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Abuhamad AY, Almasri N, Al Karaghouli Y, Kadam R, Alhashmi M, Alzaabi E, Deeb A, Fischer PR. Vitamin D deficiency and associated demographic risk factors in children at a tertiary hospital in Abu Dhabi. Paediatr Int Child Health 2024:1-6. [PMID: 39246017 DOI: 10.1080/20469047.2024.2396714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 08/15/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Despite ample sunshine, vitamin D deficiency continues to be prevalent in the Middle East. This pilot study aimed to identify the rate of vitamin D deficiency at a tertiary hospital in Abu Dhabi and to identify the associated risk factors in children and adolescents. METHODOLOGY A retrospective observational study was conducted using electronic medical records of paediatric patients who underwent 25-hydroxyvitamin D testing at Sheikh Shakhbout Medical City, Abu Dhabi between 1 January 2020 and 31 December 2021. Data on age, gender, ethnicity, weight, body mass index and other potential risk factors for vitamin D deficiency in children were recorded. Patients who were already receiving treatment for vitamin D deficiency were excluded. The collected data were analysed using standard statistical methods. RESULTS Of 26,818 patients under 18 years of age who attended the outpatient clinic, 1519 underwent 25-hydroxyvitamin D testing; 51% were male (n = 755). After applying the exclusion criteria, 1311 participants were included, 755 (58%) of whom had vitamin D concentrations of ≤50 nmol/L. Vitamin D deficiency was more common in children aged ≥10 years (69%) than in those <10 years of age (53%) (p < 0.0001). The highest prevalence of vitamin D deficiency was in those older than 16 years (86%). More females (63%, n = 407) than males (52%, n = 348) were identified as vitamin D-deficient (p = 0.0001). Vitamin D deficiency was more commonly identified during summer and autumn (59%) than in winter and spring (44%, p < 0.00001). CONCLUSION Vitamin D deficiency is prevalent in children seeking medical care in the UAE, especially in girls, older children and adolescents, and during the summer and autumn. Paediatricians should have a low screening threshold for hypovitaminosis D, or widespread supplementation should be considered.
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Affiliation(s)
- Ahmed Y Abuhamad
- Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Neamat Almasri
- Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | | | - Rochita Kadam
- Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | | | - Eiman Alzaabi
- Department of Pathology and Laboratory Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Asma Deeb
- Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- Pediatrics Department, Khalifa University, Abu Dhabi, UAE
| | - Philip R Fischer
- Pediatrics Department, Khalifa University, Abu Dhabi, UAE
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Eslami O, Cuskelly GJ, O'Connor Á. Adherence to vitamin D supplementation guidelines in children under five years of age: a systematic literature review. Eur J Nutr 2024; 63:79-92. [PMID: 37792100 DOI: 10.1007/s00394-023-03255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Despite the presence of guidelines on vitamin D supplementation in infants and young children, little is known about parental adherence to their recommendations. This review aims to summarise the evidence from observational studies investigating adherence to vitamin D supplementation guidelines in children under five years of age. METHODS Databases of PubMed, Scopus, Web of Science, and CINAHL were searched from January 2000 until July 2022. Qualitative data synthesis was used to summarise evidence on supplementation adherence. The adherence rate was categorised as low, moderate, and high if it was ≤ 50%, between 50 and 70%, and ≥ 70%, respectively. RESULTS Eleven studies investigating adherence to eight different vitamin D supplementation guidelines from European countries, USA and Canada were included. The majority of studies were cross-sectional and conducted among infants. Overall, the adherence rate ranged between 14.29% and 95.6%. Low, moderate, and high adherence to supplementation guidelines were reported in six, three, and two studies, respectively. CONCLUSION There is generally poor adherence to vitamin D supplementation guidelines in children under five years of age. Nevertheless, the evidence comes from a limited number of studies, mainly conducted in infants, with high methodological heterogeneity in terms of the vitamin D supplementation guideline assessed and the definition of supplementation adherence in the study population. Further research is warranted to identify effective health promotion interventions to increase supplementation adherence and reduce the risk of vitamin D deficiency at this critical life stage.
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Affiliation(s)
- Omid Eslami
- SHE Research Group, Department of Sport and Health Sciences, Technological University of the Shannon, Athlone, Ireland
| | - Geraldine J Cuskelly
- SHE Research Group, Department of Sport and Health Sciences, Technological University of the Shannon, Athlone, Ireland
| | - Áine O'Connor
- SHE Research Group, Department of Sport and Health Sciences, Technological University of the Shannon, Athlone, Ireland.
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Diaz-Thomas A, Iyer P. Global Health Disparities in Childhood Rickets. Endocrinol Metab Clin North Am 2023; 52:643-657. [PMID: 37865479 DOI: 10.1016/j.ecl.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Nutritional rickets is a global health problem reflecting both historical and contemporary health disparities arising from racial, ethnic, environmental, and geopolitical circumstances. It primarily affects marginalized populations and can contribute to long-term morbidity. Deficits in bone health in childhood may also contribute to osteomalacia/osteoporosis. Solutions require a global public health approach.
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Affiliation(s)
- Alicia Diaz-Thomas
- Department of Pediatrics, Division of Pediatric Endocrinology, The University of Tennessee Health Science Center, 910 Madison Avenue, Suite 1010, Memphis, TN 38163, USA.
| | - Pallavi Iyer
- Department of Pediatrics, Division of Endocrinology and Diabetes, Medical College of Wisconsin, Children's Corporate Center, Suite 520, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Vucak J, Matijevic J, Pivac I, Markic J. Adherence to Vitamin D Supplementation during Infancy-A Single Pediatric Primary Practice Retrospective Study. Pediatr Rep 2023; 15:660-667. [PMID: 37987284 PMCID: PMC10661251 DOI: 10.3390/pediatric15040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/15/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
The risk of vitamin D deficiency is high in infants. Therefore, potential vitamin D deficiency should be prophylactically treated with vitamin D supplementation. Achieving good adherence to recommended prophylactic regimens is the goal of every primary pediatrician. The aim of this paper was to establish whether Croatian infants receive recommended prophylactic doses of vitamin D regularly. We analyzed the prescription rate of vitamin D preparation during the first year of life in one pediatric primary practice. Our research has shown, for the first time in Croatia, that there is low treatment adherence. Only 7.6% of infants received the recommended doses of vitamin D. The percentage of infants in the moderately irregular adherence group was 19.3%. There was no statistical difference regarding urban or rural place of living or parents' educational level. Based on these findings, a comprehensive public health campaign is needed to improve adherence to vitamin D supplementation during infancy. Also, further studies on larger samples and on a national level are warranted.
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Affiliation(s)
- Jerko Vucak
- Primary Health Care Pediatric Practice, Sibenik 22000, Croatia;
| | - Jeronim Matijevic
- Department of Pediatrics, University Hospital of Split, Split 21000, Croatia;
| | - Ivan Pivac
- School of Medicine, University of Split, Split 21000, Croatia;
| | - Josko Markic
- Department of Pediatrics, University Hospital of Split, Split 21000, Croatia;
- School of Medicine, University of Split, Split 21000, Croatia;
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Abok II, Imoh LC, Bode-Thomas F, Oguche S, Zoakah A, Sagay A. Relationship between maternal and infant serum vitamin D levels in Jos, Plateau State, Nigeria: a cross-sectional study. Pan Afr Med J 2023; 46:48. [PMID: 38188884 PMCID: PMC10768551 DOI: 10.11604/pamj.2023.46.48.37578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/16/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction there is growing interest in the link between maternal and infant vitamin D (VD) levels. Breast milk transmission and the fact that the mother and her child may share risk factors for VD, such as exposure to sunlight, diet, and sociocultural influences may impact VD status, the magnitude of which is largely unknown in our topical low-middle income setting. We assessed the connection between maternal and infant VD status including their correlates. Methods this cross-sectional study investigated 95 maternal-infant pairs in Jos. Mothers were interviewed using a questionnaire. Blood sampling and analysis of serum total 25 hydroxy VD were performed using the chemiluminescent immunoassay method. Maternal and infant VD levels were classified as VD deficient (VDD), VD insufficient (VDI), and VD sufficient (VDS). The mean maternal and infant VD were compared, and the Spearman correlation between them was assessed, a stepwise linear regression was also performed with infant vitamin D as a dependent variable. For all statistical analysis, p<0.05 was considered significant. Results the median maternal and infant VD was 29.68 ng/ml and 29.41 ng/ml, respectively. The mean infant VD (32.19 ± 10.61 ng/ml) was comparable to maternal VD (31.12 ± 12.94 ng/ml) (p=0.483), with a Spearman correlation coefficient of 0.3 (p=0.037). Maternal vitamin D (beta=0.539, duration of exclusive breastfeeding (beta=-3.490), and infant age (beta=1.655) were found to be significant independent predictors of infant vitamin. Conclusion beyond neonatal age, a significant positive relationship between maternal and infants´ VD levels exists and suggests that family-focused vitamin D intervention might be an effective public health approach in the tropical city of Jos.
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Affiliation(s)
- Ishaya Ibrahim Abok
- Department of Paediatrics, College of Health Sciences, University of Jos, Jos, Nigeria
| | | | - Fidelia Bode-Thomas
- Department of Paediatrics, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Stephen Oguche
- Department of Paediatrics, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Ayuba Zoakah
- Department of Community Medicine, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Atiene Sagay
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Jos, Jos, Nigeria
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Aghapour B, Kheirouri S, Alizadeh M, Khodayari-Zarnaq R. Vitamin D deficiency prevention policies in Iran: a retrospective policy analysis. Front Nutr 2023; 10:1249402. [PMID: 37680901 PMCID: PMC10482268 DOI: 10.3389/fnut.2023.1249402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Aim Iran has a higher prevalence of vitamin D deficiency (VDD) than the global level. This study aimed to assess VDD prevention policies in Iran through a policy analysis of agenda setting using the multiple streams framework (MSF). Methods Using Kingdon's MSF model, this qualitative analytical study performed a policy analysis on vitamin D-related policies in Iran. The policy documents were reviewed, and in-depth interviews were conducted with stakeholders (n = 27) using the framework analysis method. To categorize data and extract the related themes, MAXQDA version 10 was used. Results According to Kingdon's MSF theory, the problem stream included the high prevalence of VDD among Iranian infants (23.3%), adolescents (76%), and adults (59.1%). The policy stream was identified to focus on preventing programs for non-communicable diseases in the health sector. The political stream indicated that national and international support could provide a political climate for this issue. Conclusion According to our results, a window of opportunity for policymaking on VDD prevention has opened. However, there are some challenges related to the implementation of these policies. These include the dominance of a treatment-based view rather than a prevention-based approach in the health sector, economic problems, and restricted access to health services due to the outbreak of coronavirus disease 2019 (COVID-19). To strengthen and implement VDD prevention policies, the stakeholders need support from high-level policymakers.
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Affiliation(s)
- Baharak Aghapour
- Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sorayya Kheirouri
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Al-Daghri NM, Sabico S, Wani K, Hussain SD, Yakout S, Aljohani N, Uday S, Högler W. Association of bone mineralization markers with dietary nutrient intake in adolescents with and without biochemical osteomalacia. Front Nutr 2023; 10:1206711. [PMID: 37528993 PMCID: PMC10388186 DOI: 10.3389/fnut.2023.1206711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
Background Dietary intake is widely known to play a crucial role in achieving peak bone mass among children and adolescents. Unfortunately, this information is lacking among Arab adolescents, an understudied demographic that has recently been observed to have a high prevalence of abnormal mineralization markers [low serum 25(OH)D, high serum alkaline phosphatase (ALP), low calcium (Ca) and/or inorganic phosphate (Pi)] suggestive of biochemical osteomalacia (OM, defined as any 2 of the 4 parameters). In order to fill this gap, we aimed to evaluate the associations of serum markers of biochemical OM with dietary intake of macronutrients, vitamins and trace minerals. Methods Saudi adolescents (N = 2,938, 57.8% girls), aged 12-17 years from 60 different schools in Riyadh, Saudi Arabia were included. Dietary intake of nutrients was calculated following a semi-quantitative 24 h dietary recall over 3 weekdays and 1 weekend-day using a validated food frequency questionnaire. Compliance to reference daily intake (RDI) of macronutrients, vitamins and trace minerals were calculated. Fasting blood samples were collected and circulating levels of 25(OH)D, ALP, Ca, and Pi were analyzed. Results A total of 1819 (1,083 girls and 736 boys) adolescents provided the dietary recall data. Biochemical OM was identified in 175 (9.6%) participants (13.5% in girls, 3.9% in boys, p < 0.01) while the rest served as controls (N = 1,644). All participants had serum 25(OH)D levels <50 nmoL/L. Most participants had very low dietary intakes of Ca (median ~ 290 mg) and vitamin D (median ~ 4 μg) which are far below the RDI of 1,300 mg/day and 20 μg/day, respectively. In contrast, excess dietary intakes of Pi, Na, K, and Fe were observed in all participants. In the biochemical OM group, thiamine and protein intake were significant predictors of serum 25(OH)D, explaining 4.3% of the variance perceived (r = 0.23, adjusted r2 = 4.3%, p = 0.01). Among controls, dietary vitamin C and vitamin D explained 0.6% of the total variation in serum 25(OH)D (r = 0.09, adjusted r2 = 0.6%, p = 0.004). Conclusion Arab adolescents do not meet the RDI for dietary Ca and vitamin D, and none have sufficient vitamin D status (25(OH)D levels >50 nmol/L) but they exceed the RDI for dietary Pi. Interpreting these data in the light of the increased prevalence of rickets in Arab countries, food fortification to optimise vitamin D and Ca intake in Saudi adolescents should be considered.
