1
|
Radonsky V, Lazaretti-Castro M, Chiamolera MI, Biscolla RPM, Lima Junior JV, Vieira JGH, Brandão CMA, Ramalho RF, Maeda SS, Cavichio MWE. Alert for the high prevalence of vitamin D deficiency in adolescents in a large Brazilian sample. J Pediatr (Rio J) 2024; 100:360-366. [PMID: 38462231 PMCID: PMC11331242 DOI: 10.1016/j.jped.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE To estimate the prevalence of vitamin D deficiency and severe deficiency in children and adolescents, in a large Brazilian sample. METHODOLOGY Results of 413,988 25(OH)D measurements in children and adolescents aged 0 to 18 years collected between 01/2014 and 10/2018 were obtained from the database of a Clinical Laboratory. In this population, 25 hydroxyvitamin D concentrations below 20 ng/mL are considered deficient, and below 12 ng/mL as severe deficiency. All measurements were performed by immunoassay and the results were distributed by gender, age group, seasonality, and latitude. RESULTS The mean of 25(OH)D levels was 29.2 ng/mL with a standard deviation of 9.2 ng/mL. Of the total samples, 0.8% had a concentration < 12 ng/mL, and 12.5% of the samples had a concentration < 20 ng/mL, with a higher prevalence in females. Children under 2 years of age had the lowest prevalence. The effects of latitude and seasonality were quite evident. In samples of female adolescents from the southern region in winter, 36% of vitamin D deficiency and 5% of severe deficiency were found. CONCLUSION In this large number of measurements of 25(OH)D in children and adolescents, 12.5% had a deficiency and 0.8% had severe deficiency. A greater deficiency was observed among adolescents, especially females, which raises questions about the need for supplementation during this period of life.
Collapse
Affiliation(s)
- Vanessa Radonsky
- Universidade Federal de São Paulo (UNIFESP), Departamento Endocrinologia, São Paulo, SP, Brazil
| | - Marise Lazaretti-Castro
- Universidade Federal de São Paulo (UNIFESP), Departamento Endocrinologia, São Paulo, SP, Brazil.
| | - Maria Izabel Chiamolera
- Universidade Federal de São Paulo (UNIFESP), Departamento Endocrinologia, São Paulo, SP, Brazil; Grupo Fleury, Departamento Endocrinologia, São Paulo, SP, Brazil
| | - Rosa Paula Mello Biscolla
- Universidade Federal de São Paulo (UNIFESP), Departamento Endocrinologia, São Paulo, SP, Brazil; Grupo Fleury, Departamento Endocrinologia, São Paulo, SP, Brazil
| | - José Viana Lima Junior
- Universidade Federal de São Paulo (UNIFESP), Departamento Endocrinologia, São Paulo, SP, Brazil; Grupo Fleury, Departamento Endocrinologia, São Paulo, SP, Brazil
| | - José Gilberto Henriques Vieira
- Universidade Federal de São Paulo (UNIFESP), Departamento Endocrinologia, São Paulo, SP, Brazil; Grupo Fleury, Departamento Endocrinologia, São Paulo, SP, Brazil
| | | | | | - Sergio Setsuo Maeda
- Universidade Federal de São Paulo (UNIFESP), Departamento Endocrinologia, São Paulo, SP, Brazil
| | | |
Collapse
|
2
|
Saros L, Hart K, Koivuniemi E, Egan B, Raats M, Laitinen K. Micronutrient supplement recommendations in pregnancy vary across a geographically diverse range of countries: a narrative review. Nutr Res 2024; 123:18-37. [PMID: 38228076 DOI: 10.1016/j.nutres.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
Specific food supplements are essential during preconception and pregnancy to ensure adequate intake of vitamins and minerals to support fetal growth and development and metabolic changes in the maternal body. Our objective was to identify food supplement recommendations, particularly those of folic acid, iron, Vitamin D, and iodine, during preconception and/or pregnancy across a geographically diverse range of countries. Further, we investigated whether country location and income-level related to the recommendations. We performed an electronic search and identified country-specific preconception and pregnancy food supplement recommendations, policy documents, and official guidelines of national organizations informing recommendations. To ensure the data were as accurate as possible, country-specific experts were contacted. Data were collected in 2017 and reevaluated in 2022. Country income level was determined by the World Bank classification. Each inspected country (n = 43) recommended folic acid supplementation, typically 400 µg/day, before and during pregnancy. About half of the countries recommended an iron supplement (dose range, 16-195 mg/day) and one quarter Vitamin D (typically 10 µg/d in higher latitudes) and iodine (150-200 µg/day). Country location and income level had some influence on the recommendations. Vitamin D was more often recommended in higher latitude, high-income countries. Almost all upper-middle and lower-middle income countries recommended iron supplementation, whereas less than one third of high-income countries had a corresponding recommendation. Findings suggest that food supplement recommendations for pregnant women vary across countries, likely influenced by geographic location as well as income level. These data may be used in the harmonization of food supplement recommendations.
Collapse
Affiliation(s)
- Lotta Saros
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland.
| | - Kathryn Hart
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland
| | - Bernadette Egan
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Monique Raats
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; Nutrition and Food Research Center, University of Turku, 20014 Turku, Finland
| |
Collapse
|
3
|
Vucak J, Matijevic J, Pivac I, Markic J. Adherence to Vitamin D Supplementation during Infancy-A Single Pediatric Primary Practice Retrospective Study. Pediatr Rep 2023; 15:660-667. [PMID: 37987284 PMCID: PMC10661251 DOI: 10.3390/pediatric15040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/15/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
The risk of vitamin D deficiency is high in infants. Therefore, potential vitamin D deficiency should be prophylactically treated with vitamin D supplementation. Achieving good adherence to recommended prophylactic regimens is the goal of every primary pediatrician. The aim of this paper was to establish whether Croatian infants receive recommended prophylactic doses of vitamin D regularly. We analyzed the prescription rate of vitamin D preparation during the first year of life in one pediatric primary practice. Our research has shown, for the first time in Croatia, that there is low treatment adherence. Only 7.6% of infants received the recommended doses of vitamin D. The percentage of infants in the moderately irregular adherence group was 19.3%. There was no statistical difference regarding urban or rural place of living or parents' educational level. Based on these findings, a comprehensive public health campaign is needed to improve adherence to vitamin D supplementation during infancy. Also, further studies on larger samples and on a national level are warranted.
Collapse
Affiliation(s)
- Jerko Vucak
- Primary Health Care Pediatric Practice, Sibenik 22000, Croatia;
| | - Jeronim Matijevic
- Department of Pediatrics, University Hospital of Split, Split 21000, Croatia;
| | - Ivan Pivac
- School of Medicine, University of Split, Split 21000, Croatia;
| | - Josko Markic
- Department of Pediatrics, University Hospital of Split, Split 21000, Croatia;
- School of Medicine, University of Split, Split 21000, Croatia;
| |
Collapse
|
4
|
Cavarzere P, Pausilli R, Nicolussi Prinicpe L, Gaudino R, Guzzo A, Cantalupo G, Antoniazzi F. Decreased vitamin D levels in the pediatric population after COVID-19 lockdown. Ital J Pediatr 2023; 49:113. [PMID: 37670325 PMCID: PMC10478299 DOI: 10.1186/s13052-023-01515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUD SARS-Cov2 infection began to spread worldwide since December 2019; on March 2020, the World Health Organization characterized its related disease, named COVID-19, as a pandemic. In Italy, to contain the spread of infection a severe lockdown in the spring 2020 was instituted. Other less severe restrictions were imposed in the winter 2020-2021 and in the spring 2021. The containment measures caused a series of consequences for the population and, in particular, for children and adolescents that presented psychophysical problems. The aim of this manuscript is to investigate the serum levels of vitamin D in children and adolescents before, during and after the lockdown consequent to COVID-19 pandemic. METHODS This is a retrospective cross-sectional study, including all children and adolescents between 1 to 18 years referring to the Pediatric Endocrinology Service of the University Hospital of Verona, Italy, between January 2019 and December 2021. All patients affected by clinical conditions that involve vitamin D metabolism or assuming vitamin D supplementation were excluded. RESULTS In total, 491 children (36.7% males and 63.3% females) were enrolled in this study. The vitamin D levels decreased over time: 28.3 ± 10.2 ng/mL in 2019; 28.2 ± 11.4 ng/mL in 2020 and 24.9 ± 10.1 ng/mL in 2021 (p < 0.05). The vitamin D levels are significant higher in summer and in autumn in comparison with the levels of winter and spring, regardless of the examined years. CONCLUSIONS The measures adopted to contain the COVID-19 pandemic led to a reduction of serum levels of vitamin D in pediatric population, probably due to the reduced solar exposure. This may have severe consequences on the bone metabolism of those children who did not present optimal vitamin D levels even before the lockdown. Therefore, an adequate supplementation of vitamin D is necessary from the end of fall to the beginning of spring (November-April) in all children and adolescents living in Northern Italy.
Collapse
Affiliation(s)
- Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Romina Pausilli
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Lara Nicolussi Prinicpe
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Rossella Gaudino
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Alessandra Guzzo
- Laboratory Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Innovation Biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Child Neuropsychiatry Unit, University Hospital of Verona, Verona, Italy
| | - Franco Antoniazzi
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy
- Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
- Regional Center for the Diagnosis and Treatment of Children and Adolescents With Rare Skeletal Disorders. Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| |
Collapse
|
5
|
PARLAK Z, İLGÜN GÜREL D, SOYER Ö, ŞEKEREL BE, ŞAHİNER ÜM. Nutritional risks in children with food allergy. Turk J Med Sci 2023; 53:845-858. [PMID: 38031941 PMCID: PMC10765559 DOI: 10.55730/1300-0144.5648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/18/2023] [Accepted: 04/04/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Food allergies (FA) are a growing problem in the pediatric population and clinical features differ according to the underlying immunological mechanisms. While the primary management strategy is to eliminate the culprit food from the diet, assessment of the potential nutritional risks of elimination is also an integral part of management. In cases that do not improve over time; if you have basic food allergies and multiple food allergies, this can also lead to negative nutritional consequences. The contribution of basic nutrients, economical and easily accessible foods to the diet, is critical and has an important place in meeting the daily adequate intake of many nutrients. In the presence of food allergy, it is necessary to meet the vitamins and minerals that cannot be obtained from allergic foods, with alternative sources or supplements. For example, insufficient calcium intake in cow's milk allergy (CMA), the most common FA in early childhood, is very likely if an alternative supplement has not been introduced. In the management of CMA, choosing the appropriate formula and/or supplement for the clinical characteristics of children, when necessary, has an important place. In conclusion, nutritional risk assessment of children with FA requires a comprehensive, detailed, and multidisciplinary approach.
Collapse
Affiliation(s)
- Zeynep PARLAK
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
- Department of Nutrition and Dietetics, Hacettepe İhsan Doğramacı Children’s Hospital, Hacettepe University, Ankara,
Turkiye
| | - Deniz İLGÜN GÜREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Özge SOYER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Bülent Enis ŞEKEREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Ümit Murat ŞAHİNER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| |
Collapse
|
6
|
Saultier P, Simonin M, Beaumais TAD, Rialland F, Alby-Laurent F, Lubnau M, Desplantes C, Jacqz-Aigrain E, Rohrlich P, Reguerre Y, Rabian F, Sirvent N, Plat GW, Petit A. [Practical management during maintenance therapy of pediatric acute lymphoblastic leukemia: Recommendations of the French Society for Childhood and Adolescent Cancer and Leukemia (SFCE)]. Bull Cancer 2022; 109:1132-1143. [PMID: 35863954 DOI: 10.1016/j.bulcan.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
Maintenance therapy is the last phase of treatment for acute lymphoblastic leukemia in children and adolescents. Although maintenance therapy is associated with toxicities and specific management issues, it is an essential phase of treatment that reduces the risk of relapse. The objective of this work is to propose a guide for the initiation, administration, and monitoring of maintenance therapy, and for the management of food, schooling, leisure, community life, risk of infection and links with family medicine.
