Preview

Current Pediatrics

Advanced search

DIFFERENTIATED («SEASON») APPROACH TO THE PROPHYLAXIS OF VITAMIN D3 INSUFFICIENCY IN CHILDREN

Abstract

Vitamin D is key part of bone tissue metabolism as in children, as in adult. It is considered that the needed quantity of vitamin D is synthesized by skin cells within ultraviolet light. As a result, provision with endogenous vitamin D significantly changes during the year; the maximum can be reached in summer months, lessening in winter. Straight consequence of these changes is insufficient bone mineralization in children. A correction of insufficiency of vitamin D, depending on season, seems to be well-grounded. But still there are some unsolved questions. It’s not clear, when «season» prophylaxis should be started, and how long should it be prolonged. Shall we use fortified food? What criteria can be used for the control of effectiveness of these measures? There is no research on this theme in Russia. Only data from single studies allow supposing that more than a half of Russian children have vitamin D insufficiency.
Key words: children, vitamin D, «season» insufficiency, prophylaxis, bone mineral density.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(5):70-79)

About the Author

R.T. Saygitov
Scientific Center of Children’s Health, Russian Academy of Medical Sciences, Moscow
Russian Federation


References

1. McCollum E.F., Simmonds N., Becker J.E., Shipley P.G. Studies on experimental rickets and experimental demonstration of the existence of a vitamin which promotes calcium deposition. J. Biol. Chem. 1922; 53: 293–312.

2. Huldschinsky K. Curing rickets by artificial UV–radiation (Heilung von Rachitis durch Kunstliche Hohensonne). Deutsche Med. Wochenschr. (in German). 1919; 45: 712–713.

3. Rauschkolb E.W., Winston D., Fenimore D.C. et al. Identification of vitamin D3 in human skin. J. Invest. Dermatol. 1969; 53: 289–293.

4. Sniadecki J. Cited by W. Mozolowski. Jerdrzej Sniadecki (1768-1883) on the cure of rickets. Nature. 1939; 143: 121 (цитировано по: Holick M.F. McCollum Award Lecture, 1994: vitamin D – new horizons for the 21st century. Am. J. Clin. Nutr. 1994; 60 (4): 619–630.

5. Norman A.W. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am. J. Clin. Nutr. 2008; 88 (2): 491–499.

6. Engelsen O., Brustad M., Aksnes L., Lund E. Daily duration of vitamin D synthesis in human skin with relation to latitude, total ozone, altitude, ground cover, aerosols and cloud thickness. Photochem. Photobiol. 2005; 81 (6): 1287–1290.

7. MacLaughlin J., Holick M.F. Aging decreases the capacity of human skin to produce vitamin D3. J. Clin. Invest. 1985; 76 (4): 1536–1538.

8. Webb A.R., Engelsen O. Calculated ultraviolet exposure levels for a healthy vitamin D status. Photochem. Photobiol. 2006; 82 (6): 1697–1703.

9. Fitzpatrick T.B. The validity and practicality of sun-reactive skin types I through VI. Arch. Dermatol. 1988; 124 (6): 869–871.

10. Lenders CM, Feldman HA, Von Scheven E. et al. Relation of body fat indexes to vitamin D status and deficiency among obese adolescents. Am. J. Clin. Nutr. 2009; 90 (3): 459–467.

11. Glerup H., Mikkelsen K., Poulsen L. et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J. Intern. Med. 2000; 247: 260–268.

12. Hatun S., Islam O., Cizmecioglu F. et al. Subclinical vitamin D deficiency is increased in adolescent girls who wear concealing clothing. J. Nutr. 2005; 135 (2): 218–222.

13. Brot C., Vestergaard P., Kolthoff N. et al. Vitamin D status and its adequacy in healthy Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Br. J. Nutr. 2001; 86 (Suppl. 1): 97–103.

14. Devgun M.S., Paterson C.R., Johnson B.E., Cohen C. Vitamin D nutrition in relation to season and occupation. Am. J. Clin. Nutr. 1981; 34 (8): 1501–1504.

15. Calvo M.S., Whiting S.J., Barton C.N. Vitamin D fortification in the United States and Canada: current status and data needs. Am. J. Clin. Nutr. 2004; 80 (6): 1710–1716.

