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. *[email protected]
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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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Increase
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
Infant-Child category has
- No consensus on MINIMUM International Units (IU) for healthy infant of normal weight
- 400 IU Vitamin D is no longer enough
Was OK in the past century, but D levels have been dropping for a great many reasons.
FDA doubles the amount of vitamin D permitted in milk – July 2016 - No consensus: range is 600 to 1600 IU – based on many randomized controlled trials
- Review of 400 IU to 2000 IU daily and higher if non-daily
- Fewer pre-infants were vitamin D deficient when they got 800 IU – RCT Feb 2014
- 1600 IU was the conclusion of three JAMA studies
1000 IU recommended in France and Finland – 2013 - appears to be a good level - 5X less mite allergy after add vitamin D
- Child bone fractures with low vitamin D were 55X more likely to need surgery
- 75 % of SIDS had low vitamin D
- Children stayed in ICU 3.5 days longer if low vitamin D – Dec 2015
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- Infants have gotten free 400 IU of vitamin D in Turkey since 2005, More for longer would be even better – Feb 2022
- Preemies should have vitamin D supplements – reaching an agreement – April 2021
- Vitamin D loading dose was as effective as daily dosing (rickets in this case) – RCT July 2021
Having a good level of vitamin D cuts in half the amount of:
- Asthma, Chronic illness, Doctor visits, Allergies, infection
Respiratory Tract Infection, Growing pains, Bed wetting
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.
More than 100 IU/kg is probably better 823 items in the category Infant/Child See also - 34 pages in Vitamin D Life had BREASTFE*in title as of Jan 2022
- "BIRTH DEFECTS" 172 items as of July 2016
- Stunting OR “low birth weight” OR LBW OR preemie OR preemies OR preterm 1940 items as of Oct 2018
- 96 Vitamin D Life pages contained PRETERM or PREEMIE in title as of Aug 2021
- "SUDDEN INFANT DEATH" OR SIDS 214 items as of Dec 2020
- Overview of Rickets and Vitamin D
- Youth category listing has
174 items along with related searches - Down syndrome and low vitamin D - several studies
- Rett syndrome associated with low vitamin D, treated by Omega-3
Comment by Vitamin D Life
14,000 IU weekly or 28,000 IU every 2 weeks might be better than 2,000 IU daily
- Take vitamin D3 daily, weekly, or bi-weekly
- Vitamin D given weekly better than daily (Nursing home, 5,600 IU weekly) – Aug 2018
- Vitamin D dosing - weekly may be better than daily – video Aug 2018
- 5,000 IU daily or 50,000 IU Vitamin D weekly repleted many dark skinned adolescents – RCT Dec 2015
- Vitamin D taken daily (4,000 IU) vs weekly (50,000 IU) – RCT 2019
- Type 1 diabetes helped with 50,000 IU of vitamin D every two weeks – Nov 2014
Promising Vitamin D Clinical Trials - 2017 contains the following
Future Clinical Trials- Monthly 60,000 IU of Vitamin D did not reduce mortality (too infrequent)- Feb 2022monthly) will reduce mortality – results due 2024
- Probably Fractures of the Tibia can be healed with 100,000 IU of vitamin D weekly – RCT 2023
- Severe sepsis may be prevented by 400,000 IU of vitamin D – RCT 2023
- Decalcify Aortic Valve – 3 year trial with 1 mg of Vitamin K and 5,000 IU of Vitamin D – 2021
- Multiple Sclerosis stem cell treatment (HSCT) probably not benefit from 200,000 IU of vitamin D – RCT 2020
- Delay onset of Multiple Sclerosis with 100,000 IU of vitamin D every two weeks – RCT 2020
- Vitamin D taken daily (4,000 IU) vs weekly (50,000 IU) – RCT 2019
- Critically ill children – randomized clinical trial to give single doses of up to 400,000 IU of vitamin D – 2019
- 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 Vitamin D Life 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 Vitamin D Life
- Vitamin D home fortification- don't wait 100 years for your govt
- Vitamin D and Rickets consensus took 80 years – how long till consensuses on 30 other health problems – Feb 2016
- A balanced diet is no longer enough – supplements needed - Vitamin D Life Oct 2012
- VITAMIN D: Public Shouldn’t Wait For Doctors To Usher In New “Golden Era” Of Preventive Medicine
- Vitamin D trials underway are unlikely to be useful – Jan 2015 10 reasons, such as too small of dose, too short of time, dose size not vary with weight, . .
- Intervention - Vitamin D category listing has
799 items along with related searches - Vitamin D intervention -100 active clinical trials as of May 2018
- 1 pill every two weeks fights all of the following
Diabetes + Heart Failure + Chronic Pain + Depression + Autism + Breast Cancer + Colon Cancer + Prostate Cancer + BPH (prostate) + Preeclampsia + Premature Birth + Falls + Cognitive Decline + Respiratory Tract Infection + Influenza + Tuberculosis + Chronic Obstructive Pulmonary Disease + Lupus + Inflammatory Bowel Syndrome + Urinary Tract Infection + Poor Sleep + Growing Pain + Multiple Sclerosis + PMS + Schizophrenia + Endometriosis + Smoking 27 problems
Note: Once a week also fights: COVID, Headaches, Colds, Fibromyalgia, Asthma, Hives, Colitis etc.Children need 2000 IU of Vitamin D (India) - RCT May 2019Printer Friendly Follow this page for updates6349 visitors, last modified 25 Aug, 2022, This page is in the following categories (# of items in each category)Attached files
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