Rickets reduced 60X - lessons learned by Turkey 2011

Vitamin D deficiency and prevention: Turkish experience.

Acta Paediatr. 2011 Sep;100(9):1195-9. doi: 10.1111/j.1651-2227.2011.02383.x. Epub 2011 Jul 4.
Hatun Ş, Ozkan B, Bereket A. abdullahbereket at gmail.com
Division of Paediatric Endocrinology, Department of Paediatrics, Kocaeli University, Kocaeli, Turkey.

A nationwide 'vitamin D prophylaxis augmentation programme' initiated in 2005 in Turkey reduced the prevalence of rickets from 6% in 1998 to 0.1% in 2008 in children under 3 years of age. The programme included free distribution of vitamin D drops to all newborns and infants (0-12 months) visiting primary health stations throughout the country. Free disposal of vitamin D to infants is an effective strategy for preventing vitamin D-deficient rickets.

PMID: 21672012

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Update April 2016 got copy of PDF from Academia.edu

 Download the PDF from VitaminDWiki

Highlights from the copy protected article, by Henry Lahore - admin of VitaminDWiki

• <10 ng in 46% to 80% of pregnant women in Turkey
• Turkey gave vitamin D free to all infants 0-12 months when visit primary health care stations
• 400 IU in 3 drops, Cost for 1 year – 2.5 USD
• Start supplementation in 1st week of life (not second week)
• Turkey medical system was used to recommending 400 IU
  It had been part of the medical curriculum for 40 years
• 400 IU was NOT ENOUGH for 27% of 2-6 month old infants (who still had < 15 ng/ml)
• Turkey plans to give 1200 IU to all pregnant women
  Comment by VitaminDWiki – 1200 IU is not enough, AND they should also give vitamin D to lactating women
• Perhaps other countries need something else – example: Eqypt Calcium
• The only downside to the supplementation: some Turkish medical schools state that ‘they cannot find a single case of rickets for teaching purposes anymore’

Comments by Henry Lahore

• Suspect that they could have had similar success by giving vitamin D to just those women who had very conservative clothing styles
    – but this could have resulted in religious overtones
• Medical community had recommended increased vitamin D for decades, but Rickets rate continued to be about 6%
• It helped that the Turkish Minster of Health was a pediatrician
• They considered also having a loading dose of vitamin D, but previously had problems with people confusing the loading dose and the maintenance doses
  – resulting in occasional vitamin D toxicity (loading dose was 100X more potent)
  Would be desirable to use a loading dose: consider: vastly different bottles, different color liquid, not as potent

Possible concepts (Lessons Learned) that can be used by other countries

1. Get buy-in from the medical establishment
2. Consider giving >4,000 IU during pregnancy, so that the infant is not born with vitamin D deficiency
   This would reduce rickets, asthma, pregnancy complications, language problems, pre-term births, autism, etc
   However, there is a barrier: World Health Organization recommends a totally inadequate 200 IU during pregnancy
3. Start supplementation at first week
4. Consider ways to have a loading dose - so that the infant does not take many months to get an adquate level of vitamin D
5. Consider more than 600 IU of vitamin D - especially for breastfeding from mothers who are very vitamin D deficient
6. Consider giving the mother enough vitamin D such that some is in her breastmilk

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131 studies cited this study as of April 2022

Google Scholar

• Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries - 2018 PDF

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See also VitaminDWiki

• Overview of Rickets and Vitamin D
• all items in category Rickets 127 items
• Group is giving only 200 IU of Vitamin D to 70 million women and children to prevent Rickets
• Turkey has yet not learned to GIVE vitamin D DURING pregnancy (5 ng average) – May 2014