Objectives: To examine the nutritional status and the prevalence of vitamin D deficiency of nine years old children in primary schools. Subjects and methods: A cross-sectional study was performed on 375 nine years old children who were not puberty in 3 primary schools in Haiduong city. Subjects were measured body weight, height and examined for vitamin D deficiency based on serum 25(OH)D concentration.
Journal of military pharma-medicine no6-2017 A CROSS-SECTIONAL SURVEY ON STATUS OF NUTRITION AND VITAMIN D DIFICINECY AMONG NINE YEARS OLD CHILDREN AT PRIMARY SCHOOLS IN HAIDUONG CITY Doan Huy Cuong*; Vu Thi Thu Hien**; Le Tran Ngoan*** Nguyen Quang Dung**; Le Danh Tuyen** SUMMARY Objectives: To examine the nutritional status and the prevalence of vitamin D deficiency of nine years old children in primary schools Subjects and methods: A cross-sectional study was performed on 375 nine years old children who were not puberty in primary schools in Haiduong city Subjects were measured body weight, height and examined for vitamin D deficiency based on serum 25(OH)D concentration Results: Prevalence of underweight, stunting, and wasting was 7.7%, 9.3% and 3.7%, respectively Prevalence of overweight and obesity was 18.7% There was no significant difference about prevalence of underweight, stunting, wasting and overweight-obesity between boys and girls Overall prevalence of vitamin D deficiency was 10.6% (in girls 12.7%, in boys 8.7%) Prevalence of vitamin D insufficiency was 70.5%, higher in girls (75.7%) compared to boys (65.8%), p < 0.05 Conclusion: Overweight and obesity was noteworthy problem among primary school children in the study populations Prevalence of vitamin D insufficiency was higher in girls compared to boys * Keywords: Nutritional status; Vitamin D deficiency; Primary school children INTRODUCTION Physical growth of children during primary school is an important stage, especially during a pre-puberty, children grows quickly in height and weight However, nutritional status of primary school children and pre-puberty period has rarely been performed in our country Vitamin D has an important role in the growth, development and maintenance of healthy bone Vitamin D deficiency can occur at any age In Vietnam, there have been warnings about vitamin D deficiency in children under years old also in adults [4] However, the problem has not been fully addressed among primary school children The objective of this study was to examine status of nutrition and vitamin D deficiency among nine years old children at primary schools in Haiduong city * 108 Military Central Hospital ** National Institute of Nutrition *** Hanoi Medical University Conresponding author: Doan Huy Cuong (drcuong108@gmail.com) Date received: 05/04/2017 Date accepted: 25/07/2017 163 Journal of military pharma-medicine no6-2017 SUBJECTS AND METHODS Subjects, location and study time - Subjects: 9-years-old, who were in 4th grade at selected primary schools, had no signs of puberty, no acute illness, parents agreed to participate - Location: Three primary schools of Thanhbinh, Haitan and Ngocchau in Haiduong city - Study time: October 2012 Study design Cross-sectional survey * Sample size: - Sample size for nutritional status survey: Use the following formula: z n = 1−α / × p(1 − p) d n: the sample size; assumptions: z = 1.96 with a confidence interval: 95%, d = 0.05; p = 24.2% (prevalence of underweight on previous studies) [1] Then, an estimated sample size for nutritional status survey was n = 282 - Sample size for vitamin D deficiency status survey: Use the following formula: z n = 1−α / × p(1 − p) d n: the sample size; assumptions: z = 1.96 with a confidence interval: 95%, d = 0.05; p = 61.6% (prevalence vitamin D deficiency on previous studies) [7] 164 Then, an estimated sample size for vitamin D deficiency status survey was n = 364 - Add 3% to sample size, the final sample size for the study was 375 children * Collect study data: - Weight, height body: Body weight was measured with the Tanita BC-571 electronic balance with a precision of 0.1 kg Body height is measured by Unicef's 3-piece logs with a precision of 0.1 cm - Blood test: Quantify 25(OH)D (vitamin D) serum by luminescence immunoassay * Classification of nutritional status