Bone Abstracts

Background: Children with special needs may be greater risk of vitamin D deficiency due to decreased mobility and outdoor play, concomitant medications that increase catabolism of vitamin D, reduced nutritional intake and low body weight. Gastrostomy-fed children receiving a nutritionally complete formula may still be at risk of vitamin D deficiency due to the above factors.

Objective: The objective of this study is to assess the vitamin D status of special needs children receiving full or partial nutrition via gastrostomy.

Methods: Thirty-two children (24 males) aged 5–16 years, from seven special schools in Manchester receiving gastrostomy feeds took part in the study. Blood samples were obtained in March 2014 (end of winter) to evaluate serum levels of 25-hydroxyvitamin D (25OHD), calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH). In addition, carers were interviewed to obtain a dietary history and assess the subjects’ exposure to sunlight. Daily vitamin D intake was estimated from enteral feed nutritional data.

Results: All children had complex medical conditions. 26 were non-ambulatory and 18 were taking anti-epileptic drugs. Nineteen children (59%) had a Fitzpatrick skin type score of III or higher (South Asian or Black African ethnicity). The children had little or no sunshine exposure in the 3 months prior to data collection.

Data on serum 25OHD was available on 30 subjects and that on PTH in 25 subjects. The mean serum 25OHD concentration was 71.1 nmol/l (±21.4 nmol/l). One child was found to be vitamin D deficient (serum 25OHD 24.6 nmol/l) and four children were vitamin D insufficient (serum 25OHD range 29.9–47.9 nmol/l). Two out of 25 children (8%) had an elevated serum PTH above the upper end of the reference range. All children had normal serum concentrations of P, Ca, and ALP. Thirteen children received <10 μg of vitamin D/day from their feed (range 3.5–9.2 μg/day). None of the children were taking vitamin supplements. Dietary calcium intake met the recommended intake for age and gender in all but one subject.

Conclusion: From our results we conclude that nutritionally complete gastrostomy feeds may be protective against vitamin D deficiency in gastrostomy-fed children with special needs.

Disclosure: The authors declared no competing interests.