Determinants of Vitamin D Levels in Italian Children and Adolescents: A Longitudinal Evaluation of Cholecalciferol Supplementation versus the Improvement of Factors Influencing 25(OH)D Status

Abstract

Objective. This paper aims to assess 25(OH)D levels in Italian children and adolescents identifying risk factors for 25(OH)D deficiency and to evaluate whether a normal 25(OH)D value can be restored in 25(OH)D-deficient patients. Methods. We evaluated 25(OH)D levels in 679 Italian children and adolescents (≤10, 11–20, 21–30, and >30 ng/mL were defined as severe deficiency, deficiency, insufficiency, and sufficiency, resp.). Of these, 365 25(OH)D-deficient were followed up for 1 year; 205 were treated with cholecalciferol (Arm A: 400 I.U.) and 160 by improving the environmental variables influencing 25(OH)D levels (Arm B). Results. At cross-sectional evaluation, 11.3% showed sufficiency, 30.0% insufficiency, and 58.7% 25(OH)D deficiency. Mean 25(OH)D was 19.08 ± 8.44 ng/mL. At the enrollment time (T 0), no difference was found between Arms A and B with respect to distribution and 25(OH)D levels. At end time (T 1) 26.0% (29.7% in Arm A versus 20.6% in Arm B) showed sufficiency, 38.4% (42.0% versus 34.4%) insufficiency, and 35.6% (28.3% versus 45.0%) 25(OH)D deficiency. Mean 25(OH)D level was 23.71 ± 6.83 ng/mL. Conclusions. Neither changes of lifestyle nor 400 I.U. cholecalciferol supplementation alone appears to be sufficient to restore adequate 25(OH)D levels.

Determinants of Vitamin D Levels in Children and Adolescents with Down Syndrome

“…The prevalence of 25(OH)D deficiency varies between 30% and 93% in different studies in adults [ 16 ], even if in Norway and Sweden the prevalence is rather low [ 17 ]. However, in a small Italian study [ 18 ], more than 80% of children showed insufficiency or deficiency of 25(OH)D; the data were confirmed in other, larger studies providing cross-sectional [ 19 ] and longitudinal data [ 20 ].…”

Vitamin D deficiency among pediatric osteoarticular tuberculosis patients

“…9,10 Having said that, studies in other countries have also shown hypovitaminosis D in non tubercular or controls patients. Studies by Gray et al (Australia) (55.9%), 3 Venturini et al (Italy and United kingdom) (47%), 4 Chung et al (Korea) (97%), 11 Stagi et al (Italy) (88.7%) 12 in pediatric groups have revealed widespread low vitamin D levels. These findings raise concerns over significance and precise standards of adequate vitamin D levels in children.…”

Vitamin D: Daily vs. Monthly Use in Children and Elderly—What Is Going On?

“…In Italy in the first year of life, an intake of 400 IU/day from six to twelve months is recommended [ 12 ], even though, as reported in Table 1 , different international health organizations give specific and sometimes slightly different recommendations due to different sun exposures and study results. In children and adolescents from 1 to 18 years of age, the recommended daily intake of Vitamin D is 600 IU/day, according to the American Academy of Pediatrics [ 30 ]. However, once again, looking at Table 2 , different international health organizations give different suggestions for the 1–18 age range.…”

“…Important factors in children over one year of age are therefore sun exposure and the presence of certain risk factors for vitamin D deficiency such as non-Caucasian ethnicity, renal or liver failure, intestinal malabsorption, chronic treatment with anticonvulsants, corticosteroids, ketoconazole, antiviral and obesity. The level of recommended daily intake of vitamin D according to the American Academy of Pediatric and Italian LARN for Children between 1 and 18 years is 600 IU/day [ 30 ]. The Endocrine Society recommends for children at risk of deficiency an intake of 600 IU/day–1000 IU/day.…”