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Affiliation(s)
- Nasser M. Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Kaiser Wani
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Syed Danish Hussain
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Sobhy Yakout
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Naji Aljohani
- Obesity Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, AL, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, AL, United Kingdom
| | - Wolfgang Högler
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, AL, United Kingdom
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
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Pieridou C, Uday S. Nutritional rickets presenting with developmental regression: a rare presentation of rickets. BMC Pediatr 2023; 23:330. [PMID: 37386483 PMCID: PMC10308663 DOI: 10.1186/s12887-023-04127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/11/2023] [Indexed: 07/01/2023] Open
Abstract
Rickets is a disorder of defective mineralisation of the growth plate. Vitamin D deficiency remains the leading cause of nutritional rickets worldwide.We present the case of a 3.5-year-old breastfed boy who presented with dental abscess when a history of developmental regression was noted. Clinical assessment revealed hypotonia, poor growth and stunting. Biochemistry identified hypocalcaemia (1.63mmol/L, [normal range (NR) 2.2-2.7mmol/L]), severe vitamin D deficiency (25hydroxyvitamin D 5.3nmol/L, [NR > 50nmol/L]) with secondary hyperparathyroidism (Parathormone 159pmol/L, [NR 1.6-7.5pmol/L]) and rickets on radiographs. Growth failure screening suggested hypopituitarism with central hypothyroidism and low IGF1 at baseline, however, dynamic tests confirmed normal axis. Management included nasogastric nutritional rehabilitation, cholecalciferol and calcium supplementation and physiotherapy. A good biochemical response in all parameters was observed within 3 weeks and reversal of developmental regression by 3 months from treatment. Developmental regression as a presentation of nutritional rickets is rare and requires a high index of suspicion.
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Affiliation(s)
- Chariklia Pieridou
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, UK.
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK.
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Comparison of cord blood and 6-month-old vitamin D levels of healthy term infants supplemented with 400 IU/day dose of vitamin D. Eur J Clin Nutr 2023; 77:182-188. [PMID: 36241726 DOI: 10.1038/s41430-022-01220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine the prevalence and risk factors of vitamin D deficiency in pregnant women and their infants at birth (cord blood) and at six months of age in Turkey, as well as to assess the compliance rates of families with vitamin D supplementation. METHODS Serum 25-hydroxyvitamin D [25(OH)D] level was measured of the mothers before delivery and of the infants both at birth (cord blood) and at six months of age. Infants who received and did not take regular vitamin D supplements were compared in terms of 25(OH) levels. Independent risk factors were determined by multiple logistic regression analysis. RESULTS The study included a total of 140 pregnant women and their infants. Vitamin D deficiency was found in 95.7% of the mothers. The prevalence of vitamin D deficiency was 87.1% in infants at birth but decreased to 5.8% at sixth month. 65.7% of infants received vitamin D supplements regularly. Despite regular vitamin D use, it was determined that 2.2% of the infants in the supplementation compliant group had vitamin D deficiency. Maternal age, maternal education level, and the number of siblings were determined to be determining factors on infants' 25(OH)D levels at six months (p < 0.05). CONCLUSIONS In Turkey, vitamin D deficiency still exists in both pregnant women and infants. Healthcare professionals and the public need to be more educated about the importance of regular supplementation. Serum 25(OH)D levels of infants should be tested periodically and personalized vitamin D supplementation planning is required based on test results.
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AlBlooshi S, Al Anouti F, Hijazi R. Knowledge about Vitamin D among Women in the United Arab Emirates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1252. [PMID: 36674002 PMCID: PMC9859501 DOI: 10.3390/ijerph20021252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Vitamin D deficiency is a significant public health issue as it affects almost 90% of the United Arab Emirates (UAE) population. A bigger portion of this percentage is women due to the physiological changes throughout their life cycle. This study aims to assess the knowledge about vitamin D among women in the UAE. This is a quantitative cross-sectional study. Using snowball sampling, an electronic questionnaire was sent to women aged 18 years and above. Overall, 1537 women completed the questionnaire. The participants had mean scores of 49.4 ± 10.7 and 59.6 ± 14.6 for general and nutritional knowledge, respectively. Factors associated with higher scores included older age, marriage, higher educational level, and having tested their vitamin D levels. Factors associated with lower scores included the history of a chronic illness and being employed. Findings indicate that women in this study showed a low level of vitamin D knowledge specifically regarding the non-skeletal benefits of vitamin D and factors that affect vitamin D synthesis. Therefore, health education and promotion programs must be implemented across the UAE to improve overall awareness about vitamin D.
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Affiliation(s)
- Sharifa AlBlooshi
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Dubai P.O. Box 19282, United Arab Emirates
| | - Fatme Al Anouti
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Rafiq Hijazi
- Department of Mathematics and Statistics, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
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Establishing the Prevalence of Osteomalacia in Arab Adolescents Using Biochemical Markers of Bone Health. Nutrients 2022; 14:nu14245354. [PMID: 36558513 PMCID: PMC9784134 DOI: 10.3390/nu14245354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Nutrition-acquired osteomalacia is a bone mineralization disorder associated with dietary calcium and/or solar vitamin D deficiency, risk factors considered common in the Middle Eastern region. Establishing less invasive, cheap, and widely available diagnostic markers for this underdiagnosed entity is essential, in particular for screening in high-risk groups. This study assessed the prevalence of biochemical osteomalacia in Arab adolescents. In this cross-sectional study performed between September 2019 and March 2021, adolescents aged 12−17 years from 60 different secondary and preparatory year schools in Riyadh, Saudi Arabia were included. Anthropometrics and fasting blood samples were collected. Biochemical osteomalacia was defined as any two of the following four serum markers of hypomineralization, namely low 25 hydroxyvitamin D (25OHD < 30 nmol/L), high alkaline phosphatase (ALP), low calcium (Ca), and/or inorganic phosphorous (Pi). A total of 2938 Arab adolescents [1697 girls; mean age (years) 14.8 ± 1.8; 1241 boys; mean age 15.1 ± 1.6] were recruited. Vitamin D deficiency was noted in 56.2% (n = 953) of girls and 27.1% (n = 336) of boys (p < 0.001). The overall prevalence of biochemical osteomalacia was 10.0% (n = 295/2938) and was higher in girls than boys (14.7% vs. 3.6%, p < 0.001). The prevalence of low serum Ca and/or Pi was also higher in girls than in boys (24.2% vs. 12.5%, respectively, p < 0.001), as well as elevated ALP (5.1% vs. 1.5%, p < 0.001). Overall, girls were 4.6 times (95% CI 3.3−6.4) more likely to have biochemical osteomalacia than boys. Screening of apparently healthy Arab adolescents revealed a high prevalence of deranged mineralization markers suggestive of biochemical osteomalacia, which was significantly more common in girls than boys and was likely associated with Arab traditional clothing and diet. The proposed combination of typically altered mineralization markers for the diagnosis of osteomalacia is, at best, suggestive until further comparisons with established diagnostic tools (histological analysis of bone biopsies) are conducted.
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To Supplement or Not to Supplement With the Sunshine Vitamin in Sunny Countries? Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gallo S, Gahche J, Kitsantas P, Makwana P, Wang Y, Chen X, Rajbhandari-Thapa J. Vitamin D Intake and Meeting Recommendations Among Infants Participating in WIC Nationally. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:499-509. [PMID: 35288058 PMCID: PMC9149040 DOI: 10.1016/j.jneb.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To report and examine associations with infant vitamin D intake and meeting recommendations among a national sample participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN Secondary analysis from the 2013-2015 WIC Infant Toddler Feeding Practices Study-2. PARTICIPANTS US Infants. VARIABLES MEASURED Total reported vitamin D intake from diet and supplementation at the time of data collection. ANALYSIS Descriptive statistics and generalized estimating equations. RESULTS The median total vitamin D intake ranged from 5.43 (95% confidence interval, 5.40-5.46) mcg/d at month 1 to 8.18 (95% confidence interval, 8.11-8.20) mcg/d at month 13, with 16% to 36% of infants meeting the infant vitamin D recommendation over that time. Overall, 6% to 12% of all participants reported supplementation across all time points. Although most (between 78% to 98%) of supplemented breastfed infants met the recommendation, very few were supplemented as a group. Hence, breastfed infants were less likely to meet the recommendation than those who were formula fed across at time points except month 1 (P < 0.001 for all). Whereas infant age, feeding type, and/or their interaction were significant predictors of both receiving supplementation and meeting the recommendation, mother/caregiver nativity (P = 0.006) and parity (P = 0.01 and P < 0.001) predicted receiving supplementation, and child sex (P < 0.001) and mother/caregiver race/ethnicity (P < 0.001) predicted meeting the recommendation. CONCLUSIONS AND IMPLICATIONS Among a national sample of infants participating in WIC between 2013-2015, a high proportion were not meeting the current vitamin D recommendation. The WIC program is 1 resource for promoting strategies for increasing the number of American infants meeting D recommendations, but a coordinated approach involving other health care providers is likely needed. Future research exploring the reason for lack of supplementation, from both the perspective of parents and providers and the clinical impact of low vitamin D intake, is warranted.
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Affiliation(s)
- Sina Gallo
- Department of Nutritional Sciences, University of Georgia, Athens, GA.
| | - Jaime Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
| | - Priyal Makwana
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
| | - Yu Wang
- Department of Statistics, University of Georgia, Athens, GA
| | - Xianyan Chen
- Department of Statistics, University of Georgia, Athens, GA
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Buttriss JL, Lanham-New SA, Steenson S, Levy L, Swan GE, Darling AL, Cashman KD, Allen RE, Durrant LR, Smith CP, Magee P, Hill TR, Uday S, Kiely M, Delamare G, Hoyland AE, Larsen L, Street LN, Mathers JC, Prentice A. Implementation strategies for improving vitamin D status and increasing vitamin D intake in the UK: current controversies and future perspectives: proceedings of the 2nd Rank Prize Funds Forum on vitamin D. Br J Nutr 2022; 127:1567-1587. [PMID: 34284830 PMCID: PMC8376911 DOI: 10.1017/s0007114521002555] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/22/2021] [Accepted: 06/08/2021] [Indexed: 12/28/2022]
Abstract
A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose-response and dietary modelling studies indicate dairy products, bread, hens' eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for 'real-world' cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D's importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.
