Standard multivitamin supplementation does not improve vitamin D insufficiency after burns

Abstract

Children suffering severe burns develop progressive vitamin D deficiency because of inability of burned skin to produce normal quantities of vitamin D 3 and lack of vitamin D supplementation on discharge. Our study was designed to determine whether a daily supplement of a standard multivitamin tablet containing vitamin D 2 400 IU (10 μg) for 6 months would raise serum levels of 25-hydroxyvitamin D [25(OH)D] to normal. We recruited eight burned children, ages 5-18, whose families were deemed reliable by the research staff. These children were given a daily multivitamin tablet in the hospital for 3 months in the presence of a member of the research staff and then given the remainder at home. At 6 months, the subjects returned for measurements of serum levels of 25(OH)D,1,25-dihydroxyvitamin D [1,25(OH) 2 D], intact parathyroid hormone (iPTH), Ca, P, albumin, and total protein as well as bone mass by dual energy X-ray absorptiometry. Serum 25(OH)D levels were compared to a group of seven age-matched burned children studied at an earlier date without the vitamin supplement but with the same method of determination of 25(OH)D at 6 months post-burn. In addition, the chewable vitamins were analyzed for vitamin D 2 content by high performance liquid chromatography. Serum concentration of 25(OH)D was 21 ± 11(SD) ng/ml (sufficient range 30-100) with only one of the eight children having a value in the sufficient range. In comparison, the unsupplemented burn patients had mean serum 25(OH)D level of 16 ± 7, P = 0.33 versus supplemented. Serum levels of 1,25(OH) 2 D, iPTH, Ca, P, albumin, and total protein were all normal in the supplemented group. Vitamin D 2 content of the chewable tablets after being saponified and extracted was 460 ± 20 IU.Bone mineral content of the total body and lumbar spine, as well as lumbar spine bone density, failed to increase as expected in the supplemented group. No correlations were found between serum 25(OH)D levels and age, length of stay, percent body surface area burn or third-degree burn. Supplementation of burned children with a standard multivitamin tablet stated to contain 400 IU of vitamin D 2 failed to correct the vitamin D insufficiency.

The Interaction Between Burn Injury and Vitamin D Metabolism and Consequences for the Patient

“…By six months post-burn, serum albumin and total protein are normal [21] although the length of time it takes serum vitamin D Binding Protein to return to normal has not been studied.…”

Nutrition therapy in the critically ill child

“…In 32 children with a mean age of 4 years and 15% TBSA burns, those randomized to vitamin C, E, and zinc supplementation demonstrated significant reductions in lipid peroxidation and time required for wound healing [50]. Vitamin D insufficiency is also prevalent in children with severe burns and is not improved with multivitamin supplementation [51,52]. Vitamin D status may influence the course of illness in critically ill children.…”

A critique of prevailing approaches to nutrient risk analysis pertaining to food supplements with specific reference to the European Union

“…This is not rational particularly if the adverse health effect in question is: (i) mild and transient; (ii) is restricted to a specific population group whose exposure could be risk managed via labelling; (iii) where there is an overlap between risk and benefit; (iv) where other adverse health effects are known not to occur even with considerably higher intake levels, and (v) where significant benefits are to be achieved at higher intakes. Klein et al (2009) found that a multivitamin containing vitamin D (5 g [200 IU] D2) did not significantly raise circulating vitamin D levels in children burns victims, implying considerably higher doses would be required. Three forms of vitamin B3, namely nicotinic acid, niacinamide and inositol hexanicotinate, illustrate the importance of different intake-response relationships of various molecular forms; variation typically occurs between individuals (adaptation and physiological requirement) as well as within the same individual, temporally.…”