Influence of Vitamin D Supplementation on Growth, Body Composition, and Pubertal Development Among School-aged Children in an Area With a High Prevalence of Vitamin D Deficiency: A Randomized Clinical Trial

Oxidative balance score is inversely associated with low muscle mass in young and middle-aged adults: a cross-sectional NHANES study

BACKGROUND

Low muscle mass is a critical indicator of frailty and adverse health outcomes. However, the potential link between systemic oxidative stress and low muscle mass remains underexplored. This study aims to investigate the association between the Oxidative Balance Score (OBS) and low muscle mass in U.S. adults.

METHODS

In this cross-sectional study, data from 4096 adults aged 20 to 59 years from National Health and Nutritional Examination Survey (NHANES) 2011 to 2018 were analyzed. Low muscle mass, the primary outcome, was evaluated utilizing the Foundation for the National Institutes of Health (FNIH) definition. Analysis involved the application of restricted cubic splines and weighted multivariate regression techniques.

RESULTS

A nonlinear association was observed between OBS and low muscle mass (p for nonlinearity < 0.0049). Compared to the lowest OBS quartile, individuals in the highest quartile had an adjusted OR of 0.26 (95% CI: 0.14-0.48) for low muscle mass (P for trend < 0.001). Additionally, the adjusted β value for ALM/BMI was 0.067 (95% CI: 0.053-0.082), P for trend < 0.001. Both dietary and lifestyle OBS also showed negative associations with low muscle mass, with fully adjusted ORs of 0.38 (95% CI: 0.19-0.76) and 0.17 (95% CI: 0.05-0.62), respectively (both P for trends < 0.01). Furthermore, in stratified analyses, this relationship was particularly prominent in the 40-59 years age group (P for interaction = 0.048).

CONCLUSION

Higher OBS, indicative of greater antioxidant exposure, was robustly associated with a lower risk of low muscle mass, particularly in 40-59 old adults. These findings underscore the potential role of oxidative balance in preserving muscle health and highlight the need for targeted interventions in this demographic. Further longitudinal studies are warranted to confirm these associations and evaluate potential clinical applications.

Retrospective Serologic Assessment of Vitamin D Levels in Children from Western Romania: A Cross-Sectional Study

Background and Objectives: Adequate levels of vitamin D are vital for both growth and immunomodulation in children. To evaluate the levels of vitamin D in children from Western Romania and to identify significant age, seasonal, and geographical disparities. Materials and Methods: This study evaluates the level of 25-hydroxyvitamin D levels assessed on Cobas 6000's module e601 in 1698 children aged 1-18 years between 1 January 2018 and 31 December 2021 from Western Romania. Results: Children aged 1-6 years predominantly present sufficient levels (>30 ng/mL), while older age groups showed a marked decline. Adolescents aged 13-18 years were most affected, with over half displaying insufficient levels (20-30 ng/mL). Rural children were more likely to achieve sufficiency compared to urban peers. Males demonstrated significantly higher vitamin D levels when compared to females. Seasonal variations showed the highest vitamin D levels during late summer and early autumn (September: aOR = 5.47; 95% CI: 3.17-9.42, p < 0.001). Multivariate analysis revealed a significant improvement in vitamin D levels during 2019-2020. Conclusions: Our findings suggest the need for targeted screening programs and health policies to address vitamin D deficiency, particularly among older children, urban residents and during winter months.

The Association of Vitamin D, Nerve Growth Factor (NGF), Brain-Derived Neurotrophic Factor (BDNF), and Glial Cell-Derived Neurotrophic Factor (GDNF) with Development in Children

BACKGROUND

Short stature remains a global problem and is associated with vitamin D status. Vitamin D is also a neurosteroid with regard to neurotrophic factors but its role in development is unclear. Therefore, this study analyzed the relationships between vitamin D, NGF, GDNF, and BDNF and developmental status in children with a history of short stature (<2 years).

METHODS

This research is a prospective cross-sectional study conducted in March 2022. The vitamin D, NGF, GDNF, and BDNF levels were measured in stored biological materials from children aged 2-4 years, and their Ages and Stages Questionnaire (ASQ-3) scores were also assessed. The results were analyzed via the chi-square test, Fisher's exact test, Mann-Whitney test for NGF, unpaired t-test, and Spearman rank correlation.

RESULTS

Among the 85 study subjects, 41.2% were short in stature, with 37% having developmental deviation. Male sex (p = 0.038) and low maternal education (p = 0.024) were associated with short stature. The mean vitamin D level was lower (p = 0.041) in children with short stature (27.65 ng/dL). The risk factors associated with short stature were vitamin D levels ≤ 32.7 ng/dL, GDNF levels ≤ 12.99 ng/mL, male sex, and low maternal education. Children with short stature (<2 years old) also demonstrated impaired problem-solving as assessed by the ASQ-3 (p = 0.005). Vitamin D was also associated with gross motor skills (p = 0.035) and personal social development (p = 0.038).

