Vitamin D deficiency and associated risk factors among young children in Malaysia
Risk Factors of Vitamin D Deficiency in Young Children
DOI:
https://doi.org/10.24191/cos.v13i1.7326Keywords:
children, risk factors, vitamin D, vitamin D deficiency, MalaysiaAbstract
Vitamin D deficiency in children is a global medical problem. The current study aimed to assess vitamin D status among preschool children in Malaysia, as well as to identify the risk factors associated with vitamin D deficiency. Methods: 120 healthy children were included. Blood samples were collected, and parents completed a questionnaire about family demographic characteristics, mother’s pregnancy information, nutritional habits and sunlight exposure. The ELISA Kit was used to determine serum vitamin D levels. Descriptive statistics and bivariate analyses were performed. A p-value ≤ 0.05 was considered statistically significant. Results: Vitamin D deficiency and insufficiency were reported in 35 %, 20 % of children respectively Chinese children were more likely to have sufficient vitamin D levels compared to other races (p= 0.050). Children deficient in vitamin D had significantly lower mean weight (p= 0.026). Mothers who had health issues during pregnancy were significantly more likely to have children deficient in vitamin D (p= 0.039). Only consumption of chicken (p= 0.048) and fortified cereal (p= 0.037) were associated with vitamin D status in children. Children exposed to sunlight in the last 2 weeks had sufficient levels of vitamin D (p= 0.026). Conclusion: High vitamin D deficiency was indicated among preschool Malaysian children. The lower body weight of children, mother’s health issues during pregnancy, less consumption of chicken and fortified cereal, less sunlight exposure and racial groups were associated with vitamin D deficiency. Health education and promotion programs for parents would help to increase knowledge aspects of vitamin D and its related benefit.
References
Almoudi, M. M., Hussein, A. S., Doss, J. G., & Schroth, R. J. (2016). Expectant mothers’ readiness to initiate preventive oral health care for their children. Saudi Journal for Dental Research, 7(2), 118–126. https://doi.org/10.1016/j.sjdr.2016.04.006.
Al-Qahtani, S. M., Shati, A. A., Alqahtani, Y. A., Dawood, S. A., Siddiqui, A. F., Zaki, M. S. A., & Khalil, S. N. (2022). Prevalence and correlates of vitamin D deficiency in children aged less than two years: a cross-sectional study from Aseer region, Southwestern Saudi Arabia. Healthcare, 10(6), 1064. https://doi.org/ 10.3390/healthcare10061064.
Al-Sadat, N., Majid, H. A., Sim, P. Y., Su, T. T., Dahlui, M., Bakar, M. F. A., Dzaki, N., Norbaya, S., Murray, L., Cantwell, M. M., & Jalaludin, M. Y. (2016). Vitamin D deficiency in Malaysian adolescents aged 13 years: findings from the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). BMJ Open, 6(8), e010689. https://doi.org/ 10.1136/bmjopen-2015-010689.
Anusha, K., Hettiaratchi, U., Gunasekera, D., Prathapan, S., & Liyanage, G. (2019). Maternal vitamin D status and its effect on vitamin D levels in early infancy in a tertiary care centre in Sri Lanka. International Journal of Endocrinology, 9, 2019. https://doi.org/10.1155/2019/9017951.
Calafiore, D., Fortunato, L., & Migliario, M. (2022). Vitamin D for clinical diseases in women: an indispensable factor in medicine and dentistry. Journal of Clinical Medicine, 11(11), 3104. https://doi.org/10.3390/jcm11113104.
Carpenter, T. O., Herreros, F., Zhang, J. H., Ellis, B. K., Simpson, C., Torrealba-Fox, E., Kim, G. J., Savoye, M., Held, N. A., & Cole, D. E. C. (2012). Demographic, dietary, and biochemical determinants of vitamin D status in inner-city children. The American Journal of Clinical Nutrition, 95(1), 137–146. https://doi.org/ 10.3945/ajcn.111.018721.
Choi, Y. J., Kim, M. K., & Jeong, S. J. (2013). Vitamin D deficiency in infants aged 1 to 6 months. Korean Journal of Pediatrics, 56(5), 205–210. https://doi.org/ 10.3345/kjp.2013.56.5.205.
Clifton Bligh, R. J., McElduff, P., & McElduff, A. (2008). Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabetic Medicine, 25(6), 678–684. https://doi.org/10.1111/j.1464-5491.2008.02422.x.
Cui, A., Xiao, P., Ma, Y., Fan, Z., Zhou, F., Zheng, J., & Zhang, L. (2022). Prevalence, trend, and predictor analyses of vitamin D deficiency in the US population, 2001–2018. Frontiers in Nutrition, 9, 965376. https://doi.org/10.3389/fnut.2022.965376.
