British Paediatric and Adolescent Bone Group's position statement on vitamin D deficiency

Arundel, Paul; Ahmed, Sonia; Allgrove, Jeremy; Bishop, Nick; Burren, Christine; Jacobs, Benjamin; Mughal, M Z; Offiah, A.C.; Shaw, N J; Paediatric, British

doi:10.1136/bmj.e8182

Cited by 58 publications

(50 citation statements)

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“…Although many clinical outcomes, including fracture and low BMD, have been linked with low circulating 25(OH)D, this remains an appropriate strategy in the absence of the definitive documentation of truly causal associations for such other conditions. Indeed, taken in the round, a threshold of 25nmol/l for deficiency, as suggested by the British Paediatric and Adolescent Bone Group [25], appears likely to prevent most cases of VDD rickets [28].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the suggested threshold for a serum 25(OH)D which is felt to constitute adequacy varies from 25 to 75nmol/l [23][24][25][26], however 25(OH)D status has been associated with a wide variety of clinical outcomes across most organ systems. Many definitions for vitamin D sufficiency have been based on a threshold for secondary hyperparathyroidism, however, even in adults there does not appear to be a single threshold below which this occurs [27].…”

Section: Serum 25-hydroxyvitamin D [25(oh)d] Is Currently Considered mentioning

confidence: 99%

“…Case-control studies of serum 25 In these studies, 25(OH)D was originally reported in ng/ml. It has been converted to nmol/l using a conversion factor of 1ng/ml=2.49nmol/l.…”

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confidence: 99%

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Vitamin D and skeletal health in infancy and childhood

et al. 2014

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During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High quality randomised trials are now required to confirm this benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Serum 25-hydroxyvitamin D [25(oh)d] Is Currently Considered mentioning

confidence: 99%

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Vitamin D and skeletal health in infancy and childhood

et al. 2014

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“…The recommendations of the Institute of Medicine in the USA for serum 25(OH)D concentration and vitamin D intake are mainly based on the effects of vitamin D on bone health, because evidence on its effects on other outcomes is still not strong enough to inform the recommendations (3) . There is no consensus on the optimal serum level of 25(OH)D. The limit of serum 25(OH)D concentration for vitamin D deficiency varies between 25 and 50 nmol/l, and the lower limit for the sufficient serum 25(OH)D concentration is suggested by some authors to be as high as 75 nmol/l (1)(2)(3)(4)(5)(6)(7)(8) . There is some evidence that serum 25(OH)D concentration above 125 nmol/l may increase the risk of vitamin D intoxication followed by hypercalcaemia, hypercalciuria and premature death (3) .…”

Section: Introductionmentioning

confidence: 99%

Determinants of serum 25-hydroxyvitamin D concentration in Finnish children: the Physical Activity and Nutrition in Children (PANIC) study

