Association Between Vitamin D Levels and Nutritional Status in Hospitalized Children: A Single-Center Cross-Sectional Study at a Tertiary Referral Hospital in Makassar, Indonesia

Abstract

In nations with low and middle incomes (LMICs), malnutrition during early childhood often occurs alongside micronutrient inadequacy, including suboptimal vitamin D status. Whether anthropometric evidence of acute malnutrition parallels circulating vitamin D in children requiring hospitalization, however, remains uncertain. This cross-sectional investigation was carried out at Dr. Wahidin Sudirohusodo Hospital in Makassar, Indonesia, an Indonesian tertiary referral center. According to weight-for-length z-scores (WLZ) or weight-for-height z-scores (WHZ), children between the ages of one month and five years were categorized as well-nourished, undernourished, or severely malnourished. The enzyme-linked immunosorbent assay (ELISA) was employed to quantify the levels of circulating 25-hydroxyvitamin D [25(OH)D]. Kruskal-Wallis analysis was applied for between-group comparison, whereas Spearman rank correlation examined the association of 25(OH)D with ordered nutritional status. A supplementary analysis assessed whether this relationship persisted after accounting for age, sex, and documented gastrointestinal problems. The analysis comprised 80 children. Median 25(OH)D concentrations were 44 ng/mL, 35 ng/mL, and 47 ng/mL in the well-nourished, undernourished, and severely malnourished groups, respectively, without a statistically significant difference among groups (p = 0.686). Vitamin D status was normal in 70 children (87.5%), insufficient in 6 (7.5%), and deficient in 4 (5.0%); severe deficiency was not detected. The four deficient cases comprised 2/40 well-nourished children (5.0%), 1/20 undernourished child (5.0%), and 1/20 severely malnourished child (5.0%). Ordered anthropometric nutritional status showed essentially no correlation with serum 25(OH)D (r = -0.023; p = 0.841), and adjustment did not alter this finding (p = 0.988). In this hospitalized cohort, wasting-based anthropometric grouping showed limited correspondence with vitamin D status. Further research should examine factors not captured by anthropometry, particularly dietary exposure, sunlight-related factors, previous supplementation, and severity of illness.