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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)

Monatsschrift Kinderheilkunde volume 166, pages 814–822 (2018)Cite this article

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.

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Authors and Affiliations

  1. Abteilung für Pädiatrische Endokrinologie, Diabetologie und Ernährungsmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland

    T. Reinehr

  2. Sozialpädiatrisches Zentrum für chronisch kranke Kinder, Pädiatrische Endokrinologie und Diabetologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    D. Schnabel

  3. Kinderklinik, Universität Ulm, Ulm, Deutschland

    M. Wabitsch

  4. Dr. von Haunersches Kinderspital, Klinikum der Universität München, LMU – Ludwig-Maximilians-Universität, München, Deutschland

    S. Bechtold-Dalla Pozzalla, C. Prell & B. Koletzko

  5. Klinik für Neonatologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    C. Bührer

  6. Wilhelmsstift Hamburg, Hamburg, Deutschland

    B. Heidtmann

  7. Evangelisches Waldkrankenhaus Spandau, Berlin, Deutschland

    F. Jochum

  8. Praxis für Kinder- und Jugendmedizin/Sport- und Ernährungsmedizin Ludwigsburg, Ludwigsburg, Deutschland

    T. Kauth

  9. Dept. für Frauen- und Kindermedizin, Pädiatrisches Forschungszentrum, Klinik und Poliklinik für Kinder und Jugendliche, Universitätsklinikum Leipzig, Leipzig, Deutschland

    A. Körner

  10. Kinderklinik Heliosklinikum Pforzheim, Pforzheim, Deutschland

    W. Mihatsch

  11. Institut für Ernährungswissenschaft, Universität Gießen, Gießen, Deutschland

    S. Rudloff

  12. Kinderzentrum Dresden-Friedrichstadt, Dresden, Deutschland

    B. Tittel

  13. Universitätskinderklinik Bonn, Bonn, Deutschland

    J. Wölfle

  14. Zentrum für Kinderheilkunde und Jugendmedizin, Universität Gießen, Gießen, Deutschland

    S. Rudloff & K.-P. Zimmer

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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.

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S. Wirth, Wuppertal

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

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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

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Schlüsselwörter

  • Infektion
  • Asthma bronchiale
  • Adipositas

Keywords

  • Infection
  • Bronchial asthma
  • Obesity