High-dose vitamin D3 in the treatment of severe acute malnutrition: a multicenter double-blind randomized controlled trial.
Am J Clin Nutr. 2018 May 1;107(5):725-733. doi: 10.1093/ajcn/nqy027.
Saleem J1,2, Zakar R1, Zakar MZ1, Belay M2, Rowe M3, Timms PM3, Scragg R4, Martineau AR2.
Children (6-58 months) with severe acute malnutrition
Randomized Controlled Trial gave 2 doses of 200,000 IU of Vitamin D3 (@ week 2 and week 4)
It is amazing how much improvement results from just $2 worth of Vitamin D by week 8
Can expect even better results (including weight gain) if:
- The Vitamin D levels were adjusted for infant weight
- i.e. children who weigh 2X more are given 2X larger doses
- Used a Vitamin D which is gut friendly (Suspect that many malnurished infants had poor guts)
- The results were checked months, not weeks later - when the body had a chance to make use of the Vitamin D
Missed opportunity: Give vitamin D to malnurished infants might prevent them from becoming malnurished children
Author said that he decided on the trial because vitamin D was being added locally and he wanted to see if it actually was helping
- Rickets virtually cured by 90,000 IU of Vitamin D along with daily Calcium – RCT Nov 2018
- Overview Loading of vitamin D
- 100,000 IU Vitamin D weekly for 4 weeks is safe and effective for children – May 2019 similar 400,000 IU total
- Malnourished children with low vitamin D were 2.8 X more likely to be stunted – Aug 2018
- Ability to walk at age 1 is 3.9 X more likely if sufficient vitamin D – July 2019
Vitamin D deficiency is common in children with severe acute malnutrition, in whom it is associated with severe wasting. Ready-to-use therapeutic food (the standard treatment) contains modest amounts of vitamin D that do not reliably correct deficiency.
The aim of this study was to determine whether high-dose oral vitamin D3 enhances weight gain and development in children with uncomplicated severe acute malnutrition.
We conducted a randomized placebo-controlled trial of high-dose vitamin D3 supplementation in children aged 6-58 mo with uncomplicated severe acute malnutrition in Pakistan. Participants were randomly assigned to receive 2 oral doses of 200,000 IU vitamin D3 or placebo at 2 and 4 wk after starting ready-to-use therapeutic food. The primary outcome was the proportion of participants gaining >15% of baseline weight at 8 wk after starting ready-to-use therapeutic food (the end of the study). Secondary outcomes were mean weight-for-height or -length z score and the proportion of participants with delayed development at the end of the study (assessed with the Denver Development Screening Tool II), adjusted for baseline values.
Of the 194 randomly assigned children who started the study, 185 completed the follow-up and were included in the analysis (93 assigned to intervention, 92 to control). High-dose vitamin D3 did not influence the proportion of children gaining >15% of baseline weight at the end of the study (RR: 1.04; 95% CI: 0.94,1.15, P = 0.47), but it did increase the weight-for-height or -length z score (adjusted mean difference: 1.07; 95% CI: 0.49,1.65, P < 0.001) and
reduce the proportion of participants with
- delayed global development (adjusted RR (aRR): 0.49; 95% CI: 0.31, 0.77, P = 0.002),
- delayed gross motor development (aRR: 0.29; 95% CI: 0.13, 0.64, P = 0.002),
- delayed fine motor development (aRR: 0.59; 95% CI: 0.38, 0.91, P = 0.018), and
- delayed language development (aRR: 0.57; 95% CI: 0.34, 0.96, P = 0.036).
High-dose vitamin D3 improved the mean weight-for-height or -length z score and developmental indexes in children receiving standard therapy for uncomplicated severe acute malnutrition in Pakistan.
This trial was registered at clinicaltrials.gov as NCT03170479.