Vitamin D Oral Replacement in Children With Obesity Related Asthma: VDORA1 Randomized Clinical Trial.

Children with asthma and obesity are more likely to have lower vitamin D levels, but the optimal replacement dose is unknown in this population. The objective of this study is identifying a vitamin D dose in children with obesity-related asthma that safely achieves serum vitamin D levels of ≥ 40 ng/mL. This prospective multisite randomized controlled trial recruited children/adolescents with asthma and body mass index ≥ 85% for age/sex. Part 1 (dose finding), evaluated 4 oral vitamin D regimens for 16 weeks to identify a replacement dose that achieved serum vitamin D levels ≥ 40 ng/mL. Part 2 compared the replacement dose calculated from part 1 (50,000 IU loading dose with 8,000 IU daily) to standard of care (SOC) for 16 weeks to identify the proportion of children achieving target serum 25(OH)D level. Part 1 included 48 randomized participants. Part 2 included 64 participants. In Part 1, no SOC participants achieved target serum level, but 50-72.7% of participants in cohorts A-C achieved the target serum level. In part 2, 78.6% of replacement dose participants achieved target serum level compared with none in the SOC arm. No related serious adverse events were reported. This trial confirmed a 50,000 IU loading dose plus 8,000 IU daily oral vitamin D as safe and effective in increasing serum 25(OH)D levels in children/adolescents with overweight/obesity to levels ≥ 40 ng/mL. Given the critical role of vitamin D in many conditions complicating childhood obesity, these data close a critical gap in our understanding of vitamin D dosing in children.

Adherence to Vitamin D Intake Guidelines in the United States.

BACKGROUND: The American Academy of Pediatrics (AAP) revised its infant vitamin D intake guidelines in 2008. We aimed to examine previously unexplored trends in meeting vitamin D intake guidelines among US infants since 2009 and whether there were differences across demographic subgroups. METHODS: We analyzed dietary recall data for infants 0 to 11 months in the 2009-2016 NHANES. We estimated the percentage meeting 2008 AAP vitamin D guidelines, defined as consuming ≥1 L of infant formula and/or receiving a vitamin D supplement of ≥400 IU. We used Poisson regressions to assess trends over time and differences across demographic subgroups. RESULTS: Overall, 27.1% (95% confidence interval [CI]: 24.3%-29.8%) of US infants in 2009-2016 met vitamin D intake guidelines, with nonbreastfeeding infants (31.1% [95% CI: 27.6%-34.5%]) more likely to meet guidelines than breastfeeding infants (20.5% [95% CI: 15.4%-25.5%]; P < .01). From 2009-2010 to 2015-2016, overall and for both breastfeeding and nonbreastfeeding infants, there were no significant changes over time in the percentage of infants who met the guidelines (P > .05). Among breastfeeding infants, those with a family income ≥400% of the federal poverty level, with a college graduate head of household, and with private insurance were more likely to meet guidelines. CONCLUSIONS: Among US infants, we observed no increase in meeting AAP vitamin D intake guidelines since 2009. Less than 40% of infants met guidelines in nearly all demographic subgroups. These findings suggest renewed consideration of how to best meet vitamin D intake guidelines.