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

Nội dung text: A cross - sectional survey on status of nutrition and vitamin D dificinecy among nine years old children at primary schools in haiduong city

1. 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 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 healthy bone. Vitamin D deficiency can occur at any age. In Vietnam, there have been Physical growth of children during primary school is an important stage, warnings about vitamin D deficiency in especially during a pre-puberty, children children under 5 years old also in adults grows quickly in height and weight. [4]. However, the problem has not been fully However, nutritional status of primary addressed among primary school children. school children and pre-puberty period The objective of this study was to has rarely been performed in our country. examine status of nutrition and vitamin D Vitamin D has an important role in the deficiency among nine years old children growth, development and maintenance of 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
2. Journal of military pharma-medicine n o6-2017 SUBJECTS AND METHODS Then, an estimated sample size for vitamin D deficiency status survey was 1. Subjects, location and study time. n = 364. - Subjects: 9-years-old, who were in 4 th grade at selected primary schools, had no - Add 3% to sample size, the final sample signs of puberty, no acute illness, parents size for the study was 375 children. agreed to participate. * Collect study data: - Location: Three primary schools of - Weight, height body: Body weight Thanhbinh, Haitan and Ngocchau in was measured with the Tanita BC-571 Haiduong city. electronic balance with a precision of 0.1 - Study time: October 2012. kg. Body height is measured by Unicef's 3-piece logs with a precision of 0.1 cm. 2. Study design. - Blood test: Quantify 25(OH)D (vitamin D) Cross-sectional survey. serum by luminescence immunoassay. * Sample size: * Classification of nutritional status - Sample size for nutritional status according to WHO 2009 [10]: survey: - Underweight when WAZ (Zscore Use the following formula: Weight for Age) < -2SD, stunting when  z 2 HAZ (Zscore Height for Age) < -2SD, n =  −α 2/1  × p 1( − p)  d  wasting when BAZ (Zscore Body Mass Index for Age) < -2SD. n: the sample size; assumptions: - Overweight when BAZ from +1SD to z = 1.96 with a confidence interval: 95%, +2SD, obesity when BAZ > +2SD. d = 0.05; p = 24.2% (prevalence of underweight on previous studies) [1]. * Classification of vitamin D serum status: Then, an estimated sample size for nutritional status survey was n = 282. Assessement of vitamin D deficiency was based on serum 25(OH)D concentration. - Sample size for vitamin D deficiency Vitamin D was deficient when 25(OH)D status survey: concentration < 50 nmol/L, vitamin D was Use the following formula: insufficient when 50 nmol/L ≤ 25(OH)D  z 2 concentration < 75 nmol/L [9]. n =  −α 2/1  × p 1( − p)  d  * Statistical analysis: n: the sample size; assumptions: z = Input data by Epidata 3.1; anthropometric 1.96 with a confidence interval: 95%, d = data was analyzed by WHO-Anthro Plus 0.05; p = 61.6% (prevalence vitamin D v.1.0.4; statistical analysis data by Stata. deficiency on previous studies) [7]. 164
3. Journal of military pharma-medicine no6-2017 RESULTS AND DISCUSSION 1. Nutritional status of subjects. Table 1: Anthropometric characteristics by gender. Subjects Boys Girls p (n = 198 ) (n = 177) Characteristics ± SD ± SD 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 p 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 (%) 8 (4.0) 6 (3.4) 14 (3.7) > 0.05 Overweight-obesity, n (%) 40 (20.2) 30 (16.9) 70 (18.7) > 0.05 Study results showed that: the Hanoi in 2009. This difference could be prevalence of underweight was 7.7%. This explained by the fact that underweight prevalence ranked as low by the WHO children tend to decrease over time and classification of malnutrition and lower the economic, social and cultural than the result of nutritional survey in conditions in Haiduong city was not good 2010 with this prevalence of elementary as in Hanoi Capital. school children was 24.2 % [1]. On the The prevalence of stunting was 9.3%. other hand, this prevalence was higher This prevalence ranked as low by the than the results of study conducted by WHO classification of malnutrition. This Huong LT and Chuc NT was 4.3% on prevalence was higher than the results of pupils at Xuanphuong primary school in study conducted by Hanh TT and et al at 165
4. Journal of military pharma-medicine n o6-2017 primary school children was 3.5% in the result of nutritional survey in 2010 with Hochiminh City in 2011 [3], lower than the this prevalence of elementary school children result of nutritional survey in 2010 with was 12.7%[1]. However, this prevalence this prevalence of elementary school was lower than results of study in Hanoi children was 23.4% [1]. This difference and Hochiminh city. Study result of Diep could be explained by the fact that DT at 2,500 primary school pupils in 2009 stunting children tend to decrease over in Hochiminh City was 28.5% [2]. Mai time and the difference about of TT's survey in 2013 in 2,375 children economic, social and cultural conditions. aged 4 - 9 in Hoankiem District, Hanoi, About wasting, the prevalence was 3.7%, the prevalence of overweight-obesity was ranked as low by the WHO classification 39.9%, overweight-obesity increases with of malnutrition. This rate was comparable age and boys is higher than girls [6]. Our to the study of Hanh TT and et al in 2011 study also found that this prevalence of for elementary school children in Hochiminh boys was higher than girls. Thus, City was 4% [3]. overweight-obesity was a very noticeable The prevalence of overweight-obesity problem in primary school children in was 18.7%. This prevalence was lower than Haiduong city. 2. Vitamin D serum status of subjects. Table 3: Vitamin D serum status of subjects. Subjects Boys Girls Total p Status (n = 196) (n = 173) (n = 369) Vitamin D serum concentration (nmol/L) 67.2 ± 13.4 62.2 ± 11.4 64.8 ± 12.7 < 0.05 Vitamin D deficiency, n (%) 17 (8.7) 22 (12.7) 39 (10.6) > 0.05 Vitamin D insufficiency, n (%) 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
5. Journal of military pharma-medicine no6-2017 vitamin D 10.6 18.9 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 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 REFERENCES * Nutritional status: 1. Viet Nam Ministry of Health, National Prevalence of underweight, stunting, Institute of Nutrition. Nutritional status of 5 - 10 years old children. National Nutritional and wasting were 7.7%, 9.3% and 3.7%, Surveys 2009 - 2010. Hanoi. Medical respectively. Prevalence of overweight Publishing House. 2010, pp.54-59 and p.87. and obesity was 18.7%. There was no 2. Diep D.T et al. Overweight, obesity and significant difference about prevalence of some epidemiological characteristics of underweight, stunting, wasting and primary school pupils in district 10, Hochiminh overweight-obesity between boys and City in the school year 2008 - 2009. Medical girls. News. 2011, December, No 67. * Vitamin D serum status: 3. Hanh T.T, Hoa V.Q, Oanh P.N, Diep D.T, Qui L.T. Nutritional status of secondary Prevalence of vitamin D deficiency was pupils in Hochiminh City. Vietnam Food and 10.6%, in girl 12.7%, in boy 8.7%. Nutrition Journal. 2012, 8 (3), pp.39-45. Prevalence of vitamin D insufficiency was 4. Hien V.T, Lam N.T, Anh L.H, Anh N.T et 70.5%, higher in girl (75.7%) compared to al. Vitamin D deficiency and related factors in boy (65.8%), p < 0.05. 15 - 49 years old women in Hanoi and 167
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