Association of Serum Vitamin A and D Status with Neuropsychological Development Outcomes in Children Aged 4 to 24 Months: A Retrospective Cross-Sectional Study
Abstract
Background: We aimed to assess the prevalence of serum Vitamin A and D status and their potential association with neuropsychological development outcomes in Southern China.
Methods: A hospital-based retrospective study was conducted in Guangzhou, China, with 4,206 children aged 4 to 24 months between 2018 and 2020. Data from the hospital’s electronic database included serum levels of Vitamin A and D, along with neuropsychological outcomes. Linear regression model was used to assess the association between serum Vitamin A and D status and neuropsychological outcomes, while multiple binary logistic regression model was applied to determine the association of these Vitamins’ levels with different neuropsychological developmental delays, adjusting for age, gender, and other potential confounders.
Results: Overall, 12.7% of children were found to be deficient in Vitamin A, while 2.5% were deficient in Vitamin D. Marginal Vitamin A deficiency (MVAD) was prevalent in 58.5% of the children, and 19.4% exhibited Vitamin D insufficiency (VDI). Neuropsychological developmental delays were observed in 7.7% to 16.8% of the children across various domains. However, there were no significant differences in neuropsychological outcomes among children with varying Vitamin A and D statuses (P-value>0.05). Even after adjusting for potential confounders, the association between Vitamin A and D levels and neuropsychological development outcomes remained statistically non-significant.
Conclusion: Our study reveals a higher prevalence of VAD and MVAD in children than VDD and VDI. However, neither Vitamin A nor Vitamin D status showed a significant association with neuro-psychological development outcomes in early childhood.
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31. Gordon CM, Feldman HA, Sinclair L, et al (2008). Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med, 162 (6):505-512.
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33. Tylavsky FA, Kocak M, Murphy LE, et al (2015). Gestational vitamin 25 (OH) D status as a risk factor for receptive language development: a 24-month, longitudinal, observational study. Nutrients, 7 (12):9918-9930.
34. Buckley GJ, Murray-Kolb LE, Khatry SK, et al (2013). Cognitive and motor skills in school-aged children following maternal vitamin A supplementation during pregnancy in rural Nepal: a follow-up of a placebo-controlled, randomised cohort. BMJ Open, 3 (5).
35. Filteau S, Rehman AM, Yousafzai A, et al (2016). Associations of vitamin D status, bone health and anthropometry, with gross motor development and performance of school-aged Indian children who were born at term with low birth weight. BMJ Open, 6 (1):e009268.
36. Gould JF, Anderson AJ, Yelland LN, et al (2017). Association of cord blood vitamin D with early childhood growth and neurodevelopment. J Paediatr Child Health, 53 (1):75-83.
37. Darling AL, Rayman MP, Steer CD, et al (2017). Association between maternal vitamin D status in pregnancy and neurodevelopmental outcomes in childhood: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Br J Nutr, 117 (12):1682-1692.
2. Perna R, Loughan A (2012). Early developmental delays: neuropsychological sequelae and subsequent diagnoses. Appl Neuropsychol Child, 1 (1):57-62.
3. Organization WHOJGWH (2020). Early child development.
4. Wang L, Chen Y, Sylvia S, et al (2021). Trajectories of child cognitive development during ages 0–3 in rural Western China: prevalence, risk factors and links to preschool-age cognition. BMC Paediatr, 21 (1):199.
5. French B, Outhwaite LA, Langley‐Evans S, et al (2020). Nutrition, growth, and other factors associated with early cognitive and motor development in Sub‐Saharan Africa: a scoping review. J Hum Nutr Diet, 33 (5):644-669.
6. Prado EL, Dewey KG (2014). Nutrition and brain development in early life. Nutr Rev, 72 (4):267-84.
7. Bhutta ZA, Salam RA, Das JK (2013). Meeting the challenges of micronutrient malnutrition in the developing world. Br Med Bull, 106:7-17.
8. Benton DJPotNS (2012). Vitamins and neural and cognitive developmental outcomes in children. Proc Nutr Soc, 71 (1):14-26.
9. Nichols EK, Khatib IM, Aburto NJ, et al (2015). Vitamin D status and associated factors of deficiency among Jordanian children of preschool age. Eur J Clin Nutr, 69 (1):90-5.
10. Shastak Y, Pelletier WJWsPSJ (2023). Delving into vitamin A supplementation in poultry nutrition: current knowledge, functional effects, and practical implications. World's Poult Sci J, 1-23.
11. Chen Y-j, Liu M, Mao C-y, Zhang S-hJBRI (2018). An investigation of vitamin levels status in the serum of children in China. BioMed Res Int, 2018:1-6.
12. Wacker M, Holick MF (2013). Vitamin D—effects on skeletal and extraskeletal health and the need for supplementation. Nutrients, 5 (1):111-148.
13. Ali A, Cui X, Eyles D (2018). Developmental vitamin D deficiency and autism: putative pathogenic mechanisms. J Steroid Biochem Mol Biol, 175:108-118.
14. Organization WH (2009). Global prevalence of vitamin A deficiency in populations at risk 1995-2005: WHO global database on vitamin A deficiency.
