Supplementation with vitamin D is now done regardless of the season! “In small children, lack of vitamin D means rickets, in older children – deficiency”

The updated medical guidelines of medical societies recommend vitamin D supplementation regardless of the season. The lifestyle has changed, we spend more time in closed spaces in front of electronic devices, and when we go outside we protect ourselves from the sun with the help of creams. “In children, the lack of vitamin D means rickets, in older children – deficiency, and in adults it can lead to a change in bone consistency”, draws the attention of Dr. Sandra Alexiu, president of the Bucharest-Ilfov Association of Family Doctors. We explain how supplementation should be done according to the age of the child and why it is also extremely important in pregnancy.

Summer has passed and with it the chance for the sun to help us synthesize vitamin D, which is essential for the harmonious growth and development of children, but also for maintaining the health of adults.

Studies show that more and more children do not have adequate levels of vitamin D – disproving the popular belief that if a child drinks milk and plays outside they will have enough vitamin D in their body to grow strong and healthy.

right healthychildren.orgthe official website of the American Academy of Pediatrics, due to lifestyle changes and the use of sunscreens, 42% of Americans are vitamin D deficient.

Among children aged between 1 and 11 years, the estimated deficit of American Academy of Pediatrics it is 15% and 17% among teenagers.

Calcium, absorbed in the body only in the presence of vitamin D

Along with calcium, vitamin D is a crucial nutrient that the body needs to form bones, teeth and maintain their health. The body can only fix calcium if it has enough vitamin D. This vitamin is also involved in the immune chain, muscle, heart and brain health.

According to specialists National Institute for Mother and Child Health “Alessandrescu-Rusescu” from Bucharest, vitamin D is the generic name of ten sterol compounds, the most important of which are two: vitamin D2 – ergocalciferol-, present in small quantities in some foods of vegetable origin in the form of ergosterol and vitamin D3 – cholecalciferol – contained in foods of animal origin or synthesized in the skin under the action of ultraviolet rays.

According to the source cited above, vitamins D2 and D3 have a similar action in the body and exercise their role only after undergoing a metabolism process at the level of the liver and kidneys resulting in an active compound – 1,25-(OH)2-cholecalciferol.

The prevalence of rickets remains high in Romania

Deficiency rickets is probably the most well-known disease caused by vitamin D deficiency, characterized by bone mineralization disorders. The list of medical conditions caused by vitamin D deficiency includes, among others, severe tooth decay, type 1 diabetes, multiple sclerosis, rheumatoid arthritis, heart disease, and certain cancers.

In Romania, the prevalence of rickets is high, although, since 2002, the Ministry of Health has been running the National Program for the prevention of rickets in children.

However, data on the level of vitamin D in the Romanian population are not known, points out Romanian Journal of Pediatrics. This is because

the determination of vitamin D is not an ordinary laboratory test, being expensive and not being reimbursed by the National Health Insurance House.

right National Institute of Public Health (INSP), one of the studies carried out in Romania, showed that the prevalence of vitamin D deficiency is 1.92% in the age group 0-1 years; 0.66% in the 1-3 years group, 1.96% in the 4-8 years group; 4.3% in the 8-13 year old group and 8.9% in the 14-18 year old group. At the same time, a toxic level of vitamin D was detected in 11.5% of children aged 0-1 years and in 4.98% of children aged 1-3 years.

Less sun, less vitamin D synthesis

The main source of vitamin D for the body is synthesis in the skin, following exposure to the sun. Ultraviolet rays that reach the skin influence the production of vitamin D3.

Any process that interferes with the availability of UV rays to the skin decreases vitamin D synthesis and acts as a risk factor in the development of rickets.

Thus, environmental factors such as geographical latitude, season, degree of sunshine, time of day, presence of clouds and pollution can influence the availability of ultraviolet rays, in general, and at the level of the skin, in particular.

Added to these are personal factors – skin pigmentation, time spent outdoors, covering the skin with clothing, the type and color of clothes, the use of products with sun protection factors, which also leave their mark on the body's exposure to UV rays and consequently influence vitamin D synthesis.

