Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland.

Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total 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 optimal concentration [30-50 ng/mL (75-125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.

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.

[Tolerability of iron preparation Actiferol Fe® in children treated for iron deficiency anemia]. / Ocena tolerowania preparatu zelaza actiferol fe® u dziecl z niedokrwistoscia z niedoboru zelaza.

INTRODUCTION: Iron de„ciency anemia is the most frequently occurring anemia during the childhood period. Supplementation with adequate doses of iron remains a basic method of prevention and treatment. The various available products containing iron are characterized by a different degree of patient tolerability. Actiferol Fe® is a micronized, dispersible ferric pyrophosphate which improves its water solubility, and therefore it has better absorption and bioavailability. AIM OF THE STUDY: The assessment of tolerability of Actiferol Fe® in children who were administered this product to treat or prevent of iron de„ciency anemia. The methods of administration and the incidence of adverse effects were analyzed. MATERIALS AND METHODS: Eighty children (64 boys and 16 girls) aged from one month to 6 years who met the criteria of an indication to be treated with iron were included into the study. The assessment of selected parameters was based on the questionnaire which included questions about tolerability, method of administration, convenience of usage and adverse e#ects. The questionnaire was „lled in by parents (usually by the mother). RESULTS: The study indicated that Actiferol Fe® has very good or good tolerability in 87.5% (70/80) of patients - 46.3% (37/80) and 41.2% (33/80), respectively. The most frequent method of administration was in liquid form after dissolving: in water - 31,3% (25/80), in orange juice - 18.8% (15/80) or in milk formulas - in 17.5% (14/80) of patients. The method of administration was assessed as convenient or very convenient by 84% (67/80) of participants. Out of the adverse effects reported, the most frequent were change in the stool consistency into harder, abdominal pain and constipation - in 20% (16/80), 11.25% (9/80), 10% (8/80) cases, respectively. Diarrhea, pain during defecation occurred occasionally. A dark color of the stool was reported by 55% (44/80) of patients. In only one case (1.25%) the parents resigned from the product administration and replaced it with another iron product (no connection with tolerability of the formulation). CONCLUSION: Actiferol Fe® is a product characterized by good tolerability, convenient usage and mild adverse effects.