Clinical improvement following vitamin D3 supplementation in Autism Spectrum Disorder

Objective: High prevalence of vitamin D deficiency was previously reported in children with Autism Spectrum Disorder (ASD), but little is known about the efficacy of vitamin D3 treatment in ASD, although data from pilot studies seem promising. We hypothesized that serum vitamin D levels are reduced in ASD and correlate with the severity of disease. Also, we hypothesized that vitamin D3 treatment may be beneficial for a considerable portion of children with ASD.

Methods: In total, 215 children with ASD and 285 healthy control children were recruited in our study. Thirty seven of 215 ASD children received vitamin D3 treatment. The Autism Behaviour Checklist (ABC) and the Childhood Autism Rating Scale (CARS) were used to assess autism symptoms. High-performance liquid chromatography was used to assess the serum 25-hydroxyvitamin D [25(OH) D] level. Evaluations of ABC, CARS, and serum 25(OH) D levels were performed before and after 3 months of treatment.

Results: Serum levels of 25(OH) D were significantly lower in ASD children than typically developing children. Levels of serum 25(OH) D were negatively correlated with ABC total scores and language subscale scores. After vitamin D3 supplementation, symptom scores were significantly reduced on the CARS and ABC. In addition, the data also suggest that treatment effects were more pronounced in younger children with ASD.

Conclusion: Vitamin D deficiency might contribute to the aetiology of ASD. Supplementation of vitamin D3, which is a safe and cost-effective form of treatment, may significantly improve the outcome of some children with ASD, especially younger children (identifier ChiCTR-CCC-13004498).

Clinical Trial Registration: The trial ‘Association of Polymorphisms of Vitamin D Metabolism-Related Genes With Autism and the Treatment of Autism with Vitamin D’ has been registered at www.chictr.org/cn/proj/show.aspx? proj=6135 (identifier ChiCTR-CCC-13004498).     

Vitamin A and vitamin D deficiencies exacerbate symptoms in children with autism spectrum disorders

Objectives: This study was designed to investigate the vitamin A (VA) and vitamin D (VD) levels in children with autism spectrum disorders (ASD) and to determine whether co-deficiency of VA and VD exacerbates clinical symptoms in autistic children.

Methods: The Autism Behavior Checklist, Childhood Autism Rating Scale (CARS), and Social Responsiveness Scale (SRS) were used to assess the symptoms of 332 children diagnosed as ASD. And the Gesell Developmental Scale (GDS) was used to evaluate neurodevelopment in children with ASD. Anthropometric measurement and questionnaire results were compared for all autistic children and 197 age- and gender-matched control children. Serum retinol levels were detected with high-performance liquid chromatography, and serum levels of 25-OH vitamin D were measured with an immunoassay method in the two groups.

Results: The Z_HA, Z_WA, and Z_BMIA of the children with ASD were significantly lower than those of the control children. Furthermore, higher proportions of children with picky eating, resistance to new foods, and eating problems were observed in the ASD group when compared with the control group. Serum retinol and 25-OH vitamin D levels in autistic children were significantly lower than those in the control children. Additionally, VA and VD co-deficiency impacts more on the symptoms and development in autistic children.

Conclusions: We found that children with autism have more VA and VD deficiencies than control children, and VA and VD co-deficiency may exacerbate the symptoms of children with ASD.     

Intermittent high-dose vitamin D corrects vitamin D deficiency in adolescents: a pilot study

We aimed to assess the safety and efficacy of high-dose intermittent vitamin D supplementation in adolescents. Twenty-two healthy adolescents with serum 25 hydroxy-vitamin D (25-OHD) of 12.5-50?nmol/l were randomised to receive 300,000?IU or 150,000?IU of vitamin D3, or placebo orally 6-monthly for 1 year. At 12 months, the average vitamin D levels for the 300,000?IU, 150,000?IU and placebo groups were 63.0, 41.1 and 35.8?nmol/l, respectively, (P=0.004 for difference between 300?000?IU group and placebo after adjustment for age, sex and seasonal variation). At 12 months, one participant receiving 300,000?IU was mildly deficient (25-OHD 49?nmol/l), whereas five out of six (83%) in the placebo and four out of seven participants (57%) in the 150,000?IU group remained deficient. There were no adverse events. Compliance was high. This suggests that 300,000?IU vitamin D3 orally 6-monthly may safely and effectively correct vitamin D deficiency in adolescents.     

