Public Health Nutrition

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Anaemia, lead poisoning and vitamin D deficiency in low-income children: do current screening recommendations match the burden of illness?

Margaret Kerseya1 c1, Ming Chia2 and Diana B Cuttsa1

a1 Department of Pediatrics, University of Minnesota, Hennepin County Medical Center, G7, 701 Park Avenue South, Minneapolis, MN 55415, USA

a2 Internal Medicine Residency, Saint Joseph's Hospital, Chicago, IL, USA

Abstract

Objective Low-income children are routinely screened for anaemia and elevated blood lead levels (EBLL) but not for vitamin D deficiency. We sought to determine the relative prevalence of and the relationship among vitamin D deficiency, anaemia and EBLL among healthy low-income paediatric clinic patients.

Design Retrospective chart review.

Setting Paediatric outpatient clinic in an urban safety net hospital in a northern US state.

Subjects Healthy toddlers and children under 6 years of age (n 127) who were seen for a routine well child check-up (WCC).

Results The prevalence of vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) < 30 ng/ml) was 62 %; the prevalence of vitamin D deficiency (25(OH)D < 20 ng/ml) was 29 %. These rates were far higher than those for anaemia (Hb < 11·0 g/dl) at 10 %, EBLL (Pb > 9 μg/dl) at 1 % or even mildly EBLL (Pb 5–9 μg/dl) at 4 % (range: 1–11). There was no relationship among any of the following: vitamin D status, anaemia or EBLL. The vast majority of children with vitamin D deficiency had both normal Hb (86 %) and Pb level (100 %). After controlling for child's age, gender and race/ethnicity, there was no association between Hb (continuous, g/dl) and vitamin D deficiency (adjusted OR (aOR) = 0·97, 95 % CI 0·64, 1·47; P = 0·88). The only significant predictor of vitamin D deficiency was increasing age in years (aOR = 1·39, 95 % CI 1·03, 1·86; P = 0·03). None of these associations changed materially when deficiency was defined as <15 ng/ml.

Conclusions Vitamin D deficiency was far more common than anaemia or EBLL, and Hb and Pb status were not predictors of vitamin D status.

(Received May 26 2010)

(Accepted November 22 2010)

(Online publication February 10 2011)

Correspondence

c1 Corresponding author: Email kerse003@umn.edu

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