Diagnosis and Management of Vitamin D Deficiency in Children

sun sky and grassVitamin D deficiency (VDD) has emerged as a common nutritional deficiency and is also one of the most common underdiagnosed nutritional deficiencies across the world. In spite of wide availability of sunlight in tropical countries, including India, many children suffer with VDD. This deficiency needs to be addressed in developing countries like India, to prevent the long term consequences of VDD. It would also help to generate evidence regarding the most effective ways to diagnose and treat this deficiency.

Key Point: VDD is widely prevalent in India, but there is no evidence available regarding the diagnosis and management of this deficiency in Indian children specifically. All the evidence for safe and effective levels of vitamin D dosages are from developed countries. Calcidiol is the best option for estimating the circulating vitamin D levels in the body. On the basis of available literature there are several equally safe and effective treatment options for VDD treatment in children. Fortification of food products seems to be the best option for prevention. Routine use of vitamin D supplementation should be considered, especially in breastfed infants, to reduce the prevalence of VDD.

Vitamin D deficiency in children

According to the US Endocrine Society, serum levels of 25(OH)D less than 20 ng/mL are considered as VDD, whereas levels between 21-29 ng/mL are considered to be insufficient for getting all of the health benefits from vitamin D in the body. Vitamin D status classification, according to the US Endocrine Society on the basis of 25(OH)D levels in the blood is as follows (1):

  1. Deficiency: <20 ng/mL (50 nmol/L)
  2. Insufficiency: 21-29 ng/mL (52.5-72.5 nmol/L)
  3. Sufficiency: 30-150 ng/mL
  4. Toxicity: >150 ng/mL

The US IOM (Institute of Medicine) classifies vitamin D status on basis 25(OH)D levels in the blood as (2):

  1. Sufficiency: >20 ng/mL
  2. Risk of toxicity: >50 ng/mL

Estimation of vitamin D level

Calcidiol (25-hydroxycholecalciferol) is the major circulating form of vitamin D in the human body, with the longest half-life among all vitamin D forms, and its estimation gives us the best measure of vitamin D status (3). Calcitriol (1,25 dihydroxycholecalciferol) is the active form, but its estimation will not give an exact measure due to its short half-life, lower available concentration in the blood, and concentration levels being affected by the level of 1-alpha-hydroxylase or parathyroid hormone (PTH) levels (3). PTH levels are not significantly affected if there is more than 20 ng/mL of vitamin D in the blood (4).

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