Persistent Effect of Vitamin D Supplementation on Musculoskeletal Parameters in Adolescents One Year After Trial Completion

Sutoyo DA, Atmaka DR. The Effect of Sucrose and Fructose Diet on Obesity in Test Animals: A Review

Latar belakang: Obesitas merupakan masalah kesehatan yang disebabkan oleh berbagai faktor salah satunya dari faktor diet. Diet tinggi sukrosa dan fruktosa dapat memicu terjadinya masalah gizi lebih yaitu overweight dan obesitas. Diet tinggi sukrosa dan fruktosa jika dilakukan seseorang yang mengalami obesitas akan menyebabkan masalah kesehatan seperti penyakit metabolik.Tujuan: Tujuan penulisan artikel ini adalah adalah membahas pengaruh diet tinggi sukrosa dan fruktosa terhadap obesitas.Metode: Penelusuran artikel berdasarkan literatur dalam 10 tahun terakhir (2010-2020) menggunakan database elektronik seperti Google Scholar, Scopus, Science Direct, dan PubMed/Medline yang menganalisis pengaruh diet tinggi sukrosa dan fruktosa terhadap obesitasUlasan: Hasil penelusuran penelitian menunjukkan bahwa diet tinggi sukrosa dan fruktosa dapat menyebabkan kenaikan berat badan, overweight, obesitas, meningkatkan lingkar pinggang, meningkatkan lemak dalam tubuh dan inflamasi pada jaringan adiposa. Dampak penyakit penyerta dari diet tinggi sukrosa dan fruktosa yaitu Nonalcoholic Fatty Liver Disease, kerusakan hati, penurunan energy expenditure dan stress oksidatif pada ginjal.Kesimpulan: Diet tinggi sukrosa dan fruktosa menyebabkan  kenaikan berat badan hingga masalah gizi lebih yaitu overweight dan obesitas. Dampak diet tinggi sukrosa dan fruktosa dengan penyakit akibat obesitas yakni menyebabkan NAFLD (Nonalcoholic Fatty Liver Disease). Penelitian terkait diet tinggi sukrosa dan fruktosa banyak dilakukan pada hewan coba. Penelitian selanjutnya diharapkan banyak dilakukan pada manusia juga, agar nantinya bisa dibandingkan dengan hasil penelitian dengan hewan coba, hasil tersebut sesuai dengan teori atau tidak.

The Effects of Vitamin D Supplementation on Serum Levels of 25 (OH) D, Serum Calcium, and Bone Density in Adolescent: A Literature Review

Latar Belakang: Stunting dan penurunan densitas tulang merupakan salah satu masalah gizi yang umum diderita oleh remaja. Hal ini terjadi akibat kurangnya asupan zat gizi yang adekuat terutama vitamin D yang berfungsi untuk pertumbuhan tulang dan mineralisasi jaringan. Jumlah yang terbatas dari makanan dan faktor pigmentasi kulit menjadi penyebab terjadinya defisiensi vitamin D sehingga dibutuhkan upaya suplementasi untuk memenuhi kebutuhan tersebut.Tujuan: Untuk menganalisis efek suplementasi vitamin D terhadap pertumbuhan linier remaja.Metode: Penelusuran artikel pada tinjauan pustaka ini dilakukan menggunakan mesin pencarian melalui Medline, PubMed, EBSCO, ELSEVIER, Cambridge Core, dan WILEY. Artikel memuat teks penuh, berbahasa inggris dan tahun terbit mulai dari 2010 hingga 2020. Kata kunci pencarian yang dimasukkan adalah vitamin D supplementation, adolescent or teenagers, linear growth, dan Bone Mass Density (BMD).Hasil: Hasil skrining menemukan 12 artikel yang memenuhi kriteria inklusi dan diklasifikasikan berdasarkan luaran penelitian yaitu kadar serum 25(OH)D merupakan parameter biokimia yang merupakan luaran yang terdapat pada 10 artikel penelitian. Parameter biokimia serum kalsium sebanyak 6 artikel, densitas tulang sebanyak 8 artikel, dan tinggi badan 2 artikel.Kesimpulan: Suplementasi vitamin D yang diberikan pada remaja yang sehat maupun tidak sehat terbukti meningkatkan kadar serum 25(OH)D.Kata kunci: Suplementasi vitamin D, serum 25(OH)D, densitas massa tulang, pertumbuhan linier remaja. ABSTRACT Background: Stunting and decreased bone density are some of the common nutritional problems that remain by adolescents. This occurs due to lack of adequate nutrition, especially vitamin D which functions for bone growth and tissue mineralization. A limited amount of food and skin pigmentation factors cause vitamin D deficiency so supplementation efforts are needed to meet those needs.Objective: To analyze the effect of vitamin D supplementation on the linear growth of adolescents.Method: Searching for articles in this literature review was done using a search engine through Medline, PubMed, EBSCO, ELSEVIER, Cambridge Core, and WILEY. The article contains the full text, English language, and year of publication from 2010 to 2020. The search keywords entered are vitamin D supplementation, adolescent or teenagers, linear growth, and Bone Mass Density (BMD).Results: The screening results found 12 articles that met the inclusion criteria and were classified based on research outcomes, namely serum 25 (OH) D levels were biochemical parameters which were the results contained in 10 research articles. Biochemical parameters of serum calcium were 6 articles, bone density were 8 articles, and height were 2 articles.Conclusion: Vitamin D supplementation given to healthy and unhealthy adolescents has been shown to increase serum 25 (OH) D levels.Keywords: Vitamin D supplementation, serum 25 (OH) D, bone mass density, adolescent linear growth. 

