Context: There has been a resurgence of vitamin D deficiency rickets throughout the developed world, with infants and adolescents being primarily affected. Adolescence is a crucial period for muscle and bone mineral accumulation. Objective: The aim was to determine the effect of vitamin D supplementation on the adolescent musculoskeletal system. Design and Setting: We conducted a community-based, double-blind, randomized controlled trial in a secondary school. Participants: Postmenarchal 12- to 14-yr-old females participated in the trial. Ninety-nine were screened, 73 were included in randomized controlled trial, and 69 completed the trial. There were no adverse events. Intervention: Four doses of 150,000 IU vitamin D2 (ergocalciferol) were given over 1 yr. Main Outcome Measures: Dual-energy x-ray absorptiometry, peripheral quantitative computed tomography, and jumping mechanography were used. Results: At follow-up, 25-hydroxyvitamin D [25(OH)D] status was 56.0 ± 8.9 nmol/liter in the intervention group and 15.8 ± 6.6 nmol/liter in controls. There were no effects of supplementation on bone; however, for muscle function, efficiency of movement improved in the vitamin D-treated group. There was an interaction between baseline 25(OH)D concentration and response to vitamin D supplementation for muscle jump velocity. Conclusions: Despite improvements in 25(OH)D status, treatment with vitamin D2 was not shown to increase mineral accretion, bone geometry or strength, muscle force, or power. There were greater increases in jump velocity in girls with the lowest baseline 25(OH)D concentrations. Lack of effect of intervention after the period of peak mineral and muscle mass accretion suggests that earlier action is required.

Besides its role in calcium homeostasis, vitamin D (VD) has an important immuno-mudulation effect. However, its role in autoimmune diseases such as type 1 diabetes is under discussion. This study designed to investigate serum VD status in children and adolescents with and without diabetes.In a case-control study, 85 diabetic and 85 non-diabetic control (total 170) aged 1–15 yr. were enrolled. History of breast feeding and vitamin supplementation was obtained; growth indices and serum levels of Calcium, phosphorous, Alkaline-Phosphatase (ALP), Hemoglobin-A1c and VD were measured and analyzed.The mean values for VD in case and control groups were 12.80 ± 10.59 and 15.85 ± 9.92 nmol/L, respectively (p = 0.057). Serum VD status in these two groups was sufficient in 5.88% and 9.41%, insufficient in 18% and 14%, and deficient in 75.29% and 76.74%, respectively. Compared to the controls, diabetics had more history of breast-feeding (62.35% vs. 42.35%; p = 0.017) and higher serum ALP levels (772.34 ± 309.89 vs. 657.99 ± 395.11 U/L; p = 0.032).More frequency of breast-feeding, higher serum ALP and mildly lower serum level of VD in diabetics suggests a significant difference in VD status in diabetics compared to the healthy peers indicating a potential role of this deficiency in the disease process.

With the widespread availability and use of pelvic sonography, the rate at which ovarian cysts are detected in the pediatric population has increased, and such cysts are an important problem encountered in pediatric surgical practice. Rational management should take into account key factors such as symptoms, patient age, menarchal status, cyst size, and character, as well as associated medical conditions. The purpose of this review is to discuss the incidence and pathophysiology of ovarian cysts in children. A management strategy is presented based on the above-mentioned key factors.

CONTEXT:There has been a resurgence of vitamin D deficiency among infants, toddlers, and adolescents in the United Kingdom. Myopathy is an important clinical symptom of vitamin D deficiency, yet it has not been widely studied.OBJECTIVE:Our objective was to investigate the relationship of baseline serum 25 hydroxyvitamin D [25(OH)D] concentration and PTH with muscle power and force.DESIGN:This was a cross-sectional study.SETTING:The study was community based in a secondary school.PARTICIPANTS:A total of 99 post-menarchal 12- to 14-yr-old females was included in the study.MAIN OUTCOME MEASURES:Jumping mechanography to measure muscle power, velocity, jump height, and Esslinger Fitness Index from a two-legged counter movement jump and force from multiple one-legged hops was performed. Body height, weight, and serum concentrations of 25(OH)D, PTH, and calcium were measured.RESULTS:Median serum 25(OH)D concentration was 21.3 nmol/liter (range 2.5-88.5) and PTH 3.7 pmol/liter (range 0.47-26.2). After correction for weight using a quadratic function, there was a positive relationship between 25(OH)D and jump velocity (P = 0.002), jump height (P = 0.005), power (P = 0.003), Esslinger Fitness Index (P = 0.003), and force (P = 0.05). There was a negative effect of PTH upon jump velocity (P = 0.04).CONCLUSION:From these data we conclude that vitamin D was significantly associated with muscle power and force in adolescent girls.

