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Современные взгляды на обогащение рациона детского и взрослого населения витамином D: проблемы и перспективы
Современные взгляды на обогащение рациона детского и взрослого населения витамином D: проблемы и перспективы
Плудовский П., Захарова И.Н., Климов Л.Я. Современные взгляды на обогащение рациона детского и взрослого населения витамином D: проблемы и перспективы. Педиатрия (Прил. к журн. Consilium Medicum). 2017; 3: 10–17.
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Аннотация
В статье представлены данные литературы о метаболизме и биологической роли витамина D в организме, сфокусировано внимание на некальциемических плейотропных эффектах, а также механизмах его влияния на иммунную, эндокринную, сердечно-сосудистую, нервную системы. Представлены современные взгляды на оптимальный уровень, критерии дефицита и гипервитаминоза D. Показана необходимость поддержания достаточного уровня активных метаболитов для обеспечения пролонгированных эффектов на состояние здоровья в детском и взрослом возрасте, причем некальциемические эффекты достигаются при более высоком уровне активных метаболитов витамина D. Достижение нормальной обеспеченности витамином D практически невозможно без обогащения рациона с помощью содержащих витамин D продуктов и/или приема препаратов холекальциферола. Представлены современные рекомендации по лечебным дозировкам витамина D, использующимся при лабораторно подтвержденном дефиците. Представлены сведения о высокой безопасности терапевтических дозировок витамина D, которые позволяют считать D-витаминизацию рационов детского и взрослого населения одной из задач системы здравоохранения в рамках концепции профилактики наиболее распространенных социально значимых заболеваний.
Ключевые слова: витамин D, кальциемические эффекты, плейотропное действие, критерии обеспеченности, профилактика, лечебные дозы, обогащение рациона, дети, взрослые.
Key words: vitamin D, calcicemic effects, pleiotropic effect, criteria of availability, prevention, therapeutic doses, enrichment of the diet, children, adults.
Ключевые слова: витамин D, кальциемические эффекты, плейотропное действие, критерии обеспеченности, профилактика, лечебные дозы, обогащение рациона, дети, взрослые.
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Key words: vitamin D, calcicemic effects, pleiotropic effect, criteria of availability, prevention, therapeutic doses, enrichment of the diet, children, adults.
Полный текст
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5. Garland CF, Kim JJ, Mohr SB et al. Meta-analysis of AllCause Mortality According to Serum 25-Hydroxyvitamin D. Am J Public Health 2014; 104 (8): E43–E50.
6. Hossein-Nezhad A, Holick MF. Vitamin D for Health: A Global Perspective. Mayo Clin Proc 2013; 88 (7): 720–55.
7. Pludowski P, Holick MF, Pilz S et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, de- mentia and mortality – A review of recent evidence. Autoimmun Rev 2013; 12 (10): 976–89.
8. Song Y, Wang L, Pittas AG et al. Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes. Diabetes Care 2013; 36 (5): 1422–8.
9. Souberbielle JC, Body JJ, Lappe JM et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun Rev 2010; 9 (11): 709–15.
10. Wang L, Song Y, Manson JE et al. Circulating 25-Hydroxy-Vitamin D and Risk of Cardiovascular Disease A Meta-Analysis of Prospective Studies. Cir Cardiovasc Qualom 2012; 5 (6): 819–29.
11. https://www.vitamindcouncil.org/health-conditions on 16.10.2016.
12. Heaney RP. Guidelines for optimizing design and analysis of clinical studies of nutrient effects. Nutr Rev 2014; 72 (1): 48–54.
13. Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (7): 1911–30.
14. Holick MF. Evolution and function of vitamin D. 2003.
15. Holick MF. Vitamin D: A millenium perspective. J Cell Biochem 2003.
16. Belaia Zh.E., Rozhinskaia L.Ia. Vitamin D v terapii osteoporoza: ego rol' v kombinatsii s preparatami dlia lecheniia osteoporoza, vneskeletnye effekty. Effektivnaia farmakoter. 2013 (38): 14–29. [in Russian]
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23. Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine
system essential for good health. Am J Clin Nutr 2008; 88 (2): 491–9.
24. De Borst MH, de Boer RA, Stolk RP et al. Vitamin D deficiency: universal risk factor for multifactorial diseases? Curr Drug Targets 2011; 12 (1): 97–106.
25. Ramagopalan SV, Heger A, Berlanga AJ et al. A ChIP-seq-defined genome-wide map
of vitamin D receptor binding: аssociations with disease and evolution. Genome Res 2010; 20 (10): 1352–60.
