Free vitamin D supplementation for every infant in Turkey

Comparison of cord blood and 6-month-old vitamin D levels of healthy term infants supplemented with 400 IU/day dose of vitamin D

OBJECTIVES

To determine the prevalence and risk factors of vitamin D deficiency in pregnant women and their infants at birth (cord blood) and at six months of age in Turkey, as well as to assess the compliance rates of families with vitamin D supplementation.

METHODS

Serum 25-hydroxyvitamin D [25(OH)D] level was measured of the mothers before delivery and of the infants both at birth (cord blood) and at six months of age. Infants who received and did not take regular vitamin D supplements were compared in terms of 25(OH) levels. Independent risk factors were determined by multiple logistic regression analysis.

RESULTS

The study included a total of 140 pregnant women and their infants. Vitamin D deficiency was found in 95.7% of the mothers. The prevalence of vitamin D deficiency was 87.1% in infants at birth but decreased to 5.8% at sixth month. 65.7% of infants received vitamin D supplements regularly. Despite regular vitamin D use, it was determined that 2.2% of the infants in the supplementation compliant group had vitamin D deficiency. Maternal age, maternal education level, and the number of siblings were determined to be determining factors on infants' 25(OH)D levels at six months (p < 0.05).

CONCLUSIONS

In Turkey, vitamin D deficiency still exists in both pregnant women and infants. Healthcare professionals and the public need to be more educated about the importance of regular supplementation. Serum 25(OH)D levels of infants should be tested periodically and personalized vitamin D supplementation planning is required based on test results.

Adjunctive vitamin D therapy in various diseases in children: a scenario according to standard guideline

Background

Adherence to standard guidelines is imperative when question comes to disease management. The present study aimed to evaluate the administration of adjunctive vitamin D therapy in various diseases, its adherence to standard guideline and the effect of socioeconomic status on the consumption of vitamin D in children.

Methods

Cross sectional observational study was conducted among 400 ambulatory pediatric patients at Children’s Hospital, Pakistan Institute of Medical Sciences Islamabad, from November 2017 to June 2018. Data were collected by a self-designed structured questionnaire from the patient’s medical chart. Adjunctive vitamin D therapy adherence was evaluated by the U. S endocrinology clinical practice guideline of vitamin D deficiency. The association between socioeconomic status and consumption of vitamin D was examined by chi-square. Alpha value (p ≤ 0.005) was considered statistically significant. Statistical analysis was done by SPSS version 25.

Results

In 400 patients, 9 diseases and 21 comorbid conditions were identified, in which adjunctive vitamin D therapy was prescribed. Adherence to vitamin D testing in high-risk vitamin D deficiency diseases as; seizures (3.8%), bone deformities (13.3%), steroid-resistant nephrotic syndrome (0.0%), cerebral palsy (5.9%) and meningitis (14.3%). Adherence to prescribed vitamin D dose was in (41.3%) patients in various diseases. Significant association (p < 0.05) was found between socioeconomic status and consumption of vitamin D in children and mothers.

Conclusions

It was found that adjunctive vitamin D was being prescribed in various diseases and comorbidities. Overall poor adherence to the standard guideline was observed in disease management in children. Low socioeconomic status affects vitamin D supplementation consumption in children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03297-z.

Factors influencing initiation and discontinuation of vitamin D supplementation among children 1-24-months-old

OBJECTIVES

To determine vitamin D supplementation frequency among children aged 1-24 months, factors that influence adherence, and reasons for discontinuation of initiated vitamin D.

METHODS

This cross-sectional study was conducted using a questionnaire administered to the mothers via face-to-face interview of 560 children aged from 1 to 24 months admitted to outpatient clinics from June to December 2017.

RESULTS

A total of 351 children were administered vitamin D, and the rate of supplementation in the first year of life was 83%, while it was only 28% between 13 and 24 months. The rate of vitamin D supplementation was higher among exclusively formula-fed children (p < .05). When the data were analyzed using logistic regression analysis, only visit family physicians were statistically significant independent variable in increasing supplementation (p < .05). Compared with family refusal, the rate of discontinuation of vitamin D by the healthcare providers was higher after the first year of life (p < .05). The rate of vitamin D discontinuation by healthcare providers, especially by nurses who considered the duration of supplementation adequate, was statistically significantly higher when compared with the fontanel closure and other independent variables (p < .05).

