{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T13:48:43Z","timestamp":1778507323733,"version":"3.51.4"},"reference-count":59,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Children with congenital adrenal hyperplasia (CAH) face significant risks of impaired growth and metabolic disturbances despite standard glucocorticoid therapy. This cross-sectional study aimed to evaluate growth outcomes, nutritional status, and associated factors among children with CAH treated in a Vietnamese tertiary pediatric center. Methods: We assessed 201 children aged 1.1\u201316.5 years in a tertiary pediatric center in Vietnam for anthropometric parameters, biochemical markers (calcium, phosphate, 25-hydroxyvitamin D), and clinical features. Growth status was evaluated using WHO standards, and bone age was assessed radiographically. Statistical analyses explored associations between growth outcomes and clinical, biochemical, and treatment-related factors. Results: Stunting was present in 16.4% of children, while 53.3% were overweight or obese. Bone age advancement occurred in 51.7% of cases. Vitamin D insufficiency or deficiency was detected in 85.6% of patients, and hypocalcemia was present in 85.1%. Overweight\/obesity, vitamin D deficiency, and bone age advancement were associated with older age, prolonged corticosteroid therapy, higher androgen levels, and clinical features of treatment imbalance (e.g., Cushingoid appearance, hyperpigmentation). Female sex was significantly associated with higher rates of stunting. Conclusions: Growth impairment, nutritional deficiencies, and skeletal maturation disturbances are prevalent among children with CAH in Vietnam. Early identification of risk factors and the implementation of tailored management strategies that address both endocrine and nutritional health are crucial for optimizing long-term outcomes.<\/jats:p>","DOI":"10.3390\/diagnostics15121534","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T09:51:22Z","timestamp":1750067482000},"page":"1534","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Growth Assessment and Nutritional Status in Children with Congenital Adrenal Hyperplasia\u2014A Cross-Sectional Study from a Vietnamese Tertiary Pediatric Center"],"prefix":"10.3390","volume":"15","author":[{"given":"Thi Thuy Hong","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Hanoi Medical University, Hanoi 11521, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khanh Minh","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Hanoi Medical University, Hanoi 11521, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thi Anh Thuong","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Hanoi Medical University, Hanoi 11521, Vietnam"},{"name":"Center for Endocrinology, Metabolism, Genetic\/Genomics and Molecular Therapy, Vietnam National Children\u2019s Hospital, Hanoi 11512, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khanh Ngoc","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Hanoi Medical University, Hanoi 11521, Vietnam"},{"name":"Center for Endocrinology, Metabolism, Genetic\/Genomics and Molecular Therapy, Vietnam National Children\u2019s Hospital, Hanoi 11512, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1404-0328","authenticated-orcid":false,"given":"Thi Bich Ngoc","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Hanoi Medical University, Hanoi 11521, Vietnam"},{"name":"Center for Endocrinology, Metabolism, Genetic\/Genomics and Molecular Therapy, Vietnam National Children\u2019s Hospital, Hanoi 11512, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phuong Thao","family":"Bui","sequence":"additional","affiliation":[{"name":"Center for Endocrinology, Metabolism, Genetic\/Genomics and Molecular Therapy, Vietnam National Children\u2019s Hospital, Hanoi 11512, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dat Tien","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Hanoi Medical University, Hanoi 11521, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0418-2613","authenticated-orcid":false,"given":"Chi Dung","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Hanoi Medical University, Hanoi 11521, Vietnam"},{"name":"Center for Endocrinology, Metabolism, Genetic\/Genomics and Molecular Therapy, Vietnam National Children\u2019s Hospital, Hanoi 11512, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"ref_1","first-page":"73","article-title":"Neonatal Screening for Congenital Adrenal Hyperplasia: Experience and Results in Argentina","volume":"21","author":"Chiesa","year":"2008","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.1210\/jc.2018-01865","article-title":"Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society* Clinical Practice Guideline","volume":"103","author":"Speiser","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1159\/000526401","article-title":"Ethnic and National Differences in Congenital Adrenal Hyperplasia Incidence: A Systematic Review and Meta-Analysis","volume":"96","author":"Sheets","year":"2023","journal-title":"Horm. Res. Paediatr."