Collapse
Affiliation(s)
- Paul Saultier
- Hôpital de la Timone Enfants, APHM, service d'hématologie, immunologie et oncologie pédiatrique, Marseille, France.
| | - Mathieu Simonin
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
| | | | - Fanny Rialland
- CHU de Nantes, service d'onco-hématologie pédiatrique, Nantes, France
| | - Fanny Alby-Laurent
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
| | - Marion Lubnau
- CHU de Nancy, service d'onco-hématologie pédiatrique, Nancy, France
| | | | - Evelyne Jacqz-Aigrain
- AP-HP, hôpital Saint-Louis, département de pharmacologie et pharmacogénétique, Paris, France
| | - Pierre Rohrlich
- CHU de Nice, service d'hématologie pédiatrique, Nice, France
| | - Yves Reguerre
- CHU de la Réunion, service d'hémato-oncologie pédiatrique, Réunion, France
| | - Florence Rabian
- AP-HP, hôpital Saint-Louis, service d'hématologie adolescents et jeunes adultes, Paris, France
| | - Nicolas Sirvent
- CHU de Montpellier, service d'hématologie et oncologie pédiatrique, Montpellier, France
| | - Geneviève Willson Plat
- CHU de Toulouse, service d'hématologie oncologie et immunologie pédiatrique, Toulouse, France
| | - Arnaud Petit
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
| |
Collapse
|
7
|
He L, Zhou P, Zhou X, Tian S, Han J, Zhai S. Evaluation of the clinical practice guidelines and consensuses on calcium and vitamin D supplementation in healthy children using the Appraisal of Guidelines for Research and Evaluation II instrument and Reporting Items for Practice Guidelines in Healthcare statement. Front Nutr 2022; 9:984423. [PMID: 36238458 PMCID: PMC9551644 DOI: 10.3389/fnut.2022.984423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to assess the methodological and reporting quality of the guidelines and consensus on calcium and vitamin D supplementation in healthy children, and the consistency of these recommendations. Methods A systematic search of relevant guideline websites and databases, including PubMed, Embase, CNKI, WangFang, and SinoMed, was undertaken from inception to April 7, 2021, by two independent reviewers who assessed the eligible guidelines using the validated Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) tools. Overall, the between-reviewer agreement was evaluated using an intra-class correlation coefficient. Results A total of 24 guidelines and consensuses from 2002 to 2022 were identified from China, the United States, Canada, France, Australia, New Zealand, Europe, and other countries and regions. These were of mixed quality, and scored poorly in the rigor of development, editorial independence, and applicability of the domains of AGREE II. Among the seven domains of the RIGHT checklist, domain one (basic information) had the highest reporting rate (69.3%), whereas domain five (review and quality assurance) had the lowest reporting rate (11.5%). The overall quality of the included guidelines and consensuses was low. Only 12 guidelines were recommended, with modifications. The recommended calcium intake for children of different ages varies greatly (400–1,150 mg/day). Among the included guidelines and consensuses, a vitamin D (VD) prevention dose of 400 IU/day in infants was generally considered safe, and 25-hydroxyvitamin-D [25(OH)D] levels of <20 ng/mL (50 nmol/L) or 20–30 ng/mL (50–75 nmol/L) indicated VD deficiency or insufficiency. However, the recommended amount of VD for children of different age groups and risk strata differed considerably (400–4,000 IU/day or 10–100 μg/day). The choice of VD2 or VD3 supplements and sunlight exposure also differed across the guidelines and consensuses. Conclusion There is considerable variability in calcium and VD guidelines and consensus development methods in calcium and VD supplementation for healthy children. Therefore, efforts are necessary to strengthen the methodological rigor of guideline development and utilize the best available evidence to underpin recommendations.
Collapse
Affiliation(s)
- Lanzhi He
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Department of Pharmacy, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Xin Zhou
- Department of Pharmacy, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Shuxia Tian
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Department of Pharmacy, Tianjin Nankai Hospital, Tianjin, China
| | - Jing Han
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- *Correspondence: Suodi Zhai,
| |
Collapse
|
8
|
Heo JS, Ahn YM, Kim ARE, Shin SM. Breastfeeding and vitamin D. Clin Exp Pediatr 2022; 65:418-429. [PMID: 34902960 PMCID: PMC9441616 DOI: 10.3345/cep.2021.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
The recent re-emergence of vitamin D deficiency (VDD) and rickets among breastfed infants without adequate sunlight exposure and vitamin D supplementation has been reported worldwide. Breastfed infants are particularly vulnerable to VDD because of the low vitamin D content of breast milk, restricted sunlight exposure, increased pollution, and limited natural dietary sources of vitamin D. The prevalence of VDD in breastfed infants differs vastly between studies and nations at 0.6%-91.1%. The recommended intake of vitamin D for lactating mothers to optimize their overall vitamin D status and, consequently, of their breast milk is 200-2,000 IU/day, indicating a lack of consensus. Some studies have suggested that maternal high-dose vitamin D supplementation (up to 6,400 IU/day) can be used as an alternate strategy to direct infant supplementation. However, concern persists about the safety of maternal high-dose vitamin D supplementation. Direct infant supplementation is the currently available option to support vitamin D status in breastfed infants. The recommended dose for vitamin D supplementation in breastfed infants according to various societies and organizations worldwide is 200-1,200 IU/day. Most international guidelines recommend that exclusively or partially breastfed infants be supplemented with 400 IU/day of vitamin D during their first year of life. However, domestic studies on the status and guidelines for vitamin D in breastfed infants are insufficient. This review summarizes the prevalence of VDD in breastfed infants, vitamin D content of breast milk, and current guidelines for vitamin D supplementation of lactating mothers and infants to prevent VDD in breastfed infants.
Collapse
Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Jang's Hospital, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Son Moon Shin
- Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | | |
Collapse
|
9
|
Bacchetta J, Edouard T, Laverny G, Bernardor J, Bertholet-Thomas A, Castanet M, Garnier C, Gennero I, Harambat J, Lapillonne A, Molin A, Naud C, Salles JP, Laborie S, Tounian P, Linglart A. Vitamin D and calcium intakes in general pediatric populations: A French expert consensus paper. Arch Pediatr 2022; 29:312-325. [PMID: 35305879 DOI: 10.1016/j.arcped.2022.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/20/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in newborns, infants, children, and adolescents to prevent vitamin D deficiency and rickets in general populations. STUDY DESIGN We formulated clinical questions relating to the following categories: the Patient (or Population) to whom the recommendation will apply; the Intervention being considered; the Comparison (which may be "no action," placebo, or an alternative intervention); and the Outcomes affected by the intervention (PICO). These PICO elements were arranged into the questions to be addressed in the literature searches. Each PICO question then formed the basis for a statement. The population covered consisted of children aged between 0 and 18 years and premature babies hospitalized in neonatology. Two groups were assembled: a core working group and a voting panel from different scientific pediatric committees from the French Society of Pediatrics and national scientific societies. RESULTS We present here 35 clinical practice points (CPPs) for the use of native vitamin D therapy (ergocalciferol, vitamin D2 and cholecalciferol, vitamin D3) and calcium nutritional intakes in general pediatric populations. CONCLUSION This consensus document was developed to provide guidance to health care professionals on the use of nutritional vitamin D and dietary modalities to achieve the recommended calcium intakes in general pediatric populations. These CPPs will be revised periodically. Research recommendations to study key vitamin D outcome measures in children are also suggested.
Collapse
Affiliation(s)
- J Bacchetta
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France; INSERM U1033, LYOS, Prévention des Maladies Osseuses, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France.
| | - T Edouard
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Unité d'Endocrinologie, Génétique et Pathologies Osseuses, Filières Santé Maladies Rares OSCAR et BOND, Hôpital des Enfants, Toulouse, France
| | - G Laverny
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, CNRS UMR7104, INSERM U1258, Université de Strasbourg, Illkirch, France
| | - J Bernardor
- INSERM U1033, LYOS, Prévention des Maladies Osseuses, Lyon, France; Département de Pédiatrie, CHU de Nice, Nice, France
| | - A Bertholet-Thomas
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France; INSERM U1033, LYOS, Prévention des Maladies Osseuses, Lyon, France
| | - M Castanet
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Département de Pédiatrie, Filière Santé Maladies Rares OSCAR, CHU Rouen, Rouen, France
| | - C Garnier
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France
| | - I Gennero
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Unité d'Endocrinologie, Génétique et Pathologies Osseuses, Filières Santé Maladies Rares OSCAR et BOND, Hôpital des Enfants, Toulouse, France
| | - J Harambat
- Centre de Référence Maladies Rénales Rares, Unité de Néphrologie Pédiatrique, Hôpital Pellegrin-Enfants, Bordeaux, France; INSERM U1219, Bordeaux, France
| | - A Lapillonne
- Service de Pédiatrie et Réanimation Néonatales, EHU 7328 Université de Paris, Hôpital Necker- Enfants Malades, Paris, France; CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - A Molin
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Département de Génétique, Filière Santé Maladies Rares OSCAR, CHU Caen, Caen, France
| | - C Naud
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Filières Santé Maladies Rares OSCAR, ORKID et ERKNet, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron 69677 CEDEX, France
| | - J P Salles
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Unité d'Endocrinologie, Génétique et Pathologies Osseuses, Filières Santé Maladies Rares OSCAR et BOND, Hôpital des Enfants, Toulouse, France
| | - S Laborie
- Service de Réanimation Néonatale, Hôpital Femme Mère Enfant, Bron, France
| | - P Tounian
- Service de Nutrition et Gastroentérologie Pédiatriques, Hôpital Trousseau, Faculté de Médecine Sorbonne Université, Paris, France
| | - A Linglart
- AP-HP, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service d'Endocrinologie et diabète de l'enfant, Filières Santé Maladies Rares OSCAR, ERN endoRARE et BOND, Plateforme d'expertise des maladies rares Paris Saclay, Hôpital Bicêtre Paris-Saclay, Université Paris Saclay, INSERM U1185, Le Kremlin Bicêtre, France
| |
Collapse
|
10
|
Hajhashemy Z, Lotfi K, Heidari Z, Saneei P. Serum Vitamin D Levels in Relation to Abdominal Obesity in Children and Adolescents: A Systematic Review and Dose-Response Meta-Analysis. Front Nutr 2022; 9:806459. [PMID: 35252295 PMCID: PMC8888413 DOI: 10.3389/fnut.2022.806459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Findings of epidemiological studies that investigated the relationship between serum vitamin D levels and abdominal obesity were inconsistent. To evaluate the relationship between blood vitamin D levels and abdominal obesity in children and adolescents, we did a comprehensive review and dose-response meta-analysis. Methods A comprehensive search in electronic databases including Scopus, Web of Science (ISI), MEDLINE (Pubmed), EMBASE, and Google Scholar was conducted, up to May 2021, for epidemiological studies that investigated the linkage between serum vitamin D levels (as the exposure) and abdominal obesity (as the outcome) in children and adolescents. Results Combining 19 effect sizes from 14 cross-sectional studies that included 29,353 apparently healthy children illustrated that the highest vs. lowest level of serum vitamin D was related to a 35% reduced odds of abdominal obesity [odds ratio (OR): 0.65; 95% CI: 0.50, 0.84]. Linear dose-response analysis revealed that each 10 ng/ml increase in serum vitamin D levels was related to a 7% decrease in odds of abdominal obesity (OR: 0.93; 95% CI: 0.90, 0.95), only among investigations that used percentiles of waist circumference (>75th or 90th) to define the disorder (including 6,868 total subjects and 1,075 cases with abdominal obesity). Increasing serum vitamin D levels from 20 to 40 ng/ml was related to reduce odds of abdominal obesity in children. Conclusion A negative relationship between blood vitamin D levels and abdominal obesity in children and adolescents was discovered in this meta-analysis of epidemiologic studies. Among investigations that used waist circumference percentiles to define the disorder, the relationship was in a dose-response manner. To affirm this relationship, more research studies are needed, particularly using a prospective design. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021261319, PROSPERO 2021, identifier: CRD42021261319.
Collapse
Affiliation(s)
- Zahra Hajhashemy
- Students' Scientific Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keyhan Lotfi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- *Correspondence: Parvane Saneei ;
| |
Collapse
|
11
|
Mathilde M, Butin M, Pascal R, Plaisant F, Laborie S, Bacchetta J. Local protocol helped to deliver vitamin D levels more accurately in preterm infants. Acta Paediatr 2022; 111:76-85. [PMID: 34460964 DOI: 10.1111/apa.16088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
AIM This study retrospectively evaluated the effectiveness and safety of a local hospital protocol of vitamin D supplementation for preterm infants, which was modified in 2016. METHODS We focussed on 99 preterm infants born before 31 weeks of gestation and admitted to the neonatal intensive care unit at the Femme Mere Enfant Hospital, Bron, France, from 1 January to 31 December 2018. Calcium and urinary calcium were measured, and 25-hydroxy vitamin D (25(OH)D) levels were monitored monthly and supplementation was adjusted, with 50-120 nmol/L considered normal. The results are presented as medians and interquartile ranges. RESULTS The infants were enrolled at a gestational age of 28.0 [26.9-29.1] weeks and birth weight of 960 [800-1160] g. When they were discharged at 37.3 [35.2-39.8] weeks, the overall 25(OH)D level was 98 [79-140] nmol/L: 4% had low levels, 63% had normal levels and 33% had high levels. Vitamin D supplementation was withdrawn for 60% more than one month before discharge. Rickets or fractures were not reported. CONCLUSION The modified protocol limited underdosing and significant overdosing, but moderate hypervitaminosis D was still frequent. Urgent studies are needed to determine the optimal supplementation and clinical impact of 25(OH)D on comorbidities in preterm infants.