The second source of vitamin D is from food, through foods of animal origin: fatty fish (salmon, tuna and mackerel), fish oils. Traces of vitamin D can also be found in egg yolk, cheese, beef liver, cow's milk, breast milk, milk formulas fortified with vitamin D, as well as in foods of plant origin and foods fortified with vitamin D. Animal foods contain mainly vitamin D3, and plant foods contain vitamin D2.

Many pregnant women are not checked during pregnancy

The child is born with a sufficient store of vitamin D for the first 8-12 weeks of life only if his mother had a normal vitamin D status during pregnancy, draw the attention of specialist doctors.

Something that rarely happens. “Many times, pregnant women in Romania do not expose themselves to the sun enough, they do not take vitamin D supplements, not all of them are properly cared for, because it happens that they are not taken into account. We have this problem in Romania – a lot of pregnant women are not checked during pregnancy”, he points out Dr. Sandra Alexiufamily doctor, president ASSOCIATION Bucharest-Ilfov Family Doctors.

“And because we have two people in one, we need to supplement vitamin D for normal development: both the mother is properly cared for during pregnancy and the child is not born with a deficiency,” adds the doctor.

Updated medical guidelines recommend lifelong vitamin D supplementation, every day, with few exceptions. One of these is the updated Guideline of the European Society of Endocrinology on the use of vitamin D in prevention.

“We come from a culture where we give, according to the newborn's discharge note, vitamin D from day 14 until 2 years and then in the cold season. Which has been completely wrong for a very long time. In reality, vitamin D is supplemented from the first day we appear in the world to the last, without a break. The breaks are possibly only about the times when we go to the sea and expose our skin almost completely, so that it synthesizes inside it vitamin D”, emphasizes the doctor Sandra Alexiu, the president of the Association of Family Doctors Bucharest-Ilfov.

“Almost all patients who get tested find they have a vitamin D deficiency”

And in the case of vitamin D, there were various periods in history when people only treated their children, says Alexiu: “For example, in Romania, before 1989, injectable vitamin D was made which was a kind of depot, i.e. a large amount that was useful for two months. You administered a large number of vitamin D units that were released slowly and reached the body for two months. After that you gave another injection and so on. Now, according to the latest information that gives us are available in modern medicine, the most important way to take vitamin D is in oily form and in the form of daily administration”.

The only time when we do not need vitamin D supplementation is the summer when we go to the beach, because then the vitamin is synthesized in the skin under the influence of sunlight. “So it's not enough that it's summer and we're well-dressed and put on sunscreen. We have to have exposed skin. Which we don't do much in recent years because the sun is strong and we've learned that the sun is not good for us. It's also the reason why almost all patients who are tested are vitamin D deficient. And that means in young children rickets, in older children deficiency, and in adults and the elderly it can lead to change in bone consistency – osteoporosis”, warns Dr. Alexiu.

Therefore, international medical recommendations provide for the administration of vitamin D throughout life, except for the days when we are exposed to the sun intensely.

Doses depending on the age of the children

“However, the dose will not necessarily be the same. Dosing according to age is recommended. There is a threshold up to 70 years of 600 IU per day and 800 after that, but also in certain diseases or in certain types of deficiencies, in which it is recommended that the dosage be more intense. For example, in pregnancy 2,000 IU is recommended, in patients with prediabetes 3,200 IU is recommended. Because it seems that the high dose of vitamin “Daily D somehow slows down the onset of diabetes and the preservation of prediabetes. This is the reason why today we recommend a completely different way. When a person has a vitamin D deficiency, it is not from the 14th day, but from the first day they are born, and for this reason, it is necessary to take this vitamin from the moment we are born,” concludes Dr. Sandra Alexiu.

right American Academy of Pediatricsall babies need vitamin D supplementation shortly after birth. Thus, babies need 400 IU of vitamin D each day, and toddlers, pre-teens and teenagers need 600 IU of vitamin D each day. Depending on the results of the tests, the doses are adjusted under the supervision of the doctor who follows the child.