Evidence of a significant vitamin D deficiency among 9-13-year-old Polish children: results of a multicentre study.

PURPOSE: To evaluate the extent to which the population of Polish preadolescents is vitamin D deficient and to assess seasonal variations in vitamin D status. PARTICIPANTS AND METHODS: A total of 720 healthy children aged 9-13 years (409 girls, 311 boys) residing in 6 representative geographical locations in Poland were studied. A parental-assisted questionnaire provided data on nutritional habits, vitamin D supplements and sun exposure. Serum concentration of 25-hydroxyvitamin was determined twice, after the winter in March and after the summer in October. RESULTS: In March, vitamin D deficiency (25-50 nmol/L) was found in 64%, and severe deficiency (< 25 nmol/L) in 20.2% of children. In October, the deficiency and severe deficiency were still noticed in 25.9 and 0.1% of children, respectively. The mean serum concentration of 25-OHD was 52% higher in October (55.4 ± 14.0 nmol/L) than in March (36.4 ± 13.5 nmol/L), (p < 0.01). In children with 25-OHD < 50 nmol/L in March, their 25-OHD concentration increased by 64% through March to October (32.5 ± 8.2 vs. 53.2 ± 7.9 nmol/L, p < 0.01). An association was found between 25-OHD concentration and regular consumption of vitamin D supplements, cod-liver oil and fish. CONCLUSIONS: The majority of preadolescent Polish boys and girls show vitamin D deficiency after the winter period, although a distinct amelioration over summertime is found in this age group. There is a need to implement effective prevention and intervention strategies in the management of vitamin D deficiency among schoolchildren in Poland, with the supplementation throughout the entire year.

Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland-Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies-2018 Update.

INTRODUCTION: Vitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency. METHODS: A systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations. RESULTS: The updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care. CONCLUSION: Vitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies and should also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.

Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency.

INTRODUCTION: Adequate Vitamin D intake and its concentration in serum are important for bone health and calcium-phosphate metabolism as well as for optimal function of many organs and tissues. Documented trends in lifestyle, nutritional habits and physical activity appear to be associated with moderate or severe Vitamin D deficits resulting in health problems. Most epidemiological studies suggest that Vitamin D deficiency is prevalent among Central European populations. Concern about this problem led to the organising of a conference focused on overcoming Vitamin D deficiency. METHODS: After reviewing the epidemiological evidence and relevant literature, a Polish multidisciplinary group formulated theses on recommendations for Vitamin D screening and supplementation in the general population. These theses were subsequently sent to Scientific Committee members of the 'Vitamin D - minimum, maximum, optimum' conference for evaluation based on a ten-point scale.With 550 international attendees, the meeting 'Vitamin D - minimum, maximum, optimum' was held on October 19-20, 2012 in Warsaw(Poland). Most recent scientific evidence of both skeletal and non-skeletal effects of Vitamin D as well as the results of panellists' voting were reviewed and discussed during eight plenary sessions and two workshops. RESULTS: Based on many polemical discussions, including post-conference networking, the key opinion leaders established ranges of serum 25-hydroxyVitamin D concentration indicating Vitamin D deficiency [< 20 ng/mL (< 50 nmol/L)], suboptimal status [20-30 ng/mL(50-75 nmol/L)], and target concentration for optimal Vitamin D effects [30-50 ng/mL (75-125 nmol/L)]. General practical guidelines regarding supplementation and updated recommendations for prophylactic Vitamin D intakes in Central European neonates, infants, children and adolescents as well as in adults (including recommendations for pregnant and breastfeeding women and the elderly) were developed. CONCLUSIONS: Improving the Vitamin D status of children, adolescents, adults and the elderly must be included in the priorities of physicians,healthcare professionals and healthcare regulating bodies. The present paper offers elaborated consensus on supplementation guidance and population strategies for Vitamin D in Central Europe.

[The vitamin D and calcium consumption and bone quality in children of lódZ (Poland) at the age 9-13 years]. / Spozycie witaminy D i wapnia a jakosc kosci dzieci lódzkich w wieku 9-13 lat.

