Vitamin D deficiency in young children. The realities of today
- Authors: Sergeev Y.S.1, Arsentev V.G.1, Shabalov N.P.1, Antsiferova E.S.1
-
Affiliations:
- S.M. Kirov Military Medical Academy
- Issue: Vol 12, No 6 (2021)
- Pages: 5-14
- Section: Editorial
- URL: https://journals.rcsi.science/pediatr/article/view/106299
- DOI: https://doi.org/10.17816/PED1265-14
- ID: 106299
Cite item
Abstract
The article presents a review of the literature on the clinical aspects of assessing vitamin D deficiency in young children by the concentration of 25(OH)D (hydroxycalciferol) in blood serum. The purpose of the review was to familiarize pediatric specialists with the real state of affairs in assessing the clinical significance of diagnosing vitamin D status, its relationship with the prevention of deficient rickets, ways of correcting and choosing the dose of calciferol. A daily dose of 400 IU of vitamin D for young children is effective and safe in preventing deficient rickets. Higher subsidized doses of calciferol have not been shown to be more effective. In addition, they can potentially lead to toxic levels of vitamin D metabolites in the blood. When using lower daily doses (less than 400 IU), an adequate prophylactic effect may not be achieved. Determination of the level of circulating serum hydroxycalciferol, which characterizes the status of vitamin D in the body, is not recommended for routine examination and as a standard for diagnosing deficient rickets in young children. Calciferol has multilateral effects, modulates not only phosphorus-calcium metabolism, but also affects other systems and functions of the body, in particular, ontogenesis and the immune system. According to foreign literature, all infants should receive vitamin D for the prevention of rickets, treatment from the age of one month. This is most reliably identified for children, probably at risk. Convincing data indicating a positive protective effect on diabetes mellitus D on unforeseen pathology, for example, the frequency of exclusion of pneumonia, infectious diarrhea, atopic dermatitis in infancy, has not yet been obtained.
Full Text
##article.viewOnOriginalSite##About the authors
Yurii S. Sergeev
S.M. Kirov Military Medical Academy
Author for correspondence.
Email: uriysergeev@yandex.ru
MD, PhD, Associate Professor
Russian Federation, Saint PetersburgVadim G. Arsentev
S.M. Kirov Military Medical Academy
Email: rainman63@mail.ru
MD, PhD, Dr. Sci. (Med.), Professor, Head, Department of Children's Diseases
Russian Federation, Saint PetersburgNikolai P. Shabalov
S.M. Kirov Military Medical Academy
Email: npshabalov@yandex.ru
MD, PhD, Dr. Sci. (Med.), Professor, Department of Children's Diseases
Russian Federation, Saint PetersburgElena S. Antsiferova
S.M. Kirov Military Medical Academy
Email: elena.ants3@gmail.com
MD, PhD, Senior teacher, Department of Children’s Diseases
Russian Federation, Saint PetersburgReferences
- Arsentev VG, Baranov VS, Shabalov NP. Nasledstvennye narusheniya soedinitel’noi tkani kak konstitutsional’naya osnova poliorgannoi patologii u detei. 2-e izd., ispr. i dop. Saint Petersburg: SpetsLit; 2019. 239 p. (In Russ.)
- Grinhalh T. How to Read a Paper. The basics of evidence-based medicine. Transl. from Engl. 4st Edition. Denisova IN, Saitkulova KI, Leonova VP, Eds. Moscow: GEOTAR-Media; 2019. 34 p. (In Russ.)
- Zaharova IN, Malcev SV, Borovik TE, et al. Results of a multicenter research “RODNICHOK” for the study of vitamin D insufficiency in infants in Russia. Pediatria. Journal named after G.N. Speransky. 2015;94(1):62–67. (In Russ.)
- Kirichenko NN, Zakrevskij VV, Konovalova IA, et al. Laboratory assessment of vitamin sufficiency of the body of military personnel in the Arctic zone of the Russian Federation. Bulletin of the Russian Military Medical Academy. 2018;4(64):86–89. (In Russ.)
- Natsional’naya programma “Nedostatochnost’ vitamina D u detei i podrostkov Rossiiskoi Federatsii: sovremennye podkhody k korrektsii”. Soyuz pediatrov Rossii. Moscow: Pediatr; 2018. 96 p. (In Russ.)
