1. Natalie Vicca Good Food for New Arrivals Project ASeTTS
Vitamin D
Natalie Vicca
Good Food for New Arrivals Project
ASeTTS

2. ASeTTS Association for Services to Torture and Trauma Survivors
Free & Confidential service
Counselling, advocacy, support, group and community activities

3. Good Food for New Arrivals
Funded by Australian Government under the Stronger Families and Communities Invest to Grow Program.

4. Services at ASeTTS www.asetts.org.au Counselling & Advocacy
Community development programs and support groups
Personal Support Program
Volunteer program
Settlement grants program
Training, professional development & consultation
Strength to Strength Relationship support
Good Food for New Arrivals Nutrition Project
Integrated service centre MDT at selected Primaries
Newly Arrived Youth Support Service
Sessional psychiatrist

5. Australia’s Humanitarian Programme
Nationally 13,000 accepted each year
2006
Total under 18 years = 56%
Under 9 years old = 27%
200 visa is refugee visa or 204 woman at risk
The SHP includes those that are sponsored to come by other family members and PPV and TPV as well as the onshore processed visas
Numbers from =12144
Total under 18 years = 56% = 6735
Under 9 years old = 27% = 3262

6. Learning Objectives Be aware of sources and function of Vit D
Be aware of the effects of Vit D deficiency
Recognise groups at risk of deficiency
The situation in WA
Identify screening/treatment strategies

7. Sources Sunlight -D3 cholecalciferol Diet -D2 ergocalciferol
Fish, Eggs, Margarine, Milk, some meats
Requirements = 5-15 Micrograms/day
(Nutrient Reference Values for Australia and New Zealand 2006)
Where do we get the stuff and how much do we need?
19-50yrs = 5mcg
51-70yrs = 10 mcg
>70yrs = 15mcg

8. Function Variety of neuromuscular and physiological functions
Maintains serum calcium and phosphorus
Role in enhancing immune function

9. sunlight skin 7 -dehydrocholesterol cholecalciferol
Vitamin D3 (fish, meat)
Vitamin D2 (supplements)
liver
The vitamin is activated through multiple organ systems
When anything is wrong with these systems there may be issues with Vitamin D i.e kidney failure, bowel disease
25 dihydroxyvitamin D3
1,25-dihydroxyvitamin D3
↑Ca absorption small intestine
↑Urinary calcium reabsorption (kidney)
↑Bone mineralisation
kidney

10. Deficiency Rickets in children Osteoporosis and Osteomalacia adults
Implicated in development of
Psoriasis
Type 1 Diabetes Mellitus
Multiple Sclerosis
Gastrointestinal Cancers
Difference due to pathogenesis of growing versus mature bone

11. WA Situation
Migrant Health found approx 16% of children and 11% of adults have moderate to severe vitamin D deficiency
Many more with mild deficiency - 40%
Have been emergency presentations due to hypocalcaemic seizures
40% of all those seen have inadequate levels of vitamin D

12. Who is at risk? Those who do not get enough sunlight.
Covered for cultural reasons
Dark skin needs longer exposure
Elderly
Breastfed babies of deficient mothers
Babies not introduced to solids appropriately
Who are we talking about?
Insufficient sun exposure
Elderly do not metabolise as efficiently

13. Sun exposure Outside of peak hours
Without sun screen for short periods only
Hands, arms and face if possible
Darker skins require longer exposure
7 minutes in summer for moderate to fair skin, up to 3-4 times longer for highly pigmented skins.

14. Symptoms and Signs Young Infants Restlessness Poor sleep Craniotabes
(Soft posterior skull due to reduced mineralisation)
Obviously difficult to assess!!

15. Older infants Delayed sitting/crawling Delayed closure fontanelle
Bossing of skull
Costochondral beading
Delayed tooth development
Photos courtesy of Tom D Thacher, MD

16. Children (1-4 yrs) Enlarged Epiphysial cartilages wrists/ankles
Kyphoscoliosis
Delayed walking
Abnormal teeth excessive caries

18. Bow leg abnormality
Knock knees
Photos courtesy of Tom D Thacher, MD

19. Marion Post Wolcott. Corbis www.fags.org

20. Older children and adolescents
Painful walking
Bowlegs
Knock knees
Abnormal teeth
Excessive caries
Neuromuscular hyperactivity muscle weakness

21. Adults Weak bones Bone pain (spinal, pelvic, legs) Muscle weakness
Hypocalcaemia
Compressed vertebrae
Pelvic flattening
Easy fracturing

22. What can be done? Screening
Blood test – vitamin D, U&E’S, PTH, Ca, LFT’s
Signs or symptoms screened by GP

23. Treatment Children Adults
Managed via PMH due to sole access to supplementation
Adults
Managed by GP
E.g. Ostelin tablets/d

24. After 2 years of treatment
Photos courtesy of Tom D Thacher, MD

25. Summary Slip Slap Slop Still stands but…. SPOT – those at risk
SCREEN - those likely to be deficient
SUPPLEMENT – those with low levels

26. Questions?