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Vitamin D, Nutrition, and Bone and Immune Function—Implications for Health and Disease from Infancy Through Adolescence

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A Special Issue of Nutrients (ISSN 2072-6643) belonging to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (15 June 2026) | Viewed by 3550

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Prof. Dr. Justyna Czech-Kowalska

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Department of Neonatology and Neonatal Intensive Care, The Children's Memorial Health Institute, 04-730 Warsaw, Poland
Interests: vitamin D and its pleiotropic action; disturbances of calcium-phosphate metabolism including osteopenia of prematurity; markers of bone tissue metabolism; body composition and bone mass assessment

Special Issue Information

Dear Colleagues,

Vitamin D and overall nutritional status are important modulators of skeletal system development and immune function across an individual’s lifespan. However, despite growing interest in this area, the data concerning pediatric populations remain limited. The developmental period—from infancy through adolescence—represents a critical window, during which nutrition programming may have long-term health implications.

Submissions addressing the role of vitamin D and nutrition in shaping immune function, bone health, and metabolism in early life are particularly encouraged. Special consideration will be given to studies involving infants, children, and adolescents, including those focused on infection, inflammation, autoimmune conditions, or musculoskeletal outcomes. We also welcome studies examining body composition, as this may both influence and reflect vitamin D status and nutritional adequacy during growth.

This Special Issue will improve our understanding of these related areas in early life and support evidence-based approaches in both clinical care and public health.

Prof. Dr. Justyna Czech-Kowalska
Guest Editor

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Keywords

vitamin D status
vitamin D supplementation
nutrition
body composition
skeletal system
bone metabolism
acquired and innate immunity
autoimmune disorders
infectious diseases
infants
children

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Published Papers (6 papers)

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20 pages, 1491 KB

Open AccessArticle

Vitamin D Status and Response to Calcifediol Supplementation in Term and Preterm Infants with Cholestasis

by Katarzyna Chada-Borowiecka, Justyna Czech-Kowalska, Edyta Czekuć-Kryśkiewicz, Ewa Skorupa, Marek Wójcik, Małgorzata Jarończyk, Rafał Bartczuk, Anna Niezgoda and Dariusz Gruszfeld

Nutrients 2026, 18(18), 2962; https://doi.org/10.3390/nu18182962 - 9 Sep 2026

Abstract

Background/Objectives: Infants with cholestasis are at risk of vitamin D status impairment; the role of prematurity remains unclear. The primary aim of this study was to characterize vitamin D status in term and preterm infants with cholestasis and to determine whether serum 25OHD concentrations were associated with gestational age, etiology of cholestasis, and biochemical markers of cholestatic activity. The secondary aim was to assess changes in serum 25OHD concentrations during calcifediol supplementation and to identify factors associated with follow-up 25OHD concentrations. Methods: In this prospective observational study with a concurrent control group, infants with cholestasis and controls underwent assessment, including serum 25-hydroxyvitamin D (25OHD), at baseline and after calcifediol supplementation in cholestatic infants. Predictors of 25OHD were evaluated using multivariable models. Results: We included 127 infants: 70 with cholestasis (39 term, 31 preterm) and 57 controls (30 term, 27 preterm). Biliary atresia was diagnosed in 21 (30%) infants. Calcifediol was administered to 38 (54%) cholestatic infants: 18 (46%) term and 20 (64%) preterm at baseline. The remaining 32 infants with cholestasis were receiving vitamin D3 supplementation. Following enrollment and review of the baseline 25OHD results, calcifediol treatment was continued or initiated in 66 of the 70 infants. Treatment was discontinued in four infants based on their high serum 25OHD concentrations. Baseline 25OHD was similar in cholestasis and controls (34.81 ± 21.33 vs. 31.55 ± 10.14 ng/mL; p = 0.261). However, vitamin D deficiency (<20 ng/mL) was more frequent in cholestatic infants than controls (22.8% vs. 5%; p < 0.05), and 25OHD concentrations > 50 ng/mL were also more frequent (18.6% vs. 3.5%; p < 0.05). Among 13 infants with 25OHD concentrations > 50 ng/mL, 11 (84.6%) infants had received calcifediol; only three exceeded 100 ng/mL. Each 1 µg/kg increase in calcifediol dose was associated with 15.7% higher expected baseline 25OHD. At follow-up, preterm and term infants had comparable 25OHD (44.15 ± 20.36 vs. 45.73 ± 18.77 ng/mL; p = 0.737); nevertheless, <30 ng/mL persisted in 23%, while >50 ng/mL occurred in 40% of cholestatic infants. Baseline 25OHD concentration and cumulative calcifediol exposure were associated with follow-up 25OHD concentration. Conclusions: Vitamin D status in cholestatic infants is highly variable. Cumulative exposure of calcifediol is associated with higher 25OHD concentrations, but heterogeneous responses require monitoring and individualized dose adjustment. Full article