- Sergeev Yu.S. Clinical diagnosis in pediatrics (formulations, classifications): a guide for physicians. 2nd ed. Moscow: GEOTAR-Media; 2021. 384 p. (In Russ.) doi: 10.33029/9704-6292-8-CDP-2021-1-384
- Abrams SA. Vitamin D in Preterm and Full-Term Infants. Ann Nutr Metab. 2020;76(Suppl. 2):6–14. doi: 10.1159/000508421
- Aloia JF, Patel M, Dimaano R, et al. Vitamin D intake to attain a desired serum 25-hydroxyvitamin D concentration. Am J Clin Nutr. 2008;87(6):1952–1958. doi: 10.1093/ajcn/87.6.1952
- Crowe FL, Mughal MZ, Maroof Z, et al. Vitamin D for Growth and Rickets in Stunted Children: A Randomized Trial. Pediatrics. 2021;147(1):e20200815. doi: 10.1542/peds.2020-0815
- Di Marco N, Kaufman J, Rodda CP. Shedding Light on Vitamin D Status and Its Complexities during Pregnancy, Infancy and Childhood: An Australian Perspective. Int J Environ Res Public Health. 2019;16(4):538. doi: 10.3390/ijerph16040538
- EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). Scientific opinion on dietary reference values for vitamin D. EFSA J. 2016;14(10): e045471. doi: 10.2903/j.efsa.2016.4547
- El Kholy M, Elsedfy H, Fernández-Cancio M, et al. Nutritional rickets: vitamin D, calcium, and the genetic make-up. Pediatr Res. 2017;81(2):356–363. doi: 10.1038/pr.2016.222
- Gallo S, Comeau K, Vanstone C, et al. Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants. JAMA. 2013;309(17): 1785–1792. doi: 10.1001/jama.2013.3404
- Gallo S, Phan A, Vanstone CA, et al. The change in plasma 25-hydroxyvitamin D did not differ between breastfed infants that received a daily supplement of ergocalciferol or cholecalciferol for 3 months. J Nutr. 2013;143(2):148–153. doi: 10.3945/jn.112.167858
- Gallo S, Hazell T, Vanstone C, et al. Vitamin D supplementation in breastfed infants from Montréal, Canada: 25-hydroxyvitamin D and bone health effects from a follow-up study at 3 years of age. Osteoporos Int. 2016;27(8): 2459–2466. doi: 10.1007/s00198-016-3549-z
- German Nutrition Society. New reference values for vitamin D. Ann Nutr Metab. 2012;60(4):241–246.
- Hauta-Alus HH, Holmlund-Suila EM, Kajantie E, et al. The Effects of Vitamin D Supplementation During Infancy on Growth During the First 2 Years of Life. J Clin Endocrinol Metab. 2021;106(3):e1140–e1155.
- Hazell T, Gallo S, Vanstone C, et al. Vitamin D supplementation trial in infancy: body composition effects at 3 years of age in a prospective follow-up study from Montréal. Pediatr Obes. 2017;12(1):38–47. doi: 10.1111/ijpo.12105
- Holmlund-Suila E, Viljakainen H, Hytinantti T, et al. High-dose vitamin d intervention in infants — effects on vitamin d status, calcium homeostasis, and bone strength. J Clin Endocrinol Metab. 2012;97(11): 4139–4147. doi: 10.1210/jc.2012-1575
- Huey SL, Acharya N, Silver A, et al. Effects of oral vitamin D supplementation on linear growth and other health outcomes among children under five years of age. Cochrane Database Syst Rev. 2020;12(12):CD012875. doi: 10.1002/14651858.CD012875.pub2
- Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D. Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Washington (DC): National Academies Press (US); 2011.
