Vitamin D in Adolescents: A Systematic Review and Narrative Synthesis of Available Recommendations

Vitamin D status and muscle strength in a pan-European cohort of children and adolescents with normal weight and overweight/obesity

This aimed to investigate associations between the vitamin D status and handgrip strength in children and adolescents considering weight status. Participants aged 7 to < 16 years from the European IDEFICS/I.Family cohort were included. Serum 25-hydroxyvitamin D [25(OH)D] and handgrip strength were measured in 2013/2014. In multivariable logistic regression models, we investigated the association of vitamin D status with handgrip strength adjusted for demographic variables, BMI z-score, sports club membership, screen time and UV intensity. Vitamin D-sufficient children had higher odds for a high handgrip strength (OR = 1.92, 95%-CI: 1.12, 3.30), but this association was limited to children with thinness/normal weight (OR = 2.60, 95%-CI: 1.41-4.81). Children with overweight (OR = 2.64, 95%-CI: 2.00, 3.49) and obesity (OR = 4.53, 95%-CI: 2.93, 7.02) were more likely to have a high handgrip strength than thin/normal weight children.

CONCLUSIONS

The positive association of vitamin D with muscle strength in our study is limited to children with low and normal BMI. In children with overweight or obesity, the higher muscle strength seems to superimpose the association with vitamin D. Overall, our results indicate the importance of sufficient levels of vitamin D and offers physical activity perspectives for children with overweight and obesity.

STUDY REGISTRATION

ISRCTN: https://doi.org/10.1186/ISRCTN62310987 .

WHAT IS KNOWN

• Studies have shown a positive association between vitamin D status and handgrip strength in older adults while studies in children and adolescents are scarce. • Conflicting results were found on whether overweight and obesity are associated with reduced or increased handgrip strength compared to normal weight.

WHAT IS NEW

• The results of this large pan-European study in children and adolescents indicate that a sufficient vitamin D status is associated with better handgrip strength, particularly in participants with thinness/normal weight. • Children with overweight and obesity have a higher handgrip strength as compared to children with thinness/normal weight which seems to superimpose the positive association between vitamin D status and handgrip strength in this group.

The Impact of Vitamin Deficiencies on Oral Manifestations in Children

Vitamins play a vital role in human health, particularly in the development and maintenance of oral health in children. These nutrients are broadly categorized into fat-soluble and water-soluble types, crucial for children's well-being. The objective of this study is to investigate the impact of vitamin deficiencies on the oral health of children, focusing on how these deficiencies contribute to various oral health issues and determining the relationship between specific vitamin shortages and oral diseases. Findings indicate that shortages in vitamins A and D lead to enamel issues and a higher susceptibility to dental diseases, vitamin E assists in treating oral mucositis, and vitamin K is essential for blood clotting in dental surgeries. Deficits in B-complex and vitamin C result in enamel hypomineralization and soft tissue ailments, including aphthous stomatitis and gingival petechiae. Additionally, a lack of vitamin B7 compromises the immune response, increasing oral candidiasis risk. Therefore, vitamin deficiencies markedly affect children's oral health, highlighting the need for joint efforts between dental professionals and caregivers for effective pediatric care. Addressing vitamin deficiencies through supplementation and tailored dental care emphasizes the significance of nutritional health in children's overall and dental well-being, advocating for a collaborative approach to achieve optimal health outcomes.

Vitamin D Status During Adolescence and the Impact of Lifestyle Changes: 2 Years' Follow-up From the Fit Futures Study

CONTEXT

Longitudinal data regarding vitamin D status in adolescence is scarce. This study presents population-based data from an Arctic adolescent population (n = 589) at 16 and 18 years.

OBJECTIVE

The aims of this study were to investigate changes in vitamin D status during 2 years in adolescence, and whether lifestyle changes were associated with serum 25-hydroxyvitamin D (s-25(OH)D) at follow-up.