(This article belongs to the Special Issue Vitamin D, Nutrition, and Bone and Immune Function—Implications for Health and Disease from Infancy Through Adolescence)

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13 pages, 1336 KB

Open AccessArticle

Vitamin D Status in Children with Primary Immunodeficiency Disorders Receiving Vitamin D Supplementation: A Retrospective Cross-Sectional Study

by Nel Dąbrowska-Leonik, Renata Grzywa-Czuba, Monika Wasiak, Mikołaj Wasil, Weronika Zaczek, Maria Żebrowska and Małgorzata Pac

Nutrients 2026, 18(17), 2845; https://doi.org/10.3390/nu18172845 - 31 Aug 2026

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Abstract

Background: Vitamin D plays an important immunomodulatory role, and vitamin D deficiency has been associated with an increased risk of infections and autoimmune disorders. Although patients with some primary immunodeficiency disorders (PID) exhibit higher rates of vitamin deficiency, there are currently no evidence-based recommendations regarding whether children with PIDs require higher vitamin D supplementation than healthy peers. This study aimed to evaluate the nutritional status of vitamin D and vitamin D supplementation in children with PIDs. Methods: The study included 132 children diagnosed with PIDs according to the 2024 update of the phenotypic classification by the International Union of Immunological Societies (IUIS). The following variables were evaluated: body mass index (BMI), 25-hydroxyvitamin D (25(OH)D), calcium, phosphorus, immunoglobulins G, A and M, and number of neutrophils and lymphocytes in the blood. Results: Vitamin D deficiency occurred in 13% of all tested children, and in 22 and 33% of children with predominantly antibody deficiencies and complement deficiencies, respectively, with the median vitamin D supplementation of 1000 IU. The median serum 25(OH)D concentration was 30.75 ng/mL (32.7 ng/mL in girls and 30 ng/mL in boys). The multiple linear regression model showed that the concentration of serum phosphorus level (b = 0.312; p = 0.0497) and immunoglobulin G level (b = 0.433; p = 0.0009) had the greatest influence on the concentration of 25(OH)D. No statistically significant differences in 25(OH)D concentrations were observed among the different IUIS diagnostic groups or between children with normal and low IgG levels. Conclusions: In this retrospective cross-sectional study, children reportedly receiving median 1000 IU supplementation had median 25(OH)D of 30.75 ng/mL with 13% deficiency prevalence; however, causal attribution requires prospective evaluation. Full article

(This article belongs to the Special Issue Vitamin D, Nutrition, and Bone and Immune Function—Implications for Health and Disease from Infancy Through Adolescence)

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18 pages, 1974 KB

Open AccessArticle

Assessment of Bone Mass and Fracture Risk Using Trabecular Bone Score in Children with Autoimmune Gastrointestinal Diseases

