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@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

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

Get buy-in from the medical establishment
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
Start supplementation at first week
Consider ways to have a loading dose - so that the infant does not take many months to get an adquate level of vitamin D
Consider more than 600 IU of vitamin D - especially for breastfeding from mothers who are very vitamin D deficient
Consider giving the mother enough vitamin D such that some is in her breastmilk

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