CONCLUSIONS

There was no association of vitamin D with NGF, GDNF, or BDNF levels. Vitamin D levels are associated with short stature and development in children, especially gross motor skills, personal social development, and problem solving.

Structural equation modeling of dietary patterns and association with vitamin D levels in children aged 9-16 years in Guangzhou, China

Background

Vitamin D deficiency and insufficiency represent critical public health concerns on a global scale. Due to the increase in indoor activities, the role of dietary intake of vitamin D has become increasingly prominent. However, previous studies have focused solely on a single food item.

Objectives

This study aimed to identify dietary patterns among school-aged children in rural areas of Guangzhou, China, and to explore their association with vitamin D levels.

Methods

A total of 2,346 children aged 6-17 years were included in this cross-sectional study. Demographic, lifestyle, and dietary data were collected through structured questionnaires. Dietary patterns were identified using factor analysis, while linear regression and structural equation modeling were employed to analyze the relationship between these patterns and vitamin D levels.

Results

Three distinct dietary patterns emerged: a fruits and vegetables pattern, high-protein pattern, and snack pattern. Analysis revealed that a higher adherence to the fruits and vegetables dietary pattern was associated with lower vitamin D levels. Conversely, among girls, a stronger preference for the high-protein dietary pattern was positively correlated with higher vitamin D levels.

Conclusion

The fruits and vegetables pattern emerged as a risk factor for inadequate internal vitamin D levels. In girls, the high-protein pattern functioned as a protective factor. These findings offer valuable insights and policy recommendations for enhancing the health status of children in rural communities.

Interaction between Vitamin D homeostasis, gut microbiota, and central precocious puberty

Central precocious puberty (CPP) is an endocrine disease in children, characterized by rapid genital development and secondary sexual characteristics before the age of eight in girls and nine in boys. The premature activation of the hypothalamic-pituitary-gonadal axis (HPGA) limits the height of patients in adulthood and is associated with a higher risk of breast cancer. How to prevent and improve the prognosis of CPP is an important problem. Vitamin D receptor (VDR) is widely expressed in the reproductive system, participates in the synthesis and function of regulatory sex hormones, and affects the development and function of gonads. In addition, gut microbiota plays an important role in human health by mainly regulating metabolites, energy homeostasis, and hormone regulation. This review aims to clarify the effect of vitamin D deficiency on the occurrence and development of CPP and explore the role of gut microbiota in it. Although evidence on the interaction between vitamin D deficiency, gut microbiota, and sexual development remains limited, vitamin D supplementation and gut microbiota interventions offer a promising, non-invasive strategy for managing CPP.

Comparative proteomic exploration of plasma proteins in different levels of vitamin D with type 2 diabetes mellitus using iTRAQ-coupled LC-MS/MS

Objectives

Due to the variety of modern diet and lifestyle changes, China has become the world's largest number of people with T2DM. How to prevent and cure T2DM has become one of the urgent public health events in China. Numerous studies have demonstrated vitamin D (VitD) was independently correlated with insulin sensitivity and β cells function. VitD deficiency occurs in about 70% to 80% of patients with T2DM. However, the reason of T2DM patients suffering from VitD deficiency is not very clear. The aim of this project is to identify biomarkers to explore potential mechanism of VitD deficiency in patients with T2DM.

Methods

We used the iTRAQ-coupled LC-MS/MS technique to screen differential expression proteins between VitD deficiency group and VitD sufficiency group in T2DM patients. Then we carried out hierarchical clustering analysis, Gene Ontology classification and enrichment analysis, KEGG pathway enrichment analysis, protein-protein interaction network (PPI) analysis and ELISA validation.

Results

We identified 63 differentially expressed proteins, 17 proteins were up-regulated and 46 proteins were down-regulated (VitD sufficiency vs. VitD deficiency). We ultimately selected four proteins, Podocalyxin (PODXL), ICAM3, MMP9, ApoF for further verification. As a result, the level of MMP9 and ICAM3 was higher in VitD sufficiency group than VitD deficiency group.

Conclusions

Our study provided a solid theoretical foundation for the study of biomarkers and their mechanisms in most patients with T2DM who suffer from vitamin D deficiency. In addition, MMP9 and ICAM3 may play critical roles in the process of VitD deficiency in T2DM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01456-w.

