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Childhood cancers – give Vitamin D loading dose if low – Oct 2021

Can screening for low vitamin D levels prevent bone health complications in paediatric oncology patients?

Cancer Rep (Hoboken) . 2021 Oct 26;e1534. doi: 10.1002/cnr2.1534
Leonie Naeije 1, Mandy Pohlui de Silva 1, Paul Hofman 2

150 000 IU1-2 year
300 000 units 2-5 year
600 000 units >5 year

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VitaminDWiki Infant-Childy pages containing CANCER in title

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Having a good level of vitamin D cuts in half the amount of:

Need even more IUs of vitamin D to get a good level if;

  • Have little vitamin D: premie, twin, mother did not get much sun access
  • Get little vitamin D: dark skin, little access to sun
  • Vitamin D is consumed faster than normal due to sickness
  • Older (need at least 100 IU/kilogram, far more if obese)
  • Not get any vitamin D from formula (breast fed) or (fortified) milk
    Note – formula does not even provide 400 IU of vitamin D daily

Infants-Children need Vitamin D

  • Sun is great – well known for 1,000’s of years.
    US govt (1934) even said infants should be out in the sun
  • One country recommended 2,000 IU daily for decades – with no known problems
  • As with adults, infants and children can have loading doses and rarely need tests
  • Daily dose appears to be best, but monthly seems OK
  • Vitamin D is typically given to infants in the form of drops
       big difference in taste between brands
       can also use water-soluable form of vitamin D in milk, food, juice,
  • Infants have evolved to get a big boost of vitamin D immediately after birth
    Colostrum has 3X more vitamin D than breast milk - provided the mother has any vitamin D to spare
  • 100 IU per kg of infant July 2011, Poland etc.
    1000 IU per 25 lbs.jpg
    More than 100 IU/kg is probably better

Did you know that:


Getting Vitamin D into infants
Many infants reject vitamin D drops, even when put on nipple
I speculate that the rejection is due to one or more of: additives, taste, and oils.
Infants have a hard time digesting oils, 1999  1997   and palm oils W.A. Price 1 2 3
Coconut oil, such as in D-Drops, is digested by infants. 1,   2   3
Bio-Tech Pharmacal Vitamin D has NO additves, taste, nor oil
One capsule of 50,000 Bio-Tech Pharmacal Vitamin D could be stirred into monthly formula or given once a month
   this would result in ~1,600 IUs per day for infant, and higher dose with weight/age/formula consumption

 Download the PDF from VitaminDWiki

Background: No international standards include vitamin D levels at diagnosis or during treatment. It is included in the Children's Oncology Group long-term follow-up guidelines. However, bone health complications (like osteopenia and atraumatic fractures) can occur at diagnosis or during treatment as well.

Cases: In this small case series, we illustrate the complexity of bone health complications among our broad paediatric oncology population. If the vitamin D level is low we supplement the patient with one standard oral dose (150 000 units for 1-2 year olds, 300 000 units for 2-5 year olds and 600 000 units for >5 year olds). We do not adjust depending on diagnosis.

Conclusion: Because of the potentially negative outcomes on short, medium and long term, we recommend checking vitamin D levels on diagnosis for all newly diagnosed patients. It is a simple, low cost test and one dose of oral supplementation can easily treat the deficiency.

REFERENCES

  • Ward LM, Ma J, Lang B, et al. Bone morbidity and recovery in children with acute lymphoblastic leukemia: results of a six-year prospective cohort study. J Bone Miner Res. 2018;33(8):1435-1443.
  • Halton JM, Atkinson SA, Fraher L, et al. Altered mineral metabolism and bone mass in children during treatment for acute lymphoblastic leukemia. J Bone Miner Res. 2009;11(11):1774-1783.
  • Mabey T, Singhatanadgige W, Yingsakmongkol W, Limthongkul W, Honsawek S. Vitamin D and spine surgery. World J Orthop. 2016;7(11):726-730.
  • Frisk P, Arvidson J, Ljunggren Ö, Gustafsson J. Decreased bone mineral density in young adults treated with SCT in childhood: the role of 25-hydroxyvitamin D. Bone Marrow Transplant. 2012;47(5):657-662.
  • Marcucci G, Beltrami G, Tamburini A, et al. Bone health in childhood cancer: review of the literature and recommendations for the management of bone health in childhood cancer survivors. Ann Oncol. 2019;30(6):908-920.
  • Wallace G, Jodele S, Myers KC, et al. Single ultra-high-dose cholecalciferol to prevent vitamin D deficiency in pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2018;24(9):1856-1860.
  • Revuelta Iniesta R, Rush R, Paciarotti I, et al. Systematic review and meta-analysis: prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients. Clin Nutr. 2016;35(1):95-108.
  • Wallace G, Jodele S, Howell J, et al. Vitamin D deficiency and survival in children after hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2015;21(9):1627-1631.
  • Orgel E, Mueske NM, Sposto R, et al. A randomized controlled trial testing an adherence-optimized Vitamin D regimen to mitigate bone change in adolescents being treated for acute lymphoblastic leukemia. Leuk Lymphoma. 2018;58(10):2370-2378.
  • Halton J, Gaboury I, Grant R, et al. Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian STeroid-associated osteoporosis in the pediatric population ( STOPP ) research program. J Bone Miner Res. 2009;24(7):1326-1334. https://doi.org/10.1359/jbmr.090202
  • Cummings EA, Ma J, Fernandez CV, et al. Incident vertebral fractures in children with leukemia during the four years following diagnosis. J Clin Endocrinol Metab. 2015;100(9):3408-3417.
  • COG. Long term follow up resourceguide. www.childrenoncologygroup.org


Created by admin. Last Modification: Thursday October 28, 2021 05:59:02 GMT-0000 by admin. (Version 4)

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