Vitamin D in Toddlers, Preschool Children, and Adolescents

The role of vitamin D in pediatric systemic lupus erythematosus - a double pawn in the immune and microbial balance

Having increased popularity during the Covid-19 pandemic, vitamin D3 is currently impressing thanks to the numerous researches aimed at its interactions with the body's homeostasis. At the same time, there is a peak in terms of recommendations for supplementation with it. Some of the studies focus on the link between autoimmune diseases and nutritional deficiencies, especially vitamin D3. Since the specialized literature aimed at children (patients between 0-18 years old) is far from equal to the informational diversity of the adult-centered branch, this review aims to bring up to date the relationship between the microbial and nutritional balance and the activity of pediatric systemic lupus erythematosus (pSLE). The desired practical purpose resides in a better understanding and an adequate, individualized management of the affected persons to reduce morbidity. The center of the summary is to establish the impact of hypovitaminosis D in the development and evolution of pediatric lupus erythematosus. We will address aspects related to the two entities of the impact played by vitamin D3 in the pathophysiological cascade of lupus, but also the risk of toxicity and its effects when the deficiency is over supplemented (hypervitaminosis D). We will debate the relationship of hypovitaminosis D with the modulation of immune function, the potentiation of inflammatory processes, the increase of oxidative stress, the perfusion of cognitive brain areas, the seasonal incidence of SLE and its severity. Finally, we review current knowledge, post-pandemic, regarding the hypovitaminosis D - pSLE relationship.

The effect of vitamin D supplementation on attacks in PFAPA syndrome patients with low vitamin D levels

BACKGROUND-AIM

To evaluate the effect of vitamin D supplementation on the frequency and duration of attacks in patients of PFAPA syndrome with low vitamin D levels.

METHODS

This retrospective study comprised PFAPA patients with vitamin D deficiency/insufficiency between 2018 and 2023. The frequency and duration of PFAPA attacks before and after vitamin D supplementation were noted.

RESULTS

Seventy-one patients were included. Of the 71 patients, 24 (33.8%) had vitamin D insufficiency, and 47 (66.2%) had vitamin D deficiency. In patients with vitamin D insufficiency, mean attack frequency and mean attack duration before vitamin D supplementation were 4.3 ± 1.9/year and 2.2 ± 1.6 days, respectively, while mean attack frequency and mean attack duration after vitamin D supplementation were 3.5 ± 2.7/year per year and 1.3 ± 0.9 days respectively (p = 0.2, p = 0.2, respectively). In patients with vitamin D deficiency, mean attack frequency and mean attack duration before vitamin D supplementation were 7.4 ± 2.1/year and 2.2 ± 1.6 days, respectively, while mean attack frequency and mean attack duration after vitamin D supplementation were 3.3 ± 2.4/year and 1.3 ± 0.9 days respectively (p < 0.01, p = 0.04, respectively). When the vitamin D level and the frequency of attacks were compared, the cut-off value of vitamin D was found to be 29.7 nmol/L.

CONCLUSIONS

In PFAPA patients with low vitamin D levels, the frequency and duration of PFAPA attacks were reduced with vitamin D supplementation. Especially at vitamin D level cut-off > 29.7 nmol/L, the frequency of attacks reduced significantly.

Vitamin D Supplementation in Neonatal and Infant MIS-C Following COVID-19 Infection

To date, the SARS-CoV-2 pandemic still represents a great clinical challenge worldwide, and effective anti-COVID-19 drugs are limited. For this reason, nutritional supplements have been investigated as adjuvant therapeutic approaches in disease management. Among such supplements, vitamin D has gained great interest, due to its immunomodulatory and anti-inflammatory actions both in adult and pediatric populations. Even if there is conflicting evidence about its prevention and/or mitigation effectiveness in SARS-CoV-2 infection, several studies demonstrated a strict correlation between hypovitaminosis D and disease severity in acute COVID-19 and MIS-C (multisystem inflammatory syndrome in children). This narrative review offers a resume of the state of the art about vitamin D's role in immunity and its clinical use in the context of the current pandemic, specially focusing on pediatric manifestations and MIS-C. It seems biologically reasonable that interventions aimed at normalizing circulating vitamin D levels could be beneficial. To help clinicians in establishing the correct prophylaxis and/or supportive therapy with vitamin D, well-designed and adequately statistically powered clinical trials involving both adult and pediatric populations are needed. Moreover, this review will also discuss the few other nutraceuticals evaluated in this context.

Proportion of vitamin D deficiency in children/adolescents with type 1 diabetes: a systematic review and meta-analysis

BACKGROUND

The impact of vitamin D on type 1 diabetes has been a controversial topic in public health. Furthermore, significant differences in the proportion of vitamin D have been noted. The purpose of this systematic review was to determine the overall proportion of vitamin D deficiency in children/adolescents with type 1 diabetes (T1D).