The Immunomodulatory Role of Vitamin D in Regulating the Th17/Treg Balance and Epithelial-Mesenchymal Transition: A Hypothesis for Gallbladder Cancer

The etiology of gallbladder cancer (GBC) is multifactorial, with chronic inflammation resulting from infections, autoimmune diseases, and lifestyle factors playing a pivotal role. Vitamin D deficiency (VDD) has been implicated in the pathogenesis of autoimmune disorders and various malignancies, including GBC. Research on autoimmune diseases highlights the anti-inflammatory properties of vitamin D, suggesting its potential to mitigate disease progression. In oncology, VDD has similarly been linked to increased inflammation, which may contribute to both the initiation and progression of cancer. A critical component in carcinogenesis, as well as in the immunomodulatory effects of vitamin D in autoimmune conditions, is the balance between T-helper 17 (Th17) cells and regulatory T (Treg) cells. We hypothesize that vitamin D may inhibit epithelial-mesenchymal transition (EMT) in GBC by modulating the spatial distribution of tumor-infiltrating T cells, particularly through the regulation of the Th17/Treg balance at the tumor margins. This Th17/Treg imbalance may act as a mechanistic link between VDD and the progression of GBC carcinogenesis. Investigating the role of an Th17/Treg imbalance as a mediator in VDD-induced EMT in GBC not only provides deeper insights into the pathogenesis of GBC but also sheds light on broader mechanisms relevant to the development of other solid organ cancers, given the expanding recognition of the roles of VDD and Th17/Treg cells in cancer biology.

Association between overweight or obesity and vitamin D status in preschool children: an epidemiological survey in Beijing, China, 2021-2023

BACKGROUND

Previous studies have shown that vitamin D deficiency is a risk factor for obesity in children and adolescents, but most focus on school-age children and adolescents, with little attention paid preschoolers.

OBJECTIVES

To explore the relationship between overweight or obesity in the context of vitamin D intake among preschool children in Beijing, and analyze the correlation.

METHODS

A total of 51,640 preschoolers (26,775 boys; 24,865 girls), aged 1-6 years, were recruited for physical examination. Overweight or obesity was defined according to the World Health Organization Child Growth and Development Standards (2006 edition). Serum 25-hydroxy (OH) vitamin D levels were determined using standardized liquid chromatography-tandem mass spectrometry (LC-MS/MS), and vitamin D status was evaluated based on the Practice Guide on Clinical Issues Related to Vitamin D Nutrition in Chinese Children (2022).

RESULTS

No significant change was observed in the incidence of overweight (7.72, 7.51, and 7.24 %) or obesity (2.75, 2.63, and 2.40 %) from 2021 to 2023. Among boys, 7.3 % were overweight and 2.8 % were obese. Among girls, 7.6 % were overweight and 2.3 % were obese. Vitamin D deficiency (2.10, 1.70, and 1.01 %) and insufficiency rate (24.09, 18.42, and 15.44 %) showed a decreasing trend. Deficiency or insufficiency was most common in children aged 36-59 months, and serum 25- (OH) vitamin D levels were significantly lower in winter compared to other seasons, with the highest levels in summer. Time spent outdoors was significantly less among children with vitamin D deficiency or insufficiency, and preschoolers who spent more than 2.94 h/day had higher serum vitamin D level. Serum 25- (OH) vitamin D levels were negatively correlated with body mass index (BMI), with overweight or obesity preschoolers showing significantly lower than their normal weight group. After adjusting for age, gender and season, family economic status, guardian educational level and time spent outdoors, the odds of vitamin D deficiency and insufficiency in overweight or obesity in preschoolers were 1.025 (95 % Cl: 1.002-1.174), 1.218 (95 % Cl: 1.099-1.708), respectively.

CONCLUSIONS

From 2021 to 2023, there was no significant change in the incidence of overweight or obesity among preschool children in Beijing. Furthermore, the rate of vitamin D deficiency or insufficiency decreased year by year. Vitamin D deficiency or insufficiency associates with factors such as age, season of the year, and time spent outdoors, and there is an association between overweight or obesity and vitamin D status among preschoolers.

Influence of vitamin D supplementation on muscle strength and exercise capacity in South African schoolchildren: secondary outcomes from a randomised controlled trial (ViDiKids)

Objective

To determine whether vitamin D supplementation influences grip strength, explosive leg power, cardiorespiratory fitness and risk of exercise-induced bronchoconstriction (EIB) in South African schoolchildren.

Methods

Substudy (n=450) in Cape Town schoolchildren aged 8-11 years nested within a phase 3 randomised placebo-controlled trial (ViDiKids). The intervention was weekly oral doses of 10 000 IU vitamin D3 (n=228) or placebo (n=222) for 3 years. Outcome measures were serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations, grip strength, standing long jump distance, peak oxygen uptake (VO2peak, determined using 20 m multistage shuttle run tests) and the proportion of children with EIB, measured at end-study.

Results

64.7% of participants had serum 25(OH)D3concentrations <75 nmol/L at baseline. At 3-year follow-up, children randomised to vitamin D versus placebo had higher mean serum 25(OH)D3 concentrations (97.6 vs 58.8 nmol/L, respectively; adjusted mean difference 39.9 nmol/L, 95% CI 36.1 to 43.6). However, this was not associated with end-study differences in grip strength, standing long jump distance, VO2peak or risk of EIB.

