Vitamin D Status: A Different Story in the Very Young versus the Very Old Romanian Patients

May Vitamin D Status: A Different Story in the Very Young versus the Very Old Romanian Patients Adela Chirita-Emandi 0 1 2 Demetra Socolov 0 1 2 Carmen Haivas 0 1 2 Anca Calapiș 0 1 2 Cristina Gheorghiu 0 1 2 Maria Puiu 0 1 2 0 1 Genetics Department, University of Medicine and Pharmacy “Victor Babeș”, Timișoara, Romania, 2 Ginecology Department, University of Medicine and Pharmacy “Gr. T. Popa”, Iași, Romania, 3 Anatomy Department, University of Medicine and Pharmacy “Victor Babeș” , Timișoara, Romania, 4 Bioclinica Laboratoarele, SA, Timișoara, Romania, 5 Genetics Department , Clinical Emergency Hospital for Children “Louis Țurcanu” , Timișoara , Romania 1 Funding: Chirita-Emandi Adela is a Postdoctoral fellow under the frame of European Social Fund, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/ 1.5/136893. Maria Puiu was funded under Operational program: Development of existing infrastructure and creation of new infrastructure (laboratories, research centers). POSCCE-A2- O2.2.1-2013-1, in the Center of Genomic Medicine from the University of Medicine and Pharmacy “Victor Babes” Timisoara. These funders had no role in study 2 Academic Editor: Dengshun Miao, Nanjing Medical University , CHINA - In Romania (latitude 48°15’N to 43°40’N), vitamin D supplementation is common practice mostly in infants 0-1 year old. No published information is available regarding epidemiological data on vitamin D status in the Romanian population for a wide age range and geographical territory. In this context, we aimed to evaluate the seasonal and age variation of vitamin D status in a large Romanian population. 6631 individuals from across Romania had performed 7544 vitamin D assessments (20122014) in a chain of private laboratories. Vitamin D (25-hydroxyvitamin D2 and 25-hydroxyvitamin D3) was measured using High Performance Liquid Chromatography. Vitamin D levels were classified as severe deficiency<10ng/mL, deficiency 10-20ng/mL, insufficiency 2129ng/mL, sufficiency 30ng/mL and potentially harmful>100ng/ml. Male to female ratio was 1:2.9. Age ranged from 0 to 85 years. Mean vitamin D levels increased from April (26.3ng/ml) to September (35.6ng/ml) and decreased from October (33.5ng/ml) to March (24.4 ng/ml). Overall 40% had sufficient vitamin D, while the rest were insufficient 33%, deficient 22%, severely deficient 4% and 1% potentially harmful (of them 81% under 1 year old). Males compared to females showed higher percentages of sufficiency (47% vs. 38%). Children 0- 2 years presented the highest percentage of vitamin D sufficiency (77%). Lowest percentages (21%) of sufficiency were in people 80-84 years. design, data collection and analysis, decision to publish, or preparation of the manuscript. All other authors received no specific funding for this work. Coauthor Anca Calapiș is employed by Bioclinica Laboratoarele, SA. Bioclinica Laboratoarele provided support in the form of salary for author AC, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section. Competing Interests: Management of Bioclinica laboratories provided the anonymized data set, and Anca Calapiș (employee of Laboratoarele Bioclinica) provided technical support in sample processing. There are no patents, products in development, or marketed products to declare. This does not alter the authors' adherence to all PLOS ONE policies on sharing data and materials. In Romania, suboptimal vitamin D levels are common (59%), especially in older age, wintertime and in women. Vitamin D supplementation would be most warranted from January to April in the Romanian population. 25-hydroxyvitamin D levels>100ng/ml were relatively prevalent in children 0-1 year old (17.3%). This was attributed to supplementation errors and the fact that high-risk individuals were more likely to visit for medical check-up. Nonetheless, it stresses the need to increase awareness of the importance of preventing Vitamin D supplementation administration errors in the young. Vitamin D is a fat-soluble compound that plays a significant role in calcium homeostasis and bone metabolism. In recent years, aside from the role of vitamin D in rickets and osteomalacia, there has been a strong interest to link vitamin D insufficiency with increases in cardiovascular disease,[1,2] cancer,[3] asthma,[4] and infection.[5,6] In other studies, low vitamin D levels have also been linked with women’s reproductive health outcomes [7] and earlier age of menarche.[8] Vitamin D supplementation seems to alleviate the incidence or adverse outcomes of these diseases and may reduce all-cause mortality.[9] The major circulating form of vitamin D is 25-hydroxyvitamin D, which is considered the best indicator of vitamin D status.[10] The prevalence of vitamin D deficiency varies greatly based on how deficiency is defined (<20 vs. 30 ng/mL). According to NHANES data, 8% of the population had very low 25-hydroxyvitamin D levels (<12 ng/mL), and 25% were at risk for deficiency (12 to 20 ng/mL).[11] A NHANES 2001 to 2004 study regarding prevalence of 25-hydroxyvitamin D levels of less than 30 ng/mL, showed that 77% of noninstitutionalized United States participants had 25-hydroxyvitamin D levels below 30 ng/mL.[12] In Europe, the HELENA study reported that about 80% of their sample had suboptimal levels (39% had insufficient, 27% deficient and 15% severely deficient levels). Vitamin D deficiency is highly prevalent in European adolescents and constitutes a public health issue.[13] In Romania several studies evaluated the vitamin D status in some areas of the country, in certain groups such as elderly individuals in nursing homes,[14,15] in health caregivers,[16] in postmenopausal women,[17] in patients from an endocrinology clinic,[18] or in patients with inflammatory bowel disease.[19] However, no published information is available regarding epidemiological data on vitamin D status in a Romanian population for a wide age range and geographical territory. In this context, we aimed to evaluate the seasonal and age variation of vitamin D status in a large Romanian population. This is a cross-sectional study, where a group of 6631 unique individuals had performed a total of 7544 vitamin D, 415 ionized calcium and 611 PTH assessments between 1st January 2012 and 30th August 2014 in a chain of private laboratories. The Bioclinica laboratories collected blood samples from 60 sites across the country in 10 major cities (Timisoara, Arad, Bistrita, Bucuresti, Constanta, Deva, Iasi, Targu Jiu, Oradea, Resita). All the blood samples were centralized in a single center in Timisoara. Date of assessment, date of birth, gender, the specialty of referring physician was available for each patient. We excluded 359 assessments for which there was no data on gender or date of bir (...truncated)