CONCLUSION

The rate of vitamin D supplementation was higher among families who visited family physicians, which suggests the importance of well-baby visits. Since vitamin D supplementation was less common among exclusively breastfed children, mothers should be educated. Healthcare professionals need further education about the importance of vitamin D supplementation and indications for discontinuation.

A major health problem facing immigrant children: nutritional rickets

OBJECTIVES

Nutritional rickets (NR) is still an important problem and one which increasing influxes of immigrants are further exacerbating. This study evaluated cases of mostly immigrant children followed up with diagnoses of NR in our pediatric endocrinology clinic.

METHODS

Details of 20 cases diagnosed with NR between 2017 and 2020 were retrieved from file records.

RESULTS

Twenty (11 male) cases were included in the study. Three (15%) were Turkish nationals and the others (85%) were immigrants. Hypocalcemia and hypophosphatemia were detected in 17 and 13, respectively. Alkaline phosphatase (ALP) values were normal in two cases, while ALP and parathyroid hormone (PTH) values were elevated in all other cases, and PTH levels were very high (473.64 ± 197.05 pg/mL). 25-hydroxyvitamin D levels were below 20 ng/mL in all cases. Patients with NR received high-dose long-term vitamin D or stoss therapy. Six patients failed to attend long-term follow-up, while PTH and ALP levels and clinical findings improved at long-term follow-up in the other 14 cases.

CONCLUSIONS

The elevated PTH levels suggest only the most severe cases of NR presented to our clinic. Clinically evident NR is therefore only the tip of the iceberg, and the true burden of subclinical rickets and osteomalacia remains unidentified. Public health policies should therefore focus on universal vitamin D supplementation and adequate dietary calcium provision, their integration into child surveillance programs, adequate advice and support to ensure normal nutrition, exposure to sunlight, and informing families of the increased risk not only for resident populations but also for refugee and immigrant children.

Vitamin D Deficiency Prevalence in Late Neonatal Hypocalcemia: A Multicenter Study

OBJECTIVE

Late neonatal hypocalcemia (LNH) is a common metabolic problem associated with hypoparathyroidism, high phosphate intake and vitamin D deficiency, often presenting with seizures. In this cross-sectional study, we aimed to evaluate the role of vitamin D deficiency in LNH in Turkey and to describe the characteristics of affected newborns.

METHODS

Conducted with a cross-sectional design and with the participation of 61 neonatal centers from December 2015 to December 2016, the study included term neonates with LNH (n=96) and their mothers (n=93). Data were registered on the FAVOR Web Registry System. Serum samples of newborns and mothers were analyzed for calcium, phosphate, magnesium, albumin, alkaline phosphatase, intact parathyroid hormone (iPTH) and 25 hydroxyvitamin D [25(OH)D] levels.

RESULTS

The median (range) onset time of hypocalcemia was 5.0 (4.0-8.0) days of age, with a male preponderance (60.4%). The median (range) serum 25(OH)D levels of the neonates and their mothers were 6.3 (4.1-9.05) and 5.2 (4.7-8.8) ng/mL, respectively. The prevalence of vitamin D deficiency (<12 ng/mL) was high in both the neonates (86.5%) and mothers (93%). Serum 25(OH)D levels of the infants and mothers showed a strong correlation (p<0.001). While the majority (93.7%) of the neonates had normal/high phosphorus levels, iPTH levels were low or inappropriately normal in 54.2% of the patients.

CONCLUSION

Vitamin D deficiency prevalence was found to be high in LNH. Efforts to provide vitamin D supplementation during pregnancy should be encouraged. Evaluation of vitamin D status should be included in the workup of LNH.

Screen Time, Age and Sunshine Duration Rather Than Outdoor Activity Time Are Related to Nutritional Vitamin D Status in Children With ASD

Objective: This study aimed to investigate the possible association among vitamin D, screen time and other factors that might affect the concentration of vitamin D in children with autism spectrum disorder (ASD). Methods: In total, 306 children with ASD were recruited, and data, including their age, sex, height, weight, screen time, time of outdoor activity, ASD symptoms [including Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule-Second Edition (ADOS-2)] and vitamin D concentrations, were collected. A multiple linear regression model was used to analyze the factors related to the vitamin D concentration. Results: A multiple linear regression analysis showed that screen time (β = -0.122, P = 0.032), age (β = -0.233, P < 0.001), and blood collection month (reflecting sunshine duration) (β = 0.177, P = 0.004) were statistically significant. The vitamin D concentration in the children with ASD was negatively correlated with screen time and age and positively correlated with sunshine duration. Conclusion: The vitamin D levels in children with ASD are related to electronic screen time, age and sunshine duration. Since age and season are uncontrollable, identifying the length of screen time in children with ASD could provide a basis for the clinical management of their vitamin D nutritional status.

