Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study
Background Vitamin D insufficiency (VDI) may be a factor in the development of type 1 diabetes (T1D). The aim of this study is to investigate the presence and persistence of VDI in a large cohort of infants with increased risk of developing T1D, in light of the differences in local supplementation g...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/8/1/e002212.full |
| _version_ | 1797354901934702592 |
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| author | Anette-Gabriele Ziegler Kristina Casteels Olga Kordonouri Helena Elding Larsson Markus Lundgren Agnieszka Szypowska Ezio Bonifacio Christiane Winkler Rachel Besser Andreas Weiss Mariusz Ołtarzewski John A. Todd An Jacobs Angela Hommel Maarten Warnants Veronika Vollmuth Thekla von dem Berge Marie-Luise Zielmann |
| author_facet | Anette-Gabriele Ziegler Kristina Casteels Olga Kordonouri Helena Elding Larsson Markus Lundgren Agnieszka Szypowska Ezio Bonifacio Christiane Winkler Rachel Besser Andreas Weiss Mariusz Ołtarzewski John A. Todd An Jacobs Angela Hommel Maarten Warnants Veronika Vollmuth Thekla von dem Berge Marie-Luise Zielmann |
| author_sort | Anette-Gabriele Ziegler |
| collection | DOAJ |
| description | Background Vitamin D insufficiency (VDI) may be a factor in the development of type 1 diabetes (T1D). The aim of this study is to investigate the presence and persistence of VDI in a large cohort of infants with increased risk of developing T1D, in light of the differences in local supplementation guidelines.Methods In the POInT Study, a multicentre primary prevention study between February 2018 and March 2021 in Germany, Poland, Belgium, England and Sweden, including infants aged 4–7 months at high genetic risk of developing β-cell autoantibodies, vitamin D levels were analysed at each study visit from inclusion (4–7 months) until 3 years, with an interval of 2 months (first three visits) or 4–6 months (visits 4–8). The protocol actively promotes vitamin D sufficiency to optimise immune tolerance. VDI was defined as a concentration below 30 ng/mL and was treated according to local guidelines of participating centres. Recovery from VDI was defined as a concentration above or equal to 30 ng/mL on the subsequent visit after VDI.Results 1050 infants were included, of which 5937 vitamin D levels were available for analyses. VDI was observed in 1464 (24.7%) visits and 507 (46.1%) of these were not resolved at the next visit. The risk of having VDI was independently associated with season (higher in winter), weight (higher with increased weight), age (higher with increased age) and country (higher in England). The risk of not recovering from VDI was independently associated with the season of the previously determined VDI, which was higher if VDI was identified in winter.Conclusions VDI is frequent in infants with increased risk of developing T1D. Treatment guidelines for VDI do not seem effective. Increasing supplementation dosages in this patient population seems warranted, especially during winter, and increasing dosages more aggressively after VDI should be considered. |
| first_indexed | 2024-03-08T13:56:30Z |
| format | Article |
| id | doaj.art-d3fa13efdd5949fca90b91f0059c3935 |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-03-08T13:56:30Z |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-d3fa13efdd5949fca90b91f0059c39352024-01-15T12:40:08ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722024-01-018110.1136/bmjpo-2023-002212Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT StudyAnette-Gabriele Ziegler0Kristina Casteels1Olga Kordonouri2Helena Elding Larsson3Markus Lundgren4Agnieszka Szypowska5Ezio Bonifacio6Christiane Winkler7Rachel Besser8Andreas Weiss9Mariusz Ołtarzewski10John A. Todd11An Jacobs12Angela Hommel13Maarten Warnants14Veronika Vollmuth15Thekla von dem Berge16Marie-Luise Zielmann17Technical University Munich, School of Medicine, Forschergruppe Diabetes at Klinikum rechts der Isar, Munich, Germany4 Department of Paediatrics, University Hospitals Leuven, Leuven, BelgiumDiabetes Center for Children and Adolescents, Auf der Bult Children`s Hospital, Hannover, Germany9 Unit for Paediatric Endocrinology, Department of Clinical Sciences Malmö, Lund University, SwedenDepartment of Paediatrics, Skåne University Hospital, Malmö, Sweden14 Department of Paediatrics, Medical University of Warsaw, Warsaw, PolandCenter for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, GermanyInstitute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany15 Department of Paediatrics, University of Oxford, Oxford, UK4IRBM Promidis, Pomezia, Italy13 Department of Screening and Metabolic Diagnostics, Institute of Mother and Child, Warsaw, Poland16 Wellcome Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK1 Department of Pediatric Endocrinology and Diabetes, KU Leuven University Hospitals Leuven, Leuven, Belgium12 Center for Regenerative Therapies, Technische Universität Dresden, Dresden, Germany2 Katholieke Universiteit Leuven, Leuven, Belgium3 Institute of Diabetes Research, Helmholtz Munich, German Center for Environmental Health, Munich, Germany10 Auf der Bult Children`s Hospital, Hannover, Germany11 Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyBackground Vitamin D insufficiency (VDI) may be a factor in the development of type 1 diabetes (T1D). The aim of this study is to investigate the presence and persistence of VDI in a large cohort of infants with increased risk of developing T1D, in light of the differences in local supplementation guidelines.Methods In the POInT Study, a multicentre primary prevention study between February 2018 and March 2021 in Germany, Poland, Belgium, England and Sweden, including infants aged 4–7 months at high genetic risk of developing β-cell autoantibodies, vitamin D levels were analysed at each study visit from inclusion (4–7 months) until 3 years, with an interval of 2 months (first three visits) or 4–6 months (visits 4–8). The protocol actively promotes vitamin D sufficiency to optimise immune tolerance. VDI was defined as a concentration below 30 ng/mL and was treated according to local guidelines of participating centres. Recovery from VDI was defined as a concentration above or equal to 30 ng/mL on the subsequent visit after VDI.Results 1050 infants were included, of which 5937 vitamin D levels were available for analyses. VDI was observed in 1464 (24.7%) visits and 507 (46.1%) of these were not resolved at the next visit. The risk of having VDI was independently associated with season (higher in winter), weight (higher with increased weight), age (higher with increased age) and country (higher in England). The risk of not recovering from VDI was independently associated with the season of the previously determined VDI, which was higher if VDI was identified in winter.Conclusions VDI is frequent in infants with increased risk of developing T1D. Treatment guidelines for VDI do not seem effective. Increasing supplementation dosages in this patient population seems warranted, especially during winter, and increasing dosages more aggressively after VDI should be considered.https://bmjpaedsopen.bmj.com/content/8/1/e002212.full |
| spellingShingle | Anette-Gabriele Ziegler Kristina Casteels Olga Kordonouri Helena Elding Larsson Markus Lundgren Agnieszka Szypowska Ezio Bonifacio Christiane Winkler Rachel Besser Andreas Weiss Mariusz Ołtarzewski John A. Todd An Jacobs Angela Hommel Maarten Warnants Veronika Vollmuth Thekla von dem Berge Marie-Luise Zielmann Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study BMJ Paediatrics Open |
| title | Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study |
| title_full | Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study |
| title_fullStr | Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study |
| title_full_unstemmed | Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study |
| title_short | Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the POInT Study |
| title_sort | vitamin d insufficiency in infants with increased risk of developing type 1 diabetes a secondary analysis of the point study |
| url | https://bmjpaedsopen.bmj.com/content/8/1/e002212.full |
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