Vitamin Information Center

The human body is an amazing factory, with all kinds of parts working together to make chemicals necessary for good health. But one thing it can’t make on its own is vitamin D. Research shows that defect can be troubling, especially among children.

To create vitamin D, which plays an important role in bone health and development, the body needs exposure to sunlight. As some countries move into autumn, the days get shorter and colder and exposure to sunlight decreases, making the colder months of the year a crucial time to watch vitamin D intake. Supplements can play an important role but one question is, how much?

Most of a child’s bone mass is built up early. A vitamin deficiency can prevent a child from building adequate bone mass now, and they won’t be able to make it all up later.

Although a study released this week found that vitamin D deficiencies are common in children around the world, there is minimal data on how much supplementation is necessary or safe.

Vitamin D is a fat — soluble vitamin directly or indirectly involved in several key body processes: regulating calcium and phosphorus levels in the blood, promoting bone formation and mineralisation, restricting parathyroid hormone secretion and promoting anti-tumour activity.

A review of medical literature on the vitamin published last year in The New England Journal of Medicine found that vitamin D is also associated with a reduced risk of type 1 diabetes in children, and may inhibit future hip fracture.

The main source of vitamin D is sunlight, which the body uses to convert vitamin D into a useable form. It’s also found naturally in eggs and fatty fish like salmon or tuna, and milk and some breakfast cereals are fortified with the vitamin.

The Institute of Medicine recommends that children get 200 IUs of vitamin D daily, but some experts say that up to 800 IUs is better.

The new study found that high doses of the vitamin were safe for children, whether taken over the short-term or for a longer period of time, and helped increased bone mass in 10 to 17 year olds.

A study released this summer found that even children who are otherwise healthy can have low levels of vitamin D, resulting in low levels of bone mineral content.

The risk for low vitamin D levels begins in infancy —breast milk, like cow’s milk, is naturally low in vitamin D. And if a mother doesn’t have enough vitamin D, her breast milk won’t either.

A vitamin D deficiency can affect bone growth even if there are no obvious problems.

A bottle of vitamin supplements
The American Academy of Paediatrics says that rickets, bone softening that can lead to fractures and deformity, in infants due to low vitamin D intake is seen in several US states.

The agency recommends that breast-fed infants receive vitamin D supplement drops.

Children at risk
“It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IUs of vitamin D per day beginning during the first two months of life,” said a clinical report for the health agency done by Dr Lawrence Gartner and Dr Frank Greer.

“In addition, it is recommended that an intake of 200 IUs of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual.”

The risks to bone health don’t end in infancy.
A Canadian study released last year found that despite guidelines for its prevention, vitamin D-deficiency rickets in childhood is still seen in the country, with an annual incidence of 2.9 cases per 100,000.

Children living in countries where exposure to sunlight is low had the highest incidence, and most of the affected children had medium to dark skin tones and had been breast fed.

“Since there were no reported cases of breast-fed children having received regular vitamin D (400 IU/d) from birth who developed rickets, the current guidelines for rickets prevention can be effective but are not being consistently implemented,” the study concluded.

Adequate vitamin D levels in the blood are important because the body can’t absorb dietary calcium without vitamin D, so in its absence it steals calcium from the bones, which increases the risk of rickets, osteoporosis and fractures.

This also places teenagers at risk because they have weaker bones that are more likely to fracture.

Children at particular risk include infants who are breast-fed exclusively and don’t receive supplementation, children who use sunscreen in summer, children who don’t use sunscreen in the summer but spend less than 15 minutes a day in direct sunlight, children who receive no supplementation in the winter, and children with chronic diseases that affect fat malabsorption, such as cystic fibrosis or celiac disease, according to the Hospital for Sick Children.

Eric Madrid, MD
Physicians and scientists are starting to realize the numerous health benefits of sunshine exposure and vitamin D supplementation. Most doctors know severe vitamin D deficiency causes rickets. Since rickets is rarely seen today, it is incorrectly assumed that vitamin D deficiency is nonexistent.

