Food supplements in the pediatric population of Serbia: A review of commonly used products

  • Nevena Dabetić University of Belgrade - Faculty of Pharmacy, Department of Bromatology, Belgrade, Serbia
  • Ivana Đuričić University of Belgrade - Faculty of Pharmacy, Department of Bromatology, Belgrade, Serbia
  • Tijana Ilić University of Belgrade - Faculty of Pharmacy, Department of Bromatology, Belgrade, Serbia
  • Olina Dudašova Petrovičova University of Belgrade - Faculty of Pharmacy, Department of Bromatology, Belgrade, Serbia
  • Margarita Dodevska Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
  • Jelena Kukić Marković University of Belgrade - Faculty of Pharmacy, Department of Pharmacognosy, Belgrade, Serbia
  • Nevena Ivanović University of Belgrade - Faculty of Pharmacy, Department of Bromatology, Belgrade, Serbia
Keywords: food supplements, pediatric population, guidelines, vitamins, herbal preparations

Abstract


Food supplements (FS) are products intended to provide additional nutrients to the normal diet. They contain concentrated amounts of nutritive and non-nutritive compounds with a nutritional or physiological effects and are available in various dosage forms for ingestion in small, defined quantities. In recent decades, FS have become increasingly popular among children. When developing pediatric products, both the nutritional needs and the safety aspects specific to this population group are considered. This report analyzes dietary supplements used by children in Serbia, focusing on dosage, safety and the existence of official guidelines. The analysis includes vitamins (D, K and B-complex), probiotics, omega-3 fatty acids, beta-glucans and various herbal products. Although these supplements are widely used in Serbia, there are official pediatric guidelines only for vitamin D, vitamin K, probiotics and omega-3 fatty acids. Herbal supplements are particularly problematic due to insufficient data on safety, interactions and possible side effects. Therefore, increased education of both parents and healthcare professionals is essential to ensure appropriate intake, maximize health benefits and support the proper and safe use of supplements in the pediatric population.

 

References

Pravilnik o dodacima ishrani (dijetetski suplementi). Belgrade: Službeni glasnik RS, 2023.

Martirosyan D, Tavva S. The science, safety, and policy of dietary supplements: A comprehensive review and future roadmap. Dietary Supplements and Nutraceuticals. 2025;4(7):25–36.

European Parliament and Council of the European Union. Directive 2002/46/EC of the European Parliament and of the Council, 2002.

Djaoudene O, Romano A, Bradai YD, Zebiri F, Ouchene A, Yousfi Y, et al. A global overview of dietary supplements: regulation, market trends, usage during the COVID-19 pandemic, and health effects. Nutrients. 2023;15(15):3320.

Barretto JR, da Cruz Gouveia MA, Alves C. Use of dietary supplements by children and adolescents. J Pediatr (Rio J). 2024;100:S31–S39.

Đorđević B, Šobajić S. Primena dijetetskih suplemenata u pedijatrijskoj populaciji. Arh farm. 2012;62(4):322.

Smolinske SC. Dietary supplements in children. Pediatr Clin North Am. 2017;64:1243–55.

Levita J, Wilar G, Wahyuni I, Bawono LC, Ramadaini T, Rohani R, et al. Clinical toxicology of vitamin D in pediatrics: a review and case reports. Toxics. 2023;11(7):642. doi: 10.3390/toxics11070642.

Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I, Chiappini E, et al. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. Ital J Pediatr. 2018;44(1):51. doi: 10.1186/s13052-018-0488-7.

Gonzalez Jiménez D, Rodríguez Delgado J, Campoy C, Galera Martínez R, Gil-Campos M, Redecillas Ferreiro S, et al. Suplementación con vitamina D en población pediátrica sana. An Pediatr (Engl Ed). 2025;102(6):503874. doi: 10.1016/j.anpedi.2025.503874.

Lamberg-Allardt C. Vitamin D in foods and as supplements. Prog Biophys Mol Biol. 2006;92(1):33–8. doi: 10.1016/j.pbiomolbio.2006.02.017.

Corsello A, Spolidoro GCI, Milani GP, Agostoni C. Vitamin D in pediatric age: current evidence, recommendations, and misunderstandings. Front Med. 2023;10:1107855. doi: 10.3389/fmed.2023.1107855.

Grossman Z, Hadjipanayis A, Stiris T, Del Torso S, Mercier JC, Valiulis A, et al. Vitamin D in European children—statement from the European Academy of Paediatrics (EAP). Eur J Pediatr. 2017;176(6):829–31.

Wood CL, Cheetham TD. Vitamin D: increasing supplement use among at-risk groups (NICE guideline PH56): Table 1. Arch Dis Child Educ Pract Ed. 2016;101(1):43–5. doi: 10.1136/archdischild-2015-308299.