Vitamin D for Improved Bone Health and Prevention of Stress Fractures: A Review of the Literature

Vitamin D is a vital nutrient and hormone needed for many essential functions in overall health. There is growing literature examining the role of vitamin D not only in the general population but also in athletes. The most predominantly studied area of vitamin D pertains to bone health. Recently, there has been increased investigation into the relationship of vitamin D and stress fractures, including genetic polymorphisms, levels of 25-hydroxyvitamin D, and bioavailable vitamin D. This review will address the most recent developments of vitamin D research and its important role in bone health in athletes.

Vitamin D in the Middle East and North Africa

PURPOSE

The Middle East and North Africa (MENA) region registers some of the lowest serum 25‑hydroxyvitamin D [25(OH)D] concentrations, worldwide. We describe the prevalence and the risk factors for hypovitaminosis D, completed and ongoing clinical trials, and available guidelines for vitamin D supplementation in this region.

METHODS

This review is an update of previous reviews published by our group in 2013 for observational studies, and in 2015 for randomized controlled trials (RCTs) from the region. We conducted a comprehensive search in Medline, PubMed, and Embase, and the Cochrane Library, using MeSH terms and keywords relevant to vitamin D, vitamin D deficiency, and the MENA region, for the period 2012-2017 for observational studies, and 2015-2017 for RCTs. We included large cross-sectional studies with at least 100 subjects/study, and RCTs with at least 50 participants per arm.

RESULTS

We identified 41 observational studies. The prevalence of hypovitaminosis D, defined as a 25‑hydroxyvitamin D [25(OH)D] level below the desirable level of 20 ng/ml, ranged between 12-96% in children and adolescents, and 54-90% in pregnant women. In adults, it ranged between 44 and 96%, and the mean 25(OH)D varied between 11 and 20 ng/ml. In general, significant predictors of low 25(OH)D levels were female gender, increasing age and body mass index, veiling, winter season, use of sun screens, lower socioeconomic status, and higher latitude.We retrieved 14 RCTs comparing supplementation to control or placebo, published during the period 2015-2017: 2 in children, 8 in adults, and 4 in pregnant women. In children and adolescents, a vitamin D dose of 1000-2000 IU/d was needed to maintain serum 25(OH)D level at target. In adults and pregnant women, the increment in 25(OH)D level was inversely proportional to the dose, ranging between 0.9 and 3 ng/ml per 100 IU/d for doses ≤2000 IU/d, and between 0.1 and 0.6 ng/ml per 100 IU/d for doses ≥3000 IU/d. While the effect of vitamin D supplementation on glycemic indices is still controversial in adults, vitamin D supplementation may be protective against gestational diabetes mellitus in pregnant women. In the only identified study in the elderly, there was no significant difference between 600 IU/day and 3750 IU/day doses on bone mineral density. We did not identify any fracture studies.The available vitamin D guidelines in the region are based on expert opinion, with recommended doses between 400 and 2000 IU/d, depending on the age category, and country.

