Evaluating nine clinical practice guidelines for Vitamin D supplementation in children and adolescents with AGREE ?:
recommendations and controversies

Chinese Journal of Evidence -Based Pediatric 2012, 7(5) 372-379 DOI: ISSN: 1673-Authors
LI Wei-Gu, LI Yu-Ning, ZHOU Xiao-Ju, ZHANG Xiu-Min
Department of Pediatrics,the First Affiliated Hospital, Lanzhou University,Lanzhou 730000,China

Objective The aim of this study was to assess the quality of clinical practice guidelines (CPGs) using the Appraisal of Guidelines for Research and Evaluation ?(AGREE ?) instrument, and to provide a reference for promotion, development and adaptation of the guidelines. The recommendations were compared among guidelines for children and adolescents vitamin D supplementation, and the basic consensus and dispute were focused.

Methods PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database, VIP Chinese Periodical Database, National Guideline Clearinghouse and relevant web sites were searched for the guidelines on children and adolescent vitamin D supplementation.
The common characteristics of guideline were descriptively analyzed. AGREE ?instrument was used to evaluate the quality of CPGs. Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters? evaluation scores. The recommendations of the included guidelines were extracted, analyzed and compared to find the similarities and differences.

Results A total of 9 CPGs were identified from the United States, China, Canada, France, Poland and Australia/ New Zealand.
The guidelines were published from 2006 to 2012,

• 3 of them were evidence-based (EB) and 2 used GRADE method,
• 1 used AHRQ evidence grading system {US}
• the rest of 6 were non-EB CPGs made by consensus of experts and article review.

?The AGREE?instrument rated CPGs among 6 domains. "Scope and purpose", "clarity and presentation", and "applicability"were averagely scored ?50%, "stakeholder involvement", "rigor of development" and "editorial independence" were scored 48%, 42% and 28% respectively and needed improved.

EB CPGs had higher quality scores compared with non-EB CPGs for “rigor of development” and “editorial independence”.

? The main recommendations of CPGs were similar.
However, there were 5 main differences summarized among CPGs.
For prevention of VD deficiency, 400 IU·d-1 of VD was considered as a safe dose for 0-1 year-old group and therefore worthy to be recommended.
For treatment of VD deficiency, America(ES) CPGs recommend 2 000 IU·d-1 of VD for at least 6 weeks(1-18 years group).

For sun exposure, America and Australia/New Zealand CPGs held different recommendations.

For supplement of VD2 or VD3, there was no consensus among included CPGs.

For 25OHD level, nearly all CPGs agreed to the increased prevalence of rickets when 25OHD <30 nmol·L-1.

For pregnant and lactating women, CPGs recommend that this group should pay attention on VD supplementation, or maintain appropriate 25OHD level.

Conclusions

1. The overall quality of the included CPGs is still to be improved, and EB CPGs have higher quality scores for “rigor of development”.
2. 400 IU·d-1 of VD is considered as a safe dose to preventing VD deficiency for all 0-18 years-old groups and therefore worthy to be recommended.
3. The recommendations of China CPGs have absorbed the high quality CPGs from other countries, so adaptation and development of Chinese own high-quality CPGs is urgently needed.

Received 2012-08-21 Revised 2012-09-07 Online: 2012-09-10
Corresponding Authors: LI Yu-ning, lwgyanda at sina.com

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PDF is attached at the bottom of page: text in Chinese, tables in English

See also VitaminDWiki

• Published Recommendations from around the world
• 400 IU of vitamin D for infants is good, 200 IU is not enough – RCT April 2013
• Infants receiving 1600 IU of vitamin D were safe and healthy – Aug 2012
• All items in category Infant/Child and vitamin D 852 items
• All items in category Youths and vitamin D 174 items
• Vitamin D prior to and after birth if wish to provide all the vitamin D from breast milk
• Vitamin D for children – translated from Spanish – July 2012
• Recommend 100 IU of vitamin D per kg of infant - Poland July 2011 many references
• Overview Pregnancy and vitamin D