Fallbrook and Temecula medical providers have diagnosed hundreds of patients with vitamin D deficiency, or about 90 percent of all patients tested. Nine out of 10 people reading this story likely suffer from vitamin D deficiency.

Why should you have your vitamin D level checked? Studies have shown that those with lower levels of vitamin D in their blood have a higher risk of developing breast cancer, ovarian cancer, colon cancer, prostate cancer, type 1 diabetes, multiple sclerosis and heart disease. One study showed greater than a 60-percent reduction in breast cancer in those with the highest levels of vitamin D in their blood.

In addition, senior citizens who have lower levels of vitamin D in their blood are at higher risk of falls, osteoporosis and bone fractures. Those who suffer from chronic pain and fibromyalgia also have lower levels of vitamin D.

Vitamin D levels are checked by a simple blood test. Treatment usually requires supplementation with vitamin D3 as opposed to the more commonly sold over the counter vitamin D.

Vitamin D is also made from moderate daily sun exposure to the arms and legs. Caution must be taken to prevent sun burning. Many sunscreens will block out UVB, which is the type of sunlight needed for skin to make vitamin D. Those with darker pigment are higher risk of deficiency, which may explain the higher incidence of diseases in certain ethnic populations.

To check your vitamin D level, contact your physician or call (951) 676-4193 for an appointment.

Eric Madrid MD is a family physician with Rancho Family Medical Group, which has offices in Fallbrook and Temecula. See www.ranchofamilymed.com.

TORONTO (Reuters) - The human body is an amazing factory, with all kinds of parts working together to the make the chemicals necessary for good health. But one thing it can’t make on its own is vitamin D. Research shows that defect can be troubling, especially among children.

To create vitamin D, which plays an important role in bone health and development, the body needs exposure to sunlight. As we move into autumn, the days get shorter and colder and our exposure to sunlight decreases, making the colder months of the year a crucial time to watch vitamin D intake. Supplements can play an important role but one question is, how much?

Most of a child’s bone mass is built up early. A vitamin deficiency can prevent a child from building adequate bone mass now, and they won’t be able to make it all up later. Although a study released this week found that vitamin D deficiencies are common in children around the world, there is minimal data on how much supplementation is necessary or safe.

Vitamin D is a fat-soluble vitamin directly or indirectly involved in several key body processes: regulating calcium and phosphorus levels in the blood, promoting bone formation and mineralization, restricting parathyroid hormone secretion and promoting anti-tumor activity. A review of medical literature on the vitamin published last year in The New England Journal of Medicine found that vitamin D is also associated with a reduced risk of type 1 diabetes in children, and may inhibit future hip fracture.

The main source of vitamin D is sunlight, which the body uses to convert vitamin D into a useable form. It’s also found naturally in eggs and fatty fish like salmon or tuna, and milk and some breakfast cereals are fortified with the vitamin. The Institute of Medicine recommends that children get 200 IUs of vitamin D daily, but some experts say that up to 800 IUs is better.

This week’s study found that high doses of the vitamin were safe for children, whether taken over the short-term or for a longer period of time, and helped increased bone mass in 10-17-year olds.

Vitamin D deficiency is particularly a problem for North Americans, research shows, due in part to the higher latitudes at which they live. As well, because of concerns about skin cancer, many people now wear sunscreen, which inhibits the body’s ability to use sunlight to make the vitamin. The Hospital for Sick Children in Toronto says that sunscreen with an SPF above 8 blocks all vitamin D production through the skin. And darker-skinned individuals living in Canada and the United States may be at particular risk because they have more melanin in their skin, which means they need more sunlight than a lighter-skinned person to make the same amount of vitamin D.

