Vitamin D in pediatrics: the need for precision medicine-based guidelines for screening, monitoring, and supplementation

PURPOSE OF REVIEW: About 7.6 million children and adolescents in the United States have vitamin D deficiency. There are significant consequences from low vitamin D states, including epigenetic modifications in utero that lead to diseases later in life. Current vitamin D guidelines are inadequate because they focus solely on the skeletal benefits of vitamin D, excluding its extra-skeletal functions. RECENT FINDINGS: Recent randomized controlled trials and large, long-term studies demonstrate the extra-skeletal benefits of vitamin D in type 1 diabetes, prediabetes, multiple sclerosis, telomere erosion, and cardiovascular health at higher serum 25-hydroxyvitamin D [25(OH)D] compared with the current recommended thresholds. These data call for a revision of current guidelines for vitamin D screening and supplementation. SUMMARY: Vitamin D is vital for health due to its skeletal and extra-skeletal functions. Extra-skeletal functions are less well known among medical personnel and the public. Thus, most of the world's population, especially children, have sustained suboptimal serum concentrations of 25(OH)D, which exert negative impacts on health across the lifespan. This Review provides the data and rationale for a comprehensive revision of vitamin D guidelines for fetuses, infants, children, and adolescents, using a precision medicine-based approach to address their skeletal and extra-skeletal needs.