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Children need 2000 IU of Vitamin D (India) - RCT May 2019

Vitamin D Supplementation: Do Indian Children Need Higher Dose? - May 2019

The recent Indian Academy of Pediatrics (IAP) guidelines recommended daily vitamin D supplementation in doses of 400 IU upto one year of age, and 600 IU from 1-18 years of age [1]. There were however concerns about the adequacy of such daily doses in the context of Indians’ ability to maintain vitamin D sufficiency due to several reasons [2]. Lack of sufficient Indian data on the correct dose and the need for studies with graded supplementation doses of vitamin D was emphasised [2].
The recent article by Marwaha, et al. [3], therefore, made for an interesting read. The authors compared the efficacy of daily vitamin D doses of 600 IU, 1000 IU, and 2000 IU to maintain vitamin D status in 216 healthy vitamin D deficient pre-pubertal girls belonging to upper socio-economic status (sEs). After 6 months of supplementation, vitamin D levels of >20 ng/mL were achieved in 91 %, 97%, and 100% girls, and there was dose dependent increase in vitamin D levels (+14.9, +18 and +22.2 ng/mL) in three groups, respectively. Also, the mean serum vitamin D concentrations remained in the insufficient range (21-30 ng/mL according to Endocrine Society guidelines, 2011) in the groups that received 600 or 1000 IU and barely reached sufficiency (>30 ng/mL) in those receiving 2000 IU/day even after 6 months. Another important documentation of the study was that the daily dose of 2000 IU did not result in vitamin D concentrations reaching toxicity range in any child. These data are similar to previous Indian studies using higher supplementation doses of vitamin D and makes a strong pitch for revisiting the IAP’s guidelines in future or at least for conducting further larger studies in Indian children [3,4]. The question whether routine vitamin D supplementation in healthy prepubertal girls has longterm skeletal benefits, as pointed out in the accompanying editorial, can only be addressed by long-term studies [5].
We also noted minor discrepancies in data presentation. ANOVA was used to study the difference in means in 3 groups, assuming normal distribution of data. But in Table II, of the article [3], results are shown in median (IQR) whereas in abstract, results section and Table I, the results are mentioned in mean (SD). The participants were only girls aged 6-12 years from upper SES mainly during winter months. Hence, the results may not be applicable to children of both sexes, in all age groups, lower SES, and throughout the year.
Suresh Kumar Angurana* and Devi Dayal Department of Pediatrics, Advanced Pediatrics Center, PGIMER, Chandigarh, India. *sureshangurana@gmail.com
 Download the PDF from VitaminDWiki
References

  • Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, Balasubramanian S, et al. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) Guidelines. Indian Pediatr. 2017;54:567-73.
  • Dayal D, Jain N. Indian children need higher vitamin D supplementation. Indian Pediatr. 2018;55:78.
  • Marwaha RK, Mithal A, Bhari N, Sethuraman G, Gupta S, Shukla M, et al. Supplementation with three different daily doses of vitamin D3 in healthy pre-pubertal school girls: A cluster randomized trial. Indian Pediatr. 2018;55:951-6.
  • Dayal D. It’s high time to revise Indian guidelines on vitamin D supplementation in children. J Pediatr Endocrinol Metab. 2016;29:425-6.
  • Seth A. Do healthy pre-pubertal girls need supplementation with vitamin D? Indian Pediatr. 2018;55:943-4.

Author’s Reply
We thank the authors for their interest in our study, and appreciate this opportunity to reply to their comments. In our study of pre-pubertal girls, we found that a daily dose of 1000 vitamin D3 achieved and maintained vitamin D sufficiency in 97% of girls [1]. In Table I, we mentioned mean and standard deviation values of baseline hormonal and biochemical parameters. Table II showed changes in hormonal and biochemical parameters after vitamin D3 supplementation. All P values were based on non- parametric one-way analysis of variance (DUNN test). We used non-parametric DUNN test in view of large standard deviations in the values. We agree with the limitation of study that the results may not be applicable to children of both sexes, in all age groups, lower socioeconomic strata, and throughout the year. Further studies with larger sample size and longer follow-up are required to confirm our findings and to evaluate the long-term benefit of the vitamin D supplementation.
Raman Kumar Marwaha Scientific Advisor (Projects), International Life Science Institute (India). marwaha_ramank at hotmail.com.
References

  • 1. Marwaha RK, Mithal A, Bhari N, Sethuraman G, Gupta S, Shukla M, et al. Supplementation with three different daily doses of vitamin D3 in healthy pre-pubertal school girls: A cluster randomized trial. Indian Pediatr. 2018;55:951-6.

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RCT Summary: Average Response to 2,000 IU 10ng ==> 32 ng

They determined that 2,000 IU was also needed to get 97.5% of the children to 20 ng


VitaminDWiki

Infant-Child category has

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


Comment by VitaminDWiki

14,000 IU weekly or 28,000 IU every 2 weeks might be better than 2,000 IU daily

Promising Vitamin D Clinical Trials - 2017 contains the following

Future Clinical Trials

  • Each page includes links to similar studies/trials
  • The year is shown as 1 year after trial starts, note sometimes publication does not occur until 4 years later.
  • These clinical trials were selected as being likely to show good results by VitaminDWiki in 2017.
  • If an item is of interest. you should consider taking Vitamin D and perhaps other supplements such as Magnesium, Omega-3, and Vitamin K rather than waiting for the results of the clinical trial to be published, or waiting several decades for your doctor to incorporate the results into his practice

See also VitaminDWiki

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Created by admin. Last Modification: Sunday May 19, 2019 11:52:08 GMT-0000 by admin. (Version 6)

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11989 India Change.jpg admin 19 May, 2019 11:15 60.38 Kb 64
11988 India baseline.jpg admin 19 May, 2019 11:14 18.43 Kb 48
11987 marwaha2018.pdf PDF 2018 admin 19 May, 2019 11:14 499.12 Kb 47
11986 Children need more Vitamin D (2,000 IU, India) May 2019.pdf PDF 2019 admin 19 May, 2019 11:13 11.12 Kb 45
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