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      Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians

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          Abstract

          Vitamin D plays a pivotal role in the regulation of calcium-phosphorus metabolism, particularly during pediatric age when nutritional rickets and impaired bone mass acquisition may occur.

          Besides its historical skeletal functions, in the last years it has been demonstrated that vitamin D directly or indirectly regulates up to 1250 genes, playing so-called extraskeletal actions. Indeed, recent data suggest a possible role of vitamin D in the pathogenesis of several pathological conditions, including infectious, allergic and autoimmune diseases. Thus, vitamin D deficiency may affect not only musculoskeletal health but also a potentially wide range of acute and chronic conditions. At present, the prevalence of vitamin D deficiency is high in Italian children and adolescents, and national recommendations on vitamin D supplementation during pediatric age are lacking. An expert panel of the Italian Society of Preventive and Social Pediatrics reviewed available literature focusing on randomized controlled trials of vitamin D supplementation to provide a practical approach to vitamin D supplementation for infants, children and adolescents.

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          Most cited references 435

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          Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition.

          The number of surviving children born prematurely has increased substantially during the last 2 decades. The major goal of enteral nutrient supply to these infants is to achieve growth similar to foetal growth coupled with satisfactory functional development. The accumulation of knowledge since the previous guideline on nutrition of preterm infants from the Committee on Nutrition of the European Society of Paediatric Gastroenterology and Nutrition in 1987 has made a new guideline necessary. Thus, an ad hoc expert panel was convened by the Committee on Nutrition of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition in 2007 to make appropriate recommendations. The present guideline, of which the major recommendations are summarised here (for the full report, see http://links.lww.com/A1480), is consistent with, but not identical to, recent guidelines from the Life Sciences Research Office of the American Society for Nutritional Sciences published in 2002 and recommendations from the handbook Nutrition of the Preterm Infant. Scientific Basis and Practical Guidelines, 2nd ed, edited by Tsang et al, and published in 2005. The preferred food for premature infants is fortified human milk from the infant's own mother, or, alternatively, formula designed for premature infants. This guideline aims to provide proposed advisable ranges for nutrient intakes for stable-growing preterm infants up to a weight of approximately 1800 g, because most data are available for these infants. These recommendations are based on a considered review of available scientific reports on the subject, and on expert consensus for which the available scientific data are considered inadequate.
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            Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain.

            Despite a growing body of evidence that Vitamin D is involved in mammalian brain functioning, there has been a lack of direct evidence about its role in the human brain. This paper reports, for the first time, the distribution of the 1,25-dihydroxyvitamin D3 receptor (VDR), and 1alpha-hydroxylase (1alpha-OHase), the enzyme responsible for the formation of the active vitamin in the human brain. The receptor and the enzyme were found in both neurons and glial cells in a regional and layer-specific pattern. The VDR was restricted to the nucleus whilst 1alpha-OHase was distributed throughout the cytoplasm. The distribution of the VDR in human brain was strikingly similar to that reported in rodents. Many regions contained equivalent amounts of both the VDR and 1alpha-OHase, however the macrocellular cells within the nucleus basalis of Meynert (NBM) and the Purkinje cells in the cerebellum expressed 1alpha-OHase in the absence of VDR. The strongest immunohistochemical staining for both the receptor and enzyme was in the hypothalamus and in the large (presumably dopaminergic) neurons within the substantia nigra. The observed distribution of the VDR is consistent with the proposal that Vitamin D operates in a similar fashion to the known neurosteroids. The widespread distribution of 1alpha-OHase and the VDR suggests that Vitamin D may have autocrine/paracrine properties in the human brain.
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              Vitamin D deficiency in children and its management: review of current knowledge and recommendations.

              Given the recent spate of reports of vitamin D deficiency, there is a need to reexamine our understanding of natural and other sources of vitamin D, as well as mechanisms whereby vitamin D synthesis and intake can be optimized. This state-of-the-art report from the Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society was aimed to perform this task and also reviews recommendations for sun exposure and vitamin D intake and possible caveats associated with these recommendations.
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                Author and article information

                Contributors
                giuseppe.saggese@med.unipi.it
                +39 0583 970371 , vieruf@hotmail.it
                flavia.prodam@med.uniupo.it
                fabiocardinale@libero.it
                irene.cetin@unimi.it
                elena.chiappini@unifi.it
                gianluigi.deangelis@unipr.it
                maddalena.massari@gmail.com
                emanuele.miraglia@unina2.it
                michele.miraglia@unina2.it
                diego.peroni@unipi.it
                terrycom1957@gmail.com
                rinoagostiniani@alice.it
                dom.careddu@alice.it
                ghigia.dan@gmail.com
                gianni.bona@maggioreosp.novara.it
                presidenza@sipps.it
                giovanni.corsello@unipa.it
                Journal
                Ital J Pediatr
                Ital J Pediatr
                Italian Journal of Pediatrics
                BioMed Central (London )
                1824-7288
                8 May 2018
                8 May 2018
                2018
                : 44
                Affiliations
                [1 ]ISNI 0000 0004 1757 3729, GRID grid.5395.a, Department of Clinical and Experimental Medicine, Section of Paediatrics, , University of Pisa, ; Pisa, Italy
                [2 ]Pediatric Unit, San Luca Hospital, Lucca, Italy
                [3 ]ISNI 0000000121663741, GRID grid.16563.37, Division of Pediatrics, Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), , University of Piemonte Orientale, ; Novara, Italy
                [4 ]Pediatric Unit, Division of Pulmonology, Allergy, and Immunology, AOU Policlinico-Giovanni XXIII, Bari, Italy
                [5 ]ISNI 0000 0004 1757 2822, GRID grid.4708.b, Department of Mother and Child, , Hospital Luigi Sacco, University of Milano, ; Milan, Italy
                [6 ]ISNI 0000 0004 1757 2304, GRID grid.8404.8, Pediatric Infectious Disease Unit, Department of Health Sciences, , University of Florence, Anna Meyer Children’s University Hospital, ; Florence, Italy
                [7 ]GRID grid.411482.a, Gastroenterology and Digestive Endoscopy Unit and Clinical Paediatrics Unit, Department of Paediatrics and Maternal Medicine, , University of Parma Hospital Trust, ; Parma, Italy
                [8 ]ISNI 0000 0001 2200 8888, GRID grid.9841.4, Department of Woman, Child and General and Specialist Surgery, , University of Campania “Luigi Vanvitelli”, ; Naples, Italy
                [9 ]Pediatric Primary Care, National Pediatric Health Care System, Milan, Italy
                [10 ]Department of Pediatrics, San Jacopo Hospital, Pistoia, Italy
                [11 ]Pediatric Primary Care, National Pediatric Health Care System, Novara, Italy
                [12 ]ISNI 0000 0004 1757 2822, GRID grid.4708.b, Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, , Università degli Studi di Milano, ; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
                [13 ]ISNI 0000000121663741, GRID grid.16563.37, Division of Pediatrics, , University of Piemonte Orientale, ; Novara, Italy
                [14 ]Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
                [15 ]ISNI 0000 0004 1762 5517, GRID grid.10776.37, Department of Sciences for Health Promotion and Mother and Child Care, Neonatal Intensive Care Unit, AOUP, , University of Palermo, ; Palermo, Italy
                Article
                488
                10.1186/s13052-018-0488-7
                5941617
                29739471
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Review
                Custom metadata
                © The Author(s) 2018

                Pediatrics

                hypovitaminosis d, deficiency, adolescents, children, supplementation, vitamin d

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