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This work was commissioned by the WHO and FAO within the framework of the update of the vitamin D requirements for children 0\u20133 years old.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A systematic search of Embase was conducted to identify studies involving children below\u00a0 4 years of age with serum 25OHD levels and radiologically confirmed rickets, without any restriction related to the geographical location or language. Study-level and individual participant data (IPD)-level random effects multi-level meta-analyses were conducted. The odds, sensitivity and specificity for rickets at different serum 25OHD thresholds were calculated for all children as well as for children with adequate calcium intakes only.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 120 studies with 5412 participants were included. At the study-level, children with rickets had a mean serum 25OHD of 23 nmol\/L (95% CI 19\u201327). At the IPD level, children with rickets had a median and mean serum 25OHD of 23 and 29\u00a0nmol\/L, respectively. More than half (55%) of the children with rickets had serum 25OHD below 25\u00a0nmol\/L, 62% below 30\u00a0nmol\/L, and 79% below 40\u00a0nmol\/L. Analysis of odds, sensitivities and specificities for nutritional rickets at different serum 25OHD thresholds suggested a minimal risk threshold of around 28\u00a0nmol\/L for children with adequate calcium intakes and 40\u00a0nmol\/L for children with low calcium intakes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This systematic review and IPD meta-analysis suggests that from a public health perspective and to inform the development of dietary requirements for vitamin D, a minimum serum 25OHD threshold of around 28 nmol\/L and above would represent a low risk of nutritional rickets for the majority of children with an adequate calcium intake.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00394-023-03299-2","type":"journal-article","created":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T17:02:02Z","timestamp":1706374922000},"page":"673-695","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Serum 25-hydroxyvitamin D threshold and risk of rickets in young children: a systematic review and individual participant data meta-analysis to inform the development of dietary requirements for vitamin D"],"prefix":"10.1007","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0455-197X","authenticated-orcid":false,"given":"Magali","family":"Rios-Leyvraz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7644-8173","authenticated-orcid":false,"given":"Tom D.","family":"Thacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1768-060X","authenticated-orcid":false,"given":"Aashima","family":"Dabas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4205-7211","authenticated-orcid":false,"given":"Heba Hassan","family":"Elsedfy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8465-5087","authenticated-orcid":false,"given":"Giampiero I.","family":"Baroncelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8185-1039","authenticated-orcid":false,"given":"Kevin D.","family":"Cashman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,27]]},"reference":[{"key":"3299_CR1","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1002\/jcb.10338","volume":"88","author":"MF Holick","year":"2003","unstructured":"Holick MF (2003) Vitamin D: a millenium perspective. 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