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28. Pilz S, Tomaschitz A. Role of vitamin D in arterial hypertension. Expert Rev Cardiovasc Ther 2010; 8 (11): 1599–608.
29. Annweiler C, Dursun E, Feron F et al. “Vitamin D and cognition in older adults”: updated international recommendations. J Intern Med 2015; 277 (1): 45–57.
30. Mal'tsev S.V., Mansurova G.Sh. Metabolizm vitamina D i puti realizatsii ego osnovnykh funktsii. Prakticheskaia med. 2014; 9 (85): 12–8. [in Russian]
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34. Yoshizawa T, Handa Y, Uematsu Y et al. Mice lacking the vitamin D receptor exhibit
impaired bone formation, uterine hypoplasia and growth retardation after weaning. Nat Genet 1997; 16 (4): 391–6.
35. Ershova O.B., Belova K.Iu., Nazarova A.V. Kal'tsii i vitamin D: vse li my o nikh znaem? Rus. med. zhurn. 2011; 19 (12): 719–24. [in Russian]
36. Van Driel M, Pols HA, van Leeuwen JP. Osteoblast differentiation and control by vitamin D and vitamin D metabolites. Curr Pharm Des 2004; 10 (21): 2535–55.
37. Zotkin E.G., Shvarts G.Ia. Vozmozhnosti klinicheskogo primeneniia vitamina D i ego aktivnykh metabolitov. Effektivnaia farmakoter. 2013; 38: 50–9. [in Russian]
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3. Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol 2014; 2 (1): 76–89.
4. Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2014; 2 (4): 307–20.
5. Garland CF, Kim JJ, Mohr SB et al. Meta-analysis of AllCause Mortality According to Serum 25-Hydroxyvitamin D. Am J Public Health 2014; 104 (8): E43–E50.
6. Hossein-Nezhad A, Holick MF. Vitamin D for Health: A Global Perspective. Mayo Clin Proc 2013; 88 (7): 720–55.
7. Pludowski P, Holick MF, Pilz S et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, de- mentia and mortality – A review of recent evidence. Autoimmun Rev 2013; 12 (10): 976–89.
8. Song Y, Wang L, Pittas AG et al. Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes. Diabetes Care 2013; 36 (5): 1422–8.
9. Souberbielle JC, Body JJ, Lappe JM et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun Rev 2010; 9 (11): 709–15.
10. Wang L, Song Y, Manson JE et al. Circulating 25-Hydroxy-Vitamin D and Risk of Cardiovascular Disease A Meta-Analysis of Prospective Studies. Cir Cardiovasc Qual
om 2012; 5 (6): 819–29.
11. https://www.vitamindcouncil.org/health-conditions on 16.10.2016.
12. Heaney RP. Guidelines for optimizing design and analysis of clinical studies of nutrient effects. Nutr Rev 2014; 72 (1): 48–54.
13. Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (7): 1911–30.
14. Holick MF. Evolution and function of vitamin D. 2003.
15. Holick MF. Vitamin D: A millenium perspective. J Cell Biochem 2003.
16. Белая Ж.Е., Рожинская Л.Я. Витамин D в терапии остеопороза: его роль в комбинации с препаратами для лечения остеопороза, внескелетные эффекты. Эффективная фармакотер. 2013 (38): 14–29. / Belaia Zh.E., Rozhinskaia L.Ia. Vitamin D v terapii osteoporoza: ego rol' v kombinatsii s preparatami dlia lecheniia osteoporoza, vneskeletnye effekty. Effektivnaia farmakoter. 2013 (38): 14–29. [in Russian]
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21. Prosser DE, Jones G. Enzymes involved in the activation and inactivation of vitamin
D. Trends Biochem Sci 2004; 29 (12): 664–73.
22. Holick MF, Garabedian M. Vitamin D: photobiology, metabolism, mechanism of action,
and clinical applications. Primer on the Metabolic Bone diseases and disorders of Mineral Metabolism ed. by M.J.Favus. 6th edition. Chapter 17. Washington, dc: American society for Bone and Mineral Research, 2006; р. 129–37.
23. Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine
system essential for good health. Am J Clin Nutr 2008; 88 (2): 491–9.
24. De Borst MH, de Boer RA, Stolk RP et al. Vitamin D deficiency: universal risk factor for multifactorial diseases? Curr Drug Targets 2011; 12 (1): 97–106.
