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Vitamin D Deficiency Associated With Increased Incidence of Gastrointestinal and Ear Infections in School-age Children

Thornton, Kathryn A. DMD, MPH*; Marín, Constanza RD; Mora-Plazas, Mercedes MSc, RD; Villamor, Eduardo MD, DrPH*

Pediatric Infectious Disease Journal: June 2013 - Volume 32 - Issue 6 - p 585–593
doi: 10.1097/INF.0b013e3182868989
Original Studies

Background: Vitamin D deficiency (VDD) is highly prevalent among children worldwide. The effects of VDD include alterations of the immune response and increased risk of infection but little evidence exists in school-age children. We investigated the association of vitamin D status with morbidity in a prospective study of school-age children from Bogotá, Colombia.

Methods: We measured plasma 25-hydroxyvitamin D (25(OH)D) concentrations in a random sample of 475 children (mean ± standard deviation age: 8.9 ± 1.6 years) and followed them for an academic year. Caregivers were asked to record daily information on the incidence of morbidity episodes using pictorial diaries. Baseline vitamin D status was classified according to 25(OH)D concentrations as deficient (<50 nmol/L), insufficient (≥50 and <75 nmol/L) or sufficient (≥75 nmol/L). We used Poisson regression to estimate incidence rate ratios and 95% confidence intervals for days with diarrhea, vomiting, diarrhea with vomiting, cough with fever and earache or discharge with fever, comparing vitamin D-deficient with vitamin D-sufficient children. Estimates were adjusted for child’s age, sex and household socioeconomic status.

Results: The prevalence of VDD was 10%; an additional 47% of children were vitamin D-insufficient. VDD was associated with increased rates of diarrhea with vomiting (adjusted incidence rate ratio: 2.05; 95% confidence interval: 1.19, 3.53) and earache/discharge with fever (adjusted incidence rate ratio: 2.36; 95% confidence interval: 1.26, 4.44). VDD was not significantly related to cough with fever.

Conclusions: These results suggest that VDD is related to increased incidence of gastrointestinal and ear infections in school-age children. The effect of correcting VDD on reducing risk of these infections needs to be tested in supplementation trials.

From the *Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI; and Fundación para Investigación en Nutrición y Salud, FINUSAD; Bogotá, Colombia.

Accepted for publication January 7, 2013.

The authors have no conflicts of interest to disclose. The Bogotá School Children Cohort is currently sponsored by the ASISA Research Fund at the University of Michigan.

Address for correspondence: Kathryn A. Thornton, DMD, MPH, Department of Epidemiology and Biostatistics, Michigan State University 909 Fee Road Room B601, East Lansing, MI 48824. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.