A cross-sectional survey on status of nutrition and vitamin D dificinecy among nine years old children at primary schools in Haiduong city

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.

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 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 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 5 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

SUBJECTS AND METHODS

1 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

2 Study design

Cross-sectional survey

* Sample size:

- Sample size for nutritional status

survey:

Use the following formula:

) 1 (

2 2 / 1

p p d

z











= −α

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:

) 1 (

2 2 / 1

p p d

z











= −α

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]

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

- 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

RESULTS AND DISCUSSION

1 Nutritional status of subjects

Table 1: Anthropometric characteristics by gender

Subjects

Characteristics

Boys (n = 198 )

± SD

Girls (n = 177)

± SD

p

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

Nutritional status

Boys (n = 198)

Girls (n = 177)

Total (n = 375)

p

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

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

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 4 - 9 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

2 Vitamin D serum status of subjects

Table 3: Vitamin D serum status of subjects

Subjects

Status

Boys (n = 196)

Girls (n = 173)

Total (n = 369)

p

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

70.5

deficiency

vitamin D insufficiency vitamin D normal

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 7 - 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

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