Vitamin D concentrations in Asian children aged 2years living in England: population survey
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7175.28 (Published 02 January 1999) Cite this as: BMJ 1999;318:28
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EDITOR
Lawson and Thomas (1) suggest that the serum concentration of 25-
hydroxycholecalciferol is substantially lower in Asian infants than in the
general population. Although this finding is highly plausible, their paper
does not provide reliable evidence regarding the presence or magnitude
of this difference. Plasma samples in Asian subjects were collected in a
different year, in a different geographical area, and were apparently
assayed in a different
laboratory from those in the external control group. Analytical methods
are unspecified.
Year to year differences in plasma 25-hydroxycholecalciferol are
likely. More importantly serum measurements of 25-hydroxycholecalciferol
differed markedly between different laboratories and within different
laboratories
over the period of their study (2). The number of subjects classified as
having 25-hydroxycholecalciferol below 25 umol/L may be as much a function
of analytical methodology as ethnic group. A similar explanation may
account for the
apparent absence of seasonal variation in the control data.
1 Lawson M, Thomas M. Vitamin D concentrations in Asian children aged
2 years living in England: population survey. BMJ 1999;318:28.
2 Carter GD, Hewitt J. the 25-hydroxyvitamin D EQAS: an update. Proc
UK NEQAS Meeting 1996;2:157.
Dr Aubrey Blumsohn MBBCh, PhD
Directorate of Biochemical Medicine
Ninewells Hospital
Dundee
Conflicts of interest: None
Competing interests: No competing interests
Editor, We have reported high incidence of vitamin D deficiency
rickets in breastfed infants and severe vitamin D deficiency in their
mothers (1).
In another study we have documented high prevalence of
hypovitaminosis D ( During
infancy and in pregnant mothers the demand for vitamin D is high. Is exposure to direct sunlight alone sufficient to maintain optimum
level of vitamin D necessary for the proper skeletal growth of the infant
and children without supplementing the diet with vitamin D? Is the fear of vitamin D toxicity real in the
recommended dose of 10ug daily?
Hypovitaminosis D is common (1,2,3) and a
serious nutritional problem. There is urgent need to correct this not only
to prevent rickets but to improve nutrition, skeletal growth and prevent
infection.
We agree with recommendations of Dr Lawson and Margaret Thomas
(3) for routine vitamin D supplementation to all infants and children at
least upto the age of two years and to pregnant and lactating mothers.
Iqbal Ahmed,
M. Atiq
1. I. Ahmed, M. Atiq, J. Iqbal, M. Khurshid and P Whittaker
Vitamin D deficiency rickets in breastfed infants presenting with
hypocalceamic seizures. Acta Paediatr 84:941-42.1995
2.M. Atiq, A. Suria, SQ. Nizami, I. Ahmed. Vitamin D status of breastfed
Pakistani infants. Acta Paediatr 87:737-40. 1998
3. VitaminD concentration in Asian children aged 2 years living in
England: Population survey. Margaret Lawson ad Margaret Thomas, MJ 1999;
318:28
Competing interests: No competing interests
The issue of Hypovitaminosis D in Asian children should raise
questions about the etiology and pathophysiology. It may be assumed that
it relates to the lack of exposure to sun light and if so this could be
the result of cultural or traditional attitdudes. I certainly do not
suggest that the same etiology exists in the UK as it was in Israel in the
early 50's but the following story should raise some questions .
Back in 1954 we were sent as medical students in our rotation in
"community medicine" to the Yemenite immigrants transition camps (
"maabarot") where 20% of the young children had full blown clinical
ricketts. The story was that the mothers believed that if the children
were not exposed to the sun they will grow less darkly tanned, thus more
easily accepted in the better off Ashkenazi community. When pills of
vitamin D were distributed to them we found out that they were fed to the
chickens... We eventually started to distibute hot meals to the children
with the soup supplemented with Vitamin D and it helped. As I said I do
not want to draw any conclusions but to suggest that cultural factors
should be looked for and dealt with. This may increase compliance and
rates of success in preventing ricketts.
Competing interests: No competing interests
Should we measure Vit D levels in without clinical signs of rickets?
Dear Sir
Working in a area with significant population from the Indian sub-
continent we do come across a significant number of normally growing
children with ferritin value less than 10mg/l and the population survey by
Lawson M and Thomas M (1) does raise the question whether we should be
doing Vit D levels in these children with no clinical rickets.
Supplementation rates still remain low. There is a known association
between high dietary phytate (inositol hexaphosphate and inositol
pentaphosphate) intake and iron
deficiency anaemia.(2) The dietary source of iron is also important as
another study (3) showed that despite similar dietary intake, ethnic
minority group children had lower ferritin than the Caucasian group. High
dietary phytate also binds to the Ferrous salts used in supplementation
.(4) Whether phytate does interfere with Vit D or Calcium absorption is
not very clear . Hence dietary factors may have an important bearing in
the amount of nutrient as
well as the absorption from the supplement given.
M.Yadav
Senior Registrar Paediatrics,
Queens Park hospital,
Blackburn BB2 3HH
Reference:
1. Lawson M, Thomas M. Vitamin D concentrations in Asian children
aged 2 years living in England: Population survey. BMJ 1998; 318: 28.(2
Jan.)
2. Brunvand L, Henriksen C, Larsson M, Sandberg AS. Iron deficiency among
pregnant Pakistanis in Norway and the content of phytic acid in their
diet.
Acta Obstet Gynecol. Scand 1995; 74 (7): 520-5
3. D'Souza SW, Lakhani P, Waters HM, Boardman KM, Cinkotai KI. Iron
deficiency in ethnic minorities: associates with dietary fibre and
phytate. Early Hum Dev 1987 ; 15 (2) : 103-11
4. Turnbull A, Cleton F, Finch CA. The absorption of haemoglobin iron.
Nutr Rev 1989; 47(2): 51-3.
Competing interests: No competing interests