25. Ramagopalan SV, Heger A, Berlanga AJ et al. A ChIP-seq-defined genome-wide map
of vitamin D receptor binding: аssociations with disease and evolution. Genome Res 2010; 20 (10): 1352–60.
26. Торшин И.Ю., Громова О.А. Экспертный анализ данных в молекулярной фармакологии. М.: МЦНМО, 2012. / Torshin I.Iu., Gromova O.A. Ekspertnyi analiz dannykh v molekuliarnoi farmakologii. M.: MTsNMO, 2012. [in Russian]
27. Mikirova NA, Belcaro G, Jackson JA, Riordan NH. Vitamin D concentrations, endothelial progenitor cells, and cardiovascular risk factors. Pan Minerva Med. 2010; 52 (2 Suppl. 1): 81–7.
28. Pilz S, Tomaschitz A. Role of vitamin D in arterial hypertension. Expert Rev Cardiovasc Ther 2010; 8 (11): 1599–608.
29. Annweiler C, Dursun E, Feron F et al. “Vitamin D and cognition in older adults”: updated international recommendations. J Intern Med 2015; 277 (1): 45–57.
30. Мальцев С.В., Мансурова Г.Ш. Метаболизм витамина D и пути реализации его
основных функций. Практическая мед. 2014; 9 (85): 12–8. / Mal'tsev S.V., Mansurova
G.Sh. Metabolizm vitamina D i puti realizatsii ego osnovnykh funktsii. Prakticheskaia
med. 2014; 9 (85): 12–8. [in Russian]
31. Hoenderop JG, Nilius B, Bindels RJ. Calcium Absorption Across Epithelia. Physiol Rev 2005; 85 (1): 373–422.
32. Hoenderop JG, van der Kemp AW, Hartog A et al. Molecular identification of the
apical Ca2+ channel in 1, 25-dihydroxyvitamin D3-responsive epithelia. J Biol Chem 1999; 274 (13): 8375–8.
33. Dardenne O, Prud’homme J, Arabian A et al. Targeted inactivation of the 25-hydroxyvitamin D(3)-1(alpha)-hydroxylase gene (CYP27B1) creates an animal model of pseudovitamin D-deficiency rickets. Endocrinology 2001; 142 (7): 3135–41.
34. Yoshizawa T, Handa Y, Uematsu Y et al. Mice lacking the vitamin D receptor exhibit
impaired bone formation, uterine hypoplasia and growth retardation after weaning. Nat Genet 1997; 16 (4): 391–6.
35. Ершова О.Б., Белова К.Ю., Назарова А.В. Кальций и витамин D: все ли мы о них
знаем? Рус. мед. журн. 2011; 19 (12): 719–24. / Ershova O.B., Belova K.Iu., Nazarova
A.V. Kal'tsii i vitamin D: vse li my o nikh znaem? Rus. med. zhurn. 2011; 19 (12): 719–24. [in Russian]
36. Van Driel M, Pols HA, van Leeuwen JP. Osteoblast differentiation and control by vitamin D and vitamin D metabolites. Curr Pharm Des 2004; 10 (21): 2535–55.
37. Зоткин Е.Г., Шварц Г.Я. Возможности клинического применения витамина D и
его активных метаболитов. Эффективная фармакотер. 2013; 38: 50–9. / Zotkin E.G., Shvarts G.Ia. Vozmozhnosti klinicheskogo primeneniia vitamina D i ego aktivnykh metabolitov. Effektivnaia farmakoter. 2013; 38: 50–9. [in Russian]
38. Пинелис В.Г., Тихомиров Е.Е., Щеплягина Л.А., Баранов А.А. Молекулярные и
генетические механизмы формирования остеопороза у детей. Рос. педиатр. журн. 2005; 3: 37–51. / Pinelis V.G., Tikhomirov E.E., Shchepliagina L.A., Baranov A.A. Molekuliarnye i geneticheskie mekhanizmy formirovaniia osteoporoza u detei. Ros. pediatr. zhurn. 2005; 3: 37–51. [in Russian]
39. Lau KHW, Baylink DJ. Treatment of 1,25(OH)2D3(D-hormone) deficiency/resistance
with D-hormone and analogs. Osteologie 2001; 10 (1): 28–39.
40. Staal A, van Wijnen AJ, Birkenhäger JC et al. Distinct conformations of vitamin D
receptor/retinoid X receptor-alpha heterodimers are specified by dinucleotide differences
in the vitamin D-responsive elements of the osteocalcin and osteopontin genes. Mol Endocrinol 1996; 10 (11): 1444–56.
