Weekly regimen of vitamin D supplementation is more efficacious than stoss regimen for treatment of vitamin D deficiency in children with chronic liver diseases
There are no evidence-based recommendations on the ideal dose and regimen for supplementation of vitamin D in children with chronic liver disease (CLD). This study aimed to compare the safety and efficacy of weekly and stoss regimens for treatment of vitamin D deficiency in these children. Children between the ages of 1 to 18 years with CLD and hypovitaminosis D defined by 25-OH vitamin D (25(OH)D) < 30µg/l were included. They were randomized to receive either stoss regimen (600,000 IU on day 1) or weekly (60,000 IU weekly) regimen of vitamin D. The 25(OH)D levels at 3 and 6 months were compared in the two groups. A total of 210 suspected cases of CLD were assessed for eligibility. Of a total of 67 children satisfying the inclusion criteria, 33 and 34 were randomized to receive stoss and weekly regimen, respectively. Final analysis included 28 children in each group. Clinical rickets was seen in 25.4% of children with hypovitaminosis D. The rise in levels of 25(OH)D at 3 months was higher with weekly regimen (34.3 ± 30.7 µg/l) as compared to stoss regimen (17.2 ± 11.5 µg/l) (p = 0.009). Rise at 6 months as compared to baseline was significantly higher with weekly regimen (30.7 ± 24µg/l) as compared to stoss regimen (11 ± 8.4 µg/l) (p < 0.001). Normal levels of 25(OH)D at 6 months were achieved in 24/28 (85.7%) of those receiving weekly regimen and 9/28 (32.1%) of those receiving stoss regimen (p < 0.001). With stoss therapy, 25(OH)D increased at 3 months as compared to baseline but thereafter dropped significantly at 6 months (p = 0.008).
What is Known:
• Vitamin D deficiency is more common and severe in children with chronic liver diseases.
• Currently used doses fail to achieve normal vitamin D levels in these children.
What is New?
• Weekly regimen of 60,000 IU of vitamin D3 is the most effective regimen for treating vitamin D deficiency in children with CLD.
• Children with CLD should further receive maintenance dose of 60,000 IU every month.
KeywordsChronic liver disease Stoss regimen Vitamin D deficiency
AST to platelet ratio index
Bone morphogenetic protein
Chronic liver disease
Pediatric end-stage liver disease
Recommended daily allowance
Vitamin D binding protein
Vitamin D deficiency
BBL and SA conceptualized and designed the work. BBL collected the data. SA and BBL analysed the data and prepared the first draft. SA, BBL, DR and RK critically reviewed, revised and approved the final version.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval Number: IEC/IRB-F.25/5/75/ILBS/AC/2014/387.
Informed consent was obtained from the parents of all the children included in the study.
- 7.Cioffi M, Corradino M, Gazzero P, Vietri MT, Di Macchia C, Contursi A, Colicigno R, Catalano T, Molinari AM (2000) Serum concentrations of intact parathyroid hormone in healthy children. Clin Chem 6:863–864Google Scholar
- 12.Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930CrossRefPubMedGoogle Scholar
- 18.Pappa H, Mitchell PD, Jiang H, Kassiff S, Philip-Dhima R, DiFabio D, Quinn N, Lawton RC, Varvaris M, Van Straaten S, Gordon CM (2012) Treatment of vitamin D insufficiency in children and adolescents with inflammatory bowel disease: a randomized clinical trial comparing three regimens. J Clin Endocrinol Metab 97:2134–2142CrossRefPubMedPubMedCentralGoogle Scholar