Dewan, M. (2017). Malaysian chef’s perception towards factory farmed poultry products: a qualitative enquiry. In Trends, issues and women in hospitality and tourism industry (First edit, pp. 21–35).
Drury, R., Rehm, A., Johal, S., & Nadler, R. (2015). Vitamin D supplementation: we must not fail our children! Medicine, 94(18), e817. https://doi.org/10.1097/MD.0000000000000817.
Esposito, S., Leonardi, A., Lanciotti, L., Cofini, M., Muzi, G., & Penta, L. (2019). Vitamin D and growth hormone in children: a review of the current scientific knowledge. Journal of Translational Medicine, 17(1), 87. https://doi.org/10.1186/s12967-019-1840-4.
Haugen, J., Ulak, M., Chandyo, R. K., Henjum, S., Thorne Lyman, A. L., Ueland, P. M., Midtun, Ø., Shrestha, P. S., & Strand, T. A. (2016). Low prevalence of vitamin D insufficiency among Nepalese infants despite high prevalence of vitamin D insufficiency among their mothers. Nutrients, 8(12), 825. https://doi.org/10.3390/nu8120825.
Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266–281. https://doi.org/10.1056/NEJMra070553.
Holick, M. F. (2010). The vitamin D deficiency pandemic: a forgotten hormone important for health. Public Health Reviews, 32(1), 267–283. https://doi.org/10.1007/BF03391602.
Holick, M. F., Binkley, N. C., Bischoff-ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., Murad, M. H., & Weaver, C. M. (2011). Evaluation, treatment, and prevention of vitamin D deficiency : an Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 96(7), 1911–1930. https://doi.org/10.1210/jc.2011-0385.
Hussein, A. S., Almoudi, M. M., Abu-Hassan, M. I., Schroth, R. J., Saripudin, B., & Shawal, M. F. (2021). Serum and saliva 25(OH)D levels in relation to dental caries in young children. Journal of Clinical Pediatric Dentistry, 45(6), 10–14. https://doi.org/10.17796/1053-4625-45.6.8.
Hussein, A. S., Almoudi, M. M., Zen, S. A. N. M., Azmi, N. H., Schroth, R. J., & Hassan, M. I. A. (2018). Parental awareness and knowledge of vitamin D and its health benefits for children. Journal of International Dental and Medical Research, 11(3), 916–924.
Khor, G. L., Chee, W. S., Shariff, Z. M., Poh, B. K., Arumugam, M., Rahman, J. A., & Theobald, H. E. (2011). High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia. BMC Public Health, 11, 95, 1–8. https://doi.org/10.1186/1471-2458-11-95.
Lee, J. Y., So, T.-Y., & Thackray, J. (2013). A review on vitamin d deficiency treatment in pediatric patients. Journal of Pediatric Pharmacology and Therapeutics, 18(4), 277–291. 10.5863/1551-6776- https://doi.org/18.4.277.
Lee, Y. W., Choon, S. E., & Izham, S. (2019). Serum 25-hydroxyvitamin D deficiency in Malaysian children with severe atopic dermatitis. Medical Journal of Malaysia, 74(4), 259–265.
Libon, F., Cavalier, E., & Nikkels, a. F. (2013). Skin color is relevant to vitamin D synthesis. Dermatology, 227(3), 250–254. https://doi.org/10.1159/000354750.
Logakodie, S., Azahadi, O., Fuziah, P., Norizzati, B. I. B., Tan, S. F., Zienna, Z. Z. R., Norliza, M., Noraini, J., Hazlin, M., Noraliza, M. Z., Sazidah, M. K., & Mimi, O. (2017). Gestational diabetes mellitus: The prevalence, associated factors and foeto-maternal outcome of women attending antenatal care. Malaysian Family Physician, 12(2), 9–17.
Mansbach, J. M., Ginde, A. A., & Camargo, C. A. (2009). Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics, 124(5), 1404–1410. https://doi.org/ 10.1542/peds.2008-2041.
Marasinghe, E., Chackrewarthy, S., Abeysena, C., & Rajindrajith, S. (2015). Micronutrient status and its relationship with nutritional status in preschool children in urban Sri Lanka. Asia Pacific journal of clinical nutrition, 24(1), 144–151. https://doi.org/10.6133/apjcn.2015.24.1.17
Mogire, R. M., Mutua, A., Kimita, W., Kamau, A., Bejon, P., Pettifor, J. M., Adeyemo, A., Williams, T. N., & Atkinson, S. H. (2020). Prevalence of vitamin D deficiency in Africa: a systematic review and meta-analysis. The Lancet Global Health, 8(1), e134–e142. https://doi.org/10.1016/S2214-109X(19)30457-7.