by Anna Łupińska, Sara Aszkiełowicz, Arkadiusz Zygmunt and Renata Stawerska

Nutrients 2026, 18(15), 2454; https://doi.org/10.3390/nu18152454 - 27 Jul 2026

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Abstract

Background/Objectives: Children with autoimmune gastrointestinal diseases are at increased risk of impaired bone health due to chronic inflammation, nutritional deficiencies, growth disturbances, and treatment-related factors. While dual-energy X-ray absorptiometry (DXA) is the standard method for assessing bone mineral density (BMD), it provides limited information on bone microarchitecture. The trabecular bone score (TBS), derived from lumbar spine DXA images, has emerged as a complementary marker of bone quality. This study aimed to evaluate bone mass and TBS in children with autoimmune gastrointestinal diseases and to assess the clinical utility of TBS in comparison with children with a history of fractures and healthy controls. Methods: This study included 152 children aged 5–18 years: 45 with autoimmune gastrointestinal diseases (Crohn’s disease, ulcerative colitis, or celiac disease), 37 with a history of fractures, and 70 healthy controls. Anthropometric measurements, serum 25-hydroxyvitamin D [25(OH)D] concentrations, DXA-derived parameters, and TBS values were analyzed. Bone mineral density was assessed at the lumbar spine and total body less head (TBLH), with additional adjustment for height-for-age Z-score (HAZ). TBS values were expressed as sex- and pubertal stage-adjusted Z-scores. Results: Low bone mass (aBMD_{for age} Z-score ≤ −2) was observed in 30.3% of participants at TBLH and 11.1% at the lumbar spine, whereas a TBS Z-score ≤ −2 was identified in 5.2% of children. No significant differences in TBS or TBS Z-scores were found among the study groups. In multivariable analysis, fracture history was independently associated with lower absolute TBS, whereas no independent predictors of TBS Z-score were identified. Children with fractures had significantly lower HAZ-adjusted lumbar spine aBMD Z-scores than children with autoimmune gastrointestinal diseases and controls. TBS Z-scores correlated positively with age-adjusted and HAZ-adjusted aBMD values but showed no association with BMI or serum 25(OH)D concentrations. Conclusions: In this cross-sectional study, TBS did not distinguish children with autoimmune gastrointestinal diseases from those with fractures or healthy controls in the unadjusted analyses. Although TBS was associated with selected DXA-derived measures of bone mineral density and fracture history was independently associated with lower absolute TBS after multivariable adjustment, no independent predictors of TBS Z-score were identified. These findings suggest that the clinical role of TBS in the assessment of pediatric bone health remains to be established. Larger prospective studies are crucial to determine whether TBS provides clinically meaningful information complementary to conventional DXA for the assessment of skeletal health and fracture risk in children. Larger prospective studies are needed to clarify the clinical value of TBS for fracture risk assessment in pediatric autoimmune gastrointestinal diseases. Full article

(This article belongs to the Special Issue Vitamin D, Nutrition, and Bone and Immune Function—Implications for Health and Disease from Infancy Through Adolescence)

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11 pages, 729 KB

Open AccessArticle

DXA-Derived Total Body Fat Percentage and Serum 25(OH)D in Overweight and Obese Children: A Cross-Sectional Study

by Jolanta Świderska, Sebastian Więckowski, Michał Wilk, Wojciech Piętak, Małgorzata Wajda-Cuszlag, Anna Świercz, Maciej Jaworski, Anna Świąder-Leśniak, Agnieszka Ochocińska, Aleksandra Borowska, Marta Baszyńska-Wilk, Piotr Socha and Elżbieta Moszczyńska

Nutrients 2026, 18(14), 2334; https://doi.org/10.3390/nu18142334 - 16 Jul 2026

Viewed by 371

Abstract

Background/Objectives: Lower serum 25-hydroxyvitamin D [25(OH)D] is common in pediatric overweight and obesity, but it remains unclear whether direct adiposity assessment adds information beyond an age- and sex-adjusted model containing BMI z-score and season. We tested whether DXA-derived total body fat percentage is associated with 25(OH)D and whether it adds explanatory power to that model. Methods: We analyzed cross-sectional data from 768 children/adolescents (10–18 years) with overweight/obesity. Anthropometry was available for all; DXA data for 489. The primary analysis used complete-case DXA data (n = 485). Vitamin D supplementation status was not available. Results: Participants with and without DXA were similar in age, sex, BMI z-score, and serum 25(OH)D, but blood sampling season differed (p < 0.001). Adding DXA-derived body fat percentage to the age- and sex-adjusted base model increased R² from 0.0498 to 0.0657 (ΔR² = 0.0159). Within the complete-case DXA subgroup (n = 485), DXA-derived total body fat percentage was inversely associated with 25(OH)D after adjustment for BMI z-score, season, age, and sex (B = −0.265; 95% CI, −0.448 to −0.082; p = 0.005). BMI z-score was significant in the base model but not after adjustment for DXA fat percentage. Conclusions: DXA-derived total body fat percentage added explanatory value for serum 25(OH)D beyond BMI z-score and season, but the incremental gain was small (ΔR² = 0.0159). The findings are consistent with BMI z-score acting as a less direct proxy for the adiposity compartment that DXA quantifies more specifically. Causal interpretation is precluded by the cross-sectional design, unknown supplementation status, and non-random DXA availability. Full article

(This article belongs to the Special Issue Vitamin D, Nutrition, and Bone and Immune Function—Implications for Health and Disease from Infancy Through Adolescence)