Conclusion

A 3-year course of weekly oral supplementation with 10 000 IU vitamin D3 elevated serum 25(OH)D3 concentrations in South African schoolchildren but did not influence muscle strength, exercise capacity or risk of EIB.

Influence of vitamin D supplementation on muscle strength and exercise capacity in Mongolian schoolchildren: secondary outcomes from a randomised controlled trial

Objective

To determine whether weekly oral vitamin D supplementation influences grip strength, explosive leg power, cardiorespiratory fitness or spirometric lung volumes in Mongolian schoolchildren.

Methods

Multicentre, randomised, placebo-controlled clinical trial conducted in children aged 6-13 years at baseline attending 18 schools in Ulaanbaatar. The intervention was weekly oral doses of 14 000 IU vitamin D3 (n=4418) or placebo (n=4433) for 3 years. Outcome measures were grip strength, standing long jump distance and serum 25-hydroxyvitamin D (25(OH)D) concentrations (determined in all participants), peak oxygen uptake (VO2peak, determined in a subset of 632 participants using 20 m multistage shuttle run tests) and spirometric outcomes (determined in a subset of 1343 participants).

Results

99.8% of participants had serum 25(OH)D concentrations <75 nmol/L at baseline, and mean end-study 25(OH)D concentrations in children randomised to vitamin D versus placebo were 77.4 vs 26.7 nmol/L (mean difference 50.7 nmol/L, 95% CI 49.7 to 51.4). However, vitamin D supplementation did not influence mean grip strength, standing long jump distance, VO2peak, spirometric lung volumes or peak expiratory flow rate, either overall or within subgroups defined by sex, baseline 25(OH)D concentration <25 vs ≥25 nmol/L or calcium intake <500 vs ≥500 mg/day.

Conclusion

A 3-year course of weekly oral supplementation with 14 000 IU vitamin D3 elevated serum 25(OH)D concentrations in Mongolian schoolchildren with a high baseline prevalence of vitamin D deficiency. However, this intervention did not influence grip strength, explosive leg power, peak oxygen uptake or spirometric lung volumes, either overall or in subgroup analyses.

Trial registration number

NCT02276755.

Effect of Customized Nutritious Breakfast and Nutrition Education on Nutritional Status of Preschool Children in Economically Underdeveloped Multi-Ethnic Areas: A Cluster Randomized Clinical Trial in Linxia, China

The nutritional status of preschool children in economically underdeveloped multi-ethnic areas is a global concern. This study aimed to examine the effect of a 2.2-year cluster randomized clinical trial that provided customized nutritious breakfast and nutrition education to preschool children in Linxia County, China. A total of 578 children aged 3 to 6 years were enrolled. After the intervention, the incidence of undernourishment was significantly lower in the intervention group compared to the control group (8.73% vs. 9.92%, OR = 0.01 [95%CI 0.00, 0.39], p = 0.014). Additionally, children with non-Muslim dietary habits had a lower incidence of undernourishment compared to those with Muslim dietary habits (OR = 0.05 [95%CI 0.00, 0.88]; p = 0.010). The intervention group also had a lower prevalence rate of wasting (OR = 0.02 [95%CI 0.00, 0.40]; p = 0.011) and a higher mean BMI-for-age Z-score (β = 1.05 [95%CI 0.32, 1.77]; p = 0.005) compared to the control group. These findings suggest that providing nutritious breakfast and nutrition education is an effective strategy to improve the nutrition and health of preschool children, particularly in economically disadvantaged regions and among children with Muslim dietary habits.

Dynamic influence of maternal education on height among Chinese children aged 0-18 years

Background

Maternal education is one of key factors affecting nurturing environment which significantly impacts children's height levels throughout their developmental stages. However, the influence of maternal education on children's height is less studied. This study aims to investigate the dynamic influence of maternal education on children's height among Chinese children aged 0-18 years.

Methods

Children undergoing health examinations from January 2021 to September 2023 were included in this study. Clinical information including height, weight, maternal pregnancy history, blood specimens for bone metabolism-related indicators and maternal education level was collected. Children's height was categorized into 14 groups based on age and gender percentiles, following WHO 2006 growth standards. One-way analysis of variance (ANOVA), linear regression, chi-square test and Fisher's exact test were applied for data analysis.

Results

A total of 6269 samples were collected, including 3654 males and 2615 females, with an average age of 8.38 (3.97) for males and 7.89 (3.55) for females. Significant correlations between maternal education level, birth weight, birth order, weight percentile, vitamin D, serum phosphorus, alkaline phosphatase levels, and children's height were identified. Birth weight's influence on height varied across age groups. Compared with normal birth weight children, low birth weight children exhibited catch-up growth within the first 6 years and a subsequent gradual widening of the height gap from 6 to 18 years old. Remarkably, the impact of maternal education on height became more pronounced among children above 3-6 years old, which can mitigate the effect of low birth weight on height.