A study released this summer found that even children who are otherwise healthy can have low levels of vitamin D, and resulting low levels of bone mineral content. More than 12 percent of the 400 kids studied by researchers at the Children’s Hospital in Boston had levels of vitamin D in their blood low enough to qualify them as deficient, and 40 percent of the children had less than the recommended level
The risk for low vitamin D levels begins in infancy - breast milk, like cow’s milk, is naturally low in vitamin D. And if a mother doesn’t have enough vitamin D, her breast milk won’t either.

A vitamin D deficiency can affect bone growth even if there are no obvious problems. The American Academy of Pediatrics says that rickets (), bone softening that can lead to fractures and deformity, in infants due to low vitamin D intake is seen in several U.S. states. The agency recommends that breast-fed infants receive vitamin D supplement drops.

“It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IUs of vitamin D per day beginning during the first 2 months of life,” said a clinical report for the health agency done by Drs. Lawrence Gartner and Frank Greer. “In addition, it is recommended that an intake of 200 IUs of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual.”

The risks to bone health don’t end in infancy. A Canadian study released last year found that despite guidelines for its prevention, vitamin D-deficiency rickets in childhood is still seen in the country, with an annual incidence of 2.9 cases per 100,000. Children living in the northern part of the country, where exposure to sunlight is the lowest, had the highest incidence, and most of the affected children had medium to dark skin tones and had been breast fed.

“Since there were no reported cases of breast-fed children having received regular vitamin D (400 IU/d) from birth who developed rickets, the current guidelines for rickets prevention can be effective but are not being consistently implemented,” the study concluded.

Adequate vitamin D levels in the blood are important because the body can’t absorb dietary calcium without vitamin D, so in its absence it steals calcium from the bones, which increases the risk of rickets, osteoporosis and fractures. This also places teenagers at risk because they have weaker bones that are more likely to fracture.

Children at particular risk include infants who are breast-fed exclusively and don’t receive supplementation, children who use sunscreen in the summer, children who don’t use sunscreen in the summer but spend less than 15 minutes a day in direct sunlight, children who receive no supplementation in the winter, and children with chronic diseases that affect fat malabsorption, such as cystic fibrosis or celiac disease, according to the Hospital for Sick Children.

Because natural sources are so rare, it’s difficult to get adequate vitamin D in the diet. One tablespoon of cod liver oil has 1,360 IUs, a serving of cooked salmon has 360, a cup of fortified milk has 98 and a whole egg has 20. Fifteen minutes of direct sunlight is enough for many people to reach their needs for vitamin D, but darker-skinned people need longer exposure and because winter sunlight in North America is indirect, supplementation may be recommended.

Do you supplement with extra vitamin D? Let us know: HealthMatters@reuters.com

Unalaska has many great things to offer, but intense sunlight is not one of them. Although the lack of powerful sun may be good for reducing our skin cancer risk, it is not good for our vitamin D levels. The body uses sunlight to make vitamin D from molecules in the skin. Many who live at northern latitudes, especially in the winter, have inadequate vitamin D levels. A study in the British Medical Journal estimates at least 1 billion people worldwide are vitamin D deficient.

Most tissues in the body have receptors for this important vitamin. All of its many functions are still being discovered. The primary role of vitamin D is maintaining normal blood levels of calcium and phosphorous. Long term vitamin D deficiency leads to rickets in children and a softening of the bones in adults.

Currently there is much research being done to discover the additional effects of vitamin D in our bodies. A recent study published in the journal Dibetologia suggests that vitamin D may play a role in preventing type 1 diabetes in children. Vitamin D deficiency has been associated with increased risk of cardiovascular disease, according to a 2008 article in the journal Circulation.

A 2007 article in the New England Journal of Medicine states that people who live at higher latitudes who have vitamin D deficiency, or lack exposure to the sun, have an increased risk of many cancers. The same article suggests vitamin D may also provide protection from hypertension, psoriasis, several autoimmune diseases (including multiple sclerosis and rheumatoid arthritis) and reduce the incidence of fractured bones.

