Treatment of Hypovitaminosis D in Infants and Toddlers

Divisions of Adolescent Medicine and Endocrinology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. .
Journal of Clinical Endocrinology & Metabolism (Impact Factor: 6.21). 08/2008; 93(7):2716-21. DOI: 10.1210/jc.2007-2790
Source: PubMed


Hypovitaminosis D appears to be on the rise in young children, with implications for skeletal and overall health.
The objective of the study was to compare the safety and efficacy of vitamin D2 daily, vitamin D2 weekly, and vitamin D3 daily, combined with supplemental calcium, in raising serum 25-hydroxyvitamin D [25(OH)D] and lowering PTH concentrations.
This was a 6-wk randomized controlled trial.
The study was conducted at an urban pediatric clinic in Boston.
Forty otherwise healthy infants and toddlers with hypovitaminosis D [25(OH)D < 20 ng/ml] participated in the study.
Participants were assigned to one of three regimens: 2,000 IU oral vitamin D2 daily, 50,000 IU vitamin D2 weekly, or 2,000 IU vitamin D3 daily. Each was also prescribed elemental calcium (50 mg/kg.d). Infants received treatment for 6 wk.
Before and after treatment, serum measurements of 25(OH)D, PTH, calcium, and alkaline phosphatase were taken.
All treatments approximately tripled the 25(OH)D concentration. Preplanned comparisons were nonsignificant: daily vitamin D2 vs. weekly vitamin D2 (12% difference in effect, P = 0.66) and daily D2 vs. daily D3 (7%, P = 0.82). The mean serum calcium change was small and similar in the three groups. There was no significant difference in PTH suppression.
Short-term vitamin D2 2,000 IU daily, vitamin D2 50,000 IU weekly, or vitamin D3 2,000 IU daily yield equivalent outcomes in the treatment of hypovitaminosis D among young children. Therefore, pediatric providers can individualize the treatment regimen for a given patient to ensure compliance, given that no difference in efficacy or safety was noted among these three common treatment regimens.

