Very high vitamin D supplementation rates among infants aged 2 months in Vancouver and Richmond, British Columbia, Canada
Barbara CrockerTim GreenSusan I. BarrBridgid BeckinghamRadhika BhagatBeata DabrowskaRachel DouthwaiteCarmen EvansonRussell FriesenKathy HydamakaWangyang LiKelly SimmonsLillian Tse
23
Citation
16
Reference
10
Related Paper
Citation Trend
Abstract:
Abstract Background Vitamin D deficiency during infancy may lead to rickets and possibly other poor health outcomes. The World Health Organization recommends exclusive breastfeeding for the first 6 months. Breast milk is the best food for infants but does not contain adequate vitamin D. Health Canada recommends all breastfed infants receive a daily vitamin D supplement of 400 IU; however, there appears to be limited current Canadian data as to whether parents or caregivers are following this advice. The aim of this study was to determine the rates of vitamin D supplementation among 2-month old infants in Vancouver and Richmond, British Columbia, Canada. Methods Mothers of all healthy infants born between April and May 2010 were approached to participate. Telephone surveys were conducted with 577 mothers (response rate 56%) when their infants turned 2 months. Results Over half of the infants received only breast milk in the week prior to the survey. One third received a mixture of breast milk and infant formula and 10% received only formula. About 80% of the infants were supplemented with vitamin D at 2 months. Infants who received only breast milk were most likely to be supplemented with vitamin D (91%). Over 60% of the infants had a total vitamin D intake of 300- < 500 IU/d from supplements and formula and only 5% did not receive any vitamin D. Most parents were advised to give vitamin D supplement by health professionals, such as public health nurses, midwives, and doctors. Conclusions About 90% of the infants received breast milk at 2 months of age. The vitamin D supplementation rate was 80%. Future studies are needed to monitor breastfeeding duration and vitamin D supplementation rates as infants get older.Vitamin D deficiency rickets is the most significant manifestation of vitamin D deficiency in growing children. Concerns have been raised in New Zealand (NZ), and worldwide, that cases continue to present, and may be possibly increasing. We undertook a prospective study to investigate the incidence and characteristics of vitamin D deficiency rickets in NZ children.
Prospective surveillance of Vitamin D Deficiency Rickets was conducted by the NZ Paediatric Surveillance Unit (NZPSU), for 36 months, from July 2010 – June 2013 inclusive. Inclusion criteria were: children aged <15 years with vitamin D deficiency rickets (defined by low 25-hydroxyvitamin D and elevated alkaline phosphatase levels, and/or radiological rickets).
58 children with confirmed vitamin D deficiency rickets were identified. Median age was 1.4 years (range 0.3 – 11), male gender 47%, 95% of children were born in NZ, as opposed to 22% of mothers. Overall annual incidence in those aged <15 years was 2.2/100,000, while incidence in the south of NZ peaked at 6.8/100,000. Overall NZ incidence in children aged <5 years was higher at 6.6/100,000. Skeletal abnormalities, poor growth and developmental delay were the most common presenting features, with hypocalcaemic convulsion in 16%. Key risk factors identified were: dark skin pigment, Indian/South Asian and African ethnicity, age ≤2 years, exclusive breast feeding, and southern latitude, particularly when combined with season (winter/spring).
Vitamin D deficiency rickets remains a health problem for New Zealand children, with significant associated morbidity. Public health policy, utilising infant supplementation, for at minimum the above identified risk factors, should be considered to reduce the incidence of this disease among those at high risk.
Dark skin
Cite
Citations (2)
Nutritional deficiency
Cite
Citations (21)
It is well known that severe vitamin D deficiency impairs bone tissue and growth plate mineralization, resulting in osteomalacia and rickets, respectively. In fact, even less severe infant vitamin D deficiency might adversely affect not only bone health but also brain development; the incidence of
Osteomalacia
Vitamin deficiency
Bone Health
Cite
Citations (6)
Solid-Phase Microextraction
Cite
Citations (11)
Osteomalacia
Bone disease
Metabolic bone disease
Cite
Citations (1)
Vitamin D deficiency is usually manifested as rickets in children. Since vitamin D deficiency/insufficiency is common worldwide, global consensus has been formulated on prevention, diagnosis and treatment of nutritional rickets represented by vitamin D-deficient rickets. This consensus has defined vitamin D insufficiency as the status with serum 25-hydroxyvitamin D(25OHD)level between 12 and 20 ng/mL and vitamin D deficiency as the status with serum 25OHD level below 12 ng/mL. Generally low dietary calcium(Ca)intake coexists with vitamin D deficiency/insufficiency in patients with rickets, and it is important to ensure sufficient Ca intake ensure in the management of nutritional rickets.
Osteomalacia
Cite
Citations (4)
Dark skin
Cite
Citations (51)
Purpose of review Here, we review the most up-to-date understanding of the pathogenesis, prevention and treatment of vitamin D deficient rickets in children. This will include recent advances in the genetic determinants of abnormal vitamin D metabolism, with the intention of aiding clinicians with establishing the diagnosis and implementing treatment plans for children presenting with vitamin D deficiency rickets. Recent findings Vitamin D deficiency rickets is a frequently encountered, but entirely preventable, disorder of bone mineral metabolism. Risk factors for developing vitamin D deficiency rickets include inadequate exposure to sunlight, exclusive breast feeding without vitamin D supplementation and inadequate intake of vitamin D, calcium or phosphorus. Other factors that may influence the development of vitamin D deficiency and/or rickets include genetic alterations or medications that alter vitamin D metabolism. Summary Vitamin D levels in individuals are influenced by environmental factors, as well as genetic factors. A thorough understanding of these factors is critical for the evaluation and treatment of a child presenting with rickets. There remains a great need for additional research to determine ideal vitamin D status across diverse populations, and to better understand how vitamin D status affects overall health.
Nature versus nurture
Cite
Citations (13)
Presentación de casos clínicos RESUMENLa deficiencia de vitamina D y el raquitismo son problemas de salud importantes en los países en desarrollo.El raquitismo congénito es una forma infrecuente de raquitismo.La deficiencia materna de vitamina D es el factor de riesgo más importante para la deficiencia de vitamina D y el raquitismo en los recién nacidos y lactantes.Presentamos el caso de un niño de 2 meses de edad, con convulsiones durante su hospitalización por neumonía.Se diagnosticó raquitismo congénito asociado a deficiencia materna de vitamina D.
Vitamin deficiency
Cite
Citations (4)