Make sure that you are getting enough vitamin D. It is difficult to get enough from the sun in the summer in Unalaska and impossible in the winter. Check out this Web site from the Norwegian Institute for Air Research to calculate how much vitamin D you are getting from the sun based on your location, weather, skin color, and clothing: http://nadir.nilu.no/~olaeng/fastrt/VitD_quartMED.html.

Obtaining adequate levels of vitamin D from your diet is not easy either. Good dietary sources include fortified milk, eggs, and fatty fish. Some studies, such as one published in the European Journal of Clinical Nutrition last year, have shown that the vitamin D fortification of milk products is not adequate to prevent vitamin D deficiency.

Infants who are breast fed are at particular risk vitamin D deficiency according to a 2004 study published in the American Journal of Clinical Nutrition. Human milk contains little vitamin D, and women who are vitamin D deficient provide even less to their breast-fed infants.

There are differing opinions on the recommended daily intake, especially in light of new studies coming out every day. The USDA recommended daily intake is 400 IUs for a healthy adult. Some physicians recommend much more than that, particularly for those deficient in the vitamin. Because vitamin D can be stored in our bodies, there are high dosages available that can be taken only once a week or once a month.

A 2003 study published in the Journal of Pediatrics looked at the vitamin D levels of women and infants in Alaska. Based on this study, the American Academy of Pediatrics recommends a universal supplement for all infants not receiving vitamin D fortified milk. Talk to your health care provider about getting the right amount of vitamin D for your health.

Tiffany Kelly is medical student from the University of Washington who visited Unalaska for the month of July, 2008. She now lives in Anchorage.

Hardly a week goes by, it seems, without a press release regarding a new vitamin D study appearing in my email box.

For example:

“Men with Low Vitamin D May Have Increased Risk of Heart Attack”
“Study Links Vitamin D to Colon Cancer Survival”
“Vitamin D Inadequacy May Exacerbate Chronic Pain”
“Low Vitamin D Levels May Worsen Osteoarthritis of the Knee”
“Low Levels of Vitamin D Associated with Depression in Older Adults”
“Study Links Vitamin D, Type 1 Diabetes”
“Vitamin D Linked to Reduced Mortality Rate in Chronic Kidney Disease”

Then, last Friday, came the uber-vitamin D press release:

“Low Vitamin D Levels Pose Large Threat to Health”

That study, published this week in the Archives of Internal Medicine, found a 26 percent increase in risk of early death from any cause among people with inadequate levels of vitamin D.

What’s going on? Why this sudden (or so it seems) interest in the “sunshine vitamin”? (The nickname comes from the fact that the vitamin is produced in the skin from sunlight.) And what are health consumers – especially here in Minnesota, where the low angle of the winter sun makes it difficult to sustain adequate vitamin D levels – to make of it all?

Old interest, new connections
Despite the current flurry of studies, research into vitamin D’s multipronged impact on human health “is not all that new,” said Kurt Kennel, M.D., an assistant professor of medicine at the Mayo Clinic in Rochester. Scientists have known since the 1970s that vitamin D’s effect on the body went beyond regulating calcium and helping to build strong bones.

Much of the past research, however, was confined to the laboratory. In recent years, thanks to better ways of assaying (or measuring) vitamin D in the body, scientists have been able to give it a more clinical face, linking it to the risk of developing different diseases.

In addition, aging baby boomers have developed a deep and personal interest in the bone-weakening disease osteoporosis.

“That put vitamin D on the map,” said Kennel.

A misnomer
To understand vitamin D’s ubiquitous role in the body, we need to stop thinking of it as a traditional vitamin.

“If we named it today, we’d call it a hormone,” said Kennel.

Like insulin, adrenaline, estrogen and other hormones, vitamin D is produced by a body organ (in this case, the skin). It’s then carried through the body by a fluid (blood) to other organs and tissues (the heart, brain, breasts, kidneys, muscles, and so on). At each of these destinations, vitamin D adeptly attaches itself to receptors on the DNA of genes in the cells’ nuclei.

