Vitamin D deficiency in children and its management: Review of current knowledge and recommendations

Pediatric Endocrine and Neuroendocrine Units, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
PEDIATRICS (Impact Factor: 5.3). 09/2008; 122(2):398-417. DOI: 10.1542/peds.2007-1894
Source: PubMed

ABSTRACT Given the recent spate of reports of vitamin D deficiency, there is a need to reexamine our understanding of natural and other sources of vitamin D, as well as mechanisms whereby vitamin D synthesis and intake can be optimized. This state-of-the-art report from the Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society was aimed to perform this task and also reviews recommendations for sun exposure and vitamin D intake and possible caveats associated with these recommendations.

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    ABSTRACT: Osteogenesis Imperfecta (OI) is a heterogeneous genetic disorder causing skeletal fragility. Although there is increasing awareness about the important role of vitamin D in pediatric bone health, specific data regarding vitamin D status are limited and sometimes unavailable in children with musculoskeletal disorders, such as OI. In this study, we aimed to examine the prevalence of vitamin D deficiency, insufficiency and sufficiency in children with OI. We used a retrospective cohort (case-only) study of 61 children diagnosed with OI. The study variables were analyzed using descriptive statistics. 25-hydroxyvitamin D serum levels less than 20 ng/ml were considered deficient, levels between 20–32 ng/ml were considered insufficient, and levels more than 32 ng/ml were considered sufficient. Sixty one patients (31 boys, 30 girls) were classified according to Sillence type (type I, n = 31; type III, n = 14; and type IV, n = 16). Overall, vitamin D insufficiency and deficiency were identified in approximately half of the patients (50.9%). Vitamin D sufficiency was observed in the majority of infants and toddlers from birth to 3 years (n=13, 56.5%) and in children aged 4–10 years (n=12, 57.1%). A minority of children over the age of 10 were vitamin D sufficient (n=5, 29.4%). The majority of Caucasian patients (n=26, 54.2%) were vitamin D sufficient. Sufficient vitamin D levels were more prevalent among type I OI patients (n =19, 61.3%). Type III patients were found to have an equal prevalence of vitamin D insufficiency (n=6, 42.9%) and sufficiency (n=6, 42.9%). Vitamin D insufficiency was most prevalent in type IV (n=8, 50). Patients with an elevated BMI had a higher prevalence of vitamin D insufficiency (n=4, 57.1%). Further studies are recommended to clarify the relationship between vitamin D serum level and BMI in OI patients.
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    ABSTRACT: Background Epidemiologic studies suggest an association between vitamin D deficiency and atopic diseases, including asthma. The objective of this study was to systematically review the benefits and harms of vitamin D supplementation in children with asthma.Methods We used standard Cochrane systematic review methodology. The search strategy included an electronic search in February 2013 of MEDLINE and EMBASE. Two reviewers completed in duplicate and independently study selection, data abstraction, and assessment of risk of bias. We pooled the results of trials using a random-effects model. We assessed the quality of evidence by outcome using the GRADE methodology.ResultsFour trials with a total of 149 children met eligibility criteria. The trials had major methodological limitations. Given the four studies reporting on asthma symptoms used different instruments to measure that outcome, we opted not to conduct a meta-analysis. Three of those studies reported improvement in asthma symptoms in the vitamin D supplemented group study, while the fourth reported no effect (very low quality evidence). For the lung function outcome, a meta-analysis of two trials assessing post treatment FEV-1 found a mean difference of 0.54 liters per second (95% CI -5.28; 4.19; low quality evidence). For the vitamin D level outcome, a meta-analysis of three trials found a mean difference of 6.56 ng/ml (95% CI -0.64; 13.77; very low quality evidence).Conclusions The available very low to low quality evidence does not confirm or rule out beneficial effects of vitamin D supplementation in children with asthma. Large-scale, well-designed and executed randomized controlled trials are needed to better understand the effectiveness and safety of vitamin D in children with asthma.
    BMC Research Notes 02/2015; 8(1):23. DOI:10.1186/s13104-014-0961-3
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    ABSTRACT: There are limited data regarding the prevalence and risk factors relating to hypovitaminosis D in children of Thailand, a tropical country with abundant sunlight. The objective of this study was to assess the prevalence of hypovitaminosis D and examine factors associated with hypovitaminosis D in school-aged children in Bangkok, Thailand - a centrally located capital city. This cross-sectional study evaluated 159 healthy children (33.3% boys and 66.7% girls), aged 6 to 12 years, in Bangkok, Thailand (located at 13.45°N). Fasting plasma samples were examined for total 25-hydroxyvitamin D [25(OH)D] using electrochemiluminescence immunoassay. Demographic characteristics (age, sex, household income), past medical history (birth weight, allergic diseases, hospitalization), amount of sun exposure, anthropometric data, and selected biochemical tests were used to investigate for factors associated with hypovitaminosis D. Overall, the mean ± SD level of plasma 25(OH)D was 64.0 ± 15.1 nmol/L. Hypovitaminosis D (<75 nmol/L) was presented in 79.2% of subjects. Of these, the prevalence of vitamin D insufficiency and vitamin D deficiency were 59.7% and 19.5%, respectively. In univariate analysis, children with hypovitaminosis D (<75 nmol/L) had a higher mean body mass index (BMI) percentile than the vitamin D-sufficient group (56.7 ± 33.9 vs. 42.6 ± 36.0; P-value = 0.04). Plasma PTH levels in the children with hypovitaminosis D were significantly higher than in the children with normal levels of vitamin D (4.34 ± 1.38 vs 3.78 ± 1.25 pmol/L; P-value = 0.04). In multivariate analysis, high BMI percentile and high PTH concentration were the parameters associated with 25(OH)D level < 75 nmol/L. The prevalence of hypovitaminosis D in healthy Thai children is very high, despite their exposure to sunlight, and that prevalence increases in children with a high BMI percentile. As a result, a formal recommendation for vitamin D supplementation in Thai children should be considered.
    BMC Public Health 12/2015; 15(1):1588. DOI:10.1186/s12889-015-1588-6 · 2.32 Impact Factor

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