},{"key":"ref_4","unstructured":"Sharma, L., Momodu, I.I., and Singh, G. (2025). Congenital Adrenal Hyperplasia. StatPearls, StatPearls Publishing."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1056\/NEJMra021561","article-title":"Congenital Adrenal Hyperplasia","volume":"349","author":"Speiser","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1210\/jc.2009-2616","article-title":"Adult Height in Patients with Congenital Adrenal Hyperplasia: A Systematic Review and Metaanalysis","volume":"95","author":"Muthusamy","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"674","DOI":"10.15537\/smj.2018.7.22193","article-title":"Growth Characteristics in Children with Congenital Adrenal Hyperplasia","volume":"39","author":"Alzanbagi","year":"2018","journal-title":"Saudi Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4429","DOI":"10.1210\/jc.2012-2102","article-title":"Clinical Characteristics of a Cohort of 244 Patients with Congenital Adrenal Hyperplasia","volume":"97","author":"Finkielstain","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","unstructured":"Huang, M., Ma, H., Du, M., Chen, H., Li, Y., Chen, Q., Zhang, J., and Guo, S. (2023). Metabolic Status in Children with Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency. Proceedings of the ESPE Abstracts, Bioscientifica."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3882","DOI":"10.1210\/jc.2009-0942","article-title":"Hydrocortisone Dosing during Puberty in Patients with Classical Congenital Adrenal Hyperplasia: An Evidence-Based Recommendation","volume":"94","author":"Bonfig","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1056\/NEJMra1909786","article-title":"Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency","volume":"383","author":"Merke","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1111\/cen.13580","article-title":"Bone Mineral Density and Body Composition in Children with Congenital Adrenal Hyperplasia","volume":"88","author":"Halper","year":"2018","journal-title":"Clin. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/eci.12426","article-title":"Chrousos Syndrome: From Molecular Pathogenesis to Therapeutic Management","volume":"45","author":"Nicolaides","year":"2015","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.3928\/19382359-20241203-02","article-title":"Congenital Adrenal Hyperplasia","volume":"54","author":"Anisowicz","year":"2025","journal-title":"Pediatr. Ann."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5680","DOI":"10.1210\/jc.2003-030123","article-title":"CYP21 Genotype, Adult Height, and Pubertal Development in 55 Patients Treated for 21-Hydroxylase Deficiency","volume":"88","author":"Balsamo","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3525","DOI":"10.1210\/jc.2002-030011","article-title":"Growth Inhibition by Glucocorticoid Treatment in Salt Wasting 21-Hydroxylase Deficiency: In Early Infancy and (Pre)Puberty","volume":"88","author":"Stikkelbroeck","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_17","unstructured":"Abdel Meguid, S.E., Soliman, A.T., De Sanctis, V., Abougabal, A.M.S., Ramadan, M.A.E.F., Hassan, M., Hamed, N., and Ahmed, S. (2022). Growth and Metabolic Syndrome (MetS) Criteria in Young Children with Classic Congenital Adrenal Hyperplasia (CAH) Treated with Corticosteroids (CS). Acta Bio-Medica Atenei Parm., 93."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.pcl.2011.07.012","article-title":"Steroid 21 Hydroxylase Deficiency Congenital Adrenal Hyperplasia","volume":"58","author":"Nimkarn","year":"2011","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1385\/ENDO:17:2:109","article-title":"Dexamethasone Enhances Vitamin D-24-Hydroxylase Expression in Osteoblastic (UMR-106) and Renal (LLC-PK1) Cells Treated with 1\u03b1,25-Dihydroxyvitamin D3","volume":"17","author":"Kurahashi","year":"2002","journal-title":"Endocrine"},{"key":"ref_20","first-page":"102","article-title":"Treatment Outcome and Some Affecting Factors of Congenital Adrenal Hyperplasia","volume":"74","author":"Nguyen","year":"2011","journal-title":"J. Med. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S67","DOI":"10.1210\/clinem\/dgae710","article-title":"Barriers to the Management of Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency","volume":"110","author":"Eitel","year":"2025","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Therrell, B.L., Padilla, C.D., Borrajo, G.J.C., Khneisser, I., Schielen, P.C.J.I., Knight-Madden, J., Malherbe, H.L., and Kase, M. (2024). Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020\u20132023). Int. J. Neonatal Screen., 10.","DOI":"10.3390\/ijns10020038"},{"key":"ref_23","unstructured":"(2025, June 12). Vietnam+ (VietnamPlus) Prenatal, Newborn Screening Programme Helps Improve Population Quality. Available online: https:\/\/en.vietnamplus.vn\/prenatal-newborn-screening-programme-helps-improve-population-quality-post250241.vnp."},{"key":"ref_24","unstructured":"de Onis, M. (2006). Length\/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development, WHO Press. WHO child growth standards."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The Diagnosis of Cushing\u2019s Syndrome: An Endocrine Society Clinical Practice Guideline","volume":"93","author":"Nieman","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1590\/2359-3997000000144","article-title":"Central Precocious Puberty: Revisiting the Diagnosis and Therapeutic Management","volume":"60","author":"Brito","year":"2016","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1515\/bmc-2014-0014","article-title":"Regulation of Meiotic Entry and Gonadal Sex Differentiation in the Human: Normal and Disrupted Signaling","volume":"5","year":"2014","journal-title":"Biomol. Concepts"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/prca.201300066","article-title":"Unraveling the Complexity of Neurodegeneration in Brains of Subjects with Down Syndrome: Insights from Proteomics","volume":"8","author":"Perluigi","year":"2014","journal-title":"Proteom. Clin. Appl."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1182\/blood.V99.6.1986","article-title":"A Randomized Comparison of nativeEscherichia Coli Asparaginase and Polyethylene Glycol Conjugated Asparaginase for Treatment of Children with Newly Diagnosed Standard-Risk Acute Lymphoblastic Leukemia: A Children\u2019s Cancer Group Study","volume":"99","author":"Avramis","year":"2002","journal-title":"Blood"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"133","DOI":"10.14740\/jocmr3710","article-title":"The Gonadotropin-Releasing Hormone Analogue Therapy May Not Impact Final Height in Precocious Puberty of Girls with Onset of Puberty Aged 6\u20138 Years","volume":"11","author":"Korkmaz","year":"2019","journal-title":"J. Clin. Med. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1590\/0004-2730000002931","article-title":"Advances in the etiology, diagnosis and treatment of central precocious puberty","volume":"58","author":"Macedo","year":"2014","journal-title":"Arq. Bras. Endocrinol. Metabol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e3495","DOI":"10.1210\/clinem\/dgab357","article-title":"FSH-Stimulated Inhibin B (FSH-iB): A Novel Marker for the Accurate Prediction of Pubertal Outcome in Delayed Puberty","volume":"106","author":"Chaudhary","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_33","first-page":"e1","article-title":"Central precocious puberty: Epidemiology, etiology, diagnosis and treatment","volume":"74","author":"Argente","year":"2011","journal-title":"An. Pediatr. Barc. Spain 2003"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"F558","DOI":"10.1136\/adc.2003.034017","article-title":"Testosterone Measurements in Early Infancy","volume":"89","author":"Tomlinson","year":"2004","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3028","DOI":"10.1210\/jc.2018-00482","article-title":"Sex Differences in Reproductive Hormones During Mini-Puberty in Infants with Normal and Disordered Sex Development","volume":"103","author":"Johannsen","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.adolescence.2018.12.007","article-title":"Physiology of Puberty in Boys and Girls and Pathological Disorders Affecting Its Onset","volume":"71","author":"Alotaibi","year":"2019","journal-title":"J. Adolesc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/MED.0000000000000339","article-title":"Testicular Growth and Development in Puberty","volume":"24","author":"Koskenniemi","year":"2017","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.bpobgyn.2017.11.004","article-title":"Disorders of Puberty","volume":"48","author":"Sultan","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"106025","DOI":"10.1016\/j.envint.2020.106025","article-title":"Maternal Phthalate Exposure Associated with Decreased Testosterone\/LH Ratio in Male Offspring during Mini-Puberty. Odense Child Cohort","volume":"144","author":"Frederiksen","year":"2020","journal-title":"Environ. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S2213-8587(15)00380-0","article-title":"Causes, Diagnosis, and Treatment of Central Precocious Puberty","volume":"4","author":"Latronico","year":"2016","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1038\/nrendo.2014.40","article-title":"Pros and Cons of GnRHa Treatment for Early Puberty in Girls","volume":"10","author":"Willemsen","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1111\/andr.13056","article-title":"The Role of Scrotal Ultrasonography from Infancy to Puberty","volume":"9","author":"Spaziani","year":"2021","journal-title":"Andrology"},{"key":"ref_43","first-page":"49","article-title":"The Role of Radiology in Head and Neck Tumours in Children","volume":"10","author":"Lloyd","year":"2010","journal-title":"Cancer Imaging Off. Publ. Int. Cancer Imaging Soc."