15. Sommer A (1993). Vitamin A, infectious disease, and childhood mortality: a 2¢ solution? J Infect Dis, 167 (5):1003-1007.
16. Stevens GA, Bennett JE, Hennocq Q, et al (2015). Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. The Lancet Global Health, 3 (9):e528-e536.
17. Singh V, West K (2004). Vitamin A deficiency and xerophthalmia among school-aged children in Southeastern Asia. Eur J Clin Nutr, 58 (10):1342-1349.
18. Chen K, Zhang X, Wei X-p, et al (2009). Antioxidant vitamin status during pregnancy in relation to cognitive development in the first two years of life. Early Hum Dev, 85 (7):421-427.
19. Holick MF (2008). The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Asp Med, 29 (6):361-368.
20. Wang L-l, Wang H-y, Wen H-k, et al (2016). Vitamin D status among infants, children, and adolescents in southeastern China. J Zhejiang Univ Sci B, 17 (7):545-552.
21. Brouwer-Brolsma EM, Vrijkotte TG, Feskens EJ (2018). Maternal vitamin D concentrations are associated with faster childhood reaction time and response speed, but not with motor fluency and flexibility, at the age of 5–6 years: the Amsterdam Born Children and their Development (ABCD) Study. Br J Nutr, 120 (3):345-352.
22. Morales E, Guxens M, Llop S, et al (2012). Circulating 25-hydroxyvitamin D3 in pregnancy and infant neuropsychological development. Pediatrics, 130 (4):e913-e920.
23. Whitehouse AJ, Holt BJ, Serralha M, et al (2012). Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics, 129 (3):485-493.
24. Wang Y, Zheng Y, Chen P, et al (2021). The weak correlation between serum vitamin levels and chronic kidney disease in hospitalized patients: a cross-sectional study. BMC Nephrology, 22 (1):292.
25. Liu R, Chen Y, Wu H, et al (2021). Serum vitamin A, D and E concentrations and status in children in Shaanxi Province, Northwest China. Asia Pac J Clin Nutr, 30 (4):687-695.
26. Liu R, Wu H, Chen Y, et al (2022). Prevalence of vitamin A and vitamin D deficiency in hospitalized neonates in Xi'an, China. Asia Pac J Clin Nutr, 31 (2):275-281.
27. Guo Y, Ke H-J, Liu Y, et al (2018). Prevalence of vitamin D insufficiency among children in southern china: A cross-sectional survey. Medicine, 97 (25).
28. Janner M, Ballinari P, Mullis P-E, et al (2010). High prevalence of vitamin D deficiency in children and adolescents with type 1 diabetes. Eur J Med Sci, 140:w13091.
29. Li H-H, Feng J-Y, Wang B, et al (2019). Comparison of the children neuropsychological and behavior scale and the Griffiths mental development scales when assessing the development of children with autism. Psychol Res Behav Manag, 12:973-981.
30. Jabri L, Rosenthal DM, Benton L, Lakhanpaul M (2020). Complementary feeding practices and nutrient intakes of children aged 6–24 months from Bangladeshi background living in Tower Hamlets, East London: a feasibility study. J Health Popul Nutr, 39 (1):1-15.
31. Gordon CM, Feldman HA, Sinclair L, et al (2008). Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med, 162 (6):505-512.
32. Chowdhury R, Taneja S, Kvestad I, et al (2020). Vitamin D status in early childhood is not associated with cognitive development and linear growth at 6-9 years of age in North Indian children: a cohort study. Nutr J, 19 (1):14.
33. Tylavsky FA, Kocak M, Murphy LE, et al (2015). Gestational vitamin 25 (OH) D status as a risk factor for receptive language development: a 24-month, longitudinal, observational study. Nutrients, 7 (12):9918-9930.
34. Buckley GJ, Murray-Kolb LE, Khatry SK, et al (2013). Cognitive and motor skills in school-aged children following maternal vitamin A supplementation during pregnancy in rural Nepal: a follow-up of a placebo-controlled, randomised cohort. BMJ Open, 3 (5).
35. Filteau S, Rehman AM, Yousafzai A, et al (2016). Associations of vitamin D status, bone health and anthropometry, with gross motor development and performance of school-aged Indian children who were born at term with low birth weight. BMJ Open, 6 (1):e009268.
36. Gould JF, Anderson AJ, Yelland LN, et al (2017). Association of cord blood vitamin D with early childhood growth and neurodevelopment. J Paediatr Child Health, 53 (1):75-83.
37. Darling AL, Rayman MP, Steer CD, et al (2017). Association between maternal vitamin D status in pregnancy and neurodevelopmental outcomes in childhood: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Br J Nutr, 117 (12):1682-1692.
| Files | ||
| Issue | Vol 54 No 5 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i5.18636 | |
| Keywords | ||
| Early childhood Serum vitamin A Serum vitamin D Cognitive development Developmental delays | ||
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How to Cite
1.
Akbar F, Guo Y, Wu J, Huang Z. Association of Serum Vitamin A and D Status with Neuropsychological Development Outcomes in Children Aged 4 to 24 Months: A Retrospective Cross-Sectional Study. Iran J Public Health. 2025;54(5):1014-1023.
