Presentation on theme: "Epidemiology of vitamin D deficiency in children presenting to a paediatric outpatient service in the UK J M Reed, J H Davies, L Blake, A Jackson, N."— Presentation transcript:
1Epidemiology of vitamin D deficiency in children presenting to a paediatric outpatient service in the UK J M Reed, J H Davies, L Blake, A Jackson, N M P Clarke Southampton General Hospital & University of Southampton
7DefinitionsDavies et al, Arch Dis Child 2010; Cheetham et al, BMJ 2010; Misra et al Pediatrics 2008
8Prevalence of vitamin D deficiency in developed countries, adults vs Prevalence of vitamin D deficiency in developed countries, adults vs. childrenHypponen et al, Am J Clin Nutr, 2007n=7347, age 45 y, UK, all white, winter/ spring 25-OHD measurement87.1% < 75 nmol/l46.6% < 40 nmol/l15.5% < 25 nmol/lFord et al, Ann Clin Biochem, 2006n=830, UK adults, multicultural inner city, Sept 25-OHD measurement< 25 nmol/l: 1 in 8 White1 in 4 Black Afro-Caribbean1 in 3 AsiansKumar et al, Pediatrics, 2009n=6275, USA, age 1-21 y, NHANES , 25-OHD measurement61%, nmol/l9%, < 37.5 nmol/lassociation with cardiovascular risk factorswhat is the prevalence of vitamin D deficiency in UK children?
9Mode of presentation of symptomatic vitamin D deficiency in the UK 16 infants (6 Asian, 10 Black) from UKall breast fed6 cardiac arrest3 died8 ventilated2 required by-pass12 required IV support2 referred for cardiac transplantHeart 2006
10Recent trends & clinical features of vitamin D deficiency presenting to a children’s hospital in GlasgowAhmed et al, Arch Dis Child, 2010
11MethodsProspective study to investigate the prevalence of deficiency in our patient populationVitamin D level in known bone pathologies- orRequested as part of investigative work-up for unexplained bone pain
27Vitamin D deficiency in children presenting to the paediatric orthopaedic clinic, Southampton (1) 25-OHD measured in those with bone pain or deformity187 children from 2008 – 201075 deficient (60 insufficiency, 15 severe deficiency)
28Vitamin D deficiency in children presenting to the paediatric orthopaedic clinic, Southampton (2)
29Further analysisNo specific diagnosis was associated with a high or low vitamin D levelThere was a lower vitamin D level found in children with unexplained joint pain (mean 22.5) compared to those with other diagnoses (mean 30.7). This was significant p<0.05.
32Prevention Infant vitamin D RNIs 8.5 ug/d up to 6 months age7 ug/d up to age 3 yearsChief Medical Officer, 20/1/2011, DOH website“children from the age of six months to five years old should be given a daily 7 micrograms vitamin D supplement”
33Prevention: Healthy Start 7.5 ug vitamin D3Free for some from age 6 monthscan be given from age 1 month on doctor’s adviceAlso contain vitamin A and vitamin CCan be bought £1.78/bottle
35Significance Sunlight exposure 15 – 20 minutes uninterrupted sunlight 3 times per weekVitamin D supplementsVitamin D status sought prior to commencing ‘observation or orthopaedic surgical intervention’
37Fractures in 348 children Femur Hand 4.9% 7.5% Tibia/fibula 7.8% Ankle 9.8%Radius/ulna54.9%Other1.7%Humerus13.5%
38Fat mass substantially inhibits bone accrual in children with prior fracture JBMR 2009
39Summary Majority of active vitamin D from sunlight Increase in cases of symptomatic vitamin D deficiency (not exclusive to poverty/ethnic minorities)Need for raised awareness and improved public health measures