Vitamin D deficiency is disproportionately prevalent among overweight and obese children,with conventional explanations such as poor dietary intake or reduced sun exposure offering only partial insight.Emerging eviden...Vitamin D deficiency is disproportionately prevalent among overweight and obese children,with conventional explanations such as poor dietary intake or reduced sun exposure offering only partial insight.Emerging evidence reveals a multifactorial pathophysiology,including sequestration of vitamin D in adipose tissue,altered hepatic metabolism,diminished bioavailability,and inflammationinduced resistance at the tissue level.These mechanisms contribute to a functional deficiency,wherein serum 25-hydroxyvitamin D levels may remain suboptimal despite adequate intake or sun exposure.Obesity-related alterations in vitamin Dbinding proteins,receptor expression,and pro-inflammatory signaling further compromise biological activity.Current diagnostic criteria and supplementation guidelines do not fully reflect these physiological complexities,leading to underdiagnosis and insufficient treatment.Personalized approaches-incorporating higher,body composition-adjusted dosing and consideration of inflammatory status-are emerging as promising strategies to restore sufficiency and improve metabolic outcomes.While preliminary evidence supports the safety and efficacy of high-dose supplementation in this population,pediatric-specific clinical trials are lacking.This review synthesizes current understanding of the pathophysiological mechanisms underlying vitamin D deficiency in pediatric obesity and emphasizes the need for individualized,evidence-based interventions to optimize vitamin D status and overall health.展开更多
文摘Vitamin D deficiency is disproportionately prevalent among overweight and obese children,with conventional explanations such as poor dietary intake or reduced sun exposure offering only partial insight.Emerging evidence reveals a multifactorial pathophysiology,including sequestration of vitamin D in adipose tissue,altered hepatic metabolism,diminished bioavailability,and inflammationinduced resistance at the tissue level.These mechanisms contribute to a functional deficiency,wherein serum 25-hydroxyvitamin D levels may remain suboptimal despite adequate intake or sun exposure.Obesity-related alterations in vitamin Dbinding proteins,receptor expression,and pro-inflammatory signaling further compromise biological activity.Current diagnostic criteria and supplementation guidelines do not fully reflect these physiological complexities,leading to underdiagnosis and insufficient treatment.Personalized approaches-incorporating higher,body composition-adjusted dosing and consideration of inflammatory status-are emerging as promising strategies to restore sufficiency and improve metabolic outcomes.While preliminary evidence supports the safety and efficacy of high-dose supplementation in this population,pediatric-specific clinical trials are lacking.This review synthesizes current understanding of the pathophysiological mechanisms underlying vitamin D deficiency in pediatric obesity and emphasizes the need for individualized,evidence-based interventions to optimize vitamin D status and overall health.
