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Vitamin D Natalie Vicca Good Food for New Arrivals Project ASeTTS.

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Presentation on theme: "Vitamin D Natalie Vicca Good Food for New Arrivals Project ASeTTS."— Presentation transcript:

1 Vitamin D Natalie Vicca Good Food for New Arrivals Project ASeTTS

2 Association for Services to Torture and Trauma Survivors Free & Confidential service Counselling, advocacy, support, group and community activities

3 Good Food for New Arrivals Funded by Australian Government under the Stronger Families and Communities Invest to Grow Program.

4 Services at ASeTTS Counselling & Advocacy Community development programs and support groups Personal Support Program Volunteer program Settlement grants program Training, professional development & consultation Strength to Strength Relationship support Good Food for New Arrivals Nutrition Project Integrated service centre MDT at selected Primaries Newly Arrived Youth Support Service Sessional psychiatrist

5 Australias Humanitarian Programme Nationally 13,000 accepted each year 2006 Total under 18 years = 56% Under 9 years old = 27%

6 Learning Objectives Be aware of sources and function of Vit D Be aware of the effects of Vit D deficiency Recognise groups at risk of deficiency The situation in WA Identify screening/treatment strategies

7 Sources Sunlight- D3 cholecalciferol Diet - D2 ergocalciferol –Fish, Eggs, Margarine, Milk, some meats Requirements = 5-15 Micrograms/day (Nutrient Reference Values for Australia and New Zealand 2006)

8 Function Variety of neuromuscular and physiological functions Maintains serum calcium and phosphorus Role in enhancing immune function

9 skin sunlight 7 -dehydrocholesterol cholecalciferol Vitamin D3 (fish, meat) Vitamin D2 (supplements) 25 dihydroxyvitamin D3 1,25-dihydroxyvitamin D3 Ca absorption small intestine Urinary calcium reabsorption (kidney) Bone mineralisation liver kidney

10 Deficiency Rickets in children Osteoporosis and Osteomalacia adults Implicated in development of – Psoriasis –Type 1 Diabetes Mellitus –Multiple Sclerosis –Gastrointestinal Cancers

11 WA Situation Migrant Health found approx 16% of children and 11% of adults have moderate to severe vitamin D deficiency Many more with mild deficiency - 40% Have been emergency presentations due to hypocalcaemic seizures

12 Who is at risk? Those who do not get enough sunlight. Covered for cultural reasons Dark skin needs longer exposure Elderly Breastfed babies of deficient mothers Babies not introduced to solids appropriately

13 Sun exposure Outside of peak hours Without sun screen for short periods only Hands, arms and face if possible Darker skins require longer exposure –7 minutes in summer for moderate to fair skin, up to 3-4 times longer for highly pigmented skins.

14 Symptoms and Signs Young Infants –Restlessness –Poor sleep –Craniotabes (Soft posterior skull due to reduced mineralisation)

15 Older infants –Delayed sitting/crawling –Delayed closure fontanelle –Bossing of skull –Costochondral beading –Delayed tooth development Photos courtesy of Tom D Thacher, MD

16 Children (1-4 yrs) –Enlarged Epiphysial cartilages wrists/ankles –Kyphoscoliosis –Delayed walking –Abnormal teeth excessive caries


18 Bow leg abnormality Knock knees Photos courtesy of Tom D Thacher, MD

19 Marion Post Wolcott. Corbis

20 Older children and adolescents –Painful walking –Bowlegs –Knock knees –Abnormal teeth –Excessive caries –Neuromuscular hyperactivity muscle weakness

21 Adults Weak bones Bone pain (spinal, pelvic, legs) Muscle weakness Hypocalcaemia Compressed vertebrae Pelvic flattening Easy fracturing

22 What can be done? Screening –Blood test – vitamin D, U&ES, PTH, Ca, LFTs –Signs or symptoms screened by GP

23 Treatment Children –Managed via PMH due to sole access to supplementation Adults –Managed by GP –E.g. Ostelin tablets/d

24 After 2 years of treatment Photos courtesy of Tom D Thacher, MD

25 Summary SPOT – those at risk SCREEN - those likely to be deficient SUPPLEMENT – those with low levels Slip Slap Slop Still stands but….

26 Questions?

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