Collapse
Affiliation(s)
- Mauras Mathilde
- Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
| | - Marine Butin
- Service de Néonatologie et Réanimation néonatale Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Centre International de Recherche en Infectiologie (CIRI) INSERM U1111CNRS UMR5308Ecole Normale Supérieure de Lyon Lyon France
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
| | - Roy Pascal
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- Laboratoire de Biométrie et Biologie Evolutive Hospices Civils de LyonCNRSUMR5558 Villeurbanne France
- Pôle Santé Publique Service de Biostatistique‐Bioinformatique Lyon France
| | - Franck Plaisant
- Service de Néonatologie et Réanimation néonatale Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Centre International de Recherche en Infectiologie (CIRI) INSERM U1111CNRS UMR5308Ecole Normale Supérieure de Lyon Lyon France
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
| | - Sophie Laborie
- Service de Néonatologie et Réanimation néonatale Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Centre International de Recherche en Infectiologie (CIRI) INSERM U1111CNRS UMR5308Ecole Normale Supérieure de Lyon Lyon France
| | - Justine Bacchetta
- Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Faculté de médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Hospices Civils de LyonHôpital Femme Mère Enfant Bron France
- Prévention des Maladies Osseuses INSERM 1033LYOS Lyon France
| |
Collapse
|
12
|
Gérard AO, Fresse A, Gast M, Merino D, Gourdan P, Laurain A, Margaritis I, Gauci PA, Huret F, Parassol N, Rocher F. Case Report: Severe Hypercalcemia Following Vitamin D Intoxication in an Infant, the Underestimated Danger of Dietary Supplements. Front Pediatr 2022; 10:816965. [PMID: 35178365 PMCID: PMC8844365 DOI: 10.3389/fped.2022.816965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
Vitamin D supplementation is routinely introduced in infants, according to medical guidelines. However, vitamin D overdose can result in life-threatening hypercalcemia. We report the case of a 3-month-old infant who suffered from severe hypercalcemia. Upon detailed questioning of the parents, a vitamin D administration error has been identified. Indeed, the parents had followed the advice of their midwife. They substituted the prescribed medicinal vitamin D by a dietary supplement, different in concentration and dosing, without performing the dose conversion needed. In fact, many different medications and dietary supplements with vitamin D exist, offering various concentrations and units of measurement. This case highlights the pivotal role of therapeutic education. Broadly, there is a need for harmonization of the regulation and labeling of dietary supplements and medications containing vitamin D.
Collapse
Affiliation(s)
- Alexandre O Gérard
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice, Nice, France.,Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Audrey Fresse
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Myriam Gast
- Department of Pediatry, Hospital Center of Bastia, Bastia, France
| | - Diane Merino
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Pierre Gourdan
- Department of Pediatry, Lenval Hospital - Centre Hospitalier Universitaire de Nice, Nice, France
| | - Audrey Laurain
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Irène Margaritis
- Nutrition Risk Assessment Unit, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - Pierre-Alexis Gauci
- Department of Gynecology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Fanny Huret
- Nutrition Risk Assessment Unit, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - Nadège Parassol
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Fanny Rocher
- Department of Pharmacology and Pharmacovigilance Center of Nice, Centre Hospitalier Universitaire de Nice, Nice, France
| |
Collapse
|
13
|
Flot C, Porquet-Bordes V, Bacchetta J, Rothenbuhler A, Lienhardt-Roussie A, Giabicani E, Gueorguieva I, Storey C, Linglart A, Salles JP, Edouard T. Demographic Characteristics, Risk Factors, and Presenting Features of Children with Symptomatic Nutritional Rickets: A French Series. Horm Res Paediatr 2021; 93:304-312. [PMID: 33120384 DOI: 10.1159/000511419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/03/2020] [Indexed: 12/19/2022] Open
Abstract
AIM To describe the demographic characteristics, risk factors, and presenting features of children with symptomatic nutritional rickets in France. METHODS This is a retrospective study of 38 children diagnosed with nutritional rickets from 1998 to 2019. RESULTS We observed a higher frequency of rickets in males (74 vs. 26%), in young children (median age at diagnosis: 23 months; 82% were younger than 5 years), and in children with a non-Caucasian ethnic background (89%). Most children were exclusively breastfed (78%) without adequate vitamin D supplementation (89%). The most common presentations were bowed legs (63%), hypocalcemic seizures (21%), and growth retardation (11%). Approximately half (62%) of the children were hypocalcemic. The children presenting with hypocalcemic seizures were significantly younger (0.8 vs. 2.2 years; p = 0.041) and had lower total serum calcium levels (1.44 vs. 2.17 mmol/L; p < 0.0001), higher phosphatemia (1.43 vs. 1.23 mmol/L; p = 0.020), and lower 25-hydroxy vitamin D levels (3 vs. 7 ng/mL; p = 0.020) but similar parathyroid hormone levels (357 vs. 289 ng/mL; p = 0.940) compared to rickets cases who did not experience hypocalcemic seizures. A dilated cardiomyopathy was detected in 14% of the children who had undergone echocardiography. CONCLUSION Nutritional rickets remains endemic in the pediatric population and its most severe forms can have life-threatening sequelae. Health practitioners need to be cognizant of these facts to raise awareness and screen high-risk populations.
Collapse
Affiliation(s)
- Claire Flot
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Unité d'Endocrinologie, Maladies Osseuses et Génétique, Hôpital des Enfants, CHU de Toulouse, ERN BOND, INSERM UMR 1043/CNRS 5828, Université Paul Sabatier, Toulouse, France
| | - Valérie Porquet-Bordes
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Unité d'Endocrinologie, Maladies Osseuses et Génétique, Hôpital des Enfants, CHU de Toulouse, ERN BOND, INSERM UMR 1043/CNRS 5828, Université Paul Sabatier, Toulouse, France
| | - Justine Bacchetta
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, INSERM UMR 1033, Bron, France
| | - Anya Rothenbuhler
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Endocrinology and Diabetology for Children, Hôpital Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France
| | - Anne Lienhardt-Roussie
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Service de Pédiatrie, CHU de Limoges, Limoges, France
| | - Eloise Giabicani
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Sorbonne Université, INSERM, Centre de Recherche Saint Antoine, APHP, Explorations Fonctionnelles Endocriniennes Hôpital Armand Trousseau, Paris, France
| | - Iva Gueorguieva
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Service d'Endocrinologie Pédiatrique Hôpital Jeanne de Flandres, CHR Lille, Lille, France
| | - Caroline Storey
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Département d'Endocrinologie et Diabétologie Pédiatrique, Hôpital Universitaire Robert-Debré, Paris, France
| | - Agnès Linglart
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Endocrinology and Diabetology for Children, Hôpital Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Pierre Salles
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France.,Unité d'Endocrinologie, Maladies Osseuses et Génétique, Hôpital des Enfants, CHU de Toulouse, ERN BOND, INSERM UMR 1043/CNRS 5828, Université Paul Sabatier, Toulouse, France
| | - Thomas Edouard
- Reference and Competence Centers for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR Network for Rare Diseases, Paris, France, .,Unité d'Endocrinologie, Maladies Osseuses et Génétique, Hôpital des Enfants, CHU de Toulouse, ERN BOND, INSERM UMR 1043/CNRS 5828, Université Paul Sabatier, Toulouse, France,
| |
Collapse
|
14
|
Fiamenghi VI, Mello EDD. Vitamin D deficiency in children and adolescents with obesity: a meta-analysis. J Pediatr (Rio J) 2021; 97:273-279. [PMID: 33022267 PMCID: PMC9432231 DOI: 10.1016/j.jped.2020.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/25/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the prevalence of vitamin D deficiency in obese children and adolescents when compared to eutrophic controls. METHODS Systematic review with meta-analysis covering studies with patients aged 0-18 years old diagnosed with obesity and vitamin D deficiency and control group of eutrophic patients. The studies were retrieved in the PubMed, Embase, and LILACS databases in December 2019. The search used the terms "obesity" in combination with "pediatric population" and "vitamin D". RESULTS Through the search 3155 articles were retrieved; and after analysis, 20 studies were selected according to the study objectives. A total of 24,600 children and adolescents were included. Through meta-analysis, the relative risk for the association between obesity and vitamin D deficiency in the pediatric population was 1.41 (95% CI: 1.26-1.59) (I² = 89%, p < 0.01). CONCLUSION Children and adolescents with obesity have higher risk of vitamin D deficiency.
Collapse
Affiliation(s)
- Verônica Indicatti Fiamenghi
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Elza Daniel de Mello
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| |
Collapse
|
15
|
Tareke AA, Hadgu AA, Ayana AM, Zerfu TA. Prenatal vitamin D supplementation and child respiratory health: A systematic review and meta-analysis of randomized controlled trials. World Allergy Organ J 2020; 13:100486. [PMID: 33294117 PMCID: PMC7691606 DOI: 10.1016/j.waojou.2020.100486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background Systematic review and meta-analyses of observational studies on maternal vitamin D status and risk of respiratory allergic conditions indicated that mothers who had supplementation during pregnancy could decrease the risk of recurrent wheeze or asthma in their offspring. Objectives We conducted this meta-analysis of Randomized Controlled Trials with the primary intention of detecting the effect of prenatal vitamin D supplementation on the offspring's asthma. Secondary outcomes under respiratory health include eczema, lower respiratory tract infections, Immunoglobulin E positive test, upper respiratory tract infections, and allergic rhinitis. Methods A comprehensive search of PubMed, ScienceDirect, Google Scholar, and Cochrane Library databases was performed to retrieve randomized controlled trials. Risk Ratio with 95% confidence intervals was computed from dichotomous data using a random-effects model, with I2 >50% representing notable heterogeneity. Results Six clinical trials met the inclusion criteria, involving a total of 2898 subjects (1461 experimental group and 1437 control group). There was non-significant inverse relationship between vitamin D intake during pregnancy and the occurrence of asthma in offspring (pooled RR = 0.89, 95% CI = 0.69-1.15, I 2 = 46% and Z-static = 0.90, P-value = 0.37). There is no significant difference in the risk of assessed childhood respiratory problems due to maternal supplementation of vitamin D during pregnancy. Conclusion and implications Currently, there is no fertile evidence to promote vitamin D supplementation in pregnancy for childhood respiratory health. Future clinical trials should emphasize early initiation of vitamin D supplementation, consider 6 weeks to 6 months postnatal critical window for vitamin D deficiency for offspring, lower risk dose of vitamin D, and identify different phenotypes of asthma and response to vitamin D supplementation.
Collapse
Affiliation(s)
- Amare Abera Tareke
- Physiology Unit, Department of Biomedical Sciences, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Addis Alem Hadgu
- Biochemistry Unit, Department of Biomedical Sciences, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Andualem Mossie Ayana
- Physiology Unit, Department of Biomedical Sciences, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Taddese Alemu Zerfu
- College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.,Global Academy of Agriculture & Food Security (GAAFS), University of Edinburgh, UK
| |
Collapse
|
16
|
Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. The Role of Micronutrients in Support of the Immune Response against Viral Infections. Nutrients 2020; 12:E3198. [PMID: 33092041 PMCID: PMC7589163 DOI: 10.3390/nu12103198] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 12/12/2022] Open
Abstract
Viral infections are a leading cause of morbidity and mortality worldwide, and the importance of public health practices including handwashing and vaccinations in reducing their spread is well established. Furthermore, it is well known that proper nutrition can help support optimal immune function, reducing the impact of infections. Several vitamins and trace elements play an important role in supporting the cells of the immune system, thus increasing the resistance to infections. Other nutrients, such as omega-3 fatty acids, help sustain optimal function of the immune system. The main aim of this manuscript is to discuss of the potential role of micronutrients supplementation in supporting immunity, particularly against respiratory virus infections. Literature analysis showed that in vitro and observational studies, and clinical trials, highlight the important role of vitamins A, C, and D, omega-3 fatty acids, and zinc in modulating the immune response. Supplementation with vitamins, omega 3 fatty acids and zinc appears to be a safe and low-cost way to support optimal function of the immune system, with the potential to reduce the risk and consequences of infection, including viral respiratory infections. Supplementation should be in addition to a healthy diet and fall within recommended upper safety limits set by scientific expert bodies. Therefore, implementing an optimal nutrition, with micronutrients and omega-3 fatty acids supplementation, might be a cost-effective, underestimated strategy to help reduce the burden of infectious diseases worldwide, including coronavirus disease 2019 (COVID-19).
Collapse
Affiliation(s)
| | | | | | | | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (F.P.); (A.A.); (C.N.)
| |
Collapse
|
17
|
|
18
|
Edouard T, Guillaume-Czitrom S, Bacchetta J, Sermet-Gaudelus I, Dugelay E, Martinez-Vinson C, Salles JP, Linglart A. Guidelines for the management of children at risk of secondary bone fragility: Expert opinion of a French working group. Arch Pediatr 2020; 27:393-398. [PMID: 32921532 DOI: 10.1016/j.arcped.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
The current French national guidelines were elaborated by a working group consisting of experts in the field of pediatric endocrinology, rheumatology, hepatogastroenterology, nephrology, and pneumology. A systematic search was undertaken of the literature published between 2008 and 2018 and indexed in PubMed. The recommendations developed were then validated by an external evaluation group comprising representatives from the various highly specialized fields in pediatrics, representatives of the societies and groups supporting the development of the guidelines, and representatives of different healthcare professions. The objective of these guidelines was to detail the current optimal management of children at risk of secondary bone fragility.