Vitamin D Knowledge,Awareness, and Attitudes of Adolescents and Adults: A Systematic Review

IntroductionThe aims of this systematic review were 2-fold: (1) evaluate the effect of vitamin D educational interventions on serum 25-hydroxyvitamin D (25-OHD) concentration in adolescents (aged 10–19 years) and adults, and (2) assess the association between serum 25-OHD concentration and vitamin D knowledge, awareness of vitamin D deficiency risk, and attitudes toward behaviors associated with acquiring vitamin D.MethodsMedline, CINAHL, Embase, and SPORTDiscus were systematically searched for studies reporting associations between serum 25-OHD concentration and vitamin D knowledge, awareness, and attitudes. Results were summarized narratively. Effect sizes were calculated when data were available.ResultsEight studies reported experimental effects (2 randomized controlled trials, 1 cluster randomized trial, 4 quasi-experiments, 1 clinical audit), and 14 reported cross-sectional associations. Seven of 8 interventions reported no effect of educational interventions on serum 25-OHD concentration. A slight majority (53%; κ = 19) of studies reported statistically significant associations between serum 25-OHD concentration and vitamin D knowledge and attitudes.Implications for Research and PracticeThe few educational interventions employed to increase serum 25-OHD concentration lack effectiveness. Future studies may use randomized controlled trial designs, enroll those at risk for vitamin D insufficiency and underrepresented in the literature, increase the salience of the information to the target population, and include safe sun exposure recommendations.     

Study of the Determinants of Vitamin D Status in Pediatric Patients With Osteogenesis Imperfecta

Objective: Vitamin D is essential to the development and maintenance of the skeleton, especially for children with bone disorders such as osteogenesis imperfecta (OI). We evaluated serum 25-hydroxyvitamin D (25-OHD) levels to assess the relationship between determinants of vitamin D status in pediatric patients with OI.

Methods: This cross-sectional study evaluated sex, age, weight, height, body mass index, OI type, sunscreen use, season of assessment, sun exposure, vitamin D and calcium supplementation, bisphosphonate treatment, bone mineral density (BMD), milk and soda consumption, mobility, and time of sedentary activity. Levels of serum 25-OHD, calcium, parathyroid hormone (PTH), phosphorus, and alkaline phosphatase (ALP) were analyzed. Serum levels of 25-OHD were classified according to sufficient (>30 ng/ml or 75 nmol/L), insufficient (20–30 ng/ml or 50–75 nmol/L), moderately deficient (20–10 ng/ml or 50–25 nmol/L), and severely deficient (<10 ng/ml or 25 nmol/L).

Results: Fifty-two patients were included and 46 (88.4%) were classified as having insufficient or deficient 25-OHD. An inverse correlation between serum 25-OHD and time of sedentary activity (r = ?0.597, p < 0.001) and a positive correlation with height (r = 0.521, p = 0.046) and whole body BMD (r = 0.586, p = 0.022) were observed. A significant difference between the number of glasses of milk consumed (p = 0.010) was observed.

Conclusion: To optimize bone health, patients with OI need to be educated regarding habits that can improve serum 25-OHD levels, such as a reduction in periods of inactivity, the importance of sun exposure, and increasing consumption of milk and fortified dairy products.     

Vitamin D Deficiency in Cord Plasma from Multiethnic Subjects Living in the Tropics

Background: Vitamin D deficiency is commonly reported in high-latitude areas and in dark-pigmented individuals. However, nothing is known about vitamin D in cord blood from multiethnic subjects living in the tropics.

Objective: Our study objective was to determine the prevalence of vitamin D deficiency in summer and winter in cord blood from multiethnic individuals in Hawai’i where sufficient sun irradiance occurs year-round for cutaneous vitamin D production.

Methods: 25-Hydroxyvitamin D (25(OH)D) levels were quantified by enzyme immunoassay in 100 cord plasma samples from apparently healthy full-term newborns and their mothers. Stratification was performed by birth season and ethnicity.

