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Takes a year to restore children and youths to good levels of vitamin D without loading dose - RCT Dec 2016

A randomized clinical trial comparing 3 different replacement regimens of vitamin D in clinically asymptomatic pediatrics and adolescents with vitamin D insufficiency

Italian Journal of Pediatrics, DOI: 10.1186/s13052-016-0314-z Published: 7 December 2016
Iman M. TalaatEmail author, Naglaa M. Kamal, Hamed A. Alghamdi, Abdulla A. Alharthi and Mohamed A. Alshahrani
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VitaminDWiki comment

Ages ranged from 2 to 18 years
Amazing that they did not vary the dose size with weight, obesity, etc.
See also VitaminDWiki

Response with 400,000 IU loading dose @ is.gd/7DayVitD
Infant-Child category starts with

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


 Download the PDF from VitaminDWiki

Background
Pediatric and Adolescent populations both have special needs for vitamin D especially for growing bone. Inadequate vitamin D is defined as 25 (OH) D(25hydroxy vitamin D) < 30 ng/ml.

Methods
We conducted a randomized, controlled clinical trial from July 2014 over 1 year, aiming to assess the changes in 25 (OH) D and biochemical outcome on calcium and PTH(parathyroid hormone) using 3 different regimens of vitamin D replacement. Initial and 4 month 25 (OH) D, calcium, PTH and 12 month 25 (OH) D levels were assayed. Participants divided into 3 groups:

  • 1) given 400 IU daily,
  • 2) given 45000 IU weekly for 2 months then 400 IU daily,
  • 3) given 2000 IU daily for 3 months then 1000 IU daily.

Results
The results showed significant difference between the 3 groups as regards 25 (OH) D at 4 and 12 months (P < 0.001). Regimens used in group 2 and 3 caused increase in 25 (OH) D after 4 month (median increase is 225% and 200% respectively). 25 (OH) D dropped in group 1 and 2 (median decrease is 42 and 53% respectively) but continued to increase in group 3 (median change is 6%). In group 2 serum calcium median change was 1.2% with few cases of hypercalcuria. 94.9, 76.1 and 7.7 are the percent of vitamin D deficient participants in groups 1, 2 and 3 respectively after 12 months follow up.

Conclusion
We advise as a replacement for vitamin D insufficiency, low loading dose with high maintaince dose rather than the opposite to achieve steady increase in serum 25 (OH) D with no hypercalcemic side effects.

From Conclusions in PDF
Till now, no standard regimen is available for treatment of
vitamin D insufficiency. We recommend low loading dose
of vitamin D around 100.000 to 200.000 IU with high
maintaince dose of 1000 IU as a way of replacement rather
than initial high dose and a low maintaince dose as the
later can cause temporary rise of 25 (OH) D and hypercalcemic
side effects.

Attached files

ID Name Comment Uploaded Size Downloads
7531 Child RCT.jpg admin 19 Dec, 2016 23.00 Kb 6551
7530 RCT Children Italy.pdf admin 19 Dec, 2016 463.71 Kb 888