Vitamin D Natalie Vicca Good Food for New Arrivals Project ASeTTS.

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

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

www.asetts.org.au

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

skin

sunlight

7 -dehydrocholesterolcholecalciferol

Vitamin D3 (fish, meat)

Vitamin D2 (supplements)

25 dihydroxyvitamin D3

1,25-dihydroxyvitamin D3

↑Ca absorption small intestine

↑Urinary calcium reabsorption (kidney)

↑Bone mineralisation

liver

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

Marion Post Wolcott. Corbis www.fags.org

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….

Questions?