Defining Vitamin D Insufficiency in School Age Children: A Randomized Placebo Controlled Trial of Vitamin D3 (Vitamin D RCT)

The study objective is to characterize the threshold levels of serum 25-hydroxyvitamin D for the definition of vitamin D insufficiency in 8-14 year old African American and Caucasian children.

We propose a 6 month randomized placebo controlled trial of vitamin D (vitamin D3 1000 IU/day vs. placebo) initiated during October through March (during fall and winter) in 8 to 14 year old African American and Caucasian children. The results of the trial will help establish the cutoff threshold value of serum 25(OH)D for defining vitamin D insufficiency in preadolescent and adolescent children. Safety of vitamin D supplementation will be assessed by measuring serum calcium at 0, 2 and 6 months and by monitoring for adverse events. Currently recommended adequate intake for vitamin D of 200 IU daily may not meet the body's daily needs for vitamin D. Therefore, it is likely that a higher level of daily vitamin D intake may be needed to meet the body's skeletal and non-skeletal demands for vitamin D. Determining the dietary required intake of vitamin D for the prevention of vitamin D insufficiency during childhood has immense public health potential for addressing health disparities and ensuring better bone health during adulthood. The primary outcome measure will be serum 25(OH)D and parathyroid hormone (PTH). The secondary outcome measures will include: markers of bone formation (serum P1NP) and bone resorption (serum CTX).We will also examine differences in serum 25(OH)D, PTH, and markers of bone turnover in African American vs. Caucasian children.

Study Overview

• Status: Completed
• Conditions: Healthy
• Intervention / Treatment: Dietary supplement: Vitamin D3 1000 IU; Dietary supplement: Placebo Tablet

Detailed Description

Epidemiologic and clinical data document a high prevalence of vitamin D insufficiency among adults and adolescents in the US. Vitamin D insufficiency during childhood has the potential to impact the acquisition of peak bone mass. Vitamin D insufficiency is also associated with several non-skeletal disorders including cancer (prostate, breast, and colon), diabetes mellitus (type 1 and type 2), and multiple sclerosis. In our pilot study nearly 50% of 6 to 10 year old African American children residing in Pittsburgh, Pennsylvania, were deemed vitamin D insufficient (serum 25-hydroxyvitamin D (25(OH)D): ≤ 20 ng/mL; Rajakumar K, et al. Clinical Pediatrics. 2005;44:683-692). To extend this field further, we are proposing a randomized placebo-controlled trial of vitamin D3 for establishing the serum 25-hydroxyvitamin D (25(OH)D) cutoff threshold levels for defining vitamin D insufficiency during childhood and to document the safety and efficacy of treatment on the vitamin D status of the study cohort. A total of 168 (African American: 84, Caucasian: 84) 8 to 14 year old preadolescent and adolescent children will undergo a randomized-placebo controlled trial (RCT) of vitamin D3 1000 IU daily vs. placebo for 6 months initiated during fall and winter (October through March). Safety of vitamin D supplementation will be assessed by measuring serum calcium at 0, 2 and 6 months and by monitoring for adverse events. We will also examine the differences in serum 25(OH)D, PTH, and markers of bone turnover in African American vs. Caucasian children. The primary outcome measure will be serum 25(OH)D and PTH. The secondary outcome measures will include: markers of bone formation: serum osteocalcin (OC) and bone resorption: serum C-terminal cross-linking telopeptide of type 1 collagen (serum CTX). Additional outcomes will include: dietary intake of vitamin D and calcium, skin color (Fitzpatrick Sunreactive Skin Type and Melanin Index), sun exposure, and body mass index. Vitamin D deficiency will be defined as serum 25-hydroxyvitamin D concentrations <20 ng/mL. Public health importance of childhood vitamin D insufficiency is linked to the impact of vitamin D status on the acquisition of peak bone mass. Reduced peak bone mass can predispose to premature onset of osteoporosis and increase the risk for osteoporosis related fragility fractures. Achieving and maintaining vitamin D sufficiency during childhood can positively impact the skeletal health of children and reduce their "osteoporosis" burden during adulthood, and modify their risk for the non-skeletal disorders associated with chronic vitamin D insufficiency. Paucity of data regarding threshold levels of serum 25(OH)D associated with vitamin D insufficiency status among school age children and the likelihood that the serum 25(OH)D threshold levels for vitamin D sufficiency could be different among African American and Caucasian children makes it compelling for this issue to be explored. Based on expert opinion and supportive data in the medical literature, we feel that the currently recommended adequate intake for vitamin D for pre- and adolescent children (200 IU daily) is woefully inadequate to meet the daily needs for vitamin D. Therefore, it is likely that a higher level of daily vitamin D intake may be needed to meet the body's skeletal and non-skeletal demands for vitamin D. This study will determine the serum 25(OH)D cutoff for the definition of vitamin D insufficiency and document the safety and efficacy of treatment on vitamin D status.

