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      Influence of vitamin D supplementation on growth, body composition, pubertal development and spirometry in South African schoolchildren: a randomised controlled trial (ViDiKids)

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          Abstract

          Objective

          To determine whether weekly oral vitamin D supplementation influences growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren.

          Design

          Phase 3 double-blind randomised placebo-controlled trial.

          Setting

          Socioeconomically disadvantaged peri-urban district of Cape Town, South Africa.

          Participants

          1682 children of black African ancestry attending government primary schools and aged 6–11 years at baseline.

          Interventions

          Oral vitamin D 3 (10 000 IU/week) versus placebo for 3 years.

          Main outcome measures

          Height-for-age and body mass index-for-age, measured in all participants; Tanner scores for pubertal development, spirometric lung volumes and body composition, measured in a subset of 450 children who additionally took part in a nested substudy.

          Results

          Mean serum 25-hydroxyvitamin D 3 concentration at 3-year follow-up was higher among children randomised to receive vitamin D versus placebo (104.3 vs 64.7 nmol/L, respectively; mean difference (MD) 39.7 nmol/L, 95% CI 37.6 to 41.9 nmol/L). No statistically significant differences in height-for-age z-score (adjusted MD (aMD) −0.08, 95% CI −0.19 to 0.03) or body mass index-for-age z-score (aMD −0.04, 95% CI −0.16 to 0.07) were seen between vitamin D versus placebo groups at follow-up. Among substudy participants, allocation to vitamin D versus placebo did not influence pubertal development scores, % predicted forced expiratory volume in 1 s (FEV1), % predicted forced vital capacity (FVC), % predicted FEV1/FVC, fat mass or fat-free mass.

          Conclusions

          Weekly oral administration of 10 000 IU vitamin D 3 boosted vitamin D status but did not influence growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren.

          Trial registration numbers

          ClinicalTrials.gov NCT02880982, South African National Clinical Trials Register DOH-27-0916-5527.

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          Most cited references27

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          Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement

          Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities. Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients’ experiences. Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices. Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.
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            Long-term consequences of stunting in early life.

            This review summarizes the impact of stunting, highlights recent research findings, discusses policy and programme implications and identifies research priorities. There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Recent research findings, including follow-up of an intervention trial in Guatemala, indicate that stunting can have long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. This evidence has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the global burden of disease and for fostering economic development. Follow-up of randomized intervention trials is needed in other regions to add to the findings of the Guatemala trial. Further research is also needed to: understand the pathways by which prevention of stunting can have long-term effects; identify the pathways through which the non-genetic transmission of nutritional effects is mediated in future generations; and determine the impact of interventions focused on linear growth in early life on chronic disease risk in adulthood. © 2011 Blackwell Publishing Ltd.
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              The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action

              Background In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025. Main body Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children’s Fund (UNICEF), WHO and the World Bank. The Institute for Health Metrics and Evaluation (IHME) has published country-level estimates of obesity in children aged 2–4 years. For children aged 5–19 years, obesity estimates are available from the NCD Risk Factor Collaboration. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2–4 years has increased moderately. In 1975, obesity in children aged 5–19 years was relatively rare, but was much more common in 2016. Conclusions It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity. Although cost-effective interventions such as WHO ‘best buys’ have been identified, political will and implementation have so far been limited. There is therefore a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity. To be successful, the obesity epidemic must be a political priority, with these issues addressed both locally and globally. Work by governments, civil society, private corporations and other key stakeholders must be coordinated.
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                Author and article information

                Journal
                BMJ Paediatr Open
                BMJ Paediatr Open
                bmjpo
                bmjpo
                BMJ Paediatrics Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2399-9772
                2024
                10 April 2024
                : 8
                : 1
                : e002495
                Affiliations
                [1 ] departmentDesmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine , Ringgold_37716University of Cape Town , Cape Town, South Africa
                [2 ] departmentDepartment of Medicine , Ringgold_37716University of Cape Town , Cape Town, South Africa
                [3 ] departmentHealth through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology , Faculty of Health Sciences University of Cape Town , Cape Town, South Africa
                [4 ] departmentSAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics , Faculty of Health Sciences University of the Witwatersrand , Johannesburg, South Africa
                [5 ] departmentWolfson Institute of Population Health, Faculty of Medicine and Dentistry , Queen Mary University of London , London, UK
                [6 ] departmentBlizard Institiute, Faculty of Medicine and Dentistry , Ringgold_4617Queen Mary University of London , London, UK
                [7 ] departmentCentre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine , Faculty of Health Sciences University of Cape Town , Cape Town, South Africa
                [8 ] Ringgold_5388Walter and Eliza Hall Institute of Medical Research , Melbourne, Victoria, Australia
                [9 ] departmentDepartment of Paediatrics and Child Health , Ringgold_37716University of Cape Town , Cape Town, South Africa
                [10 ] departmentNorwich Medical School , University of East Anglia , Norwich, UK
                [11 ] departmentDepartment of Laboratory Medicine , Norfolk and Norwich University Hospital NHS Foundation Trust , Norwich, UK
                [12 ] departmentMRC Lifecourse Epidemiology Centre , University of Southampton , Southampton, UK
                [13 ] University Hospital Southampton NHS Foundation Trust , Southampton, UK
                [14 ] The Francis Crick Institute , London, UK
                [15 ] departmentDepartment of Infectious Diseases , Imperial College London , London, UK
                Author notes
                [Correspondence to ] Prof Adrian R Martineau; a.martineau@ 123456qmul.ac.uk

                KM and LM are joint first authors.

                Author information
                http://orcid.org/0000-0001-5387-1721
                Article
                bmjpo-2024-002495
                10.1136/bmjpo-2024-002495
                11015302
                38599800
                d029dd16-fb0e-4881-982b-5b48f61215e5
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 07 January 2024
                : 29 February 2024
                Funding
                Funded by: UK Medical Research Council;
                Award ID: MR/M026639/1
                Award ID: MR/R023050/1
                Categories
                Nutrition
                1506
                Original research
                Custom metadata
                unlocked

                adolescent health,growth
                adolescent health, growth

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