et al. 2016

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We studied vitamin D intake, serum 25-hydroxyvitamin D (S-25(OH)D) concentration, determinants of S-25(OH)D and risk factors for S-25(OH)D <50 nmol/l in a population sample of Finnish children. We studied 184 girls and 190 boys aged 6-8 years, analysed S-25(OH)D by chemiluminescence immunoassay and assessed diet quality using 4-d food records and other lifestyle factors by questionnaires. We analysed the determinants of S-25(OH)D using linear regression and risk factors for S-25(OH)D <50 nmol/l using logistic regression. Mean dietary intake of vitamin D was 5·9 (SD 2·1) µg/d. Altogether, 40·8 % of children used no vitamin D supplements. Of all children, 82·4 % did not meet the recommended total vitamin D intake of 10 µg/d. Milk fortified with vitamin D was the main dietary source of vitamin D, providing 48·7 % of daily intake. S-25(OH)D was <50 nmol/l in 19·5 % of children. Consumption of milk products was the main determinant of S-25(OH)D in all children (standardised regression coefficient β = 0·262; P < 0·001), girls (β = 0·214; P = 0·009) and boys (β = 0·257; P = 0·003) in multivariable models. Vitamin D intake from supplements (β = 0·171; P = 0·035) and age (β = − 0·198; P = 0·015) were associated with S-25(OH)D in girls. Children who drank ≥450 g/d of milk, spent ≥2·2 h/d in physical activity, had ≥13·1 h/d of daylight time or were examined in autumn had reduced risk for S-25(OH)D <50 nmol/l. Insufficient vitamin D intake was common among Finnish children, one-fifth of whom had S-25(OH)D <50 nmol/l. More attention should be paid to the sufficient intake of vitamin D from food and supplements, especially among children who do not use fortified milk products.Key words: Vitamin D: 25-Hydroxyvitamin D: Children: Determinants Vitamin D is a pro-hormone that is converted in the liver to 25-hydroxyvitamin D (25(OH)D) and then in the kidney to 1,25-dihydroxyvitamin D, the active metabolite that regulates Ca, P and bone metabolism (1) . Vitamin D can be obtained from foods and supplements or synthesised endogenously in the skin in response to the UVB radiation of the sun. The major circulating form of vitamin D in serum is 25(OH)D, which is commonly used as an indicator of vitamin D status. Knowledge of the health effects of vitamin D is increasing. In addition to the well-known beneficial effect of vitamin D on bone health, there is some evidence that higher serum levels of 25(OH)D are associated with better muscle strength (2) and decreased risk of several diseases such as type 1 diabetes and other autoimmune diseases, cancer and infections (1) . The recommendations of the Institute of Medicine in the USA for serum 25(OH)D concentration and vitamin D intake are mainly based on the effects of vitamin D on bone health, because evidence on its effects on other outcomes is still not strong enough to inform the recommendations (3) . There is no consensus on the optimal serum level of 25(OH)D. The limit of serum 25(OH)D concentration for vitamin D deficiency varies between 25 and 50 nmol/l, and the lower limit ...

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“…Vitamin D (25-hydroxyvitamin D2 and 25-hydroxyvitamin D3) status was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) using commercial standard in human serum (Chromsystems, München, Germany). Using the British Paediatric and Adolescent Bone Group's position statement, vitamin D deficiency was defined when serum vitamin D (25OHD) levels were < 25 nmol/L, insufficiency when levels were 25-50 nmol/L and sufficiency at a concentration greater than 50 nmol/L [14].…”

Section: Bone Biochemistrymentioning

confidence: 99%

A retrospective analysis of longitudinal changes in bone mineral content in cystic fibrosis

Chirita-Emandi

Shepherd

Kyriakou

et al. 2017

Journal of Pediatric Endocrinology and Metabolism

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Background: We aimed to describe the longitudinal changes in bone mineral content and influencing factors, in children with cystic fibrosis (CF). Methods: One hundred children (50 females) had dual X-ray absorptiometry (DXA) performed. Of these, 48 and 24 children had two to three scans, respectively over 10 years of follow-up. DXA data were expressed as lumbar spine bone mineral content standard deviation score (LSBMCSDS) adjusted for age, gender, ethnicity and bone area. Markers of disease, anthropometry and bone biochemistry were collected retrospectively. Results: Baseline LSBMCSDS was > 0.5 SDS in 13% children, between − 0.5; 0.5 SDS, in 50% and ≤ − 0.5 in the remainder. Seventy-eight percent of the children who had baseline LSBMCSDS > − 0.5, and 35% of the children with poor baseline (LSBMCSDS < − 0.5), showed decreasing values in subsequent assessments. However, mean LS BMC SDS did not show a significant decline in subsequent assessments (− 0.51; − 0.64; − 0.56; p = 0.178). Lower forced expiratory volume in 1 s percent (FEV1%) low body mass

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British Paediatric and Adolescent Bone Group's position statement on vitamin D deficiency

Cited by 58 publications

References 1 publication

Vitamin D and skeletal health in infancy and childhood

Vitamin D and skeletal health in infancy and childhood

Determinants of serum 25-hydroxyvitamin D concentration in Finnish children: the Physical Activity and Nutrition in Children (PANIC) study

A retrospective analysis of longitudinal changes in bone mineral content in cystic fibrosis

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