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50. Dini C, Bianchi A. The potential role of vitamin D for prevention and treatment of tuberculosis and infectious diseases. Ann Ist Super Sanita 2012; 48 (3): 319–27.
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66. Chowdhury R, Stevens S, Ward H et al. Circulating vitamin D, calcium and risk of
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67. Uluduz D, Adil MM, Rahim B et al. Vitamin D deficiency and osteoporosis in stroke survivors: an analysis of National Health and Nutritional Examination Survey (NHANES). J Vasc Interv Neurol 2014; 7 (1): 23–8.
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in the vitamin D-responsive elements of the osteocalcin and osteopontin genes. Mol Endocrinol 1996; 10 (11): 1444–56.
41. Zakharova I.N., Iablochkova S.V., Dmitrieva Iu.A. Izvestnye i neizvestnye effekty vitamina D. Vopr. sovrem. pediatrii. 2013; 12 (2): 20–5. [in Russian]
42. Mal'tsev S.V., Arkhipova N.N., Shakirova E.M. Vitamin D, kal'tsii i fosfaty u zdorovykh detei i pri patologii. Kazan', 2012. [in Russian]
43. Shilin D.E. Vitamin-gormon D v klinike XXI veka: pleiotropnye effekty i laboratornaia otsenka (lektsiia). Klin. lab. diagnostika. 2010; 12: 17–23. [in Russian]
44. Christakos S, Dhawan P, Benn B et al. Vitamin D: molecular mechanism of action. Ann N Y Acad Sci 2007; 1116: 340–8.
45. Grant WB. The role of vitamin D supplements in treating health condition and diseases common among those with intellectual and/or developmental disabilities. Stand Med Pediatr 2015; 12 (5): 775–80.
46. Zakharova I.N., Dmitrieva Iu.A., Vasil'eva S.V., Evseeva E.A. Chto nuzhno znat' pediatru o vitamine D: novye dannye o ego roli v organizme (chast' 2). Pediatriia. Zhurn. im. G.N.Speranskogo. 2014; 93 (6): 125–31. [in Russian]
47. Drozdov V.N. Defitsit vitamina D kak faktor polimorbidnosti. Eksperim. i klin. gastroenterologiia. 2015; 118 (6): 82–8. [in Russian]
48. Peelen E, Knippenberg S, Muris AH et al. Effects of vitamin D on the peripheral adaptive immune system: a review. Autoimmun Rev 2011; 10 (12): 733–43.
49. Sundaram ME, Coleman LA. Vitamin D and influenza. Adv Nutr 2012; 3 (4): 517–25.
50. Dini C, Bianchi A. The potential role of vitamin D for prevention and treatment of tuberculosis and infectious diseases. Ann Ist Super Sanita 2012; 48 (3): 319–27.
51. Bitetto D, Fabris C. Vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C. Transpl Int 2011; 24 (1): 43–50.
52. Bergman P, Lindh БU, Björkhem-Bergman L, Lindh JD. Vitamin D and respiratory
tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2013; 8 (6): e65835.
53. Herscovitch K, Dauletbaev N, Lands LC. Vitamin D as an anti-microbial and anti-inflammatory therapy for cystic fibrosis. Paediatr Respir Rev 2014; 15 (2): 154–62.
54. Reich KM, Fedorak RN, Madsen K, Kroeker KI. Vitamin D improves inflammatory bowel disease outcomes: basic science and clinical outcomes. World J Gastroenterol 2014; 20 (17): 4934–47.
55. Ford ES, Ajani UA, McGuire LC, Liu S. Concentrations of serum vitamin D and the
metabolic syndrome among U.S. adults. Diabetes Care 2005; 28 (5): 1228–30.
56. Forouhi NG, Luan J, Cooper A et al. Baseline serum 25-hydroxyvitamin d is predictive of future glycemic status and insulin resistance: the medical research councilely prospective study 1990–2000. Diabetes 2008; 57 (10): 2619–25.