Turck D, Bresson J, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, et al. Dietary reference values for vitamin D. EFSA J. 2016;14(10):4547. doi: 10.2903/j.efsa.2016.4547.

Dupuy M, Bondonno NP, Pokharel P, Linneberg A, Levinger I, Schultz C, et al. Vitamin K: metabolism, genetic influences, and chronic disease outcomes. Food Sci Nutr. 2025;13(6):e70431. doi: 10.1002/fsn3.70431.

Hand I, Noble L, Abrams SA. Vitamin K and the newborn infant. Pediatrics. 2022;149(3):e2021056036. doi: 10.1542/peds.2021-056036.

Turck D, Bresson J, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, et al. Dietary reference values for vitamin K. EFSA J. 2017;15(5):4780. doi: 10.2903/j.efsa.2017.4780.

Jullien S. Vitamin K prophylaxis in newborns. BMC Pediatr. 2021;21(S1):350. doi: 10.1186/s12887-021-02701-4.

Araki S, Shirahata A. Vitamin K deficiency bleeding in infancy. Nutrients. 2020;12(3):780. doi: 10.3390/nu12030780.

Mihatsch WA, Braegger C, Bronsky J, Campoy C, Domellöf M, Fewtrell M, et al. Prevention of vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2016;63(1):123–9. doi: 10.1097/MPG.0000000000001232.

Vitamin K kod novorođenčadi [Internet]. Udruženje pedijatara Srbije; 2023 [cited 2025 Jun 22]. Available from: https://www.udruzenjepedijatara.rs/wp-content/uploads/2023/07/vitamin_kk.pdf.

Combs Jr GF, McClung JP. The vitamins: fundamental aspects in nutrition and health. 6th ed. London: Academic Press; 2022.

European Commission. Commission Delegated Regulation (EU) 2016/127 of 25 September 2015 supplementing Regulation (EU) No 609/2013 as regards the specific compositional and information requirements for infant formula and follow-on formula, 2016.

European Commission. Commission Directive 2008/100/EC of 28 October 2008 amending Council Directive 90/496/EEC on nutrition labeling for foodstuffs as regards recommended daily allowances, energy conversion factors and definitions, 2008.

Kreutz JM, Heynen L, Vreugdenhil ACE. Nutrient deficiencies in children with celiac disease during long term follow-up. Clin Nutr. 2023;42(7):1175–80. doi: 10.1016/j.clnu.2023.05.003.

Okuka N, Berit H, Đorđević B, Ivanović N. Effects of probiotic intervention on obesity-related miRNAs. Arh farm. 2024;74(3):391–409.

WGO Global guideline: probiotics and prebiotics [Internet]. World Gastroenterology Organisation; 2023 [cited 2025 Jun 22]. Available from: https://www.worldgastroenterology.org.

Szajewska H, Berni Canani R, Domellöf M, Guarino A, Hojsak I, Indrio F, et al. Probiotics for the management of pediatric gastrointestinal disorders: position paper of the ESPGHAN special interest group on gut microbiota and modifications. J Pediatr Gastroenterol Nutr. 2023;76(2):232–47.

Stav ekspertske grupe o primeni probiotika kod novorođene dece [Internet]. Udruženje pedijatara Srbije, Sekcija za neonatologiju; 2023 [cited 2025 Jun 22]. Available from: https://www.udruzenjepedijatara.rs/wpcontent/uploads/2023/08/AZURIRAN_STAV_O_PRIMENI_PROBIOTIKA_KOD_NOVORO.pdf.

Halken S, Muraro A, de Silva D, Khaleva E, Angier E, Arasi S, et al. European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group. EAACI guideline: preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol. 2021;32(5):843–58.

Meirlaen L, Levy EI, Vandenplas Y. Prevention and management with pro-, pre- and synbiotics in children with asthma and allergic rhinitis: a narrative review. Nutrients. 2021;13(3):934. doi: 10.3390/nu13030934.

Fiocchi A, Pawankar R, Cuello-Garcia C, Ahn K, Al-Hammadi S, Agarwal A, et al. World Allergy Organization-McMaster University guidelines for allergic disease prevention (GLAD-P): probiotics. World Allergy Organ J. 2015;8(1):1–13.

Djuricic I, Calder PC. Beneficial outcomes of omega-6 and omega-3 polyunsaturated fatty acids on human health: an update for 2021. Nutrients. 2021;13(7):2421. doi: 10.3390/nu13072421.

Mallick R, Basak S, Duttaroy AK. Docosahexaenoic acid, 22:6n-3: its roles in the structure and function of the brain. Int J Dev Neurosci. 2019;79:21–31. doi: 10.1016/j.ijdevneu.2019.10.004.

Sherzai D, Moness R, Sherzai S, Sherzai A. A systematic review of omega-3 fatty acid consumption and cognitive outcomes in neurodevelopment. Am J Lifestyle Med. 2023;17(5):649–85. doi: 10.1177/15598276221129914.