MOH. (2005). Recommended nutrient intakes for Malaysia. A report of the technical working group on nutritional guidelines. National coordinating committee on food and nutrition, Ministry of health Malaysia, Putrajaya. https://www.moh.gov.my/moh/images/gallery/rni/insert.pdf.
MOH. (2017). Recommended nutrient intakes for Malaysia. A report of the technical working group on nutritional guidelines. National coordinating committee on food and nutrition, Ministry of health Malaysia, Putrajaya. https://hq.moh.gov.my/nutrition/wp-content/uploads/2023/12/FA-Buku-RNI.pdf
Mokhtar, R. R., Holick, M. F., Sempértegui, F., Griffiths, J. K., Estrella, B., Moore, L. L., Fox, M. P., & Hamer, D. H. (2018). Vitamin D status is associated with underweight and stunting in children aged 6–36 months residing in the Ecuadorian Andes. Public Health Nutrition, 21(11), 1974–1985. https://doi.org/10.1017/S1368980017002816.
Poh, B. K., Ng, B. K., Siti Haslinda, M. D., Nik Shanita, S., Wong, J. E., Budin, S. B., Ruzita, A. T., Ng, L. O., Khouw, I., & Norimah, a K. (2013). Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). British Journal of Nutrition, 110(S3), S21–S35. https://doi.org/ 10.1017/S0007114513002092.
Powers, H. J., Stephens, M., Russell, J., & Hill, M. H. (2016). Fortified breakfast cereal consumed daily for 12 wk leads to a significant improvement in micronutrient intake and micronutrient status in adolescent girls: a randomised controlled trial. Nutrition Journal, 15(1), 69. https://doi.org/10.1186/s12937-016-0185-6.
Ross, A. C., Taylor, C. L., Yaktine, A. L., & Del Valle, H. B. (2011). Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK56070/ doi: 10.17226/13050.
Schroth, R. J., Levi, J. A., Sellers, E. A. C., Friel, J., Kliewer, E., & Moffatt, M. E. (2013). Vitamin D status of children with severe early childhood caries: a case-control study. BMC Pediatrics, 13(1), 174. https://doi.org/10.1186/1471-2431-13-174.
Sempos, C. T., Heijboer, A. C., Bikle, D. D., Bollerslev, J., Bouillon, R., Brannon, P. M., DeLuca, H. F., Jones, G., Munns, C. F., & Bilezikian, J. P., Andrea, G., & Binkley, N. (2018). Vitamin D assays and the definition of hypovitaminosis D: results from the First International Conference on Controversies in Vitamin D. British Journal of Clinical Pharmacology, 84(10), 2194–2207. https://doi.org/10.1111/bcp.13652.
Sethu, S., Shetty, R., Deshpande, K., Pahuja, N., Chinnappaiah, N., Agarwal, A., & Sharma, A., & Ghosh, A. (2016). Correlation between tear fluid and serum vitamin D levels. Eye and Vision, 3(1), 22. https://doi.org/10.1186/s40662-016-0053-7.
Soheilykhah, S., Mojibian, M., Rashidi, M., Rahimi Saghand, S., & Jafari, F. (2010). Maternal vitamin D status in gestational diabetes mellitus. Nutrition in Clinical Practice, 25(5), 524–527. https://doi.org/ 10.1177/0884533610379851.
Tan, M. L., Abrams, S. A., & Osborn, D. A. (2020). Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. Cochrane Database of Systematic Reviews, 12(12), CD013046. https://doi.org/10.1002/14651858.CD013046.pub2.
Taylor, C. L., Patterson, K. Y., Roseland, J. M., Wise, S. A., Merkel, J. M., Pehrsson, P. R., & Yetley, E. A. (2014). Including food 25-hydroxyvitamin D in intake estimates may reduce the discrepancy between dietary and serum measures of vitamin D status. The Journal of Nutrition, 144(5), 654–659. https://doi.org/10.3945/jn.113.189811.
Voortman, T., van den Hooven, E. H., Heijboer, A. C., Hofman, A., Jaddoe, V. W. V, & Franco, O. H. (2015). Vitamin D deficiency in school-age children is associated with sociodemographic and lifestyle factors. The Journal of Nutrition, 145(4), 791–798. https://doi.org/10.3945/jn.114.208280.
WHO. (2018). Infant and young child feeding. https://www.who.int/data/nutrition/nlis/info/infant-and-young-child-feeding.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Compendium of Oral Science
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Materials contained in the journal may be reproduced for educational purposes provided that both the author(s) and the journal are appropriately recognised; otherwise duplication is not permitted. No articles, reports, or portions there of may be translated into other languages, published in books, journals, magazines, or any other print form without written permission from the authors and from the journal.
Disclaimer: The statements, opinions and data expressed in the articles and reports herein are those of the author(s) and not of the publisher and the editor(s). The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any schemes, methods, instructions or ideas referred to in the content.
