Vitamin-D-Supplementierung jenseits des zweiten Lebensjahres

Gemeinsame Stellungnahme der Ernährungskommission der Deutschen Gesellschaft für Kinder und Jugendmedizin (DGKJ e. V.) und der Deutschen Gesellschaft für Kinderendokrinologie und Diabetologie (DGKED e. V.)

Vitamin D supplementation beyond the second year of life

Joint statement of the Nutrition Committee of the German Society for Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Endocrinology and Diabetology (DGKED)

Zusammenfassung

Hintergrund

Niedrige Vitamin-D-Serum-Konzentrationen werden nicht nur mit der Rachitis, sondern vor allem aufgrund von Assoziationsstudien auch mit weiteren Erkrankungen in Zusammenhang gebracht. Da die Vitamin-D-Serum-Konzentrationen bei vielen deutschen Kindern und Jugendlichen jenseits des Säuglingsalters unter dem Zielwert liegen, wird bei Kindern auch eine Vitamin-D-Supplementierung diskutiert.

Methodik

Basierend auf einer Literaturrecherche randomisierter kontrollierter Studien (RCT) werden die Daten zu Wirkungen einer Vitamin-D-Supplementierung jenseits des zweiten Lebensjahres analysiert.

Ergebnisse

Eine Vitamin-D-Supplementierung hat einen möglichen Nutzen für die Risikosenkung von Influenzainfektionen und für seltenere Exazerbationen bei Asthma bronchiale, beeinflusst hier jedoch nicht die Krankheitsschwere. Eine Vitamin-D-Supplementierung hat keinen relevanten Einfluss auf Aufmerksamkeitsdefizit- und Hyperaktivitätssyndrom, Herzinsuffizienz, arterielle Hypertonie, Auftreten eines Diabetes mellitus Typ 2 oder der Schubhäufigkeit bei multipler Sklerose, verringerte jedoch die Anzahl neu auftretender Herde im Magnetresonanztomogramm (MRT). Für andere Endpunkte fehlen kontrollierte randomisierte Interventionsstudien.

Schlussfolgerung

Aufgrund der vorliegenden Studienlage kann auch bei Vitamin-D-Serum-Konzentrationen unterhalb der Referenzwerte eine generelle Vitamin-D-Supplementierung für Kinder im Alter >2 Lebensjahre ohne Risikofaktoren und ohne chronische Erkrankungen, die potenziell mit Störungen der Kalzium- oder Vitamin-D-Resorption einhergehen, nicht empfohlen werden.

Abstract

Background

Low serum concentrations of vitamin D have been associated with rickets and also with other disorders in observational studies. Since vitamin D serum concentrations in German children and adolescents are frequently below reference values, it is debated whether vitamin D should be broadly supplemented also after infancy.

Methods

The effects of vitamin D supplementation in children >2 years of age were analyzed based on a literature review of randomized controlled trials (RCTs).

Results

Vitamin D supplementation has a potential benefit for reduction of the risk of influenza infections. The RCTs with vitamin D supplementation demonstrated less exacerbation of bronchial asthma in vitamin D supplemented children but showed no impact on the severity of bronchial asthma. The RCTs demonstrated no clinical effect of vitamin D supplementation on attention deficit hyperactivity disorders, arterial hypertension, heart insufficiency, incidence of diabetes mellitus type 2, and relapses of multiple sclerosis; however, the number of new lesions in magnetic resonance imaging (MRI) was reduced. For other endpoints RCTs are lacking.

Conclusion

Based on the available studies, a general vitamin D supplementation cannot be recommended in children aged >2 years even with subnormal vitamin D concentrations but without other risk factors or chronic diseases associated with disorders of calcium or vitamin D resorption.

This is a preview of subscription content, log in to check access.

Abb. 1

Literatur

  1. 1.

    Ernährungskommission der Deutschen Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Arbeitsgemeinschaft Pädiatrische Endokrinologie, Böhles HJ, Fusch C, Genzel-Boroviczény O, Jochum F, Kauth T, Kersting M, Koletzko B, Lentze MJ, Moß A, Mihatsch WA, Przyrembel H, Schnabel D, Wabitsch M (2011) Vitamin-D-Versorgung im Säuglings‑, Kindes- und Jugendalter. Monatsschr Kinderheilkd 160(11):1163–1166

    Google Scholar 

  2. 2.

