Vitamin D Recommendations: Do Dark-Skinned Children Require Supplements?

I saw a 12-year-old African American US girl as a new patient and checked her vitamin D level, which we usually do on our panels these days. The level was 8.8 ng/mL, with a "normal" reported as higher than 32 ng/mL. What are current recommendations for vitamin D replacement in children-let alone dark-skinned children?

I would appreciate a response to this puzzling situation, even though I know we really do NOT know what the varables may be for age, race, latitude, and other situations of the patients we see. 

-- Charlene M. Morris, DFAAPA, MPAS, PA-C Pamlico Medical Center, North Carolina

The African American population has typically the lowest 25-hydroxyvitamin D (25-OHD) concentrations.  We know that the vitamin D in infant formula and 400 IU vitamin D supplements for breast fed African American infants will prevent rickets-a good functional outcome. The recommendation for children after the age of 1 year through 18 years is 600 IU per day of vitamin D, according to the new guidelines from the Institute of Medicine. Interestingly enough, African American children tend to have adequate bone mineral density, despite the low 25-OHD level, which implies that other factors-genetics, physical activity, and perhaps calcium intake-are more important than the actual measured 25-OHD level in this population.
 
We could use more research on the implications of lower 25-OHD levels in the African American population. However, given the generally low levels of 25-OHD, adverse effects are hard to identify.

-- Frank R. Greer, MD
Professor of Pediatrics
University of Wisconsin School of Medicine, Madison