Vitamin D deficiency in childhood is a re-emerging public health problem in developed countries. In addition to skeletal consequences, the vitamin deficiency is involved in the development of serious health extra-skeletal problems in childhood. Scientists have researched the available evidence in the field and the limitations of current strategies to control this condition.
Vitamin D deficiency (also known as Hypovitaminosis D) in childhood is a re-emerging public health problem in developed countries. The deficiency of vitamin D is known to cause rickets in children and osteomalacia (softening of the bones) in adults. Over the past two decades, new life style habits, the current obesity epidemic in children and adolescents and other preventable risk factors have led to a resurgence of nutritional rickets.
Vitamin D status is a major determinant of bone health in infants, children and adolescents, but increasing evidence shows that this vitamin has also important extra-skeletal effects. In this regard, the influence of vitamin D on the immune system through the modulation of both innate and adaptive immunity is of particular importance.
In their review article published in the Journal of Pediatric Endocrinology and Metabolism, the authors present article highlights on the need to establish a universally accepted “normal” vitamin D status in the general pediatric population and in children with special medical conditions. They also highlight how current strategies should be personalized for the screening, prevention and treatment of hypovitaminosis D.
Epidemiological studies have suggested that vitamin D deficiency may play a role in a variety of extra-skeletal disorders such as asthma, atopic dermatitis, type 1 diabetes mellitus, inflammatory bowel disease. As a result of these findings, interest in vitamin D has increased.
The recognition of vitamin D deficiency is often difficult on a clinical basis, as silent forms are by far the most common.
Currently, universal screening for hypovitaminosis D is not recommended, while pediatric groups at higher risk for insufficiency or deficiency should be screened, and supplemented where appropriate.
More hours of sunlight needed
In order to prevent vitamin D deficiency, there are few measures to be taken, namely increasing sunlight exposure, fortification of the habitual food supply, and vitamin D supplementation.
Treatment is aimed at replenishing the stores of 25-hydroxylated vitamin D, and should be restricted to children with symptomatic hypovitaminosis D, due to the potential for vitamin D toxicity.
Currently, no consensus exists on the “normal” serum levels of 25-hydroxylated vitamin D in children, and there are conflicting recommendations for vitamin D supplementation and treatment. Moreover, the short- and long-term global health impact of hypovitaminosis D remains to be defined.
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