As I am headed to the medicine cabinet to take my evening dose of calcium and vitamin D, I am also multitasking and reading the latest article in Pediatrics regarding vitamin D levels in children.
In the last several decades there has been a lot of discussion in the adult literature about osteopenia and osteoporosis as well as the prevention and treatment of these conditions. The latest studies involving vitamin D and calcium metabolism are now appearing in the pediatric literature as newer information about the long-term health effects of vitamin D continues to evolve. It is certainly a hot topic these days, with more studies to come.
The association between low levels of calcium and vitamin D has long been known as a cause of rickets. But rickets was thought to have been a bone disease of years ago (at least that was what I was taught) until recent studies showed that there were indeed still children who were developing rickets.
An editorial in Pediatrics stated that the strongest evidence about the effects of vitamin D deficiency was related to the risk of developing rickets. Upon further evaluation it was found that rickets could be prevented and treated by increasing the daily amount of vitamin D a child received and subsequent recommendations were made that all children should receive 400 units of vitamin D daily. It was previously thought to be about half that much.
The current study in Pediatrics shows that only one in five children between the ages of one and 11 receive adequate daily vitamin D. In African American and Hispanic children as many as 80 to 90 percent may be vitamin D deficient. Not only is vitamin D important in bone metabolism and heath, other studies have suggested that vitamin D may play a role in preventing infectious diseases, diabetes and even some types of cancer. Some other pediatric studies have shown that teens with low vitamin D levels had higher blood pressure and cholesterol levels, and also had a greater tendency to be overweight. I am sure there will be continued investigational studies into all of the above.
How does all of this fit together? As a child’s diet changes and they no longer receive formula, their daily milk intake may be reduced and in turn their calcium and vitamin D intake is inadequate. In my personal experience and practice I find many children do not “like” milk and are allowed to choose other beverages, such as water, juice and even soft drinks. Although many parents think their children are getting their dietary calcium and vitamin D from other dairy products (yogurt cheeses, fortified juices), it is difficult to do without some daily milk intake. Even two glasses a day needs to be supplemented by other dairy products and many children have no milk.
Additionally, vitamin D is made after our skin is exposed to sunlight. Due to the recommendations for routine sunscreen use in children and adults, we may not make as much vitamin D from sun exposure. It is also known that dark skinned children, especially in more northern latitudes are more likely to be vitamin D deficient. At the same time, children do not play outside as often and this too may contribute to obesity and lower vitamin D levels. All of these variables need further study and may be somehow intertwined.
While the data continues to be accumulated and additional studies determine age appropriate blood levels of vitamin D, one thing is for sure: daily milk intake and dairy intake is vital to our growing children for a multitude of reasons. It is far easier to remember to pour your child, tween or teen a glass of milk than to remind them to take a vitamin or two every day for the rest of their childhood. I can barely remember to take my own!
That’s your daily dose, we’ll chat again tomorrow.