Nutritional rickets around the world: an update

Worldwide, nutritional rickets continues to be an evolving problem with several causes. This paper provides an updated literature review characterising the prevalence, aetiology, pathophysiology and treatment of nutritional rickets worldwide. A systematic review of articles on nutritional rickets from various geographical regions was undertaken. For each region, key information was extracted, including prevalence, cause of rickets specific to the region, methods of confirming the diagnosis and current treatment and preventive measures. Calcium deficiency continues to be a major cause of rickets in Africa and Asia. Vitamin D deficiency rickets is perhaps increasing in the Americas, Europe and parts of the Middle East. There continues to be a distinct presentation of calcium-predominant versus vitamin D predominant rickets, although there are overlapping features. More careful diagnosis of rickets and reporting of 25-OHD concentrations has improved accurate knowledge of rickets prevalence and better delineated the cause. Nutritional rickets continues to be an evolving and multi-factorial problem worldwide. It is on a spectrum, ranging from isolated vitamin D deficiency to isolated calcium deficiency. Specific areas which require emphasis include a consistent community approach to screening and diagnosis, vitamin D supplementation of infants and at-risk children, prevention of maternal vitamin D deficiency and the provision of calcium in areas with low calcium diets.

Relationship between newborn craniotabes and vitamin D status

OBJECTIVE

In recent studies, vitamin D deficiency during pregnancy and early infancy has been reported to predispose children to many chronic diseases, except those of the skeletal system. The aim of this study was to investigate whether craniotabes in otherwise healthy newborns is physiological, its relationship to vitamin D deficiency and whether or not it requires treatment.

METHODS

A total of 150 healthy newborns with a weight of over 2000 g were included. Newborns were divided into two groups during postnatal discharge (1-3.'s day): those with and without craniotabes. The 25-hydroxy (OH) vitamin D levels of the newborns' mothers were measured, and all infants were re-evaluated for craniotabes, as well as tested to determine levels of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH) and 25(OH) vitamin D, urine calcium and creatinine.

RESULTS

Craniotabes was present in 45 (30%) of newborns enrolled in the study. Craniotabes of the newborns born during the winter months was significantly higher. PTH level was significantly higher in 1-month-old newborns with craniotabes than those without craniotabes. No relationship was observed between diet and craniotabes, but in exclusively breastfed infants, vitamin D level was statistically significantly lower. No statistically significant difference was found in the occurrence of craniotabes in newborns with or without vitamin D support.

CONCLUSION

The relationship between newborn craniotabes and maternal vitamin D deficiency is not clear. However, the present study illustrates that maternal vitamin D deficiency is still a major problem. Therefore, measures to prevent maternal vitamin D deficiency should be strengthened.

Prevention and consequences of vitamin D deficiency in pregnant and lactating women and children: A symposium to prioritise vitamin D on the global agenda

The Department of Nutrition for Health and Development of the World Health Organization (WHO) in collaboration with the Executive Committee of the 18th Vitamin D Workshop (VDW), organised a joint symposium on the prevention and consequences of vitamin D deficiency in pregnant women and children, convening experts on vitamin D, clinicians and policy-makers. The overall aim was to identify priority areas for research and to discuss the need for global options for policy, with a focus on the prevention of rickets in infants and children and vitamin D deficiency in pregnant women. The scope and purpose were: (i) to present the WHO research strategy for health, addressing vitamin D-related public health problems and the process for the development of evidence-informed guidelines in general and how vitamin D interventions in diverse populations could be prioritised; (ii) to provide an overview of vitamin D status in children and pregnant and lactating women across the world; (iii) to review the health risks associated with vitamin D deficiency in children and in pregnant women and their offspring; (iv) to understand the aetiology of vitamin D deficiency in pregnant women and children; (v) to identify and interpret biomarkers to assess vitamin D status and to consider possible clinical and biochemical screening tools for determining the prevalence of nutritional rickets in at risk groups or communities; and (vi) to provide an overview of policies and recommendations on vitamin D across the world. The format of the symposium was a composite of comprehensive scientific presentations and a panel debate with international experts on WHO guidelines, nutritional rickets, nutritional policy and consequences of vitamin D deficiency during pregnancy. This paper summarizes the content and outcomes of the panel debate.