according to WHO 2009 [10]: - Underweight when WAZ (Zscore Weight for Age) < -2SD, stunting when HAZ (Zscore Height for Age) < -2SD, wasting when BAZ (Zscore Body Mass Index for Age) < -2SD - Overweight when BAZ from +1SD to +2SD, obesity when BAZ > +2SD * Classification of vitamin D serum status: Assessement of vitamin D deficiency was based on serum 25(OH)D concentration Vitamin D was deficient when 25(OH)D concentration < 50 nmol/L, vitamin D was insufficient when 50 nmol/L ≤ 25(OH)D concentration < 75 nmol/L [9] * Statistical analysis: Input data by Epidata 3.1; anthropometric data was analyzed by WHO-Anthro Plus v.1.0.4; statistical analysis data by Stata Journal of military pharma-medicine no6-2017 RESULTS AND DISCUSSION Nutritional status of subjects Table 1: Anthropometric characteristics by gender Subjects Boys (n = 198 ) ± SD ± SD Characteristics p Girls (n = 177) Age (month) 112.0 ± 3.0 112.4 ± 3.1 > 0.05 Weight (kg) 28.2 ± 5,4 27.6 ± 5.0 > 0.05 Height (cm) 129.5 ± 5.4 129.8 ± 6.0 > 0.05 WAZ (Zsore) -0.39 ± 1.22 -0.54 ± 1.11 > 0.05 HAZ (Zscore) -0.78 ± 0.91 -0.79 ± 0.99 > 0.05 BAZ (Zsore) 0.07 ± 1.28 -0.14 ± 1.05 > 0.05 Study results showed that there was no significant difference about anthropometric characteristics between boys and girls: age, weight, height, Zscore WAZ, Zscore HAZ, Zscore BAZ Table 2: Prevalence of malnutrition and overweight, obesity of subjects Subjects Boys Girls Total Nutritional status (n = 198) (n = 177) (n = 375) Underweight, n (%) 16 (8.1) 13 (7.3) 29 (7.7) > 0.05 Stunting, n (%) 16 (8.1) 19 (10.7) 35 (9.3) > 0.05 Wasting, n (%) (4.0) (3.4) 14 (3.7) > 0.05 40 (20.2) 30 (16.9) 70 (18.7) > 0.05 Overweight-obesity, n (%) Study results showed that: the prevalence of underweight was 7.7% This prevalence ranked as low by the WHO classification of malnutrition and lower than the result of nutritional survey in 2010 with this prevalence of elementary school children was 24.2 % [1] On the other hand, this prevalence was higher than the results of study conducted by Huong LT and Chuc NT was 4.3% on pupils at Xuanphuong primary school in p Hanoi in 2009 This difference could be explained by the fact that underweight children tend to decrease over time and the economic, social and cultural conditions in Haiduong city was not good as in Hanoi Capital The prevalence of stunting was 9.3% This prevalence ranked as low by the WHO classification of malnutrition This prevalence was higher than the results of study conducted by Hanh TT and et al at 165 Journal of military pharma-medicine no6-2017 primary school children was 3.5% in Hochiminh City in 2011 [3], lower than the result of nutritional survey in 2010 with this prevalence of elementary school children was 23.4% [1] This difference could be explained by the fact that stunting children tend to decrease over time and the difference about of economic, social and cultural conditions About wasting, the prevalence was 3.7%, ranked as low by the WHO classification of malnutrition This rate was comparable to the study of Hanh TT and et al in 2011 for elementary school children in Hochiminh City was 4% [3] The prevalence of overweight-obesity was 18.7% This prevalence was lower than the result of nutritional survey in 2010 with this prevalence of elementary school children was 12.7%[1] However, this prevalence was lower than results of study in Hanoi and Hochiminh city Study result of Diep DT at 2,500 primary school pupils in 2009 in Hochiminh City was 28.5% [2] Mai TT's survey in 2013 in 2,375 children aged - in Hoankiem District, Hanoi, the prevalence of overweight-obesity was 39.9%, overweight-obesity increases with age and boys is higher than girls [6] Our study also found that this prevalence of boys was higher than girls Thus, overweight-obesity was a very noticeable problem in primary school children in Haiduong city Vitamin D serum status of subjects Table 3: Vitamin D serum status of subjects Subjects Status Vitamin D serum concentration (nmol/L) Vitamin D deficiency, n (%) Vitamin D insufficiency, n (%) Boys Girls Total p (n = 196) (n = 173) (n = 369) 67.2 ± 13.4 62.2 ± 11.4 64.8 ± 12.7 < 0.05 17 (8.7) 22 (12.7) 39 (10.6) > 0.05 129 (65.8) 131 (75.7) 260 (70.5) < 0.05 The results showed that vitamin D serum concentration