Journal of Bone and Mineral Metabolism

, Volume 27, Issue 4, pp 502–506 | Cite as

Standard multivitamin supplementation does not improve vitamin D insufficiency after burns

  • Gordon L. Klein
  • David N. Herndon
  • Tai C. Chen
  • Gabriela Kulp
  • Michael F. Holick
Original Article

Abstract

Children suffering severe burns develop progressive vitamin D deficiency because of inability of burned skin to produce normal quantities of vitamin D3 and lack of vitamin D supplementation on discharge. Our study was designed to determine whether a daily supplement of a standard multivitamin tablet containing vitamin D2 400 IU (10 μg) for 6 months would raise serum levels of 25-hydroxyvitamin D [25(OH)D] to normal. We recruited eight burned children, ages 5–18, whose families were deemed reliable by the research staff. These children were given a daily multivitamin tablet in the hospital for 3 months in the presence of a member of the research staff and then given the remainder at home. At 6 months, the subjects returned for measurements of serum levels of 25(OH)D,1,25-dihydroxyvitamin D [1,25(OH)2D], intact parathyroid hormone (iPTH), Ca, P, albumin, and total protein as well as bone mass by dual energy X-ray absorptiometry. Serum 25(OH)D levels were compared to a group of seven age-matched burned children studied at an earlier date without the vitamin supplement but with the same method of determination of 25(OH)D at 6 months post-burn. In addition, the chewable vitamins were analyzed for vitamin D2 content by high performance liquid chromatography. Serum concentration of 25(OH)D was 21 ± 11(SD) ng/ml (sufficient range 30–100) with only one of the eight children having a value in the sufficient range. In comparison, the unsupplemented burn patients had mean serum 25(OH)D level of 16 ± 7, P = 0.33 versus supplemented. Serum levels of 1,25(OH)2D, iPTH, Ca, P, albumin, and total protein were all normal in the supplemented group. Vitamin D2 content of the chewable tablets after being saponified and extracted was 460 ± 20 IU. Bone mineral content of the total body and lumbar spine, as well as lumbar spine bone density, failed to increase as expected in the supplemented group. No correlations were found between serum 25(OH)D levels and age, length of stay, percent body surface area burn or third-degree burn. Supplementation of burned children with a standard multivitamin tablet stated to contain 400 IU of vitamin D2 failed to correct the vitamin D insufficiency.

Keywords

Vitamin D insufficiency Burns Children 25-hydroxyvitamin D 

References

  1. 1.
    Klein GL, Bi LX, Sherrard DJ, Beavan SR, Ireland D, Compston JE, Williams WG, Herndon DN (2004) Evidence supporting a role of glucocorticoids in short-term bone loss in burned children. Osteoporos Int 15:468–474PubMedCrossRefGoogle Scholar
  2. 2.
    Klein GL, Nicolai M, Langman CB, Cuneo BF, Sailer DE, Herndon DN (1997) Dysregulation of calcium homeostasis following severe burn injury in children: possible role of magnesium depletion. J Pediatr 131:246–251PubMedCrossRefGoogle Scholar
  3. 3.
    Murphey ED, Chattopadhyay N, Bai M, Kifor O, Harper D, Traber DL, Hawkins HK, Brown EM, Klein GL (2000) Up-regulation of the parathyroid calcium-sensing receptor after burn injury in sheep: a potential contributory factor to post-burn hypocalcemia. Crit Care Med 28:3885–3890PubMedCrossRefGoogle Scholar
  4. 4.
    Klein GL, Chen TC, Holick MF, Langman CB, Price H, Celis MM, Herndon DN (2004) Synthesis of vitamin D in skin after burns. Lancet 363:291–292PubMedCrossRefGoogle Scholar
  5. 5.
    Klein GL, Langman CB, Herndon DN (2002) Vitamin D depletion following burn injury in children: a possible factor in post-burn osteopenia. J Trauma 346:346–350CrossRefGoogle Scholar
  6. 6.
    Klein GL, Herndon DN, Rutan TC, Sherrard DJ, Coburn JW, Langman CB, Thomas ML, Haddad JG, Cooper CW, Miller NL, Alfrey AC (1993) Bone disease in burn patients. J Bone Miner Res 8:337–345PubMedCrossRefGoogle Scholar
  7. 7.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  8. 8.
    Chen TC, Turner AK, Holick MF (1990) Methods for the determination of the circulating concentration of 25-hydroxyvitamin D. J Nutr Biochem 1:315–319PubMedCrossRefGoogle Scholar
  9. 9.
    Chen TC, Turner AK, Holick MF (1990) A method for the determination of the circulating concentration of 1,25-dihydroxyvitamin D. J Nutr Biochem 1:320–327PubMedCrossRefGoogle Scholar
  10. 10.
    Chen TC, Turner AK, Holick MF (1990) A method for the determination of circulating concentrations of vitamin D. J Nutr Biochem 1:272–276PubMedCrossRefGoogle Scholar
  11. 11.
    Lu Z, Chen TC, Zhang A, Persons KS, Kohn N, Berkowitz R, Martinello S, Holick MF (2007) An evaluation of the vitamin D3 content in fish: is the vitamin D content adequate to satisfy the dietary requirement for vitamin D? J Steroid Biochem Mol Biol 103:642–644PubMedCrossRefGoogle Scholar
  12. 12.
    Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22:142–146PubMedGoogle Scholar
  13. 13.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716PubMedCrossRefGoogle Scholar
  14. 14.
    Kalkwarf HJ, Zemel BS, Gilsanz V, Lappe JM, Horlick M, Oberfield S, Mahboubi S, Fan B, Fredrick MM, Winer K, Shepherd JA (2007) The bone mineral density in childhood study: bone mineral content and density according to age, sex, and race. J Clin Endocrinol Metab 92:2087–2099PubMedCrossRefGoogle Scholar
  15. 15.
    Bikle DD, Siiteri PH, Ryzen E, Haddad JG (1985) Serum protein binding of 1,25-dihydroxyvitamin D: a re-evaluation by direct measurement of the free metabolite levels. J Clin Endocrinol Metab 61:969–975PubMedCrossRefGoogle Scholar
  16. 16.
    Tangpricha V, Koutkia P, Rieke SM, Chen TC, Perez AA, Holick MF (2003) Fortification of orange juice with vitamin D: a novel approach for enhancing vitamin D nutritional health. Am J Clin Nutr 77:1478–1483PubMedGoogle Scholar
  17. 17.
    Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D, Reitz R, Salameh W, Ameri A, Tannenbaum AD (2008) Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentration of 25-hydroxyvitamin D. J Clin Endocrinol Metab 93:677–681PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer 2009

Authors and Affiliations

  • Gordon L. Klein
    • 1
    • 3
  • David N. Herndon
    • 2
    • 3
  • Tai C. Chen
    • 4
  • Gabriela Kulp
    • 2
    • 3
  • Michael F. Holick
    • 4
  1. 1.Department of PediatricsUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA
  3. 3.Shriners Burns HospitalGalvestonUSA
  4. 4.Section of Endocrinology, Diabetes and Nutrition, Department of MedicineBoston University School of MedicineBostonUSA

Personalised recommendations