Children with cystic fibrosis not well covered by guidelines for vitamin D needsOctober 10, 2008Hopkins Children's experts call for higher doses to address deficiencies Existing recommendations for treating vitamin D deficiency in children with cystic fibrosis (CF) are too low to cover the serious need, leaving most at high risk for bone loss and rickets, according to researchers at Johns Hopkins Children's Center. In results of their investigation, published in the October issue of The Journal of Pediatrics, the Johns Hopkins team found that nearly half of the 262 children with CF in the study were vitamin D deficient, and the majority of these remained persistently so, despite getting restorative doses equal to or higher than the recommendations set by the Cystic Fibrosis Foundation. As a result of the findings, Hopkins already has amended its treatment protocol and now treats both adult and pediatric CF patients who have vitamin D deficiency with 50,000 IU daily for four weeks. Growing children with CF are especially vulnerable to vitamin D deficiency because a hallmark of their condition is poor absorption of nutrients and malnutrition. CF, a genetic disorder, is marked by the body's inability to transport chloride in and out of cells, causing mild to life-threatening complications, including recurrent and severe lung infections and delayed growth. The Cystic Fibrosis Foundation defines vitamin D deficiency in patients as levels lower than 30 nanograms per milliliter and recommends that patients who are vitamin D deficient receive a weekly dose of 50,000 IU of ergocalciferol, a form of vitamin D. "These findings are a big wake-up call not only because they show that many children with CF are lacking vitamin D, but also because the deficiency persists even in those children who are treated with weekly doses twice or three times as high as the current recommendations," says Hopkins Children's lung specialist Deanna Green, M.D., who led the research. "Clearly there is an urgent need to find more effective ways to restore healthy vitamin D levels." In the meantime, investigators say, doctors caring for patients with CF should think about increasing the vitamin D intake beyond the current recommendations in those who are vitamin D deficient. They should also check vitamin D levels at least once a year in all CF patients and more frequently in those with abnormally low levels. In the current study of CF patients treated at Hopkins Children's between 2003 and 2006, investigators found that 86 percent were vitamin D deficient in 2003, 50 percent were deficient in 2004, 54 percent were deficient in 2005, and 46 percent were deficient in 2006. Comparing different weekly intakes of ergocalciferol, the Hopkins team found that the currently recommended 50,000 IU per week for eight weeks was effective in only 33 percent of the patients with vitamin D deficiency, while increasing the therapy to twice a week was effective in 26 percent of patients. Delivering the same dose three times a week corrected the deficiency in just 43 percent of children. Vitamin D levels appeared to follow fluctuations in seasonal sun exposure, dropping sharply in the fall and winter and peaking during spring and summer. Vitamin D deficiency was worst during the fall, with 83 percent of patients testing deficient, while only 41 percent were vitamin D deficient in the summer. Sun exposure is critical for vitamin D synthesis and production. Some doctors recommend sun exposure twice a week for up to 30 minutes at a time, but the debate is ongoing because sun exposure without protection increases the risk of skin cancer. "Clearly we haven't established an optimal dose for treating vitamin D deficiency and more research is needed to do so," says senior researcher Peter Mogayzel, M.D. Ph.D., director of Hopkins Children's Cystic Fibrosis Center. "But what we know for sure is that the current recommendations are too low, and doctors should treat their patients with vitamin D deficiencies more aggressively," New therapies and earlier diagnosis have led to more and more CF patients living longer and well into adulthood, which means that vitamin D deficiency will be increasingly important for CF patients as they age. "It is a testament to the advances we've made in treating CF, but as more and more patients survive and live longer, they will begin to face chronic conditions usually seen in healthy adults," Mogayzel says. "If we do not treat vitamin D deficiency early on, bone disease and osteoporosis will be increasingly a problem in the aging CF population." The findings come on the heels of another Hopkins study showing that low levels of vitamin D increased the overall risk of death by 26 percent in the general population. Johns Hopkins Medical Institutions |
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| Related Vitamin D Deficiency Current Events and Vitamin D Deficiency News Articles Multiple health concerns surface as winter, vitamin D deficiences arrive A string of recent discoveries about the multiple health benefits of vitamin D has renewed interest in this multi-purpose nutrient, increased awareness of the huge numbers of people who are deficient in it, spurred research and even led to an appreciation of it as "nature's antibiotic." Heart and bone damage from low vitamin D tied to declines in sex hormones Researchers at Johns Hopkins are reporting what is believed to be the first conclusive evidence in men that the long-term ill effects of vitamin D deficiency are amplified by lower levels of the key sex hormone estrogen, but not testosterone. New study links vitamin D deficiency to cardiovascular disease and death While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well - and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease. Latest analysis confirms suboptimal vitamin D levels in millions of US children Millions of children in the United States between the ages of 1 and 11 may suffer from suboptimal levels of vitamin D, according to a large nationally representative study published in the November issue of Pediatrics, accompanied by an editorial. Insufficient levels of vitamin D puts elderly at increased risk of dying from heart disease A new study by researchers at the University of Colorado Denver and Massachusetts General Hospital (MGH) shows vitamin D plays a vital role in reducing the risk of death associated with older age. Key feature of immune system survived in humans, other primates for 60 million years A new study has concluded that one key part of the immune system, the ability of vitamin D to regulate anti-bactericidal proteins, is so important that is has been conserved through almost 60 million years of evolution and is shared only by primates, including humans - but no other known animal species. Metabolic bone disease in cirrhosis patients Long-standing liver disease has long been recognized to result in fragile bones with increased risk of fractures. In various international studies, the overall incidence has varied from 11% to 48%, with a fracture rate of 3%-44%. Millions of US children low in vitamin D Seven out of ten U.S. children have low levels of vitamin D, raising their risk of bone and heart disease, according to a study of over 6,000 children by researchers at Albert Einstein College of Medicine of Yeshiva University. Children's Hospital Oakland scientist characterizes new syndrome of allergy, apraxia, malabsorption A landmark study conducted by Children's Hospital & Research Center Oakland is the first to reveal a new syndrome in children that presents with a combination of allergy, apraxia and malabsorption. Autism spectrum disorders were variably present. Winter- and spring-onset RA patients have worse 6 month outcomes than those with summer onset When a patient's first symptoms of rheumatoid arthritis (RA) occur in winter, the severity of their RA (as measured by the modified Total Sharp Score, mTSS, an assessment of erosion and joint space narrowing) was rated more severe at six months, when compared to patients whose RA first became symptomatic in summer (Odds Ratio (OR) =2.82 [1.14;7], p=0.0255). More Vitamin D Deficiency Current Events and Vitamin D Deficiency News Articles |
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