METHODS

Based on six electronic databases (PubMed, Web of Science, Embase, Ovid Medline, ProQuest, and Cochrane Library), eligible studies since the databases' inception up to April 2022 were searched. Reference lists were also manually searched to identify additional studies. Overall, studies with statistical information on vitamin D deficiency in children and adolescents with T1D were included, and a random effects model was applied for the meta-analysis. In addition, subgroup and sensitivity analyses were carried out to evaluate heterogeneity, and publication bias was evaluated by using Egger's test.

RESULTS

A total of 45 studies involving 6,995 participants met the inclusion criteria; these included 25 countries covering Africa, Oceania, Europe, North America and Asia. The proportion of vitamin D deficiency in children/adolescents with T1D was 45% (95% confidence interval [CI] 37-54%, I2 = 97.94%). Subgroup analysis further revealed that the publication year, study design, vitamin D classification, season and geographical region significantly contributed to the variation in the reported incidence of vitamin D deficiency.

CONCLUSIONS

The results of the meta-analysis showed that the proportion of vitamin D deficiency among T1D children/adolescents was 45%. In addition, the proportion remains higher, which has important implications for adapting health and social care systems.

Bone Material Properties in Bone Diseases Affecting Children

PURPOSE OF REVIEW

Metabolic and genetic bone disorders affect not only bone mass but often also the bone material, including degree of mineralization, matrix organization, and lacunar porosity. The quality of juvenile bone is moreover highly influenced by skeletal growth. This review aims to provide a compact summary of the present knowledge on the complex interplay between bone modeling and remodeling during skeletal growth and to alert the reader to the complexity of bone tissue characteristics in children with bone disorders.

RECENT FINDINGS

We describe cellular events together with the characteristics of the different tissues and organic matrix organization (cartilage, woven and lamellar bone) occurring during linear growth. Subsequently, we present typical alterations thereof in disorders leading to over-mineralized bone matrix compared to those associated with low or normal mineral content based on bone biopsy studies. Growth spurts or growth retardation might amplify or mask disease-related alterations in bone material, which makes the interpretation of bone tissue findings in children complex and challenging.

Novel Insights into Somatic Comorbidities in Children and Adolescents Across Psychiatric Diagnoses: An Explorative Study

Many children with psychiatric disorders display somatic symptoms, although these are frequently overlooked. As somatic morbidity early in life negatively influences long-term outcomes, it is relevant to assess comorbidity. However, studies of simultaneous psychiatric and somatic assessment in children are lacking. The aim of this study was to assess the prevalence of somatic comorbidities in a clinical sample of children and adolescents with psychiatric disorders in a naturalistic design. Data were assessed from 276 children with various psychiatric disorders (neurodevelopmental disorders, affective disorders, eating disorders and psychosis) aged 6-18 years. These data were collected as part of routine clinical assessment, including physical examination and retrospectively analyzed. For a subsample (n = 97), blood testing on vitamin D3, lipid spectrum, glucose and prolactin was available. Results of this cross-sectional study revealed that food intake problems (43%) and insomnia (66%) were common. On physical examination, 20% of the children were overweight, 12% displayed obesity and 38% had minor physical anomalies. Blood testing (n = 97) highlighted vitamin D3 deficiency (< 50 nmol/L) in 73% of the children. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. The main somatic comorbidities in this broad child- and adolescent psychiatric population consisted of (1) problems associated with food intake, including obesity and vitamin D3 deficiency and (2) sleeping problems, mainly insomnia. Child and adolescent psychiatrists need to be aware of potential somatic comorbidities and may promote a healthy lifestyle.

Evaluation of vitamin D levels and affecting factors of vitamin D deficiency in healthy children 0-18 years old

The frequency of vitamin D deficiency in healthy children is relatively high. Moreover, vitamin D supplementation in children is under the requested levels. The aim of this study is to determine the frequency of vitamin D deficiency and the factors that influence vitamin D levels in healthy children. During the study period, 3368 vitamin D levels of healthy children, aged 0-18 years, were evaluated retrospectively. Vitamin D levels were categorized as deficiency (< 12 ng/ml), insufficiency (12-20 ng/ml), and sufficiency (> 20 ng/ml). The prevalence of vitamin D deficiency and insufficiency was found to be 18-24.9% in healthy children, respectively. It was found that the frequency of vitamin D deficiency increased with age. In addition, the most severe and highest risk group for vitamin D deficiency were adolescent girls. Moreover, being in the winter or spring season and living in the north of the 40th parallel are the other risk factors for vitamin D deficiency.