Collapse
Affiliation(s)
- T Edouard
- Unité d'endocrinologie, maladies osseuses et génétique, centre de référence des maladies rares du calcium et du phosphate, filière OSCAR, ERN BOND, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| | - S Guillaume-Czitrom
- AP-HP, médecine des adolescents, GHU Bicêtre Paris-Saclay, 94270 Le Kremlin-Bicêtre cedex, France
| | - J Bacchetta
- Service de néphrologie, rhumatologie et dermatologie pédiatrique, centre de référence des maladies rares du calcium et du phosphate, filière OSCAR, CHU de Lyon, 69677 Bron cedex, France
| | | | - E Dugelay
- Service de gastroentérologie et hépatologie pédiatrique, CHU Robert-Debré, 75019 Paris, France
| | - C Martinez-Vinson
- Service de gastroentérologie et hépatologie pédiatrique, CHU Robert-Debré, 75019 Paris, France
| | - J P Salles
- Unité d'endocrinologie, maladies osseuses et génétique, centre de référence des maladies rares du calcium et du phosphate, filière OSCAR, ERN BOND, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - A Linglart
- AP-HP, endocrinologie et diabète de l'enfant, centre de référence des maladies rares du calcium et du phosphate, filière OSCAR, GHU Bicêtre Paris-Saclay, 94270 Le Kremlin-Bicêtre cedex, France
| |
Collapse
|
19
|
Ilmiawati C, Oviana A, Friadi A, Reza M. Sunlight exposed body surface area is associated with serum 25-hydroxyvitamin D (25(OH)D) level in pregnant Minangkabau women, Indonesia. BMC Nutr 2020; 6:18. [PMID: 32467767 PMCID: PMC7232832 DOI: 10.1186/s40795-020-00342-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/10/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is highly prevalent in women, and living in a tropical country with a year-round abundance of sunlight as the primary source of vitamin D does not seem to guarantee adequate serum 25(OH)D. While living in the tropics, Minangkabau women are known to dress specifically according to their culture. This study was aimed to elucidate the association of sunlight exposed body surface area with serum 25(OH)D in pregnant Minangkabau women of Indonesia. METHODS We performed a cross-sectional study on 88 Minangkabau women in late pregnancy. Lifestyle data were collected using a questionnaire, and dietary intake of vitamin D was calculated from 24-h food recall. The skin pigmentation type was determined by the Fitzpatrick scale, and the body surface area exposed to sunlight was estimated. Serum 25(OH)D was quantified by ELISA method. Serum 25(OH)D differences according to the duration of sunlight exposure, skin pigmentation type, and sunscreen use were statistically analyzed by ANOVA. The correlation of sunlight exposed body surface area and serum 25(OH)D was analyzed by Spearman's correlation. RESULTS Nearly half of the subjects (n = 40; 45.5%) were deficient in vitamin D (< 20 ng/ml) with serum 25(OH)D level 23.0 ± 10.0 ng/ml (mean ± SD) and the estimated daily intake of vitamin D was 5.6 ± 3.9 μg/1000 kcal/day (mean ± SD). The median percentage of body area exposed to sunlight was 15.8%. There were no differences in serum 25(OH)D levels according to sunlight exposure time, skin pigmentation type, and sunscreen use. The percentage of body area exposed to sunlight was positively correlated with serum 25(OH)D level (Spearman's ρ = 0.403; p < 0.001). CONCLUSIONS Vitamin D deficiency is prevalent in pregnant Minangkabau women. Since increasing body surface area exposed to sunlight may not be culturally acceptable, vitamin D supplementation needs to be considered in this population.
Collapse
Affiliation(s)
- Cimi Ilmiawati
- Department of Pharmacology, Faculty of Medicine, Andalas University, Gedung A, Lantai 1, Main Campus Limau Manis, Pauh, PO. BOX 49, Padang, West Sumatra 25166 Indonesia
| | - Athica Oviana
- Graduate Program of Midwifery, Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
- School of Midwifery, STIKes Perintis, Padang, West Sumatra Indonesia
| | - Andi Friadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
| | - Mohamad Reza
- Department of Biology, Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
| |
Collapse
|
20
|
Patseadou M, Haller DM. Vitamin D in Adolescents: A Systematic Review and Narrative Synthesis of Available Recommendations. J Adolesc Health 2020; 66:388-407. [PMID: 31685374 DOI: 10.1016/j.jadohealth.2019.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Practical guidelines help clinicians make their preventive and therapeutic choices and improve care management. Our purpose was to collect and synthesize available recommendations concerning vitamin D in adolescents (aged 10-19 years). METHODS We searched PubMed, EMBASE, and Cochrane databases from inception to February 5, 2019, for guidance published by different professional associations and governments. We also searched the reference lists of identified recommendations and explored the gray literature using Web search engines. We organized documents by theme: dietary requirements, thresholds, prophylactic supplementation, and treatment of deficiency. RESULTS A total of 32 documents were identified. Most of them targeted the general population and not specifically the age group of adolescents. There is a general agreement that adolescents should not have serum 25-hydroxyvitamin D concentrations below 25-30 nmol/L to avoid poor bone health. However, there is lack of consensus on the optimal concentration to aim for, levels varying between 25 nmol/L and 150 nmol/L. Adequate nutritional requirements of vitamin D are also subject to debate with values ranging between 200 IU/d and 1,000 IU/d. The upper tolerable intake is estimated at 4,000 IU/d by all study groups. Certain associations recommend routine vitamin D supplementation in adolescents. The recommended daily preventive doses vary between 400 IU and 4,000 IU, depending on season, skin pigmentation, sun exposure, consumption of vitamin D-fortified foods, body mass index, and coexistence of certain medical conditions. In case of deficiency, different therapeutic regimens of oral vitamin D are proposed depending on the presence of illness and/or the baseline serum 25-hydroxyvitamin D concentrations. Duration of the treatment varies between 4 weeks and 3 months. A maintenance dose is generally recommended after treatment. CONCLUSIONS At present, there is no consensus among the different societies about vitamin D needs during adolescence. Stronger, evidence-based guidance is needed to inform clinical practice.
Collapse
Affiliation(s)
- Magdalini Patseadou
- Adolescent and Young Adult Health Clinic, Department of Woman, Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland; Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Dagmar M Haller
- Adolescent and Young Adult Health Clinic, Department of Woman, Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland; Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
21
|
Intermittent cholecalciferol supplementation in children and teenagers followed in pediatric nephrology: data from a prospective single-center single-arm open trial. Eur J Pediatr 2020; 179:661-669. [PMID: 31873802 DOI: 10.1007/s00431-019-03553-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/24/2022]
Abstract
Vitamin D deficiency is frequent in pediatric nephrology. The 2017 European guidelines recommend keeping 25OH vitamin D (25-D) levels within the 75-120 nmol/L range, ideally with daily supplementation. Intermittent supplementation with D3 has also been proposed. We aimed to assess the influence of our local protocol of intermittent vitamin D supplementation on the evolution of 25-D levels between baseline and 2 months. VITATOL is a prospective single-center study performed in our tertiary unit in children and teenagers followed for chronic kidney disease (CKD), kidney transplantation, or stable chronic nephrotic syndrome with 25-D levels below 75 nmol/L. Intermittent oral cholecalciferol (100,000 IU) was administered depending on baseline vitamin D levels and body weight. The primary outcome was the change in 25-D levels between baseline and 2 months. Secondary outcomes were the evolution of the main mineral biomarkers. Thirty-seven patients were included. Two months after beginning supplementation, corresponding to a median(min-max) of 46 (14-79) days after the last dose of vitamin D, 25-D levels increased from 50 to 76 nmol/L (p < 0.001), 18 patients having 25-D levels within the target range and 2 above. All patients displayed 25-D levels above 50 nmol/L. There were no significant changes in phosphate, PTH, alkaline phosphatase, and FGF23 levels before and after supplementation. Calcium levels increased from 2.39 to 2.44 mmol/L (p = 0.017), but no differences in calciuria and urinary calcium/creatinine ratio were observed.Conclusion: This vitamin D supplementation protocol using intermittent moderate doses of cholecalciferol seems efficient in 54% of cases, with neither significant overdose nor hypercalciuria. What is Known: • Vitamin D deficiency is frequent in pediatric nephrology. • The 2017 European guidelines recommend keeping 25OH vitamin D levels within the 75-120 nmol/L range ideally with daily supplementation, but intermittent supplementation with D3 has also been proposed. What is New: • We assessed the influence of a local protocol of intermittent vitamin D supplementation on the evolution of 25-D levels between baseline and 2 months in children and teenagers followed in pediatric nephrology. • The intermittent cholecalciferol supplementation protocol seems efficient in 54% of cases, with neither significant overdose nor hypercalciuria.
Collapse
|
22
|
Jensen ME, Ducharme FM, Alos N, Mailhot G, Mâsse B, White JH, Sadatsafavi M, Khamessan A, Tse SM, Alizadehfar R, Bock DE, Daigneault P, Lemire C, Yang C, Radhakrishnan D. Vitamin D in the prevention of exacerbations of asthma in preschoolers (DIVA): protocol for a multicentre randomised placebo-controlled triple-blind trial. BMJ Open 2019; 9:e033075. [PMID: 31892662 PMCID: PMC6955525 DOI: 10.1136/bmjopen-2019-033075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Preschoolers have the highest rate of emergency visits and hospitalisations for asthma exacerbations of all age groups, with most triggered by upper respiratory tract infections (URTIs) and occurring in the fall or winter. Vitamin D insufficiency is highly prevalent in Canadian preschoolers with recurrent asthma exacerbations, particularly in winter. It is associated with more URTIs and, in patients with asthma, more oral corticosteroid (OCS) use. Although evidence suggests that vitamin D supplements significantly decrease URTIs and asthma exacerbations requiring OCS, there is insufficient data in preschoolers. This study aims to determine the impact of vitamin D3 supplementation on exacerbations requiring OCS, in preschoolers with recurrent URTI-induced asthma exacerbations. METHODS AND ANALYSIS This is a phase III, randomised, triple-blind, placebo-controlled, parallel-group multicentre trial of vitamin D3 supplementation in children aged 1-5 years, with asthma triggered by URTIs and a recent history of frequent URTIs and OCS use. Children (n=865) will be recruited in the fall and early winter and followed for 7 months. They will be randomised to either the (1) intervention: two oral boluses of 100 000 international unit (IU) vitamin D3 (3.5 months apart) with 400 IU vitamin D3 daily; or (2) control: identical placebo boluses with daily placebo. The primary outcome is the number of exacerbations requiring OCS per child, documented by medical and pharmacy records. Secondary outcomes include number of laboratory-confirmed viral URTIs, exacerbation duration and severity, parent functional status, healthcare use, treatment deintensification, cost and safety. ETHICS AND DISSEMINATION This study has received ethical approval from all sites. Results will be disseminated via international conferences and manuscripts targeting paediatricians and respirologists, and to families of asthmatic children via our Quebec parents-partners outreach programme. If proven effective, findings may markedly influence the management of URTI-induced asthma in high-morbidity preschoolers and could be directly implemented into practice with an update to clinical guidelines. TRIAL REGISTRATION NUMBER NCT03365687.
Collapse
Affiliation(s)
- Megan E Jensen
- Priority Research Centre Grow Up Well, School of Medicine & Public Health, Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Francine M Ducharme
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Nathalie Alos
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Pediatric Endocrinology Service, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Geneviève Mailhot
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Benoît Mâsse
- Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
- School of Public Health, University of Montreal, Montreal, Québec, Canada
| | - John H White
- Department of Physiology, McGill University, Montreal, Québec, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Khamessan
- Euro-Pharm International Canada Inc, Montreal, Québec, Canada
| | - Sze Man Tse
- Department of Social & Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Reza Alizadehfar
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Dirk E Bock
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Patrick Daigneault
- Department of Pediatrics, Centre Mère-Enfant du CHU de Québec, Quebec City, Quebec, Canada
| | - Chantal Lemire
- Division of Allergy and Immunology, Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Connie Yang
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Dhenuka Radhakrishnan
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| |
Collapse
|
23
|
Bacchetta J, Ginhoux T, Bernoux D, Dubourg L, Ranchin B, Roger C. Assessment of mineral and bone biomarkers highlights a high frequency of hypercalciuria in asymptomatic healthy teenagers. Acta Paediatr 2019; 108:2253-2260. [PMID: 31215071 DOI: 10.1111/apa.14907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
Abstract
AIM Assessment of mineral metabolism is complex in paediatrics. METHODS We assessed the evolution of the main mineral and bone biomarkers (total/bone alkaline phosphatase ALP/BAP, β-crosslaps, osteocalcin, sclerostin, C-terminal and intact FGF23) in 100 healthy teenagers (10-18 years, 50 boys). RESULTS At a mean age of 13.7 ± 2.2 years, phosphatemia, tubular phosphate reabsorption, ALP and BAP significantly decreased along puberty in both genders, whilst parathyroid hormone (PTH), 25-vitamin D (25D), FGF23, plasma calcium and urinary calcium were not modified. In girls, osteocalcin, β-crosslaps and sclerostin significantly decreased at the end of puberty. Calciuria above the crystallisation threshold (>3.8 mmol/L) and urinary calcium/creatinine ratio >0.7 mmol/mmol were found in 39% and 6% of subjects, respectively. Multivariable analyses showed that renal function and PTH were significant predictors of calciuria and urinary calcium/creatinine, whilst 25D remained a predictor only of urinary calcium/creatinine ratio. CONCLUSION Using the most recent assays, this study provides data for mineral/bone biomarkers across puberty and highlights the risk of hyper-calciuria in apparent asymptomatic healthy teenagers, not related to calcium intake but rather to 25D. Future studies are required to dissect the underlying mechanisms increasing calciuria and prevent nephrolithiasis as early as during childhood.
