Vitamin D Screening Variations in Children and Adolescents: Who should be Screened?

Variation in vitamin D status in infants and children: a two-year cross-sectional study in Shanghai, China

BACKGROUND

Vitamin D deficiency (VDD) is a public health problem. The variation in vitamin D status across regions and populations remains unclear, and there is a lack of consensus regarding the screening for VDD in individuals.

METHODS

Children who visited the hospital from January 2019 to December 2020 were included in this study. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured using an enzyme-linked immunosorbent assay. The cutoffs for serum 25(OH)D concentrations to define deficiency, insufficiency, and sufficiency were < 20 ng/mL, 20-30 ng/mL, and ≥ 30 ng/mL, respectively.

RESULTS

A total of 7285 children aged 0-11 years were assessed; the mean 25(OH)D level was 31.4 ng/mL, and the median 25(OH)D level was 30.7 (interquartile range 24.4, 37.5) ng/mL. The 25(OH)D level declined with age in clinical visiting children aged 0-11 years, but maintained a consistently high level in health examination children aged 4-11 years. The percentages of 25(OH)D < 20 ng/mL and 25(OH)D < 30 ng/mL were 10.0% and 43.8%, respectively. Higher percentages of VDD were found in clinical visiting children than in health examination children within the 6-11-year group (53.3% vs. 14.7%) and winter (44.3% vs. 15.4%).

CONCLUSION

Low vitamin D status (deficiency and insufficiency) was more common in clinic-visiting children than in health examinations, especially in schoolchildren and in the winter. The study implies the positive effects of vitamin D assessments included in child health checkups to optimize vitamin D status.

Treatment of vitamin D deficiency in children

INTRODUCTION

Vitamin D deficiency affects from 10% to 50% in various pediatric population groups and causes life-threatening hypocalcemia in infants, crippling rickets in infants and children, and increased risk of subsequent adult metabolic and neurologic problems.

AREAS COVERED

An English language literature search of PubMed was performed since 1940 as were the authors' personal literature collections. References identified in the reviewed literature are considered.

DIAGNOSIS

The diagnosis of vitamin D deficiency is based on serum 25-hydroxyvitamin D levels. Clinical features of rickets include bone deformities and elevated alkaline phosphatase. Most children and adolescents who are biochemically vitamin D deficient do not have specific symptoms or signs of deficiency.

PREVENTION

Prevention of vitamin D deficiency is via exposure to sunshine, food and beverage fortification, and dietary supplementation.

TREATMENT

Effective treatment of vitamin D deficiency is via oral or injectable administration of vitamin D. Dosing and duration of vitamin D therapy have been described for healthy children and for children with underlying medical conditions, but recommendations vary.

EXPERT OPINION

Further investigation is needed to determine long-term non-skeletal effects of childhood vitamin D deficiency, benefits of supplementation in asymptomatic individuals with biochemical vitamin D deficiency, and appropriate screening for vitamin D deficiency in asymptomatic children and adolescents.

Relationship Between Hypovitaminosis D and Fractures Among Adolescents With Overweight or Obesity

Adolescents with overweight/obesity are at risk for vitamin D insufficiency and deficiency. Both overweight/obesity and vitamin D insufficiency/deficiency may predispose to fractures. We enrolled 103 participants (53.3% females, 15.9 ± 2.2 years) in a retrospective case-control study to determine whether an association exists between fractures and a low 25-hydroxyvitamin D (25[OH]D) among adolescents whose body mass index (BMI) ≥ 85 percentile. Cases (n = 28) sustaining a low/medium impact fracture were matched to controls (n = 75) without a fracture history. A conditional-logistic regression analysis addressing the common vitamin D insufficiency/deficiency cutoffs was used. Overweight, obesity, and significant obesity rates were 10.7%, 53.4%, and 35.9%, respectively. Mean (±SD) 25(OH)D was 16.5 ± 6.4 ng/mL. In all, 25(OH)D insufficiency rates (level <20 ng/mL) were 70.5%. Matched cases and controls had similar 25(OH)D insufficiency/deficiency rates (P > .05). Controlling for race and seasonality showed no association between fractures and 25(OH)D insufficiency/deficiency (P > .05). These data suggest that fractures are not associated with low 25(OH)D levels among adolescents whose BMI ≥ 85th percentile.

VITAMIN D STATUS IN CHILDREN WITH PARALITIC SYNDROMS

OBJECTIVE

The aim: Determination of serum 25(OH)D in the children with paralytic syndromes and its distribution depending on age, sex, taking anticonvulsant drugs, nutritional status for a period of one year (autumn-spring) of one center.

PATIENTS AND METHODS

Materials and methods: There were recruited of 77 children with paralytic syndromes and 73 health children for the same period aged from 1 till 18 years. The study included a scrutiny of medical history and analysis of medical documents, assessment of motor dysfunction by GMFCS, and nutritional status.