CONCLUSION

 This study showed that vitamin D deficiency still remains a major problem for healthy children and daily supplementation of vitamin D is mandatory. Prophylactic vitamin D supplementation and adequate sunlight exposure should be provided for all children, in particular healthy adolescents. In addition, future studies may focus on screening for vitamin D status in children who did not receive vitamin D supplementation.

WHAT IS KNOWN

• Vitamin D is an essential component in bone metabolism. Seasonality, age, sex, dark skin pigmentation, and limited exposure to sunlight are causes of vitamin D deficiency. • The World Health Organization has drawn attention to this increased frequency, recommending lifelong, regular vitamin D prophylaxis.

WHAT IS NEW

• The frequency of vitamin D deficiency and insufficiency was found to be 42.9% in healthy children and the frequency significantly increased with age. • There were almost no cases of prophylactic vitamin D usage in adolescent group which are at the highest risk.

Effect of Vitamin D Supplementation on (25(OH)D) Status in Children 12-30 Months of Age: A Randomized Clinical Trial

Vitamin D (VD) deficiency (serum 25(OH)D < 50 nmol/L) affects 27.3% of preschool children in Mexico. The purpose of this study was to assess the effect of vitamin D supplementation at different doses on serum 25(OH)D concentrations in preschool children. In a randomized control trial, 222 children 12-30 months old were randomly assigned to one of four treatment groups: (1) Vitamin D2 (Ergocalciferol) 400 IU/day (n = 56); (2) Vitamin D2 (Ergocalciferol) 800 IU/day (n = 55); (3) Vitamin D3 (Cholecalciferol) 1000 IU/day (n = 56); or (4) multiple micronutrients (MM) non-VD (n = 55). Supplements were given five days/wk for three months. Serum 25(OH)D was measured at baseline and after three months. At baseline, mean serum 25(OH)D was 58.9 ± 12.6 nmol/L and 23.4% were VD-deficient. There was a statistically significant increase in serum concentrations of 25(OH)D (range across groups: +8.2 to +17.3 nmol/L). Additionally, the prevalence of vitamin D deficiency decreased after three months: for D2 400 IU, -9.0%; for D2 800 IU, -11.0%; for D3 1000 IU, -18.0%; and for MM non-VD, -2.8% (p < 0.05). No adverse effects were observed. VD supplementation for three months was effective for increasing serum 25(OH)D concentrations and for reducing VD deficiency in preschool children. The highest efficacy was observed by giving 1000 IU D3/d.

A Phase 1 Study of Oral Vitamin D3in Boys and Young Men With X-Linked Adrenoleukodystrophy

Background and Objectives

There are no therapies for preventing cerebral demyelination in X-linked adrenoleukodystrophy (ALD). Higher plasma vitamin D levels have been linked to lower risk of inflammatory brain lesions. We assessed the safety and pharmacokinetics of oral vitamin D dosing regimens in boys and young men with ALD.

Methods

In this open-label, multicenter, phase 1 study, we recruited boys and young men with ALD without brain lesions to a 12-month study of daily oral vitamin D3supplementation. Our primary outcome was attainment of plasma 25-hydroxyvitamin D levels in target range (40–80 ng/mL) at 6 and 12 months. Secondary outcomes included safety and glutathione levels in the brain, measured with magnetic resonance spectroscopy, and blood, measured via mass spectrometry. Participants were initially assigned to a fixed dosing regimen starting at 2,000 IU daily, regardless of weight. After a midstudy safety assessment, we modified the dosing regimen, so all subsequent participants were assigned to a weight-stratified dosing regimen starting as low as 1,000 IU daily.

Results

Between October 2016 and June 2019, we enrolled 21 participants (n = 12, fixed-dose regimen; n = 9, weight-stratified regimen) with a median age of 6.7 years (range: 1.9–22 years) and median weight of 20 kg (range: 11.7–85.5 kg). The number of participants achieving target vitamin D levels was similar in both groups at 6 months (fixed dose: 92%; weight stratified: 78%) and 12 months (fixed dose: 67%; weight stratified: 67%). Among the 12 participants in the fixed-dose regimen, half had asymptomatic elevations in either urine calcium:creatinine or plasma 25-hydroxyvitamin D; no laboratory deviations occurred with the weight-stratified regimen. Glutathione levels in the brain, but not the blood, increased significantly between baseline and 12 months.

Discussion

Our vitamin D dosing regimens were well tolerated and achieved target 25-hydroxyvitamin D levels in most participants. Brain glutathione levels warrant further study as a biomarker for vitamin D and ALD.

Classification of Evidence

This study provides Class IV evidence that fixed or weight-stratified vitamin D supplementation achieved target levels of 25-hydroxyvitamin D in boys and young men with X-ALD without brain lesions.

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.