METHODS

Fit Futures is a longitudinal study at 69°N in Norway. Participants had their s-25(OH)D levels analyzed in their first and third year of upper secondary school (median age 16 and 18 years), in Fit Futures 1 (FF1) and Fit Futures 2 (FF2), respectively. Self-reported lifestyle habits were registered through questionnaires. The association between lifestyle changes and s-25(OH)D levels at follow-up were calculated by regression analyses, controlling for baseline s-25(OH)D levels.

RESULTS

Longitudinal data were available for 309 girls and 280 boys. The proportion of adolescents with s-25(OH)D <50 nmol/L were 73.7% in FF1 and 77.1% in FF2, while the proportion <30 nmol/L constituted 35.7% in FF1 and 40.9% in FF2. Of those with s-25(OH)D <30 nmol/L (severe vitamin D deficiency) in FF1, 73.3% remained severely deficient in FF2. Among boys, an increase in UV exposure was significantly associated with higher s-25(OH)D levels in FF2 (beta; CI [nmol/L] 12.9; 9.1, 16.7). In girls, decreased vitamin/mineral supplement intake was significantly associated with lower s-25(OH)D at FF2 (-6.7; -10.2, -3.1), while increased UV (10.8; 7.0, 14.7) and combined hormonal contraceptive exposure (12.1; 6.0, 18.1) in FF2 was significantly associated with higher s-25(OH)D levels in FF2.

CONCLUSION

Severe vitamin D deficiency was prevalent throughout adolescence. Lifestyle changes may alter s-25(OH)D levels in this age group.

Mini-Review on Vitamin D in Pediatric Population and its Role in Respiratory and Atopic Disorders

In recent years, our comprehension of the function of vitamin D has significantly evolved. The ubiquitous presence of the vitamin D receptor (Vitamin D Receptor- VDR) in the body has led to its redefinition from a steroidal hormone primarily involved in skeletal functions to a hormone with pleiotropic effects, exerting its influence on the circulatory, nervous, and immune systems. This has prompted investigations into its potential use in preventing and treating chronic metabolic disorders, cardiovascular diseases, infections, and allergic and autoimmune diseases. This comprehensive review explores the various aspects of vitamin D, including its sources, synthesis, functions, and its impact on different physiological systems. It delves into the epidemiology of vitamin D deficiency, highlighting its occurrence among various age demographics and geographic regions. The impact of vitamin D on the immune system is also explored, elucidating its immunomodulatory and anti-inflammatory properties, particularly in the context of respiratory infections. The review discusses emerging evidence concerning the potential advantages of vitamin D in respiratory diseases, pediatric asthma and atopic dermatitis. It also addresses vitamin D supplementation recommendations for various pediatric populations, including term and preterm infants. The growing concern regarding the global health impacts of insufficient vitamin D levels necessitates further research to bridge gaps in knowledge, particularly in enhancing screening, prevention, and approaches to address vitamin D deficiency from birth onwards. In summary, this comprehensive overview underscores the vital role of vitamin D, highlighting the significance of understanding its multifaceted functions and the need for tailored supplementation strategies, especially in vulnerable populations.

Vitamin D and depressive symptoms in an early adolescent cohort

BACKGROUND

To explore the cross-sectional and longitudinal association between vitamin D and depressive symptoms across early adolescence.

METHODS

This longitudinal study included 1607 early adolescents [mean (s.d.) age, 12.49 years; 972 (60.5%) males] from the Chinese Early Adolescents Cohort, recruited from a middle school in Anhui Province and followed up annually (2019-2021). Serum 25(OH)D levels were measured in both 2019 and 2021. Self-reports on depression were assessed at each of three time points from 2019 to 2021.

