The Journal of Nutrition
Vitamin D Status of Inuit Preschoolers Reflects
Season and Vitamin D Intake1,2
Jessy El Hayek,3,4Grace Egeland,3,4and Hope Weiler3,4*
3School of Dietetics and Human Nutrition, McGill University, Montreal H9X 3V9, Quebec, Canada; and4Centre for Indigenous Peoples’
Nutrition and Environment, McGill University Macdonald Campus, Sainte-Anne-de-Bellevue, Quebec H9X 3V9m Canada
Rickets ascribedto hypovitaminosis D remains a publichealth concern amongAboriginalchildren in Canada and theUnited
States. Our primary objective in this study was to investigate the prevalence and risk factors (gender, age, vitamin D
intake, and socioeconomic status) for low vitamin D status of Inuit preschoolers living in 16 Arctic communities (51oN-
70oN) and participating in the 2007–2008 Nunavut Child Inuit Health Survey. Children were selected randomly in summer
(n = 282) and a follow-up was performed in winter for a subsample (n = 52). Dietary intake was assessed through the
administration of a 24-h dietary recall and a FFQ. Anthropometric measurements (height, weight) were assessed. Plasma
25-hydroxy vitamin D was measured using a chemiluminescent assay (Liaison, Diasorin). Prevalence of vitamin D
insufficiency (,75 nmol/L) among preschoolers was 78.6% and 96.8% in summer and winter, respectively. Median
vitamin D concentrations and interquartile ranges in summer and winter were 48.3 (32.8–71.3) and 37.7 (21.4–52.0) nmol/
L, respectively. The prevalence of vitamin D deficiency , 25 and , 37.5 nmol/L was 13.6 and 36.5%, respectively.
Children who met or exceeded the adequate intake, those who consumed 2 or more milk servings (1 serving = 250 mL),
and those who lived in households without crowding (47.7%) had a better vitamin D status than those who did not. The
milk, interventions promoting vitamin D supplementation may be required.J. Nutr. 140: 1839–1845, 2010.
In the United States, national data on rickets prevalence is
unavailable; however, a review of reports published between
1986 and 2003 regarding nutritional rickets among children ,
18 y of age identified 166 cases in 22 published studies (1). In
Canada, a recent pediatric surveillance assessment of rickets
estimated 2.9 cases/100,000 infants and children (0–18 y) (2).
The majority of cases were characterized by darker skin
pigmentation and lack of vitamin D supplementation. The
highest incidence rate was observed among children living in the
Northwest Territories (15 cases/100,000) and Nunavut (14
cases/100,000). However, only a limited number of studies have
assessed vitamin D status of infants and children at high
latitudes (2). In addition, evidence suggests that Aboriginal
people have low intakes of vitamin D, have shifted toward the
consumption of more market foods (3), and have reduced their
consumption of traditional foods rich in vitamin D (4). Further,
infrequent use of vitamin D supplements (5), darker skin (6),
higher obesity rates (7), and northern latitude (2) are risk factors
predisposing Arctic Indigenous Peoples to vitamin D deficiency
or insufficiency. At northern latitudes, season strongly affects
endogenous vitamin D synthesis as a function of solar UVB
radiation (290–315 mm) (8). Ineffective synthesis of vitamin D
lasts from November through February in Boston (42.28N);
however, at higher latitudes, this period extends to 6 mo. For
instance, in Edmonton (528N) and some parts of Norway
(618N), this ineffective winter period extends from October
through March (9).
One of the modifiable risk factors for vitamin D deficiency is
dietary intake. It is anticipated that intakes in young children are
below current recommendations and are insufficient to meet
new status targets (75 nmol/L) set by the Canadian Pediatric
Society (CPS)5(10). When the 25-hydroxy vitamin D [25(OH)D]
concentration exceeds 75 nmol/L, parathyroid hormone (PTH)
concentration plateaus in adolescents (11) and intestinal
calcium transport increases in 6- to 10-y-old children (12).
Although limited data are available on the vitamin D status of
Aboriginal youth (13,14), studies conducted in more southern
regions in the United States (408N) and Canada (528N) (15,16)
link low vitamin D intake with lower 25(OH)D concentrations.
Furthermore, winter season (14,15), high BMI (17,18), and race
(19,20) were important predictors of hypovitaminosis D. The
1Supported by grants of the International Polar Year and Canadian Institutes for
2Author disclosures: J. Hayek, G. Egeland, and H. Weiler, no conflicts of
* To whom correspondence should be addressed. E-mail: hope.weiler@mcgill.
5Abbreviations used: AAP, American Academy of Pediatrics; DV, daily value;
CPS, Canadian Pediatric Society; IQR, interquartile range; PTH, parathyroid
hormone; 25(OH)D, 25-hydroxy vitamin D.
ã 2010 American Society for Nutrition.
Manuscript received March 26, 2010. Initial review completed May 31, 2010. Revision accepted July 11, 2010.
First published online August 11, 2010; doi:10.3945/jn.110.124644.
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