Is Sunshine Vitamin Related to Adolescent Depression? A Cross-Sectional Study of Vitamin D Status and Depression Among Rural Adolescents

BACKGROUND

Adolescence is the phase of rapid transition of the body. The requirement of all minerals and vitamins changes in this phase of life so does Vitamin D. Despite Vitamin D being abundantly available, its deficiency, which can cause innumerable side effects on the body, is extremely common among the general population.  Material and methods: The present study was a cross-sectional study carried out from January 2021 to July 2022 for two years at various government rural high schools in Kolar, Karnataka, India. All adolescents who were aged 11-18 years and studying in 9^th and 10^th standards were included in the study after consent and assent. Adolescent boys and girls with any pre-existing mental health illness were excluded from the study. To assess depression, Beck's Depression Inventory (BDI-II) was used. Vitamin D3 levels were assessed by using VITROS Immunodiagnostic products using a 25-OH Total reagent pack. All data were entered in a Microsoft Excel sheet (Redmond, USA) and analyzed using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. To check for the association between factors, Chi-square was applied with a level of significance defined as a p-value less than 0.05.

RESULTS

Out of 451 students, 272 (60.3%) belonged to the 15-year age group, 224 (49.7%) were boys, 235 (52.1%) were studying in 10^th standard, 323 (71.6 %) belonged to nuclear families, 379 (84%) were non-vegetarian by diet, 222 (49.2%) had sun exposure in the afternoon, and 156 (34.6%) had a sun exposure of fewer than 60 minutes, 133 (29.5%) had severe depression according to Beck's Depression Inventory-II. One hundred sixty-two (35.9%) had insufficient Vitamin D3 levels (12-20 ng/ml), and 66 (14.6%) had deficient levels of Vitamin D3 (less than 12 ng/dl). There was a statistically significant association between depression and Vitamin D3 levels.

CONCLUSION

There are innumerable causes of adolescent depression. The present study shows Vitamin D levels were statistically associated with depression among adolescents. Vitamin D supplementation of at least 600 international units, which is the recommended dietary allowance (RDA), could be beneficial in tackling Vitamin D to sufficiency status (20-100 ng/ml) and also indirectly address Adolescent Depression. Better study designs, like randomized control trials showing Vitamin D intervention and its possible curative role in adolescent depression, are required to establish the causal association.

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 attenuates biofilm-associated infections via immunomodulation and cathelicidin expression: a narrative review

INTRODUCTION

Infections are becoming more difficult to treat, at least partly on account of microbes that produce biofilms. Reports suggest that decreased levels of antimicrobial peptides like cathelicidin, elevated levels of inflammatory cytokines, and biofilm formation are all associated with vitamin D deficiency, making vitamin D - deficient individuals more susceptible to infection. Infections attributable to biofilm-producing microbes can be managed by adjuvant therapy with vitamin D because of its immunomodulatory role, particularly because of the ability of vitamin D-pathway to induce the antimicrobial peptides like cathelicidin and decrease proinflammatory cytokines.

AREAS COVERED

This narrative review covers biofilm formation, infections associated with biofilm due to vitamin D deficiency, putative role of vitamin D in host protection and the effect of vitamin D supplementation in biofilm-associated infections. A comprehensive literature search in PubMed and Google Scholar utilizing suitable keywords at multiple time points extracted relevant articles.

EXPERT OPINION

Although vitamin D deficiency has been associated with infections by biofilm producing microbes, comprehensive clinical trials in various ethnicities are required to understand the likely relationships between vitamin D receptor gene expression, cathelicidin levels, and infection outcome. Current evidence hypothesizes that maintaining normal vitamin D level can help prevent and treat these infections.

Dietary Supplements among Children Ages 0-3 Years in Poland-Are They Necessary?

(1) Background: One of the ways to prevent nutritional deficiencies may be supplementation. Experts have observed the increased use of dietary supplements, not only in adults but also in children. Considering controversies among dietary supplements and possible errors in children's feeding, the goal of our research was to evaluate use and reasons behind supplementation in terms of children's diet analysis. (2) Methods: Our research involved 507 legal guardians of the youngest children (up to 3 years of age) and was conducted via a questionnaire. (3) Results: 79% of all children received dietary supplements. The analysis of children's diets showed a need to implement omega-3 acids and vitamin D supplementation, which was very low in children. On the other hand, vitamin C, vitamin B, vitamin A, and copper levels were extremely high. (4) Conclusions: Popularity of dietary supplements in Polish children aged 0-3 years old is an omnipresent issue. Although the reasoning behind administering nutritional supplements to children seems justified, considering the supply of vitamin D and omega-3 fatty acids, it seems justified to increase parents' knowledge in this regard in terms of the use and means to choose the best supplement possible, as dietary supplementation should always be tailored to individual needs.

