24 Vitamin D global guidelines for children, huge diversity

Evaluation of the clinical practice guidelines and consensuses on calcium and vitamin D supplementation in healthy children using the Appraisal of Guidelines for Research and Evaluation II instrument and Reporting Items for Practice Guidelines in Healthcare statement

Front Nutr. 2022 Sep 27;9:984423.doi: 10.3389/fnut.2022.984423

Lanzhi He 1 2 , Pengxiang Zhou 1 3 , Xin Zhou 4 , Shuxia Tian 1 5 , Jing Han 1 6 , Suodi Zhai 1 3

Background: This study aimed to assess the methodological and reporting quality of the guidelines and consensus on calcium and vitamin D supplementation in healthy children, and the consistency of these recommendations.

Methods: A systematic search of relevant guideline websites and databases, including PubMed, Embase, CNKI, WangFang, and SinoMed, was undertaken from inception to April 7, 2021, by two independent reviewers who assessed the eligible guidelines using the validated Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) tools. Overall, the between-reviewer agreement was evaluated using an intra-class correlation coefficient.

Results: A total of 24 guidelines and consensuses from 2002 to 2022 were identified from China, the United States, Canada, France, Australia, New Zealand, Europe, and other countries and regions. These were of mixed quality, and scored poorly in the rigor of development, editorial independence, and applicability of the domains of AGREE II. Among the seven domains of the RIGHT checklist, domain one (basic information) had the highest reporting rate (69.3%), whereas domain five (review and quality assurance) had the lowest reporting rate (11.5%). The overall quality of the included guidelines and consensuses was low.

Only 12 guidelines were recommended, with modifications. The recommended calcium intake for children of different ages varies greatly (400-1,150 mg/day).

Among the included guidelines and consensuses, a vitamin D (VD) prevention dose of 400 IU/day in infants was generally considered safe, and 25-hydroxyvitamin-D [25(OH)D] levels of <20 ng/mL (50 nmol/L) or 20-30 ng/mL (50-75 nmol/L) indicated VD deficiency or insufficiency.

However, the recommended amount of VD for children of different age groups and risk strata differed considerably (400-4,000 IU/day or 10-100 μg/day). The choice of VD2 or VD3 supplements and sunlight exposure also differed across the guidelines and consensuses.

Conclusion: There is considerable variability in calcium and VD guidelines and consensus development methods in calcium and VD supplementation for healthy children. Therefore, efforts are necessary to strengthen the methodological rigor of guideline development and utilize the best available evidence

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VitaminDWiki - Consensus Vitamin D category contains

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VitaminDWiki - Optimum category contains

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Dose size needed per individual varies by 4X

1. Amount needed varies with weight
   • perhaps 100 IU per 1 kg infant, 1000 IU per 10kg child
2. Preemies need much larger doses (45 studies as of Oct 2022
   • 10% of all births are preemies - yet recommendations rarely consider preemies

3. Amount needed varies with skin color

4. Amount needed varies with genes

5. Amount needed varies with heallth problem to be prevented

6. Amount needed varies with heallth problem to be treated

7. Amount needed increases if poor gut if not use a gut-friendly form

See related in VitaminDWiki

• Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013 2013

• Predict Vitamin D - also predicting how dose size each person needs

• Huge variation in response to vitamin D supplementation – personal vitamin D response index – Dec 2016

• Reasons for low response to vitamin D

• 10 reasons for poor response to Vitamin D (race, binding protein, etc.) – Nov 2017

• Is 50 ng of vitamin D too high, just right, or not enough

• Vitamin D home fortification- don't wait 100 years for your govt

• VITAMIN D: Public Shouldn’t Wait For Doctors To Usher In New “Golden Era” Of Preventive Medicine

• Recommend 100 IU of vitamin D per kg of infant - Poland July 2011

11+ CALL FOR ACTION in VitaminDWiki titles

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