Introduction: Vitamin D plays a key role in bone health of adolescents. Meanwhile, its potential extra-skeletal health benefits have resulted in the association of vitamin D deficiency with a wide range of acute and chronic diseases. As a consequence, hypovitaminosis D in adolescence is considered to have serious adverse effects and is highlighted as a global public health concern. Practical guidelines help clinicians make their preventive and therapeutic choices and improve care management.
Objective: Our purpose was to collect and synthesize available recommendations concerning vitamin D in adolescents, mainly vitamin D thresholds and vitamin D status, dietary requirements, prophylactic supplementation and treatment of deficiency.
Methods: We conducted a systematic review of the literature. We searched guidance published by different professional associations and governments from different regions of the world.
Results: We identified thirty-one documents. Most of them targeted the general population and not specifically the age group of adolescents. There is general agreement that adolescents should not have serum 25hydroxyvitamin D concentrations below 2530 nmol/L in order to avoid poor bone health. However, there is lack of consensus on the optimal concentration to aim for, levels varying between 25 nmol/L and 125 nmol/L. Adequate nutritional requirements of vitamin D are also controversial with values varying between 200 IU/d and 1,000 IU/d. The upper tolerable intake is estimated at 4,000 IU/d by all study groups. Certain associations recommend routine vitamin D supplementation in adolescents. The recommended daily doses vary between 400 IU and 2,000 IU, depending on skin pigmentation, sun exposure, consumption of vitamin D-fortified foods, body mass index and coexistence of certain medical conditions. In case of deficiency, an oral daily regimen of vitamin D, ergocalciferol/D2 or cholecalciferol/D3, is recommended for at least 4 weeks. A maintenance dose after the end of treatment is essential and is usually equivalent to the daily dietary intake recommended by the relevant study group.
Conclusion: At present, there is no consensus among the different societies and countries about vitamin D during adolescence. In clinical settings, this lack of consent makes decisions difficult or problematic under certain clinical conditions. Strong guidance is needed to establish homogenous, evidence-based recommendations.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology