Arch Pediatr Adolesc Med. 2008;162(6):505-512.
Prevalence of Vitamin D Deficiency Among Healthy Infants and Toddlers
Results The prevalence of vitamin D deficiency (=20 ng/mL) [JL edit: 50nmol/L] was 12.1% (44 of 365 participants), and 146 participants (40.0%) had levels below an accepted optimal threshold (=30 ng/mL) [JL edit: or 75 nmol/L - musculoskeletal optimal as opposed to immune optional]... breastfeeding without supplementation among infants and lower milk intake among toddlers were significant predictors of vitamin D deficiency. In vitamin D–deficient participants, 3 participants (7.5%) exhibited rachitic changes on radiographs, whereas 13 (32.5%) had evidence of demineralization.
Conclusions Suboptimal vitamin D status is common among otherwise healthy young children. Predictors of vitamin D status vary in infants vs toddlers, information that is important to consider in the care of these young patients. One-third of vitamin D–deficient participants exhibited demineralization, highlighting the deleterious skeletal effects of this condition.
Vitamin D deficiency has been widely reported in all age groups in recent years. Rickets has never been eradicated in developed countries, and it most commonly affects children from recent immigrant groups. There is much evidence that current vitamin D guidelines for the neonatal period, 5–10 μg (200–400 IU)/day, prevent rickets at the typical calcium intakes in developed countries. The annual incidence of vitamin D-deficiency rickets in developed countries ranges between 2.9 and 7.5
cases per 100,000 children. The prevalence of vitamin D deficiency in mothers and their neonates is remarkable, and the results of one study suggest that third-trimester 25-hydroxyvitamin D (25(OH)D)
is associated with fetal bone mineral accrual that may affect prepubertal bone mass accumulation. Beyond infancy, the evidence indicates that 5 μg (200 IU)/day of vitamin D has little effect on vitamin D status as measured by the serum 25(OH)D concentration. Two randomized clinical
trials show that higher vitamin D intake improves one-year gain in bone density in adolescent girls. The functions of vitamin D extend beyond bone to include immune system regulation and antiproliferative
effects on cells. Early life vitamin D inadequacy is implicated in the risk of bone disease, autoimmune disease, and certain cancers later in life; however, long-term interventional studies do not exist to validate the widespread implementation of greater vitamin D consumption. Here we
review the available data concerning vitamin D status and health effects of vitamin D in pregnancy through to and including adolescence.
Vitamin D intake and type 1 diabetes prevention The intake of vitamin D, either as a supplement or via food, has been the subject of recent studies examining populations with a high risk for type 1 diabetes. Hypponen et al. found a significantly reduced risk of 0.22 for type 1 diabetes in a birth-cohort study when high-dose vitamin D supplementation (O50 mg dK1, 2000 U dK1) was given regularly or irregularly . By contrast, those children with
suspected rickets during the first year of life had a threefold increased risk of developing type 1 diabetes during later life.
Similarly, increased vitamin D intake during pregnancy significantly reduced b-cell autoimmunity in offspring as detected by islet autoantibodies . However, this effect was restricted to vitamin D intake from food. In a Norwegian study, the use of cod liver oil
either during pregnancy or in the first year of life was associated with a lower incidence of type 1 diabetes . Whether this was the result of the content of vitamin D or long-chain n-3 fatty acids (or a combination) merits further investigation . Furthermore, a EURODIAB (European Community Concerted Action Programme in Diabetes) subgroup multicentre study of cases and controls found that the risk for type 1 diabetes was significantly reduced in countries
with vitamin D supplementation during childhood .
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