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Affiliation(s)
- Judy L. Buttriss
- British Nutrition Foundation, London, UK
- Department of Nutrition, Food and Exercise Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Susan A. Lanham-New
- Department of Nutrition, Food and Exercise Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | | | | | | | - Andrea L. Darling
- Department of Nutrition, Food and Exercise Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Kevin D. Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
| | | | - Louise R. Durrant
- Department of Nutrition, Food and Exercise Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
- Yakult, London, UK
| | - Collin P. Smith
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Pamela Magee
- Nutrition Innovation Centre for Food & Health, Ulster University at Coleraine, Coleraine, UK
| | - Tom R. Hill
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Suma Uday
- University of Birmingham, Birmingham, UK
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
| | | | | | | | | | - John C. Mathers
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ann Prentice
- MRC Nutrition and Bone Health Group, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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15
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Arshad H, Khan FU, Ahmed N, Anwer N, Gillani AH, Rehman A. Adjunctive vitamin D therapy in various diseases in children: a scenario according to standard guideline. BMC Pediatr 2022; 22:257. [PMID: 35525920 PMCID: PMC9077968 DOI: 10.1186/s12887-022-03297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adherence to standard guidelines is imperative when question comes to disease management. The present study aimed to evaluate the administration of adjunctive vitamin D therapy in various diseases, its adherence to standard guideline and the effect of socioeconomic status on the consumption of vitamin D in children. METHODS Cross sectional observational study was conducted among 400 ambulatory pediatric patients at Children's Hospital, Pakistan Institute of Medical Sciences Islamabad, from November 2017 to June 2018. Data were collected by a self-designed structured questionnaire from the patient's medical chart. Adjunctive vitamin D therapy adherence was evaluated by the U. S endocrinology clinical practice guideline of vitamin D deficiency. The association between socioeconomic status and consumption of vitamin D was examined by chi-square. Alpha value (p ≤ 0.005) was considered statistically significant. Statistical analysis was done by SPSS version 25. RESULTS In 400 patients, 9 diseases and 21 comorbid conditions were identified, in which adjunctive vitamin D therapy was prescribed. Adherence to vitamin D testing in high-risk vitamin D deficiency diseases as; seizures (3.8%), bone deformities (13.3%), steroid-resistant nephrotic syndrome (0.0%), cerebral palsy (5.9%) and meningitis (14.3%). Adherence to prescribed vitamin D dose was in (41.3%) patients in various diseases. Significant association (p < 0.05) was found between socioeconomic status and consumption of vitamin D in children and mothers. CONCLUSIONS It was found that adjunctive vitamin D was being prescribed in various diseases and comorbidities. Overall poor adherence to the standard guideline was observed in disease management in children. Low socioeconomic status affects vitamin D supplementation consumption in children.
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Affiliation(s)
- Hafsa Arshad
- Department of Pharmacy Quaid-i-Azam University, Islamabad, 45320 Pakistan
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Naveed Ahmed
- Department of Pharmacy Quaid-i-Azam University, Islamabad, 45320 Pakistan
| | - Naveed Anwer
- Department of Pharmacy Quaid-i-Azam University, Islamabad, 45320 Pakistan
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061 China
| | - Asim.ur. Rehman
- Department of Pharmacy Quaid-i-Azam University, Islamabad, 45320 Pakistan
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16
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Hurmuzlu Kozler S, Saylı TR. Factors influencing initiation and discontinuation of vitamin D supplementation among children 1-24-months-old. Curr Med Res Opin 2022; 38:435-441. [PMID: 34817302 DOI: 10.1080/03007995.2021.2010460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine vitamin D supplementation frequency among children aged 1-24 months, factors that influence adherence, and reasons for discontinuation of initiated vitamin D. METHODS This cross-sectional study was conducted using a questionnaire administered to the mothers via face-to-face interview of 560 children aged from 1 to 24 months admitted to outpatient clinics from June to December 2017. RESULTS A total of 351 children were administered vitamin D, and the rate of supplementation in the first year of life was 83%, while it was only 28% between 13 and 24 months. The rate of vitamin D supplementation was higher among exclusively formula-fed children (p < .05). When the data were analyzed using logistic regression analysis, only visit family physicians were statistically significant independent variable in increasing supplementation (p < .05). Compared with family refusal, the rate of discontinuation of vitamin D by the healthcare providers was higher after the first year of life (p < .05). The rate of vitamin D discontinuation by healthcare providers, especially by nurses who considered the duration of supplementation adequate, was statistically significantly higher when compared with the fontanel closure and other independent variables (p < .05). CONCLUSION The rate of vitamin D supplementation was higher among families who visited family physicians, which suggests the importance of well-baby visits. Since vitamin D supplementation was less common among exclusively breastfed children, mothers should be educated. Healthcare professionals need further education about the importance of vitamin D supplementation and indications for discontinuation.
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Affiliation(s)
| | - Tulin R Saylı
- Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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17
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Kurnaz E, Çetinkaya S, Elmaoğulları S, Araslı Yılmaz A, Muratoğlu Şahin N, Keskin M, Savaş Erdeve Ş. A major health problem facing immigrant children: nutritional rickets. J Pediatr Endocrinol Metab 2022; 35:223-229. [PMID: 34610231 DOI: 10.1515/jpem-2021-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nutritional rickets (NR) is still an important problem and one which increasing influxes of immigrants are further exacerbating. This study evaluated cases of mostly immigrant children followed up with diagnoses of NR in our pediatric endocrinology clinic. METHODS Details of 20 cases diagnosed with NR between 2017 and 2020 were retrieved from file records. RESULTS Twenty (11 male) cases were included in the study. Three (15%) were Turkish nationals and the others (85%) were immigrants. Hypocalcemia and hypophosphatemia were detected in 17 and 13, respectively. Alkaline phosphatase (ALP) values were normal in two cases, while ALP and parathyroid hormone (PTH) values were elevated in all other cases, and PTH levels were very high (473.64 ± 197.05 pg/mL). 25-hydroxyvitamin D levels were below 20 ng/mL in all cases. Patients with NR received high-dose long-term vitamin D or stoss therapy. Six patients failed to attend long-term follow-up, while PTH and ALP levels and clinical findings improved at long-term follow-up in the other 14 cases. CONCLUSIONS The elevated PTH levels suggest only the most severe cases of NR presented to our clinic. Clinically evident NR is therefore only the tip of the iceberg, and the true burden of subclinical rickets and osteomalacia remains unidentified. Public health policies should therefore focus on universal vitamin D supplementation and adequate dietary calcium provision, their integration into child surveillance programs, adequate advice and support to ensure normal nutrition, exposure to sunlight, and informing families of the increased risk not only for resident populations but also for refugee and immigrant children.
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Affiliation(s)
- Erdal Kurnaz
- Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Semra Çetinkaya
- Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Selin Elmaoğulları
- Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Aslıhan Araslı Yılmaz
- Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Nursel Muratoğlu Şahin
- Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Melikşah Keskin
- Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Şenay Savaş Erdeve
- Clinic of Pediatric Endocrinology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
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Glatt DU, McSorley E, Pourshahidi LK, Revuelta Iniesta R, McCluskey J, Beggan L, Slevin M, Gleeson N, Cobice DF, Dobbin S, Magee PJ. Vitamin D Status and Health Outcomes in School Children in Northern Ireland: Year One Results from the D-VinCHI Study. Nutrients 2022; 14:nu14040804. [PMID: 35215452 PMCID: PMC8875093 DOI: 10.3390/nu14040804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Vitamin D status has never been investigated in children in Northern Ireland (UK). (2) Methods: Children (4-11 years) (n = 47) were recruited from November 2019 to March 2020 onto the cross-sectional study. Anthropometry was assessed. Plasma 25-hydroxyvitamin D (25(OH)D) was analysed. Vitamin D intake, parental knowledge and perceptions, participant habits, physical activity and sedentary behaviour were established via questionnaire. Muscle strength was assessed via isometric grip strength dynamometry and balance via dominant single-leg and tandem stance. Parathyroid hormone, bone turnover markers (OC, CTX and P1NP), glycated haemoglobin and inflammatory markers (CRP, IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8 and TNF-α) were analysed. (3) Results: Mean (SD) 25(OH)D was 49.17 (17.04) nmol/L (n = 47); 44.7% of the children were vitamin D sufficient (25(OH)D >50 nmol/L), 48.9% were insufficient (25-50 nmol/L) and 6.4% were deficient (<25 nmol/L). 25(OH)D was positively correlated with vitamin D intake (µg/day) (p = 0.012, r = 0.374), spring/summer outdoor hours (p = 0.006, r = 0.402) and dominant grip strength (kg) (p = 0.044, r = 0.317). Vitamin D sufficient participants had higher dietary vitamin D intake (µg/day) (p = 0.021), supplement intake (µg/day) (p = 0.028) and spring/summer outdoor hours (p = 0.015). (4) Conclusion: Over half of the children were vitamin D deficient or insufficient. Wintertime supplementation, the consumption of vitamin D rich foods and spring/summer outdoor activities should be encouraged to minimise the risk of vitamin D inadequacy.
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Affiliation(s)
- Dominique Ulrike Glatt
- Department of Dietetics and Nutrition, Queen Margaret University, Edinburgh EH21 6UU, UK; (J.M.); (N.G.)
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
- Correspondence: (D.U.G.); (R.R.I.); (P.J.M.)
| | - Emeir McSorley
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
| | - L. Kirsty Pourshahidi
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
| | - Raquel Revuelta Iniesta
- Department of Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK
- Correspondence: (D.U.G.); (R.R.I.); (P.J.M.)
| | - Jane McCluskey
- Department of Dietetics and Nutrition, Queen Margaret University, Edinburgh EH21 6UU, UK; (J.M.); (N.G.)
| | - Laura Beggan
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), Ulster University, Coleraine BT52 1SA, UK; (D.F.C.); (S.D.)
| | - Mary Slevin
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
| | - Nigel Gleeson
- Department of Dietetics and Nutrition, Queen Margaret University, Edinburgh EH21 6UU, UK; (J.M.); (N.G.)
| | - Diego F. Cobice
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), Ulster University, Coleraine BT52 1SA, UK; (D.F.C.); (S.D.)
| | - Sara Dobbin
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), Ulster University, Coleraine BT52 1SA, UK; (D.F.C.); (S.D.)
| | - Pamela J. Magee
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
- Correspondence: (D.U.G.); (R.R.I.); (P.J.M.)
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Verminderte Mineralisation des Knochens: Rachitis und Osteomalazie. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-021-01392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ZusammenfassungDie Mineralisation der Wachstumsfuge und des Knochens benötigt suffiziente Mengen an Kalzium und Phosphat, um ein adäquates Körperwachstum und eine adäquate Knochenstärke zu gewährleisten. Bei Mangelzuständen nehmen Härte und Stärke des Knochens ab (Osteomalazie), mit typischen Veränderungen an der Wachstumsfuge (Rachitis). Die vermeidbaren Komplikationen einer erworbenen Rachitis können lebensbedrohlich sein und sind auch deshalb ein global wichtiges Public-Health-Thema. Typische klinische Zeichen, Laborparameter und radiologische Veränderungen sollten zur unverzüglichen Diagnose führen. Erbliche und erworbene Formen der Rachitis wie X‑chromosomale Hypophosphatämie oder Hypophosphatasie werden, wie oftmals bei seltenen Erkrankungen, spät diagnostiziert. Diagnose, Therapie und Management von Rachitiden sollten durch tertiäre kinderosteologische Spezialisten erfolgen, die in internationalen „Rare-diseases“-Netzwerken arbeiten und in enger Kooperation mit Selbsthilfegruppen stehen.
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Vitamin D Supplementation in Exclusively Breastfed Infants Is Associated with Alterations in the Fecal Microbiome. Nutrients 2022; 14:nu14010202. [PMID: 35011077 PMCID: PMC8747039 DOI: 10.3390/nu14010202] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 02/01/2023] Open
Abstract
Breastfeeding and introduction of solid food are the two major components of infant feeding practices that influence gut microbiota composition in early infancy. However, it is unclear whether additional factors influence the microbiota of infants either exclusively breastfed or not breastfed. We obtained 194 fecal samples from infants at 3–9 months of age, extracted DNA, and sequenced the V4 region of the 16S rRNA gene. Feeding practices and clinical information were collected by questionnaire and abstraction of birth certificates. The gut microbiota of infants who were exclusively breastfed displayed significantly lower Shannon diversity (p-adjust < 0.001) and different gut microbiota composition compared to infants who were not breastfed (p-value = 0.001). Among the exclusively breastfed infants, recipients of vitamin D supplements displayed significantly lower Shannon diversity (p-adjust = 0.007), and different gut microbiota composition structure than non-supplemented, breastfed infants (p-value = 0.02). MaAslin analysis identified microbial taxa that associated with breastfeeding and vitamin D supplementation. Breastfeeding and infant vitamin D supplement intake play an important role in shaping infant gut microbiota.