Conclusion

We found that weight percentile, birth weight, birth order, bone marker levels, and maternal education level have significant effect on height. Maternal education attenuates the impact of low birth weight on height. The findings indicated that maternal education plays a consistent and critical role in promoting robust and healthy growth.

High serum klotho levels are inversely associated with the risk of low muscle mass in middle-aged adults: results from a cross-sectional study

Objective

Muscle mass gradually declines with advancing age, and as an anti-aging protein, klotho may be associated with muscle mass. This study aims to explore the relationship between klotho levels and muscle mass in the middle-aged population.

Methods

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011 to 2018, we conducted a cross-sectional analysis on a cohort of individuals aged 40-59. Weighted multivariable analysis was employed to assess the correlation between klotho and low muscle mass, with stratified and Restricted Cubic Spline (RCS) analyses.

Results

The cross-sectional investigation revealed a significant negative correlation between klotho levels and the risk of low muscle mass (Model 3: OR = 0.807, 95% CI: 0.712-0.915). A notable interaction between klotho and sex was observed, with a significant interaction effect (P for interaction = 0.01). The risk association was notably higher in females. The risk association was notably higher in females. Additionally, RCS analysis unveiled a significant linear relationship between klotho and low muscle mass (P for nonlinear = 0.9495, P for overall<0.0001).

Conclusion

Our observational analysis revealed a noteworthy inverse relationship between klotho and low muscle mass, particularly prominent among female participants. This discovery provides crucial insights for the development of more effective intervention strategies and offers a new direction for enhancing muscle quality in the middle-aged population.

Micronutrient deficiency and supplements in schoolchildren and teenagers

PURPOSE OF REVIEW

The essential micronutrients are corner stones in the functional and physical development. Early deficiency has life-long consequences. While awareness about iron deficiency is relatively high, it remains lower for other micronutrients. This review aims at reporting on recent data and attracting attention to the high prevalence of micronutrient deficiencies in school-age and adolescent individuals.

RECENT FINDINGS

Iron deficiency anaemia remains highly prevalent worldwide and the most frequent deficiency but can be corrected with simple tools ranging from food fortification, nutritional intervention, and to supplements. The link between micronutrient (MN) deficiency and neurobehavioral disorders is increasingly established and is worrying even in Western countries. Paediatric individuals are prone to imbalanced diets and picky eating behaviour, and their diets may then become incomplete: the highest risk for deficiency is observed for iron, zinc and vitamin D.

SUMMARY

There is not much new information, but rather confirmation of the importance of health policies. Well conducted randomized controlled trials confirm that deficiencies can be corrected efficiently including with food fortification, and result in clinical benefits. Individual complementation should be considered in children and adolescents with proven deficiency.

Influence of vitamin D supplementation on bone mineral content, bone turnover markers, and fracture risk in South African schoolchildren: multicenter double-blind randomized placebo-controlled trial (ViDiKids)

Randomized controlled trials (RCTs) to determine the influence of vitamin D on BMC and fracture risk in children of Black African ancestry are lacking. We conducted a sub-study (n = 450) nested within a phase 3 RCT of weekly oral supplementation with 10 000 IU vitamin D3 vs placebo for 3 yr in HIV-uninfected Cape Town schoolchildren aged 6-11 yr. Outcomes were BMC at the whole body less head (WBLH) and LS and serum 25-hydroxyvitamin D3 (25(OH)D3), PTH, alkaline phosphatase, C-terminal telopeptide, and PINP. Incidence of fractures was a secondary outcome of the main trial (n = 1682). At baseline, mean serum 25(OH)D3 concentration was 70.0 nmol/L (SD 13.5), and 5.8% of participants had serum 25(OH)D3 concentrations <50 nmol/L. Among sub-study participants, end-trial serum 25(OH)D3 concentrations were higher for participants allocated to vitamin D vs placebo (adjusted mean difference [aMD] 39.9 nmol/L, 95% CI, 36.1 to 43.6) and serum PTH concentrations were lower (aMD -0.55 pmol/L, 95% CI, -0.94 to -0.17). However, no interarm differences were seen for WBLH BMC (aMD -8.0 g, 95% CI, -30.7 to 14.7) or LS BMC (aMD -0.3 g, 95% CI, -1.3 to 0.8) or serum concentrations of bone turnover markers. Fractures were rare among participants in the main trial randomized to vitamin D vs placebo (7/755 vs 10/758 attending at least 1 follow-up; adjusted odds ratio 0.70, 95% CI, 0.27 to 1.85). In conclusion, a 3-yr course of weekly oral vitamin D supplementation elevated serum 25(OH)D3 concentrations and suppressed serum PTH concentrations in HIV-uninfected South African schoolchildren of Black African ancestry but did not influence BMC or serum concentrations of bone turnover markers. Fracture incidence was low, limiting power to detect an effect of vitamin D on this outcome.