CONCLUSION

Hypovitaminosis D is prevalent in the MENA region, and doses of 1000-2000 IU/d may be necessary to reach a desirable 25(OH)D level of 20 ng/ml. Studies assessing the effect of such doses of vitamin D on major outcomes, and confirming their long term safety, are needed.

Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians

Vitamin D plays a pivotal role in the regulation of calcium-phosphorus metabolism, particularly during pediatric age when nutritional rickets and impaired bone mass acquisition may occur.Besides its historical skeletal functions, in the last years it has been demonstrated that vitamin D directly or indirectly regulates up to 1250 genes, playing so-called extraskeletal actions. Indeed, recent data suggest a possible role of vitamin D in the pathogenesis of several pathological conditions, including infectious, allergic and autoimmune diseases. Thus, vitamin D deficiency may affect not only musculoskeletal health but also a potentially wide range of acute and chronic conditions. At present, the prevalence of vitamin D deficiency is high in Italian children and adolescents, and national recommendations on vitamin D supplementation during pediatric age are lacking. An expert panel of the Italian Society of Preventive and Social Pediatrics reviewed available literature focusing on randomized controlled trials of vitamin D supplementation to provide a practical approach to vitamin D supplementation for infants, children and adolescents.

Vitamin D replacement in children, adolescents and pregnant women in the Middle East and North Africa: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Hypovitaminosis D affects one-third to two-thirds of children and pregnant women from the Middle East and North Africa (MENA) region.

OBJECTIVE

To evaluate in infants, children, adolescents and pregnant women, from the MENA region, the effect of supplementation with different vitamin D doses on the change in 25-hydroxyvitamin D [25(OH)D] level reached, and other skeletal and non-skeletal outcomes.

METHODS

This is a systematic review of randomized controlled trials of vitamin D supplementation conducted in the MENA region. We conducted a comprehensive literature search in 7 databases, without language or time restriction, until November 2016. Two reviewers abstracted data from the included studies, independently and in duplicate. We calculated the mean difference (MD) and 95% CI of 25(OH)D level reached when at least 2 studies were eligible in each comparison (low (<800IU), intermediate (800-2000IU) or high (>2000IU) daily dose of vitamin D, or placebo). We pooled data using RevMan version 5.3.

RESULTS

We identified a total of 15 eligible trials: one in infants, 4 in children and adolescents and 10 in pregnant women. In children and adolescents, an intermediate vitamin D dose (1901IU/d), resulted in a mean difference in 25(OH)D level of 13.5 (95% confidence interval (CI) 8.1-18.8) ng/ml, compared to placebo, favoring the intermediate dose (p<0.001). The proportion of children and adolescents reaching a 25(OH)D level≥ 20ng/ml was 74% in the intermediate dose group. In pregnant women, four trials started supplementation at 12-16weeks of gestation and continued until delivery, and six trials started supplementation at 20-28weeks' gestation and stopped it at delivery. The MD in 25(OH)D level reached was 8.6 (95% CI 5.3-11.9) ng/ml (p<0.001) comparing the high dose (3662IU/d) to the intermediate dose (1836IU/d), and 12.3 (95% CI 6.4-18.2) ng/ml (p<0.001), comparing the high dose (3399IU/d) to the low dose (375IU/d). Comparing the intermediate (1832IU/d) to the low dose (301IU/d), the MD in 25(OH)D level achieved was 7.8 (95% CI 4.5-10.8) ng/ml (p<0.001). The proportion of pregnant women reaching a 25(OH)D level≥20ng/ml was 80%-90%, 73% and 27%-43% in the high, intermediate, and low dose groups, respectively. The risk of bias in the included studies, for children, adolescents and pregnant women, ranged from low to high across all doamins.

CONCLUSION

In children, adolescents and pregnant women from the MENA, an intermediate vitamin D dose of 1000-2000IU daily may be necessary to allow for the majority of the population to reach a desirable 25(OH)D level of 20ng/ml. Further high quality RCTs are required to confirm/refute the beneficial impact of vitamin D supplementation on various clinically important outcomes.