    Wabitsch M, Koletzko B, Schnabel D, Moss A (2011) Vitamin-D-Versorgung im Säuglings‑, Kindes- und Jugendalter. www.dgkj.de/wissenschaft/stellungnahmen/meldung/meldungsdetail/vitamin_d_versorgung_im_saeuglings_kindes_und_jugendalter/. Zugegriffen: 16.12.2017

    Google Scholar 

  3. 3.

    Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K et al (2016) Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab 101(2):394–415

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. 4.

    Bührer C, Genzel-Broviczeny O, Jochum F, Kauth T, Kersting M, Koletzko B et al (2014) Ernährung gesunder Säuglinge. Monatsschr Kinderheilkd. https://doi.org/10.1007/s00112-014-3129-2

    Article  Google Scholar 

  5. 5.

    Grossman Z, Hadjipanayis A, Stiris T, Del TS, Mercier JC, Valiulis A et al (2017) Vitamin D in European children-statement from the European Academy of Paediatrics (EAP). Eur J Pediatr 176(6):829–831

    Article  PubMed  Google Scholar 

  6. 6.

    Bös K, Schmidt S, Bergmann K, Lämmle L, Koletzko B (2012) Einflussfaktoren auf die Vitamin-D-Versorgung deutscher Kinder und Jugendlicher. Ernahr Umsch 09:496–503

    Google Scholar 

  7. 7.

    Hintzpeter B, Scheidt-Nave C, Muller MJ, Schenk L, Mensink GB (2008) Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 138(8):1482–1490

    Article  PubMed  CAS  Google Scholar 

  8. 8.

    Farrar MD, Mughal MZ, Adams JE, Wilkinson J, Berry JL, Edwards L et al (2016) Sun exposure behavior, seasonal vitamin D deficiency, and relationship to bone health in adolescents. J Clin Endocrinol Metab 101(8):3105–3113

    Article  PubMed  CAS  Google Scholar 

  9. 9.

    Deutsche Gesellschaft für Ernährung (2018) Empfehlung zu Vitamin D. www.dge.de/wissenschaft/referenzwerte/vitamin-d/. Zugegriffen: 16.12.2017

    Google Scholar 

  10. 10.

    Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP (2014) Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 348:g2035

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Grober U, Spitz J, Reichrath J, Kisters K, Holick MF (2013) Vitamin D: update 2013: from rickets prophylaxis to general preventive healthcare. Dermatoendocrinol 5(3):331–347

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. 12.

    Bouillon R, Verlinden L (2014) Does a better vitamin D status help to reduce cardiovascular risks and events? Endocrine 47(3):662–663

    Article  PubMed  CAS  Google Scholar 

  13. 13.

    Manson JE, Brannon PM, Rosen CJ, Taylor CL (2016) Vitamin D deficiency – is there really a pandemic? N Engl J Med 375(19):1817–1820

    Article  PubMed  CAS  Google Scholar 

  14. 14.

    Bolland MJ, Grey A, Gamble GD, Reid IR (2014) The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2(4):307–320

    Article  PubMed  CAS  Google Scholar 

  15. 15.

    Gil AJ, Plaza-Diaz J, Mesa MD (2018) Vitamin D: classic and novel actions. Ann Nutr Metab 72(2):87–95. https://doi.org/10.1159/000486536

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Wang Y, Zhu J, DeLuca HF (2012) Where is the vitamin D receptor? Arch Biochem Biophys 523(1):123–133

    Article  PubMed  CAS  Google Scholar 

  17. 17.

    Hewison M (1992) Vitamin D and the immune system. J Endocrinol 132(2):173–175

    Article  PubMed  CAS  Google Scholar 

  18. 18.

    Zittermann A, Pilz S, Hoffmann H, Marz W (2016) Vitamin D and airway infections: a European perspective. Eur J Med Res 21:14

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. 19.

