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Ann Pediatr Endocrinol Metab > Volume 27(1); 2022 > Article
Lim: Commentary on “Low serum 25-hydroxyvitamin D level is associated with obesity and atherogenesis in adolescent boys”
Vitamin D deficiency is a major public health concern in children and adolescents [1]. Based on a definition of vitamin D deficiency and insufficiency of <20 ng/mL and <30 ng/mL serum 25-hydroxyvitamin D3 (2(OH)D3) concentrations, respectively [2], the prevalence of vitamin D deficiency was 15% of the pediatric population in the United States [3]. In Korea, over onethird of children aged 1–15 years have vitamin D deficiency, and 90% or more of children and adolescents have vitamin D deficiency or insufficiency; this might result from lifestyle changes with increasing screen-time, sunscreen use [4], decreasing outdoor physical activity, and insufficient vitamin D intake [1].
The role of vitamin D in bone metabolic modulation is well established. Recent studies have also shown that vitamin D status is associated with infectious diseases, some cancers, autoimmune diseases, and diabetes mellitus, in addition to skeletal diseases [5]. A few studies have revealed that vitamin D deficiency can increase the risk of cardiovascular complications and metabolic dysfunction such as obesity, hypertension, dyslipidemia, and hyperglycemia during childhood and adolescence [6]. Moreover, a few meta-analyses have demonstrated that vitamin D supplementation may improve metabolic homeostasis and help promote general health [3,7,8].
The underlying pathophysiological mechanisms between low serum levels of vitamin D and obesity remain unclear. Some evidence has suggested that obesity may cause hypovitaminosis D due to volumetric dilution and sequestration in the adipose tissue, decreased cutaneous biosynthesis of vitamin D, and reduced expression of vitamin D-metabolizing enzymes. Conversely, low vitamin D may cause obesity due to regulation of adiposity-related genes and leptin, and vitamin D receptor gene polymorphism [9,10]. However, most previous studies agree that weight reduction has only a weak benefit in terms of vitamin D level, and vitamin D supplementation does not affect body weight or body mass index, except for body fat distribution [9,10].
The results of this study provide evidence that low serum 25(OH)D3 levels are positively associated with the risk of obesity and atherogenesis in Japanese adolescent boys, but not in girls [11]. This sex difference was presumed to be related to body composition, sun exposure, puberty. A few studies also reported sex differences in vitamin D deficiency and vitamin D-driven improvements in testosterone [12]. However, the mechanism of these sex differences remains unclear.
This study has some limitations. The authors did not evaluate participants’ pubertal status, socio-economic conditions, physical activity, or nutritional status. These factors strongly influence weight balance and serum vitamin D level.
Further multicenter longitudinal investigations are needed to determine the relationship underlying serum vitamin D levels, metabolic derangements, and sex differences in children and adolescents, including confounding factors.

Notes

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

References

1. Seo JH, Chung HJ, Kim HJ, Yeom JS, Park JS, Park ES, et al. Increasing vitamin D deficiency in children from 1995 to 2011. Turk J Pediatr 2016;58:616–22.
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7. Akbari M, Moosazaheh M, Lankarani KB, Tabrizi R, Samimi M, Karamali M, et al. The effects of vitamin D supplementation on glucose metabolism and lipid profiles in patients with gestational diabetes: a systematic review and meta-analysis of randomized controlled trials. Horm Metab Res 2017;49:647–53.
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8. Chung IH, Kang YS, Yoo EG. Response to vitamin D replacement in overweight and normal weight children with vitamin D deficiency. Ann Pediatr Endocrinol Metab 2019;24:22–6.
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9. Karampela I, Sakelliou A, Vallianou N, Christodoulatos GS, Magkos F, Dalamaga M. Vitamin D and obesity: current evidence and controversies. Curr Obes Rep 2021;10:162–80.
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10. Barrea L, Frias-Toral E, Pugliese G, Garcia-Velasquez E, DE Los Angeles Carignano M, Savastano S, et al. Vitamin D in obesity and obesity-related diseases: an overview. Minerva Endocrinol (Torino) 2021;46:177–92.
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11. Naganuma J, Koyama S, Arisaka O, Yoshihara S. Low serum 25-hydroxyvitamin D level is associated with obesity and atherogenesis in adolescent boys. Ann Pediatr Endocrinol Metab 2022;27:30–6.
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12. Sanghera DK, Sapkota BR, Aston CE, Blackett PR. Vitamin D status, gender differences, and cardiometabolic health disparities. Ann Nutr Metab 2017;70:79–87.
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