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Serum 25-hydroxyvitamin D response to oral vitamin D intake in children

Department of Nutrition Science, University of Bonn, Endenicher Allee 11–13, 53115 Bonn, Germany, E-mail: a.zittermann{at}uni-bonn.de

Dear Sir:

In a recent issue of the Journal, Heaney et al (1) reported important new data on the requirement of oral vitamin D to maintain physiologic concentrations of circulating 25-hydroxyvitamin D [25(OH)D] in adults. Some years ago, an analysis was performed of serum concentrations of 25-hydroxyvitamin D₂ [25(OH)D₂] and 25-hydroxyvitamin D₃ [25(OH)D₃] in German pediatric patients ( age: 5.2 y; body wt: 21.7 kg) with phenylketonuria (n = 3) or maple syrup urine disease (n = 3) during the winter (January–March) and summer (July–September) (2). All patients were free of diseases affecting vitamin D metabolism. They were supplemented daily with doses of 15.6–25.0 µg vitamin D₂/d (mean: 19.6 µg vitamin D₂/d) for a minimum of 1.5 y, which corresponded to a mean vitamin D₂ intake of 1.37 µg • kg body wt^-1 • d^-1 in winter and of 1.27 µg • kg body wt^-1 • d^-1 in summer. Serum concentrations of 25(OH)D₂ and 25(OH)D₃ showed inverse seasonal variations (winter: 71.1 ± 33.6 and 25.3 ± 9.9 nmol/L; summer: 43.0 ± 22.5 and 62.5 ± 26.3 nmol/L, respectively). Normally, concentrations of 25(OH)D₂ in German children are close to zero (< 3 nmol/L) (2). Therefore, serum concentrations of this metabolite reliably reflect the effects of supplementation. Increments per µg vitamin D₂/kg body wt were 60 nmol/L in winter and 39 nmol/L in summer. An oral intake of vitamin D₃ results in a 70% higher serum 25(OH)D concentration than does an oral intake of the same amount of vitamin D₂ (3). Considering these differences in the effects of oral vitamin D₂ and vitamin D₃ on serum 25(OH)D concentrations, the abovementioned data on 25(OH)D₂ increments and 25(OH)D₃ baseline concentrations in summer are in line with values calculated by Heaney et al in adults with baseline 25(OH)D concentrations of 70 nmol/L. Moreover, the earlier data indicate that an oral intake of vitamin D₂ results in relatively high serum 25(OH)D₂ concentrations when initial 25(OH)D₃ concentrations are low. The seasonal differences in serum 25(OH)D₂ increments support the assumption of Heaney et al (1) that the increment in serum 25(OH)D concentrations after vitamin D supplementation may depend on baseline 25(OH)D concentrations (1). Together, the earlier data and the data of Heaney et al indicate that an oral dose of vitamin D₂ or vitamin D₃ would lead to a comparable increase in circulating 25(OH)D concentrations in children and adults when the initial 25(OH)D₃ concentrations in the groups are similar and when equivalent oral vitamin D doses expressed per kilogram body weight/d are given.

REFERENCES

1. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:204–10.[Abstract/Free Full Text]
2. Zittermann A. Vitamin D status of patients with hereditary disturbances in amino acid metabolism and of patients with cystic fibrosis. PhD dissertation. Rheinische Friedrich Wilhelms Universität, Bonn, Germany, 1987 (in German).
3. Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R. Evidence that vitamin D₃ increases serum 25-hydroxyvitamin D more efficiently than does vitamin D₂. Am J Clin Nutr 1998;68:854–8.[Abstract]

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