < 0.001), and duration of breast feeding (r = - 0.270, P = 0.027), but a significant positive correlation with vitamin D intake (r = 0.335, P = 0.021), calcium intake (r = 0.25, P = 0.029), duration of formula feeding (r = 0.354, P = 0.019), and outdoor physical activity (r = 0.381, P = 0.011) was found. Multivariable predictors of hypovitaminosis D were preschool age (OR = 11, [95 % CI: 2.78 - 43.57], P < 0.001), outdoor physical inactivity (OR = 2.44, [95 % CI: 0.93 - 14.12], P < 0.001), obesity (OR = 2.3, [95 % CI: 1.25 - 7.08], P = 0.008), overweight (OR = 2.16, [95 % CI: 1.18 - 6.01], P = 0.039), inadequate vitamin D intake (OR = 1.65, [95 % CI: 1.12 - 2.53], P = 0.012), exclusive formula feeding (OR = 0.53, [95 % CI: 0.41 - 0.72], P < 0.001), and breast and formula feeding (OR = 0.62 [95 % CI: 0.39 - 0.88], P = 0.002). Conclusion: Hypovitaminosis D is a public health concern, especially in preschool children. Possible determinants of low vitamin D status in preschool children in the Makkah region could be related to age, high BMI, inadequate vitamin D intake, exclusive breastfeeding, and outdoor physical inactivity.