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    • "As vitamin D dosages in this study are within the Tolerable Upper Intake Level as recommended by Health Canada for children older than 1 year of age (2500 IU per day for children 1–3 years and 3000 IU/day for children 4–8 years), risk of vitamin D excess is low [70]. In addition, other studies which have used vitamin D doses of up to 50,000 IU per week in children did not show evidence of vitamin D toxicity [118,119]. However, we will monitor for adverse events by ensuring that our participating physicians are aware of signs and symptoms of vitamin D toxicity including nephrolithiasis and hypercalcemia. "
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    ABSTRACT: Vitamin D levels are alarmingly low (<75 nmol/L) in 65-70% of North American children older than 1 year. An increased risk of viral upper respiratory tract infections (URTI), asthma-related hospitalizations and use of anti-inflammatory medication have all been linked with low vitamin D. No study has determined whether wintertime vitamin D supplementation can reduce the risk of URTI and asthma exacerbations, two of the most common and costly illnesses of early childhood. The objectives of this study are: 1) to compare the effect of 'high dose' (2000 IU/day) vs. 'standard dose' (400 IU/day) vitamin D supplementation in achieving reductions in laboratory confirmed URTI and asthma exacerbations during the winter in preschool-aged Canadian children; and 2) to assess the effect of 'high dose' vitamin D supplementation on vitamin D serum levels and specific viruses that cause URTI.Methods/design: This study is a pragmatic randomized controlled trial. Over 3 successive winters we will recruit 750 healthy children 1-5 years of age. Participating physicians are part of a primary healthcare research network called TARGet Kids! Children will be randomized to the 'standard dose' or 'high dose' oral supplemental vitamin D for a minimum of 4 months (200 children per group). Parents will obtain a nasal swab from their child with each URTI, report the number of asthma exacerbations and complete symptom checklists. Unscheduled physician visits for URTIs and asthma exacerbations will be recorded. By May, a blood sample will be drawn to determine vitamin D serum levels. The primary analysis will be a comparison of URTI rate between study groups using a Poisson regression model. Secondary analyses will compare vitamin D serum levels, asthma exacerbations and the frequency of specific viral agents between groups. Identifying whether vitamin D supplementation of preschoolers can reduce wintertime viral URTIs and asthma exacerbations and what dose is optimal may reduce population wide morbidity and associated health care and societal costs. This information will assist in determining practice and health policy recommendations related to vitamin D supplementation in healthy Canadian preschoolers and place Canada at the forefront of pediatric vitamin D health outcomes research.
    Full-text · Article · Feb 2014 · BMC Pediatrics
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    • "Furthermore, the 25(OH)D3 levels did not change in the group that received 1,000 IU vitamin D2 daily. Similarly, infants (mean age, 10 months) who received 2,000 IU (50 µg) daily or 50,000 IU (2,000 µg) vitamin D2 weekly for 6 weeks (throughout the year) experienced an elevation in serum total 25(OH)D concentrations (via a chemiluminescent assay) equivalent to concentrations observed in children who received 2,000 IU vitamin D3 daily (42). Biancuzzo et al. (43) very recently showed in a study of healthy adult men and women (n=105; mean age, 40.3 years) in late winter that, using analysis of the area under the curve, there was no significant difference in serum total 25(OH)D (via liquid chromatography tandem mass spectroscopy) between subjects who consumed vitamin D3-fortified orange juice and vitamin D3 capsules. "
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    ABSTRACT: There is little doubt that vitamin D deficiency across all age groups in Europe is a problem. Low vitamin D status arises due to limited, if any, dermal synthesis during the winter months at latitudes above 40°N, putting increased importance on dietary supply of the vitamin. However, dietary intakes by most populations are low due to the limited supply of vitamin D-rich foods in the food chain. Thus strategies that effectively address this public health issue are urgently required. It has been emphasized and re-emphasized that there are only a limited number of public health strategies available to correct low dietary vitamin D intake: (1) improving intake of naturally occurring vitamin D-rich foods, (2) vitamin D fortification (mandatory or voluntarily) of food, and (3) vitamin D supplementation. Recent evidence suggests that the levels of vitamin D added to food would need to be high so as to ensure dietary requirements are met and health outcomes optimized. In addition, knowledge of the most effective forms of vitamin D to use in some of these preventative approaches is important. There is still uncertainty in relation to the relative efficacy of vitamin D(2) versus D(3), the two main food derived forms and those used in vitamin D supplements. The major metabolite of vitamin D with biological activity is 1,25(OH)(2)D; however, this is usually used for pharmacological purposes and is not typically used in normal, healthy people. The other major metabolite, 25(OH)D, which has also been used for pharmacological purposes is present in certain foods such as meat and meat products (particularly offal) as well as eggs. This metabolite may have the potential to boost vitamin D status up to five times more effectively that native vitamin D(3) in foods. However, the exact bioactivity of this compound needs to be established.
    Full-text · Article · Apr 2012 · Food & Nutrition Research
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    • "Although there has been some controversy as to whether vitamin D3 is as effective as vitamin D2 in maintaining vitamin D status in humans most studies in children and adults have demonstrated that they are equally effective151617. "
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    ABSTRACT: Vitamin D is a sunshine vitamin that has been produced on this earth for more than 500 million years. Because foods contain so little vitamin D most humans have always depended on sun exposure for their vitamin D requirement. Vitamin D deficiency has been defined as a serum 25-hydroxyvitamin D concentration < 20 ng/mL (50 nmol/L); vitamin D insufficiency as a serum 25-hydroxyvitamin D of 21-29 ng/mL and vitamin D sufficiency as a serum 25-hydroxyvitamin D of 30-100 ng/mL whereas toxicity is usually not seen until blood levels are above 150 ng/mL. Vitamin D deficiency is a global health problem that increases risk for metabolic bone diseases in children and adults as well as many chronic illnesses including autoimmune diseases, type 2 diabetes, cardiovascular disease, infectious disease, and cancer. The major causes of vitamin D deficiency are lack of adequate sensible exposure to sunlight, inadequate dietary intake and obesity. The United States Endocrine Society recommended that to prevent vitamin D deficiency in those at risk, children 1 year and older require 600-1,000 international unit (IU) of vitamin D daily and adults require 1,500-2,000 IU of vitamin D daily. Obese patients require 2-3 times more vitamin D to both treat and prevent vitamin D deficiency.
    Full-text · Article · Jan 2012
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