Collapse
Affiliation(s)
- Justine Bacchetta
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hôpital Femme Mère Enfant Bron France
- Faculté de Médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- INSERM UMR 1033 Lyon France
| | - Tiphanie Ginhoux
- EPICIME‐CIC 1407 de Lyon, Inserm Service de Pharmacotoxicologie CHU‐Lyon Bron France
| | - Delphine Bernoux
- EPICIME‐CIC 1407 de Lyon, Inserm Service de Pharmacotoxicologie CHU‐Lyon Bron France
- Service d'Endocrinologie, Diabétologie et Métabolisme pédiatriques Hôpital Femme Mère Enfant Bron France
| | - Laurence Dubourg
- Faculté de Médecine Lyon Est Université Claude Bernard Lyon 1 Lyon France
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale Groupement Hospitalier Edouard Herriot Hospices Civils de Lyon Lyon France
- Laboratory of Tissue Biology and Therapeutic Engineering UMR 5305 CNRS University Lyon 1 Lyon France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rares du Calcium et du Phosphore Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques Hôpital Femme Mère Enfant Bron France
| | - Christelle Roger
- Laboratoire de Biochimie et Biologie Moléculaire Groupe Hospitalier Sud Hospices Civils de Lyon Lyon France
| |
Collapse
|
24
|
Chouraqui JP, Tavoularis G, Turck D, Ferry C, Feillet F. Mineral and vitamin intake of infants and young children: the Nutri-Bébé 2013 survey. Eur J Nutr 2019; 59:2463-2480. [PMID: 31555975 DOI: 10.1007/s00394-019-02093-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/11/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Minerals and vitamins are essential for optimal growth and development, particularly during the first years of life. Therefore, regularly evaluating their intake makes sense. For this purpose, we report the data from the Nutri-Bébé 2013 survey in comparison with the European Food Safety Authority Adequate Intake (AI), or Average Requirement, (AR) according to age. METHODS This observational, nationally representative, cross-sectional survey was conducted in 1035 non-breastfed French children aged 0.5-35 months. Dietary intake was recorded using a food diary on three non-consecutive days, framed by two face-to-face interviews. RESULTS The intake of zinc, magnesium and water-soluble vitamins most of the time met the recommendations. From the first weeks of life, sodium intake exceeded the AI, with a maximum median intake of 1137 mg/day after the age of 30 months. However, it has decreased since 2005. Calcium median intake often exceeded the AI or AR, reaching a maximum of 780 mg/day between 18 and 23 months. Median vitamin A intake always exceeded the AI or AR but exceeded the recommended upper limit in only a few cases. After 2 years, median iron intake was clearly below the AR, i.e. lower than 6.0 mg/day. Dietary vitamin D intake was below the AI, thereby justifying adequate supplementation. Vitamin E intake was below the AI in 50-75% of toddlers. CONCLUSION This survey highlights excessive sodium intake as well as a shortfall of iron, vitamin D, and vitamin E intakes. The potential consequences of these discrepancies with respect to health outcomes remain to be assessed.
Collapse
Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Medical and Surgical Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, 21 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Gabriel Tavoularis
- CREDOC (Centre de Recherche pour l'Etude et l'Observation des Conditions de Vie), 142 rue du Chevaleret, 75013, Paris, France
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, INSERM U995, 59037, Lille, France
| | | | | |
Collapse
|
25
|
Albertini F, Marquant E, Reynaud R, Lacroze V. Two cases of fractures in neonates associated with maternofetal vitamin D deficiency. Arch Pediatr 2019; 26:361-364. [PMID: 31353147 DOI: 10.1016/j.arcped.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/01/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
Vitamin D supplementation is essential for the entire population, especially during pregnancy and in the pediatric period. We report two case studies of full-term newborns who presented long-bone fractures associated with severe vitamin D deficiency transmitted to them by their mothers, even though maternal supplementation had been implemented according to the existing recommendations. These observations encourage the investigation of neonatal vitamin D deficiency in the presence of long-bone fractures in the absence of traumatic birth and the necessity of reenforcing the means of prevention and the selection of risk groups in order to adjust vitamin D supplementation during pregnancy individually.
Collapse
Affiliation(s)
- F Albertini
- Service de médecine néonatale, CHU de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France.
| | - E Marquant
- Service de pédiatrie multidisciplinaire, CHU de la Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - R Reynaud
- Service de pédiatrie multidisciplinaire, CHU de la Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - V Lacroze
- Service de médecine néonatale, CHU de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| |
Collapse
|
26
|
Pharmacokinetics of a New Pharmaceutical Form of Vitamin D3 100,000 IU in Soft Capsule. Nutrients 2019; 11:nu11030703. [PMID: 30917531 PMCID: PMC6470992 DOI: 10.3390/nu11030703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023] Open
Abstract
Vitamin D deficiency is frequent in the general population and both subjects and health professionals could benefit from a broader range of vitamin D3 formulations. We conducted a single-dose, open-label, parallel-group, randomized bioequivalence study to compare a single dose of a newly developed vitamin D3 100,000 IU in a soft capsule (Group 1) with the reference drug vitamin D3 100,000 IU oral solution in ampoule (Group 2) in healthy volunteers over a four-month period. The primary endpoint was the area under the curve (AUC) of serum 25-hydroxyvitamin-D (25(OH)D) concentrations on Day 112. This study was conducted in France from February to June 2014 in 53 young adults with a mean age of 26.9 years. At baseline, low mean serum 25(OH)D levels were observed in both groups (10.6 ng/mL in Group 1 and 9.0 ng/mL in Group 2). On Day 112, the AUC of serum 25(OH)D concentration was 2499.4 ± 463.8 nmol/mL (7.8 ± 0.2 for LogAUC) for Group 1 and 2152.3 ± 479.8 nmol/mL (7.6 ± 0.2 for LogAUC) for Group 2. Bioequivalence of the two treatments was not demonstrated. Superiority of vitamin D3 100,000 IU soft capsule was observed with p = 0.029 for AUC and p = 0.03 for LogAUC using a non-parametric Wilcoxon test. The profile of the serum 25(OH)D concentration showed a significant difference in favor of Group 1 on Days 1, 3, 7, 14 and 90. Mean serum 25(OH)D concentrations in Group 1 were between 20 and 30 ng/mL during the four-month period and under 20 ng/mL throughout the study in Group 2, except on Day 112. Mean Cmax for Group 1 was significantly higher (p = 0.002). Fourteen days were needed to reach Tmax by more than half the subjects in Group 1 compared to 45 days in Group 2. Both treatments were well tolerated, with no severe or related adverse events reported. In conclusion, the pharmacokinetic profile of the new formulation of vitamin D3 100,000 IU soft capsule is superior to that of the oral solution in ampoule. The new formulation increased serum 25(OH)D levels to above 20 ng/mL and maintained levels from 20 ng/mL to 30 ng/mL for four months in late winter and spring.
Collapse
|
27
|
Ducharme FM, Jensen M, Mailhot G, Alos N, White J, Rousseau E, Tse SM, Khamessan A, Vinet B. Impact of two oral doses of 100,000 IU of vitamin D 3 in preschoolers with viral-induced asthma: a pilot randomised controlled trial. Trials 2019; 20:138. [PMID: 30777118 PMCID: PMC6379931 DOI: 10.1186/s13063-019-3184-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/07/2019] [Indexed: 02/08/2023] Open
Abstract
Background New evidence supports the use of supplemental vitamin D in the prevention of exacerbation of asthma; however, the optimal posology to sufficiently raise serum levels while maximising adherence is unclear. The objective was to ascertain the efficacy of high-dose vitamin D3 in increasing serum vitamin D in preschoolers with asthma and provide preliminary data on safety and efficacy outcomes. Methods We conducted a 7-month, triple-blind, randomised, placebo-controlled, pilot trial of children aged 1–5 years with viral-induced asthma. Participants were allocated to receive two oral doses of 100,000 IU vitamin D3 (intervention) or identical placebo (control) 3.5 months apart, once in the fall and once in the winter. Serum 25-hydroxyvitamin D (25OHD) was measured by tandem mass spectrometry at baseline, 10 days, 3.5 months, 3.5 months + 10 days, and 7 months. The main outcome was the change in serum 25OHD from baseline (Δ25OHD) over time and at 3.5 and 7 months; other outcomes included the proportion of children with 25OHD ≥ 75 nmol/L, safety, and adverse event rates. Results Children (N = 47) were randomised (intervention, 23; control, 24) in the fall. There was a significant adjusted group difference in the Δ25OHD (95% confidence interval) of 57.8 (47.3, 68.4) nmol/L, p < 0.0001), with a time (p < 0.0001) and group*time interaction effect (p < 0.0001), in favour of the intervention. A significant group difference in the Δ25OHD was observed 10 days after the first (119.3 [105.8, 132.9] nmol/L) and second (100.1 [85.7, 114.6] nmol/L) bolus; it did not reach statistical significance at 3.5 and 7 months. At 3.5 and 7 months, respectively, 63% and 56% of the intervention group were vitamin D sufficient (≥ 75 nmol/L) compared to 39% and 36% of the control group. Hypercalciuria, all without hypercalcaemia, was observed in 8.7% of intervention and 10.3% of control samples at any time point. Exacerbations requiring rescue oral corticosteroids, which appear as a promising primary outcome, occurred at a rate of 0.87/child. Conclusion Two oral boluses of 100,000 IU vitamin D3,once in the fall and once in the winter, rapidly, safely, and significantly raises overall serum vitamin D metabolites. However, it is sufficient to maintain 25OHD ≥ 75 nmol/L throughout 7 months in only slightly more than half of participants. Trial registration ClinicalTrials.gov, NCT02197702 (23 072014). Registered on 23 July 2014. Electronic supplementary material The online version of this article (10.1186/s13063-019-3184-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Francine Monique Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, Quebec, Canada. .,Department of Pediatrics, University of Montreal, Sainte-Justine University Health Centre, 3175 Côte Ste-Catherine, Montreal, Quebec, H3T 1C5, Canada. .,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada.
| | - Megan Jensen
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, Quebec, Canada
| | - Geneviève Mailhot
- Department of Nutrition, University of Montreal, Montreal, Quebec, Canada
| | - Nathalie Alos
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - John White
- Department of Physiology, McGill University, Montreal, Quebec, Canada
| | - Elizabeth Rousseau
- Department of Pediatrics, University of Montreal, Sainte-Justine University Health Centre, 3175 Côte Ste-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Sze Man Tse
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Sainte-Justine University Health Centre, 3175 Côte Ste-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Ali Khamessan
- Euro-Pharm International Canada, Montreal, Quebec, Canada
| | - Benjamin Vinet
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
28
|
Serum 25-hydroxyvitamin D response to vitamin D supplementation in infants: a systematic review and meta-analysis of clinical intervention trials. Eur J Nutr 2019; 59:359-369. [PMID: 30721411 DOI: 10.1007/s00394-019-01912-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/23/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE For the prevention of nutritional rickets, 400 IU vitamin D daily and circulating 25-hydroxyvitamin D (25OHD) concentrations > 50 nmol/L are recommended, whereas the toxicity threshold is set at 250 nmol/L. We synthesized the evidence for the effect of vitamin D supplementation on incremental 25OHD in infants up to 1 year of age. METHODS We performed a systematic review and meta-analysis of intervention trials in several databases. A total of 87 records were identified for full-text review and 27 articles with 61 studies were included in the final analysis. RESULTS The selected 61 studies included 1828 participants. Nineteen cohorts had already mean baseline 25OHD levels ≥ 50 nmol/L. The weighted mean difference in 25OHD following vitamin D supplementation was + 49.4 nmol/L (95% CI 43.6-55.3 nmol/L; P < 0.001). The increment was dose-dependent (P = 0.002), was higher in full-term than in pre-term infants (P < 0.001), was higher in infants with baseline 25OHD < 50 nmol/L as compared to ≥ 50 nmol/L (P = 0.001), and was marginally influenced by the 25OHD test procedure (P = 0.080). Vitamin D3 doses of 400 IU/day were sufficient to achieve 25OHD concentrations ≥ 50 nmol/L in most full-term infants. A 25OHD level of 250 nmol/L was not exceeded in ≥ 97.5% of infants at doses between 200 and 1200 IU/day, but potentially in ≥ 2.5% of infants at a dose of 1600 IU/day. CONCLUSIONS Vitamin D supplementation of 400 IU/day is sufficient for achieving 25OHD concentrations able to prevent nutritional rickets. A more personalized vitamin D dosing strategy would require 25OHD testing, but also assay standardization.
