He Lanzhi, Zhou Pengxiang, Zhou Xin, Tian Shuxia, Han Jing, Zhai Suodi
Department of Pharmacy, Peking University Third Hospital, Beijing, China.
Department of Pharmacy, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Front Nutr. 2022 Sep 27;9:984423. doi: 10.3389/fnut.2022.984423. eCollection 2022.
This study aimed to assess the methodological and reporting quality of the guidelines and consensus on calcium and vitamin D supplementation in healthy children, and the consistency of these recommendations.
A systematic search of relevant guideline websites and databases, including PubMed, Embase, CNKI, WangFang, and SinoMed, was undertaken from inception to April 7, 2021, by two independent reviewers who assessed the eligible guidelines using the validated Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) tools. Overall, the between-reviewer agreement was evaluated using an intra-class correlation coefficient.
A total of 24 guidelines and consensuses from 2002 to 2022 were identified from China, the United States, Canada, France, Australia, New Zealand, Europe, and other countries and regions. These were of mixed quality, and scored poorly in the rigor of development, editorial independence, and applicability of the domains of AGREE II. Among the seven domains of the RIGHT checklist, domain one (basic information) had the highest reporting rate (69.3%), whereas domain five (review and quality assurance) had the lowest reporting rate (11.5%). The overall quality of the included guidelines and consensuses was low. Only 12 guidelines were recommended, with modifications. The recommended calcium intake for children of different ages varies greatly (400-1,150 mg/day). Among the included guidelines and consensuses, a vitamin D (VD) prevention dose of 400 IU/day in infants was generally considered safe, and 25-hydroxyvitamin-D [25(OH)D] levels of <20 ng/mL (50 nmol/L) or 20-30 ng/mL (50-75 nmol/L) indicated VD deficiency or insufficiency. However, the recommended amount of VD for children of different age groups and risk strata differed considerably (400-4,000 IU/day or 10-100 μg/day). The choice of VD2 or VD3 supplements and sunlight exposure also differed across the guidelines and consensuses.
There is considerable variability in calcium and VD guidelines and consensus development methods in calcium and VD supplementation for healthy children. Therefore, efforts are necessary to strengthen the methodological rigor of guideline development and utilize the best available evidence to underpin recommendations.
本研究旨在评估健康儿童钙和维生素D补充剂相关指南及共识的方法学质量和报告质量，以及这些建议的一致性。
由两名独立评审员从指南起始至2021年4月7日，对相关指南网站和数据库进行系统检索，包括PubMed、Embase、中国知网、万方和中国生物医学文献数据库，他们使用经过验证的《研究与评价指南工具II》（AGREE II）和《医疗保健实践指南报告条目》（RIGHT）工具对符合条件的指南进行评估。总体而言，使用组内相关系数评估评审员之间的一致性。
共识别出2002年至2022年来自中国、美国、加拿大、法国、澳大利亚、新西兰、欧洲和其他国家及地区的24项指南和共识。这些质量参差不齐，在AGREE II的制定严谨性、编辑独立性和适用性领域得分较低。在RIGHT清单的七个领域中，领域一（基本信息）的报告率最高（69.3%），而领域五（评审与质量保证）的报告率最低（11.5%）。纳入的指南和共识的总体质量较低。仅12项指南经修改后被推荐。不同年龄段儿童的推荐钙摄入量差异很大（400 - 1150毫克/天）。在纳入的指南和共识中，婴儿维生素D（VD）预防剂量一般认为400国际单位/天是安全的，25 - 羟基维生素D[25(OH)D]水平<20纳克/毫升（50纳摩尔/升）或20 - 30纳克/毫升（50 - 75纳摩尔/升）表明VD缺乏或不足。然而，不同年龄组和风险分层儿童的VD推荐量差异很大（400 - 4000国际单位/天或10 - 100微克/天）。不同指南和共识在VD2或VD3补充剂的选择以及阳光照射方面也存在差异。
健康儿童钙和VD补充剂的钙和VD指南及共识制定方法存在相当大的差异。因此，有必要加强指南制定的方法学严谨性，并利用现有最佳证据来支持建议。