16. Нормы физиологических потребностей в энергии и пищевых веществах для различных групп населения Российской Федерации. Методические рекомендации. Под ред. Тутельяна В.А. М. 2008. 39 с.

17. Масягина О.А. Нарушение обмена кальция у детей с патологией щитовидной железы. Автореф. дис. …канд. мед. наук. СПб. 2006. 21 с.

18. Holick M.F. Vitamin D. A millenium perspective. J. Cell Biochem. 2003; 88: 296–307.

19. MacLaughlin J.A., Anderson R.R., Holick M.F. Spectral character of sunlight modulates photosynthesis of previtamin D3 and its photoisomers in human skin. Science. 1982; 216 (4549): 1001–1003.

20. Holick M.F., MacLaughlin J.A., Clark M.B. et al. Photosynthesis of previtamin D3 in human skin and the physiologic consequences. Science. 1980; 210: 203–205.

21. Dueland S., Pedersen J.I., Helgerud P., Drevon C.A. Absorption, distribution, and transport of vitamin D3 and 25-hydroxyvitamin D3 in the rat. Am. J. Physiol. 1983; 245: 463–467.

22. Norman A.W. Bone biochemistry and physiology from the perspectives of the vitamin D endocrine system. Current Opinion Rheumatol. 1992; 4: 375–382.

23. Holick M.F. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am. J. Clin. Nutr. 2004; 80 (Suppl. 6): 1678–1688.

24. Matsuoka L.Y., Ide L., Wortsman J. et al. Sunscreens suppress cutaneous vitamin D3. J. Clin. Endocrinol. Metab. 1987; 64: 1165–1168.

25. Preece M.A., Tomlinson S., Ribot C.A. et al. Studies of vitamin D deficiency in man. Q. J. Med. 1975; 44 (176): 575–589.

26. Schlichting C.L., Styer D.J. Vitamin D status of submariners during patrol. Naval Submarine Medical Research Laboratory, 1989. Report № 1129. [цитировано по: Gertner J., Horn W. Vitamin D supplementation in submariners. 2008. Доступно на: http://www.dtic.mil/dtic/].

27. Dlugos D.J., Perrotta P.L., Horn W.G. Effects of the submarine environment on renal-stone risk factors and vitamin D metabolism. Undersea Hyperb. Med. 1995; 22: 145–152.

28. Duplessis C.A., Harris E.B., Watenpaugh D.E., Horn W.G. Vitamin D supplementation in underway submariners. Aviat. Space Environ. Med. 2005; 76 (6): 569–575.

29. Meier C., Woitge H.W., Witte K. et al. Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: a randomized controlled open label prospective trial. J. Bone Miner. Res. 2004; 19 (8): 1221–1230.

30. Rockell J.E., Green T.J., Skeaff C.M. et al. Season and ethnicity are determinants of serum 25–hydroxyvitamin D concentrations in New Zealand children aged 5–14. J. Nutr. 2005; 135 (11): 2602–2608.

31. Davies P.S., Bates C.J., Cole T.J. et al. Vitamin D: seasonal and regional differences in preschool children in Great Britain. Eur. J. Clin. Nutr. 1999; 53 (3): 195–198.

32. Gordon C.M., DePeter K.C., Feldman H.A. et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch. Pediatr. Adolesc. Med. 2004; 158 (6): 531–537.

33. Willis C.M., Laing E.M., Hall D.B. et al. A prospective analysis of plasma 25-hydroxyvitamin D concentrations in white and black prepubertal females in the southeastern United States. Am. J. Clin. Nutr. 2007; 85 (1): 124–130.

34. Willett A.M. Factors affecting vitamin D status in older adolescents and their relevance to bone health. PhD Thesis. University of Cambridge. 2004. Proc. Nutr. Soc. 2005; 64 (2): 193-203.

35. Macdonald H.M., Mavroeidi A., Barr R.J. et al. Vitamin D status in postmenopausal women living at higher latitudes in the UK in relation to bone health, overweight, sunlight exposure and dietary vitamin D. Bone. 2008; 42 (5): 996–1003.

36. Heaney R.P., Davies K.M., Chen T.C. et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am. J. Clin. Nutr. 2003; 77 (1): 204-210.

37. Heaney R.P., Armas L.A., Shary J.R. et al. 25–Hydroxylation of vitamin D3: relation to circulating vitamin D3 under various input conditions. Am. J. Clin. Nutr. 2008; 87 (6): 1738–1742.