- Julies P, Lynn RM, Pall K, et al. Nutritional rickets under 16 years: UK surveillance results. Arch Dis Child. 2020;105(6):587–592. doi: 10.1136/archdischild-2019-317934
- Jullien S. Vitamin D prophylaxis in infancy. BMC Pediatr. 2021;21(Suppl 1):319. doi: 10.1186/s12887-021-02776-z
- Ladhani S, Srinivasan L, Buchanan C, Allgrove J. Presentation of vitamin D deficiency. Arch Dis Child. 2004;89(8):781–784. doi: 10.1136/adc.2003.031385
- Lips P, Cashman KD, Lamberg-Allardt C, et al. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol. 2019;180(4):23–54. doi: 10.1530/EJE-18-0736
- Mimouni FB, Huber-Yaron A, Cohen S. Vitamin D requirements in infancy: a systematic review. Curr Opin Clin Nutr Metab Care. 2017;20(3):232–236. doi: 10.1097/MCO.0000000000000368
- Moon RJ, Harvey NC, Davies JH, Cooper C. Vitamin D and skeletal health in infancy and childhood. Osteoporos Int. 2014;25(12):2673–2684. doi: 10.1007/s00198-014-2783-5
- Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;101(2):394–415.
- Nutritional rickets: a review of disease burden, causes, diagnosis, prevention and treatment. World Health Organization. 2019. 63 p. Available from: https://apps.who.int/iris/bitstream/handle/10665/329859/9789241516587-eng.pdf
- Paradowski PT, Domagalski K, Sypniewska G. Low Serum 25-hydroxyvitamin D Level Does Not Adversely Affect Bone Turnover in Prepubertal Children. Nutrients. 2021;13(10):3324. doi: 10.3390/nu13103324
- Ramasamy I. Vitamin D Metabolism and Guidelines for Vitamin D Supplementation. Clin Biochem Rev. 2020;41(3):103–126. doi: 10.33176/AACB-20-00006
- Roth DE, Abrams SA, Aloia J, et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann NY Acad Sci. 2018;1430(1):44–79. doi: 10.1111/nyas.13968
- Rueter K, Black LJ, Jones A, et al. Analytical Bias in the Measurement of Plasma 25-Hydroxyvitamin D Concentrations in Infants. Int J Environ Res Public Health. 2020;17(2):412. doi: 10.3390/ijerph17020412
- Rueter K, Jones AP, Siafarikas A, et al. In “High-Risk” Infants with Sufficient Vitamin D Status at Birth, Infant Vitamin D Supplementation Had No Effect on Allergy Outcomes: A Randomized Controlled Trial. Nutrients. 2020;12(6):1747. doi: 10.3390/nu12061747
- Scientific Advisory Committee on Nutrition (SACN) Vitamin D and Health. 2016. 304 p. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_ report.pdf
- Tan ML, Abrams SA, Osborn DA. Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. Cochrane Database Syst Rev. 2020;12:CD013046. doi: 10.1002/14651858.CD013046.pub2
- Tanaka K, Terao J, Shidoji Y, et al. Dietary reference intakes for Japanese 2010: fat-soluble vitamins. J Nutr Sci Vitaminol. 2013;59(6):584–595. doi: 10.3177/jnsv.59.584
- Taylor SN. Vitamin D in Toddlers, Preschool Children, and Adolescents. Ann Nutr Metab. 2020;76 (Suppl 2):30–41.
- Turck D, Bresson J, Burlingame B, et al. Scientific opinion on dietary reference values for vitamin D EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). EFSA J. 2016;179. doi: 10.2903/j.efsa.2016.NNN
- Uday S, Högler W. Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies. Curr Osteoporos Rep. 2017;15(4):293–302. doi: 10.1007/s11914-017-0383-y
- Wagner CL, Greer FR. Section on breastfeeding and committee on nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142–1152. doi: 10.1542/peds.2008-1862
- Ward LM, Gaboury I, Ladhani M, Zlotkin S. Vitamin D-deficiency rickets among children in Canada. CMAJ. 2007;177(2):161–166. doi: 10.1503/cmaj.061377
- Weisberg P, Scanlon KS, Li R, Cogswell ME. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J ClinNutr. 2004;80(Suppl 6):1697–1705. doi: 10.1093/ajcn/80.6.1697S44.
- Yakoob MY, Salam RA, Khan FR, Bhutta ZA. Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database Syst Rev. 2016;11(11): CD008824. doi: 10.1002/14651858.CD008824.pub2
- Yousef S, Manuel D, Colman I, et al. Vitamin D Status among First-Generation Immigrants from Different Ethnic Groups and Origins: An Observational Study Using the Canadian Health Measures Survey. Nutrients. 2021;13(8):2702. doi: 10.3390/nu13082702