Sun Exposure in Children: Balancing the Benefits and Harms

High-dose oral vitamin D supplementation for prevention of infections in children aged 0 to 59 months: a systematic review and meta-analysis

CONTEXT

Vitamin D plays an important role in immune function, and the deficiency thereof has been associated with several infections, most notably respiratory tract infections. However, data from intervention studies investigating the effect of high-dose vitamin D supplementation on infections have been inconclusive.

OBJECTIVE

The aim of this study was to evaluate the level of evidence regarding the efficacy of vitamin D supplementation above the standard dose (400 IU) in preventing infections in apparently healthy children < 5 years of age.

DATA SOURCES

PubMed, Scopus, Science Direct, Web of Science, Google Scholar, CINAHL, and MEDLINE electronic databases were searched between August 2022 and November 2022. Seven studies met the inclusion criteria.

DATA EXTRACTION

Meta-analyses of outcomes in more than one study were performed using Review Manager software. Heterogeneity was evaluated using the I2 statistic. Randomized controlled trials in which vitamin D was supplemented at > 400 IU compared with placebo, no treatment, or standard dose were included.

DATA ANALYSIS

Seven trials that enrolled a total of 5748 children were included. Odds ratios (ORs) with 95%CIs were calculated using random- and fixed-effects models. There was no significant effect of high-dose vitamin D supplementation on the incidence of upper respiratory tract infection (OR, 0.83; 95%CI, 0.62-1.10). There was a 57% (95%CI, 0.30-0.61), 56% (95%CI, 0.27-0.07), and 59% (95%CI, 0.26-0.65) reduction in the odds of influenza/cold, cough, and fever incidence, respectively, with daily supplementation of vitamin D > 1000 IU. No effect was found on bronchitis, otitis media, diarrhea/gastroenteritis, primary care visits for infections, hospitalizations, or mortality.

CONCLUSION

High-dose vitamin D supplementation provided no benefit in preventing upper respiratory tract infections (moderate certainty of evidence) but reduced the incidence influenza/cold (moderate certainty of evidence), cough, and fever (low certainty of evidence). These findings are based on a limited number of trials and should be interpreted with caution. Further research is needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42022355206.

Assessment of maternal knowledge of solar exposure and vitamin D in the neonatal period

OBJECTIVE

To assess mothers' knowledge on sun exposure related to serum vitamin D levels in the neonatal period.

METHODS

Observational, analytical and cross-sectional study, carried out from August 2020 to May 2021 through a questionnaire directed to mothers of newborns, in a maternity hospital in Southern Brazil.

RESULTS

From 141 interviewees, 132 (93.6%) believe it is important to expose the neonate to sun, 101 (71.6%) think this exposure can increase vitamin D levels, 86 (61%) received such information from a doctor, 108 (76.6%) believe there are no risks of sun exposure, 88 (62.4%) claim it isn´t necessary to use any kind of protection, 96 (68.1%) said that only exposure to the sun was necessary to maintain adequate levels of vitamin D during the neonatal period. Only two mothers (1.4%) claim that you should not exposure the neonate to the sun, and only one (0.7%) stated that sun expose can cause skin problems.

CONCLUSIONS

Most mothers lack satisfactory knowledge about sun exposure related to serum vitamin D levels in the neonatal period. The need to inform and clarify the population about sun exposure during this period is remarkable, in addition to disseminating the proper way to maintain serum levels of vitamin D.

Relationship between maternal and infant serum vitamin D levels in Jos, Plateau State, Nigeria: a cross-sectional study

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.

The Sunlight-Vitamin D Connection: Implications for Patient Outcomes in the Surgical Intensive Care Unit

This review delves into the intricate relationship between Vitamin D and patient outcomes in the Surgical Intensive Care Unit (SICU). Vitamin D, known for its multifaceted roles in immune modulation, inflammation regulation, and maintenance of calcium homeostasis, emerges as a pivotal factor in the care of critically ill patients. Our exploration reveals a high prevalence of Vitamin D deficiency in the SICU, primarily attributable to limited sunlight exposure, comorbidities, and medication use. Importantly, Vitamin D status impacts infection rates, mortality, and length of stay in the SICU, making it a clinically relevant consideration. Mechanistic insights into the immunomodulatory and anti-inflammatory effects of Vitamin D shed light on its potential benefits in critical care. However, challenges, including accurate assessment, individualised supplementation, and ethical considerations regarding sunlight exposure, are evident. The prospect of personalised Vitamin D supplementation strategies offers promise for optimising patient care. In conclusion, the Sunlight-Vitamin D Connection holds significant potential to improve outcomes in the SICU, emphasising the importance of further research and tailored approaches for the well-being of critically ill individuals.

