Vitamin D in the Healthy European Paediatric Population

Abstract

In recent years, reports suggesting a resurgence of vitamin D deficiency in the Western world, combined with various proposed health benefits for vitamin D supplementation, have resulted in increased interest from health care professionals, the media, and the public. The aim of this position paper is to summarise the published data on vitamin D intake and prevalence of vitamin D deficiency in the healthy European paediatric population, to discuss the health benefits of vitamin D and to provide recommendations for the prevention of vitamin D deficiency in this population. Vitamin D plays a key role in calcium and phosphate metabolism and is essential for bone health. There is insufficient evidence from interventional studies to support vitamin D supplementation for other health benefits in infants, children, and adolescents. The pragmatic use of a serum concentration >50 nmol/L to indicate sufficiency and a serum concentration <25 nmol/L to indicate severe deficiency is recommended. Vitamin D deficiency occurs commonly among healthy European infants, children, and adolescents, especially in certain risk groups, including breast-fed infants, not adhering to the present recommendation for vitamin D supplementation, children and adolescents with dark skin living in northern countries, children and adolescents without adequate sun exposure, and obese children. Infants should receive an oral supplementation of 400 IU/day of vitamin D. The implementation should be promoted and supervised by paediatricians and other health care professionals. Healthy children and adolescents should be encouraged to follow a healthy lifestyle associated with a normal body mass index, including a varied diet with vitamin D-containing foods (fish, eggs, dairy products) and adequate outdoor activities with associated sun exposure. For children in risk groups identified above, an oral supplementation of vitamin D must be considered beyond 1 year of age. National authorities should adopt policies aimed at improving vitamin D status using measures such as dietary recommendations, food fortification, vitamin D supplementation, and judicious sun exposure, depending on local circumstances.

Cross-sectional analysis of universal vitamin D supplementation in former East Germany during the first year of life

“…25(OH)D levels decreased at 6 months of age when solids were introduced (Table 1). Considering that human milk contains 25 IU/L of vitamin D or less [26] compared to an average vitamin D content of 40-100 IU/100 kcal in infant formula and 40-120 IU/100 kcal in follow-on formula [25], these findings reflect that a combination of fortified formula-use and vitamin D supplementation has a potential to induce elevated 25(OH)D levels. In this context it is of interest that our group could previously demonstrate that supplementation with 250 IU/day is sufficient during the first 8 weeks of life [31].…”

“…There is debate about the association between 25(OH)D levels and health outcomes. Levels < 50 nmol/L are widely regarded as vitamin D deficiency, a target of > 50 nmol/L is recommended [5,25,26]. For adults > 75 nmol/L has been proposed as needed to support extraskeletal functions of vitamin D [4].…”

Vitamina D em pediatria

“…Muitos autores têm utilizado e definido deficiência como concentrações séricas de 25(OH)D menores que 20 ng/ml (50 nmol/l) [38][39][40][41] .…”

Deficiencia de vitamina D en la práctica clínica pediátrica

“…12 Esta evidencia coincide con la recomendación de la European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), con aportes de 800 a 1000 UI de VD diarios, calculados a partir de alimentación y suplemento oral. 13 Obesidad y DVD: La evidencia en niños prepúberes muestra una relación inversa entre las concentraciones séricas de 25(OH)D e indicadores de adiposidad, 14,15 que es consistente con la hipótesis del secuestro de la VD por el tejido adiposo, dada su naturaleza liposoluble. 16 Además, estos resultados coinciden con un estudio reciente que mostraba que el exceso de peso en niños influía en el suplemento farmacológico de VD y lograba una menor alza de 25(OH)D; por lo tanto, los niños con exceso de peso podrían requerir dosis mayores de VD Enfermedad celíaca Dieta libre de gluten.…”