Incidence rate of symptomatic vitamin D deficiency in children: a nationwide survey in Japan — ASN Events
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Incidence rate of symptomatic vitamin D deficiency in children: a nationwide survey in Japan (#170)

Takuo Kubota 1 , Yosikazu Nakamura 2 , Kenji Ihara 3 , Koji Oba 4 , Sachiko Kitanaka 5 , Satoshi Kusuda 6 , Satomi Koyama 7 , Yusuke Tanahashi 8 , Yukihiro Hasegawa 9 , Seiji Fukumoto 10 , Ikuma Fujiwara 11 , Toshimi Michigami 12 , Tohru Yorifuji 13 , Keisuke Nagasaki 14 , Yuko Sakamoto 15 , Toshiaki Shimizu 16 , Hirokazu Tsukahara 17 , Haruo Mizuno 18 , Keiichi Ozono 1
  1. Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  2. Jichi Medical University, Shimotsuke, Tochigi, Japan
  3. Oita University Faculty of Medicine, Oita, Japan
  4. The University of Tokyo Graduate School of Medicine, Tokyo, Japan
  5. The University of Tokyo Graduate School of Medicine, Tokyo, Japan
  6. Tokyo Women's Medical University Medical Center, Tokyo, Japan
  7. Dokkyo Medical University, Mibu, Tochigi, Japan
  8. Asahikawa Medical University, Asahikawa , Hokkaido, Japan
  9. Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
  10. Tokushima University, Tokushima, Japan
  11. Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
  12. Osaka Medical Center for Maternal and Child Health, Izumi, Osaka, Japan
  13. Osaka City General Hospital, Osaka, Japan
  14. Niigata University Graduate School of Medical and Dental Sciences , Niigata, Japan
  15. Juntendo University Nerima Hospital, Tokyo, Japan
  16. Juntendo University Graduate School of Medicin, Tokyo, Japan
  17. Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  18. Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan

There is a concern that vitamin D deficiency is prevalent among children in Japan as well as in the world, based on anecdotal reports. We conducted a nationwide epidemiologic survey of symptomatic vitamin D deficiency to observe its incidence rate among Japanese children. A questionnaire inquiring the number of new patients with vitamin D deficient rickets and/or hypocalcemia visiting the target hospitals between 2013 and 2015 was sent to 855 hospitals with department of pediatrics, which were randomly selected from the all hospitals in Japan. Diagnostic criteria for vitamin D deficiency were based on the guidance provided by the Japanese Society for Pediatric Endocrinology. In details, vitamin D dependent rickets was defined as clinical signs and symptoms and radiographic findings related to rickets, increased serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) concentrations and either of hypophosphatemia or hypocalcemia, and hypocalcemia due to vitamin D deficiency was defined as clinical signs and symptoms related to hypocalcemia, physical and radiographic findings related to rickets, increased ALP and PTH concentrations and decreased serum calcium levels. The response rate was 53%. We identified 249 children with vitamin D deficiency, comprised of 212 rickets, 26 symptomatic hypocalcemia, and 11 of both. The estimated number of patients with vitamin D deficiency per year was 184 (95% CI: 145–223). The overall annual incidence rate among children under 15 years of age was 1.1 per 100,000 population per year (95% CI: 0.9–1.4). This is the first nationwide survey on definitive clinical vitamin D deficiency in children in Japan. The lower incidence rate in comparison with previous studies in developed countries might be due to the different inclusion criteria among studies. Determining the frequency of vitamin D deficiency among children would be useful to develop public health strategies to prevent it.