Vitamin D Deficiency in Chronic Childhood Disorders: Importance of Screening and Prevention

Abstract

Vitamin D plays a vital role in regulating calcium and phosphate metabolism and maintaining bone health. A state of prolonged or profound vitamin D deficiency (VDD) can result in rickets in children and osteomalacia in children and adults. Recent studies have demonstrated the pleiotropic action of vitamin D and identified its effects on multiple biological processes in addition to bone health. VDD is more prevalent in chronic childhood conditions such as long-standing systemic illnesses affecting the renal, liver, gastrointestinal, skin, neurologic and musculoskeletal systems. VDD superimposed on the underlying disease process and treatments that can adversely affect bone turnover can all add to the disease burden in these groups of children. The current review outlines the causes and mechanisms underlying poor bone health in certain groups of children and young people with chronic diseases with an emphasis on the proactive screening and treatment of VDD.

Vitamin D Supplementation at a Dose of 10 µg/Day in Institutionalized Children with Severe Motor and Intellectual Disabilities

“…While there are various recommendations for the dosage of VD supplementation [ 23 ], the appropriate dosage for institutionalized children with SMID remains unclear [ 3 ]. In the Dietary Reference Intakes for Japanese, the RDAs for children in this study ranged from 3.0 µg/day to 9.5 µg/day [ 10 ].…”

“…VD is an important factor for preventing osteoporosis and bone fractures in these children [ 2 ]. VDD is likely to occur in people living at high latitudes and indoors, those who excessively use sunscreen, those with pigmented skin, and those with insufficient ultraviolet (UV) B exposure [ 3 ]. Studies showed that VDD is common in the northern part of Japan because of limited daylight hours, especially during winter [ 4 ].…”

“…However, to our knowledge, there are no studies of VD supplementation in institutionalized children with SMID. Therefore, the optimal VD dosage for children with long-term SMID has not been established [ 3 ]. The Japanese Dietary Reference Intakes for children under 15 years of age require 3–9.5 µg/day of VD [ 10 ], whereas the American Academy of Pediatrics recommends 10 µg/day from infancy to early childhood and beyond [ 11 ].…”

Calcium, Phosphate, and Vitamin D in Children and Adolescents with Chronic Diseases: A Cross-Sectional Study

“…In childhood, it is involved in the development of serious extra skeletal health conditions, including atopy and autoimmunity [51], HTA, obesity, high-density lipoprotein, systolic blood pressure, fasting glucose, insulin resistance (IR), hyperglycemia, and dyslipidemia [52]. In children and adolescents, obesity, and chronic illnesses, such as celiac disease, CF, inflammatory bowel disease, and short bowel syndrome, as well as the use of some medications (anticonvulsants), are risk factors for developing VDD [14,53]. In its non-skeletal actions, Vit-D regulates several genes (3% of the human genome) engulfed in cellular differentiation, cell cycle control, and cellular function, exerting non-calcemic/pleiotropic effects on extra-skeletal target tissues, immune and CV systems, endocrine pancreatic cells, muscle, and adipose tissue [54], as well as in the glucose metabolism, skin, reproductive system, and neurocognitive functions [55].…”

“…Furthermore, Vit-D has anti-inflammatory, insulin-sensitizing effects and regulates Ca and P balance [13]. In childhood, Vit-D deficiency (VDD) is more prevalent in chronic illnesses such as long-term systemic diseases that compromise the renal, hepatic, gastrointestinal, skin, neurological, and musculoskeletal systems [14].…”