Results: Mean 25(OH)D levels were 24.5 ng/mL (9.1–68.3 ng/mL). Overall, 28% of samples were vitamin D deficient (<20 ng/mL) and 50% were insufficient (20–30 ng/mL). 25(OH)D levels (ng/mL) were highest in Caucasians (30.5, n = 19), followed by Asians (25.1, n = 43), Hispanics (21.5, n = 3), Pacific Islanders (20.0, n = 25), and African Americans (19.6, n = 2). Differences among groups were significant (p = 0.008). Cord plasmas from summer versus winter were higher overall (p = 0.001) and among Asians (p = 0.0003). Seasonal changes were correlated with sun irradiance overall (r = 0.43, p = 0.0001), among Caucasians (r = 0.45, p = 0.05), and among Asians (r = 0.45, p = 0.0001).

Conclusion: Our results suggest that prenatal supplement recommendations of 400 IU vitamin D/day do not protect against vitamin D deficiency, even in subjects living in the tropics where ample sun irradiance exists for cutaneous vitamin D synthesis. The high prevalence of vitamin D deficiency we observed emphasizes the necessity for regular 25(OH)D monitoring, particularly during pregnancy and lactation, in dark-pigmented individuals, and during winter months.     

Single high-dose vitamin D at birth corrects vitamin D deficiency in infants in Mexico

Abstract

This study examined the prevalence of vitamin D deficiency in mothers and infants in Tijuana, Mexico and determined the effect of a single oral dose of 50?000?IU vitamin D₃ at birth on 25-hydroxyvitamin D (25[OH]D) levels during infancy. Healthy infants were randomized to receive vitamin D₃ or placebo at birth. At birth 23% of infants were vitamin D deficient and 77% had vitamin D insufficiency (mean 25[OH]D level 18.9?ng/ml); 10% of mothers were vitamin D deficient and 61% were insufficient. Infants receiving vitamin D₃ had higher 25(OH)D levels at two months (N?=?29; 33.9 versus 24.2?ng/ml) and six months (N?=?21; 36.5 versus 27.4?ng/ml). Exclusively breastfed infants had lower 25(OH)D levels at two months (14.9 versus 33.4?ng/ml). Vitamin D deficiency is common in infants and mothers in Tijuana, Mexico. A single dose of vitamin D₃ at birth was safe and significantly increased 25(OH)D levels during infancy.     

Effect of Vitamin D Supplementation on Depressive Symptoms in Patients With Knee Osteoarthritis

ObjectivesTo determine the effect of vitamin D supplementation and maintaining sufficient serum vitamin D on depressive symptoms in patients with knee osteoarthritis (OA) and vitamin D deficiency.DesignA prespecified secondary analysis of a multicentre, randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to receive oral vitamin D₃ (50,000 IU, n = 209) or placebo (n = 204) monthly for 24 months. In addition, participants who completed the trial were classified into 2 groups according to their serum 25(OH)D levels at month 3 and 24 as follows: not consistently sufficient (serum 25(OH)D ≤ 50 nmol/L at month 3 and/or 24), and consistently sufficient (serum 25(OH)D > 50 nmol/L at both month 3 and 24). Multilevel mixed-effect models were used to compare differences of change in PHQ-9 scores between groups.Setting and ParticipantsThis clinical trial was conducted in participants with symptomatic knee OA and vitamin D deficiency from June 2010 to December 2013 in Tasmania and Victoria, Australia.MeasuresThe primary outcome was the depressive symptoms change over 24 months, which was measured using the Patient Health Questionnaire (PHQ-9, 0-27).ResultsOf 599 participants who were screened for eligibility, 413 participants were enrolled (mean age: 63.2 years; 50.3% female) and 340 participants (intervention n = 181, placebo n = 159, 82.3% retention rate) completed the study. The baseline prevalence of depression (PHQ-9 score ≥5) was 25.4%. Depressive symptoms improved more in the vitamin D supplementation group compared to the placebo group [β: ?0.66, 95% confidence interval (CI): ?1.22 to ?0.11, P for difference = .02] and in the participants who maintained vitamin D sufficiency compared to those who did not (β: ?0.73, 95% CI: ?1.41 to ?0.05, P for difference = .04) over 24 months.Conclusions/ImplicationsThese findings suggest that vitamin D supplementation and maintaining adequate vitamin D levels over 24 months may be beneficial for depressive symptoms in patients with knee OA.     