    Hollis BW (2010) Assessment and interpretation of circulating 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in the clinical environment. Endocrinol Metab Clin North Am 39(2):271–286 (table)

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. 20.

    Binkley N, Dawson-Hughes B, Durazo-Arvizu R, Thamm M, Tian L, Merkel JM et al (2017) Vitamin D measurement standardization: the way out of the chaos. J Steroid Biochem Mol Biol 173:117–121

    Article  PubMed  CAS  Google Scholar 

  21. 21.

    Heaney RP (2008) Vitamin D and calcium interactions: functional outcomes. Am J Clin Nutr 88(2):541S–544S

    Article  PubMed  CAS  Google Scholar 

  22. 22.

    Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2011) Dietary reference intakes: calcium and vitamin D. National Academies Press, Washington, DC

    Google Scholar 

  23. 23.

    King JC, Garza C (2007) Harmonization of nutrient intake values. Food Nutr Bull 28(1 Suppl International):S3–S12

    Article  PubMed  Google Scholar 

  24. 24.

    Koletzko B, Bhatia J, Bhutta Z, Cooper P, Makrides M, Uauy R et al (2015) Pediatric nutrition in practice, 1. Aufl. Karger, Basel

    Google Scholar 

  25. 25.

    Hill TR, Cotter AA, Mitchell S, Boreham CA, Dubitzky W, Murray L et al (2008) Vitamin D status and its determinants in adolescents from the Northern Ireland Young Hearts 2000 cohort. Br J Nutr 99(5):1061–1067

    Article  PubMed  CAS  Google Scholar 

  26. 26.

    Carson EL, Pourshahidi LK, Hill TR, Cashman KD, Strain JJ, Boreham CA et al (2015) Vitamin D, muscle function, and cardiorespiratory fitness in adolescents from the young hearts study. J Clin Endocrinol Metab 100(12):4621–4628

    Article  PubMed  CAS  Google Scholar 

  27. 27.

    Lehtonen-Veromaa MK, Mottonen TT, Nuotio IO, Irjala KM, Leino AE, Viikari JS (2002) Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: a 3-y prospective study. Am J Clin Nutr 76(6):1446–1453

    Article  PubMed  CAS  Google Scholar 

  28. 28.

    Lehtonen-Veromaa M, Mottonen T, Irjala K, Nuotio I, Leino A, Viikari J (2000) A 1‑year prospective study on the relationship between physical activity, markers of bone metabolism, and bone acquisition in peripubertal girls. J Clin Endocrinol Metab 85(10):3726–3732

    PubMed  CAS  Google Scholar 

  29. 29.

    Viljakainen HT, Natri AM, Karkkainen M, Huttunen MM, Palssa A, Jakobsen J et al (2006) A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1‑year intervention. J Bone Miner Res 21(6):836–844

    Article  PubMed  CAS  Google Scholar 

  30. 30.

    Winzenberg T, Powell S, Shaw KA, Jones G (2011) Effects of vitamin D supplementation on bone density in healthy children: systematic review and meta-analysis. BMJ 342:c7254

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Winzenberg TM, Powell S, Shaw KA, Jones G (2010) Vitamin D supplementation for improving bone mineral density in children. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006944.pub2

    PubMed  Article  Google Scholar 

  32. 32.

    Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM (2001) Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 358(9292):1500–1503

    Article  PubMed  CAS  Google Scholar 

  33. 33.

    Harjutsalo V, Sund R, Knip M, Groop PH (2013) Incidence of type 1 diabetes in Finland. JAMA 310(4):427–428

    Article  PubMed  CAS  Google Scholar 

  34. 34.

    Zipitis CS, Akobeng AK (2008) Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Arch Dis Child 93(6):512–517

    Article  PubMed  CAS  Google Scholar 

  35. 35.

    Makinen M, Mykkanen J, Koskinen M, Simell V, Veijola R, Hyoty H et al (2016) Serum 25-hydroxyvitamin D concentrations in children progressing to autoimmunity and clinical type 1 diabetes. J Clin Endocrinol Metab 101(2):723–729

    Article  PubMed  CAS  Google Scholar 

  36. 36.

    Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U et al (2016) Vitamin D for the management of asthma. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011511.pub2

    PubMed  Article  Google Scholar 

  37. 37.

    Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H (2010) Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr 91(5):1255–1260

    Article  PubMed  CAS  Google Scholar 

  38. 38.

    Camargo CA Jr., Ganmaa D, Frazier AL, Kirchberg FF, Stuart JJ, Kleinman K et al (2012) Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Pediatrics 130(3):e561–e567

    Article  PubMed  Google Scholar 

  39. 39.

    Aglipay M, Birken CS, Parkin PC, Loeb MB, Thorpe K, Chen Y et al (2017) Effect of high-dose vs standard-dose wintertime vitamin D supplementation on viral upper respiratory tract infections in young healthy children. JAMA 318(3):245–254

    PubMed  PubMed Central  CAS  Google Scholar 

  40. 40.

    Yakoob MY, Salam RA, Khan FR, Bhutta ZA (2016) Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008824.pub2

    PubMed  PubMed Central  Article  Google Scholar 

  41. 41.

    Witham MD, Nadir MA, Struthers AD (2009) Effect of vitamin D on blood pressure: a systematic review and meta-analysis. J Hypertens 27(10):1948–1954

    Article  PubMed  CAS  Google Scholar 

  42. 42.

    de Vries MA, van der Meulen N, van de Geijn GM, Klop B, van der Zwan EM, Prinzen L et al (2017) Effect of a single dose vitamin D3 on postprandial arterial stiffness and inflammation in vitamin D deficient women. J Clin Endocrinol Metab 102(3):992. https://doi.org/10.1210/jc.2016-3394

    PubMed  Article  Google Scholar 

  43. 43.

    Wang L, Song Y, Manson JE, Pilz S, Marz W, Michaelsson K et al (2012) Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 5(6):819–829

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. 44.

    Kelly A, Brooks LJ, Dougherty S, Carlow DC, Zemel BS (2011) A cross-sectional study of vitamin D and insulin resistance in children. Arch Dis Child 96(5):447–452

    Article  PubMed  Google Scholar 

  45. 45.

    Jorde R, Sollid ST, Svartberg J, Schirmer H, Joakimsen RM, Njolstad I et al (2016) Vitamin D 20,000 IU per week for five years does not prevent progression from prediabetes to diabetes. J Clin Endocrinol Metab 101(4):1647–1655

    Article  PubMed  Google Scholar 

  46. 46.

    Mousa A, Naderpoor N, de Court, Teede H, Kellow N, Walker K et al (2017) Vitamin D supplementation has no effect on insulin sensitivity or secretion in vitamin D‑deficient, overweight or obese adults: a randomized placebo-controlled trial. Am J Clin Nutr 105(6):1372–1381

    PubMed  CAS  Google Scholar 

  47. 47.

    Seida JC, Mitri J, Colmers IN, Majumdar SR, Davidson MB, Edwards AL et al (2014) Clinical review: effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab 99(10):3551–3560

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. 48.

    Ferira AJ, Laing EM, Hausman DB, Hall DB, McCabe GP, Martin BR et al (2016) Vitamin D supplementation does not impact insulin resistance in black and white children. J Clin Endocrinol Metab 101(4):1710–1718

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Wu C, Qiu S, Zhu X, Li L (2017) Vitamin D supplementation and glycemic control in type 2 diabetes patients: a systematic review and meta-analysis. Metabolism 73:67–76

    Article  PubMed  CAS  Google Scholar 

  50. 50.

    Mirhosseini N, Vatanparast H, Mazidi M, Kimball SM (2017) The effect of improved serum 25-Hydroxyvitamin D status on glycemic control in diabetic patients: a meta-analysis. J Clin Endocrinol Metab 102(9):3097–3110

    Article  PubMed  Google Scholar 

  51. 51.

    Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P et al (2017) Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 356:i6583

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. 52.

    Kim YR, Seo SC, Yoo Y, Choung JT (2017) Are children with asthma in south korea also associated with vitamin D deficiency? Environ Health Toxicol 32:e2017005

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Esfandiar N, Alaei F, Fallah S, Babaie D, Sedghi N (2016) Vitamin D deficiency and its impact on asthma severity in asthmatic children. Ital J Pediatr 42(1):108

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  54. 54.

