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Vitamin D
Dr.Ahmed Noureldin Ahmed
MBBCH, DCH, DTM&H (Cairo(
Senior Pediatrician 
Vitamin D is a group of fat-soluble
Pro-hormones
, the two major forms of which are:1-Vitamin
D
2
or 
Ergocaciferol
Vit. D
2
is derived from
Fungal and Plant
sources, and is not produced by the human body.2-vitamin
D
3
or 
Cholecalciferol
Vitamin D
3
is derived from animal sources and is produced in skin exposed to sunlight,Specifecally UVB Radiation.Vitamin D plays an important role in the maintenance of 
Organ
System.
Vitamin D regulates the
Calcium and Phosphorus
levels in the
Blood
by promotingtheir absorption in the
intestines
, and by promoting re-absorption of calcium in theKidneys, which enables normal mineralization of bones and prevents hypocalcemic
 Tetany
.
Vitamin D is an essential hormone for bone growth and development inchildren and promotes skeletal health in adults. Currently, an adequatedaily intake of 200 IUs of vitamin D for children is recommended. This isalso the recommendation from the AAP. These levels, however, may notbe adequate for bone growth and musculoskeletal health in children andadolescents
It is also needed for bone growth and bone remodeling byosteoblastsandosteoclasts.
•
Vitamin D can promote soft tissuecalcification.
•
It inhibits
Parathyroid Hormone
secretion from the
Parathyroid
gland.
•
Vitamin D affects the
immune
System
by promoting, phagocytosis , anti-tumor activity, and immunomodulatory functions.1(
Vitamin D deficiency
is a growing problem around the world, including indeveloped countries where children spend little time outside.
Questions have existed for some time regarding the adequacy of the
 
current RDA, particularly for older children and adolescents, whoundergo a great deal of bone growth. As the researchers of this studynote, Vitamin D levels during adolescence have bearing on a child’sfuture bone density and risk for other diseases
.
Vit.D and RDA for Children
Science Daily (May 28, 2008) — The current (RDA) of vitamin D forchildren is 200 IU, but new research reveals that children may need andcan safely take 10-times that amount. According to new research thisorder-of-magnitude increase could improve the bone health of childrenworldwide and may have other long-term health benefits
.
Study 1
: Newresearchpublished in the Journal of Clinical Endocrinology and Metabolismsuggeststhat the current children’s RDA for Vitamin D (200 IUs does not sufficientlysupport the “bone growth and musculoskeletal health of children and adolescents.”The RDAvalue for children was set at 200 IUs because, unlike testing for adults’ dosage, there wasn’tadequate research into the benefits of higher amounts
.
For this placebo-controlled study,
 
researchers gave children various doses of vitamin D atvarious intervals and measured the impact this had on serum levels of 25-OHD. For theshort-term study, 25 students (15 boys and 10 girls received one-weekly, 14,000 IU doses of vitamin D for eight weeks. Serum levels of 25-OHD were then measured for an additionaleight weeks. This portion of the test was conducted during the summer and early fall, whenthe highest natural levels of vitamin D are reached. For the long-term, one-year study, 340students (172 boys and 168 girls received either a low dose of vitamin D (1,400 IUs eachweek or a high dose (14,000 IUs each week .(The study notes that previous research has indicated no difference between daily and weeklysupplementation of Vitamin D. To ensure full compliance, the researchers required weekly,on-site administration of the supplement.At the end of the study periods,
only those children who had received the “high” dosageof vitamin D had the recommended optimum serum (blood) levels as they are definedfor adults
. (There is less agreement about an ideal serum level for children. Other benefitswere seen in those who received the higher dose. Researchers observed “substantialincrements in lean mass, bone area and bone mass” particularly in girls. Their observationsfrom the study caused them to suggest that serum OHD-25 (vitamin D levels in the mid-thirties (ng/ml may be a reasonable and beneficial target for this age group. The researchersnoted that adolescents would be less likely candidates for toxicity because of their body’suse of the vitamin for constant growth.Our research reveals that vitamin D, at dosesequivalent to 2,000 IUs a day, is not only safe for adolescents, but it is actually necessary for achieving desirable vitamin D levels",2(Vitamin D3 is one of the most common forms of vitamin D, and is easily converted to 25-OHD (25-hydroxyvitamin, which is the active form of vitamin D found in the blood
.
For this placebo-controlled study, researchers gave children various doses of vitamin D atvarious intervals and measured the impact this had on serum levels of 25-OHD.For the short-term study, 25 students (15 boys and 10 girls received one-weekly, 14,000 IUdoses of vitamin D for eight weeks. Serum levels of 25-OHD were then measured for an
 