Causes of rickets include vitamin D deficiency, inherited disorders of vitamin D metabolism, dietary calcium deficiency and disorders of renal re-absorption of phosphorus.1 We have recently seen cases of rickets in exclusively breastfed infants <6 months old born to vitamin D deficient mothers. This observation led us to speculate that rickets in such infants might arise in part because of low breast milk concentrations of calcium and phosphorus. Therefore, the aim of this pilot study was to compare calcium and phosphorus concentrations in the breast milk of vitamin D deficient and replete mothers. A …

We performed a systematic review to examine the effect of nutritional interventions on nutritional status, quality of life (QoL) and mortality in patients with head and neck squamous cell cancer (HNSCC) receiving radiotherapy or chemoradiotherapy.We searched Pubmed, EMBASE, CENTRAL and Cinahl from inception through January 3rd, 2012 to identify randomized controlled trials (RCTs) from a broad range of nutritional interventions in patients with HNSCC during (chemo)radiotherapy. Two reviewers independently assessed study eligibility and risk of bias, and extracted data.Of 1141 titles identified, 12 study reports were finally included, describing 10 different studies with 11 interventions. Four out of 10 studies examined the effects of individualized dietary counseling, and showed significant benefits on nutritional status and QOL compared to no counseling or general nutritional advice by a nurse (p < 0.05). Three studies on oral nutritional supplements (ONS) were inconsistent about the effect on nutritional status compared with no supplementation. One study showed that nasogastric tube feeding had beneficial effects on nutritional status compared to ONS, but not in all patient groups (p < 0.04). One study showed benefits of percutaneous endoscopic gastronomy (PEG) feeding on nutritional status shortly after RT compared with nasogastric feeding (p = 0.001). Two studies showed that prophylactic PEG feeding was not superior over tube feeding if required.This review shows beneficial effects of individualized dietary counseling on nutritional status and QoL, compared to no counseling or standard nutritional advice. Effects of ONS and tube feeding were inconsistent.

Aims: To determine the prevalence of hypovitaminosis D among healthy adolescent schoolgirls attending an inner city multiethnic girls’ school. Methods: Fifty one (28%) of 182 girls (14 white, 37 non-white; median age 15.3 years, range 14.7–16.6) took part in the study. Biochemical parameters, dietary vitamin D intake, muscle function parameters, duration of daily sunlight exposure (SE), and percentage of body surface area exposed (%BSA) were measured. Results: Thirty seven (73%) girls were vitamin D deficient (25-hydroxyvitamin D (25OHD) <30 nmol/l) and 9 (17%) were severely deficient (25OHD <12.5 nmol/l). The median (range) 25OHD concentration of white girls (37.3 nmol/l (18.3–73.3)) was higher than that of non-white girls (14.8 nmol/l (5.8–42.8)). The median (range) concentration of parathyroid hormone in white girls (2.8 pmol/l (1.0–3.7)) was lower than that of non-white girls (3.4 pmol/l (1.7–34.2)). Serum Ca, inorganic phosphate, alkaline phosphatase, and 1,25-dihydroxyvitamin D were not different in white and non-white girls. For the whole group, 25OHD concentration was related to the estimated SE and %BSA, but not to estimated intake of vitamin D. In white girls, the estimated SE and %BSA were significantly higher than that of non-white girls. The median times taken to complete the Gower’s manoeuvre and grip strength were not different in the two groups; these variables were not related to serum 25OHD. Conclusions: Hypovitaminosis D is common among healthy adolescent girls; non-white girls are more severely deficient. Reduced sunshine exposure rather than diet explains the difference in vitamin D status of white and non-white girls.