Vitamin D Recommendations: Do Dark-Skinned Children Require Supplements?

 Consultations & Comments

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Vitamin D Recommendations: Do Dark-Skinned Children Require Supplements?

I saw a 12-year-old African American US girl as a new patient and checked her vitamin D level, which we usually do on our panels these days. The level was 8.8 ng/mL, with a “normal” reported as higher than 32 ng/mL. What are current recommendations for vitamin D replacement in children—let alone dark-skinned children?

I would appreciate a response to this puzzling situation, even though I know we really do NOT know what the variables may be for age, race, latitude, and other situations of the patients we see.

—— Charlene M. Morris, DFAAPA, MPAS, PA-C
         Pamlico Medical Center, North Carolina   

The African American population typically has the lowest 25-hydroxyvitamin D (25-OHD) concentrations. We know that the vitamin D in infant formula and 400-IU vitamin D supplements for breast-fed African American infants will prevent rickets—a good functional outcome. The recommendation for children after the age of 1 year through 18 years is 600 IU of vitamin D per day, according to the new guidelines from the Institute of Medicine.¹ Interestingly enough, African American children tend to have adequate bone mineral density, despite the low 25-OHD level, which implies that other factors—genetics, physical activity, and perhaps calcium intake—are more important than the actual measured 25-OHD level in this population.

We could use more research on the implications of lower 25-OHD levels in the African American population. However, given the generally low levels of 25-OHD, adverse effects are hard to identify.

—— Frank R. Greer, MD
         Professor of Pediatrics
         University of Wisconsin School of Medicine
         Madison