Acanthosis nigricans is a strong predictor of low blood calcidiol levels in children and adolescents

Authors: ISART, FERNANDO - Children'S Nutrition Research Center (CNRC); ISART-INFANTE, FERNANDO - Ecocheck Laboratories, Llc; HEIDEL, ERIC - University Of Tennessee; SISLEY, STEPHANIE - Children'S Nutrition Research Center (CNRC)

Submitted to: Metabolic Syndrome and Disorders
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/19/2022
Publication Date: 7/14/2022
Citation: Isart, F.A., Isart-Infante, F.J., Heidel, E.R., Sisley, S. 2022. Acanthosis nigricans is a strong predictor of low blood calcidiol levels in children and adolescents. Metabolic Syndrome and Related Disorders. https://doi.org/10.1089/met.2022.0005.
DOI: https://doi.org/10.1089/met.2022.0005

Interpretive Summary: Low levels of vitamin D can result in problems with bone development or density. Thus, it is very important to determine who should be screened for low vitamin D levels. Two other risk factors for low vitamin D levels are obesity and metabolic syndrome (where children have obesity with abnormalities in blood pressure, blood sugar, and/or blood fats). However, since there are so many children with obesity, it is debated whether children with obesity should have vitamin D levels drawn routinely. Determining if there are subsets of children with obesity who are more likely to have low vitamin D levels and thus need vitamin D levels measured is important. Acanthosis nigricans is a physical examination finding where there is dark, raised skin on the back of the neck (as well as other areas of the body). Since acanthosis nigricans is linked to metabolic syndrome, we tested if the presence of acanthosis nigricans might be a marker for low vitamin D levels in children. In this study we found, that children with acanthosis were 3.6 times more likely to have low vitamin D levels that those without acanthosis nigricans. We also found that individuals who had low vitamin D levels were more likely to have metabolic syndrome, independent of their body size. Thus, our research shows that children with acanthosis are at a higher risk of low vitamin D levels. This work may indicate that children with acanthosis nigricans should have vitamin D levels drawn routinely.

Technical Abstract: Clinical consensus differs as to when blood vitamin D (VD) levels should be measured in children. Obesity and metabolic syndrome are risk factors for low VD levels and are also associated with acanthosis nigricans(AN). To test whether the clinical diagnosis of AN is a strong predictor for vitamin D deficiency (VDD) in children. Within the study period (2015–2020), we identified 677 consecutive individuals (age <18 years) with available calcidiol measurements and compared those with (n = 273) and without (n = 404) AN. Bivariate associations and the occurrence of AN were tested using the chi-squared test. Multivariate logistic regression was performed to control for confounding variables, and adjusted odds ratios with 95% confidence intervals (CI)were reported. Multiple regression analysis was performed, and unstandardized beta coefficients, standard errors, and standardized beta coefficients were reported. Individuals with AN had 3.6 times higher odds of VDD than those without (95% CI: 1.38–9.51, P = 0.009). Males had 0.41 times lower odds of having AN than females (95% CI: 0.21–0.79, P = 0.008). Individuals with vitamin D sufficiency (VDS) were much less likely to be diagnosed with metabolic syndrome compared with those who were vitamin D deficient (P = 0.011), even after adjusting for body mass index z-scores. Children and adolescents with AN are at a higher risk of VDD and should likely be tested for low calcidiol levels.