Vitamin D plays an important role in regular bone growth and in adequate function of the innate immune system, including barrier functions of mucous membranes. A sufficient supply during pregnancy and lactation protects the child from infectious diseases. Clinical symptoms of severe vitamin D deficiency (rickets) are well known and can be easily detected. Signs and symptoms beyond deficiency, however, remain to be elucidated. Based on clinical and observational data, the plasma level of 25(OH)D may serve as a ‘marker’ to detect or define a subclinical deficiency. Levels below 50 nmol/l might be insufficient to maintain the non-bone-related activities of vitamin D. Finally, it has to be considered that all of the nonbone activities of vitamin D are in concert with vitamin A (9-cis retinoic acid). Studies combining both vitamins in sufficient amounts (cod liver oil) demonstrated a beneficial effect on the prevention of respiratory tract infections. Consequently, it should be strongly recommended to increase the intake of vitamin D and to ensure a daily intake of vitamin A as counseled.

1.
{BC0}1 Urbain P, Singler F, Ihorst G, Biesalski HK, Bertz H: Bioavailability of vitamin D(2) from UV-B-irradiated button mushrooms in healthy adults deficient in serum 25-hydroxyvitamin D: a randomized controlled trial. Eur J Clin Nutr 2011;65:965–971.
2.
{BC0}2 Park EA: The therapy of rickets. J Am Med Assoc 1940;115:370–379.
3.
{BC0}3 Ginde AA, Scragg R, Schwartz RS, Camargo CA Jr: Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults. J Am Geriatr Soc 2009;57:1595–1603.
4.
{BC0}4 Truesdell D, Shin H, Liu PY, Ilich JZ: Vitamin D Status and Framingham Risk Score in overweight postmenopausal women. J Womens Health (Larchmt) 2011, E-pub ahead of print.
5.
{BC0}5 Rodríguez-Rodríguez E, Navia-Lombán B, López-Sobaler AM, Ortega RM: Associations between abdominal fat and body mass index on vitamin D status in a group of Spanish schoolchildren. Eur J Clin Nutr 2010;64:46.
6.
{BC0}6 Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, Holick MF, Hollis BW, Lamberg-Allardt C, McGrath JJ, Norman AW, Scragg R, Whiting SJ, Willett WC, Zittermann A: The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007;85:649–650.
7.
{BC0}7 Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA: The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96:53–58.
8.
{BC0}8 DeLuca HF: Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004;80(suppl):1689S–1696S.
9.
{BC0}9 Heaney RP: The vitamin D requirement in health and disease. J Steroid Biochem Mol Biol 2005;97:13.
10.
10 Papapetrou PD: The interrelationship of serum 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D in pregnancy at term: a meta-analysis. Hormones (Athens) 2010;9:136–144.
11.
11 Brannon PM, Picciano MF: Vitamin D in pregnancy and lactation in humans. Annu Rev Nutr 2011;31:89–115.
12.
12 Hensel KJ, Randis TM, Gelber SE, Ratner AJ: Pregnancy-specific association of vitamin D deficiency and bacterial vaginosis. Am J Obstet Gynecol 2011;204:41.e1–9.
13.
13 Bodnar LM, Krohn MA, Simhan HN: Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. J Nutr 2009;139:1157–1161.
14.
14 Mehta S, Spiegelman D, Aboud S, Giovannucci EL, Msamanga GI, Hertzmark E, Mugusi FM, Hunter DJ, Fawzi WW: Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania. Eur J Clin Nutr 2010;64:808–817.
15.
15 Mora JR, Iwata M, von Andrian UH: Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol 2008;8:685–689.
16.
16 Clairmont A, Tessman D, Stock A, Nicolai S, Stahl W, Sies H: Induction of gap junctional intercellular communication by vitamin D in human skin fibroblasts is dependent on the nuclear induction of gap junctional intercellular communication by vitamin D in human skin fibroblasts is dependent on the nuclear vitamin D receptor. Carcinogenesis 1996;17:1389–1391.
17.
17 Baltes S, Nau H, Lampen A: All-trans retinoic acid enhances differentiation and influences permeability of intestinal Caco-2 cells under serum-free conditions. Dev Growth Differ 2004;46:503–514.
18.
18 Hewison M: Vitamin D and innate and adaptive immunity. Vitam Horm 2011;86:23–62.
19.
19 Kamen DL, Tangpricha V: Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med (Berl) 2010;88:441–450.
20.
20 Schulz C, Engel U, Kreienberg R, Biesalski HK: Vitamin A and beta-carotene supply of women with gemini or short birth intervals: a pilot study. Eur J Nutr 2007:46:12–20.
21.
21 Godel JC, Basu TK, Pabst HF, Hodges RS, Hodges PE, Ng ML: Perinatal vitamin A (retinol) status of northern Canadian mothers and their infants. Biol Neonate 1996:69:133–138.
22.