Tian A, Xu L, Szeto IM, Wang X, Li D. Effects of different proportions of DHA and ARA on cognitive development in infants: a meta-analysis. Nutrients. 2025;17(6):1091. doi: 10.3390/nu17061091.

Agostoni C, Bresson J, Fairweather-Tait S, Flynn A, Golly I, Korhonen H, et al. Tolerable upper intake level of EPA, DHA and DPA. EFSA J. 2012;10(7):2815.

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Dietary reference values for nutrients: summary report. EFSA J. 2017;15(12):e15121.

Definitivan stav o DHA [Internet]. Udruženje pedijatara Srbije; 2023 [cited 2025 Jun 22]. Available from: https://www.udruzenjepedijatara.rs/wp-content/uploads/2023/07/AZUR_Definitivno_DHA.pdf.

Yu S, Wang J, Li Y, Wang X, Ren F, Wang X. Structural studies of water-insoluble β-glucan from oat bran and its effect on improving lipid metabolism in mice fed high-fat diet. Nutrients. 2021;13(9):3254. doi: 10.3390/nu13093254.

Henrion M, Francey C, Lê KA, Lamothe L. Cereal β-glucans: the impact of processing and how it affects physiological responses. Nutrients. 2019;11(8):1729. doi: 10.3390/nu11081729.

Suchecka D, Gromadzka-Ostrowska J, Żyła E, Harasym JP, Oczkowski M. Selected physiological activities and health promoting properties of cereal beta-glucans: a review. J Anim Feed Sci. 2017;26(3):183–91.

Zhong X, Wang G, Li F, Fang S, Zhou S, Ishiwata A, et al. Immunomodulatory effect and biological significance of β-glucans. Pharmaceutics. 2023;15(6):1615. doi: 10.3390/pharmaceutics15061615.

Mejía SMV, de Francisco A, Bohrer B. A comprehensive review on cereal β-glucan: extraction, characterization, causes of degradation, and food application. Crit Rev Food Sci Nutr. 2020;60(21):3693–704. doi: 10.1080/10408398.2019.1706444.

El Enshasy HA, Hatti-Kaul R. Mushroom immunomodulators: unique molecules with unlimited applications. Trends Biotechnol. 2013;31(12):668–77. doi: 10.1016/j.tibtech.2013.09.003.

Giavasis I. Bioactive fungal polysaccharides as potential functional ingredients in food and nutraceuticals. Curr Opin Biotechnol. 2014;26:162–73. doi: 10.1016/j.copbio.2014.01.010.

Bhoite R, Satyavrat V, Premasudha SM. Clinical benefits of β-glucan supplementation in children: a review. Discov Food. 2022;2:37. doi: 10.1007/s44187-022-00038-0.

Wzorek-Łyczko K, Woźniak W, Piwowarczyk A, Kuchar E. The anti-infective effect of β-glucans in children: a scoping review. Int J Vitam Nutr Res. 2024;94(3–4):296–307. doi: 10.1024/0300-9831/a000793.

De Marco Castro E, Calder PC, Roche HM. β-1,3/1,6-Glucans and immunity: state of the art and future directions. Mol Nutr Food Res. 2021;65(1):e1901071. doi: 10.1002/mnfr.201901071.

Richter J, Svozil V, Král V, Rajnohová Dobiášová L, Stiborová I, Vetvicka V. Clinical trials of yeast-derived β-(1,3) glucan in children: effects on innate immunity. Ann Transl Med. 2014;2(2):15. doi: 10.3978/j.issn.2305-5839.2014.02.01.

Henao SLD, Urrego SA, Cano AM, Higuita EA. Randomized clinical trial for the evaluation of immune modulation by yogurt enriched with β-glucans from Lingzhi or Reishi medicinal mushroom, Ganoderma lucidum (Agaricomycetes), in children from Medellin, Colombia. Int J Med Mushrooms. 2018;20(8):705–16. doi: 10.1615/IntJMedMushrooms.2018026501.

Virginio Agostoni C, Bresson J, Fairweather-Tait S, Flynn A, Golly I, Korhonen H, et al. Safety of 'yeast beta-glucans' as a novel food ingredient. EFSA J. 2011;9(5):2137. doi: 10.2903/j.efsa.2011.2137.

European Commission. Commission Implementing Decision (EU) 2017/2078 of 10 November 2017 authorising the placing on the market of yeast beta-glucans as a novel food ingredient, 2017.

Gökkaya İ, Subaş T, Renda G, Şahin S, Özgen U, Yıldız N, et al. The use of herbal products/dietary supplements and affecting factors in patients applying to a pediatric neurology outpatient clinic: a descriptive questionnaire study. Eur J Ther. 2023;29(4):873–82. doi: 10.58600/eurjther1858.