INTRODUCTION: Only few publications concern the influence of the vitamin D and calcium consumption on the bone mineralization in the developmental age. AIM OF THE STUDY: The aim of the study was the analysis of the vitamin D and calcium diet supply in relation to the bone status assessed with Quantitative Ultrasound (QUS) in growing children. MATERIAL AND METHODS: The study comprised 643 pupils (384 girls and 259 boys) at the age 9-13 years from primary schools in lódZ. The medium daily consumption of vitamin D and calcium was estimated with the computer program Dieta 2. In all children the QUS was performed. RESULTS: Extreme deficiency of vitamin D was found in the diet of nearly all examined children (in 96,7% schoolgirls and 95,7% schoolboys). Girls consumed on average 25,5% of recommended values, boys 33,3%. Considerable deficiency of diet calcium was observed in 92% schoolgirls and 81,9% of schoolboys. The medium daily consumption of calcium was higher than vitamin D and reached 59,2% of recommended values in girls and 66,2% in boys. In 48% of children an decrease of at least one of the QUS parameters was observed. The statistical analysis showed positive, significant correlation between QUS parameters and calcium consumption, it was not observed for vitamin D. CONCLUSIONS: 1. The deficiency of diet vitamin D and calcium is common in children in lódZ. 2. The extremely low supply of diet vitamin D does not meet the recommended values. 3. The lowering of the QUS parameters observed in 48% of children indicates for worse bone mineralization and bone quality. 4. The results of this study indicate for the necessity of changes in nutritional habits of children and adolescence and if it is not possible the supplementation of vitamin D and calcium.

The clinical efficacy of vitamin D in children with primary low bone mass.

INTRODUCTION: Vitamin D supplementation in prevention and treatment of osteoporosis is a widely accepted standard, but the latest studies show the necessity of increasing the intake of this vitamin to keep its concentration on higher levels - above 30 ng/ml. The best index describing the body vitamin D supply is hepatic metabolite of vitamin D (25OHD) concentration in the serum. There are few data on efficacy of this vitamin intake in children with low bone mass. AIM OF THE STUDY was to find out if vitamin D supplementation causes a significant increase in the hepatic metabolite concentrations and how it affects the clinical course of the disease and the results of densitometric tests in children with primary low bone mass. MATERIAL AND METHODS: Seventy six children aged 6 to 18.5 years (35 girls and 41 boys) with primary osteoporosis or low bone mass diagnosed based on clinical and densitometric signs were included in the study. In all children, the concentrations of 25OD and PTH were measured and densitometric evaluations were taken twice, before and after 1 year of vitamin D intake. According to literature data, 30 ng/ml was adopted as the lower limit of normal 25OHD levels in children with osteoporosis and low bone mass. RESULTS: Vitamin D supplementation for 12 months of osteoporosis and low bone mass therapy in children caused a statistically significant increase in concentrations of the hepatic metabolite of vitamin D and a significant reduction in serum PTH levels. The changes in 25OHD levels depended on the vitamin D dose used (658 IU/day), and only this amount allowed to achieve an improvement in the densitometric parameters, in particular the increase in bone mineral density (BMD) in the lumbar spine. CONCLUSIONS: 1. Based on the performed study in children with idiopathic reduction of bone mineral density the normalisation of the calcitropic hormones and improvement in the densitometric parameters assessing bone mineral density is necessary. 2. A detailed statistical analysis has shown that the increase in both vitamin D metabolites and bone mineral density is caused by vitamin D supplementation at a dose of 685 IU/day; this is an important practical aspect of this study.

[Recommendations of prophylaxis of vitamin D deficiency in Poland (2009)]. / Zalecenia dotyczace profilaktyki niedoborów witaminy D w polsce (2009).

Adequate vitamin D intake and its status as well outdoor physical activity are important not only for normal bone development and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. National Consultants and experts in this field established the Polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women based on current literature review. Taking into consideration pleyotropic vitamin D action and safety aspects serum 25-hydroxyvitamin D (25-OHD) level of 20-60 ng/ml (50-750 nmol/l) in children and 30-80 ng/ml (75-200 nmol/I) in adults is considered as optimal. Sunlight exposure inducing vitamin D production in the skin is main endogen source of vitamin D in the body but sunscreens may reduce skin synthesis by 90%. In Poland, skin synthesis is effective only from April to September so other sources of vitamin D such as diet and supplements play an important role. All newborns should be supplemented with 400 IU/d of vitamin D beginning from the first few days of life and continue during infancy. In formula fed infants vitamin D intake from the diet should be taken into account. In preterm infants higher total vitamin D intake (400-800 IU/day) is recommended till 40 weeks post conception. Total vitamin D intake in children and adolescents required from all sources (diet and/or supplements) should be 400 IU/d between October and March and throughout the whole year in case of inadequate vitamin D skin synthesis during the summer months. In overweight/obese children supplementation with higher dosage of vitamin D up to 800-1000 IU/d should be considered. Adults require 800-1000 IU/d of vitamin D. In pregnant and lactating women such supplementation is recommended in case of inadequate intake from diet and/or skin synthesis supplementation. Monitoring of serum 25-OHD level to define optimal dosage should be considered.