As we’re now learning, the resulting effects appear to be remarkably beneficial, possibly protecting against heart disease, kidney disease, diabetes, osteoporosis, multiple sclerosis, certain types of cancers (including breast, lung and colon) and other major illnesses and conditions.

The latest study
In the newly published study – considered the most compelling evidence of vitamin D’s overall health benefits to date – a team of John Hopkins researchers analyzed vitamin D levels in more than 13,000 men and women aged 20 and older who participated in a large ongoing health survey conducted by the Centers for Disease Control and Prevention. The data was collected between 1988 and 1994.

To ensure comparable results, vitamin D levels were surveyed during the summer among participants living in northern states and during the winter among those in southern states.

All participants were tracked until Dec. 31, 2000, by which time 1,806 had died. Those whose vitamin D levels had been the lowest (less than 17.8 nanograms per milliliter of blood) had a 26 percent increased rate of death from any cause compared to those with the highest vitamin D levels (above 50 nanograms per milliliter).

Cardiovascular disease seemed to be the major factor in these deaths, although the study wasn’t able to determine with scientific certainty a cause-effect relationship between low vitamin D levels and heart attacks and strokes.

“In the past few months, several other papers have confirmed that low vitamin D levels are associated with increased risk of heart attacks and strokes,” said Erin Michos, M.D., one of the study’s lead investigators.

In fact, earlier this year, Michos and her team showed an 80 percent increased risk of peripheral artery disease among people with vitamin D deficiency.

It may not be long before vitamin D deficiency is added to the long list of risk factors for heart disease, she said.

What’s a consumer to do?
Vitamin D deficiency is, by some accounts, reaching epidemic proportions. A review article published in The New England Journal of Medicine last year reported that up to 50 percent of children and adults in the United States have insufficient levels (less than 20 nanograms per milliliter).

“Vitamin D deficiency is getting a lot more common because we’re getting more obese and sedentary, and we’re spending less time in the sun,” said Michos.

People who are over the age of 50, who have dark skin, or who wear clothing that covers most of their skin are also at increased risk. (The last two reasons, said Kennel, are partly why Minnesota’s Somali immigrants have higher-than-average rates of vitamin D deficiency.)

Both Kennel and Michos recommend that people boost their vitamin D levels by eating salmon, mackerel and other fatty fish and fortified dairy products. (Years ago, vitamin D used to be added to beer, but, alas, no longer.) You can also take cod-liver oil (yes, just as your great-grandparents did) and/or vitamin supplements.

Federal guidelines currently recommend that adults get 200 to 600 international units (IU) of vitamin D daily. Those recommendations are currently under review, said Kennel, and will most likely be upped.

The National Osteoporosis Society already recommends 800 to 1,000 IU to people aged 50 and older. And the Canadian Cancer Society, citing Canada’s northern latitude, recommends that adults living there take 1,000 IU of vitamin D daily during fall and winter.

Currently, most experts put the safe upper limit of vitamin D from supplementary sources at 2,000 IU per day. But that number, too, may be increased.

Out in the noonday sun
The best way to get vitamin D, of course, is to spend time in the sun. In a single 10-minute midday outing, your skin will produce about 10,000 IU.

Fortunately, your skin won’t let you overdose on vitamin D from the sun. But spending unprotected time in the sun increases your risk of skin cancer, which has also reached epidemic proportions in the United States.

“Unfortunately, the time of the day the dermatologist wants you to be out – the morning and the evening – is the worst time for your body to make vitamin D,” said Kennel.

If you think you’re at increased risk for vitamin D deficiency, talk with your physician about having your blood levels of the vitamin checked. You’ll then have a better idea of whether you need supplements.

And remember: Although the recent findings about vitamin D are intriguing and promising, the benefits are not yet proven.

Studies of other nutrients and hormones – vitamin E, vitamin A, and estrogen, to name a few – were also found to benefit the heart in observational studies. But when it came time for the clinical trials, not only did they fail to prevent heart disease, they actually increased the risk.

