Assessment of vitamin and trace element status (VTE) is important in the clinical management of the sick child. In this position paper, we present the various assessment methods available to the clinical practitioner, and critically discuss pitfalls with interpretation of their results. There are 4 main approaches to assess the VTE body status of an individual patient including clinical examination, dietary assessment, and measurement of direct and indirect biomarkers of VTE in biological samples. Clinical signs of VTE deficiencies usually present only when body stores are substantially depleted and are often difficult to detect or differentiate from other nonnutrient-related causes. In isolation, dietary assessment of micronutrients can be inaccurate and imprecise, in disease and in individual patient assessment but may be useful to complement findings from other VTE assessment methods. Use of biomarkers is the most common approach to assess VTE status in routine practice but in the presence of systemic inflammatory response and in the absence of appropriate paediatric reference intervals, interpretation of biomarker results might be challenging and potentially mislead clinical practice. The use of a multimodal approach, including clinical examination, dietary assessment, and laboratory biomarkers is proposed as the optimal way to ascertain the VTE status of individual patients. In the presence of acute inflammatory conditions, VTE measurements in plasma should be replaced by biomarkers not affected by systemic inflammatory response or delayed until inflammatory state is resolved.

Children's Hospital Zagreb Croatia University of Zagreb School of Medicine Croatia

Department of Clinical Sciences Pediatrics Umeå University Umeå Sweden

Department of Neonatal Intensive Care Oslo University Hospital Oslo Norway

Department of Nutrition Exercise and Sports University of Copenhagen and Pediatric Nutrition Unit Copenhagen University Hospital Rigshospitalet Denmark

Department of paediatric Gastroenterology Great Ormond Street Hospital for Children NHS Foundation Trust London UK

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Pediatrics San Paolo Hospital Department of Health Sciences University of Milan Milan Italy

Division of Gastroenterology Hepatology and Nutrition The Hospital for Sick Children Toronto Canada

Human Nutrition School of Medicine Dentistry and Nursing University of Glasgow New Lister Building Glasgow Royal Infirmary Glasgow UK

Newcastle Neonatal Service Newcastle Hospitals NHS Trust and Newcastle University Newcastle upon Tyne

Ospedale Pediatrico Giovanni XXIII University of Bari Bari Italy

Paediatric Gastroenterology Erasmus MC Sophia Children's Hospital Rotterdam the Netherlands

Paris Descartes University APHP Necker Enfants Malades hospital Paris France and CNRC Baylor College of Medicine Houston TX

Pediatric Hepatology Gastroenterology and Transplantation ASST Papa Giovanni XXIIII Bergamo Italy

Scottish Trace Element and Micronutrient Diagnostic and Research Laboratory Department of Clinical Biochemistry Glasgow Royal Infirmary

UCL Great Ormond Street Institute of Child Health London UK

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