38. Stryd R.P., Gilbertson T.J., Brunden M.N. A seasonal variation study of 25–hydroxyvitamin D3 serum levels in normal humans. J. Clin. Endocrinol. Metab. 1979; 48 (5): 771–775.

39. Holick M.F. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am. J. Clin. Nutr. 2004; 79 (3): 362–371.

40. Bergstralh E.J., Sinaki M., Offord K.P. et al. Effect of season on physical activity score, back extensor muscle strength, and lumbar bone mineral density. J. Bone Miner. Res. 1990; 5 (4): 371–377.

41. Rapuri P.B., Kinyamu H.K., Gallagher J.C., Haynatzka V. Seasonal changes in calciotropic hormones, bone markers, and bone mineral density in elderly women. J. Clin. Endocrinol. Metab. 2002; 87 (5): 2024–2032.

42. Marwaha R.K., Tandon N., Reddy D.R. et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am. J. Clin. Nutr. 2005; 82 (2): 477–482.

43. Cashman K.D., Hill T.R., Cotter A.A. et al. Low vitamin D status adversely affects bone health parameters in adolescents. Am. J. Clin. Nutr. 2008; 87 (4): 1039–1044.

44. Foo L.H., Zhang Q., Zhu K. et al. Low vitamin D status has an adverse influence on bone mass, bone turnover, and muscle strength in Chinese adolescent girls. J. Nutr. 2009; 139 (5): 1002–1007.

45. Lehtonen-Veromaa M.K., Möttönen T.T., Nuotio I.O. et al. Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3 y. prospective study. Am. J. Clin. Nutr. 2002; 76 (6): 1446–1453.

46. Tylavsky F.A., Ryder K.M., Li R. et al. Preliminary findings: 25(OH) D levels and PTH are indicators of rapid bone accrual in pubertal children. J. Am. Coll. Nutr. 2007; 26 (5): 462–470.

47. Diplock A.T., Aggett P.J., Ashwell M. et al. Scientific concepts of functional foods in Europe. Br. J. Nutr. 1999; 81 (Suppl. 1): 1–27.

48. Seamans K.M., Cashman K.D. Existing and potentially novel functional markers of vitamin D status: a systematic review. Am. J. Clin. Nutr. 2009; 89 (6): 1997–2008.

49. Bener A., Al-Ali M., Hoffmann G.F. High prevalence of vitamin D deficiency in young children in a highly sunny humid country: a global health problem. Minerva Pediatr. 2009; 61 (1): 15–22.

50. Bischoff-Ferrari H.A., Willett W.C., Wong J.B. et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch. Intern. Med. 2009; 169 (6): 551–561.

51. Bischoff-Ferrari H.A., Dawson–Hughes B., Staehelin H.B. et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009; 339: 3692.

52. Viljakainen H.T., Natri A.M., Kärkkäinen M. et al. A positive dose-response effect of vitamin D supplementation on site specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo controlled 1year intervention. J. Bone Miner. Res. 2006; 21 (6): 836–844.

53. Wagner C.L., Greer F.R; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008; 122 (5): 1142–1152.

54. Cranney A., Horsley T., O'Donnell S. et al. Effectiveness and safety of vitamin D in relation to bone health. Evid. Rep. Technol. Assess (Full Rep). 2007; 158: 1–235.

55. McKenna M.J., Freaney R., Byrne P. et al. Safety and efficacy of increasing wintertime vitamin D and calcium intake by milk fortification. QJM. 1995; 88 (12): 895–898.

56. O'Donnell S., Cranney A., Horsley T. et al. Efficacy of food fortification on serum 25–hydroxyvitamin D concentrations: systematic review. Am. J. Clin. Nutr. 2008; 88 (6): 1528–1534.

57. Щеплягина Л.А., Моисеева Т.Ю. Дефицит кальция — возможности пищевой коррекции у дошкольников. Consilium medicum. Педиатрия. 2007; 1: 80–83.


Review

For citations:


Saygitov R. DIFFERENTIATED («SEASON») APPROACH TO THE PROPHYLAXIS OF VITAMIN D3 INSUFFICIENCY IN CHILDREN. Current Pediatrics. 2009;8(5):70-79.

Views: 513


ISSN 1682-5527 (Print)
ISSN 1682-5535 (Online)