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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

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, oil
One capsule of 50,000 Bio-Tech Pharmacal Vitamin D could be stirred into monthly formula
   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
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 16:10 23.00 Kb 2567
7530 RCT Children Italy.pdf PDF 2016 admin 19 Dec, 2016 16:10 463.71 Kb 240
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