Influence of vitamin D supplementation on growth, body composition, pubertal development and spirometry in South African schoolchildren: a randomised controlled trial (ViDiKids)

OBJECTIVE

To determine whether weekly oral vitamin D supplementation influences growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren.

DESIGN

Phase 3 double-blind randomised placebo-controlled trial.

SETTING

Socioeconomically disadvantaged peri-urban district of Cape Town, South Africa.

PARTICIPANTS

1682 children of black African ancestry attending government primary schools and aged 6-11 years at baseline.

INTERVENTIONS

Oral vitamin D3 (10 000 IU/week) versus placebo for 3 years.

MAIN OUTCOME MEASURES

Height-for-age and body mass index-for-age, measured in all participants; Tanner scores for pubertal development, spirometric lung volumes and body composition, measured in a subset of 450 children who additionally took part in a nested substudy.

RESULTS

Mean serum 25-hydroxyvitamin D3 concentration at 3-year follow-up was higher among children randomised to receive vitamin D versus placebo (104.3 vs 64.7 nmol/L, respectively; mean difference (MD) 39.7 nmol/L, 95% CI 37.6 to 41.9 nmol/L). No statistically significant differences in height-for-age z-score (adjusted MD (aMD) -0.08, 95% CI -0.19 to 0.03) or body mass index-for-age z-score (aMD -0.04, 95% CI -0.16 to 0.07) were seen between vitamin D versus placebo groups at follow-up. Among substudy participants, allocation to vitamin D versus placebo did not influence pubertal development scores, % predicted forced expiratory volume in 1 s (FEV1), % predicted forced vital capacity (FVC), % predicted FEV1/FVC, fat mass or fat-free mass.

CONCLUSIONS

Weekly oral administration of 10 000 IU vitamin D3 boosted vitamin D status but did not influence growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren.

TRIAL REGISTRATION NUMBERS

ClinicalTrials.gov NCT02880982, South African National Clinical Trials Register DOH-27-0916-5527.

Influence of vitamin D supplementation on muscle strength and exercise capacity in Mongolian schoolchildren: a randomised controlled trial

Objective

To determine whether weekly oral vitamin D supplementation influences grip strength, explosive leg power, cardiorespiratory fitness or spirometric lung volumes in Mongolian schoolchildren.

Methods

Multicentre, randomised, double-blind, placebo-controlled clinical trial conducted in children aged 6-13 years at baseline attending 18 schools in Ulaanbaatar. The intervention was weekly oral doses of 14,000 IU vitamin D3 (n=4418) or placebo (n=4433) for 3 years. Outcome measures were grip strength, standing long jump distance and serum 25-hydroxyvitamin D (25[OH]D) concentrations (determined in all participants), peak oxygen uptake (VO2peak, determined in a subset of 632 participants using 20-metre multi-stage shuttle run tests) and spirometric outcomes (determined in a subset of 1,343 participants).

Results

99.8% of participants had serum 25(OH)D concentrations <75 nmol/L at baseline, and mean end-study 25(OH)D concentrations in children randomised to vitamin D vs. placebo were 77.4 vs. 26.7 nmol/L (mean difference 50.7 nmol/L, 95% CI, 49.7 to 51.4). However, vitamin D supplementation did not influence mean grip strength, standing long jump distance, VO2peak, spirometric lung volumes or peak expiratory flow rate, either overall or within sub-groups defined by sex, baseline 25(OH)D concentration <25 vs. ≥25 nmol/L or calcium intake <500 vs. ≥500 mg/day.

Conclusion

A 3-year course of weekly oral supplementation with 14,000 IU vitamin D3 elevated serum 25(OH)D concentrations in Mongolian schoolchildren with a high baseline prevalence of vitamin D deficiency. However, this intervention did not influence grip strength, explosive leg power, peak oxygen uptake or spirometric lung volumes, either overall or in sub-group analyses.

Higher ultra processed foods intake is associated with low muscle mass in young to middle-aged adults: a cross-sectional NHANES study

Design

Ultra-processed foods (UPFs) have become a pressing global health concern, prompting investigations into their potential association with low muscle mass in adults.

Methods

This cross-sectional study analyzed data from 10,255 adults aged 20-59 years who participated in the National Health and Nutritional Examination Survey (NHANES) during cycles spanning from 2011 to 2018. The primary outcome, low muscle mass, was assessed using the Foundation for the National Institutes of Health (FNIH) definition, employing restricted cubic splines and weighted multivariate regression for analysis. Sensitivity analysis incorporated three other prevalent definitions to explore optimal cut points for muscle quality in the context of sarcopenia.