    Meyer T, Becker A, Sundermann J, Rothenberger A, Herrmann-Lingen C (2017) Attention deficit-hyperactivity disorder is associated with reduced blood pressure and serum vitamin D levels: results from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Eur Child Adolesc Psychiatry 26(2):165–175

    Article  PubMed  Google Scholar 

  55. 55.

    Avcil S, Uysal P, Yilmaz M, Erge D, Demirkaya SK, Eren E (2017) Vitamin D deficiency and a blunted parathyroid hormone response in children with attention-deficit/hyperactivity disorder. Clin Lab 63(3):435–443

    PubMed  Google Scholar 

  56. 56.

    Mohammadpour N, Jazayeri S, Tehrani-Doost M, Djalali M, Hosseini M, Effatpanah M et al (2016) Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: a randomized, double blind, placebo-controlled trial. Nutr Neurosci 7:1–8

    CAS  Google Scholar 

  57. 57.

    Reinehr T, de Sousa G, Alexy U, Kersting M, Andler W (2007) Vitamin D status and parathyroid hormone in obese children before and after weight loss. Eur J Endocrinol 157(2):225–232

    Article  PubMed  CAS  Google Scholar 

  58. 58.

    Saneei P, Salehi-Abargouei A, Esmaillzadeh A (2013) Serum 25-hydroxy vitamin D levels in relation to body mass index: a systematic review and meta-analysis. Obes Rev 14(5):393–404

    Article  PubMed  CAS  Google Scholar 

  59. 59.

    Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72(3):690–693

    Article  PubMed  CAS  Google Scholar 

  60. 60.

    Jagannath VA, Fedorowicz Z, Asokan GV, Robak EW, Whamond L (2010) Vitamin D for the management of multiple sclerosis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008422.pub2

    Article  PubMed  Google Scholar 

  61. 61.

    Kampman MT, Steffensen LH, Mellgren SI, Jorgensen L (2012) Effect of vitamin D3 supplementation on relapses, disease progression, and measures of function in persons with multiple sclerosis: exploratory outcomes from a double-blind randomised controlled trial. Mult Scler 18(8):1144–1151

    Article  PubMed  CAS  Google Scholar 

  62. 62.

    Soilu-Hanninen M, Aivo J, Lindstrom BM, Elovaara I, Sumelahti ML, Farkkila M et al (2012) A randomised, double blind, placebo controlled trial with vitamin D3 as an add on treatment to interferon beta-1b in patients with multiple sclerosis. J Neurol Neurosurg Psychiatr 83(5):565–571

    Article  Google Scholar 

  63. 63.

    James E, Dobson R, Kuhle J, Baker D, Giovannoni G, Ramagopalan SV (2013) The effect of vitamin D‑related interventions on multiple sclerosis relapses: a meta-analysis. Mult Scler 19(12):1571–1579 (Oct)

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Consortia

Ethics declarations

Interessenkonflikt

T. Reinehr, D. Schnabel, M. Wabitsch, S. Bechtold-Dalla Pozzalla, C. Bührer, B. Heidtmann, F. Jochum, T. Kauth, A. Körner, W. Mihatsch, C. Prell, S. Rudloff, B. Tittel, J. Wölfle, K.‑P. Zimmer und B. Koletzko geben an, dass kein Interessenkonflikte hinsichtlich der Inhalte dieser Stellungnahme bestehen.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

T. Reinehr und D. Schnabel haben gleichwertig zu dem Manuskript beigetragen.

Redaktion

A. Borkhardt, Düsseldorf

S. Wirth, Wuppertal

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Reinehr, T., Schnabel, D., Wabitsch, M. et al. Vitamin-D-Supplementierung jenseits des zweiten Lebensjahres. Monatsschr Kinderheilkd 166, 814–822 (2018). https://doi.org/10.1007/s00112-018-0502-6

Download citation

Schlüsselwörter

  • Infektion
  • Asthma bronchiale
  • Adipositas

Keywords

  • Infection
  • Bronchial asthma
  • Obesity