VITAMIN –D DIFICIENCY
IN CHILDREN
DR. PRADEEP DUBEY
MD(PED). DCH.
CONSULTANT PEDITRICIAN.
“AADIGURU”
NEURO PEDITRIC CENTRE
PREM MANDIR CHOWK, WRIGHT TOWN , JABALPUR.
20th century witnessed - Discovery of Vit D
Nutrition Research, Vol. 19, No. 11, pp. 1683-1718, 1999
The Evolution of Vit D
Bone health Vitamin
Miracle Drug
Vitamin D & Cancer
J. Nutr. 135: 2739S–2748S, 2005.
First evidence for anticancer effects of Vit D
Biochem Biophys Res Commun. 1981 Oct 15;102(3):937-43.
Clinical trials - Vit D & Cancer
Ann Epidemiol 2009;19:468–483.
Infections
• TB
• Epidemic influenza
• HIV
• Vaginal infections
Nobel Prize in Physiology or Medicine, 1903
Dr.Niels Ryberg Finsen
Finsen extended his work to all forms of internal TB
Sputum Conversion Rate
• RCT
• Sputum conversion rates from AFB positive to negative– Vit D 0.25 mg/day supplemented patients -100%
– Non-supplemented patients- 77%
South Med J. Author manuscript; available in PMC 2010 November 1.
Refractory case of PTB- Improvement with Vit D
Vitamin D & Autoimmune diseases
You look
delicious!
Who are you?
Where am I?
T1DM
RA
N Engl J Med 2007;357:266-81.
J. Nutr. 135: 2739S–2748S, 2005.
IBD
Multiple
sclerosis
Vit D deficiencyAn Important, Common, & Easily
Treatable Cardiovascular Risk Factor?
PTH
IR & Pancreatic
cell dysfunction
Inflammation
Diabetes & Metabolic
Syndrome
Atherosclerosis
Adverse CV events
J Am Coll Cardiol 2008;52:1949–56
RAAS
Hypertension &
Hypertrophy
Vitamin D deficiency in healthy South
Indians
Rural
80%
70%
Insufficient (20–30 ng/mL)
70%
Sufficient (30 ng/mL)
% Patients
60%
50%
Deficient (<20 ng/mL)
44%
40%
39.50%
29%
30%
16.50%
20%
10%
0%
Women
Men
Am J Clin Nutr 2007; 85: 1062-7
1%
Deficient
70%
44%
Insufficient
29%
39.50%
Sufficient
1%
16.50%
Vitamin D deficiency in healthy South
Indians
Urban
80%
70%
75%
Insufficient (20–30 ng/mL)
62%
Sufficient (30 ng/mL)
60%
% Patients
Deficient (<20 ng/mL)
50%
40%
26%
30%
19%
20%
6%
10%
0%
Women
Men
Am J Clin Nutr 2007; 85: 1062-7
Deficient
75%
62%
Insufficient
19%
26%
12%
Sufficient
6%
12%
Groups at Risk of Vitamin D Inadequacy
Breastfed infants
AAP recommends that exclusively and partially breastfed infants be
supplemented with 400 IU of vitamin D per day
Older adults
Older adults are at increased risk of developing vitamin D insufficiency
People with limited sun exposure
Homebound individuals, people who wear long robes and head
coverings, & people with occupations that limit sun exposure
People with dark skin
People with fat malabsorption
People who are obese or who have undergone gastric bypass surgery
Cause of Rickets – The First Insight
Vit D physiology
N Engl J Med 2007;357:266-81.
RICKETS ROSARY
SKELETAL CHANGES
HEALING RICKETS
LINE OF CALCIFICATION
NORMAL PELVIS
DEFORMED PELVIS
Dose of Vitamin D
For treatment of Vitamin D Deficiency
 Loading dose
60,000 IU/Week for 8 weeks
 Blood test
 Maintenance dose
60,000 IU/ Month
Recommended Vitamin D Intake by Endo. Society
Guidelines, 2011
Reasonable daily
allowance (IU/ day)
Reasonable allowance (IU/
month)
0-6 months
400-1000
12000-30000
6-12 months
400-1000
12000-30000
Children (1-18 yrs)
1000-2000
30,000-60,000
Adults (19-50 yrs)
1500-2000
45,000-60,000
Elderly (51-70 yrs)
1500-2000
45,000-60,000
Elderly (71 yrs)
1500-2000
45,000-60,000
Pregnancy
1500-2000
45,000-60,000
Lactation
1500-2000
45,000-60,000