RESULTS

Results: Among children with paralytic syndromes there were spastic tetraparesis 59.7%, malnutrition 92%, IV-V level of gross motor disfunction 80.5%, antiseizure medications 59.7% and cognitive impairment 77.9%. The variation of serum 25(OH)D is from 6.1 to 76.7 ng/mL with median 18.3 ng/mL in healthy children. The variation of serum 25(OH)D is from 2.2 to 83.0 ng/mL with median 14.8 ng/mL in children with paralytic syndromes (p=0.0103). Vitamin status among them is the following: insufficiency (21-29 ng/mL)-28.7% vs 16.8%; deficiency (<20 ng/mL)-56.1 vs 72.2% (p=0.0300). The 25.9% children with paralytic syndromes and those who have deficiency demonstrate severe deficiency (<10 ng/mL) compare 10.9% in healthy children (p=0.00189). There is a tendency to decrease of serum 25(OH)D in children with paralytic syndrome older 7 years.

CONCLUSION

Conclusions: We failed to record a significant difference in the 25(ОН)D between males and females, between different level of GMFCS, and anticonvulsants using. Deficiency of vitamin D in 2.25 times higher in children with paralytic syndromes and severe malnutrition. Additional researches with specific items are need in perspective.

Vitamin D supplementation for autoimmune hepatitis: A need for further investigation

Autoimmune hepatitis is a chronic liver disease harboring an autoimmune basis and progressive character. Despite still obscurity in etiology and pathogenesis, some evidence supports the importance of sustaining the immune system. Vitamin D is a lipo-soluble vitamin, which has been identified as decreased in our body. It is often due to the daily habit change and decrease of individual sun exposure due to the increase of the ultraviolet-induced potential melanocytic transformation. Here, we emphasize the importance of vitamin D supplementation in patients affected with liver disease.

Tension-Sided Femoral Neck Stress Fracture in an Adolescent with Vitamin D Deficiency and Osteomalacia: A Case Report

CASE

An adolescent girl presented with groin pain without any history of trauma. Imaging showed a tension-sided stress fracture of the femoral neck. Vitamin D deficiency (VDD), and raised alkaline phosphatase and parathyroid hormone levels were found. Pain relief was not achieved with nonoperative treatment. Considering the risk of fracture progression and displacement, the fracture was fixed with cannulated cancellous screws. Fracture healed without any complications.

CONCLUSION

A tension-sided femoral neck stress fracture, with VDD and osteomalacia, is a rare cause of hip pain in an adolescent. Surgical fracture stabilization is necessary in addition to medical treatment.

Vitamin D in Toddlers, Preschool Children, and Adolescents

BACKGROUND

Vitamin D supplementation is known to both prevent and treat rickets, a disease of hypomineralized bone. Childhood is a period of great bone development and, therefore, attention to the vitamin D needed to optimize bone health in childhood is imperative.

SUMMARY

Observational studies have pointed to a vitamin D status, as indicated by a 25-hydroxyvitamin D concentration, of 50 nmol/L to ensure avoidance of rickets and of 75 nmol/L to optimize health. However, the benefits of achieving these levels of vitamin D status are less evident when pediatric randomized, controlled trials are performed. In fact, no specific pediatric vitamin D supplementation has been established by the existing evidence. Yet, study of vitamin D physiology continues to uncover further potential benefits to vitamin D sufficiency. This disconnection between vitamin D function and trials of supplementation has led to new paths of investigation, including establishment of the best method to measure vitamin D status, examination of genetic variation in vitamin D metabolism, and consideration that vitamin D status is a marker of another variable, such as physical activity, and its association with bone health. Nevertheless, vitamin D supplementation in the range of 10-50 μg/day appears to be safe for children and remains a promising intervention that may yet be supported by clinical trials as a method to optimize pediatric health. Key Message: Pediatric vitamin D status is associated with avoidance of rickets. Randomized, controlled trials of vitamin D supplementation for pediatric bone health are limited and equivocal in their results. Beyond bone, decreased risk for autoimmune, infectious, and allergic diseases has been associated with higher vitamin D status. The specific vitamin D supplementation to optimize toddler, child, and adolescent outcomes is unknown, but doses 10-50 μg/day are safe and may be beneficial.

Vitamin D screening

At present, there is no need and no sufficient evidence to support universal screening for vitamin D status. There are four categories of subjects in whom there is no requirement for screening, since a number of studies indicate beneficial effects of vitamin D supplementation; these are represented by children and adolescents, pregnant women, patients taking bone active drugs and subjects with documented hypovitaminosis D. In the remaining subjects, the utilization of adequate questionnaires will target with sufficient sensitivity and specificity those with hypovitaminosis D. These must be first supplemented and, at a later time, serum 25(OH)D assay should be requested to confirm attainment of sufficiency, independently of the threshold chosen. This strategy will cut costs deriving from both widespread use of vitamin D assays and vitamin D supplementation.