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Archives de pédiatrie
Volume 21, n° 10
pages 1106-1114 (octobre 2014)
Doi : 10.1016/j.arcped.2014.04.012
Received : 8 January 2014 ;  accepted : 15 April 2014
Statut en vitamine D des enfants de 6 à 10ans : étude nationale multicentrique chez 326 enfants
Vitamin D status in 6- to 10-year-old children: A French multicenter study in 326 children
 

E. Mallet a, , J. Gaudelus b, P. Reinert c, J. Stagnara d, J. Bénichou e, J.-P. Basuyau f, M. Maurin g, J. Cordero h, A. Roden i, J. Uhlrich i
a Centre de référence des maladies rares du calcium et du phosphore, CIC Inserm 204 antenne pédiatrique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France 
b CHU Jean-Verdier, 93140 Bondy, France 
c Hôpital intercommunal, 94000 Créteil, France 
d CIC Inserm 201, EPICIME, RIPPS, CHU, 69500 Lyon, France 
e Unité de biostatistique, Inserm U 657, CHU de Rouen, 76000 Rouen, France 
f Laboratoire de biochimie, CRLCC Henri-Becquerel, 76000 Rouen, France 
g GECEM, 92120 Montrouge, France 
h Laboratoire Rottapharm, 75013 Paris, France 
i Département médical, laboratoire Novartis Santé Familiale, 92500 Rueil-Malmaison, France 

Auteur correspondant.
Résumé
Objectif

Apprécier le statut en vitamine D des enfants de 6 à 10ans.

Méthode

L’étude s’est déroulée sur deux hivers d’ensoleillement différent dans 20 puis 22 centres. Trois cent enfants âgés de 6 à 10ans devaient être inclus en fin de période hivernale et les dosages réalisés sur reliquat biologique dans un laboratoire centralisé. Les seuils actuellement retenus de 25 hydroxyvitamine D (25-OH-D) ont permis de définir les situations de déficit sévère ou carence (≤25 nmol/L), de déficit (25<25-OH-D50 nmol/L), de statut satisfaisant (50<25-OH-D100 nmol/L) et de concentration haute (>100 nmol/L). Un questionnaire standardisé a permis de renseigner les informations connexes nécessaires et les niveaux d’ensoleillement ont été connus grâce à Météo-France.

Résultats

Un dosage plasmatique de 25-OH-D a pu être réalisé chez 326 enfants ; 38 % avaient reçu une supplémentation vitaminique D depuis la rentrée scolaire. On a compté 3,1 % d’enfants en situation de carence, 34,4 % en déficit, 53,1 % en statut satisfaisant et 9,5 % avec une concentration haute sans conséquence sur la calcémie et la calciurie. Une différence nord/sud a été observée. Dans la population non supplémentée (n =188), 5,3 % étaient carencés, 45,2 % en déficit et 48,4 % avaient un taux satisfaisant. Le pourcentage de carence et de déficit était double l’hiver le moins ensoleillé. Dans la population supplémentée (n =119), aucune carence n’a été constatée ; 13,4 % des enfants étaient en situation de déficit et 22,7 % avaient une concentration haute sans signe de surcharge.

Conclusion

Un tiers des enfants présentait une concentration déficitaire en 25-OH-D. Parmi les enfants supplémentés, aucun n’était carencé, peu en situation de déficit et aucun signe de surcharge n’a été noté alors que chez les enfants non supplémentés la moitié (50,5 %) était en situation de déficit en fin d’hiver. Ces résultats plaident en faveur d’une supplémentation hivernale chez les enfants.

The full text of this article is available in PDF format.
Summary
Objective

To assess the vitamin D status of children aged 6–10years in the French general population for whom no guidelines have yet been defined due to insufficient data.

Method

The study was conducted during two winters with very different sunshine levels: 5 March to 17 April 2012 and 8 January to 16 April 2013 in 20 then 22 centers. Three hundred children (60 children for each year of age) attending an ambulatory care unit or outpatient department for a reason unrelated to vitamin D status were included at the end of winter in 20 hospital centers (ten centers in the northern half of France above latitude 46–47°N/Lille: 50°N and ten centers in the southern half of France below latitude 46–47°N/Marseille: 43°N). Centralized 25 hydroxyvitamin D (25(OH)D), alkaline phosphatase (ALP), and parathormone (PTH) assays were performed on leftover blood samples. The currently accepted normal range for 25(OH)D was used to define the following categories: ≤25nmol/L: severe vitamin D deficiency, 25nmol/L<vitamin D deficiency50nmol/L, 50nmol/L<sufficient vitamin D status100nmol/L, >100nmol/L: high vitamin D status. A standardized questionnaire was used to collect the child's characteristics, use of a vitamin D supplement, and milk and dairy product intake. The cumulative number of hours of sunshine over the 90days prior to inclusion in each center was obtained from the Météo-France weather bureau.

Results

25(OH)D assays were performed in 326 children; more than 95% of children received milk and dairy products and 38% had received a vitamin D supplement since starting the school year: 3.1% of children in the overall population presented severe vitamin D deficiency, 34.4% presented vitamin D deficiency, 53.1% had a sufficient vitamin D status, and 9.5% had a 25(OH)D concentration >100nmol/L with no impact on serum calcium and urinary calcium. Children living in the north of France generally had lower 25(OH)D levels than children living in the south of France. In the non-supplemented population (n =188), 5.3% of children presented severe vitamin D deficiency, 45.2% presented vitamin D deficiency and 48.4% had sufficient 25(OH)D levels. The percentage of children with severe vitamin D deficiency or vitamin D deficiency was twofold higher during the winter with poor sunshine compared to the sunnier winter with a less marked north/south difference. No case of severe vitamin D deficiency was observed in the supplemented population (n =119); 10–15% of children presented vitamin D deficiency and 22.7% had a 25(OH)D concentration >100nmol/L, while remaining within the acceptable range. Two cases of hypervitaminosis without hypercalcemia were identified: one after an unknown loading dose with a calcium/creatinine ratio in the normal range (0.8); for the second one, no additional information could be obtained. Vitamin D supplementation considerably reduced the north/south difference and the Winter1/Winter2 difference. A child not receiving a vitamin D supplement had a ninefold higher risk of vitamin D deficiency at the end of winter than a child receiving a vitamin D supplement (OR=8.8; 95%CI, 4.6–16.8).

Conclusion

At least one-third of children aged 6–10years presented deficient 25(OH)D levels. None of the children receiving a vitamin D supplement presented severe vitamin D deficiency, only a small number of children presented vitamin D deficiency (n =16 (13.4%)), and no signs of overload were observed, while one half of non-supplemented children (n =95 (50.5%)) presented at least vitamin D deficiency at the end of winter. These results support the need for vitamin D supplementation during winter in children aged 6–10years.

The full text of this article is available in PDF format.


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