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CPS Statements > Vitamin D supplementation: Recommendations for Canadian mothers and infants > Flashcards

Vitamin D supplementation: Recommendations for Canadian mothers and infants Flashcards

1
Q

How many cases of confirmed rickets occurred between 2002 and 2004 in Canada?

A

104

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2
Q

What percentage of patients with confirmed rickets were First Nations?

A

13%

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3
Q

What percentage of patients with confirmed rickets were Inuit?

A

12%

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4
Q

What percentage of patients with confirmed rickets were Middle Eastern?

A

14%

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5
Q

What has vitamin D deficiency been associated with?

A
  1. Osteoporosis
  2. Asthma
  3. Autoimmune disorders i.e. RA, MS, IBD
  4. Diabetes
  5. Muscle function disturbance
  6. TB resistance
  7. Cancers
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6
Q

What has maternal vitamin D deficiency been associated with?

A
  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
  7. SGA
  8. Decreased vitamin D in breast milk
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7
Q

What is the origin of vitamin D3?

A

Produced in skin of animals

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8
Q

What is the origin of vitamin D2?

A

Plants

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9
Q

What is 25-OH-vitamin D?

A

Stable but inactive form
Defines vitamin D status
25-hydroxylation in liver

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10
Q

What is 1,25 (OH)-2vitamin D?

A

Unstable but active form

1-hydroxylation in kidney

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11
Q

What is optimal plasma 25(OH)-vitamin D levels?

A

PTH production and calcium re-absorption from bone minimized
Intestinal calcium absorption stabilized

75-225 nmol/L

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12
Q

What level of vitamin D is considered pharmacological with potential adverse effects

A

> 225nmol/L

Hypercalcemia, calcium deposits in tissue

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13
Q

What level of vitamin D is considered toxic?

A

> 500nmol/L

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14
Q

What level of vitamin D is considered deficient?

A

<25nmol/L

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15
Q

What level of vitamin D is considered insufficient?

A

25-75nmol/L

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16
Q

What factors affect sun exposure and thus vitamin D3 production?

A
  1. Latitude
  2. Skin pigmentation
  3. Clothing
  4. Sunscreen
17
Q

What is the Canadian Dermatology Association recommendation regarding sun exposure?

A

<1yo avoid direct sunlight and use sunscreens

18
Q

What are some food sources for vitamin D?

A
  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
19
Q

What is the Health Canada recommendation for maternal supplementation?

A

200IU/day

20
Q

How much vitamin D is in prenatal supplements?

A

400IU vitamin D3 per day

21
Q

What is the recommendations regarding vitamin D supplementation in preterm infants?

A

200IU/kg/day to maximum 400IU/day

22
Q

What is the recommendations regarding vitamin D supplementation in term infants?

A

400IU/day from any source x 1 year

800IU/day for northern Native communities during winter months

23
Q

What is the recommendations regarding vitamin D supplementation in 1-8yo children?

A

200IU/day

24
Q

What is the recommendations regarding vitamin D supplementation in 19-50yo?

A

200IU/day

25
Q

What is the recommendations regarding vitamin D supplementation in 51-70yo?

A

400IU/day

26
Q

What is the recommendations regarding vitamin D supplementation in >71yo?

A

600IU/day

27
Q

What vitamin D dosing might be needed in adults?

A

800-1000 IU/day up to 2000-4000IU.day in special circumstances

28
Q

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?

A

1000 IU/day

29
Q

What is the tolerable upper intake level of vitamin D in adults?

A

2000IU/day

Evidence absence of toxicity 10 000IU/day vitamin D3

30
Q

What is the prediction regarding supplementation with vitamin D3?

A

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

31
Q

In which groups of people is vitamin D deficiency most common?

A

Common in adults and children in Canada esp.:

  1. Aboriginal
  2. high Arctic regions
  3. Infants <1yo esp. if breastfed
32
Q

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?

A

> 1000IU/day

33
Q

What does vitamin D requirements vary with?

A

Weight and BMI

34
Q

Why are vitamin D levels lower in high Arctic regions?

A
  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
35
Q

What are some other recommendations regarding vitamin D supplementation?

A
  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
36
Q

What are the CPS recommendations regarding vitamin D supplementation?

A
  1. Focus special attention on First Nations and Inuit peoples, due to high level of vitamin D deficiency and insufficiency
  2. Recommendations for vitamin D intake from all sources:
    a) Preterm infants 200IU/kg/day (max. 400IU/day)
    b) Term infants <1yo: 400IU/day
    c) Term infants <1yo north 55th parallel: 800IU/day
    between October and April
    d) Term infants <1yo between 40-55th parallel with additional risk factors: 800IU/day
  3. Research is required for optimal dosing in older infants as may need to be weight based
  4. Infants and children should be exposed to sunlight for short periods (<15min/day) to maximize cutaneous production of vitamin D yet minimize skin damage
  5. Consider supplementing pregnant and lactating women (esp. in winter) with 2000IU/day vitamin D
  6. Check vitamin 25(OH)D and calcium periodically on 2000IU/day regimen
  7. Research recommended for:
    a) Effectiveness and possible side effects of supplementation of mothers during pregnancy
    b) Vitamin D requirements for toddlers and older children
    c) Development of a cheaper, accurate, and more universally available assessment of vitamin D status than the 25(OH)D assay
    d) Indicators of hypercalcemia should be included in any investigations

CPS Statements (223 decks)

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