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Vitamin D

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  1. Vitamin D Natalie Vicca Good Food for New Arrivals Project ASeTTS

  2. ASeTTS • Association for Services to Torture and Trauma Survivors • Free & Confidential service • Counselling, advocacy, support, group and community activities

  3. Good Food for New Arrivals • Funded by Australian Government under the Stronger Families and Communities Invest to Grow Program.

  4. Services at ASeTTS www.asetts.org.au • Counselling & Advocacy • Community development programs and support groups • Personal Support Program • Volunteer program • Settlement grants program • Training, professional development & consultation • Strength to Strength Relationship support • Good Food for New Arrivals Nutrition Project • Integrated service centre MDT at selected Primaries • Newly Arrived Youth Support Service • Sessional psychiatrist

  5. Australia’s Humanitarian Programme • Nationally 13,000 accepted each year 2006 • Total under 18 years = 56% • Under 9 years old = 27%

  6. Learning Objectives • Be aware of sources and function of Vit D • Be aware of the effects of Vit D deficiency • Recognise groups at risk of deficiency • The situation in WA • Identify screening/treatment strategies

  7. Sources • Sunlight -D3 cholecalciferol • Diet -D2 ergocalciferol • Fish, Eggs, Margarine, Milk, some meats • Requirements = 5-15 Micrograms/day (Nutrient Reference Values for Australia and New Zealand 2006)

  8. Function • Variety of neuromuscular and physiological functions • Maintains serum calcium and phosphorus • Role in enhancing immune function

  9. sunlight skin 7 -dehydrocholesterol cholecalciferol Vitamin D3 (fish, meat) Vitamin D2 (supplements) liver 25 dihydroxyvitamin D3 1,25-dihydroxyvitamin D3 ↑Ca absorption small intestine ↑Urinary calcium reabsorption (kidney) ↑Bone mineralisation kidney

  10. Deficiency • Rickets in children • Osteoporosis and Osteomalacia adults • Implicated in development of • Psoriasis • Type 1 Diabetes Mellitus • Multiple Sclerosis • Gastrointestinal Cancers

  11. WA Situation • Migrant Health found approx 16% of children and 11% of adults have moderate to severe vitamin D deficiency • Many more with mild deficiency - 40% • Have been emergency presentations due to hypocalcaemic seizures

  12. Who is at risk? • Those who do not get enough sunlight. • Covered for cultural reasons • Dark skin needs longer exposure • Elderly • Breastfed babies of deficient mothers • Babies not introduced to solids appropriately

  13. Sun exposure • Outside of peak hours • Without sun screen for short periods only • Hands, arms and face if possible • Darker skins require longer exposure • 7 minutes in summer for moderate to fair skin, up to 3-4 times longer for highly pigmented skins.

  14. Symptoms and Signs • Young Infants • Restlessness • Poor sleep • Craniotabes (Soft posterior skull due to reduced mineralisation)

  15. Older infants • Delayed sitting/crawling • Delayed closure fontanelle • Bossing of skull • Costochondral beading • Delayed tooth development Photos courtesy of Tom D Thacher, MD

  16. Children (1-4 yrs) • Enlarged Epiphysial cartilages wrists/ankles • Kyphoscoliosis • Delayed walking • Abnormal teeth excessive caries

  17. Bow leg abnormality Knock knees Photos courtesy of Tom D Thacher, MD

  18. Marion Post Wolcott. Corbis www.fags.org

  19. Older children and adolescents • Painful walking • Bowlegs • Knock knees • Abnormal teeth • Excessive caries • Neuromuscular hyperactivity muscle weakness

  20. Adults • Weak bones • Bone pain (spinal, pelvic, legs) • Muscle weakness • Hypocalcaemia • Compressed vertebrae • Pelvic flattening • Easy fracturing

  21. What can be done? • Screening • Blood test – vitamin D, U&E’S, PTH, Ca, LFT’s • Signs or symptoms screened by GP

  22. Treatment • Children • Managed via PMH due to sole access to supplementation • Adults • Managed by GP • E.g. Ostelin 1000 3-5 tablets/d

  23. After 2 years of treatment Photos courtesy of Tom D Thacher, MD

  24. Summary • SPOT – those at risk • SCREEN - those likely to be deficient • SUPPLEMENT – those with low levels • Slip • Slap • Slop • Still stands but….

  25. Questions?