Stay tuned.

Medical experts now claim that taking vitamin D supplements during early childhood may dramatically cut the odds of developing Type 1 diabetes later in life. Researches found that children given additional vitamin D were up to 80% less likely to develop Type 1 diabetes than those not given the supplement.

They also found that the higher and more regular the dose, the lower the likelihood of developing the condition. These findings came from the analysis of five studies in various countries.

One of the studies that was looked at was a Finnish sudy that followed more than 12,000 children born in 1966 in Finland. Their study showed that those who took any amount of vitamin D had a lower rate of diabetes than those who did, and those who took recommended amounts of vitamin D were at an 80% reduced risk of developing it.

Type 1 diabetes is an auto-immune disease in which the immune system destroys its own cells. It develops when insulin-secreting cells in the pancreas are destroyed.

Researchers believe that vitamin D, which is believed to be an immuno-suppressant agent, may prevent an overly aggressive response from the immune system. Nutrition experts recommend 8.5 microgrammes a day, and 7 microgrammes a day for those age 7 months to three years.

NEW YORK (Reuters Health) - Softening of the skull bones in normal-appearing newborns is tied to a vitamin D deficiency in the womb, according to Japanese researchers.

They suggest that breast-fed infants with this condition may need vitamin D supplements.

Soft skull bones, also known as craniotabes, in normal newborns is usually regarded as no cause for alarm, but Dr. Tohru Yorifuji at Kyoto University Hospital and colleagues dispute this in their report in the Journal of Clinical Endocrinology and Metabolism. They point to evidence that the condition is associated with type 1 diabetes, reduced bone mass during childhood, and lowered immunity.

In their study, the researchers screened 1120 normal infants at 5 to 7 days of age. Craniotabes was considered present when “the skull bones reversibly bended by application of pressure by the examiner’s fingers.”

They found that 246 babies, or 22 percent, had craniotabes. The highest rate occurred among infants born in April and May, and the lowest in those born in November.

Vitamin D production in the body is triggered by sunlight, and Yorifuji’s team points out that the rate of craniotabes “was influenced by the daylight hours approximately 4 months prior to delivery.” They say this strongly suggests that “the condition is associated with vitamin D deficiency in utero.”

Low vitamin D levels and other abnormalities at 1 month of age were more common in babies who were breast-fed than in those who were fed formula at least part of the time, the investigators found.

They therefore recommend “treating breast-fed infants with craniotabes with vitamin D, or preferably, treating all pregnant women with vitamin D.”

SOURCE: Journal of Clinical Endocrinology and Metabolism, online February 12, 2008.

BABIES are healthier if their mothers are pregnant with them over summer, according to research.

Researchers said babies with softer skulls were more likely to have been in the womb over winter - because their mothers lacked enough vitamin D, which is absorbed from sunlight.

Dr Tohru Yorifuji from the Kyoto University Hospital said his team’s study of more than 1100 newborns in Japanese hospitals revealed that pregnancies over winter could lead to problems in babies.

“Craniotabes, the softening of skull bones, in otherwise normal newborns has largely been regarded as a physiological condition without the need for treatment,” Dr Yorifuji said.

“Our findings, however, show that this untreated condition may be the result of a potentially dangerous vitamin D deficiency.”

In an article to be published in the May edition of the Journal of Clinical Endocrinology & Metabolism, the researchers said 22 per cent of babies studied had craniotabes.

“The incidence was highest in (babies) born in April-May and lowest in those born in November,” the researchers said.

“Otherwise, the incidence of craniotabes was not significantly related with the maternal age, number of pregnancies, birth weight, or weeks of pregnancies.”

Dr Yorifuji said mothers should also be concerned about how much vitamin D their baby needed while feeding.

“Until more research is done on the effects of perinatal vitamin D deficiency, we suggest treating breast-fed infants with craniotabes with vitamin D, or preferably, treating all pregnant women with vitamin D.”

