Flashcards in Vitamin D supplementation: Recommendations for Canadian mothers and infants Deck (36):
How many cases of confirmed rickets occurred between 2002 and 2004 in Canada?
What percentage of patients with confirmed rickets were First Nations?
What percentage of patients with confirmed rickets were Inuit?
What percentage of patients with confirmed rickets were Middle Eastern?
What has vitamin D deficiency been associated with?
3. Autoimmune disorders i.e. RA, MS, IBD
5. Muscle function disturbance
6. TB resistance
What has maternal vitamin D deficiency been associated with?
1. Bone density
2. Asthma severity
3. Susceptibility to type 1 DM
4. Enamel defects in primary and permanent teeth --> dental caries
5. Newborn hypocalcemia
6. Newborn rickets
8. Decreased vitamin D in breast milk
What is the origin of vitamin D3?
Produced in skin of animals
What is the origin of vitamin D2?
What is 25-OH-vitamin D?
Stable but inactive form
Defines vitamin D status
25-hydroxylation in liver
What is 1,25 (OH)-2vitamin D?
Unstable but active form
1-hydroxylation in kidney
What is optimal plasma 25(OH)-vitamin D levels?
PTH production and calcium re-absorption from bone minimized
Intestinal calcium absorption stabilized
What level of vitamin D is considered pharmacological with potential adverse effects
Hypercalcemia, calcium deposits in tissue
What level of vitamin D is considered toxic?
What level of vitamin D is considered deficient?
What level of vitamin D is considered insufficient?
What factors affect sun exposure and thus vitamin D3 production?
2. Skin pigmentation
What is the Canadian Dermatology Association recommendation regarding sun exposure?
<1yo avoid direct sunlight and use sunscreens
What are some food sources for vitamin D?
1. Infant formulas, dairy milk, fortified rice and soy beverage ~400IU/L
2. Canned salmon (530IU/3oz)
3. Canned tuna (200IU/3oz)
4. Fatty fish
5. Aquatic mammals i.e. seals, polar bears
What is the Health Canada recommendation for maternal supplementation?
How much vitamin D is in prenatal supplements?
400IU vitamin D3 per day
What is the recommendations regarding vitamin D supplementation in preterm infants?
200IU/kg/day to maximum 400IU/day
What is the recommendations regarding vitamin D supplementation in term infants?
400IU/day from any source x 1 year
800IU/day for northern Native communities during winter months
What is the recommendations regarding vitamin D supplementation in 1-8yo children?
What is the recommendations regarding vitamin D supplementation in 19-50yo?
What is the recommendations regarding vitamin D supplementation in 51-70yo?
What is the recommendations regarding vitamin D supplementation in >71yo?
What vitamin D dosing might be needed in adults?
800-1000 IU/day up to 2000-4000IU.day in special circumstances
What is the highest continuing daily intake of vitamin D that is likely to pose no risks of adverse health effects for infants up to 1yo?
What is the tolerable upper intake level of vitamin D in adults?
Evidence absence of toxicity 10 000IU/day vitamin D3
What is the prediction regarding supplementation with vitamin D3?
As more and more evidence of the relationship between the level of vitamin D in diseases such as osteoporosis, cancer, diabetes, autoimmune diseases and neuromuscular disorders emerges, it is predicted that treatment with physiological doses of vitamin D3 (between 4000 IU/day to 10,000 IU/day from all sources, including sun, food and supplements) with periodic monitoring of blood 25(OH)D (calcidiol) levels and calcium levels will become routine to maintain 25(OH)D levels of 75 to 150 nmol/L
In which groups of people is vitamin D deficiency most common?
Common in adults and children in Canada esp.:
2. high Arctic regions
3. Infants <1yo esp. if breastfed
What vitamin D supplementation level is required in pregnancy and lactation to maintain optimal levels of 25(OH)D for both mothers and their infants?
What does vitamin D requirements vary with?
Weight and BMI
Why are vitamin D levels lower in high Arctic regions?
1. Lack of light for much of the year
2. Dressing for intense cold decreases the opportunity for vitamin D production in skin
3. Dependence of traditional vitamin D rich foods has diminished
What are some other recommendations regarding vitamin D supplementation?
1. In infants and children living in the north, levels of supplementation of vitamin D of 400 IU/day to 800 IU/day appear safe. However, vitamin D deficiency continues to be prevalent in this group and doses may need to be increased, especially in light of the evidence that the amount of vitamin D needed for sufficiency can vary with weight or BMI. Overweight and obese children are at higher risk for vitamin D deficiency and may need a higher intake
2. There appears to be discrepancy between our current practice and recommended intakes, which needs to be addressed