• Study Type: Interventional
• Enrollment (Actual): 157
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15217
      • Children's Hospital of Pittsburgh

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 14 years (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age: 8-14 years
• Race: African American or Caucasian
• Children not taking multivitamins for at least 1 month before enrollment and agree not to start any multivitamin supplements during the 6-month trial period.
• Children who are on multivitamins can be considered for enrollment only if they are able to and agree to stop their multivitamin tablet for a 1 month washout period prior to enrollment.
• Absence of chronic diseases that could affect growth or calcium or vitamin D metabolism

Exclusion Criteria:

• Hepatic or renal disease
• Metabolic rickets
• Malabsorptive disorders (Crohn's disease, cystic fibrosis and celiac disease) or cancer
• Treatment with anticonvulsants or systemic glucocorticoids

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo; Placebo Tablet	Dietary supplement: Placebo Tablet; Placebo Tablet once daily for 6 months
Experimental: Vitamin D3; Vitamin D3 1000 IU Tablet	Dietary supplement: Vitamin D3 1000 IU; Vitamin D3 1000 IU Tablet once daily for 6 months

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Serum 25-hydroxyvitamin D	Circulating concentration of 25 hydroxyvitamin D is a biomarker of vitamin D status. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D concentrations <20 ng/mL.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parathyroid Hormone (PTH) Dietary Data		6 months
Osteocalcin (OC)	Marker of bone formation	6 months
Collagen Type 1 Cross-linked C-telopeptide (CTx)	Collagen type 1 cross-linked C-telopeptide (CTx) is a marker of bone resorption.	6 months

Collaborators and Investigators

• Sponsor: University of Pittsburgh
• Investigators: Principal Investigator: Kumaravel Rajakumar, MD, University of Pittsburgh

Publications and helpful links

General Publications

• Rajakumar K, Moore CG, Yabes J, Olabopo F, Haralam MA, Comer D, Bogusz J, Nucci A, Sereika S, Dunbar-Jacob J, Holick MF, Greenspan SL. Effect of Vitamin D3 Supplementation in Black and in White Children: A Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab. 2015 Aug;100(8):3183-92. doi: 10.1210/jc.2015-1643. Epub 2015 Jun 19.

Study record dates

Study Major Dates

• Study Start: October 1, 2008
• Primary Completion (Actual): October 1, 2011
• Study Completion (Actual): October 1, 2011

Study Registration Dates

• First Submitted: August 7, 2008
• First Submitted That Met QC Criteria: August 11, 2008
• First Posted (Estimate): August 12, 2008

Study Record Updates

• Last Update Posted (Estimate): December 29, 2015
• Last Update Submitted That Met QC Criteria: November 30, 2015
• Last Verified: November 1, 2015

More Information

Terms related to this study

• Keywords: Adolescent; Child; African American; Vitamin D Deficiency; Vitamin D Insufficiency; Caucasian; Preadolescent; Definition
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Micronutrients; Vitamins; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Vitamin D; Cholecalciferol
• Other Study ID Numbers: 1K23HD052550-01A2 (U.S. NIH Grant/Contract)