维生素D在孤独症谱系障碍中作用的研究进展

孤独症谱系障碍(ASD)是影响儿童健康的严重公共问题之一,以社交沟通障碍、兴趣或活动范围狭窄以及重复刻板行为为特征。近年来越来越多的研究显示,ASD患儿维生素D(VitD)水平明显低于同龄健康儿童,VitD缺乏可能与ASD的发病机制相关。本文就VitD与ASD的相关研究进行综述。     

维生素D在孤独症谱系障碍中作用的研究进展

孤独症谱系障碍(ASD)是影响儿童健康的严重公共问题之一,以社交沟通障碍、兴趣或活动范围狭窄以及重复刻板行为为特征。近年来越来越多的研究显示,ASD患儿维生素D(VitD)水平明显低于同龄健康儿童,VitD缺乏可能与ASD的发病机制相关。本文就VitD与ASD的相关研究进行综述。     

孤独症诊断观察量表模块1和儿童期孤独症评定量表的临床应用对比

目的 分析第二版孤独症诊断观察量表(ADOS-2)模块1与儿童期孤独症评定量表(CARS)对儿童孤独症谱系障碍(ASD)的诊断价值,为临床应用提供参考依据。方法 2019年1月—2022年3月在广东省妇幼保健院儿童神经康复医学科初次就诊,第一诊断为ASD、全面发育迟缓儿(GDD)及评估为正常的104例儿童为研究对象。其中ASD患儿60例(高、低功能各30例)为ASD组,24例全面发育迟缓患儿(GDD患儿)及正常儿20例为非ASD组,两组均采用ADOS-2模块1和CARS评估。比较两个量表与美国《精神疾病诊断与统计手册(第5版)》(DSM-5)中ASD诊断结果的一致性,对比两者诊断ASD的敏感性、特异性。结果 1)ADOS-2模块1与DSM-5的一致性好(Kappa=0.862),CARS与DSM-5的一致性为中等(Kappa=0.509),ADOS-2模块1与CARS间的一致性为好(Kappa=0.695)。2)ADOS-2模块1的敏感性优于CARS,差异有统计学意义(χ²=13.333,P<0.001)。ADOS-2模块1在诊断IQ≥70和IQ<70的儿童中的敏感性、特异性的对比差异无统计学意义(P>0.05)。CARS在诊断IQ<70的儿童的敏感性优于IQ≥70的儿童(χ²=7.500,P=0.006),特异性比较差异无统计学意义(P>0.05)。结论 ADOS-2 模块1、CARS均为辅助诊断ASD的重要工具,ADOS-2模块1在ASD儿童的早期诊断中具有更高的敏感性和特异性。临床工作中,对IQ≥70的儿童,建议降低CARS的诊断阈值,以提高CARS的诊断敏感性,降低漏诊率。     

A Randomized Clinical Trial of Vitamin D Supplementation in Healthy Adolescents

PurposeThe most safe and effective dose of vitamin D supplementation for healthy adolescents is currently unknown. The aim of this study was to compare the efficacy of 200 IU versus 1,000 IU of daily vitamin D₃ for supplementation in healthy adolescents with baseline vitamin D sufficiency.MethodsWe conducted a double-blind, randomized clinical trial. Fifty-six subjects, ages 11–19 years, with baseline vitamin D sufficiency received 1,000 IU or 200 IU of daily vitamin D₃ for 11 weeks. Compliance was assessed using MEMS6 Trackcaps and pill counts.ResultsFifty-three subjects completed the clinical trial. Subjects in the two treatment arms were similar in terms of age, race, gender, body mass index, and dietary calcium and vitamin D intake. Serum 25(OH)D level in the 200 IU treatment arm was 28.1 ± 6.2 ng/mL at baseline (mean ± SD) and 28.9 ± 7.0 ng/mL at follow-up. In the 1,000 IU treatment arm, 25(OH)D levels were 29.0 ± 7.3 and 30.1 ± 6.6 at baseline and follow-up, respectively. Mean change in 25(OH)D level did not differ significantly between treatment arms (p = .87), nor did mean change in parathyroid hormone, calcium, phosphate, bone turnover markers, fasting glucose, or fasting insulin.ConclusionsIn healthy adolescents with baseline vitamin D sufficiency, supplementation with vitamin D₃ doses of 200 and 1,000 IU for 11 weeks did not increase serum 25(OH)D levels, with no significant difference observed between treatment arms.     