},{"key":"ref_44","unstructured":"World Health Organization (2007). WHO Child Growth Standards: Head Circumference-for-Age, Arm Circumfer-ence-for-Age, Triceps Skinfold-for-Age and Subscapular Skinfold-for-Age: Methods and Development, World Health Organization Child Growth Standard."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_46","unstructured":"Kliegman, R.M., Blum, N.J., Tasker, R.C., Wilson, K.M., St. Geme, J.W., Schuh, A.M., Mack, C.L., Deardorff, M.A., and Nelson, W.E. (2025). Nelson Textbook of Pediatrics, Elsevier. [22nd ed.]."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.beem.2008.10.010","article-title":"Management of the Child with Congenital Adrenal Hyperplasia","volume":"23","author":"Hindmarsh","year":"2009","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_48","first-page":"445","article-title":"Growth and Treatment in Congenital Adrenal Hyperplasia: An Observational Study from Diagnosis to Final Height","volume":"97","author":"Hogling","year":"2024","journal-title":"Horm. Res. Paediatr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e487","DOI":"10.1210\/clinem\/dgab701","article-title":"Characteristics of Growth in Children with Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency During Adrenarche and Beyond","volume":"107","author":"Troger","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1159\/000320700","article-title":"Gender Dichotomy in Long Term Growth Trajectories of Children with 21-Hydroxylase Deficiency Congenital Adrenal Hyperplasia","volume":"75","author":"Patel","year":"2011","journal-title":"Horm. Res. Paediatr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1542\/peds.2005-1005","article-title":"Obesity Among Children and Adolescents with Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency","volume":"117","author":"Simm","year":"2006","journal-title":"Pediatrics"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ecl.2013.10.005","article-title":"Mechanisms of Glucocorticoid-Induced Insulin Resistance","volume":"43","author":"Geer","year":"2014","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Kim, M.S., Fraga, N.R., Minaeian, N., and Geffner, M.E. (2022). Components of Metabolic Syndrome in Youth with Classical Congenital Adrenal Hyperplasia. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.848274"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Ben Simon, A., Brener, A., Segev-Becker, A., Yackobovitch-Gavan, M., Uretzky, A., Schachter Davidov, A., Alaev, A., Oren, A., Eyal, O., and Weintrob, N. (2022). Body Composition in Children and Adolescents with Non-Classic Congenital Adrenal Hyperplasia and the Risk for Components of Metabolic Syndrome: An Observational Study. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1022752"},{"key":"ref_55","unstructured":"Ministry of Health Vietnam (2021). General Nutrition Survey 2019\u20132020, Medical Publishing House."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.jpeds.2014.11.027","article-title":"The Relation of Peripubertal and Pubertal Growth to Final Adult Height in Children with Classic Congenital Adrenal Hyperplasia","volume":"166","author":"Bomberg","year":"2015","journal-title":"J. Pediatr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"109","DOI":"10.3906\/sag-1301-114","article-title":"Bone Mineral Density and Vitamin D Status in Children and Adolescents with Congenital Adrenal Hyperplasia","volume":"44","author":"Demirel","year":"2014","journal-title":"Turk. J. Med. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Laillou, A., Wieringa, F., Tran, T.N., Van, P.T., Le, B.M., Fortin, S., Le, T.H., Pfanner, R.M., and Berger, J. (2013). Hypovitaminosis D and Mild Hypocalcaemia Are Highly Prevalent among Young Vietnamese Children and Women and Related to Low Dietary Intake. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0063979"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Vrani\u0107, L., Mikola\u0161evi\u0107, I., and Mili\u0107, S. (2019). Vitamin D Deficiency: Consequence or Cause of Obesity?. Medicina, 55.","DOI":"10.3390\/medicina55090541"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1534\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:52:58Z","timestamp":1760032378000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1534"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":59,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["diagnostics15121534"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15121534","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,16]]}}}