Vitamin D Deficiency in Children and Adolescents in Bağcılar, İstanbul

OBJECTIVE

This study aimed to evaluate the frequency of seasonal 25-hydroxyvitamin D [25(OH)D] deficiency and insufficiency in children and adolescents living in Bağcılar, district of İstanbul city.

METHODS

Serum vitamin D levels of 280 children aged 3-17 years old were measured at the end of winter and at the end of summer. Of the total group, vitamin D levels were re-measured in 198 subjects. Vitamin D deficiency was defined as a serum 25(OH)D level less than 15 ng/mL and insufficiency-as levels between 15 and 20 ng/mL. Patients whose vitamin D levels were less than 15 ng/mL at the end of winter were treated with 2000 units/day of vitamin D for 3 months.

RESULTS

In the "end of winter" samples, 25(OH)D deficiency was present in 80.36% of the subjects and insufficiency in 11.79%. In the "end of summer" samples, vitamin D deficiency was detected in 3.44% and insufficiency in 27.75%. Vitamin D levels in the "end of winter" samples were not significantly different between boys and girls, while "end of summer" levels were significantly lower in girls (p=0.015). Sunlight exposure was significantly higher in boys (p=0.011). The group with sufficient dairy product consumption had significantly higher vitamin D levels in both "end of summer" and "end of winter" samples. Limb pain was frequently reported in children with low vitamin D levels in the "end of winter" samples (p=0.001). Negative correlations were observed between vitamin D levels and season and also between vitamin D levels and age.

CONCLUSION

It is essential to provide supplemental vitamin D to children and adolescents to overcome the deficiency seen especially at the end of winter.

Nutritional rickets in Turkey

Nutritional rickets (NR) remains the most common form of developmental bone disease, in spite of the efforts of clinicians and health care providers to reduce the incidence of the disease in Turkey. Today, it is well known that the etiology of NR exists along a spectrum ranging from isolated vitamin D deficiency to isolated calcium deficiency. In Turkey, almost all NR results from vita-min D deficiency that may have temporary but profound effects on short- and long-term skeletal development. Recent evidence suggests that vitamin D deficiency during infancy may predispose a patient to diseases such as diabetes mellitus, cancer, multiple sclerosis, etc. The factors responsible for the high prevalence of vitamin D deficiency in developing countries and its resurgence in developed countries include the following: limited sunshine exposure as individuals spend more time indoors watching television and working on computers or intentional sunshine avoidance for skin cancer prevention. Traditional clothing (covered dress) further limits the exposure to sunshine and thus decreases the endogenous synthesis of vitamin D. In Turkey, maternal vitamin D deficiency and breast feeding without supplementation are the most prominent reasons. The diagnosis of NR is established with a thorough history and physical examination and confirmed by laboratory evaluation. In conclusion, recent literature has drawn attention to the supplemental doses of vitamin D required to achieve a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/l), the serum concentration that is needed to optimize absorption of dietary calcium, suppress excess secretion of parathyroid hormone, and reduce fracture risk as well as prevent long-term negative effects.

Intracranial hemorrhage in infants as a serious, and preventable consequence of late form of vitamin K deficiency: a selfie picture of Turkey, strategies for tomorrow

PURPOSE

Vitamin K deficiency bleeding is one of the most common causes of acquired hemostatic disorder in early infancy. Although vitamin K is practiced routinely after every birth in Turkey, children with type of vitamin K deficiency bleedings (L-VKDB) can be encountered. We aimed to evaluate the clinical features of the children with L-VKDB reported from Turkey.

METHODS

Between 1995 and 2013, 48 studies reporting 534 children with L-VKDB were evaluated in this study.

RESULTS

Of the 534 reported children (178 girls, 356 boys), 486 (91 %) were extremely breastfed. The most common bleeding sites were intracranial hemorrhage, gastrointestinal, and umbilical in 414 (77.4 %), 33 (6.2 %), and 33 (6.2 %) children, respectively, and 35 (6.6 %) children had been diagnosed incidentally without any bleeding. The etiology of 399 (74.7 %) children were classified as idiopathic, whereas 135 (25.3 %) were secondary. Intramuscular vitamin K was administered in 248 (46.4 %), not administered in 228 (42.7 %), and the administration of vitamin K were not determined in 58 (10.9 %) children. The outcomes of Turkish cohort showed that 111 (20.8) children died, 257 (48.1 %) cases developed neurologic deficit (mainly epilepsy and psychomotor retardation), and only 166 (31.1 %) patients recovered without squeal.