Vitamin D and Cardiovascular Disease

Vitamin D participates in numerous physiologic and pathologic processes. Most tissues have vitamin D receptors (VDRs), and vitamin D is an important regulator of gene expression. Approximately 1 billion people worldwide have insufficient levels of vitamin D. Deficiency has been associated with many chronic diseases, including cardiovascular disease (CVD), which is the leading cause of death in both men and women. A relationship between vitamin D and CVD is implicated; however studies show conflicting data. Epidemiologic evidence and observational studies demonstrate an association between vitamin D deficiency and CVD; however, this is not substantiated by randomized controlled trials (RCTs). Many questions remain unanswered, but growing evidence supports a beneficial role of vitamin D on cardiovascular health.

Key teaching points:

? Vitamin D influences many cellular functions.

? A global pandemic of vitamin D deficiency exists.

? Epidemiologic data and observational studies suggest that vitamin D deficiency may increase cardiovascular risk.

? RCTs show no significant relationship (however, studies have significant limitations).

? The association between vitamin D status and CVD is uncertain, but low vitamin D levels may be an independent and modifiable CV risk factor.

     

Safety and Efficacy of Early Vitamin D Supplementation in Critically Ill Extremely Preterm Infants: An Ancillary Study of a Randomized Trial

BackgroundDespite substantial evidence that vitamin D deficiency is highly prevalent among infants born extremely preterm (≤28 weeks’ of gestation), several consensus statements do not recommend vitamin D doses >400 IU/day for these infants. Safety remains a concern.ObjectiveThe study aim was to determine safety and efficacy profiles of enteral vitamin D in Black and White infants randomized to three different vitamin D doses soon after birth.DesignAncillary study of a masked randomized clinical trial.Participants/settingSeventy-three infants born extremely preterm between 2012 and 2015 at a southern US academic neonatal unit (33’ latitude) who had >90% compliance with the assigned intervention were included.InterventionInfants were randomized to receive placebo (placebo group), 200 IU/day vitamin D (200 IU group), or 800 IU/day vitamin D (800 IU group) during the first 28 days after birth.Main outcome measuresSafety outcomes included serum 25-hydroxy vitamin D (25[OH]D) and calcium concentrations. Efficacy outcomes included the predictive risk of bronchopulmonary dysplasia.Statistical analysisPer-protocol analysis using unadjusted, repeated-measures mixed models.ResultsMean birth weight was 815 ± 199 g. Half were male and 56% were Black. Of 58 infants with 25(OH)D measurements at birth, 40 (69%) had vitamin D deficiency (<20 ng/mL). The mean difference in 25(OH)D in nanograms per milliliter between Postnatal Day 28 and Postnatal Day 1 was +9 in the placebo group, +23 in the 200 IU group, and +62 in the 800 IU group (P < 0.0001). The increase observed in 25(OH)D was more significant among Black infants. The predictive risk of severe bronchopulmonary dysplasia in the 200 IU and 800 IU groups was lower, but this difference did not reach statistical significance. No vitamin D or calcium toxicity was observed.ConclusionsA vitamin D dose of 800 IU/day safely corrected vitamin D deficiency by Postnatal Day 14.     

