Vitamin D deficiency in childhood — A review of current guidelines on diagnosis and management
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Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context,it has been reported to be present in majority of children in spite of wide availability of sunlight. Recent guidelines have defined vitamin D status as severe deficiency, deficiency, sufficiency and risk for toxicity as 25(OH)D levels <5, <15, >20 and >50ng/mL, respectively.The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Treatment is necessary for all individuals with deficiency whether symptomatic or not and consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens with equal efficacy and safety, combined with calcium supplements. Routine supplementation starting from newborn period is being increasingly endorsed by various international organizations. Prevention by sensible sunlight exposure, food fortification and routine supplementation are the currently available options for tackling this nutritional deficiency.
- Holick MF. Vitamin D: extraskeletal health. Rheum Dis Clin North Am. 2012; 38:141–160. CrossRef
- Holick MF, Vitamin D deficiency. N Engl J Med. 2007;357:266–281. CrossRef
- Harinarayanan CV, Joshi SR. Vitamin D status in India — Its implications and remedial measures. J Assoc Physicians. 2009;57: 40–48.
- Marwaha RK, Sripathy G. Vitamin D and Bone mineral density of healthy school children in northern India. Indian J Med Res. 2008;127:239–244.
- Harinarayan CV. Prevalence of vitamin D insufficiency in postmenopausal south Indian women. Osteoporos Int. 2005;16:397–402. CrossRef
- Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, et al. A comparison of calcium, vitamin D or both for nutritional rickets in Nigerian children. N Engl J Med. 1999;34:563–568. CrossRef
- Pettifor JM. Nutritional rickets: deficiency of vitamin D, calcium or both? Am J Clin Nutr. 2004;80:17255–17295.
- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment and prevention of vitamin D deficiency: an Endocrine Society. Practice guideline. J. Clin Endocrinol Metab. 2011;96:1911–1930. CrossRef
- Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteapor Int. 1997;7:439–443. CrossRef
- Malabanan AO, Turner AK, Holick MF. Severe generalized bone pain and osteoporosis in a premenopausal black female: effect of vitamin D replacement. J Clin Densitometr. 1998;1:201–204. CrossRef
- Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Institute of Medicine; 2011.
- Hill TR, Flynn A, Kiely M, Cahsman KD. Prevalence of suboptimal vitamin D status in young, adult and elderly Irish subjects.Ir Med J. 2006;99:48–49.
- Lips P. Which circulating level of 25-hydroxyvitamin D is appropriate? J Steroid Biochem Mol Biol. 2004;89–90:611–614. CrossRef
- Van der Meer IM, Karamali NS, Boeke AJP, Lips P, Middelkoop BJC, Verhoeven I, et al. High prevalence of vitamin D deficiency in pregnant non-Western women in the Hague, Netherlands. Am J Clin Nutr. 2006;84:350–353.
- Laaksi IT, Ruohola J-PS, Ylikomi TJ, Auvinen RI, Haataja RI, Pihlajamaki HK, et al. Vitamin D fortification as public health policy: significant improvement in vitamin D status in young Finnish men. Eur J Clin Nutr. 2006;60:1035–1038. CrossRef
- Vieth R, Carter G. Difficulties with vitamin D nutrition research: Objective targets of adequacy and assays for 25-hydroxyvitamin D. Eur J Clin Nutr. 2001;55:221–222. CrossRef
- Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute Of Medicine: What clinicians need to know? J Clin Endocrinol Metab. 2011;96:53–58. CrossRef
- Gordon CM, De Peter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531–537. CrossRef
- Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M; Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management. Review of current knowledge and Recommendations. Pediatrics. 2008;122;398. CrossRef
- Munns C, Zacharin MR, Rodda CP, Batch JA, Morley R, Cranswick NE, et al. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust. 2006;185:268–272.