57. Karonova T.L., Grineva E.N., Mikheeva E.P. i dr. Uroven' vitamina D i ego vzaimosviaz' s kolichestvom zhirovoi tkani i soderzhaniem adipotsitokinov u zhenshchin reproduktivnogo vozrasta. Problemy endokrinol. 2012; 6: 19–23. [in Russian]
58. Todieva A.M., Nikitina I.L., Karonova T.L. i dr. Vitamin D i metabolicheskii status u detei i podrostkov s ozhireniem. Vopr. det. dietologii. 2013; 11 (3): 15–22. [in Russian]
59. Blum M, Dolnikowski G, Seyoum E, Susan SH. Vitamin D3 in fat tissue. Endocrin Rev 2008; 33: 90–4.
60. De Paula FJA, Rosen CJ. Vitamin D and fat in Vitamin D. Eds D.Feldman, J.W.Pike,
J.S.Adams. Academic Press 2011; p. 769–76.
61. Dong JY, Zhang WG, Chen JJ et al. Vitamin D intake and risk of type 1 diabetes: a
meta-analysis of observational studies. Nutrients 2013; 5 (9): 3551–62.
62. Nader NS, Aguirre Castaneda R, Wallace J et al. Effect of vitamin D3 supplementation on serum 25(OH)D, lipids and markers of insulin resistance in obese adolescents: a prospective, randomized, placebo-controlled pilot trial. Horm Res Paediatr
2014; 82 (2): 107–12.
63. Kumar J, Muntner P, Kaskel FJ et al. Prevalence and associations of 25-Hydroxyvitamin D deficiency in US Children: NHANES 2001–2004. Pediatrics 2009; 124 (3): e362-e370.
64. Rodríguez-Rodríguez E, Ortega RM, González-Rodríguez LG, López-Sobaler AM. Vitamin D deficiency is an independent predictor of elevated triglycerides in Spanish school children. Eur J Nutr 2010; 50 (5): 373–8.
65. Li YC et al. 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002; 110 (2): 229–38.
66. Chowdhury R, Stevens S, Ward H et al. Circulating vitamin D, calcium and risk of
cerebrovascular disease: a systematic review and meta-analysis. Eur J Epidemiol 2012; 27 (8): 581–91.
67. Uluduz D, Adil MM, Rahim B et al. Vitamin D deficiency and osteoporosis in stroke survivors: an analysis of National Health and Nutritional Examination Survey (NHANES). J Vasc Interv Neurol 2014; 7 (1): 23–8.
68. Wang Y, Ji H, Tong Y, Zhang ZB. Prognostic value of serum 25-hydroxyvitamin D in patients with stroke. Neurochem Res 2014; 39 (7): 1332–7.
69. Whitehouse AJ, Holt BJ, Serralha M et al. Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics 2012; 129 (3): 485–93.
70. Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr 2008; 88 (2): 491S–9S.
71. Jones G, Prosser DE, Kaufmann M. 25-Hydroxyvitamin D-24-hydroxylase (CYP24A1): Its important role in the degradation of vitamin D. Archives of Bioche- mistry and Biophysics. 2012; 523 (1): 9–18.
72. Juonala M, Voipio A, Pahkala K et al. Childhood 25-OH Vitamin D Levels and Carotid
Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study. J Clin Endocrinol Metab 2015; 100 (4): 1469–76.
73. McDonnell SL, Baggerly C, French CB et al. Serum 25Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study. Plos One 2016; 11 (4).
74. Spedding S, Vanlint S, Morris H, Scragg R. Does Vitamin D Sufficiency Equate to a Single Serum 25Hydroxyvitamin D Level or Are Different Levels Required for Non- Skeletal Diseases? Nutrients 2013; 5 (12): 5127–39.
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Авторы
П.Плудовский1, И.Н.Захарова2, Л.Я.Климов*3
1 Детский мемориальный институт здоровья, Варшава, Польша;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;
3 ФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава России. 355017, Россия, Ставрополь, ул. Мира, д. 310
*klimov_leo@mail.ru
1 The Children‘s Memorial Health Institute Warsaw, Masovian District, Poland;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1;
3 Stavropol State Medical University of the Ministry of Health of the Russian Federation. 355017, Russian Federation, Stavropol, ul. Mira, d. 310
*klimov_leo@mail.ru
1 Детский мемориальный институт здоровья, Варшава, Польша;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;
3 ФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава России. 355017, Россия, Ставрополь, ул. Мира, д. 310
*klimov_leo@mail.ru
________________________________________________
1 The Children‘s Memorial Health Institute Warsaw, Masovian District, Poland;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1;
3 Stavropol State Medical University of the Ministry of Health of the Russian Federation. 355017, Russian Federation, Stavropol, ul. Mira, d. 310
*klimov_leo@mail.ru
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