Colombo F, Restani P, Biella S, Di Lorenzo C. Botanicals in functional foods and food supplements: tradition, efficacy and regulatory aspects. Appl Sci. 2020;10(7):2387. doi: 10.3390/app10072387.

European Union herbal monograph on Echinacea purpurea (L.) Moench, radix [Internet]. EMA; 2016 [cited 2025 Aug 10]. Available from: https://www.ema.europa.eu/en/documents/herbal-references/draft-european-union-herbal-monograph-echinacea-purpurea-l-moench-radix_en.pdf.

Przybylska-Balcerek A, Szablewski T, Szwajkowska-Michałek L, Świerk D, Cegielska-Radziejewska R, Krejpcio Z, et al. Sambucus nigra extracts—natural antioxidants and antimicrobial compounds. Molecules. 2021;26(10):2910. doi: 10.3390/molecules26102910.

Mahboubi M. Sambucus nigra (black elder) as alternative treatment for cold and flu. Adv Tradit Med. 2021;21(3):405–14. doi: 10.1007/s13596-020-00469-z.

Reina BD, Malheiros SS, Vieira SM, Ferreira de Andrade P, Dovigo LN. Unlocking the therapeutic potential of Pelargonium sidoides natural extract: a scoping review. Heliyon. 2024;10(23):e40554. doi: 10.1016/j.heliyon.2024.e40554.

European Union herbal monograph on Pelargonium sidoides DC; Pelargonium reniforme Curt., radix [Internet]. EMA; 2022 [cited 2025 Aug 7]. Available from: https://www.ema.europa.eu/en/documents/herbal-monograph/draft-european-union-herbal-monograph-pelargonium-sidoides-dc-and-or-pelargonium-reniforme-curt-radix_en.pdf.

Laurindo LF, Takeda LN, Machado NM, Otoboni AMMB, de Alvares Goulart R, Catharin VCS, et al. Health benefits of acerola (Malpighia spp) and its by-products: a comprehensive review of nutrient-rich composition, pharmacological potential, and industrial applications. Food Biosci. 2024;62:105422. doi: 10.1016/j.fbio.2023.105422.

Polumackanycz M, Kaszuba M, Konopacka A, Marzec-Wróblewska U, Wesolowski M, Waleron K, et al. Phenolic composition and biological properties of wild and commercial dog rose fruits and leaves. Molecules. 2020;25(22):5272. doi: 10.3390/molecules25225272.

Vitamin C – Health Professional Fact Sheet [Internet]. National Institutes of Health, Office of Dietary Supplements; 2025 [cited 2025 Aug 7]. Available from: https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/#h20.

Oršolić N, Jazvinšćak Jembrek M. Royal jelly: biological action and health benefits. Int J Mol Sci. 2024;25(11):6023. doi: 10.3390/ijms25116023.

Kumar R, Thakur A, Kumar S, Hajam YA. Royal jelly a promising therapeutic intervention and functional food supplement: a systematic review. Heliyon. 2024;10(17):e37138. doi: 10.1016/j.heliyon.2024.e37138.

Strant M, Yücel B, Topal E, Puscasu AM, Margaoan R, Varadi A. Use of royal jelly as functional food in human and animal health. J Anim Prod. 2019;60(2):131–44. doi: 10.29185/hayuretim.513449.

Pecquet C. Allergic reactions to insect secretions. Eur J Dermatol. 2013;23(6):767–73. doi: 10.1684/ejd.2013.2186.

Yuksel S, Akyol S. The consumption of propolis and royal jelly in preventing upper respiratory tract infections and as dietary supplementation in children. J Intercult Ethnopharmacol. 2016;5(3):308–11. doi: 10.5455/jice.20160331064836.

Miraldi E, Cappellucci G, Baini G, Pistone ES, Allodi M, Costantino G, et al. Chemical markers in Italian propolis: chrysin, galangin and CAPE as indicators of geographic origin. Plants. 2024;13(19):2734. doi: 10.3390/plants13192734.

Alvarenga L, Cardozo LFMF, Borges NA, Chermut TR, Ribeiro M, Leite M Jr, et al. To bee or not to bee? The bee extract propolis as a bioactive compound in the burden of lifestyle diseases. Nutrition. 2021;83:111094. doi: 10.1016/j.nut.2020.111094.

Tamer R, Yozgat CY, Batu J. Role of propolis consumption on endocrine disruption in children. Indian J Pediatr. 2024;91:1201. doi: 10.1007/s12098-024-05247-2.

Menniti-Ippolito F, Mazzanti G, Vitalone A, Firenzuoli F, Santuccio C. Surveillance of suspected adverse reactions to natural health products. Drug Saf. 2008;31(5):419–23. doi: 10.2165/00002018-200831050-00007.

Published
2025/10/26
Section
Professional articles