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Högler W, Tischlinger K, Fraser WD, Tang JCY, Uday S. Influence of maternal socioeconomic deprivation and living environment on newborn bloodspot 25-hydroxyvitamin D levels. Front Endocrinol (Lausanne) 2022; 13:978580. [PMID: 37091212 PMCID: PMC10116494 DOI: 10.3389/fendo.2022.978580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/24/2022] [Indexed: 04/25/2023] Open
Abstract
Objectives Vitamin D deficiency in neonates can have life-threatening consequences, hence the knowledge of risk factors is essential. This study aimed to explore the effect of maternal socioeconomic status (SES) on newborn 25-hydroxyvitamin D (25OHD) concentrations. Design Over two 1-week periods (winter and summer of 2019), 3000 newborn heel prick dried blood spots (DBS) and additional data of newborns, from a regional newborn screening laboratory (52° N) in the West Midlands, UK, were gathered. Post code was replaced with lower layer super output area (LSOA). Index of Multiple Deprivation (IMD) quintiles for the corresponding LSOA was used to assess SES [quintile one (Q1): most deprived 20%, quintile five (Q5): least deprived 20%]. Each of the seven domains of deprivation were examined (income, employment, education, health, barriers to housing and services, crime and living environment). 25OHD was measured on 6mm sub-punch from DBS using quantitative liquid chromatography tandem mass spectrometry and equivalent plasma values were derived. Results In total 2999 (1500 summer-born, 1499 winter-born) newborn DBS (1580 males) were analysed. Summer-born newborns had significantly higher 25OHD (IQR) concentrations [49.2 (34.3; 64.8) nmol/l] than winter-born newborns [29.1 (19.8; 40.6) nmol/l, p<0.001].25OHD levels varied significantly between the different IMD quintiles in the whole (p<0.001) and summer-born cohort (p<0.001), but not in the winter-born cohort (p=0.26), whereby Q1 had the lowest 25OHD concentrations. Among the domains of deprivation, living environment had a significant influence on 25OHD levels (β=0.07, p=0.002). In this subdomain, 25OHD levels varied significantly between quintiles in the whole (p<0.001) and summer-born cohort (mean 25OHD Q1 46.45 nmol/l, Q5 54.54 nmol/l; p<0.001) but not in the winter-born cohort (mean 25OHD Q1 31.57 nmol/l, Q5 31.72 nmol/l; p=0.16). In a regression model, living environment was still significant (p=0.018), albeit less than season of birth and ethnicity. Conclusion Among the seven domains of deprivation, maternal living environment had the greatest effect on newborn 25OHD levels. Whilst improved living environment positively influenced vitamin D status in the summer-born babies, winter-born had low 25OHD levels irrespective of the environment. Strategies such as enhanced supplementation and food fortification with vitamin D should be considered to overcome the non-modifiable main risk factors for vitamin D deficiency.
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Affiliation(s)
- Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- *Correspondence: Wolfgang Högler,
| | - Katharina Tischlinger
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - William D. Fraser
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- Departments of Diabetes and Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jonathan C. Y. Tang
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- Clinical Biochemistry, Departments of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Suma Uday
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Department of Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom
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22
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Uday S, Högler W. The burden of vitamin D deficiency in household members of children presenting with symptomatic vitamin D deficiency. Front Endocrinol (Lausanne) 2022; 13:958422. [PMID: 36111298 PMCID: PMC9468761 DOI: 10.3389/fendo.2022.958422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Micronutrient deficiencies are common among household/family members due to shared lifestyle and dietary habits. The extent of biochemical abnormalities in household members of children presenting with symptomatic vitamin D deficiency remains unknown. AIM Investigate the prevalence of vitamin D deficiency and biochemical osteomalacia in the mothers and siblings of children presenting with symptomatic vitamin D deficiency. METHODS All mothers and sibling of children referred to a single tertiary endocrine centre between January 2018 and December 2021, with symptomatic vitamin D deficiency were investigated prospectively for vitamin D deficiency [defined as 25 hydroxyvitamin D (25OHD) < 30nmol/L] and biochemical osteomalacia [vitamin D deficiency and elevated alkaline phosphatase (ALP) and/or parathormone (PTH)] as per clinical guidelines. REULTS Ninety-seven family members (68 siblings and 29 mothers) of 29 index cases (median age 1.7 years, 55.5% male) were investigated. The majority (65.5%, n=19) were of Asian ethnic background. The mean (SD) 25OHD levels of the index, maternal and sibling cohorts were 15 (10), 15 (7) and 20 (10) nmol/L respectively. Vitamin D deficiency was noted in 93% of the maternal and 79% of the sibling cohorts. Biochemical osteomalacia was present in 72% of the maternal and 79% of the sibling cohorts. Mothers of infants had significantly lower mean 25OHD levels compared to mothers of older children [11 (n=12) vs 18 nmol/L (n=17) respectively, p=0.006)], most of whom were symptomatic (66.6%, n=8/12). None of the mothers had hypocalcaemia. Among the 10% (n=7) of the siblings with hypocalcaemia, 86% (n=6/7) had concurrent dietary calcium deficiency and 71.4% (n= 5/7) reported symptoms in retrospect. Hypocalcaemic siblings had significantly lower 25OHD (7 vs 15 nmol/L, p<0.001), higher PTH (175 vs 58 ng/L, p<0.001) and ALP (846 vs 318 IU/L, p<0.001), respectively compared to normocalcaemic siblings. CONCLUSIONS In view of the substantial morbidity uncovered in household/family members of children diagnosed with symptomatic vitamin D deficiency, we recommend universal supplementation of all risk groups. Biochemical testing and treatment is indicated to replenish stores only in those at highest risk such as mothers of infants, individuals with concurrent dietary calcium deficiency and those with clinical symptoms.
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Affiliation(s)
- Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Suma Uday,
| | - Wolfgang Högler
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
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23
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[Vitamin D insufficiency in a healthy pediatric population. The importance of early prophylaxis]. NUTR HOSP 2021; 38:1155-1161. [PMID: 34431303 DOI: 10.20960/nh.03606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: vitamin D maintains the concentration of calcium and phosphorus within the physiological range, allowing normal metabolism and bone mineralization. Recently, vitamin D deficiency has been related not only with rickets but also with an increased risk of other pathologies. The aim of this descriptive, observational, cross-sectional study was to assess vitamin D concentration levels in a healthy pediatric population, as well as the current situation of prophylaxis. Vitamin D determination was measured by serum 25-hydroxyvitamin D (25(OH)D) concentration. Methods: a total of 258 healthy patients between 3 months and 15 years of age were enrolled (6.77 ± 3.95 years; 73.6 % were male). Results: the mean value of 25-hydroxyvitamin D was 26.60 ng/mL ± 8.02 ng/mL, and up to 20.9 % of the population showed insufficient levels. Statistically significant differences in vitamin D levels were observed between ages (p = 0.002), ethnicity groups (p = 0.038), and skin types (p = 0.000). In addition, a higher prevalence of vitamin D insufficiency in children who had never previously received vitamin D supplementation (41.6 %) was observed compared to those that had taken supplementation in the first year of life (16.7 %). Conclusion: our study shows a high prevalence of vitamin D deficiency among healthy children, and the benefit of prophylaxis with vitamin D supplementation.
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Kazemain E, Ansari S, Davoodi SH, Patterson WB, Shakerinava P, Wagner CL, Amouzegar A. The Effect of Maternal Vitamin D Supplementation on Vitamin D Status of Exclusively Breast Feeding Mothers and Their Nursing Infants: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Adv Nutr 2021; 13:S2161-8313(22)00077-1. [PMID: 34718374 PMCID: PMC8970834 DOI: 10.1093/advances/nmab126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The optimal vitamin D supplementation plan during lactation is unclear. We investigated the effect of maternal vitamin D supplementation on mother-infant dyads' vitamin D status during lactation. All controlled trials that compared vitamin D supplements to placebo or low doses of vitamin D in breastfeeding mothers were included. Pooled effect size and the associated 95% confidence interval (CI) for each outcome were estimated using random-effects models. A one-stage random-effect dose-response model was used to estimate the dose-response relation across different vitamin D dosages and serum 25-hydroxy vitamin D (25(OH)D) concentrations. We identified 19 clinical trials with 27 separate comparison groups (n = 3337 breastfeeding mothers). Maternal vitamin D supplement dosages were associated with circulating 25(OH)D concentrations in breastfeeding women in a non-linear fashion. Supplementation with 1000 IU of vitamin D/day increased serum 25(OH)D concentrations by 7.8 ng/mL while there was a lower increase in concentrations at vitamin D doses of >2000 IU/day (3.07 and 2.05 ng/mL increases between 2000 to 3000 and 3000 to 4000 IU/day, respectively). A linear relationship was observed between maternal vitamin D supplementation dosage and the infants' circulating 25(OH)D concentrations. Each additional 1000 IU of maternal vitamin D intake was accompanied by a 2.7 ng/mL increase in serum 25(OH)D concentration in their nursing infants. The subgroup analysis showed that maternal vitamin D supplementation was accompanied by a statistically significant increase in infants' 25(OH)D concentration in the trials with a duration of >20 weeks, vitamin D supplementation >1000 IU/day, East Indian participants, maternal BMI <25 kg/m2, and studies with an overall low risk of bias. Long-term maternal supplementation with vitamin D at a high dose (>6000 IU/day) effectively corrected vitamin D deficiency in both mothers and infants. Nevertheless, infants with 25(OH)D concentrations over 20 ng/mL may require a relatively low maternal dose to maintain vitamin D sufficiency. STATEMENT OF SIGNIFICANCE This study is the first dose-response analysis on the relation between circulating 25-hydroxy vitamin D (25(OH)D) and maternal vitamin D supplementation in mother-infant dyads. We also considered factors such as study design and population characteristics that may affect the outcomes of a given vitamin D trial that have been overlooked in previous reviews.
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Affiliation(s)
- Elham Kazemain
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Samaneh Ansari
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Hossein Davoodi
- Department of Basic Sciences and Cellular and Molecular Nutrition, Faculty of Nutrition Sciences and Food Technology and National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences,Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - William B Patterson
- Dept of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Pedram Shakerinava
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Carol L Wagner
- Address correspondence to Address correspondence to CLW (e-mail: )
| | - Atieh Amouzegar
- Address correspondence to Address correspondence to AA (e-mail: )
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Improving Vitamin D Intake in Young Children-Can an Infographic Help Parents and Carers Understand the Recommendations? Nutrients 2021; 13:nu13093140. [PMID: 34579017 PMCID: PMC8469200 DOI: 10.3390/nu13093140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022] Open
Abstract
Vitamin D deficiency is a serious public health issue in the United Kingdom. Those at increased risk, such as pregnant women, children under 5 years and people from ethnic groups with dark skin, are not all achieving their recommended vitamin D. Effective vitamin D education is warranted. A qualitative study was undertaken to evaluate the acceptability and understanding of a vitamin D infographic, developed using recommendations from previous research. Fifteen parents/carers, recruited through local playgroups and adverts on popular parent websites, participated in focus groups and telephone interviews. The majority were female, White British and educated to degree level. A thematic analysis methodology was applied. The findings indicated that understanding and acceptability of the infographic were satisfactory, but improvements were recommended to aid interpretation and create more accessible information. These included additional content (what vitamin D is; other sources; its health benefits; methods/doses for administration and scientific symbols used) and improved presentation (eye-catching, less text, simpler language, more images and a logo). Once finalized, the infographic could be a useful tool to educate families around vitamin D supplementation guidelines, support the UK Healthy Start vitamins scheme and help improve vitamin D status for pregnant and lactating women and young children.