Consumer Behavior, Skin Phototype, Sunscreens, and Tools for Photoprotection: A Review

Sunscreens and photoprotection tools along with consumer habits and behaviors, can mitigate the skin damage caused by excessive solar radiation. For example, protecting oneself in the shade, avoiding inadequate sun exposure at times of higher incidence of UVB radiation (between 10:00 a.m. and 4:00 p.m.), wearing clothes with sun protection factors, applying sunscreens at the correct amounts and intervals, and wearing glasses with anti-UVA and UVB lenses are effective measures for protecting an individual. Therefore, the objective of this review was to highlight the importance of photoprotection for all skin phototypes, as skin cancer is a worldwide public health problem. In this review of the scientific literature on the Scopus platform between 2015 and 2022, we addressed the most common behaviors among different individuals and their phototypes, the importance of clarifying population habits against solar radiation, and the use of sunscreens and photoprotection tools to provide advice on healthy and safe sun exposure.

Breastfeeding and vitamin D

The recent re-emergence of vitamin D deficiency (VDD) and rickets among breastfed infants without adequate sunlight exposure and vitamin D supplementation has been reported worldwide. Breastfed infants are particularly vulnerable to VDD because of the low vitamin D content of breast milk, restricted sunlight exposure, increased pollution, and limited natural dietary sources of vitamin D. The prevalence of VDD in breastfed infants differs vastly between studies and nations at 0.6%-91.1%. The recommended intake of vitamin D for lactating mothers to optimize their overall vitamin D status and, consequently, of their breast milk is 200-2,000 IU/day, indicating a lack of consensus. Some studies have suggested that maternal high-dose vitamin D supplementation (up to 6,400 IU/day) can be used as an alternate strategy to direct infant supplementation. However, concern persists about the safety of maternal high-dose vitamin D supplementation. Direct infant supplementation is the currently available option to support vitamin D status in breastfed infants. The recommended dose for vitamin D supplementation in breastfed infants according to various societies and organizations worldwide is 200-1,200 IU/day. Most international guidelines recommend that exclusively or partially breastfed infants be supplemented with 400 IU/day of vitamin D during their first year of life. However, domestic studies on the status and guidelines for vitamin D in breastfed infants are insufficient. This review summarizes the prevalence of VDD in breastfed infants, vitamin D content of breast milk, and current guidelines for vitamin D supplementation of lactating mothers and infants to prevent VDD in breastfed infants.

Vitamin D Levels in Ethnic Minority Adolescents in Primary Care

INTRODUCTION

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

METHOD

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

RESULTS

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

DISCUSSION

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

Knowledge and Practice of Infants Exposure to Sunlight Among Lactating Mothers Attending at Yirgalem Hospital, Sidama Regional State

Background:

Exposure to sunlight is vital for the synthesis of vitamin-D and vitamin D plays an important role in growth and bones strength. Therefore, this study aimed to assess the knowledge and practice of infants exposure to sunlight among lactating women.

Methods:

A cross-sectional study was conducted from May 01 to 30, 2019 among 327 infant coupled lactating mothers attended at Yirgalem General Hospital. An interviewer-administered questionnaire was used to collect relevant data through a convenient sampling technique.

Results:

A total of 84.7% of respondents exposed infants to sunlight. More than 94% knew the benefit of exposing infants to sunlight. About 20.9%, 25.6%, and 19.9% of mothers exposed infants to sunlight within 15, 16 to 30, and 31 to 45 days of birth, respectively. In addition, 59.9% of respondents exposed infants to sunshine daily and 72.2% exposed without clothing the infants’ body. Moreover, 63.5% of mothers have applied lubricants and overall 54.5% of mothers exposed infants to sunlight in good practice. Unemployed women were 4.7 times more likely (aOR; 95%CI: 4.7; 2.0-11.4) to expose infants to sunlight when compared to those employed, while women whose husbands have at least secondary education level were 5.1 times more likely (aOR; 95%CI: 5.1; 1.6-16.1) to expose infants to sunlight when compared to those unable to read and write.

Conclusion:

More than 45% and more than one-third of lactating mothers had poor practice and exposed infants to sunlight for inadequate time, respectively. Therefore, the finding indicates a need for awareness creation to increase women’s knowledge and practice toward the exposure of infants to sunlight.