Vitamin D levels among children, adolescents, adults, and elders in Pakistani population: a cross-sectional study

Background

Vitamin D is not only an essential part of a healthy diet but it is also known as the sunshine hormone. It helps to absorb calcium and phosphate within the body and is essential for the development of teeth and bones in growing children. Deficiency in vitamin D causes weak bones, osteoporosis in older individuals, and osteomalacia in children. It also causes loss of alveolar bone around the teeth, increased dental cavities, and other problems associated with gum disease. It can cause depression, fatigue, and appetite loss. This study aims to observe vitamin D deficiency, insufficiency, and sufficiency among children, adults, adolescents, and elders in the Pakistani population.

Methods

A cross-sectional survey was conducted with 27,880 individuals referred from the general out-patient-department (OPD) to Dow Diagnostic Research and Reference Laboratory (DDRRL) units at Dow University of Health Sciences (DUHS) Karachi, Pakistan, for a period of three months from January to March 2017. They were examined for laboratory findings of serum 25 hydroxyvitamin D levels to determine vitamin D deficiency, insufficiency, and sufficiency among all age groups of both male and female genders.

Results

A total of 26,750 individuals with a mean age of 38 ± 18 years were statistically examined for laboratory findings of serum vitamin D levels. Vitamin D deficiency was observed in 56% of individuals with a mean log of 1.01 ± 0.18 ng/ml serum vitamin D levels, vitamin D insufficiency in 20% of individuals with a mean log of 1.38 ± 0.05 ng/ml serum vitamin D levels and vitamin D sufficiency in 24% individuals with a mean log of 1.63 ± 0.12 ng/ml serum vitamin D levels. The highest percentage of individuals deficient in vitamin D were children and adolescents of age ranging between 6 to 18 years.

Conclusion

The findings of vitamin D deficiency in children and adolescents direct higher authorities in the public health sector to take immediate steps to screen, intervene and educate high-risk populations incorporating vitamin D supplements to establish preventive and therapeutic measures.

Vitamin D and Zinc are Interlinked but Affected by Different Growth Factors in Iranian Children and Adolescents: Vitamin D and Zinc in Iranian Children and Adolescents

Background: Zinc and vitamin D are essential factors required for growth. Recently, studies have shown a possible link between serum zinc and vitamin D levels. Objectives: This study was designed to evaluate this link and its possible affecting growth factors in children and adolescents in Iran. Methods: This cross-sectional study was performed on the data obtained from children aged 2 to 18 years old referring to a growth assessment clinic for routine growth follow-ups in the city of Shiraz from April to August 2019. A total of 454 children who were checked for 25-hydroxyvitamin D and zinc simultaneously were included. Results: Vitamin D was negatively correlated with body mass index (BMI) z-scores, while zinc was positively correlated with vitamin D and height z-scores. Subjects with vitamin D levels ≤ 8.6 ng/mL were 2.081 times more likely to have a zinc deficiency. Vitamin D insufficiency was significantly higher in overweight and obese children. Mean vitamin D and zinc levels were significantly lower, and vitamin D insufficiency was significantly higher in boys than girls. While mean zinc levels were significantly lower in short children, the prevalence of zinc deficiency was not statistically different between short and normal height statures. Conclusions: Very low vitamin D levels are likely to be accompanied by zinc deficiency, possibly caused by malnutrition and the modulatory effect of serum vitamin D on zinc absorption. Unlike zinc deficiency, vitamin D insufficiency is much more prevalent in Iranian children than in children from other countries. Vitamin D and zinc are associated with BMI and height z-scores, respectively.

A comprehensive look into the association of vitamin D levels and vitamin D receptor gene polymorphism with obesity in children

Childhood obesity accounts for several psychosocial and clinical consequences. Psychosocial consequences include lower self-esteem, social isolation, poor academic achievement, peer problems, and depression, whereas clinical consequences are cardiovascular diseases, type 2 diabetes, dyslipidemia, cancer, autoimmune diseases, girls early polycystic ovarian syndrome (PCOS), asthma, bone deformities, etc. A growing number of studies have uncovered the association of childhood obesity and its consequences with vitamin-D (vit-D) deficiency and vitamin-D receptor (VDR) gene polymorphisms such as single nucleotide polymorphisms (SNPs), e.g., TaqI, BsmI, ApaI, FokI, and Cdx2. Considering the impact of vit-D deficiency and VDR gene polymorphisms, identifying associated factors and risk groups linked to lower serum vit-D levels and prevention of obesity-related syndromes in children is of utmost importance. Previously published review articles mainly focused on the association of vit-D deficiency with obesity or other non-communicable diseases in children. The nature of the correlation between vit-D deficiency and VDR gene polymorphisms with obesity in children is yet to be clarified. Therefore, this review attempts to delineate the association of obesity with these two factors by identifying the molecular mechanism of the relationship.