Results

The weighted prevalence of low muscle mass was 7.65%. Comparing the percentage of UPFs calories intake between individuals with normal and low muscle mass, the values were found to be similar (55.70 vs. 54.62%). Significantly linear associations were observed between UPFs consumption and low muscle mass (P for non-linear = 0.7915, P for total = 0.0117). Upon full adjustment for potential confounding factors, participants with the highest UPFs intake exhibited a 60% increased risk of low muscle mass (OR = 1.60, 95% CI: 1.13 to 2.26, P for trend = 0.003) and a decrease in ALM/BMI (β = -0.0176, 95% CI: -0.0274 to -0.0077, P for trend = 0.003). Sensitivity analysis confirmed the consistency of these associations, except for the International Working Group on Sarcopenia (IWGS) definition, where the observed association between the highest quartiles of UPFs (%Kcal) and low muscle mass did not attain statistical significance (OR = 1.35, 95% CI: 0.97 to 1.87, P for trend = 0.082).

Conclusion

Our study underscores a significant linear association between higher UPFs consumption and an elevated risk of low muscle mass in adults. These findings emphasize the potential adverse impact of UPFs on muscle health and emphasize the need to address UPFs consumption as a modifiable risk factor in the context of sarcopenia.

Vitamin D supplements for fracture prevention in schoolchildren in Mongolia: analysis of secondary outcomes from a multicentre, double-blind, randomised, placebo-controlled trial

BACKGROUND

Vitamin D supplementation has been shown to increase total hip areal bone mineral density in healthy children and adolescents. We aimed to investigate whether supplementing schoolchildren living in Mongolia with weekly vitamin D3 for 3 years affected fracture risk.

METHODS

We did a multicentre, double-blind, randomised, placebo-controlled trial across 18 public schools in Ulaanbaatar, Mongolia. Schoolchildren were eligible if they were aged 6-13 years at screening, had a negative QuantiFERON-TB Gold In-tube assay (QFT) result, were not hypersensitive to vitamin D or immunocompromised, did not use vitamin D supplements, did not have clinical signs of rickets, and had no intention of leaving Ulaanbaatar within 3 years. Participants were randomly assigned (1:1) to receive either vitamin D (oral dose of 14 000 international units [IU] vitamin D3, once per week) or placebo for 3 years using permuted block randomisation stratified by school of attendance. Participants, care providers, and all trial staff were masked to group assignment during the intervention. Prespecified secondary outcomes were incidence of fractures and adverse events, ascertained using questionnaires. The fracture and safety analyses included participants who completed at least one follow-up fracture questionnaire. We estimated adjusted risk ratios (RRs) and 95% CIs using generalised linear models with binomial distribution and a log link function with adjustment for school of attendance. The trial is registered with ClinicalTrials.gov, NCT02276755, and the intervention ended in May, 2019.

FINDINGS

Between Sept 2, 2015, and March 20, 2017, 11 475 children were invited to participate in the study and 8851 were recruited and randomly assigned to receive either vitamin D (n=4418) or placebo (n=4433). 8348 participants were included in the fracture and safety analyses (4176 [94·5%] in the vitamin D group and 4172 [94·1%] in the placebo group). Of these, 4125 (49·4%) were female, 4223 (50·6%) were male, and 7701 (92·2%) were of Khalkh ancestry. Median age was 9·2 years (IQR 8·0-10·7) and 7975 (95·5%) participants had baseline serum 25-hydroxyvitamin D concentrations less than 50 nmol/L. During a median follow-up of 3·0 years (IQR 2·9-3·1), 268 (6·4%) participants in the vitamin D group and 253 (6·1%) in the placebo group reported one or more fractures (adjusted RR 1·10, 95% CI 0·93-1·29; p=0·27). Incidence of adverse events did not differ between study groups.

INTERPRETATION

Oral vitamin D supplementation at a dose of 14 000 IU/week for 3 years was safe, but did not influence fracture risk in schoolchildren living in Mongolia who had a high baseline prevalence of vitamin D deficiency.

FUNDING

US National Institutes of Health.

Vitamin D supplementation to prevent tuberculosis infection in South African schoolchildren: multicenter phase 3 double-blind randomized placebo-controlled trial (ViDiKids)

OBJECTIVES

To determine whether weekly oral supplementation with 10,000 IU vitamin D3 for 3 years reduces the risk of sensitization to M. tuberculosis in South African schoolchildren aged 6-11 years with negative QuantiFERON-tuberculosis (TB) Gold Plus (QFT-Plus) assay results at baseline.

METHODS

We conducted a phase 3 randomized placebo-controlled trial in 1682 children attending 23 primary schools in Cape Town. The primary outcome was a positive end-trial QFT-Plus result, analyzed using a mixed effects logistic regression model with the school of attendance included as a random effect.