additional eight weeks. This portion of the test was conducted during the summer and earlyfall, when the highest natural levels of vitamin D are reached.For the long-term, one-year study, 340 students (172 boys and 168 girls received either alow dose of vitamin D (1,400 IUs each week or a high dose (14,000 IUs each week .(Only children given the equivalent of 2,000 IUs a day of vitamin D increased 25-OHDlevels from the mid-teens to the mid-thirties (ng/ml--the level considered optimal for adults. None of the children in either trial showed any evidence for vitamin D intoxication.Although many experts agree that a 25-OHD level of 30 ng/ml is desirable in adults, whatconstitutes an optimal D level for children and adolescents is more debatable. According tothe researchers, due to rapid skeletal growth, children and adolescents are more likely to bevitamin D deficient, and are far less likely to reach vitamin D levels that doctors wouldconsider toxic."Supplementation of children and adolescents with 2,000 IUs a day of vitamin D3 is welltolerated and safe," said Dr. Fuleihan. "This is particularly relevant in light of theincreasingly recognized health benefits of vitamin D for adults and children
Study2 : Low Vitamin D Levels May Be Common In OtherwiseHealthy Children
ScienceDaily (July 10, 2007 — Many otherwise healthy children and adolescents have lowvitamin D levels, which may put them at risk for bone diseases such as rickets. AfricanAmerican children, children above age nine and with low dietary vitamin D intake were themost likely to have low levels of vitamin D in their blood, according to researchers from TheChildren's Hospital of Philadelphia.A study in the current issue of the American Journal of Clinical Nutrition measured bloodlevels of vitamin D in 382 healthy children between six years and 21 years of age living inthe northeastern U.S. Researchers assessed dietary and supplemental vitamin D intake, aswell as body mass, and found that more than half of the children had low blood levels of vitamin D. Of the subjects, 55 percent of the children had inadequate vitamin D blood levelsand 68 percent overall had low blood levels of the vitamin in the wintertime."The bestindicator of a person's vitamin D status is the blood level of a vitamin D compound called25-hydroxyvitamin D," said Babette Zemel, Ph.D., a nutritional anthropologist at Children'sHospital and primary investigator of this study. "Vitamin D deficiency remains an under-recognized problem overall, and is not well studied in children".3(Vitamin D is crucial for musculoskeletal health. The primary dietary source of the vitamin isfortified milk, but the best way to increase vitamin D levels is from exposure to sunshine.Severe deficits in vitamin D may lead to muscle weakness, defective bone mineralizationand rickets. In addition to musculoskeletal effects, vitamin D is important for immunefunction, and low blood levels of the vitamin may contribute to diseases such ashypertension, cancer, multiple sclerosis and type 1 diabetes. Decreased blood levels of vitamin D have also been linked to obesity.ScienceDaily (Oct. 14, 2008 — The AmericanAcademy of Pediatrics (AAP is doubling the amount of vitamin D it recommends for infants, children and adolescents. The new clinical report, "Prevention of Rickets andVitamin D Deficiency in Infants, Children, and Adolescents," recommends all childrenreceive 400 IU a day of vitamin D, beginning in the first few days of life.
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