Stable Rates of Low Vitamin D Status Among Children Despite Increase in Testing: A Population-Based Study
J Pediatr. 2021 Jul 19;S0022-3476(21)00704-6. doi: 10.1016/j.jpeds.2021.07.037 PDF costs $36
Alyssa A Kerber 1, Mitchell M Pitlick 2, Anna E Kellund 1, Amy L Weaver 3, Seema Kumar 4, Avni Y Joshi 5
Objective: To determine the trends in testing and incidence of vitamin D deficiency/insufficiency in Olmsted County, Minnesota over a 16 year period.
Study design: The Rochester Epidemiology Project (REP) was used to identify Olmsted County, Minnesota residents <19 years of age who had 25-hydroxyvitamin D (25(OH)D) levels measured between January 2, 2002 and December 31, 2017. Using each patient's first 25(OH)D measurement during this period, patients were categorized into 3 groups: <20ng/ml, 20-50ng/ml, or >50 ng/mL. Vitamin D deficiency/insufficiency was defined as a total 25(OH)D level of <20 ng/mL.
Results: There was a 42-fold increase in the proportion of the county's pediatric population tested each year, starting at 3.7 per 10,000 persons in 2002 and increasing to 156.1 per 10,000 persons in 2017. The largest increase in testing occurred in children 10 years and older, specifically females in this age group for which we observed a 90-fold increase from 2002 to 2017. During the 16-year period, the incidence of vitamin D deficiency/insufficiency (per 10,000 persons) increased from 1.7 in 2002-2003 to 19.9 in 2016-2017, but the proportion that were tested and had vitamin D deficiency/insufficiency remained stable with rates of 21.9% (95% CI 16.1-29.1%) in 2006-2007 and 18.5% (95% CI 16.0-21.2%) in 2016-2017.
Conclusion: The proportion of the county's pediatric population with vitamin D testing increased from 2002 to 2017, which paralleled increased incidence of vitamin D deficiency/insufficiency, but the proportion tested that had vitamin D deficiency/insufficiency remained stable over time.
Many countries found a huge increase in cost of testing but with no increase in levels of Vitamin D
Often because the doctors sill do not prescribe large enough doses
- 94 X increase in Vitamin D testing in Australia (2000-2010, then they shut it down) – Dec 2019
- Vitamin D tests for Canadian BC adults can only be ordered by specialists – Oct 2019
- Some employers offer vitamin D testing, some doctors reduce doses, even if deficient – July 2018
- Virtually all infants in Poland got 400 IU of Vitamin D daily (not enough, non-daily is better) – April 2021
- Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013
- Yet most doctors still only prescribe 400 IU, which is not enough to raise Vitamin D levels
Also: Sometimes the Vitamin D form is not appropriate (poor gut, allergic, ...)
Also: Sometimes the dose size does not increase with patient age/weight
Also: Sometimes the dose size does not increase with patient obesity