RESULTS

In the whole sample, higher baseline serum 25(OH)D levels were linked with a lower risk of cumulative incident depression within two-year follow-ups (adjusted RR = 0.97, 95% CI 0.94-0.99) and the increasing trajectory of depression symptoms across the three waves (adjusted RR = 0.97, 95% CI 0.95-0.99). Baseline vitamin D deficiency (VDD) (adjusted RR = 1.50, 95% CI 1.10-2.05) were associated with an increased risk for the increasing trajectory of depression symptoms across the three waves. Remitted VDD was positively related to one dichotomous depression symptoms across three waves (adjusted OR 2.15, 95% CI 1.15-4.01). The above-mentioned significant association was also found in males. Additionally, baseline VDD (adjusted OR 1.59, 95% CI 1.04-2.44) and persistent VDD (adjusted OR 1.58, 95% CI 1.02-2.60) were linked to an increased risk of having two dichotomous depression symptoms only in males.

CONCLUSIONS

Our results highlight a prospective association between baseline vitamin D and depression risk in early adolescents. Additionally, a male-specific association between vitamin D and depression risk was observed. Our findings support a potential beneficial effect of vitamin D supplementation in reducing depression risk in early adolescents.

Vitamin D in pediatric age: Current evidence, recommendations, and misunderstandings

In recent years vitamin D has been in the spotlight of many researchers for its possible role in various disorders, including autoimmune and infectious diseases. Even if vitamin D deficiency remains a major public health problem, its symptomatic manifestations are less and less common in clinical practice, and pediatric age represents a “gray area” where vitamin D supplementation is often administered in the absence of an effective evaluation of its status. Moreover, a poor knowledge about different definitions of “deficiency,” “insufficiency,” and similar terms is spread among clinicians, while guidelines are not univocal, especially after the first year of life. The aim of this brief opinion paper is to sum up recent evidence about vitamin D status and its supplementation in pediatrics, in order to better clarify a common definition of its deficiency. The aim of this opinion article is to raise awareness on this topic among clinicians and encourage a discussion on the real need for routine 25-hydroxycholecalciferol serum evaluation and its supplementation.

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.

Analysis of hot trends in research on the association between vitamin D and cardiovascular disease

Objective

Vitamin D deficiency is the most common nutrient deficiency. Numerous studies suggest that vitamin D is an independent risk factor for cardiovascular disease. The objective is to visualize the research hotspots and evolution trends of the correlation between vitamin D and cardiovascular disease by using multivariate statistics and social network analysis techniques and to compare adult research with that of children in this field.

Methods

(Vitamin D [MeSH Major Topic]) AND (cardiovascular disease [MeSH Major Topic]) were retrieved from the PubMed database by time period. The bibliographic items co-occurrence matrix builder (BICOMB) was adopted to extract high-frequency subject terms and establish the core subject term co-occurrence matrix. With the Netdraw function of Ucinet 6.0 software, the social network of core subject terms was completed.

Results

Before 2010, there was a slow increase in the number of research papers covering all age groups in this field (157, 54, 84, and 211 papers were published in stages 1-4, respectively). From 2010 to 2020, there were 1,423 papers retrieved, showing a significantly increased research heat. The overall development trend of the research on the association between vitamin D and cardiovascular disease in children is similar to that in all age groups. From 2010 to 2020, 122 related papers were published (while before 2009, there were only 43 papers in all), presenting a good overall development trend. The social network analysis of core subject terms showed gradually increased correlations between research hotspots, from the early studies limited on the physiological function of vitamin D in cardiovascular diseases, to the role of vitamin D in the comorbidities of various cardiovascular diseases and its value as an intervention measure. Researches on the association between vitamin D and cardiovascular disease has a good overall development trend. Study of the mechanisms and the role of vitamin D in the common co-morbidities of cardiovascular disease and its therapeutic value will be the focus of future research.

Vitamin D Levels in Ethnic Minority Adolescents in Primary Care

INTRODUCTION

This pilot study examined the distribution of low vitamin D levels among ethnic minority adolescents in primary care to elucidate the clinical needs of this diverse population.

METHOD

A cross-sectional study was conducted using a retrospective patient chart review. Participants were a consecutive sample of 119 ethnically diverse adolescents aged 12-18 years, attending a primary care clinic, who had a wellness examination in 2018 and documented vitamin D levels on the basis of previously collected blood work.