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11 pages, 868 KB

Open AccessArticle

Densitometry Versus Bioimpedance for Modeling Vitamin D–Endocrine and Metabolic Associations in Pediatric Obesity: A Cross-Sectional Parallel-Modality Analysis

by Elżbieta Jakubowska-Pietkiewicz, Jędrzej Chrzanowski and Elżbieta Woźniak

Nutrients 2026, 18(5), 750; https://doi.org/10.3390/nu18050750 - 26 Feb 2026

Cited by 1 | Viewed by 686

Abstract

Background/Objectives: It has been previously shown that bioimpedance assessment (BIA) systematically underestimates adiposity compared to densitometry analysis (DXA), though the methods correlate strongly. However, whether DXA outperforms BIA for physiology modeling—using vitamin D as a sentinel signal—remains uncertain. We compared DXA and BIA side-by-side to model (i) adiposity–25(OH)D associations, (ii) mediation-style links with metabolic outcomes, and the vitamin D–PTH–calcium axis. Methods: We performed a cross-sectional analysis of 165 children with simple obesity and no vitamin D prophylaxis collected between July 2022 and July 2025. We measured adiposity through DXA and BIA methods, laboratory 25(OH)D, and associated biochemical and clinical parameters: PTH, calcium, phosphate, glucose/insulin/HOMA-IR, lipids. Information on age, sex, and season was recorded and used to adjust for potential covariates. Parallel analyses included partial correlations, linear regression, mediation models, and Bland–Altman analysis for DXA–BIA agreement. Results: The cohort median age was 13 years; median 25(OH)D level was 21.9 ng/mL. DXA fat % exceeded BIA (46.6% vs. 36.7%). Univariately, 25(OH)D correlated inversely with adiposity (DXA rho = −0.16, BIA rho = −0.19), but adiposity was not a significant determinant of 25(OH)D after season/age adjustment with either modality. No mediation of vitamin D to metabolic associations via adiposity were detected. The vitamin D–PTH–calcium axis was robust across modalities. Conclusions: In children with established obesity, seasonal and age factors dominate 25(OH)D variability, while the adiposity contributes little within-group. Vitamin D shows endocrine but not metabolic associations, and within this homogenous pediatric obesity cohort, DXA does not outperform BIA for physiologic modeling. Full article

(This article belongs to the Special Issue Vitamin D, Nutrition, and Bone and Immune Function—Implications for Health and Disease from Infancy Through Adolescence)

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18 pages, 1610 KB

Open AccessReview

Vitamin D and Neonatal Sepsis: Current Evidence, Biological Mechanisms, and Future Directions—A Scoping Review

by Dominika Paw, Renata Bokiniec, Krzysztof Włodarczyk and Alicja Kołodziejczyk-Nowotarska

Nutrients 2026, 18(15), 2517; https://doi.org/10.3390/nu18152517 - 3 Aug 2026

Viewed by 366

Abstract

Objective: Neonatal sepsis is a major cause of morbidity and mortality. Vitamin D modulates immune responses and influences the risk and outcomes of neonatal sepsis. Therefore, we aimed to systematically outline the role of vitamin D in neonatal sepsis, including its effects on incidence, severity, treatment outcomes, and underlying mechanisms. Methods: A literature search was conducted in the MEDLINE and EMBASE databases with English language restrictions and no date limit. Eligible sources included experimental, observational, and descriptive studies as well as reviews addressing vitamin D status, supplementation, and mechanisms in neonatal sepsis. This review followed the PRISMA Extension for Scoping Reviews guidelines. Results: Forty-five studies were selected and analyzed. Vitamin D deficiency was globally prominent among neonates and may be correlated with an increased risk or severity of sepsis. Most studies were observational, primarily case-control or cross-sectional, and conducted in South Asia and the Middle East, with increasing research activity after 2018. The number of term infants was higher than that of preterm infants. Recently, innate immune mechanisms, including antimicrobial peptides and toll-like receptor signaling, were highlighted. However, comparisons across studies were limited by inconsistencies in design, vitamin D cut-offs, timing of blood sampling, and sepsis definitions. Only six studies included patients with culture-proven sepsis, whereas others included clinically suspected cases. Few studies assessed the long-term outcomes, immune maturation, or neurodevelopmental consequences. Conclusions: Vitamin D deficiency may be associated with neonatal sepsis; however, the findings remain inconsistent because of methodological variability. Therefore, high-quality, standardized, multicenter studies are needed. The review also identified substantial methodological heterogeneity regarding vitamin D assessment, sepsis definitions, and neonatal populations, which currently limits evidence-based clinical recommendations. Full article

(This article belongs to the Special Issue Vitamin D, Nutrition, and Bone and Immune Function—Implications for Health and Disease from Infancy Through Adolescence)

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