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Ruangkit C, Suwannachat S, Wantanakorn P, Sethaphanich N, Assawawiroonhakarn S, Dumrongwongsiri O. Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial. BMC Pediatr 2021; 21:378. [PMID: 34470599 PMCID: PMC8408999 DOI: 10.1186/s12887-021-02849-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background Many international medical organizations recommend vitamin D supplementation for infants, especially exclusively breastfed infants. In Thailand, however, data regarding the vitamin D status in Thai infants are lacking. Such data would help to support physician decisions and guide medical practice. Methods Full-term, exclusively breastfed infants were randomized into two groups at 2 months of age to continue exclusive breastfeeding either without vitamin D supplementation (control group, n = 44) or with vitamin D3 supplementation at 400 IU/day (intervention group, n = 43) until 6 months of age. At 6 months, the serum vitamin D (25OHD) of the infants and their mothers, serum bone marker, and infants’ growth parameters were compared between the two groups. Results The infants’ serum 25OHD concentration was lower in the control group than intervention group (20.57 ± 12.66 vs. 46.01 ± 16.42 ng/mL, p < 0.01). More infants had vitamin D sufficiency (25OHD of > 20 ng/mL) in the intervention group than control group (93.0% vs. 43.2%, p < 0.01). There were no significant differences in the maternal 25OHD concentrations between the control and intervention groups (25.08 ± 7.75 vs. 23.75 ± 7.64 ng/mL, p = 0.42). Serum calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase, and infants’ growth parameters were comparable between the two groups. After adjustment for the confounding factors, 25OHD concentration in the intervention group was 25.66 ng/mL higher than the control group (95% confidence interval, 19.07–32.25; p < 0.001). Vitamin D supplement contributed to an 88.7% decrease in the prevalence of vitamin D insufficiency/deficiency (relative risk, 0.11; 95% confidence interval, 0.04–0.35; p < 0.01). Conclusions Most full-term, exclusively breastfed Thai infants have serum vitamin D concentration below sufficiency level at 6 months of age. However, vitamin D supplementation (400 IU/day) improves their vitamin D status and prevents vitamin D deficiency. Trial registration The study was pre-registered in the Thai Clinical Trials Registry (TCTR20190622001) on 22/06/2019.
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Affiliation(s)
- Chayatat Ruangkit
- Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Sukrit Suwannachat
- Chakri Narubodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pornchanok Wantanakorn
- Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Napapailin Sethaphanich
- Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Surapat Assawawiroonhakarn
- Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Oraporn Dumrongwongsiri
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400, Thailand.
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Levy B, O'Callaghan KM, Qamar H, Mahmud AA, Gernand AD, Islam MM, Roth DE. Basal Vitamin D Status and Supplement Dose Are Primary Contributors to Maternal 25-Hydroxyvitamin D Response to Prenatal and Postpartum Cholecalciferol Supplementation. J Nutr 2021; 151:3361-3378. [PMID: 34302350 PMCID: PMC8562081 DOI: 10.1093/jn/nxab265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/28/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Variability in the 25-hydroxyvitamin D [25(OH)D] response to prenatal and postpartum vitamin D supplementation is an important consideration for establishing vitamin D deficiency prevention regimens. OBJECTIVES We aimed to examine interindividual variation in maternal and infant 25(OH)D following maternal vitamin D supplementation. METHODS In a randomized trial of maternal vitamin D supplementation (Maternal Vitamin D for Infant Growth Trial), healthy pregnant women (n = 1300) received a prenatal cholecalciferol (vitamin D-3) dose of 0, 4200, 16,800, or 28,000 IU/wk from 17 to 24 wk of gestation followed by placebo to 6 mo postpartum. A fifth group received 28,000 IU cholecalciferol/wk both prenatally and postpartum. In a subset of participants, associations of 25(OH)D with hypothesized explanatory factors were estimated in women at delivery (n = 655) and 6 mo postpartum (n = 566), and in their infants at birth (n = 502) and 6 mo of age (n = 215). Base models included initial 25(OH)D and supplemental vitamin D dose. Multivariable models were extended to include other individual characteristics and specimen-related factors. The model coefficient of determination (R2) was used to express the percentage of total variance explained. RESULTS Supplemental vitamin D intake and initial 25(OH)D accounted for the majority of variance in maternal 25(OH)D at delivery and postpartum (R2 = 70% and 79%, respectively). Additional characteristics, including BMI, contributed negligibly to remaining variance (<5% increase in R2). Variance in neonatal 25(OH)D was explained mostly by maternal delivery 25(OH)D and prenatal vitamin D intake (R2 = 82%). Variance in 25(OH)D in later infancy could only partly be explained by numerous biological, sociodemographic, and laboratory-related characteristics, including feeding practices (R2 = 43%). CONCLUSIONS Presupplementation 25(OH)D and vitamin D supplemental dose are the major determinants of the response to maternal prenatal vitamin D intake. Vitamin D dosing regimens to prevent maternal and infant vitamin D deficiency should take into consideration the mean 25(OH)D concentration of the target population.
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Affiliation(s)
- Benjamin Levy
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen M O'Callaghan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Huma Qamar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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Rustecka A, Maret J, Drab A, Leszczyńska M, Tomaszewska A, Lipińska-Opałka A, Będzichowska A, Kalicki B, Kubiak JZ. The Impact of COVID-19 Pandemic during 2020-2021 on the Vitamin D Serum Levels in the Paediatric Population in Warsaw, Poland. Nutrients 2021; 13:nu13061990. [PMID: 34207901 PMCID: PMC8227523 DOI: 10.3390/nu13061990] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The main source of vitamin D is skin synthesis, which depends on sunlight exposure. During the pandemic, COVID-19 children were obliged to home confinement, which potentially limiting sunlight exposure. The aim of this study was to evaluate whether home confinement led to decreased vitamin D serum levels in children in Warsaw, Poland. METHODS The study included 1472 children who were divided into two groups, based on the date of 25(OH)D level blood sampling: before and during the pandemic. Children under 1 year of age (infants) were analysed separately. RESULTS A statistically significant decrease in the average level of vitamin D was observed between groups of children over 1 year of age (35 ng/mL ± 18 vs. 31 ng/mL ± 14). In infants from both groups, the mean vitamin D levels were within the normal range (Group 1 inf 54 ng/mL ± 21 vs. Group 2 inf 47 ng/mL ± 15). The characteristic seasonal variability was observed before the pandemic, with maximal vitamin D levels in summer (40 ng/mL ± 17) and minimal levels in winter (30 ng/mL ± 14). During the pandemic, no seasonal variability was observed (summer 30 ng/mL ± 11 vs. winter 30 ng/mL ± 19). CONCLUSIONS The COVID-19 pandemic restrictions led to a significant decrease in vitamin D serum levels in children.
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Affiliation(s)
- Agnieszka Rustecka
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Justyna Maret
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Ada Drab
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Michalina Leszczyńska
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Agata Tomaszewska
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Agnieszka Lipińska-Opałka
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
- Correspondence:
| | - Agata Będzichowska
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Bolesław Kalicki
- Pediatric, Nephrology and Allergology Clinic, Military Institute of Medicine, 04-141 Warsaw, Poland; (A.R.); (J.M.); (A.D.); (M.L.); (A.T.); (A.B.); (B.K.)
| | - Jacek Z. Kubiak
- Cell Cycle Group, Faculty of Medicine, Institute of Genetics and Development of Rennes, University of Rennes 1, 35000 Rennes, France;
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Vitamin D status of children with Paediatric Inflammatory Multisystem Syndrome Temporally associated with Severe acute respiratory syndrome coronavirus 2 (PIMS-TS). Br J Nutr 2021; 127:896-903. [PMID: 33977890 PMCID: PMC8245338 DOI: 10.1017/s0007114521001562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has caused mild illness in children, until the emergence of the novel hyperinflammatory condition paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS). PIMS-TS is thought to be a post-SARS-CoV-2 immune dysregulation with excessive inflammatory cytokine release. We studied 25 hydroxyvitamin D (25OHD) concentrations in children with PIMS-TS, admitted to a tertiary paediatric hospital in the UK, due to its postulated role in cytokine regulation and immune response. Eighteen children (median (range) age 8·9 (0·3-14·6) years, male = 10) met the case definition. The majority were of Black, Asian and Minority Ethnic (BAME) origin (89 %, 16/18). Positive SARS-CoV-2 IgG antibodies were present in 94 % (17/18) and RNA by PCR in 6 % (1/18). Seventy-eight percentage of the cohort were vitamin D deficient (< 30 nmol/l). The mean 25OHD concentration was significantly lower when compared with the population mean from the 2015/16 National Diet and Nutrition Survey (children aged 4–10 years) (24 v. 54 nmol/l (95 % CI −38·6, −19·7); P < 0·001). The paediatric intensive care unit (PICU) group had lower mean 25OHD concentrations compared with the non-PICU group, but this was not statistically significant (19·5 v. 31·9 nmol/l; P = 0·11). The higher susceptibility of BAME children to PIMS-TS and also vitamin D deficiency merits contemplation. Whilst any link between vitamin D deficiency and the severity of COVID-19 and related conditions including PIMS-TS requires further evidence, public health measures to improve vitamin D status of the UK BAME population have been long overdue.
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Abstract
Defective mineralization of the growth plate and preformed osteoid result in rickets and osteomalacia, respectively. The leading cause of rickets worldwide is solar vitamin D deficiency and/or dietary calcium deficiency collectively termed as nutritional rickets. Vitamin D deficiency predominates in high-latitude countries in at-risk groups (dark skin, reduced sun exposure, infants and pregnant and lactating women) but is emerging in some tropical countries due to sun avoidance behaviour. Calcium deficiency predominates in tropical countries, especially in the malnourished population. Nutritional rickets can have devastating health consequences beyond bony deformities (swollen wrist and ankle joints, rachitic rosary, soft skull, stunting and bowing) and include life-threatening hypocalcaemic complications of seizures and, in infancy, heart failure due to dilated cardiomyopathy. In children, diagnosis of rickets (always associated with osteomalacia) is confirmed on radiographs (cupping and flaring of metaphyses) and should be suspected in high risk individuals with the above clinical manifestations in the presence of abnormal blood biochemistry (high alkaline phosphatase and parathyroid hormone, low 25-hydroxyvitamin D and calcium and/or low phosphate). In adults or adolescents with closed growth plates, osteomalacia presents with non-specific symptoms (fatigue, malaise and muscle weakness) and abnormal blood biochemistry, but only in extreme cases, it is associated with radiographic findings of Looser's zone fractures. Bone biopsies could confirm osteomalacia at earlier disease stages, for definitive diagnosis. Treatment includes high-dose cholecalciferol or ergocalciferol daily for a minimum of 12 wk or stoss therapy in exceptional circumstances, each followed by lifelong maintenance supplementation. In addition, adequate calcium intake through diet or supplementation should be ensured. Preventative approaches should be tailored to the population needs and incorporate multiple strategies including targeted vitamin D supplementation of at-risk groups and food fortification with vitamin D and/or calcium. Economically, food fortification is certainly the most cost-effective way forward.
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Affiliation(s)
- Suma Uday
- Department of Endocrinology & Diabetes, Birmingham Women's & Children's NHS Foundation Trust; Institute of Metabolism & Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Wolfgang Högler
- Institute of Metabolism & Systems Research, University of Birmingham, Edgbaston, Birmingham, UK; Department of Paediatrics & Adolescent Medicine, Johannes Kepler University, Kepler University Hospital, Med Campus IV, Linz, Austria
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Perrella S, Gridneva Z, Lai CT, Stinson L, George A, Bilston-John S, Geddes D. Human milk composition promotes optimal infant growth, development and health. Semin Perinatol 2021; 45:151380. [PMID: 33431112 DOI: 10.1016/j.semperi.2020.151380] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Human milk is a living dynamic fluid that promotes optimal nutrition and development of the infant and impacts health across the lifespan. This review reports on the diverse range of nutrients, immune protection factors, hormones, microbes and metabolites in human milk and their impacts on infant nutrition and health. While many of these components are stable across lactation and similar between women, some vary over time, and in response to maternal and infant health status, maternal diet and geographic location. Human milk may be considered as personalized nutrition, with many components working synergistically to stimulate and support the infant's immature immune system, while enhancing appropriate development, growth and body composition.