25(OH)Vitamin D Deficiency and Calcifediol Treatment in Pediatrics

Vitamin D is essential for the normal mineralization of bones during childhood. Although diet and adequate sun exposure should provide enough of this nutrient, there is a high prevalence of vitamin D deficiency rickets worldwide. Children with certain conditions that lead to decreased vitamin D production and/or absorption are at the greatest risk of nutritional rickets. In addition, several rare genetic alterations are also associated with severe forms of vitamin-D-resistant or -dependent rickets. Although vitamin D3 is the threshold nutrient for the vitamin D endocrine system (VDES), direct measurement of circulating vitamin D3 itself is not a good marker of the nutritional status of the system. Calcifediol (or 25(OH)D) serum levels are used to assess VDES status. While there is no clear consensus among the different scientific associations on calcifediol status, many clinical trials have demonstrated the benefit of ensuring normal 25(OH)D serum levels and calcium intake for the prevention or treatment of nutritional rickets in childhood. Therefore, during the first year of life, infants should receive vitamin D treatment with at least 400 IU/day. In addition, a diet should ensure a normal calcium intake. Healthy lifestyle habits to prevent vitamin D deficiency should be encouraged during childhood. In children who develop clinical signs of rickets, adequate treatment with vitamin D and calcium should be guaranteed. Children with additional risk factors for 25(OH)D deficiency and nutritional rickets should be assessed periodically and treated promptly to prevent further bone damage.

How Much Does Serum 25(OH)D Improve by Vitamin D Supplement and Fortified Food in Children? A Systematic Review and Meta-Analysis

OBJECTIVES

This study was conducted to respond certain important questions regarding the efficacy of vitamin D fortification and supplementation in children using a meta-analytical approach.

METHODS

MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar were searched, and 2341 studies were found in a preliminary search. After screening of titles and abstracts, 31 studies were selected.

RESULTS

Significant raises in circulating 25-hydroxy vitamin D (25(OH)D) concentrations were observed in both groups that took vitamin D supplement (mean difference [MD] 28.7, 95% confidence interval [CI] 22.5-34.9) and vitamin D-fortified foods (MD 20.29, 95% CI 13.3-27.2). The meta-regression revealed a significant association between age of participants (B -1.4, 95% CI -2.8, -0.02, P = 0.047) and dose of vitamin D (B 0.007, 95% CI 0.003, 0.01, P < 0.001), with the effect on serum 25(OH)D concentrations. The analysis showed that serum 25(OH)D concentration increases by 0.7 nmol/L for every 100 IU of vitamin D intake after adjustment for age, baseline serum 25(OH)D and latitude which is far less than the reported amount in adults.

CONCLUSIONS

Altogether, these findings indicate that in a mass vitamin D fortification program, circulating 25(OH)D concentration response in children may be lower in children than in adults and vitamin D supplementation may still be needed in this subpopulation.

Vitamin D deficiency in children with cerebral palsy: A narrative review of epidemiology, contributing factors, clinical consequences and interventions

Sufficient vitamin D levels are necessary, not only for mineralization, normal growth and development of bones, but also for the prevention of fatal chronic diseases like diabetes mellitus, metabolic syndrome and cancer. This is of particular importance in children with neuro- and musculoskeletal disorders, especially cerebral palsy (CP). CP is a heterogeneous group of childhood developmental disability disorders described by uncharacteristic posture, balance, and movement. Patients with CP are at an increased risk of vitamin D deficiency and as a result reduced bone mineral density, bone fragility, osteopenia, and rickets. The present review aims to combine and summarize available evidence, regarding the epidemiology, underlying contributing factors, clinical consequences, and treatment interventions of vitamin D deficiency in children with CP.

Vitamin D status in children with a psychiatric diagnosis, autism spectrum disorders, or internalizing disorders

BACKGROUND AND OBJECTIVE

Multiple studies suggest that children with Autism Spectrum Disorders (ASD) have significantly lower vitamin D3 levels than typically developing children. However, whether vitamin D3 deficiency is more common in children with ASD than in children with other psychiatric disorders remains unclear. This study was conducted to explore the prevalence of vitamin D3 in children with a psychiatric diagnosis including children with ASD or with internalizing disorders (mood and anxiety disorders). In addition, this study investigated the potential associations between vitamin D3 and Body Mass Index (BMI).

MATERIALS AND METHODS

Clinical data, including BMI and vitamin D3 levels, of 93 children (6-18 years; n = 47; 51% female) with ASD (n = 58) and internalizing disorders (n = 37) were retrospectively analyzed.

