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Vitamin D in Adolescents: A Systematic Review and Narrative Synthesis of Available Recommendations

  • Magdalini Patseadou
    Correspondence
    Address correspondence to: Magdalini Patseadou, M.D., Ph.D., Consultation Santé Jeunes, Département de la Femme, de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Genève, Boulevard de la Cluse 87, 1205 Geneva, Switzerland.
    Affiliations
    Adolescent and Young Adult Health Clinic, Department of Woman, Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland

    Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
    Search for articles by this author
  • Dagmar M. Haller
    Affiliations
    Adolescent and Young Adult Health Clinic, Department of Woman, Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland

    Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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      Abstract

      Purpose

      Practical guidelines help clinicians make their preventive and therapeutic choices and improve care management. Our purpose was to collect and synthesize available recommendations concerning vitamin D in adolescents (aged 10–19 years).

      Methods

      We searched PubMed, EMBASE, and Cochrane databases from inception to February 5, 2019, for guidance published by different professional associations and governments. We also searched the reference lists of identified recommendations and explored the gray literature using Web search engines. We organized documents by theme: dietary requirements, thresholds, prophylactic supplementation, and treatment of deficiency.

      Results

      A total of 32 documents were identified. Most of them targeted the general population and not specifically the age group of adolescents. There is a general agreement that adolescents should not have serum 25-hydroxyvitamin D concentrations below 25–30 nmol/L 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 150 nmol/L. Adequate nutritional requirements of vitamin D are also subject to debate with values ranging 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 preventive doses vary between 400 IU and 4,000 IU, depending on season, skin pigmentation, sun exposure, consumption of vitamin D–fortified foods, body mass index, and coexistence of certain medical conditions. In case of deficiency, different therapeutic regimens of oral vitamin D are proposed depending on the presence of illness and/or the baseline serum 25-hydroxyvitamin D concentrations. Duration of the treatment varies between 4 weeks and 3 months. A maintenance dose is generally recommended after treatment.

      Conclusions

      At present, there is no consensus among the different societies about vitamin D needs during adolescence. Stronger, evidence-based guidance is needed to inform clinical practice.

      Keywords

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      Linked Article

      • No Magic Bolus: What the History of Rickets and Vitamin D Can Teach Us About Setting Standards
        Journal of Adolescent HealthVol. 66Issue 4
        • Preview
          A recurring theme of Patseadou and Haller's analysis is the “lack of consensus among countries about the optimal status and adequate nutritional requirements” [1]. A quick survey of the history of vitamin D goes a long way in explaining this uncertainty. And although history may offer precious little to turn that uncertainty to consensus, it can highlight some of the cultural and technological barriers to establishing a consistent and comprehensive set of standards going forward. This brief overview will refer mostly to rickets, which modern readers will correctly understand as the most visible component of the complex issue of vitamin D deficiency.
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