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Affiliation(s)
- Sharon Perrella
- School of Molecular Science, The University of Western Australia, M310, 35 Stirling Highway, Crawley Western Australia 6009, Australia.
| | - Zoya Gridneva
- School of Molecular Science, The University of Western Australia, M310, 35 Stirling Highway, Crawley Western Australia 6009, Australia
| | - Ching Tat Lai
- School of Molecular Science, The University of Western Australia, M310, 35 Stirling Highway, Crawley Western Australia 6009, Australia
| | - Lisa Stinson
- School of Molecular Science, The University of Western Australia, M310, 35 Stirling Highway, Crawley Western Australia 6009, Australia
| | - Alexandra George
- School of Molecular Science, The University of Western Australia, M310, 35 Stirling Highway, Crawley Western Australia 6009, Australia
| | - Sabrina Bilston-John
- School of Molecular Science, The University of Western Australia, M310, 35 Stirling Highway, Crawley Western Australia 6009, Australia
| | - Donna Geddes
- School of Molecular Science, The University of Western Australia, M310, 35 Stirling Highway, Crawley Western Australia 6009, Australia
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Uday S, Naseem S, Large J, Denmeade R, Goddard P, Preece MA, Dunn R, Fraser W, Tang JCY, Högler W. Failure of national antenatal vitamin D supplementation programme puts dark skinned infants at highest risk: A newborn bloodspot screening study. Clin Nutr 2020; 40:3542-3551. [PMID: 33358424 DOI: 10.1016/j.clnu.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the prevalence of vitamin D deficiency on dried blood spots (DBS) obtained at newborn blood spot screening (NBS) and thereby test the efficacy of the UK national antenatal supplementation programme in an increasingly ethnically diverse English population. To evaluate the seasonal and ethnic variation in neonatal plasma 25 hydoxyvitamin D (25OHD) and its determinants. DESIGN Three thousand random DBS samples received at a single regional newborn screening laboratory (52° N) over two one-week periods, one in winter (February 2019) and one in summer (August 2019), were collected. Data was collected from NBS cards on birth weight, gestational age, maternal age, ethnicity, and post code which was replaced with index of multiple deprivation (IMD). 25OHD concentrations were measured on 6 mm sub-punch from DBS using quantitative liquid chromatography tandem mass spectrometry adjusted to equivalent plasma values. 25OHD variation with season was assessed using Mann-Whitney U test and ethnic groups compared using Kruskal-Wallis test. Linear regression was used to assess the determinants of 25OHD concentrations. RESULTS 25OHD measurements were available in 2999 (1580 males) subjects [1499 winter-born and 1500 summer-born]. The majority were white British (59.1%) and born at term (mean ± SD gestational age of 38.8 ± 1.8 weeks) with a mean (±SD) birth weight of 3306 (±565) grams. The overall prevalence of vitamin D deficiency [25OHD<30 nmol/L (12 μg/L)] was 35.7% (n = 1070) and insufficiency [30-50 nmol/L (12-20 μg/L)] 33.7% (n = 1010). The median (IQR) 25OHD concentration was significantly lower in the winter-born compared to summer-born [29.1 (19.8, 40.6) vs 49.2 (34.3, 64.8) nmol/L respectively; p < 0.001]. Across both seasons, when compared to white British babies (41.6 nmol/L), the median 25OHD concentrations were significantly lower in babies of black (30.3 nmol/L; p < 0.001), Asian (31.3 nmol/L; p < 0.001), any other mixed (32.9 nmol/L; p < 0.001), mixed white and black (33.7 nmol/L; p < 0.05) and any other white (37.7 nmol/L; p < 0.05) ethnicity. The proportion of deficiency was also higher in babies of Asian (48%), black (47%) and mixed ethnicity (38-44%) compared to any other white (34%) or white British (30%) ethnicity. Season of birth, ethnicity, gestation and maternal age accounted for almost 24% of the variation in 25OHD concentrations. CONCLUSION The current UK antenatal supplementation programme fails to protect newborns from vitamin D deficiency, especially those from minority ethnic groups who are at high risk of vitamin D deficiency. Nearly 70% of all newborns and 85% of winter-borns had 25OHD concentrations below 50 nmol/L (20 μg/L). Almost 50% of babies of Black or Asian origin were deficient at birth, which explains their high risk of hypocalcaemic complications and rickets if left unsupplemented. Our findings call for an immediate review of the delivery of antenatal and infant vitamin D supplementation programmes and implementation of food fortification in the long term.
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Affiliation(s)
- Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK; Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Sunia Naseem
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jamie Large
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Russell Denmeade
- Department of Newborn Screening and Biochemical Genetics, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Philippa Goddard
- Department of Newborn Screening and Biochemical Genetics, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Mary Anne Preece
- Department of Newborn Screening and Biochemical Genetics, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Rachel Dunn
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - William Fraser
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ, UK; Departments of Diabetes and Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
| | - Jonathan C Y Tang
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Wolfgang Högler
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, 4020, Linz, Austria
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Differences and determinants of vitamin D deficiency among UK biobank participants: A cross-ethnic and socioeconomic study. Clin Nutr 2020; 40:3436-3447. [PMID: 33309415 DOI: 10.1016/j.clnu.2020.11.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/28/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The public health relevance of true vitamin D deficiency is undisputed, although controversy remains regarding optimal vitamin D status. Few contemporary cross-ethnic studies have investigated the prevalence and determinants of very low 25-hydroxyvitamin D [25(OH)D] concentrations. METHODS We conducted cross-ethnic analyses on the prevalence and determinants of vitamin D deficiency (25(OH)D ≤ 25 nmol/L) using data from 440,581 UK Biobank participants, of which 415,903 identified as White European, 7880 Asian, 7602 Black African, 1383 Chinese, and 6473 of mixed ancestry. Determinants of vitamin D deficiency were examined by logistic regression. RESULTS The prevalence of vitamin D deficiency was highest among participants of Asian ancestry (57.2% in winter/spring and 50.8% in summer/autumn) followed by those of Black African ancestry (38.5% and 30.8%, respectively), mixed (36.5%, 22.5%), Chinese (33.1%, 20.7%) and White European ancestry (17.5%, 5.9%). Participants with higher socioeconomic deprivation were more likely to have 25(OH)D deficiency compared to less deprived participants (P = <1 × 10-300); this pattern was more apparent among those of White European ancestry and in summer (Pinteraction ≤6.4 × 10-5 for both). In fully-adjusted analyses, regular consumption of oily fish was associated with reduced odds of vitamin D deficiency across all ethnicities, while outdoor-time in summer was less effective for Black Africans (OR 0.89, 95% CI 0.70, 1.12) than White Europeans (OR 0.40, 95% CI 0.38, 0.42). CONCLUSIONS Severe vitamin D deficiency remains an issue throughout the UK, particularly in lower socioeconomic areas. In some groups, levels of deficiency are alarmingly high with one-half of Asian and one-third of Black African ancestry populations affected across seasons. KEY MESSAGES The prevalence of vitamin D deficiency in the UK is alarming, with certain ethnic and socioeconomic groups considered particularly vulnerable.
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Meena P, Saran AN, Shah D, Gupta P. Compliance to Prescription of Routine Vitamin D Supplementation in Infants. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-2037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Drall KM, Field CJ, Haqq AM, de Souza RJ, Tun HM, Morales-Lizcano NP, Konya TB, Guttman DS, Azad MB, Becker AB, Lefebvre DL, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. Vitamin D supplementation in pregnancy and early infancy in relation to gut microbiota composition and C. difficile colonization: implications for viral respiratory infections. Gut Microbes 2020; 12:1799734. [PMID: 32779963 PMCID: PMC7524344 DOI: 10.1080/19490976.2020.1799734] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In Canada and the US, the infant diet is supplemented with vitamin D via supplement drops or formula. Pregnant and nursing mothers often take vitamin D supplements. Since little is known about the impact of this supplementation on infant gut microbiota, we undertook a study to determine the association between maternal and infant vitamin D supplementation, infant gut microbiota composition and Clostridioides difficile colonization in 1,157 mother-infant pairs of the CHILD (Canadian Healthy Infant Longitudinal Development) Cohort Study over 2009-2012. Logistic and MaAsLin regression were employed to assess associations between vitamin D supplementation, and C. difficile colonization, or other gut microbiota, respectively. Sixty-five percent of infants received a vitamin D supplement. Among all infants, infant vitamin D supplementation was associated with a lower abundance of genus Megamonas (q = 0.01) in gut microbiota. Among those exclusively breastfed, maternal prenatal supplementation was associated with lower abundance of Bilophila (q = 0.01) and of Lachnospiraceae (q = 0.02) but higher abundance of Haemophilus (q = 0.02). There were no differences in microbiota composition with vitamin D supplementation among partially and not breastfed infants. Neither infant nor maternal vitamin D supplementation were associated with C. difficile colonization, after adjusting for breastfeeding status and other factors. However, maternal consumption of vitamin-D fortified milk reduced the likelihood of C. difficile colonization in infants (adjustedOR: 0.40, 95% CI: 0.19-0.82). The impact of this compositional difference on later childhood health, especially defense against viral respiratory infection, may go beyond the expected effects of vitamin D supplements and remains to be ascertained.
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Affiliation(s)
- Kelsea M. Drall
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Andrea M. Haqq
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Hein M. Tun
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada,HKU-Pasteur Research Pole, School of Public Health, Hong Kong University, Hong Kong SAR, China
| | | | - Theodore B. Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David S. Guttman
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, Canada,Centre for the Analysis of Genome Evolution & Function, University of Toronto, Toronto, ON, Canada
| | - Meghan B. Azad
- Department of Pediatrics & Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Allan B. Becker
- Department of Pediatrics & Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | | | - Piush J. Mandhane
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Theo J. Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ONCanada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Medicine, McMaster University, Hamilton, ON, Canada,Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ONCanada
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Departments of Pediatrics, Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada,School of Public Health, University of Alberta, Edmonton, Canada,CONTACT : Anita L Kozyrskyj 3-527 Edmonton Clinic Health Academy, Edmonton, ABT6G 1C9, Canada
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Yeşiltepe-Mutlu G, Aksu ED, Bereket A, Hatun Ş. Vitamin D Status Across Age Groups in Turkey: Results of 108,742 Samples from a Single Laboratory. J Clin Res Pediatr Endocrinol 2020; 12:248-255. [PMID: 31893581 PMCID: PMC7499130 DOI: 10.4274/jcrpe.galenos.2019.2019.0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim was to determine vitamin D status in the general population in Turkey between 2011 and 2016, and to evaluate the effectiveness of the national vitamin D supplementation programme. METHODS Serum 25-hydroxyvitamin D (25-OHD) measurement data were retrieved from an internationally accredited laboratory, operating nationwide. A total of 108,742 measurements of 25-OHD were analyzed using the cut-off values of 0-11 ng/mL, 12-19 ng/mL, 20-49 ng/mL, 50-70 ng/mL and >70 ng/mL for vitamin D deficiency, insufficiency, sufficiency, possibly harmful and excess respectively. RESULTS The mean±standard deviation 25-OHD level was 21.6±13.3 ng/mL. Mean 25-OHD concentrations by age groups were: 37.3 ng/mL, 30.1 ng/mL and 23.7 ng/mL for <1, 1-10 and 11-18 year old groups, respectively. Mean 25-OHD levels of children <1 year and 1-3 years of age were significantly higher than those found in other age groups. The prevalence of vitamin D deficiency (<12 ng/mL) was lowest in children at 1-3 years of age (5%). In subjects older than 18 years of age, mean 25-OHD levels were 18.2 ng/mL, 20.1 ng/mL, 21.9 ng/mL and 21.1 ng/mL for age groups 19-30, 31-50, 51-70 and >70 years, respectively. CONCLUSION Successful implementation of the national vitamin D supplementation programme, appears to have nearly eliminated vitamin D deficiency for children under 1-years of age. However, the positive impact of the vitamin D supplementation diminishes as children get older suggesting that supplementation may be required in the older children and adults. In addition, improved awareness of the benefits and risks of excess vitamin D should prevent unnecessary and excessive use of vitamin D supplements.
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Affiliation(s)
- Gül Yeşiltepe-Mutlu
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey,* Address for Correspondence: Koç University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 505 723 57 25 E-mail:
| | - Ekin Deniz Aksu
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükrü Hatun
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Moon RJ, Curtis EM, Cooper C, Davies JH, Harvey NC. Vitamin D supplementation: are multivitamins sufficient? Arch Dis Child 2020; 105:791-793. [PMID: 30804007 PMCID: PMC7115846 DOI: 10.1136/archdischild-2018-316339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Public Health England advises 400 IU/day vitamin D supplementation for children over 1 year. Commercially available children's multivitamin and vitamin D supplements were surveyed to determine the vitamin D content. METHODS Multivitamins and vitamin D supplements marketed at children <12 years and sold by nine UK supermarkets and health supplement retailers were surveyed. Vitamin D content was determined from manufacturer's websites and product packaging. RESULTS 67 multivitamins were surveyed, containing 0-800 IU/day vitamin D. Only 25%-36%, depending on the child's age, provided ≥400 IU/day vitamin D. Supplements containing only vitamin D or labelled as for 'healthy bones' typically had higher vitamin D content (57%-67% contained ≥400 IU/day). CONCLUSIONS Few multivitamin products supply the recommended 400 IU/day vitamin D. Clinicians need to be aware of this when recommending vitamin D supplementation and advise parents/carers to choose a product that contains ≥400 IU/day vitamin D.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University Hospital Southampton, Southampton, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University Hospital Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University Hospital Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Justin H Davies
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University Hospital Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Adherence to the infant vitamin D supplementation policy in Ireland. Eur J Nutr 2020; 60:1337-1345. [PMID: 32681322 DOI: 10.1007/s00394-020-02334-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE From September 2010 until November 2019, Ireland's infant vitamin D supplementation policy recommended administration of 5 μg/day of vitamin D3 from birth to 12 months to all infants, regardless of feeding method. This study aims to examine policy adherence. METHODS In the prospective COMBINE birth cohort study (recruited 2015-2017), detailed longitudinal supplement data were examined in 364 infants across the first year of life, according to product type, dose, frequency, and duration. Vitamin D supplement use at 2, 6, and 12 months in COMBINE was compared with the BASELINE cohort (recruited 2008-2011, n = 1949). RESULTS In COMBINE, 92% of infants initiated supplementation at birth. The median supplementation duration was 51 (40, 52) weeks, with a range of 3-52 weeks. While supplementing, most parents (92%) used an exclusive vitamin D supplement as recommended and 88% gave 5 µg/day. Half (51%) gave vitamin D daily and a further 33% supplemented at least 3-6 times/week. Overall, 30% adhered fully to the policy, providing 5 µg vitamin D3 daily from birth to 12 months. A further 16% were broadly compliant, giving 5 µg frequently for the full 12 months. Vitamin D supplement use at 2, 6, and 12 months in COMBINE was 93%, 89%, and 72%, considerably higher than our earlier BASELINE cohort at 49%, 64%, and 44% at the same time points (all P < 0.001). CONCLUSIONS We report a high level of vitamin D supplementation initiation at birth, with full to broad policy adherence among more than half of infants. There is scope to improve overall compliance by focusing on supplementation frequency.
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Julies P, Lynn RM, Pall K, Leoni M, Calder A, Mughal Z, Shaw N, McDonnell C, McDevitt H, Blair M. Nutritional rickets under 16 years: UK surveillance results. Arch Dis Child 2020; 105:587-592. [PMID: 31949032 DOI: 10.1136/archdischild-2019-317934] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The UK national incidence of nutritional rickets is unknown. We aimed to describe the incidence, presentation and clinical management of children under 16 years with nutritional rickets in the UK presenting to secondary care. METHODS Prospective data were collected monthly between March 2015 and March 2017 from 3500 consultant paediatricians using British Paediatric Surveillance Unit methodology. Clinicians completed online clinical questionnaires for cases fitting the surveillance case definition. RESULTS 125 cases met the case definition, an annual incidence of 0.48 (95% CI 0.37 to 0.62) per 100 000 children under 16 years. 116 children were under 5 years (annual incidence of 1.39 (95% CI 1.05 to 1.81) per 100 000. Boys (70%) were significantly more affected than girls (30%) (OR 2.17, 95% CI 1.25 to 3.78). The majority were of Black (43%) or South Asian (38%) ethnicity. 77.6% of children were not taking vitamin D supplements despite being eligible. Complications included delayed gross motor development (26.4%), fractures (9.6%), hypocalcaemic seizures (8%) and dilated cardiomyopathy (3%). Two children died (1.6%). In eight cases, rickets was confirmed radiologically and biochemically [raised serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) levels ] but were excluded from the incidence analysis for not meeting the case definition of 25-hydroxyvitamin D of <25 nmol/L. CONCLUSION The incidence of nutritional rickets in the UK is lower than expected. Serious complications and unexpected deaths, particularly in Black and South Asian children under 5 years, occurred. Both vitamin D deficiency and dietary calcium deficiency are role players in pathogenesis. Uptake of vitamin D supplementation remains low.
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Affiliation(s)
- Priscilla Julies
- Child Health, Royal Free London NHS Foundation Trust, London, UK
| | - Richard M Lynn
- Institute of Child Health, University College London Research Department of Epidemiology and Public Health, London, UK.,BPSU, Royal College of Paedaitrics, London, UK
| | - Karina Pall
- BPSU, Royal College of Paediatrics and Child Health, London, UK
| | - Marina Leoni
- BPSU, Royal College of Paediatrics and Child Health, London, UK
| | - Alistair Calder
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Nick Shaw
- Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, West Midlands, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Ciara McDonnell
- Endocrinology Department, Children's University Hospital, Temple Street, Dublin, Ireland
| | - Helen McDevitt
- Paediatric Bone and Endocrinology, Royal Hospital for Children Glasgow, Glasgow, UK.,Neonatology, Royal Hospital for Children Glasgow, Glasgow, UK
| | - Mitch Blair
- Paediatrics, Imperial College London, Harrow, UK
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Lemoine A, Giabicani E, Lockhart V, Grimprel E, Tounian P. Case report of nutritional rickets in an infant following a vegan diet. Arch Pediatr 2020; 27:219-222. [PMID: 32334899 DOI: 10.1016/j.arcped.2020.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/19/2020] [Accepted: 03/28/2020] [Indexed: 01/24/2023]
Abstract
We report the case of a 13-month-old infant who was referred to the pediatric emergency department because of psychomotor regression with four bone fractures due to nutritional rickets. The reason was prolonged breastfeeding from a vegetarian mother followed by a vegan diet for the infant after weaning. Rickets is one of the many nutritional deficiencies that could affect infants fed vegan or vegetarian diets. These diets are a public health concern requiring adapted information that suggests alternative formulas made from rice or soy proteins and adapted supplementation after weaning.
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Affiliation(s)
- A Lemoine
- Paediatric Nutrition and Gastroenterology Department, Trousseau Hospital-AP-HP, Sorbonne Université, 26, avenue du Dr Arnold-Netter, 75012 Paris, France.
| | - E Giabicani
- Sorbonne Université, INSERM, Centre de Recherche Saint Antoine, APHP, Hôpital Armand Trousseau, Explorations Fonctionnelles Endocriniennes, 75012, Paris, France
| | - V Lockhart
- Sorbonne Université, INSERM, Centre de Recherche Saint Antoine, APHP, Hôpital Armand Trousseau, Explorations Fonctionnelles Endocriniennes, 75012, Paris, France
| | - E Grimprel
- Department of Paediatrics, Trousseau Hospital-AP-HP; Sorbonne Université, 75012 Paris, France
| | - P Tounian
- Paediatric Nutrition and Gastroenterology Department, Trousseau Hospital-AP-HP, Sorbonne Université, 26, avenue du Dr Arnold-Netter, 75012 Paris, France
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Wang J, Zhang JY, Wei R, Hu S, Lin T, Lash GE, Tan M. Serum 25 hydroxyvitamin D status in 6-month-old infants in Guangzhou, China: A paired longitudinal follow up study. MATERNAL AND CHILD NUTRITION 2020; 16:e12924. [PMID: 31970860 PMCID: PMC7083469 DOI: 10.1111/mcn.12924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 10/10/2019] [Accepted: 11/14/2019] [Indexed: 01/08/2023]
Abstract
To assess the vitamin D status in healthy 6‐month‐old infants, as well as vitamin D supplementation and feeding patterns in Guangzhou, China, serum 25‐hydroxyvitamin D (25OHD) concentrations of 202 infants were measured at birth (cord blood) and at 6 months of age in Guangzhou, China. Questionnaires acquiring demographic characteristics, maternal and infantile vitamin D supplementation during pregnancy and first 6 months after birth, and feeding patterns during the first 6 months were completed by participating mothers. Physical examinations and blood sampling were carried out among infants at 6 months of age. The majority of infants (93.6%) were supplemented with vitamin D during the first 6 months of life on a voluntary basis. The M ± SD of cord serum 25OHD concentration was 46.2 ± 16.4 nmol/L, whereas the M ± SD of 25OHD concentration at 6 months was 82.9 ± 24.9 nmol/L. Serum 25OHD concentrations <30 nmol/L were seen in 34 (16.8%) infants at birth but only one (0.5%) at 6 months. Only 11 (5.4%) infants had concentrations >75 nmol/L at birth, whereas the majority of infants (n = 131, 64.9%) had concentrations >75 nmol/L at 6 months. The main predictors of 25OHD levels at 6 months included season, vitamin D supplementation, parental education level, and feeding patterns. To conclude, serum 25OHD concentrations were low at birth in a southern Chinese population, and infantile supplementation is an effective way to improve 25OHD status. Exclusively breastfed infants might need greater vitamin D supplementation, and individualized vitamin D supplementation plans might be needed.
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Affiliation(s)
- Jing Wang
- Department of Children Health Care, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Joy Yue Zhang
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ru Wei
- Department of Children Health Care, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shunping Hu
- Department of Obstetrics, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tao Lin
- Virus Laboratory, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Gendie E Lash
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Meizhen Tan
- Department of Children Health Care, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Abstract
Vitamin D has important roles in calcium metabolism and in the prevention of rickets and osteomalacia; low levels of 25-hydroxyvitamin D are common in the general population and amongst pregnant women. Whilst there is a wealth of observational evidence linking vitamin D deficiency to a wide range of disease outcomes, there are currently few high-quality randomised controlled trials to confirm any causal associations, although many are currently in progress. Furthermore, currently, the vast majority of published guidelines recommend standard supplemental vitamin D doses for children and pregnant women, yet there is increasing recognition that individual characteristics and genetic factors may influence the response to supplementation. As such, future research needs to concentrate on documenting definite beneficial clinical outcomes of vitamin D supplementation, and establishing personalised dosing schedules and demonstrating effective approaches to optimising initiation and adherence.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Paediatric Endocrinology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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O'Callaghan KM, Taghivand M, Zuchniak A, Onoyovwi A, Korsiak J, Leung M, Roth DE. Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation. Adv Nutr 2020; 11:144-159. [PMID: 31552417 PMCID: PMC7442322 DOI: 10.1093/advances/nmz098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023] Open
Abstract
Daily oral vitamin D supplementation (400 IU) is recommended for breastfeeding infants (≤1 y). Recent studies have examined alternative approaches to preventing vitamin D deficiency in this population. This systematic review and meta-analysis aimed to estimate the effects of maternal postpartum (M-PP) or infant intermittent (I-INT) vitamin D supplementation on infant 25-hydroxyvitamin D [25(OH)D] concentrations in comparison to routine direct infant daily (I-D) oral supplementation (400 IU). MEDLINE, MEDLINE In-Process, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to December 2018. Inclusion criteria consisted of published, peer-reviewed, vitamin D intervention trials involving lactating women and/or exclusively or partially breastfed term infants. Two reviewers independently extracted study characteristics (e.g., sample size, intervention dose, and duration and mode of administration) and related biochemical and clinical outcomes. Of 28 included trials, 5 randomized controlled trials were incorporated in meta-analyses examining infant 25(OH)D. Overall, M-PP supplementation resulted in modestly lower infant 25(OH)D compared with I-D supplementation (weighted mean difference = -8.1 nmol/L; 95% CI: -15.4, -0.9; I2 = 45%; P = 0.14; 3 trials), but the 2 most recent trials found M-PP to achieve similar infant 25(OH)D as I-D. Comparison of I-INT with I-D was confined to 2 trials with contradictory findings, and it was considered inappropriate for pooled analysis. Meta-analysis was therefore limited by a small number of eligible trials with variable quality of analytically derived 25(OH)D data and inconsistent reporting of safety outcomes, including effects on calcium homeostasis. Considering all 28 included trials, this systematic review highlights M-PP and I-INT regimens as plausible substitutes for routine daily infant vitamin D supplementation, but evidence remains too weak to support a policy update. Dose-ranging, adequately powered trials are required to establish the efficacy, safety, and feasibility of alternative strategies to prevent vitamin D deficiency in breastfeeding infants. This review was registered with PROSPERO as CRD42017069905.