RESULTS

829 vs. 853 QFT-Plus-negative children were randomized to receive vitamin D3 vs. placebo, respectively. Mean end-study 25(OH)D concentrations in participants randomized to vitamin D vs. placebo were 104.3 vs 64.7 nmol/l, respectively (95% confidence interval for difference, 37.6 to 41.9 nmol/l). A total of 76/667 (11.4%) participants allocated to vitamin D vs. 89/687 (13.0%) participants allocated to placebo tested QFT-Plus positive at 3-year follow-up (adjusted odds ratio 0.86, 95% confidence interval 0.62-1.19, P = 0.35).

CONCLUSION

Weekly oral supplementation with 10,000 IU vitamin D3 for 3 years elevated serum 25(OH)D concentrations among QFT-Plus-negative Cape Town schoolchildren but did not reduce their risk of QFT-Plus conversion.

Influence of vitamin D supplementation on fracture risk, bone mineral density and bone biochemistry in Mongolian schoolchildren: multicenter double-blind randomized placebo-controlled trial

Background

Randomized controlled trials (RCT) of vitamin D supplementation to reduce fracture risk in children are lacking.

Methods

We conducted a Phase 3 RCT of weekly oral supplementation with 14,000 IU vitamin D3 for 3 years in Mongolian schoolchildren aged 6-13 years. Serum 25-hydroxyvitamin D (25[OH]D) concentrations and the proportion of participants reporting ≥1 fracture were secondary outcomes for the main trial. Radial bone mineral density (BMD) was assessed in a nested sub-study, with serum concentrations of parathyroid hormone (PTH) and bone-specific alkaline phosphatase (BALP) determined in a subset of participants.

Findings

8851 children were enrolled in the main trial, of whom 1465 also participated in the sub-study. Vitamin D deficiency was prevalent at baseline (25[OH]D <20 ng/mL in 90.1%). The intervention elevated 25(OH)D concentrations (adjusted inter-arm mean difference [aMD] 20.3 ng/mL, 95% CI 19.9 to 20.6) and suppressed PTH concentrations (aMD -13.6 pmol/L, 95% CI -23.5 to -3.7), but it did not influence fracture risk (adjusted risk ratio 1.10, 95% CI 0.93 to 1.29, P=0.27) or radial BMD z-score (aMD -0.06, 95% CI -0.18 to 0.07, P=0.36). Vitamin D suppressed serum BALP concentrations more among participants with baseline 25(OH)D concentrations <10 vs. ≥10 ng/mL (Pinteraction=0.04). However, effects of the intervention on fracture risk and radial BMD were not modified by baseline vitamin D status (Pinteraction≥0.67).

Interpretation

Weekly oral vitamin D supplementation elevated serum 25(OH)D concentrations and suppressed PTH concentrations in vitamin D-deficient schoolchildren in Mongolia. However, this was not associated with reduced fracture risk or increased radial BMD.

Funding

National Institutes of Health.

Oral vitamin D supplementation and body weight in children and adolescents: a systematic review and meta-analysis of randomized controlled trials

This study was designed to ascertain whether oral vitamin D supplementation (oral supplementation and fortified foods) is associated with changes in body weight measures in children and adolescents, using a systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Scopus, Cochrane, and Web of Science databases were searched from inception to October 28, 2022. The mean difference and corresponding 95% confidence interval (CI) of interested outcomes were pooled using a random-effects model. Twenty-one RCTs were included in the meta-analysis, and the results showed a significant decrease in body mass index (BMI) following vitamin D supplementation in children and adolescents (n = 9 studies, 1029 participants; weighted mean difference: - 0.43 kg/m², 95% CI: - 0.79, - 0.08; P = 0.02; I² = 58.5%). Overall, oral vitamin D supplementation had no significant effect on body weight and other anthropometric indices, including fat mass, lean mass, waist circumference, BMI Z-score, and height. Although results of body weight changed to significant after sensitivity analysis (WMD = 0.39 kg, 95% CI = 0.01, 0.78; P = 0.04; I² = 0%, P-heterogeneity = 0.71), we also found significant weight gain in healthy pediatric population, and when the dose of vitamin D supplementation was up to 600 IU/day, the certainty of evidence was very low for weight, moderate for height and BMI, and low for the remaining outcomes.

CONCLUSION

Our results suggest that vitamin D supplementation may lead to a statistically significant weight gain in children and adolescents, while BMI was reduced. Although no significant change was observed in height, it seems vitamin D supplementation may elicit these changes by increasing skeletal growth; however, this remains to be verified. Further high-quality RCTs, with longer duration and larger sample sizes, are needed to yield more certain evidence in this regard.

WHAT IS KNOWN

• Available evidence indicates an inverse association between body weight/fat mass and vitamin D status in children and adolescents; however, findings regarding the effect of vitamin D supplementation on anthropometric measurements in children are controversial.

WHAT IS NEW

• Our results showed a significant decrease in BMI following vitamin D supplementation in children. • A significant weight gain also was observed after sensitivity analysis, and in healthy pediatric population, and when the dose of vitamin D supplementation was up to 600 IU/day.