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The specific reason for this may be related to the ability of TZDs to inhibit the entry of pyruvate into the TCA cycle [167]

Therefore, the melanin levels are greatly affected when this enzyme is inhibited

To address this, providers sometimes recommend a daily multi-vitamin, especially if the children: Have self-restricted diets Follow a specific diet (for example, if a child is consuming a diet free of casein, a multi-vitamin may be necessary to ensure adequate vitamin D and calcium intake.) Have chronic diarrhea, constipation, or gastrointestinal inflammation The use of mega-dose vitamins and nutritional supplements beyond a multi-vitamin are not fully supported for routine use

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