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Affiliation(s)
- Karen M O'Callaghan
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Mahgol Taghivand
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anna Zuchniak
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Akpevwe Onoyovwi
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Jill Korsiak
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Michael Leung
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Aguiar M, Andronis L, Pallan M, Högler W, Frew E. The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales. Eur J Clin Nutr 2019; 74:825-833. [PMID: 31427760 DOI: 10.1038/s41430-019-0486-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vitamin D deficiency (VDD) affects the health and wellbeing of millions worldwide. In high latitude countries such as the United Kingdom (UK), severe complications disproportionally affect ethnic minority groups. OBJECTIVE To develop a decision-analytic model to estimate the cost effectiveness of population strategies to prevent VDD. METHODS An individual-level simulation model was used to compare: (I) wheat flour fortification; (II) supplementation of at-risk groups; and (III) combined flour fortification and supplementation; with (IV) a 'no additional intervention' scenario, reflecting the current Vitamin D policy in the UK. We simulated the whole population over 90 years. Data from national nutrition surveys were used to estimate the risk of deficiency under the alternative scenarios. Costs incurred by the health care sector, the government, local authorities, and the general public were considered. Results were expressed as total cost and effect of each strategy, and as the cost per 'prevented case of VDD' and the 'cost per Quality Adjusted Life Year (QALY)'. RESULTS Wheat flour fortification was cost saving as its costs were more than offset by the cost savings from preventing VDD. The combination of supplementation and fortification was cost effective (£9.5 per QALY gained). The model estimated that wheat flour fortification alone would result in 25% fewer cases of VDD, while the combined strategy would reduce the number of cases by a further 8%. CONCLUSION There is a strong economic case for fortifying wheat flour with Vitamin D, alone or in combination with targeted vitamin D3 supplementation.
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Affiliation(s)
- M Aguiar
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - L Andronis
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Population, Evidence and Technologies, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - M Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - W Högler
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Johannes Kepler University, Linz, A-4040, Austria.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - E Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
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Uday S, Högler W. Spot the silent sufferers: A call for clinical diagnostic criteria for solar and nutritional osteomalacia. J Steroid Biochem Mol Biol 2019; 188:141-146. [PMID: 30654108 DOI: 10.1016/j.jsbmb.2019.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 01/02/2019] [Accepted: 01/12/2019] [Indexed: 11/29/2022]
Abstract
Osteomalacia and rickets result from defective mineralization when the body is deprived of calcium. Globally, the main cause of osteomalacia is a lack of mineral supply for bone modeling and remodeling due to solar vitamin D and/or dietary calcium deficiency. Osteomalacia occurs when existing bone is replaced by unmineralized bone matrix (osteoid) during remodeling in children and adults, or when newly formed bone is not mineralized in time during modeling in children. Rickets occurs when hypomineralization affects the epiphyseal growth plate chondrocytes and adjacent bone metaphysis in growing children. Hence, osteomalacia co-exists with rickets in growing children. Several reports in the last decade highlight the resurgence of so-called "nutritional" rickets in the dark-skinned population living in high-income countries. However, very few studies have ever explored the hidden iceberg of nutritional osteomalacia in the population. Rickets presents with hypocalcaemic (seizures, tetany, cardiomyopathy), or hypophosphataemic complications (leg bowing, knock knees, rachitic rosary, muscle weakness) and is diagnosed on radiographs (cupping and fraying of metaphyses). In contrast, osteomalacia lacks distinctive, non-invasive diagnostic laboratory or imaging criteria and the clinical presentation is non-specific (general fatigue, malaise, muscle weakness and pain). Hence, osteomalacia remains largely undiagnosed, as a hidden disease in millions of dark-skinned people who are at greatest risk. Radiographs may demonstrate Looser's zone fractures in those most severely affected, however to date, osteomalacia remains a histological diagnosis requiring a bone biopsy. Biochemical features of high serum alkaline phosphatase (ALP), high parathyroid hormone (PTH) with or without low 25 hydroxyvitamin D (25OHD) concentrations are common to both rickets and osteomalacia. Here, we propose non-invasive diagnostic criteria for osteomalacia. We recommend a diagnosis of osteomalacia in the presence of high ALP, high PTH, low dietary calcium intake (<300 mg/day) and/or low serum 25OHD (<30 nmol/L). Presence of clinical symptoms (as above) or Looser's zone fractures should be used to reaffirm the diagnosis. We call for further studies to explore the true prevalence of nutritional osteomalacia in various populations, specifically the Black and Asian ethnic groups, in order to identify the hidden disease burden and inform public health policies for vitamin D/calcium supplementation and food fortification.
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Affiliation(s)
- Suma Uday
- Department of Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, UK; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Wolfgang Högler
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Department of Paediatrics and Adolescent Medicine, Johannes Kepler University, Linz, Austria.
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Serum 25-hydroxyvitamin D response to vitamin D supplementation in infants: a systematic review and meta-analysis of clinical intervention trials. Eur J Nutr 2019; 59:359-369. [PMID: 30721411 DOI: 10.1007/s00394-019-01912-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/23/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE For the prevention of nutritional rickets, 400 IU vitamin D daily and circulating 25-hydroxyvitamin D (25OHD) concentrations > 50 nmol/L are recommended, whereas the toxicity threshold is set at 250 nmol/L. We synthesized the evidence for the effect of vitamin D supplementation on incremental 25OHD in infants up to 1 year of age. METHODS We performed a systematic review and meta-analysis of intervention trials in several databases. A total of 87 records were identified for full-text review and 27 articles with 61 studies were included in the final analysis. RESULTS The selected 61 studies included 1828 participants. Nineteen cohorts had already mean baseline 25OHD levels ≥ 50 nmol/L. The weighted mean difference in 25OHD following vitamin D supplementation was + 49.4 nmol/L (95% CI 43.6-55.3 nmol/L; P < 0.001). The increment was dose-dependent (P = 0.002), was higher in full-term than in pre-term infants (P < 0.001), was higher in infants with baseline 25OHD < 50 nmol/L as compared to ≥ 50 nmol/L (P = 0.001), and was marginally influenced by the 25OHD test procedure (P = 0.080). Vitamin D3 doses of 400 IU/day were sufficient to achieve 25OHD concentrations ≥ 50 nmol/L in most full-term infants. A 25OHD level of 250 nmol/L was not exceeded in ≥ 97.5% of infants at doses between 200 and 1200 IU/day, but potentially in ≥ 2.5% of infants at a dose of 1600 IU/day. CONCLUSIONS Vitamin D supplementation of 400 IU/day is sufficient for achieving 25OHD concentrations able to prevent nutritional rickets. A more personalized vitamin D dosing strategy would require 25OHD testing, but also assay standardization.
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Uday S, Högler W. Prevention of rickets and osteomalacia in the UK: political action overdue. Arch Dis Child 2018; 103:901-906. [PMID: 29661756 DOI: 10.1136/archdischild-2018-314826] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
The consequences of vitamin D and dietary calcium deficiency have become a huge public health concern in the UK. The burden of disease from these deficiencies includes rickets, and hypocalcaemic seizures, dilated cardiomyopathy and mostly occult myopathy and osteomalacia. The increasing burden of the disease is intrinsically linked to ethnicity and the population demographic changes in the UK. Three facts have led to the resurfacing of the English disease: (1) the UK has no ultraviolet sunlight for at least 6 months of the year, (2) dark skin produces far less vitamin D than white skin per unit ultraviolet light exposure, and (3) non-European Union immigration over the last century. To date, the UK government demonstrates incomplete understanding of these three facts, and its failure to adjust its prevention programmes to changing demographics is endangering the health and life of UK residents with dark skin, of whom infants are the most vulnerable. Establishing accountability through the implementation of monitored antenatal and infantile supplementation programmes and mandatory food fortification is overdue.
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Affiliation(s)
- Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Wolfgang Högler
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Uday S, Fratzl-Zelman N, Roschger P, Klaushofer K, Chikermane A, Saraff V, Tulchinsky T, Thacher TD, Marton T, Högler W. Cardiac, bone and growth plate manifestations in hypocalcemic infants: revealing the hidden body of the vitamin D deficiency iceberg. BMC Pediatr 2018; 18:183. [PMID: 29940979 PMCID: PMC6019205 DOI: 10.1186/s12887-018-1159-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst hypocalcemic complications from vitamin D deficiency are considered rare in high-income countries, they are highly prevalent among Black, Asian and Minority Ethnic (BAME) group with darker skin. To date, the extent of osteomalacia in such infants and their family members is unknown. Our aim was to investigate clinical, cardiac and bone histomorphometric characteristics, bone matrix mineralization in affected infants and to test family members for biochemical evidence of osteomalacia. CASE PRESENTATION Three infants of BAME origin (aged 5-6 months) presented acutely in early-spring with cardiac arrest, respiratory arrest following seizure or severe respiratory distress, with profound hypocalcemia (serum calcium 1.22-1.96 mmol/L). All infants had dark skin and vitamin D supplementation had not been addressed during child surveillance visits. All three had severely dilated left ventricles (z-scores + 4.6 to + 6.5) with reduced ejection fraction (25-30%; normal 55-70), fractional shortening (7 to 15%; normal 29-40) and global hypokinesia, confirming hypocalcemic dilated cardiomyopathy. They all had low serum levels of 25 hydroxyvitamin D (25OHD < 15 nmol/L), and elevated parathyroid hormone (PTH; 219-482 ng/L) and alkaline phosphatase (ALP; 802-1123 IU/L), with undiagnosed rickets on radiographs. One infant died from cardiac arrest. At post-mortem examination, his growth plate showed a widened, irregular zone of hypertrophic chondrocytes. Histomorphometry and backscattered electron microscopy of a trans-iliac bone biopsy sample revealed increased osteoid thickness (+ 262% of normal) and osteoid volume/bone volume (+ 1573%), and extremely low bone mineralization density. Five of the nine tested family members had vitamin D deficiency (25OHD < 30 nmol/L), three had insufficiency (< 50 nmol/L) and 6/9 members had elevated PTH and ALP levels. CONCLUSIONS The severe, hidden, cardiac and bone pathology described here exposes a failure of public health prevention programs, as complications from vitamin D deficiency are entirely preventable by routine supplementation. The family investigations demonstrate widespread deficiency and undiagnosed osteomalacia in ethnic risk groups and call for protective legislation.
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Affiliation(s)
- Suma Uday
- Department of Endocrinology & Diabetes, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Nadja Fratzl-Zelman
- 1st Medical Department Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre, Meidling, Vienna, Austria
| | - Paul Roschger
- 1st Medical Department Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre, Meidling, Vienna, Austria
| | - Klaus Klaushofer
- 1st Medical Department Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre, Meidling, Vienna, Austria
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Vrinda Saraff
- Department of Endocrinology & Diabetes, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Ted Tulchinsky
- Emeritus, Braun School of Public Health and Community Medicine, Hadassah Medical Center, Hebrew University-Hadassah, Ein Karem, Jerusalem, Israel
| | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamas Marton
- Department of Cellular Pathology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Wolfgang Högler
- Department of Endocrinology & Diabetes, Birmingham Women's and Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. .,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
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Fiscaletti M, Stewart P, Munns CF. The importance of vitamin D in maternal and child health: a global perspective. Public Health Rev 2017; 38:19. [PMID: 29450091 PMCID: PMC5809824 DOI: 10.1186/s40985-017-0066-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/21/2017] [Indexed: 12/12/2022] Open
Abstract
Vitamin D and calcium are important nutrients for skeletal growth and bone health. Children and pregnant women are particularly vulnerable to 25-hydroxy vitamin D deficiency (VDD). VDD, with or without dietary calcium deficiency, can lead to nutritional rickets (NR), osteomalacia, and disturbances in calcium homeostasis. Multiple studies have linked VDD to adverse health outcomes in both children and pregnant women that extend beyond bone health. VDD remains an important global public health concern, and an important differentiation must be made between the impact of VDD on children and adults. Reports of increased incidence of NR continue to emerge. NR is an entirely preventable condition, which could be eradicated in infants and children worldwide with adequate vitamin D and calcium supplementation. The desire and necessity to put in place systems for preventing this potentially devastating pediatric disease should not elicit dispute. VDD and NR are global public health issues that require a collaborative, multi-level approach for the implementation of feasible preventative strategies. This review highlights the history, risk factors, and controversies related to VDD during pregnancy and childhood with a particular focus on global NR prevention.
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Affiliation(s)
- M Fiscaletti
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - P Stewart
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - CF Munns
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
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