RESULTS

In the overall sample, the prevalence of vitamin D3 deficiency (<50 nmol/L) was 77.4%. Additionally, 75.9% of the children with ASD and 79.5% with internalizing disorders had vitamin D3 deficiency. BMI was inversely related to vitamin D3 in the total group (p = 0.016). The multiple regression model for the total group significantly predicted vitamin D3 (p = 0.022). Age contributed significantly to the prediction. Stratified for sex and primary diagnosis, multiple regression models showed that for boys with ASD, higher BMI levels were associated with lower vitamin D3 levels (p = 0.031); in boys with internalizing disorders and in girls, no relation was found between BMI and vitamin D3 levels.

CONCLUSION

In this this cross-sectional, explorative study high rates of vitamin D3 deficiency in children with different psychiatric disorders were found. The results showed an inverse relation between BMI and vitamin D3 levels in the total group. Vitamin D3 deficiency was particularly common in boys with ASD and obesity. Lifestyle factors may contribute to the association between high BMI and low vitamin D3 levels in boys with ASD. Vitamin D3 deficiency is common in patients with psychiatric disorders and it is highly recommended to increase clinicians' awareness of this common and remediable risk factor.

Serum Biomarkers of Environmental Enteric Dysfunction and Growth Perspective in Egyptian Children

BACKGROUND: Environmental enteric dysfunction (EED) is a chronic subclinical condition, contributed to limited sources and poor countries. EED pathology is concerned with small intestine structure and function, which affect the macronutrients and micronutrients absorption with consequent growth faltering. AIM: This study aimed to evaluate some serum biomarkers involved in EED and determine their association with stunting and faltering growth in children; zonulin, endotoxin core antibody (EndoCAb), high-sensitive C-reactive protein (hsCRP), alpha-1-acid glycoprotein (AGP), and tumor necrosis factor (TNF), serum iron, and Vitamins A and D. PATIENTS AND METHODS: This case–control study enrolled 105 children aged from 1 to 10 years old, having weight-for-age z-scores and height-for-age z-scores (WAZ or HAZ) ranging from −1.5 to −2. They were compared with control group consisted of 100 children having WAZ or HAZ > −1 of matched age and sex. Assessment of serum markers levels of enteric dysfunction (zonulin and EndoCAb), markers of systemic inflammation (Hs CRP and AGP), along with serum micronutrients (vitamin A, vitamin D and iron) in children with malnutrition in comparison to controls. RESULTS: There was a highly significant decrease as regarding the anthropometric measurements; weight, height, BMI, and arm circumference. Moreover, significant increase in serum zonulin, EndoCAb, HsCRP, and AGP and highly significant decrease of serum Vitamin D and iron in cases group as compared to control group. Height Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D. Weight Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D and Vitamin A. Regression analysis noted increase of zonulin and α1AGP as high associative markers with height Z score affection, however, increase of zonulin was high associative markers with weight Z score affection. CONCLUSION: Faltering growth is associated with elevated serum systemic markers of intestinal inflammation (HsCRP and α1AGP). EED may be a cause of faltering growth.

Vitamin D Status Is Associated with Modifiable Lifestyle Factors in Pre-Adolescent Children Living in Urban Kuala Lumpur, Malaysia

Studies on vitamin D status and its determinants in growing children in countries with ample sunshine such as Malaysia have been limited. The aim of our study was to determine factors associated with serum 25(OH)D concentrations such as lifestyle, dietary intake, anthropometry, and body composition in 243 pre-adolescent Malaysian children from low-income families living in Kuala Lumpur. This cross-sectional study measured bone density and body composition using dual-energy X-ray absorptiometry (DXA), while serum 25(OH)D was measured using LC-MS/MS. Time spent outdoors, body surface area exposed to sunlight, dietary intake, and physical activity level were assessed using questionnaires. Multiple linear regression and stepwise analysis were performed to identify significant predictors for serum 25(OH)D. About 69.4% had 25(OH)D < 50 nmol/L, and 18.9% were vitamin-D-deficient with 25(OH)D < 30 nmol/L. Girls had a nine-fold higher prevalence of vitamin D deficiency than boys. Body surface area exposed to sunlight, Sun Index, and fat mass were significant predictors of 25(OH)D concentrations in this population. Modifiable lifestyle factors such as sun exposure and reducing obesity are important public health guidance to ensure optimal vitamin D status in these children.

Vitamin D Status and Its Influence on the Health of Preschool Children in Hangzhou

Objective: Vitamin D deficiency and insufficiency in children are global public health problems. However, few studies have focused on vitamin D status in healthy preschool children, especially in Asia. This study aimed to investigate vitamin D status and host-related factors in healthy preschool children in Hangzhou to analyze the impact of low vitamin D levels (<30 ng/mL) on health outcomes (obesity, early childhood caries, and respiratory tract infections).