Interactions of Lead,Calcium , Vitamin D,and Nutrition in Lead-Burdened Children

This study was undertaken to evaluate relationships between blood or serum levels of lead (Pb), calcium, and 25-hydroxyvitamin D (25-OHD), within the framework of a nutritional survey of lead-burdened children. The results demonstrate that: regardless of blood Pb concentration and season of the year, serum 25-OHD concentration reflects vitamin D intake; high blood Pb (≥60μg/dl) was associated with decreased levels of 25-OHD (18 ± 1 ng/ml vs. 32 ± 1 in controls, P <C .001); concentrations of Pb and calcium were inversely correlated in control and lead-burdened children; and children in the high blood Pb group (≥60 μg/dl) had lower mean daily intakes of both calcium (610 ± 20 mg vs. 770±20 in controls, P < .001) and vitamin D (210±17 IU vs. 325±20 in controls, P < .001). These data indicate that, in Pb-burdened children, multiple factors modify the absorption and toxicity of Pb, and relative vitamin D deficiency, not excess, is associated with high blood Pb levels. Assessment of nutrition, calcium metabolism, and vitamin D status is recommended in evaluating children known to have undue absorption of Pb.     

Body Size and Serum 25 Hydroxy Vitamin D Response to Oral Supplements in Healthy Older Adults

Background: Vitamin D insufficiency is prevalent in the northeast United States. Since vitamin D insufficiency is readily amenable to supplementation, it is important to understand what factors are associated with serum 25 hydroxy vitamin D (25(OH)D) response to vitamin D supplementation.

Objective: In this study we examined the association of serum 25(OH)D response to vitamin D supplementation with body size in a population of elderly subjects.

Methods: 257 healthy, ambulatory men and women 65 years of age or older were randomly assigned to treatment with either 700 IU/day (17.5 μg/d) of supplemental vitamin D₃ and 500 mg/day (12.5 mmol/d) of supplemental calcium, or to placebo.

Results: In multivariate regression analyses, after adjusting for baseline 25(OH)D, season, and sex, we found change in 25(OH)D to be inversely associated with baseline BMI (p = 0.01) in subjects treated with supplements for one year. Change in 25(OH)D was also negatively associated with other baseline anthropometric measurements in these subjects.

Conclusion: Our study implies that body size should be taken into account when estimating the amount of vitamin D intake needed to raise 25(OH)D to the desired level.     

Subject Index to Volume 15

Objective: Vitamin D deficiency continues to be a problem in pediatrics. This report presents four children, one Caucasian male and three African-American females aged 4 to 24 months who were treated for vitamin D deficiency rickets.

Methods: One female was diagnosed in the Emergency Department during evaluation of a viral syndrome, another presented with hypocalcemic seizures and the third was a self-referral for evaluation of widened wrists. The male had biochemical rickets discovered incidentally during a hospitalization for pneumonia. All were breastfed without formula supplements. The 24-month female had severe cow and soy protein allergies and received multivitamin supplements intermittently. Birth order was from third to sixth child. Two families practiced Islam and the mothers wore veils. The females had a weight deficit for height. The females demonstrated a rachitic rosary, widening of the wrists and leg bowing. At diagnosis the serum calcium was 5.0–8.6 mg/dl, the inorganic phosphorus was 1.5–3.9 mg/dl and the alkaline phosphatase was 408–3324 U/L. The serum intact parathormone levels and the vitamin D levels were measured at Nichols Laboratories. The 25-OH vitamin D levels were 2–22 ng/ml and the 1,25(OH)₂ vitamin D levels were 14–122 pg/ml. All had elevated parathormone levels. The three females had roentgenographic evidence of rickets. Two of the children also demonstrated iron deficiency.

Results: All patients responded to Vitamin D supplements, beginning at 2000 IU for the male and 8,000–10,000 IU daily for the females. Two children were also given calcium supplements. The three females all showed complete healing of the rickets radiologically within six months. The serum intact parathormone demonstrated an inverse correlation with the serum calcium during recovery (r=?0.669; p<0.05).

Conclusion: Vitamin D deficiency does still occur. Breastfed children of multiparous mothers, with increased skin pigmentation, living in the higher latitudes are at increased risk and would benefit from vitamin D supplementation while breastfeeding.     

Autism Rates Associated with Nutrition and the WIC Program

Objectives: Autism rates in the United States are increasing at a rate of 15% per year. Autistic children are diagnosed by age 3 when they have problems communicating and interacting socially. This study uses nutritional epidemiology and an ecologic study design to link the possible cause of autism to nutrition by creating autism rates for the 50 states of America and comparing them with published measures of infant nutrition such as duration of exclusive breast-feeding and participation in the Women, Infants, and Children (WIC) program. The percentage of infants with measles, mumps, and rubella (MMR) inoculations was also compared with the autism rates.

