Adam R. Aluisio, MD, MSca,b,
Zabihullah Maroof, MD, MPH, PhDa,
Daniel Chandramohan, MBBS, MSc, PhDa,
Jane Bruce, MSca,
M. Zulf Mughal, MBChBc,
Zulfiqar Bhutta, MBBS, PhDd,
Gijs Walraven, MD, MPH, PhDe,
Mohammad I. Masher, MDf,
Jeroen H.J. Ensink, MSc, PhDa, and
Semira Manaseki-Holland, MBBS, MPH, PhDg
A Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom;
B Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York;
C Department of Pediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom;
D Division of Women and Child Health, Aga Khan University, Karachi, Pakistan;
E Community Health, Delegation of the Aga Khan Development Network Foundation, Gouvieux, France;
F Department of Paediatrics, Kabul Medical University, Kabul, Afghanistan; and
G School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Alabama
OBJECTIVE: To investigate the effect of vitamin D3 supplementation on the incidence and risk for first and recurrent diarrheal illnesses among children in Kabul, Afghanistan.
METHODS: This double-blind placebo-controlled trial randomized 3046 high-risk 1- to 11-month-old infants to receive 6 quarterly doses of oral vitamin D3 (cholecalciferol 100 000 IU) or placebo in inner city Kabul. Data on diarrheal episodes (≥3 loose/liquid stools in 24 hours) was gathered through active and passive surveillance over 18 months of follow-up. Time to first diarrheal illness was analyzed by using Kaplan-Meier plots. Incidence rates and hazard ratios (HRs) were calculated by using recurrent event Poisson regression models.
RESULTS: No significant difference existed in survival time to first diarrheal illness (log rank P = .55). The incidences of diarrheal episodes were 3.43 (95% confidence interval CI, 3.28–3.59) and 3.59 per child-year (95% CI, 3.44–3.76) in the placebo and intervention arms, respectively. Vitamin D3 supplementation was found to have no effect on the risk for recurrent diarrheal disease in either intention-to-treat (HR, 1.05; 95% CI, 0.98–1.17; P = .15) or per protocol (HR, 1.05; 95% CI, 0.98–1.12; P = .14) analyses. The lack of preventive benefit remained when the randomized population was stratified by age groups, nutritional status, and seasons.
CONCLUSIONS: Quarterly supplementation with vitamin D3 conferred no reduction on time to first illness or on the risk for recurrent diarrheal disease in this study. Similar supplementation to comparable populations is not recommended. Additional research in alternative settings may be helpful in elucidating the role of vitamin D3 supplementation for prevention of diarrheal diseases.
Vitamin D levels decrease at an expodential rate. (see graph below)
Can expect than 33,000 IU monthly would have been of some benefit.
50,000 IU monthly or twice a month would have been even better.
- 300000 IU of vitamin D every 3 months may not have been enough – July 2010
- 200,000 every 3 months (= 2222 IU daily) to achieve 20-30 ng target
- 100000 IU of vitamin D every three months had problems – 2011
- 2X more childhood diarrhea or ear infection if less than 20 ng of vitamin D – Jan 2013
- Take vitamin D3 daily, weekly, or bi-weekly had the following graphics
starting at 27 nanograms/ml, half life is about 50 days