22 Lietz G, Lange J, Rimbach G: Molecular and dietary regulation of beta,beta-carotene 15,15′-monooxygenase 1 (BCMO1). Arch Biochem Biophys 2010;502:8–16.
23.
23 Karatekin G, Kaya A, Salihoğlu O, Balci H, Nuhoğlu A: Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 2009;63:47.
24.
24 Inamo Y, Hasegawa M, Saito K, Hayashi R, Ishikawa T, Yoshino Y, Hashimoto K, Fuchigami T: Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children. Pediatr Int 2011;53:199–201.
25.
25 Roth DE, Shah R, Black RE, Baqui AH: Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh. Acta Paediatr 2010;99:389–393.
26.
26 McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, Rosenberg AM: Vitamin D deficiency in young children with severe acute lower respiratory infection. Pediatr Pulmonol 2009;44:981–988.
27.
27 Strobel M, Tinz J, Biesalski HK: The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. Eur J Nutr 2007;46(suppl 1):I1–I2.
28.
28 Biesalski HK: The significance of vitamin A for the development and function of the lung. Forum Nutr 2003;56:37.
29.
29 Tupasi TE, Lucero MG, Magdangal DM, Mangubat NV, Sunico ME, Torres CU, de Leon LE, Paladin JF, Baes L, Javato MC: Etiology of acute lower respiratory tract infection in children from Alabang, Metro Manila. Rev Infect Dis 1990;12(suppl 8):S929–S939.
30.
30 Sempértegui F, Estrella B, Camaniero V, Betancourt V, Izurieta R, Ortiz W, Fiallo E, Troya S, Rodríguez A, Griffiths JK: The beneficial effects of weekly low-dose vitamin A supplementation on acute lower respiratory infections and diarrhea in Ecuadorian children. Pediatrics 1999;104:e1.
31.
31 Bhandari N, Bhan MK, Sazawal S: Impact of massive dose of vitamin A given to preschool children with acute diarrhoea on subsequent respiratory and diarrhoeal morbidity. BMJ 1994;309:1404–1407.
32.
32 Schwalfenberg GK: A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Mol Nutr Food Res 2011;55:96–108.
33.
33 Wang TT, Nestel FP, Bourdeau V, Nagai Y, Wang Q, Liao J, Tavera-Mendoza L, Lin R, Hanrahan JW, Mader S, White JH: Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol 2004;173:2909–2912.
34.
34 Linday LA, Shindledecker RD, Tapia-Mendoza J, Dolitsky JN: Effect of daily cod liver oil and a multivitamin-mineral supplement with selenium on upper respiratory tract pediatric visits by young, inner-city, Latino children: randomized pediatric sites. Ann Otol Rhinol Laryngol 2004;113:891.
35.
35 Linday LA: Cod liver oil, young children, and upper respiratory tract infections. J Am Coll Nutr 2010;29:559–562.
36.
36 Linday LA, Umhau JC, Shindledecker RD, Dolitsky JN, Holick MF: Cod liver oil, the ratio of vitamins A and D, frequent respiratory tract infections, and vitamin D deficiency in young children in the United States. Ann Otol Rhinol Laryngol 2010;119:64–67.
37.
37 Bahl R, Bhandari N, Taneja S, Bhan MK: The impact of vitamin A supplementation on physical growth of children is dependent on season. Eur J Clin Nutr 1997;51:26.
38.
38 Johnson DD, Wagner CL, Hulsey TC, McNeil RB, Ebeling M, Hollis BW: Vitamin D deficiency and insufficiency is common during pregnancy. Am J Perinatol 2011;28:7–12.
39.
39 Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL: Vitamin D supplementation during pregnancy: double blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011, DOI: 10.1002/jbmr.463.
40.
40 Hintzpeter B, Mensink GB, Thierfelder W, Müller MJ, Scheidt-Nave C: Vitamin D status and health correlates among German adults. Eur J Clin Nutr 2008;62:1079–89.
41.
41 Hintzpeter B, Scheidt-Nave C, Müller MJ, Schenk L, Mensink GB: Higher prevalence of vitamin D deficiency is associated with immigrant background among children and adolescents in Germany. J Nutr 2008;138:1482–1490.
42.
42 Lee JM, Smith JR, Phillip BL, Chen TC: Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr 2007;46:42–44.
43.
43 World Health Organization: Complementary Feeding of Young Children in Developing Countries. Geneva, WHO, 1998.
44.
44 Andiran N, Yordam N, Ozön A: Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition 2002;18:47–50.
45.
45 Wilson RD, Johnson JA, Wyatt P, Allen V, Gagnon A, Langlois S, Blight C, Audibert F, Désilets V, Brock JA, Koren G, Goh YI, Nguyen P, Kapur B, Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada and The Motherrisk Program: Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can 2007;29:1003–1026.
46.
47.
47 Nutrient Data Laboratory: Food Composition Classics. http://www.nal.usda.gov/fnic/foodcomp/Data/Classics/index.html
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.