rajeev slides
TRANSCRIPT
Background:
In the later part of 19th
century estimated that nearly
80-90% of children who lived
in industrialized cities of
Europe and North America
had rickets.
J Clin Invest. 2006;116(8):2062-2072
Definition:
Rickets :
It is caused by failure of osteiod to calcify in growing
person.
Failure of osteiod to calcify in adults is called
Osteomalacia.
Severe chronic vitamin D deficiency [25(OH)D level
>15 ng/ml] leads to overt skeletal abnormalities in
children that is typically defined as rickets.
Vitamin D deficiency rickets occurs when the
metabolites of vitamin D are deficient.
“Vitamin D is critical for skeletal development and
cellular function because of its effect on calcium
homeostasis by promoting intestinal calcium
absorption”
Clinical Signs and Symptoms of
vitamin D deficiency:
Vitamin D content of common foods
Craniotabes Hair loss or alopecia
Genu varum or valgum Delayed dentintion
Costchondral swellings Refusal to walk
Growth delay Fracture
Muscle weakness Seizure
Harrison’s grooves Tetany
Micheal F. Holick. Vitamin D –Physiology, Molecular Biology, and Clinical Applications. 2nd Edition. Humana Press.
Radiological Image:Radiograph in a 4-year-old girl with rickets depicts bowing of
the legs caused by loading.
http://emedicine.medscape.com/article/985510-overview
Clinical Investigations:
Calcium
Phosphorous
Alkaline phosphatase
Parathyroid Hormone
25-hydroxy vitamin D
1,25 –dihydroxy vitamin D
http://emedicine.medscape.com/article/985510-overview
Serum measurement of
Vitamin D – An Introduction:
The sunshine vitamin
The primary source – exposure to ultraviolet B sunlight.
Secondary sources- Fatty fish, fish oil, eggs, from
products (such as milk and orange juice and vitamin D
supplements.
Content of Vitamin D in Foods:
Food items
Cow’s milk 3-40 IU/L
Butter (100gm) 35 IU/L
Egg yolk 20-25 IU/L
Fish (100gm) 44-624 IU
Yoghurt (100gm) 89 IU
Cheese (100gm) 12-44 IU
Ind J Endo Metab. 2012; 16(2): 164–176.
Factors associated with deficiency:
• Religious customs
• Atmospheric pollution
• Skin pigmentation
• Vegetarian diets
• Maternal vitamin D deficiency
Ind J Med Res.2008;127 (): 245-249
FACT:The high prevalence of hypovitaminosis D in a
number of developing countries exists despite the
fact that a large number of these countries lie in
zones that have sufficient sunlight for vitamin D
synthesis for most if not all of the year.
Vitamin D deficiency is now recognized
as a pandemic.
Am J Clin Nutr. 2008;87(4):1080S-6S.
Vitamin D status:
25(OH)D Level
(ng/mL)
25(OH)D Level
(nmol/L)
Health Implications
<20 <50 Deficiency
20-32 50-80 Insufficiency
32-100 80-250 Sufficiency
54-90 135-225 Normal in sunny
countries
>100 >250 Excess
>150 >325 Intoxication
Alternative Medicine Review.2008;13(1):1-20 ,Alternative Medicine Review.2005;10(2):94-111
Recommendations:Daily intake
American Academy of Pediatrics 400 IU
Canadian Pediatric Society 400 IU
Health Canada 400 IU
Health policy in North America 400 IU
Institute of Medicine , Food & Nutrition Board
0-12 months 400 IU
1-3years 600 IU
The Endocrine Society
0-12 months 400-1000 IU
1-3 years 600-1000 IU
Appl Physiol Nutr Metab. 2010;35(3):303-9, Am Fam Physician.2010;81(6):745-8. Pediatrics 2008;122;398
Institute of Medicine. Nov 2010. The Endocrine Society. 2011.
FACT:
Vitamin D deficiency in pediatric patients has
serious implications.
Several recent studies have demonstrated an
alarming prevalence of medical conditions related
to this nutritionall problem, ranging from severe
nutritional rickets to sub-clinical vitamin D
deficiency even within industrialized societies.
It is estimated that children need at least 400-1000 IU of
vitamin D a day
while teenagers and adults need at least 2000 IU of
vitamin D a day to satisfy their body's vitamin D
requirement.
Curr Drug Targets. 2011 Jan;12(1):4-18.
Subjects: 44 disabled children with cerebral palsy
Treatment: Oral vitamin D 1000 IU five days per week
Treatment Duration :10 weeks
17.6014.8
22.4
0.00
5.00
10.00
15.00
20.00
25.00
Baseline Control Group
At End of Therapy
25
(O
H)D
n
g/m
L
Neuropediatrics. 2007;38(4):167-72.
Neuromuscular Disorder
vitamin D(3) supplementation resulted in significant increase in vitamin D
level and was not associated with hypecalcemia or other adverse effect.
Seasonal Influenza ASubjects: School children (6-15yrs)
Primary outcome: Incidence of seasonal influenza A
Treatment: Oral vitamin D 1200 IU
Treatment Duration :4 months
10.8
18.6
0
5
10
15
20
Vit D Group Placebo Group
Incidence of Influenza A (%)
vitamin D(3) supplementation during the winter may reduce the
incidence of influenza A, especially in specific subgroups of
schoolchildren.
Am J Clin Nutr. 2010;91(5):1255-60.