was 64.8 ± 12.7 nmol/L, with this concentration of boys higher than girls, significant difference with p < 0.05 This may explained that boys were more likely to participate in outdoor activities than girls, so boys exposed to sunlight are more likely to have higher vitamin D serum concentration than girls About the prevalence of vitamin D deficiency in children, the results showed that this prevalence was 10.6% with 12.7% for girls and 8.7% for boys The prevalence of insufficiency was 70.5%, in girls was 75.7% higher than boys was 65.8%, significant difference with p < 0.05 166 Journal of military pharma-medicine no6-2017 18.9 10.6 vitamin D deficiency vitamin D insufficiency vitamin D normal 70.5 Figure 1: Levels of serum vitamin D deficiency of subjects Khor et al in 2011 found that the prevalence of vitamin D deficiency in children - 12 years old in Kuala Lumpur, Malaysia was 70.4% [8] In our study results, prevalence of vitamin D deficiency was 10.6%, lower than this prevalence of other countries in the region, but the prevalence of vitamin D insufficiency was quite high: 70.5% Such, lack of vitamin D serum was common even with the tropical sunshine country like Malaysia and in our study Having too much sunshine did not necessarily help to improve vitamin D deficiency status It is important for us to keep in touch with how it was and for how long CONCLUSION * Nutritional status: Prevalence of underweight, stunting, and wasting were 7.7%, 9.3% and 3.7%, respectively Prevalence of overweight and obesity was 18.7% There was no significant difference about prevalence of underweight, stunting, wasting and overweight-obesity between boys and girls * Vitamin D serum status: Prevalence of vitamin D deficiency was 10.6%, in girl 12.7%, in boy 8.7% Prevalence of vitamin D insufficiency was 70.5%, higher in girl (75.7%) compared to boy (65.8%), p < 0.05 REFERENCES Viet Nam Ministry of Health, National Institute of Nutrition Nutritional status of 10 years old children National Nutritional Surveys 2009 - 2010 Hanoi Medical Publishing House 2010, pp.54-59 and p.87 Diep D.T et al Overweight, obesity and some epidemiological characteristics of primary school pupils in district 10, Hochiminh City in the school year 2008 - 2009 Medical News 2011, December, No 67 Hanh T.T, Hoa V.Q, Oanh P.N, Diep D.T, Qui L.T Nutritional status of secondary pupils in Hochiminh City Vietnam Food and Nutrition Journal 2012, (3), pp.39-45 Hien V.T, Lam N.T, Anh L.H, Anh N.T et al Vitamin D deficiency and related factors in 15 - 49 years old women in Hanoi and 167 Journal of military pharma-medicine no6-2017 Huong L.T, Chuc N.T Nutritional status and some related factors of children in a rural primary school in northern Vietnam Journal of Applied Medicine 2009, No 669, pp.2-4 Khor G.L, Chee W.S, Shariff Z.M, Poh B.K, Arumugam M, Rahman J.A, Theobald H.E High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia BMC Public Health 2011, 11, 95 Mai T.T, Hop L.T, Lam N.T, Xuan N.T Overweight-obesity and hyperlipidemia status in to years old in some school in Hoankiem, Hanoi Vietnam Food and Nutrition Journal 2013, (3), August Vieth R Why the minimum desirable serum 25-hydroxyvitamin D level should be 75 nmol/L (30 ng/mL) Best Pract Res Clin Endocrinol Metab 2011, 25 (4), pp.681-691 Bener A, Al-Ali M, Hoffmann G.F Vitamin D deficiency in healthy children in a sunny country: associated factors Int J Food Sci Nutr 2009, 60 (5), pp.60-70 10 WHO WHO AnthroPlus for Personal Computers Software for assessing growth of the world’s children and adolescents 2009, pp.9-11 Haiduong Vietnam Food and Journal 2010, (3 + 4), pp.40-47 168 Nutrition ... Classification of vitamin D serum status: Assessement of vitamin D deficiency was based on serum 25(OH )D concentration Vitamin D was deficient when 25(OH )D concentration < 50 nmol/L, vitamin D was insufficient... 25(OH )D concentration < 75 nmol/L [9] * Statistical analysis: Input data by Epidata 3.1; anthropometric data was analyzed by WHO-Anthro Plus v.1.0.4; statistical analysis data by Stata Journal of. .. deficiency and related factors in 15 - 49 years old women in Hanoi and 167 Journal of military pharma-medicine no6-2017 Huong L.T, Chuc N.T Nutritional status and some related factors of children in a