Abstract
BackgroundSymptomatic vitamin D deficiency is associated with slowed growth in children. It is unknown whether vitamin D repletion in children with asymptomatic serum vitamin D deficiency can restore normal growth.ObjectiveWe tested the impact of vitamin D-supplementation on serum concentrations of 25-hydroxyvitamin D [25(OH)D] and short-term growth in Mongol children, with very low serum vitamin D levels in winter.DesignWe conducted two randomized, double-blind, placebo-controlled trials in urban school age children without clinical signs of rickets. The Supplementation Study was a 6-month intervention with an 800 IU vitamin D3 supplement daily, compared with placebo, in 113 children aged 12–15 years. A second study, the Fortification Study, was a 7-week intervention with 710 ml of whole milk fortified with 300 IU vitamin D3 daily, compared with unfortified milk, in 235 children aged 9–11 years.ResultsAt winter baseline, children had low vitamin D levels, with a mean (±SD) serum 25-hydroxyvitamin D [25(OH)D] concentration of 7.3 (±3.9) ng/ml in the Supplementation Study and 7.5 (±3.8) ng/ml in the Fortification Study. The serum levels increased in both vitamin D groups—by 19.8 (±5.1) ng/ml in the Supplementation Study, and 19.7 (±6.1) ng/ml in the Fortification Study. Multivariable analysis showed a 0.9 (±0.3 SE) cm greater increase in height in the vitamin-D treated children, compared to placebo treated children, in the 6-month Supplementation Study (p = 0.003). Although the children in the 7-week Fortification Study intervention arm grew 0.2 (±0.1) cm more, on average, than placebo children this difference was not statistically significant (p = 0.2). There were no significant effects of vitamin D supplements on differences in changes in weight or body mass index in either trial. For the Fortification Study, girls gained more weight than boys while taking vitamin D 3 (p-value for interaction = 0.03), but sex was not an effect modifier of the relationship between vitamin D3 and change in either height or BMI in either trial.ConclusionsCorrecting vitamin D deficiency in children with very low serum vitamin D levels using 800 IU of vitamin D3 daily for six months increased growth, at least in the short-term, whereas, in a shorter trial of 300 IU of D fortified milk daily for 7 weeks did not.
Highlights
Adequate vitamin D is required to achieve genetic growth potential among children, though a definition of “adequate” is not well established [1,2]
There were no significant effects of vitamin D supplements on differences in changes in weight or body mass index in either trial
The movement of large numbers of formerly nomadic people to the city of Ulaanbaatar has resulted in increased exposure to air pollution, which influences vitamin D status by absorbing ultraviolet B radiation responsible for cutaneous production of vitamin D [6, 7]
Summary
Adequate vitamin D is required to achieve genetic growth potential among children, though a definition of “adequate” is not well established [1,2]. 37 ̊N and below 37 ̊S, ultraviolet B radiation from the sun is too weak to induce significant cutaneous vitamin D synthesis during the winter [3,4]. The movement of large numbers of formerly nomadic people to the city of Ulaanbaatar has resulted in increased exposure to air pollution, which influences vitamin D status by absorbing ultraviolet B radiation responsible for cutaneous production of vitamin D [6, 7]. Vitamin D deficiency in children has been linked to linear growth retardation in the presence of rickets [8, 9]. The relation between vitamin D and linear growth, is less clear in children without clinical manifestations of deficiency, such as bowed legs. Symptomatic vitamin D deficiency is associated with slowed growth in children. It is unknown whether vitamin D repletion in children with asymptomatic serum vitamin D deficiency can restore normal growth.
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