Use of dietary supplements by children and adolescents

Barretto, Junaura Rocha; Gouveia, Mara Alves da Cruz; Alves, Crésio

doi:10.1016/j.jped.2023.09.008

Review article • J. Pediatr. (Rio J.) 100 (suppl 1) • Mar-Apr 2024 • https://doi.org/10.1016/j.jped.2023.09.008 linkcopy

Use of dietary supplements by children and adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives Narrative review evaluating the use of dietary supplements by children and adolescents.

Data source The terms “dietary supplements”, “children” and “adolescents” were used in combination in the PubMed, MEDLINE, and SciELO databases, between 2000 and 2023, evaluating studies in humans, published in Portuguese, English, French and Spanish.

Data synthesis The use of dietary supplements by children and adolescents has increased in recent decades. The most commonly used supplements are vitamins, minerals, trace elements, proteins, amino acids, melatonin, fatty acids, probiotics and energy drinks.

Conclusion Despite having specific indications, most of the time they are not prescribed by a healthcare professional. The reasons for use are varied. In children, the main reasons are protection against infections, stimulating growth, and poor food intake, with multivitamins and minerals being the most commonly used supplements. In adolescents, they are used to improve athletic performance and attain the “ideal body”, with proteins and amino acids being the most often used nutrients. As they are not regulated by health agencies and are sold without a prescription, their unsupervised use can lead to inadequate doses, with inefficiency or overdose risk. As for compounding formulations, or when available in preparations with multiple nutrients, the chance of errors increases. It is essential that pediatricians advise parents and patients about the indications, risks and benefits, prescribing them when necessary.

Keywords
Dietary supplement; Vitamins; Minerals; Trace elements; Probiotics; Melatonin

Caregivers’ perception	Most used supplements
- Ensure adequate nutrient intake - Stimulate growth and weight gain - Increase the supply of vitamins and minerals - Protect against flu and infections - Insufficient intake of fruits and vegetables - Lower cost than food	- Multivitamins, vitamin C, vitamin D, calcium, probiotics, omega-3
Adolescents’ perception	Most used supplements
- Improve athletic performance - Improve performance - Increase muscle mass - Attain the “ideal body” - Improve sleep	- Whey protein, amino acids, carnitine, energy drinks, melatonin

Children and adolescents
Supplement vitamin D 400 IU/day (< 1 year) and 600 IU/day (> 1 year), in - Children on exclusive breastfeeding, starting soon after birth. For preterm babies, supplementation should be started when their weight >1500 g and there is tolerance to oral intake. - Children using milk formula fortified with vitamin D who ingest less than 1000 mL/day. - Children and adolescents who do not ingest at least 600 IU of vitamin D/day in their diet. - Children and adolescents who are not exposed to the sun regularly.
Supplement vitamin D (600-1800 IU/day) in the following risk groups - Pregnancy. - Lactation. - Strictly vegetarian diet. - Obesity. - Chronic liver disease. - Chronic nephropathy. - Intestinal malabsorption (e.g. celiac disease, Crohn's disease, cystic fibrosis, bariatric surgery). - Hyperparathyroidism. - Use of medications: anticonvulsants (phenobarbital, phenytoin, carbamazepine, oxcarbazepine) corticosteroids, azole antifungals (ketoconazole), antiretrovirals, cholestyramine, orlistat, rifampicin.
Encourage the practice of outdoor activities - There is no consensus regarding the duration, time and frequency of sun exposure due to the risk of this exposure causing skin cancer.
Encourage regular consumption of foods rich in vitamin D
*The exact duration of vitamin D supplementation is not defined. Children with risk factors for hypovitaminosis D should maintain supplementation for as long as the risk factor is present. Healthy children, without risk factors, but with limited sun exposure, should have supplementation assessed individually.

Situation	Recommendation
Full-term newborns, appropriate weight for gestational age, regardless of the type of feeding	1 mg of elemental iron/kg/day until the 24th month of life
Full-term newborns weighing < 2500 g.	2 mg of elemental iron/kg/day during the first year. After this period, 1 mg/kg/day for another year
Preterm newborns weighing > 1500 g	2 mg of elemental iron/kg/day during the first year. After this period, 1 mg/kg/day for another year
Preterm newborns weighing between 1500 and 1000 g	3 mg elemental iron/kg/day during the first year. After this period, 1 mg/kg/day for another year
Preterm newborns weighing < 1000 g	4 mg of elemental iron/kg/day during the first year. After this period, 1 mg/kg/day for another year

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