Collapse
|
29
|
Mazzoleni S, Magni G, Toderini D. Effect of vitamin D3 seasonal supplementation with 1500 IU/day in north Italian children (DINOS study). Ital J Pediatr 2019; 45:18. [PMID: 30691521 PMCID: PMC6350345 DOI: 10.1186/s13052-018-0590-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/22/2018] [Indexed: 12/20/2022] Open
Abstract
Background The appropriate dose of vitamin D supplementation in children is still debated. We calculated that the recommended dose of 600–1000 IU vitamin D3/day is not sufficient to reach a serum 25-hydroxyvitamin D (25-OH-D) level of at least 30 ng/ml (75 nmol/l) in north Italian children > 12 months. The aim of this study was to analyse the effect of seasonal supplementation with 1500 IU (=37.5 μg) vitamin D3/day. Methods DINOS (D-vitamIN Oral Supplementation) study was a pilot, monocentric, non-random case-control register study. It was conducted in a paediatric primary care setting near Padova (North Italy, 45°N latitude). The data of 203 children (girls:boys 1:1,33) aged 2–15 years, collected between November 2010 and January 2015, were analysed. Active group A (n = 82) were given 1500 IU vitamin D3/day from November to April; control Group B (n = 121) received no supplementation. The serum 25-OH-D test was part of a laboratory tests panel and performed using a chemiluminescence immunoassay method. Results Serum 25-OH-D mean level + standard deviation throughout the period was 32 + 13 ng/ml (80 + 32 nmol/l) in group A vs 22 + 10 ng/ml (55 + 25 nmol/l) in group B. In group A 12% had vitamin D deficiency 25-OH-D < 20 ng/ml (50 nmol/l) and 1.2% severe vitamin D deficiency 25-OH-D < 10 ng/ml (25 nmol/l). In group B 46% had vitamin D deficiency and 9% severe deficiency (P < 0.001). In group A mean levels were normal or near-normal all the year except in May. Group B reached mean 25-OH-D levels close to 30 ng/ml (75 nmol/l) only in late summer. The active group mean 25-OH-D level was normal in preschoolers and schoolers but not in adolescents. Non-white children had a three-times vitamin D deficiency probability despite supplementation. Conclusions Vitamin D supplementation with at least 1500 IU vitamin D3/day from November to April was found appropriate for children in North Italy. A prolongation until May could be useful. Higher doses and/or prolonged periods could be more appropriate especially in adolescents and in non-white children. Study registration DINOS gained the approval of Padova Ethics Committee (n. 3960/U16/2016). Electronic supplementary material The online version of this article (10.1186/s13052-018-0590-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stefano Mazzoleni
- Primary Care Paediatrician Azienda ULSS 6 Euganea Regione Veneto, Polistudio Pediatrico, via D'Annunzio 3/A, Piove di Sacco, Padova, Italy.
| | - Giovanna Magni
- Senior Biostatistician, NRC Azienda Ospedaliera Padova, Padova, Italy.,Unità di Ricerca Clinica, Istituto Oncologico Veneto, Padova, Italy
| | - Daniela Toderini
- Endocrinologist and General Practitioner Azienda ULSS 6 Euganea Regione Veneto, Studio via Benizzi 6, Padova, Italy
| |
Collapse
|
30
|
Vitamin D receptor gene polymorphisms modify the association of serum 25-hydroxyvitamin D levels with handgrip strength in the elderly in Northern China. Nutrition 2019; 57:202-207. [DOI: 10.1016/j.nut.2018.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/21/2018] [Accepted: 05/26/2018] [Indexed: 12/29/2022]
|
31
|
Zakharova I, Klimov L, Kuryaninova V, Nikitina I, Malyavskaya S, Dolbnya S, Kasyanova A, Atanesyan R, Stoyan M, Todieva A, Kostrova G, Lebedev A. Vitamin D Insufficiency in Overweight and Obese Children and Adolescents. Front Endocrinol (Lausanne) 2019; 10:103. [PMID: 30881343 PMCID: PMC6406072 DOI: 10.3389/fendo.2019.00103] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 02/04/2019] [Indexed: 12/11/2022] Open
Abstract
Excessive body weight and obesity in childhood and adolescence are becoming more and more important unfavorable factors that entail extremely adverse consequences and require close attention of physicians of any specialty. Along with the high prevalence of obesity and metabolic syndrome in pediatric patients, children and adolescents in the majority of countries are diagnosed with vitamin D deficiency. Among the non-calcaemic effects of vitamin D, a significant role is played by its impact on the hormonal regulation of glucose metabolism and the synthesis of adipokines by fat tissue. The review presents literature data indicative of a close pathogenic relationship between vitamin D insufficiency and impaired tissue insulin sensitivity. It demonstrates the role of vitamin D insufficiency in immune reactions resulting in development of subclinical inflammation in fat tissue infiltrated with macrophages and lymphocytes. It also shows the role of adipokines, immune system cells and pro-inflammatory cytokines produced by them in the pathogenesis of obesity, as well as the function of vitamin D as an endocrine and paracrine regulator of the process of inflammation in adipose tissue. The relationships between the principal adipokines (leptin, adiponectin, resistin) are revealed in the presence of normal vitamin D content and in vitamin D deficiency. The carbohydrate and lipid metabolism parameters in overweight children and adolescents with vitamin D insufficiency are analyzed. A high prevalence of vitamin D insufficiency in overweight and obese children and adolescents (increasing along with the severity of obesity) is demonstrated. The review also presents the current recommendations for the correction of vitamin D insufficiency and underlines the need for higher cholecalciferol doses to achieve serum calcifediol targets in overweight and obese children and adolescents.
Collapse
Affiliation(s)
- Irina Zakharova
- Department of Paediatrics, Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia
| | - Leonid Klimov
- Department of Paediatrics, Stavropol State Medical University, Stavropol, Russia
| | - Victoria Kuryaninova
- Department of Paediatrics, Stavropol State Medical University, Stavropol, Russia
- *Correspondence: Victoria Kuryaninova
| | - Irina Nikitina
- Department of Paediatrics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Svetlana Malyavskaya
- Department of Paediatrics, Northern State Medical University, Arkhangelsk, Russia
| | - Svetlana Dolbnya
- Department of Paediatrics, Stavropol State Medical University, Stavropol, Russia
| | - Anna Kasyanova
- Department of Paediatrics, Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia
| | - Roza Atanesyan
- Department of Paediatrics, Stavropol State Medical University, Stavropol, Russia
| | - Marina Stoyan
- Department of Paediatrics, Stavropol State Medical University, Stavropol, Russia
| | - Anastasiya Todieva
- Department of Paediatrics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Galina Kostrova
- Department of Paediatrics, Northern State Medical University, Arkhangelsk, Russia
| | - Andrey Lebedev
- Department of Paediatrics, Northern State Medical University, Arkhangelsk, Russia
| |
Collapse
|
32
|
Guo Y, Ke HJ, Liu Y, Fu M, Ning J, Yu L, Xiao Y, Che D, Chen XY, Deng YH, Wu JL. Prevalence of vitamin D insufficiency among children in southern china: A cross-sectional survey. Medicine (Baltimore) 2018; 97:e11030. [PMID: 29923990 PMCID: PMC6023856 DOI: 10.1097/md.0000000000011030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Vitamin D deficiency is associated with numerous public health issues. Limited data are available for children in southern China, a region that receives abundant sunlight. We aimed to estimate the 25-hydroxyvitamin D (25(OH)D) levels in children in that area, and to determine seasonal variations in serum 25(OH)D levels. A total of 16,755 children aged 0 to 6 years, who visited the Guangdong Women and Children's Hospital for health examination between January 2016 and May 2017, were included in the present study. The serum 25(OH)D levels ranged from 10.5 to 307.4 nmol/L (mean ± standard deviation: 78.5 ± 26.3 nmol/L). The prevalence of vitamin D deficiency and insufficiency were 10.8% and 39.0%, respectively. The mean serum 25(OH)D level in spring (71.8 ± 24.9 nmol/L) was lower than that in other seasons. From January to April, we found a relatively high prevalence of vitamin D deficiency or insufficiency, both of which were also found to increase with age. Logistic regression analysis revealed that vitamin D deficiency and insufficiency were significantly associated with age and season. Deficiency and insufficiency of vitamin D are common among children in southern China, despite the area receiving sufficient sunlight.
Collapse
Affiliation(s)
- Yong Guo
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Hai-Jin Ke
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Ying Liu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Min Fu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Jing Ning
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Li Yu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Yu Xiao
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Di Che
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Xiao-Yan Chen
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| | - Yu-Hong Deng
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jie-Ling Wu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University
| |
Collapse
|
33
|
Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I, Chiappini E, de’ Angelis GL, Massari M, Miraglia Del Giudice E, Miraglia Del Giudice M, Peroni D, Terracciano L, Agostiniani R, Careddu D, Ghiglioni DG, Bona G, Di Mauro G, Corsello G. 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. Ital J Pediatr 2018; 44:51. [PMID: 29739471 PMCID: PMC5941617 DOI: 10.1186/s13052-018-0488-7] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/16/2018] [Indexed: 02/07/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Giuseppe Saggese
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | | | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, Novara, Italy
| | - Fabio Cardinale
- Pediatric Unit, Division of Pulmonology, Allergy, and Immunology, AOU Policlinico-Giovanni XXIII, Bari, Italy
| | - Irene Cetin
- Department of Mother and Child, Hospital Luigi Sacco, University of Milano, Milan, Italy
| | - Elena Chiappini
- Pediatric Infectious Disease Unit, Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Gian Luigi de’ Angelis
- Gastroenterology and Digestive Endoscopy Unit and Clinical Paediatrics Unit, Department of Paediatrics and Maternal Medicine, University of Parma Hospital Trust, Parma, Italy
| | - Maddalena Massari
- Department of Mother and Child, Hospital Luigi Sacco, University of Milano, Milan, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Luigi Terracciano
- Pediatric Primary Care, National Pediatric Health Care System, Milan, Italy
| | | | - Domenico Careddu
- Pediatric Primary Care, National Pediatric Health Care System, Novara, Italy
| | - Daniele Giovanni Ghiglioni
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianni Bona
- Division of Pediatrics, University of Piemonte Orientale, Novara, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, Neonatal Intensive Care Unit, AOUP, University of Palermo, Palermo, Italy
| |
Collapse
|
34
|
Nutritional management of cow's milk allergy in children: An update. Arch Pediatr 2018; 25:236-243. [PMID: 29576253 DOI: 10.1016/j.arcped.2018.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Abstract
Cow's milk is one of the most common foods responsible for allergic reactions in children. Cow's milk allergy (CMA) involves immunoglobulin E (IgE)- and non-IgE-mediated reactions, the latter being both variable and nonspecific. Guidelines thus emphasize the need for physicians to recognize the specific syndromes of CMA and to respect strict diagnostic modalities. Whatever the clinical pattern of CMA, the mainstay of treatment is the elimination from the diet of cow's milk proteins. The challenge is that both the disease and the elimination diet may result in insufficient height and weight gain and bone mineralization. If, during CMA, the mother is not able or willing to breastfeed, the child must be fed a formula adapted to CMA dietary management, during infancy and later, if the disease persists. This type of formula must be adequate in terms of allergic efficacy and nutritional safety. In older children, when CMA persists, the use of cow's milk baked or heated at a sufficient temperature, frequently tolerated by children with CMA, may help alleviate the stringency of the elimination diet. Guidance on the implementation of the elimination diet by qualified healthcare professionals is always necessary. This guidance should also include advice to ensure adequate bone growth, especially relating to calcium intake. Specific attention should be given to children presenting with several risk factors for weak bone mineral density, i.e., multiple food allergies, vitamin D deficiency, poor sun exposure, steroid use, or severe eczema. When CMA is outgrown, a prolonged elimination diet may negatively impact the quality of the diet over the long term.
Collapse
|
35
|
Vitamin D Supplementation in Childhood - A Review of Guidelines. Indian J Pediatr 2018; 85:194-201. [PMID: 28963648 DOI: 10.1007/s12098-017-2476-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
Abstract
Vitamin D, a unique vitamin with endocrine function is required in the human body primarily for calcium homeostasis and possibly several other functions. Deficiency of the vitamin is extremely frequent world-wide. Studies on Indian population place the prevalence of deficiency at 70 to 100% in healthy individuals. There are several guidelines available on definition of vitamin D deficiency and supplementation in healthy children and adults. Sufficiency or deficiency of the vitamin depend upon the levels of 25OHD and various cut-offs are suggested by different groups formulating the guidelines. Although the vitamin is synthesized in the skin with the help of sunlight, it is mostly agreed by various groups that oral supplementation must be done in infants and in certain high risk groups. No such formal guidelines currently exist for Indian children though there is a need to develop one.
Collapse
|
36
|
Delecroix C, Brauner R, Souberbielle JC. Vitamin D in children with growth hormone deficiency due to pituitary stalk interruption syndrome. BMC Pediatr 2018; 18:11. [PMID: 29368588 PMCID: PMC5784716 DOI: 10.1186/s12887-018-0992-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/17/2018] [Indexed: 01/06/2023] Open
Abstract
Background Recent studies have shown a relationship between vitamin D status and growth hormone (GH) and insulin-like growth factor 1 (IGF1). The objective of this study was to assess vitamin D status in children with GH deficiency due to pituitary stalk interruption syndrome (PSIS) and to investigate the relationship between 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25 (OH) 2D) serum levels and patient characteristics. Methods A retrospective single-center study of 25OHD and 1,25(OH)2D serum concentrations in 50 children with PSIS at the initial evaluation before treatment. Results Mean concentrations of 33.2 ± 18.0 ng/mL for 25OHD and 74.5 ± 40.7 ng/L for 1,25(OH)2D were measured. Additionally, 25OHD concentrations were significantly higher in boys than in girls (p = 0.04) and lower in the cold season than in the sunny season (p = 0.03). Significant positive correlations were observed between the GH peak and serum 1,25 (OH) 2D concentrations (Rho = 0.35; p = 0.015) and the 1,25(OH)2D/25OHD ratio (Rho = 0.29; p < 0.05). No correlation was found for other characteristics, including IGF1. Conclusions Vitamin D status in children with hypothalamic-pituitary deficiency due to PSIS was similar to that reported in national and European studies in healthy children. The positive significant correlations between the GH peak and the 1,25 (OH)2D concentration as well as with the 1,25 (OH)2D/25OHD ratio suggest that even in these patients who had severely impaired GH secretion and low IGF1 levels, an interplay between the GH/IGF1 axis and the vitamin D system still exists.