A lack of vitamin D in adults has previously been linked to increased risks of multiple sclerosis, type 1 diabetes and other diseases.

Vitamin D supplements in early childhood may ward off the development of type 1 diabetes in later life, reveals a research review published online March 13 in the Archives of Disease in Childhood  An Autoimmune Disorder
Type 1 diabetes is an autoimmune disorder, in which insulin producing beta cells in the pancreas are destroyed by the body’s own immune system, starting in early infancy. The disease is most common among people of European descent, with around 2 million Europeans and North Americans affected. Its incidence is rising at roughly 3% a year, and it is estimated that new cases will have risen 40% between 2000 and 2010.

A trawl of published evidence on vitamin D supplementation in children produced five suitable studies, the pooled data from which were re-analyzed.

The results showed that:

Vitamin D, Latitude & Diabetes Incidence
Levels of vitamin D, and sunlight, from which the body manufactures the vitamin, have been implicated in the risks of developing various autoimmune disorders, including multiple sclerosis and rheumatoid arthritis.

And there is a striking difference in the incidence of type 1 diabetes according to latitude and levels of sunlight exposure, with a child in Finland 400 times more likely to develop the disease than a child in Venezuela, say the authors.

Further evidence of vitamin D’s role comes from the fact that pancreatic beta cells and immune cells carry receptors or docking bays for the active forms of the vitamin.

Newswise — Softening of the skull bones in normal-looking babies might reflect vitamin D deficiency during pregnancy, according to a new study accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM). Furthermore, breast-feeding without vitamin D supplementation could prolong the deficiency, which might lead to a risk of serious health problems later in life, including type 1 diabetes and decreased bone density.

“Craniotabes, the softening of skull bones, in otherwise normal newborns has largely been regarded as a physiological condition without the need for treatment,” said Dr. Tohru Yorifuji, of Kyoto University Hospital in Japan. “Our findings, however, show that this untreated condition may be the result of a potentially dangerous vitamin D deficiency.”

For this study researchers evaluated 1,120 newborns for incidence of craniotabes, and at 5-7 days of age, 246 neonates (22 percent) were found to have craniotabes. Researchers also found the incidence of craniotabes had obvious seasonal variations. This clear seasonal variation strongly suggests that the condition is associated with prenatal vitamin D deficiency and likely reflects the amount of sun exposure of pregnant women.

Most importantly, vitamin D deficiency in neonates, could persist into later life, especially in breast-fed infants who do not receive a formula containing vitamin D supplementation. In this study, more than half of the breast-fed infants with craniotabes showed statistically significant low levels of serum 25-OH vitamin D, the storage form of vitamin D. Some of those infants also had symptoms of an overactive parathyroid gland consistent with vitamin D deficiency.

Vitamin D deficiency has not received as much attention as it once did, however several recent studies have reported a resurgence of the condition, even in developed countries. Vitamin D deficiency classically presents with skeletal manifestations such as rickets in childhood or the softening of bones in adults. In addition, vitamin D deficiency in adults can also lead to increased incidence of immunological diseases such as multiple sclerosis, type 1 diabetes, or even colorectal cancer.

“Until more research is done on the effects of perinatal vitamin D deficiency, we suggest treating breast-fed infants with craniotabes with vitamin D, or preferably, treating all pregnant women with vitamin D,” said Yorifuji.

Other researchers working on the study include Junko Yorifuji, Shizuyo Nagai, Masahiko Kawai, Toru Momoi, and Tatsutoshi Nakahata of Kyoto University Hospital in Japan; Kenji Tachibana and Hiroshi Hatayama of Adachi Hospital in Japan; and Hironori Nagasaka of Chiba Children’s Hospital in Japan.

A rapid release version of this paper has been published on-line and will appear in the May 2008 issue of JCEM, a publication of The Endocrine Society.

Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society, and the field of endocrinology, visit our web site at http://www.endo-society.org.