Methods: A total of 1,510 healthy children aged 24–72 months from 15 kindergartens in Hangzhou were included. Data on the children's gender, age, body mass index (BMI), caries, and blood samples available for vitamin D analysis were collected from June to August 2018. A total of 325 children aged 36–48 months took part in a survey on the frequency of respiratory tract infections in the last year.

Results: The children's mean 25(OH)D level was 28.01 ± 7.29 ng/mL. A total of 11.4% of the children had vitamin D deficiency, and 52.6% had vitamin D insufficiency. Only 36.0% had vitamin D sufficiency. No significant difference was found by gender or BMI group. However, children in the obesity group had the highest prevalence of vitamin D deficiency and the lowest 25(OH)D levels. A significant negative correlation was found between the 25(OH)D level and child age (r = −0.144, p < 0.001). Regression analysis showed that the children’s 25(OH)D levels decreased by 0.17 ng/mL per month with age. In addition, children with low vitamin D levels might increase the risk of obesity and early childhood caries. Multiple linear regression indicated that the number of caries in children increased by 0.08 per 1-ng/mL decrease in the 25(OH)D level (β = −0.08, p < 0.001).

Conclusion: Vitamin D deficiency/insufficiency is a serious problem among healthy preschool children in Hangzhou. Public health policies or interventions should be implemented to ensure that preschool children have adequate vitamin D to reduce the risk of related diseases.

Vitamin D sufficiency attenuates the effect of early social adversity on child antisocial behavior

BACKGROUND

Vitamin D insufficiency and child antisocial behavior are public health concerns. It is unknown whether vitamin D plays a role in antisocial outcomes. This study examines whether higher levels of vitamin D can act as a protective factor against antisocial behavior for children who are exposed to early social adversity.

METHODS

In a community sample of 300 children aged 11-12 years (151 females, 149 males), serum concentrations of 25-hydroxyvitamin D [25(OH)D] were assessed alongside early social adversity, and both parent and child-reported antisocial behavior.

RESULTS

Vitamin D moderated the association between early social adversity and multiple antisocial outcomes. Higher social adversity was associated with greater antisocial behavior among vitamin D-insufficient [25(OH)D < 30 ng/mL], but not vitamin D-sufficient children [25(OH)D ⩾ 30 ng/mL], after adjusting for other variables. Results from child reports of antisocial behavior were replicated with parent reports, providing support for the robustness of the findings. At serum 25(OH)D concentrations above 27.16-30.69 ng/mL (close to 30 ng/mL, the recommended optimal vitamin D level for pediatric populations), the effect of social adversity on antisocial behavior outcomes was nullified.

CONCLUSIONS

To our knowledge, this study is the first to document that a nutritional factor, vitamin D, can potentially confer resilience to antisocial behavior. Our findings in a pediatric population suggest a possible role of vitamin D supplementation in interventions to reduce antisocial behavior, which may be further investigated in future randomized controlled trials.

Serum Biomarkers of Environmental Enteric Dysfunction and Growth Perspective in Egyptian Children

BACKGROUND: Environmental enteric dysfunction (EED) is a chronic subclinical condition, contributed to limited sources and poor countries. EED pathology is concerned with small intestine structure and function, which affect the macronutrients and micronutrients absorption with consequent growth faltering. AIM: This study aimed to evaluate some serum biomarkers involved in EED and determine their association with stunting and faltering growth in children; zonulin, endotoxin core antibody (EndoCAb), high-sensitive C-reactive protein (hsCRP), alpha-1-acid glycoprotein (AGP), and tumor necrosis factor (TNF), serum iron, and Vitamins A and D. PATIENTS AND METHODS: This case–control study enrolled 105 children aged from 1 to 10 years old, having weight-for-age z-scores and height-for-age z-scores (WAZ or HAZ) ranging from −1.5 to −2. They were compared with control group consisted of 100 children having WAZ or HAZ > −1 of matched age and sex. Assessment of serum markers levels of enteric dysfunction (zonulin and EndoCAb), markers of systemic inflammation (Hs CRP and AGP), along with serum micronutrients (vitamin A, vitamin D and iron) in children with malnutrition in comparison to controls. RESULTS: There was a highly significant decrease as regarding the anthropometric measurements; weight, height, BMI, and arm circumference. Moreover, significant increase in serum zonulin, EndoCAb, HsCRP, and AGP and highly significant decrease of serum Vitamin D and iron in cases group as compared to control group. Height Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D. Weight Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D and Vitamin A. Regression analysis noted increase of zonulin and α1AGP as high associative markers with height Z score affection, however, increase of zonulin was high associative markers with weight Z score affection. CONCLUSION: Faltering growth is associated with elevated serum systemic markers of intestinal inflammation (HsCRP and α1AGP). EED may be a cause of faltering growth.