Collapse
Affiliation(s)
- Cécile Delecroix
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France
| | - Raja Brauner
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France.
| | - Jean-Claude Souberbielle
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Service d'Explorations Fonctionnelles, Paris, France
| |
Collapse
|
37
|
Frelut ML, Girardet JP, Bocquet A, Briend A, Chouraqui JP, Darmaun D, Dupont C, Feillet F, Hankard R, Rozé JC, Simeoni U. Impact of obesity on biomarkers of iron and vitamin D status in children and adolescents: The risk of misinterpretation. Arch Pediatr 2018; 25:3-5. [DOI: 10.1016/j.arcped.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
|
38
|
There is no association between vitamin D status and characteristics of central precocious puberty in girls. Eur J Pediatr 2017; 176:1677-1680. [PMID: 28963633 DOI: 10.1007/s00431-017-3022-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/16/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
UNLABELLED Vitamin D deficiency has been associated with several pathologies in humans and has recently been linked to idiopathic central precocious puberty in girls. We evaluated this potential link in a retrospective study. Among 493 girls with idiopathic central precocious puberty previously described, we selected 145 girls for whom a plasma sample at the initial evaluation was available to determine the concentration of 25OHD and 1,25(OH)2D. We analyzed the correlation between different puberty characteristics (BMI, growth rate the year before the onset of puberty, bone age, LH and FSH peaks, LH/FSH peak ratio, and estradiol concentration) and the concentration of 25OHD and 1,25(OH)2D. The mean 25OHD serum concentration was 27.6±17.3 ng/mL. Eleven percent of the patients had a severe vitamin D deficiency, 18.6% had a moderate deficiency, 39.4% had an optimal vitamin D status, and 31% had a 25OHD concentration above 30 ng/mL. Season was the only factor that appeared to influence the 25OHD concentration. No correlation was found between 25OHD serum concentration and different puberty characteristics. CONCLUSION Overall, our patients had a satisfactory vitamin D status. We did not find any correlation between vitamin D status and the characteristics of central precocious puberty. Further studies are required to confirm this hypothesis. What is known: • Vitamin D status seems to affect gonadal hormones and fertility. • Vitamin D deficiency may contribute to earlier puberty and was associated with earlier menarche. What is new: • 25OHD of 145 girls with precocious puberty was similar to or higher than that of healthy French children or adolescents. • We did not find any correlation between vitamin D status and puberty characteristics.
Collapse
|
39
|
Tarbé de Saint Hardouin AL, Angoulvant F, Chéron G. [Rickets from vitamin D deficiency and family deficiency]. Presse Med 2017; 46:1226-1231. [PMID: 29129413 DOI: 10.1016/j.lpm.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/10/2017] [Accepted: 09/15/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Anne-Laure Tarbé de Saint Hardouin
- Assistance publique-hôpitaux de Paris, hôpital Necker-Enfants-Malades, service des urgences pédiatriques, 149, rue de Sèvres, 75015 Paris, France.
| | - François Angoulvant
- Assistance publique-hôpitaux de Paris, hôpital Necker-Enfants-Malades, service des urgences pédiatriques, 149, rue de Sèvres, 75015 Paris, France; Université Paris-Descartes, 15, rue de l'École-de-médecine, 75270 Paris cedex 06, France
| | - Gérard Chéron
- Assistance publique-hôpitaux de Paris, hôpital Necker-Enfants-Malades, service des urgences pédiatriques, 149, rue de Sèvres, 75015 Paris, France; Université Paris-Descartes, 15, rue de l'École-de-médecine, 75270 Paris cedex 06, France
| |
Collapse
|
40
|
Dubern B. Dénutrition chez l’enfant et l’adolescent obèse. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Vierge M, Laborie S, Bertholet-Thomas A, Carlier MC, Picaud JC, Claris O, Bacchetta J. [Neonatal intoxication to vitamin D in premature babies: A series of 16 cases]. Arch Pediatr 2017; 24:817-824. [PMID: 28818584 DOI: 10.1016/j.arcped.2017.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/15/2017] [Accepted: 06/24/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Preterm neonates are particularly at risk of vitamin D (25-D) deficiency. To prevent rickets and osteopenia in this population, international guidelines vary between 800 and 1000IU per day of vitamin D in Europe and recommend 400IU per day in the USA. Target levels of circulating 25-D are not well identified, with the lower target level 50-75nmol/L and the upper target level probably 120nmol/L. METHODS Between 2013 and 2015, 16 premature infants (born<35WG) were referred to pediatric nephrology clinics because of symptoms secondary to 25-D overdose during the neonatal period. Clinical and biological data were retrospectively reviewed to better define this population. The results are presented as the median (range). RESULTS Gestational age was 27 (24-35)WG with a birth weight of 810 (560-2120)g. Nephrocalcinosis was the initial symptom in 37% of cases, hypercalcemia in 44%, and hypercalciuria in 19%. Daily vitamin D doses were 333 (35-676)IU. Age and body weight at initial symptom were 36.6 (27.6-47.6)WG and 2300 (640-3760)g, respectively. The 25-D level at the time of the first dosage was 210 (119-350)nmol/L and the 1-25 vitamin D level was 370 (245-718)pmol/L (local normal values for age<240). During follow-up, 12 patients displayed nephrocalcinosis, ten hypercalciuria, and three hypercalcemia. The 25-D level normalized in ten patients within 10 (3-32)months after vitamin D withdrawal. Nephrocalcinosis improved in ten of 12 patients, within 12 (3-30)months. Vitamin D could be readministered in ten patients. When searched (n=3), no CYP24A1 mutation was identified in two patients, but was identified in the heterozygous state in one. CONCLUSION A 25-D overdose should be systematically ruled out in the presence of nephrocalcinosis, hypercalcemia, and/or hypercalciuria during infancy in children born preterm. Studies are required to assess the exact frequency of 25-D deficiency and overdose in this population, as well as to evaluate the potential deleterious effects of this imbalance on bone, kidney, and brain development.
Collapse
Affiliation(s)
- M Vierge
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron, France.
| | - S Laborie
- Service de néonatologie, hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - A Bertholet-Thomas
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron, France
| | - M-C Carlier
- Département de biologie, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France
| | - J-C Picaud
- Service de néonatologie, hôpital de la Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard-Lyon 1, 69008 Lyon, France
| | - O Claris
- Service de néonatologie, hôpital Femme-Mère-Enfant, 69500 Bron, France; Université Claude-Bernard-Lyon 1, 69008 Lyon, France
| | - J Bacchetta
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard-Lyon 1, 69008 Lyon, France
| |
Collapse
|
42
|
Abstract
Vitamin D is essential for calcium and bone homeostasis. Humans are largely dependent on UVB-radiation-induced photosynthesis of vitamin D, as few foods contain vitamin D. However, the same radiation that produces vitamin D is also carcinogenic, albeit with a long lag time, and causes DNA damage. In view of the increasing life expectancy, avoiding excessive sun exposure is prudent. Several groups of people have a shortfall between their requirements for vitamin D and their combined endogenous synthesis and intake from natural foods, and therefore need vitamin D supplementation. Governments and scientific societies are regularly updating their recommendations for intake of vitamin D, especially for groups that should (infants) or prefer to (especially elderly individuals) avoid direct sunlight. An overview of such guidelines is presented in this Review. A fairly large consensus exists that all infants should receive 400 international units (IU) (10 μg) daily during their first year of life and that elderly individuals should have access to vitamin D supplementation (at recommended dosages varying from 400 IU to 800 IU daily in most governmental guidelines but at higher dosages in other guidelines). All guidelines unanimously agree that serum levels of 25-hydroxyvitamin D (25OHD) <25 nmol/l (10 ng/ml) should be avoided at all ages. Children and adults who have limited sun exposure should receive vitamin D supplementation, but the recommended doses vary widely (from 200 IU to 2,000 IU daily), in line with disagreement regarding the minimal desirable serum concentration of 25OHD (which varies from 25 nmol/l to >100 nmol/l).
Collapse
Affiliation(s)
- Roger Bouillon
- Clinical and Experimental Endocrinology, Katholieke Universiteit (KU) Leuven, Herestraat 49 ON1 Box 902, Leuven 3000, Belgium
| |
Collapse
|
43
|
Estrade S, Majorel C, Tahhan N, Dulac Y, Baunin C, Gennero I, Chaix Y, Salles JP, Edouard T. [Severe nutritional rickets in young children: Resurgence of an old disease]. Arch Pediatr 2017; 24:737-742. [PMID: 28668218 DOI: 10.1016/j.arcped.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/21/2017] [Accepted: 05/29/2017] [Indexed: 11/18/2022]
Abstract
Nutritional rickets remains a significant public health issue for children worldwide. Although it has almost disappeared in industrialized countries following routine vitamin D supplementation, recent evidence suggests an increasing incidence, especially in young children. In addition to the classical clinical consequences on bone and the growth plate, rickets may also be associated with life-threatening neurological and cardiac complications in the most severe forms. Consequently, early screening and treatment are required. Here, we report the case of a 2-year-old child who presented with severe nutritional rickets associated with seizure and cardiomyopathy. Family screening revealed rickets in all the siblings. This case report emphasizes the importance of being aware of this disease, notably in population with sociocultural risk factors.
Collapse
Affiliation(s)
- S Estrade
- Unité de neurologie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - C Majorel
- Unité de neurologie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - N Tahhan
- Unité de cardiologie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - Y Dulac
- Unité de cardiologie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - C Baunin
- Unité d'imagerie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - I Gennero
- Laboratoire de biochimie, institut fédératif de biologie, CHU de Toulouse, 31059 Toulouse cedex 9, France; Inserm/CNRS UMR 1043/5828, centre de physiopathologie de Toulouse Purpan (CPTP), université de Toulouse-Paul-Sabatier, Toulouse, 31059 Toulouse cedex 9, France
| | - Y Chaix
- Unité de neurologie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - J-P Salles
- Inserm/CNRS UMR 1043/5828, centre de physiopathologie de Toulouse Purpan (CPTP), université de Toulouse-Paul-Sabatier, Toulouse, 31059 Toulouse cedex 9, France; Unité d'endocrinologie, maladies osseuses et génétique, centre de référence des maladies rares du métabolisme du calcium et du phosphore, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - T Edouard
- Inserm/CNRS UMR 1043/5828, centre de physiopathologie de Toulouse Purpan (CPTP), université de Toulouse-Paul-Sabatier, Toulouse, 31059 Toulouse cedex 9, France; Unité d'endocrinologie, maladies osseuses et génétique, centre de référence des maladies rares du métabolisme du calcium et du phosphore, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| |
Collapse
|
44
|
Dalle Carbonare L, Valenti MT, Del Forno F, Caneva E, Pietrobelli A. Vitamin D: Daily vs. Monthly Use in Children and Elderly-What Is Going On? Nutrients 2017; 9:E652. [PMID: 28672793 PMCID: PMC5537772 DOI: 10.3390/nu9070652] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/26/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
Vitamin D deficiency is highly prevalent among children and adults worldwide. Agreement exists that vitamin D deficiency should be corrected. However, the definitions of vitamin deficiency and effective vitamin D replacement therapy are inconsistent in the literature. Not only is the dosing regimen still under debate, but also the time and period of administration (i.e., daily vs. monthly dose). In pediatric as well as elderly subjects, dosing regimens with high vitamin D doses at less frequent intervals were proposed to help increase compliance to treatment: these became widespread in clinical practice, despite mounting evidence that such therapies are not only ineffective but potentially harmful, particularly in elderly subjects. Moreover, in the elderly, high doses of vitamin D seem to increase the risk of functional decline and are associated with a higher risk of falls and fractures. Achieving good adherence to recommended prophylactic regimens is definitely one of the obstacles currently being faced in view of the wide segment of the population liable to the treatment and the very long duration of prophylaxis. The daily intake for extended periods is in fact one of the frequent causes of therapeutic drop-outs, while monthly doses of vitamin D may effectively and safely improve patient compliance to the therapy. The aim of our paper is a quasi-literature review on dosing regimens among children and elderly. These two populations showed a particularly significant beneficial effect on bone metabolism, and there could be different outcomes with different dosing regimens.
Collapse
Affiliation(s)
- Luca Dalle Carbonare
- Clinic of Internal Medicine, section D, Department of Medicine, University of Verona, Verona 37134, Italy.
| | - Maria Teresa Valenti
- Clinic of Internal Medicine, section D, Department of Medicine, University of Verona, Verona 37134, Italy.
| | - Francesco Del Forno
- Clinic of Internal Medicine, section D, Department of Medicine, University of Verona, Verona 37134, Italy.
| | - Elena Caneva
- Pediatric Unit, Verona University Medical School, Verona 37122, Italy.
| | - Angelo Pietrobelli
- Pediatric Unit, Verona University Medical School, Verona 37122, Italy.
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| |
Collapse
|
45
|
Kehoe L, Walton J, McNulty BA, Nugent AP, Flynn A. Dietary strategies for achieving adequate vitamin D and iron intakes in young children in Ireland. J Hum Nutr Diet 2016; 30:405-416. [PMID: 27990698 DOI: 10.1111/jhn.12449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inadequate intakes of vitamin D and iron have been reported in young children in Ireland. The present study aimed to identify the main foods determining vitamin D and iron intakes and to model the impact of dietary strategies to improve adequacy of these micronutrients in young children. METHODS The present study is based on the Irish National Pre-School Nutrition Survey (NPNS), which estimated food and nutrient intakes in a representative sample (n = 500) of children (aged 1-4 years) using a 4-day weighed food record. Dietary strategies were modelled using DaDiet© software (Dazult Ltd, Co. Kildare, Republic of Ireland) and the usual intake distribution, prevalence of inadequate intakes and risk of excessive intakes were estimated using the National Cancer Institute method. RESULTS Fortified foods and nutritional supplements were the key foods influencing the intakes of vitamin D and iron. Adding a 5 μg day-1 vitamin D supplement, fortifying cow's milk (CM) with vitamin D or replacing CM with growing-up milk (GUM) would modestly increase intakes of vitamin D. A combined strategy of fortifying CM with vitamin D or replacing CM with GUM plus a 5 μg day-1 vitamin D supplement would increase mean intakes of vitamin D (from 3.5 μg day-1 at baseline to ≥11 μg day-1 ) and substantially reduce the prevalence of inadequate intakes (from >95% to 12-36%). Fortifying CM with iron or replacing CM with GUM would increase mean intakes of iron (from 7.3 mg day-1 to >10 mg day-1 ), achieving adequate intakes across all ages. CONCLUSIONS Based on real food consumption data in a representative sample of Irish children, we have shown that through targeted dietary strategies adequate intakes of iron are achievable and intakes of vitamin D could be greatly improved.