RESULTS

Sixty-one percent of adolescents had low vitamin D levels. Vitamin D deficiency increased with age, independently of ethnicity or gender.

DISCUSSION

A significant number of ethnically diverse adolescents presented with low vitamin D levels. A need exists to raise awareness among clinicians regarding social determinants of health and culturally sensitive dietary practices to improve vitamin D levels and prevent long-term complications, focusing on adolescent at-risk ethnic groups.

Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age.

Conclusions

This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Analysis of vitamin D metabolic markers by mass spectrometry: Recent progress regarding the "gold standard" method and integration into clinical practice

Liquid chromatography/tandem mass spectrometry is firmly established today as the gold standard technique for analysis of vitamin D, both for vitamin D status assessments as well as for measuring complex and intricate vitamin D metabolic fingerprints. While the actual mass spectrometry technology has seen only incremental performance increases in recent years, there have been major, very impactful changes in the front- and back-end of MS-based vitamin D assays; for example, the extension to new types of biological sample matrices analyzed for an increasing number of different vitamin D metabolites, novel sample preparation techniques, new powerful chemical derivatization reagents, as well the continued integration of high resolution mass spectrometers into clinical laboratories, replacing established triple-quadrupole instruments. At the same time, the sustainability of mass spectrometry operation in the vitamin D field is now firmly established through proven analytical harmonization and standardization programs. The present review summarizes the most important of these recent developments.

Three monthly doses of 150,000 IU of oral cholecalciferol correct vitamin D deficiency in adolescents: A pragmatic study

OBJECTIVES

To assess the efficacy of an oral high-dose cholecalciferol regimen in correcting vitamin D deficiency (VDD) in adolescents and to explore potential predictive factors on the response to treatment.

METHODS

This is a retrospective chart review conducted in the Adolescent Outpatient Clinic, Geneva University Hospitals, Switzerland. One hundred-three otherwise healthy vitamin D deficient [serum 25-hydroxyvitamin D, 25(OH)D, level <50 nmol/L] adolescents (mean age 16.6) attending the clinic between 1 January 2016 and 31 December 2018 received 150,000 IU of oral cholecalciferol every month for 3 months (cumulative dose of 450,000 IU). We measured the change in serum 25(OH)D levels pre- and post-treatment and the achievement of serum 25(OH)D level post-treatment ≥75 nmol/L.

RESULTS

The mean serum 25(OH)D level increased by 320%, from 26 nmol/L at baseline to 83 nmol/L at the end of the study (P < .001). The rise was significantly higher for patients initially tested in the winter/spring (mean 65 nmol/L) compared with those initially tested in the summer/autumn (mean 48 nmol/L) (P < .003). No clear relationship was found between the response to treatment and the vitamin D status at baseline. The effect of age, gender, origin and body mass index was not statistically significant.

CONCLUSIONS

The present intermittent high-dose regimen is effective in treating VDD in healthy adolescents without significant variations in response between different subgroups.

Vitamin D supplementation: position Statement of the Iberoamerican Society of Osteoporosis and Mineral Metabolism (SIBOMM)

BACKGROUND

Vitamin D (VD) deficiency is a global pandemic that affects more than a third of the population worldwide. The population of Latin America and the Caribbean exceeds 620 million inhabitants with diverse ethnic origins and different latitudes and altitudes, which make comparisons and generalizations difficult.

AIM AND METHOD

We sought to establish an expert consensus regarding the recommendations for VD supplementation in Latin America by means of the Delphi methodology.

RESULTS

The prophylactic dosage of VD in the general population should be individualized according to age, race, body weight, sun exposure of an individual, altitude, and dietary and exercise habits, without ruling out existing chronic diseases.

CONCLUSION

The importance of VD has been widely documented and its deficiency is a pandemic. Many individuals have difficulty meeting daily VD requirements through food and the sun. The population of Latin America and the Caribbean has diverse ethnics, cultures, in addition to living in different latitudes and altitudes. Therefore, it is important to make a position on VD supplementation, given the different characteristics, ages and serum levels of 25(OH)D.