Children who are overweight or asthmatic need more Vitamin D – Aug 2023

Pharmacokinetics of Oral Vitamin D in Children with Obesity and Asthma

Clin Pharmacokinet. 2023 Aug 30. doi: 10.1007/s40262-023-01285-9
Jason E Lang 1 2, Rodrigo Gonzalez Ramirez 3, Stephen Balevic 4 3, Scott Bickel 5, Christoph P Hornik 4 3, J Marc Majure 6, Saranya Venkatachalam 3, Jessica Snowden 7, Brian O'Sullivan 8, Laura James 7

Both overweight and asthma are known to reduce Vitamin D response

Note: Some of the children (age 6-15) did not get >43 ng in 4 months

Background and objective: Vitamin D insufficiency is common in several pediatric diseases including obesity and asthma. Little data exist describing the pharmacokinetics of oral vitamin D in children or the optimal dosing to achieve therapeutic 25(OH)D targets. Describe the pharmacokinetics of oral Vitamin D in children with asthma.

Methods: This was a multi-center, randomized, open-label, oral supplementation study to describe the pharmacokinetics of vitamin D in children aged 6-17 years who have asthma and were overweight/obese. Participants had a serum 25(OH)D concentration between 10 and < 30 ng/mL at baseline. In Part 1 of the study, we assessed four 16-week dosing regimens for their ability to achieve 25(OH)D concentrations ≥ 40 ng/mL. Using serial serum 25(OH)D sampling over 28 weeks, we created a population pharmacokinetic model and performed dosing simulations to achieve 25(OH)D concentrations ≥ 40 ng/mL. In Part 2, the optimal regimen chosen from Part 1 was compared (2:1) to a standard-of-care control dose (600 international units IU daily) over 16 weeks. A final population pharmacokinetic model using both parts was developed to perform dosing simulations and determine important co-variates in the pharmacokinetics of vitamin D.

Results: Based on empiric and simulation data, the daily dose of 8000 IU and a loading dose of 50,000 IU were chosen; this regimen raised 25(OH)D concentrations above 40 ng/mL in the majority of participants while avoiding concentrations > 100 ng/mL. A 50,000-IU loading dose led to faster achievement of 25(OH)D therapeutic concentrations (≥ 40 ng/mL). The estimated median (5th-95th percentiles) apparent clearance of vitamin D from the final population pharmacokinetic model was 0.181 (0.155-0.206) L/h. The body mass index z-score was a significant covariate on apparent clearance and was associated with a significantly decreased median half-life in 25(OH)D (body mass index z-score 1.00-1.99: 97.7 days, body mass index z-score 2.00-2.99: 65.9 days, body mass index z-score ≥ 3.00: 39.1 days, p < 0.001).

Conclusions: Obesity impacts vitamin D clearance and the half-life, but serum concentrations > 40 ng/mL can be reached in most children using a loading dose of 50,000 IU followed by a daily dose of 8000 IU.
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158+ Vitamin D Life pages contain ASTHMA... in the title

which includes:

• Resulting childhood Asthma cut in half if 4,400 IU Vitamin D (5 ways to improve it) - RCT April 2023
• Asthma probably fought by Vitamin D in more than 4 ways – review May 2023
• Asthma treated by Vitamin D - 13th Meta-analysis – July 2022
• Wheezing and asthmatic children have weaker Vitamin D responses - May 2022

Vitamin D Life – Overview Obesity and Vitamin D contains:

• FACT: People who are obese have less vitamin D in their blood
• FACT: Obese need a higher dose of vitamin D to get to the same level of vit D
• FACT: When obese people lose weight the vitamin D level in their blood increases
• FACT: Adding Calcium, perhaps in the form of fortified milk, often reduces weight
• FACT: 168 trials for vitamin D intervention of obesity as of Dec 2021
• FACT: Less weight gain by senior women with > 30 ng of vitamin D
• FACT: Dieters lost additional 5 lbs if vitamin D supplementation got them above 32 ng - RCT
• FACT: Obese lost 3X more weight by adding $10 of Vitamin D
• FACT: Those with darker skins were more likely to be obese Sept 2014
• OBSERVATION: Low Vitamin D while pregnancy ==> more obese child and adult
• OBSERVATION: Many mammals had evolved to add fat and vitamin D in the autumn
  • and lose both in the Spring - unfortunately humans have forgotten to lose the fat in the Spring
• SPECULATION: Low vitamin D might be one of the causes of obesity – several studies
• SUGGESTION: Probably need more than 4,000 IU to lose weight if very low on vitamin D due to
    risk factors such as overweight, age, dark skin, live far from equator,shut-in, etc.
• Obesity category has 428 items See also: Weight loss and Vitamin D - many studies   Child Obesity and Vitamin D - many studies

Obese need more Vitamin D

• Normal weight     Obese     (50 ng = 125 nanomole)

Click here for 2014 study

• Normal weight     Obese     (50 ng = 125 nanomole)

Vitamin D Life - 34 studies in both categories Obesity and Infant-Child

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