CONCLUSIONS

The compliance of prophylactic measures in Turkey does not seem to be satisfactory. As a further measure of tomorrow, we vigorously emphasize that a national surveillance program may be initiated. An additional intramuscular dose or oral supplementation of vitamin K especially for exclusively breast-fed infants may reduce this catastrophic problem in our country.

Vitamin D status of exclusively breastfed 4-month-old infants supplemented during different seasons

OBJECTIVE

To examine the vitamin D status of 4-month-old exclusively breastfed infants supplemented with 400 IU daily of vitamin D and to determine whether there was any seasonal variation in serum 25-hydroxyvitamin D (25(OH)D) levels of infants.

METHODS

In this cross-sectional study, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels of 143 exclusively breastfed 4-month-old infants supplemented daily with 400 IU of vitamin D were measured in a temperate latitude, Izmir, Turkey, between May 2008 and April 2009. A questionnaire on demographic characteristics of infants and mothers, vitamin D supplementation of infants after birth, mothers' multivitamin supplementation, dressing habits, and consumption of dairy products during pregnancy was used.

RESULTS

Vitamin D deficiency (≤ 50 nmol/L) and insufficiency (51-74 nmol/L) were determined in 40 (28%) and 55 (38.5%) infants, respectively. During winter days, serum 25(OH)D levels were <20 ng/mL in 45.4% of infants and <10 ng/mL in 10.6% of infants. Season of blood sampling, compliance of vitamin D supplementation, maternal education level, and consumption of dairy products were highly predictive of serum 25(OH)D levels in multiple linear regression analysis (P < .05). The use of the Pearson correlation test found a statistically significant negative correlation between 25(OH)D and parathyroid hormone levels (r = -0.419, P < .001).

CONCLUSIONS

Despite supplementation with 400 IU of vitamin D daily, the rate of vitamin D deficiency was worryingly high in 4-month-old exclusively breastfed infants living in Izmir, Turkey. So, additional studies are needed to clarify optimal amount of vitamin D supplementation to the infants, especially during winter days.

Vitamin D deficiency in children and adolescents

OBJECTIVE

Vitamin D deficiency is an important health problem in both developed and developing countries. Recent reports on the extraskeletal effects of vitamin D have led to increased interest in prevalence studies on states of deficiency/insufficiency of vitamin D. The aim of this study was to determine the frequency of vitamin D deficiency and insufficiency in children and adolescents residing in Ankara, Turkey and to investigate the factors associated with low vitamin D status.

METHODS

A total of 440 children and adolescents aged between 0 and 16 years were enrolled in this study. The subjects were divided into three groups according to their vitamin D status (deficiency ≤15 ng/mL; insufficiency: 15-20 ng/mL; sufficiency ≥20 ng/mL) and also according to their age (preschool<5 years; middle childhood: 5-10 years; adolescence: 11-16 years).

RESULTS

Overall, 40% of the subjects were found to have 25 hydroxy vitamin D [25(OH)D] levels of less than 20 ng/mL. The levels indicated a deficiency state in 110 subjects (25%) and insufficiency - in 66 (15%). The rate of vitamin D deficiency was higher in girls, regardless of age. 25(OH)D levels correlated negatively with age (r=-0.48, p<0.001), body mass index (BMI) (r=-0.20, p=0.001) and intact parathyroid hormone (iPTH) level (r=-0.31, p=0.001). A positive correlation was observed between 25(OH)D and serum ferritin levels (r=0.15, p=0.004).

CONCLUSIONS

The high frequency of vitamin D deficiency in childhood (especially among adolescent girls) indicates a need for supplementation and nutritional support.

Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey

BACKGROUND

The aim of this study was to establish the frequencies of vitamin D deficiency and insufficiency among healthy children aged 1-16 years and also to determine the factors affecting the levels of vitamin D in Turkey.

METHODS

A total of 849 healthy individuals whose ages ranged from 1 to 16 years were included in the study. Serum 25(OH)D, calcium, phosphorous and alkaline phosphatase l levels were measured at the end of the winter period. The approximate daily calcium intake was calculated by using a 1-week diet history.

RESULTS

We determined that the prevalence of vitamin D deficiency (<20 ng/mL) was 8% and that of vitamin D insufficiency (20-29 ng/mL) was 25.5% in the population investigated. The average daily intake of calcium was especially low in the >8-year-old age group (<1300 mg/day).

