Determinants of 25(OH)D Sufficiency in Obese Minority Children: Selecting Outcome Measures and Analytic Approaches

Objective To highlight complexities in defining vitamin D sufficiency in children. Study design Serum 25-(OH) vitamin D [25(OH) D] levels from 140 healthy obese children age 6 to 21 years living in the inner city were compared with multiple health outcome measures, including bone biomarkers and cardiovascular risk factors. Several statistical analytic approaches were used, including Pearson correlation, analysis of covariance (ANCOVA), and hockey stick regression modeling. Results Potential threshold levels for vitamin D sufficiency varied by outcome variable and analytic approach. Only systolic blood pressure (SBP) was significantly correlated with 25(OH) D (r = -0.261; P = .038). ANCOVA revealed that SBP and triglyceride levels were statistically significant in the test groups [25(OH) D <10, <15 and <20 ng/mL] compared with the reference group [25(OH) D >25 ng/mL]. ANCOVA also showed that only children with severe vitamin D deficiency [25(OH) D <10 ng/mL] had significantly higher parathyroid hormone levels (Delta = 15; P = .0334). Hockey stick model regression analyses found evidence of a threshold level in SBP, with a 25(OH) D breakpoint of 27 ng/mL, along with a 25(OH) D breakpoint of 18 ng/mL for triglycerides, but no relationship between 25(OH) D and parathyroid hormone. \ Conclusions Defining vitamin D sufficiency should take into account different vitamin D-related health outcome measures and analytic methodologies. (J Pediatr 2011;158:930-4).