[Prophylaxis of vitamin D deficiency--Polish recommendations 2009]. / Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D--2009.

Appropriate state procurement system for vitamin D is important not only for the proper functioning of the skeletal, maintaining calcium and phosphorus homeostasis, but also for a number of other organs and tissues in our body. In connection with the change in lifestyle including dietary habits change, the widespread use of UV filters and less outdoor activity, observed an increase in the percentage of vitamin D deficiency, both in population and developmental age and adults. Based on the results of recent scientific research team of experts provides recommendations for preventive Polish supply of vitamin D in infants, children, adolescents and adults, including pregnant women and nursing mothers.

[Prophylaxis of vitamin D deficiency--Polish recommendation 2009]. / Stanowisko Zespolu Ekspertów. Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D - 2009.

Adequate vitamin D intake and its status are important not only for bone health and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. Basing on current literature review and opinions of National Consultants and experts in the field, polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women have been established.

New trends in the treatment of osteogenesis imperfecta type III - own experience.

INTRODUCTION: Osteogenesis imperfecta (OI) is a genetic disorder caused by a mutation in the genes that encode the chains of type I collagen. Clinical manifestations include increased bone fragility and blue sclerae. OI type III is the most severe form with fractures occurring already in utero. Fracture immobilisation and orthopaedic surgery are the mainstay of treatment for patients with OI, and are combined with rehabilitation and bisphosphonate therapy. PATIENTS AND METHODS: The study involved 8 children with osteogenesis imperfecta type III, aged 1 month to 6 years. All of them were treated with cyclic intravenous infusions of pamidronate. Laboratory studies conducted before and after each 3-day cycle of pamidronate therapy included complete blood count, serum calcium, phosphorus, magnesium, osteocalcin, and calcium/creatinine index in morning urine and collagen type I cross-linked N-telopeptide (NTx). Infant total body densitometric scans were obtained in 5/8 patients. RESULTS: Patients were treated for periods of 3-58 months. Fracture rates decreased with treatment in all patients compared to the prenatal period. Pamidronate also slowed down bone turnover, and particularly the resorption rate. The most common side effects during treatment included hypocalcaemia (7/8 patients) and fever (up to 39 degrees C) after the first cycle of treatment. CONCLUSION: Symptomatic bisphosphonate therapy in children with osteogenesis imperfecta ameliorated the clinical course (decreased bone pain and reduced incidence of fractures). Pamidronate therapy had a positive impact on functional parameters such as independence in everyday activities and better mobility. The treatment was safe.

[Assessment of bone mineralization and dietary intake of select nutritional components in school children from Lódz]. / Ocena stanu mineralizacji koscca i pokrycia zapotrzebowania na wybrane skladniki pokarmowe u dzieci lódzkich w wieku szkolnym.

UNLABELLED: Development of bone mass, except genetic disposition, is modulated by environmental factors, especially diet. THE AIM of this study was to evaluate the skeleton mineralization and the influence of some nutritional components on bone mineralization in school children. MATERIAL AND METHODS: The study comprised 170 healthy children (92 girls and 78 boys) aged of 9,1-14,7 years, attending schools in Lódz. Mean dietary intake of calcium, phosphorus, potassium, natrium, magnesium, vitamin D and protein was assessed by a 3-day diet interview. Nutritional analysis was performed by computer program Dieta2. Bone mineralization was evaluated by ultrasound examination of the calcaneous with Achilles Solo plus apparatus. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and automatically calculated Stiffness index were analysed. Reference values were accepted as +/- 1,00 standard deviation from mean values for sex and age (Z-score). RESULTS: A lot of abnormalities in dietary intake of chosen nutritional compounds were found: significantly low vitamin D intake in all studied school kids (mean - 23% of reference daily intake, in children with vitamin D supplementation - 36.1%), calcium deficiency in 148 children (mean daily intake - 62.1% of reference uptake) and magnesium deficiency in 82 children. In all examined subjects high natrium consumption was found (mean 659.9%) and increased protein intake in 142 and phosphorus in 127 children were observed (152.9% and 135.5% of reference daily uptake, respectively). Decreased Z-score values for Stiffness index in 37 school kids, for SOS in 75, and for BUA in 15 were observed; the lowering of at least of one of the examined parameters was found in 79 children (46.5%). Increased Stiffness index was stated in 25 subjects, SOS in 8, and BUA in 54. CONCLUSIONS: Results of this study indicate that vitamin D, calcium and magnesium deficiency and evaluated consumption of natrium, protein and phosphorus are very common in the diet of school children. These abnormalities may decrease skeletal mineralization in the developmental age, and also later in the life.