Collapse
Affiliation(s)
- L Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - J Walton
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - B A McNulty
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland
| | - A P Nugent
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Flynn
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| |
Collapse
|
46
|
Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal MZ, Mäkitie O, Ramos-Abad L, Ward L, DiMeglio LA, Atapattu N, Cassinelli H, Braegger C, Pettifor JM, Seth A, Idris HW, Bhatia V, Fu J, Goldberg G, Sävendahl L, Khadgawat R, Pludowski P, Maddock J, Hyppönen E, Oduwole A, Frew E, Aguiar M, Tulchinsky T, Butler G, Högler W. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr 2016; 85:83-106. [PMID: 26741135 DOI: 10.1159/000443136] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. PROCESS Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.
Collapse
|
47
|
Jensen ME, Mailhot G, Alos N, Rousseau E, White JH, Khamessan A, Ducharme FM. Vitamin D intervention in preschoolers with viral-induced asthma (DIVA): a pilot randomised controlled trial. Trials 2016; 17:353. [PMID: 27456232 PMCID: PMC4960871 DOI: 10.1186/s13063-016-1483-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 06/21/2016] [Indexed: 12/31/2022] Open
Abstract
Background Trials in school-aged children suggest vitamin D supplementation reduces asthma exacerbations. Primary aim: to examine whether vitamin D3 (100,000 IU) rapidly raises serum 25-hydroxyvitamin D (25OHD) ≥75 nmol/L in asthmatic preschoolers. Methods In a double-blind, randomised, placebo-controlled trial, preschool-aged children with asthma received 100,000 IU vitamin D3 (intervention) or placebo (control), followed by 400 IU vitamin D3 daily for 6 months. Serum 25OHD was measured at baseline, 10 days, 3 and 6 months. Outcomes included the group difference in 25OHD change from baseline at 3 months (Δ25OHD); the proportion of children with 25OHD ≥75 nmol/L at 3 months; the pattern in serum vitamin D over 6 months; the proportion of children with hypercalciuria at any time point (safety); and group rates for oral corticosteroids. Continuous outcomes were analysed using generalised linear mixed models and group rate ratios of events per child were assessed using a Poisson distribution model. Results Twenty-two children were randomised (intervention:11; control:11) during winter. At 3 months, the group difference in Δ25OHD (7.2 nmol/L; 95 % CI: -13.7, 28.1) was not significant; yet, 100 % versus 54.5 % (intervention versus control) had serum 25OHD ≥75 nmol/L. There was a significant group difference in Δ25OHD at 10 days (110.3 nmol/L; 95 % CI: 64.0, 156.6). One child in each group had transient hypercalciuria at 10 days. Group oral corticosteroids rates were 0.82 and 1.18/child, intervention versus control (rate ratio = 0.68; 95 % CI: 0.30, 1.62; non-significant). Conclusions Following 100,000 IU vitamin D3, all children reached serum 25OHD ≥75 nmol/L, compared with half who received placebo. Daily supplementation, sun exposure and insufficient power may explain the absence of a significant 3-month group difference in Δ25OHD. No clinically important alterations in bone metabolism biomarkers occurred. Group oral corticosteroid rates will inform sample size calculations for the larger trial. (NCT01999907, 25 November 2013). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1483-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Megan E Jensen
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, Quebec, Canada.
| | - Genevieve Mailhot
- Department of Nutrition, University of Montreal, Montreal, QC, Canada
| | - Nathalie Alos
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | | | - John H White
- Department of Physiology and Medicine, McGill University, Montreal, QC, Canada
| | - Ali Khamessan
- Euro-Pharm International Canada, Montreal, QC, Canada
| | - Francine M Ducharme
- Departments of Pediatrics and of Social and Preventive Medicine and Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
48
|
Mazahery H, Conlon C, Beck KL, Kruger MC, Stonehouse W, Camargo CA, Meyer BJ, Tsang B, Mugridge O, von Hurst PR. Vitamin D and omega-3 fatty acid supplements in children with autism spectrum disorder: a study protocol for a factorial randomised, double-blind, placebo-controlled trial. Trials 2016; 17:295. [PMID: 27334138 PMCID: PMC4917935 DOI: 10.1186/s13063-016-1428-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/02/2016] [Indexed: 12/18/2022] Open
Abstract
Background There is strong mechanistic evidence to suggest that vitamin D and omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFAs), specifically docosahexaenoic acid (DHA), have the potential to significantly improve the symptoms of autism spectrum disorder (ASD). However, there are no trials that have measured the effect of both vitamin D and n-3 LCPUFA supplementation on autism severity symptoms. The objective of this 2 × 2 factorial trial is to investigate the effect of vitamin D, n-3 LCPUFAs or a combination of both on core symptoms of ASD. Methods/design Children with ASD living in New Zealand (n = 168 children) will be randomised to one of four treatments daily: vitamin D (2000 IU), n-3 LCPUFAs (722 mg DHA), vitamin D (2000 IU) + n-3 LCPUFAs (722 mg DHA) or placebo for 12 months. All researchers, participants and their caregivers will be blinded until the data analysis is completed, and randomisation of the active/placebo capsules and allocation will be fully concealed from all mentioned parties. The primary outcome measures are the change in social-communicative functioning, sensory processing issues and problem behaviours between baseline and 12 months. A secondary outcome measure is the effect on gastrointestinal symptoms. Baseline data will be used to assess and correct basic nutritional deficiencies prior to treatment allocation. For safety measures, serum 25-hydroxyvitamin D 25(OH)D and calcium will be monitored at baseline, 6 and 12 months, and weekly compliance and gastrointestinal symptom diaries will be completed by caregivers throughout the study period. Discussion To our knowledge there are no randomised controlled trials assessing the effects of both vitamin D and DHA supplementation on core symptoms of ASD. If it is shown that either vitamin D, DHA or both are effective, the trial would reveal a non-invasive approach to managing ASD symptoms. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN12615000144516. Registered on 16 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1428-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hajar Mazahery
- Institute of Food Science and Technology - School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Cathryn Conlon
- Institute of Food Science and Technology - School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Kathryn L Beck
- Institute of Food Science and Technology - School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Marlena C Kruger
- Institute of Food Science and Technology - School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Welma Stonehouse
- Commonwealth Scientific Industrial Research Organisation (CSIRO) Food, Nutrition and Bioproducts, Adelaide, SA, Australia
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara J Meyer
- School of Medicine, University of Wollongong, Illawarra, NSW, 2522, Australia
| | - Bobby Tsang
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Owen Mugridge
- Institute of Food Science and Technology - School of Food and Nutrition, Massey University, Auckland, New Zealand
| | - Pamela R von Hurst
- Institute of Food Science and Technology - School of Food and Nutrition, Massey University, Auckland, New Zealand.
| |
Collapse
|
49
|
Lee M, Ebert JR, Kadakia MP, Zhang J, Czerwinski SA. Inverse associations between cardiometabolic risk factors and 25-hydroxyvitamin D in obese American children and adolescents. Am J Hum Biol 2016; 28:736-42. [PMID: 27135761 DOI: 10.1002/ajhb.22863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 02/22/2016] [Accepted: 04/08/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To examine the association between 25-hydroxyvitamin D [25(OH)D] concentrations and cardiometabolic risk factors in obese American children. METHODS A cross-sectional study was conducted on 209 obese children (55% females, 25.8% black) aged between 6 and 19 years old. Study measurements included plasma 25(OH)D concentrations, blood pressure, lipids and oxidized LDL levels, insulin resistance (IR) indices from glucose, insulin and 5 hour oral glucose tolerance test. RESULTS Fifty-one percent of the children had vitamin D deficiency. Older age [OR (95% CI) = 1.16 (1.00, 1.35)], black race/ethnicity [15.39 (5.79, 40.92)], winter/spring season [3.46 (1.69, 7.02)] and higher body mass index (BMI) [1.05 (0.99, 1.11)] were associated with increased odds of having vitamin D deficiency. None of cardiometabolic risk factors examined were significantly associated with vitamin D deficiency in age, race/ethnicity, season, and BMI adjusted models. In age, race/ethnicity, season and BMI adjusted models, total cholesterol (β = -0.001, P = 0.013), non-HDL-C (β = -0.001, P = 0.014), and oxidized LDL (β = -0.087, P = 0.045) were inversely associated with log-transformed 25(OH)D. An approximate 10 mg/dl increase in total cholesterol or in non-HDL-C was associated with an approximate 1.3% decrease in the geometric mean of 25(OH)D concentration. Further a 10% increase in ox-LDL levels was associated with an approximate 0.8% decrease in the geometric mean of 25(OH)D. CONCLUSION Vitamin D deficiency is prevalent in obese American children. There was evidence that some cardiometabolic risk factors including lipid levels and oxidized LDL levels were significantly inversely associated with 25(OH)D concentration in our sample. Am. J. Hum. Biol. 28:736-742, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Miryoung Lee
- Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
| | - James R Ebert
- Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Madhavi P Kadakia
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Jin Zhang
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Stefan A Czerwinski
- Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| |
Collapse
|
50
|
Darmawikarta D, Chen Y, Lebovic G, Birken CS, Parkin PC, Maguire JL. Total Duration of Breastfeeding, Vitamin D Supplementation, and Serum Levels of 25-Hydroxyvitamin D. Am J Public Health 2016; 106:714-9. [PMID: 26890167 PMCID: PMC4816081 DOI: 10.2105/ajph.2015.303021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To determine the association between total breastfeeding duration and serum 25-hydroxyvitamin D (25-OHD) and to explore whether vitamin D supplementation influences this association. METHODS We conducted a cross-sectional study of healthy children between September 2011 and August 2013 through the TARGet Kids! primary health care research network. Of the 4533 eligible children, we included only the 2508 who had 25-OHD measured. We assessed adjusted associations of total breastfeeding duration (in months) with serum 25-OHD and in supplemented versus nonsupplemented children, with the odds of 25-OHD less than 20 nanograms per milliliter. RESULTS Each 1-month increase in total breastfeeding duration was associated with a 0.12 nanograms per milliliter lower median serum 25-OHD (95% confidence interval [CI] = -0.21 ng/mL, -0.02 ng/mL) among children who were not supplemented. The odds of serum 25-OHD less than 20 nanograms per milliliter increased by 6% (odds ratio [OR] = 1.06; 95% CI = 1.03, 1.10) for every 1-month increase in total breastfeeding duration among nonsupplemented children. The interaction between vitamin D supplementation, duration of breastfeeding, and median serum 25-OHD was statistically significant (P = .04). CONCLUSIONS Breastfed children who were not supplemented, particularly those breastfed more than 1 year, appear to have lower vitamin D status. Vitamin D supplementation may mitigate this risk. These findings support recommendations for supplementation during breastfeeding of any duration.
Collapse
Affiliation(s)
- Denise Darmawikarta
- Denise Darmawikarta, Yang Chen, Gerald Lebovic, and Jonathan L. Maguire are with the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Catherine S. Birken, Patricia C. Parkin, and Jonathon L. Maguire are with the Department of Pediatrics, Hospital for Sick Children, Toronto, and the Department of Pediatrics, University of Toronto
| | - Yang Chen
- Denise Darmawikarta, Yang Chen, Gerald Lebovic, and Jonathan L. Maguire are with the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Catherine S. Birken, Patricia C. Parkin, and Jonathon L. Maguire are with the Department of Pediatrics, Hospital for Sick Children, Toronto, and the Department of Pediatrics, University of Toronto
| | - Gerald Lebovic
- Denise Darmawikarta, Yang Chen, Gerald Lebovic, and Jonathan L. Maguire are with the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Catherine S. Birken, Patricia C. Parkin, and Jonathon L. Maguire are with the Department of Pediatrics, Hospital for Sick Children, Toronto, and the Department of Pediatrics, University of Toronto
| | - Catherine S Birken
- Denise Darmawikarta, Yang Chen, Gerald Lebovic, and Jonathan L. Maguire are with the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Catherine S. Birken, Patricia C. Parkin, and Jonathon L. Maguire are with the Department of Pediatrics, Hospital for Sick Children, Toronto, and the Department of Pediatrics, University of Toronto
| | - Patricia C Parkin
- Denise Darmawikarta, Yang Chen, Gerald Lebovic, and Jonathan L. Maguire are with the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Catherine S. Birken, Patricia C. Parkin, and Jonathon L. Maguire are with the Department of Pediatrics, Hospital for Sick Children, Toronto, and the Department of Pediatrics, University of Toronto
| | - Jonathon L Maguire
- Denise Darmawikarta, Yang Chen, Gerald Lebovic, and Jonathan L. Maguire are with the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Catherine S. Birken, Patricia C. Parkin, and Jonathon L. Maguire are with the Department of Pediatrics, Hospital for Sick Children, Toronto, and the Department of Pediatrics, University of Toronto
| |
Collapse
|