Study Design: Autism rates for each state were established. The percentage of infants who participate in the WIC program for low-income families was calculated for each of the 50 states as well as 21 New Jersey and 30 Oregon counties and compared with their autism rates. An ecologic study design with correlation coefficients is limited, but it is useful for generating hypotheses to be tested.

Results: The states with the highest WIC participation have significantly lower autism rates (p < 0.02). A similar pattern was observed in 21 New Jersey counties (p < 0.02) and 30 Oregon counties (p < 0.05). In contrast, there was a direct correlation with the increasing percentage of women exclusively breast-feeding from 2000–2004 (p < 0.001). Infants who were solely breast-fed had diets that contained less thiamine, riboflavin, and vitamin D than the minimal daily requirements (MDR). There was no correlation of MMR inoculations with the autism rate.

Conclusion: The mothers who are exclusively breast-feeding should also continue their prenatal vitamins or their equivalent and make better dietary choices. These results suggest that autism may be nutritionally related to a possible deficiency of riboflavin or the cognitive vitamins such as thiamine or vitamin D. However, due to an ecologic study design there is a potential for fallacy because individuals were not examined. The results suggest the need for a robust observational study in advance of, and to confirm the need for, an intervention study.     

Estimation of Vitamin D Intake Based on a Scenario for Fortification of Dairy Products with Vitamin D in a Tehranian Population,Iran

Objective: The aim of this study was to evaluate possible effects of food fortification practices on vitamin D intake in adults.

Design and setting: This was designed as a cross-sectional, population-based study.

Subjects: We investigated vitamin D intake in a population-based sample of 5224 adults, using a validated food frequency questionnaire. A theoretical model was conducted to evaluate the hypothetical effects of dairy product fortification.

Results: Dairy had the highest mean of vitamin D intake among food groups. If all types of milk were fortified by vitamin D (42 IU/100 grams of milk), the mean intake of vitamin D would reach 132 ± 148 (92(180)) IU/day. If both milk and yogurt were fortified to 42 IU/100 g and 89 IU/100 g, respectively, the average mean vitamin D intake from foods in this population would increase from 84 ± 88 IU/day to 308 ± 240 IU/day. As the fortification level increased, the proportions of young people with more than the recommended daily allowance (RDA) of vitamin D increased from 1.1% to 77.4% in men and from 1.4% to 80% in women, but none of them achieved the tolerable upper intake level (UL) of vitamin D.

Conclusion: The proposed fortification scenario would provide enough vitamin D intakes by RDA in a population aged between 18 and 50 years (about 80% of the population), with none of them achieving ULs.     

Vitamin D status in children and young adults with perinatally acquired HIV infection

Background & aims

To assess vitamin D (Vit-D) [serum 25-hydroxyvitamin D (25-OHD) concentrations] in children and young adults with perinatally acquired HIV compared to geographically similar healthy children.

Methods

25-OHD in children and young adults with HIV was compared to a healthy group. Vit-D deficiency and insufficiency were defined as 25-OHD <11 ng/mL and 25-OHD <30 ng/mL, respectively.

Results

Children with HIV (n = 81), mean age 13.8 ± 4.1 years, 48% female, 83% Black, were compared to healthy subjects (n = 372), mean age 12.4 ± 3.4 years, 51% female, 37% Black. For the HIV group, 84% were on HAART, 54% had plasma HIV RNA <400 cpm, and 35% had moderate to severe immunosuppression (CD4+ count <500 cells/mm). Vit-D deficiency/insufficiency was present in 36% and 89% of those with HIV, and 15% and 84% of the comparison group, respectively. Vit-D deficiency was more prevalent in those with HIV (unadjusted odds ratio: 3.25; 95% CI: 1.9–5.5). For both groups, prevalence of Vit-D deficiency increased with age, BMI Z-score, Black race, and in winter/spring months. Vit-D deficiency was associated with a greater degree of immunosuppression in the subjects with HIV.

Conclusions

Vit-D deficiency was increased in subjects with perinatally acquired HIV and may be associated with disease severity.