Vitamin D Natalie Vicca Good Food for New Arrivals Project ASeTTS
ASeTTS • Association for Services to Torture and Trauma Survivors • Free & Confidential service • Counselling, advocacy, support, group and community activities
Good Food for New Arrivals • Funded by Australian Government under the Stronger Families and Communities Invest to Grow Program.
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
Australia’s Humanitarian Programme • Nationally 13,000 accepted each year 2006 • Total under 18 years = 56% • Under 9 years old = 27%
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
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)
Function • Variety of neuromuscular and physiological functions • Maintains serum calcium and phosphorus • Role in enhancing immune function
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
Deficiency • Rickets in children • Osteoporosis and Osteomalacia adults • Implicated in development of • Psoriasis • Type 1 Diabetes Mellitus • Multiple Sclerosis • Gastrointestinal Cancers
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
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
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.
Symptoms and Signs • Young Infants • Restlessness • Poor sleep • Craniotabes (Soft posterior skull due to reduced mineralisation)
Older infants • Delayed sitting/crawling • Delayed closure fontanelle • Bossing of skull • Costochondral beading • Delayed tooth development Photos courtesy of Tom D Thacher, MD
Children (1-4 yrs) • Enlarged Epiphysial cartilages wrists/ankles • Kyphoscoliosis • Delayed walking • Abnormal teeth excessive caries
Bow leg abnormality Knock knees Photos courtesy of Tom D Thacher, MD
Older children and adolescents • Painful walking • Bowlegs • Knock knees • Abnormal teeth • Excessive caries • Neuromuscular hyperactivity muscle weakness
Adults • Weak bones • Bone pain (spinal, pelvic, legs) • Muscle weakness • Hypocalcaemia • Compressed vertebrae • Pelvic flattening • Easy fracturing
What can be done? • Screening • Blood test – vitamin D, U&E’S, PTH, Ca, LFT’s • Signs or symptoms screened by GP
Treatment • Children • Managed via PMH due to sole access to supplementation • Adults • Managed by GP • E.g. Ostelin 1000 3-5 tablets/d
After 2 years of treatment Photos courtesy of Tom D Thacher, MD
Summary • SPOT – those at risk • SCREEN - those likely to be deficient • SUPPLEMENT – those with low levels • Slip • Slap • Slop • Still stands but….