Vitamin D for Growth and Rickets in Stunted Children: A Randomized Trial

Abstract

BACKGROUND AND OBJECTIVES: Vitamin D is essential for healthy development of bones, but little is known about the effects of supplementation in young stunted children. Our objective was to assess the effect of vitamin D supplementation on risk of rickets and linear growth among Afghan children. METHODS:In this double-blind, placebo-controlled trial, 3046 children ages 1 to 11 months from inner-city Kabul were randomly assigned to receive oral vitamin D 3 (100 000 IU) or placebo every 3 months for 18 months. Rickets Severity Score was calculated by using wrist and knee radiographs for 631 randomly selected infants at 18 months, and rickets was defined as a score .1.5. Weight and length were measured at baseline and 18 months by using standard techniques, and z scores were calculated.RESULTS: Mean (95% confidence interval [CI]) serum 25-hydroxyvitamin D (seasonally corrected) and dietary calcium intake were insufficient at 37 (35-39) nmol/L and 372 (327-418) mg/day, respectively. Prevalence of rickets was 5.5% (placebo) and 5.3% (vitamin D): odds ratio 0.96 (95% CI: 0.48 to 1.92); P = .9. The mean difference in height-for-age z score was 0.05 (95% CI: 20.05 to 0.15), P = .3, although the effect of vitamin D was greater for those consuming .300 mg/day of dietary calcium (0.14 [95% CI: 0 to 0.29]; P = .05). There were no between-group differences in weight-for-age or weight-for-height z scores.CONCLUSIONS: Except in those with higher calcium intake, vitamin D supplementation had no effect on rickets or growth.

Association Between Vitamin D Status and Undernutrition Indices in Children: A Systematic Review and Meta-Analysis of Observational Studies

“…We detected that risk of stunting and underweight did not elevated in low serum vitamin D. In line with our finding, a double-blind, placebo-controlled trial on 3,046 children ages 1-11 months from inner-city Kabul indicated that supplementation with 100,000 IU vitamin D3 for 18 months had no effect on weight age, weight for height, height for age (31). In contrast to our findings, Kumar et al, in a randomized clinical trial, investigated the effects of 35 µg/week vitamin D in low birth weight infants (1.8-2.5 kg) from birth up to 6 months of age in India.…”

Vitamin D: Bolus Is Bogus—A Narrative Review

“…Half were on placebo and half received 100,000 IU of vitamin D every 3 months for 18 months. (46) There was no effect of the bolus vitamin D treatment on growth, and in a subgroup of 20% of children who received radiographic evaluation, rickets frequency was the same (5.4%) between bolus vitamin D and placebo groups. Clearly bolus dosing of vitamin D also contrasts sharply with the historical precedent of daily dosing benefits in the prevention and treatment of rickets.…”

“…(43) Other observational studies suggested that hospitalization rates are doubled, and critical care and mortality are tripled in adults with vitamin D deficiency. (30,44,45) Further, Akbar et al (46,47) reviewed 14 studies with almost one million adults in 2021 and concluded that 25(OH)D deficiency was associated with both severity of COVID and threefold higher odds of mortality. This association was confirmed by another recent review supporting a twofold increased risk of mortality and a fourfold increased risk of critical care admission, although the authors pointed out the weak quality of observational studies.…”

Vitamin D in critical care: where are we now and what is next?

“…], not even in rickets, the hallmark condition of severe vitamin D deficiency [12]. This is explained by the induction of the major catabolizing enzyme 24hydroxylase at least for 28 days after a bolus dose.…”

“…This must be followed by a maintenance dose. Accumulating evidence suggests that bolus doses are, therefore, not suited to improve clinical outcomes in vitamin D-deficient patients [11 ▪▪ ], not even in rickets, the hallmark condition of severe vitamin D deficiency [12]. This is explained by the induction of the major catabolizing enzyme 24-hydroxylase at least for 28 days after a bolus dose.…”