- Koutkia P, Chen TC, Holick MF. Vitamin D intoxication associated with an over the counter supplement. N Engl J. Med. 2001;345:66–67. CrossRef
- Adams JS, Lee G. Gains in bone mineral density with resolution of vitamin D intoxication. Annals Int Med. 1997;127:203–206. CrossRef
- Holick MF. Vitamin D status: measurement, interpretation and clinical application. Ann Epidemiol. 2009;19:73–78. CrossRef
- Gordon CM, Williams AL, Feldman HA, May J, Sinclair L, Vasquez A, et al. Treatment of hypovitaminosis D in infants and toddlers. J Clin Endocrinol Metab. 2008;93:2716–2721 CrossRef
- Shah B, Finberg L. Single day therapy for nutritional vitamin D deficiency rickets: a preferred method. J. Pediatr. 1994;125:487–490. CrossRef
- Hochberg Z, Bereket A, Davenport M, Delemarre-Van de Waal HA, De Schepper J, Levine MA, et al. Consensus development for the supplementation of vitamin D in childhood and adolescence. Horm Res. 2002;58:39–51. CrossRef
- Soliman AT, El-Dabbagh M, Adel A, Al Ali M, Aziz Bedair EM, Elalaily RK. Clinical responses to mega dose of vitamin D3 in infants and toddlers with vitamin D deficiency rickets. J Trop Pediatr. 2010;56:19–26. CrossRef
- Sahay M, Sahay R. Rickets vitamin D deficiency and dependency. Indian J Endocrinol Metab. 2012;16:164–176. CrossRef
- Joiner TA, Foster C, Shope T. The many faces of vitamin D deficiency rickets. Pediatr Rev. 2000;21:296. CrossRef
- Asmas LA, Hollis BW, Haeney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J. Clin Endocrinol Metab.2004; 89: 5387–5391. CrossRef
- Spence JT, Serwint JR. Secondary prevention of vitamin D deficiency rickets. Pediatrics. 2004;113(1 Pt 1):e70–e72. CrossRef
- Goel KM, Sweet EM, Logan RW, Warren JM, Arneil GC, Shanks RA. Florid and subclinical rickets among immigrant children in Glasgow. Lancet.1976;1:141–145
- Pettifor JM, Isdale JM, Sahakian J, Hansen JD. Diagnosis of subclinical rickets. Arch Dis Child. 1980;55:155–157. CrossRef
- Taylor JA, Richter M, Done S, Feldman KW. The utility of alkaline phosphatase measurement as a screening test for rickets in breast fed infants and toddlers. A study from pudget sound pediatric research network. Clinical Pediatr. 2010;49:1103–1110. CrossRef
- Aloia JF. The 2011 report on dietary reference intake for vitamin D. Where do we go from here? J Clin Endocrinol Metab. 2011;96:2987–2996. CrossRef
- Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. J Bone miner Res. 2011;26:455–467. CrossRef
- Moy R, Shaw N, Mather I. Vitamin D supplementation in pregnancy. Lancet. 2004; 363(9408):574. CrossRef
- Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia. Vitamin D and adult bone health in Australia and New Zealand: a position statement. Med J Aust. 2005;182: 281–285.
- Thomson K, Morley R, Grover SR, Zacharin MR. Postnatal evaluation of vitamin D and bone health in women who were vitamin -D deficient in pregnancy, and their infants. Med J Aust. 2004;181:486–488.
- Basile LA, Taylor SN, Wagner CL, Horst RL, Hollis BW. The effect of high dose vitamin D supplementation on serum vitamin D levels and milk calcium concentration in lactating women and their infants. Breastfeed Med. 2006;1:27–36. CrossRef
- Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW. High dose vitamin D3 supplementation in a cohort of breast feeding mothers and their infants: a 6 month follow-up pilot study. Breastfeed Med. 2006;1:59–70. CrossRef
- Balasubramanian S, Ganesh R. Vitamin D deficiency in exclusively breast fed infants. Indian J Med Res. 2008;127:250–255.
- Specker BL, Valanis B, Hertzberg V, Edwards N, Tsang RC. Sunshine exposure and serum 25- hydroxy vitamin D concentrations in exclusively breastfed infants. J. Pediatr. 1985;107:372–376. CrossRef
- Lamberg-Allardt C. Vitamin D in foods and as supplements. Prog Biophys Mol Biol. 2006;92:33–38. CrossRef
- Natri AM, Salo P, Vikstedt T, Palssa A, Huttunen M, Kärkkäinen MU, et al. Bread fortified with cholecalciferol increases the serum 25-hydroxyvitamin D concentration in women as effectively as a cholecalciferol supplement. J. Nutr. 2006;136:123–127.
- Babu US, Calvo MS. Modern India and the vitamin D dilemma: evidence for the need of a national food fortification program. Mol Nutr Food Res. 2010;54: 1134–1147.
- Vitamin D deficiency in childhood — A review of current guidelines on diagnosis and management
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