expert opinion

More and more children are affected by vitamin D deficiency

February 15, 2012

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German Society of Pediatrics and Adolescent Medicine (Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V., [DGKJ]), Berlin, Germany

Vitamin D plays a key role in our health. Deficiency in this vitamin increases the risk of many diseases, including rickets, osteoporosis, diabetes, multiple sclerosis, hypertension, muscle weakness and diverse forms of cancer. In Germany, the daily intake of vitamin D in the diet is in some cases substantially lower than the recommended amounts. It is difficult to obtain an adequate supply from the diet alone: appreciable amounts of the vitamin are only found in fatty marine fish (e.g. salmon, herring, mackerel, cod liver oil), and in eggs and milk. In order to consume the recommended daily amount of vitamin D – between 400 and 800 IU – it would be necessary to eat at least three or four fish meals per week or a minimum of ten eggs per day.

Ultraviolet solar rays can activate the precursors of vitamin D in the skin and convert them to vitamin D. Hence the best cure for a lack of this vitamin would be sunbathing daily, which is, unfortunately, quite difficult at Northern and Central European latitudes. UVB radiation is generally too weak here from November to February to trigger the body to produce the adequate production of vitamin as deemed necessary.

In Germany, low levels of vitamin D are found in girls between ages 11 and 13 and boys between ages 14 and 17, i.e. precisely when they are at an important stage for the growth and mineralization of their bones. The worryisome changes in lifestyle habits of children and young people are the underlying reason for this: even children in primary school are spending around nine sedentary hours per day and only one hour getting exercise. The WHO recommends at least one hour of exercise daily at least five days a week, a rate only achieved now in Germany by one-third of boys between ages 11 and 15 and one-quarter of girls of the same age. The proportion of children who spend four hours or more sitting in front of a screen has risen conside-rably in recent years. Currently, nine and ten-year-olds watch 71 minutes of television and play on the computer for 30 minutes every day on week days. Doctors should remind parents how important it is for their children to go out and be active in the fresh air for at least a half an hour every day, ideally with the head, arms and legs exposed. Starting at one year of age, all children who do not spend enough time in the sunshine should be given a vitamin D supplement of 400 IU per day.

Children who are either overweight or on a vegan or macrobiotic diet with insufficient calcium, vitamin D and fat additives are at particular risk of inadequate supply. At our latitudes, dark-skinned adolescents from immigrant families are also at risk of vitamin D deficiency because dark pigmentation reduces the production of vitamin D in the skin. Another group at risk is young girls who either avoid going outside or keep them-selves covered for religious or other cultural reasons.

Even babies are at risk of vitamin D deficiency since breast milk only contains small amounts of vitamin D: this is insufficient for the needs of a breastfed infant. The same applies to infant formulas. In order to keep the risk of rickets at bay, almost all babies today receive prophylactic vitamin D preparations. From an infant’s first week of life to its second spring, i.e. for a period of one to one and a half years depending on which time of year it was born, it should be given tablets or drops containing 400 to 500 IU of vitamin D3 daily. Ideally, these should be combined with a fluoride prophylaxis to combat tooth decay. Currently, the costs of the additional vitamin D administration in the first 12 to 18 months of a baby’s life are borne by the health insurance providers.”

Berlin, Germany, January 2012