CONCLUSION

Vitamin D insufficiency was found to be very common in the population investigated. The daily calcium intake was below the adequate levels especially in school children. Vitamin D supplementation after the first year of life could be beneficial especially for school children and adolescents. The government must develop public policies for the fortification of milk, milk products, and fruit juices with vitamin D.

Vitamin D deficiency and prevention: Turkish experience

A nationwide 'vitamin D prophylaxis augmentation programme' initiated in 2005 in Turkey reduced the prevalence of rickets from 6% in 1998 to 0.1% in 2008 in children under 3 years of age. The programme included free distribution of vitamin D drops to all newborns and infants (0-12 months) visiting primary health stations throughout the country. Free disposal of vitamin D to infants is an effective strategy for preventing vitamin D-deficient rickets.

Prevention of Vitamin D deficiency in infancy: daily 400 IU vitamin D is sufficient

Summary

Nutritional rickets

Nutritional rickets (NR) is still the most common form of growing bone disease despite the efforts of health care providers to reduce the incidence of the disease. Today, it is well known that the etiology of NR ranges from isolated vitamin D deficiency (VDD) to isolated calcium deficiency. In Turkey, almost all NR cases result from VDD. Recent evidence suggests that in addition to its short- or long-term effects on skeletal development, VDD during infancy may predispose the patient to diseases such as diabetes mellitus, cancer and multiple sclerosis. Among the factors responsible for the high prevalence of VDD in developing countries and its resurgence in developed countries is limited sunshine exposure due to individuals' spending more time indoors (watching television and working on computer) or avoiding sun exposure intentionally for fear of skin cancer. Traditional clothing (covering the entire body except the face and hands) further limits the exposure time to sunlight and, thus, decreases the endogenous synthesis of vitamin D. In Turkey, maternal VDD and exclusive breastfeeding without supplementation were reported to be the most prominent reasons leading to NR. The diagnosis of NR is established by a thorough history and physical examination and confirmed by laboratory evaluation. Recent reports draw attention to the supplemental doses of vitamin D required to achieve a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/l) - the serum concentration that is needed to optimize absorption of dietary calcium and to suppress excessive secretion of parathyroid hormone. This type of prevention will also reduce fracture risk as well as prevent long-term negative effect of vitamin D insufficiency.

Nutritional rickets: still a problem for the pediatric population

Rickets is a mineralization disorder of the growing bone. Nutritional rickets is still prevalent in many parts of the developing world and is re-emerging in developed countries. Although vitamin D deficiency plays a central role in the pathogenesis of this disease, calcium deficiency and genetic factors may also cause or contribute to the development of rickets. This review will focus on the classical form of nutritional rickets, in other words, vitamin D-deficiency rickets. The epidemiology, ethiopathogenesis, risk factors, clinical picture, diagnosis, treatment and prevention of nutritional rickets are reviewed.

Prevalence of vitamin D deficiency rickets in the eastern part of Turkey

Turkey, especially its eastern part, has been accepted as endemic for vitamin D deficiency rickets (VDDR). In a study performed by our team in the region in 1998, the incidence of VDDR was 6.09% in children aged between 0-3 years. In 2005, the Ministry of Health initiated a free vitamin D supplementation campaign nationwide for every infant to eradicate VDDR. In this study, we aimed to investigate the prevalence of VDDR in children aged between 0-3 years in order to evaluate the effectiveness of this campaign. Between March 2007 and February 2008, 39,133 children aged between 0-3 years who were brought to different pediatric outpatient clinics in Erzurum, Turkey, were examined for VDDR. VDDR diagnosis was made by radiological and biochemical findings in the cases who were initially suspected of having clinical VDDR. During a one-year period, 39 (0.099%) of the 39,133 patients were diagnosed with VDDR. None of the cases with rickets was taking vitamin D supplementation. The most frequent physical findings were rachitic rosary, enlargement of the wrists, and craniotabes. The laboratory findings of the cases were compatible with VDDR; serum calcium (Ca) 7.5 +/- 1.9 mg/dL, PO4 4.4 +/- 1.3 mg/dL, alkaline phosphatase (ALP) 1,341 +/- 823, 25-hydroxyvitamin D (25 (OH) D) 5.8 +/- 2.9 ng/mL, intact parathyroid hormone (iPTH) 240 +/- 106 pg/mL. It was concluded that, although VDDR has been a continuing childhood health problem, a nationwide free vitamin D supplementation campaign initiated by the government appeared to be effective in eliminating VDDR.