Serum 25-hydroxyvitamin D threshold and risk of rickets in young children: a systematic review and individual participant data meta-analysis to inform the development of dietary requirements for vitamin D.

Autor: Rios-Leyvraz M; Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland. magali.leyvraz@gmail.com., Thacher TD; Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA., Dabas A; Department of Pediatrics, Maulana Azad Medical College, New Delhi, India., Elsedfy HH; Department of Pediatrics, Ain Shams University, Cairo, Egypt., Baroncelli GI; Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy., Cashman KD; Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, and Department of Medicine, University College Cork, Cork, Ireland.
Jazyk: angličtina
Zdroj: European journal of nutrition [Eur J Nutr] 2024 Apr; Vol. 63 (3), pp. 673-695. Date of Electronic Publication: 2024 Jan 27.
DOI: 10.1007/s00394-023-03299-2
Abstrakt: Purpose: The objective of this systematic review was to determine a minimum serum 25-hydroxyvitamin D (25OHD) threshold based on the risk of having rickets in young children. This work was commissioned by the WHO and FAO within the framework of the update of the vitamin D requirements for children 0-3 years old.
Methods: A systematic search of Embase was conducted to identify studies involving children below  4 years of age with serum 25OHD levels and radiologically confirmed rickets, without any restriction related to the geographical location or language. Study-level and individual participant data (IPD)-level random effects multi-level meta-analyses were conducted. The odds, sensitivity and specificity for rickets at different serum 25OHD thresholds were calculated for all children as well as for children with adequate calcium intakes only.
Results: A total of 120 studies with 5412 participants were included. At the study-level, children with rickets had a mean serum 25OHD of 23 nmol/L (95% CI 19-27). At the IPD level, children with rickets had a median and mean serum 25OHD of 23 and 29 nmol/L, respectively. More than half (55%) of the children with rickets had serum 25OHD below 25 nmol/L, 62% below 30 nmol/L, and 79% below 40 nmol/L. Analysis of odds, sensitivities and specificities for nutritional rickets at different serum 25OHD thresholds suggested a minimal risk threshold of around 28 nmol/L for children with adequate calcium intakes and 40 nmol/L for children with low calcium intakes.
Conclusion: This systematic review and IPD meta-analysis suggests that from a public health perspective and to inform the development of dietary requirements for vitamin D, a minimum serum 25OHD threshold of around 28 nmol/L and above would represent a low risk of nutritional rickets for the majority of children with an adequate calcium intake.
(© 2024. The Author(s).)
Databáze: MEDLINE
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