Severe Burn Injury Causes Vitamin D Deficiency in Children

Children with burn injuries that cover more than 40% of their bodies may become vitamin D deficient, according to a new study in The Lancet (2004;363:291–2). Deficiency of vitamin D in children may lead to long-term adverse effects, such as rickets (softening of the bones), bone fractures, and osteoporosis.

Vitamin D is necessary for maintaining a normal blood concentration of calcium; it also enhances the absorption of calcium from the intestines. Vitamin D can be manufactured in the body from a precursor molecule that is produced when the skin is exposed to direct sunlight. People living in Northern regions (such as Sweden, Norway, and Alaska) and those who avoid the sun or cover their bodies when outdoors may be prone to developing vitamin D deficiency; however, ordinarily only a small amount of sun exposure is required to prevent it. This new research suggests severely burned skin may inhibit vitamin D production.

In the study, 12 children between 4 and 14 years old with severe burns (average burn area of 52% of total body area) had skin biopsies taken from burned skin and healthy looking skin adjacent to the burn area. Each skin sample was measured for 7-dehydrocholesterol, a precursor molecule for pre-vitamin D3 (25-hydroxycholecalciferol), and a second skin sample was exposed to ultraviolet (UV) light for four minutes and measured for pre-vitamin D3. Pre-vitamin D3 is converted in the kidneys to the active form of vitamin D. Blood levels of pre-vitamin D3 and active vitamin D3 were also measured. Skin and blood samples were compared with healthy skin and blood samples from non-burned children.

No significant decrease in blood levels of active vitamin D3 was observed in children with severe burns, compared with blood levels of active vitamin D3 in healthy children. However, 73% of the burn victims had significantly lower blood levels of pre-vitamin D3, suggesting vitamin D deficiency. The amount of 7-dehydrocholesterol from the skin sample that was not exposed to UV light was lower in the burned skin than in unburned skin. The skin samples exposed to UV light showed that both burned skin and adjacent skin to the burn scar had significantly lower pre-vitamin D3 levels than non-burned skin. This shows that conversion of 7-dehydrocholesterol to pre-vitamin D3 is impaired in not just burn scar areas, but also in healthy-looking skin adjacent to the scar. This means that vitamin D production in children with burns may be less than previously thought.

Several studies have shown that children with severe burns have a higher risk of bone fracture and osteoporosis, though the exact mechanism of how this occurs is not completely understood. The current study found no difference in the blood level of active vitamin D3, which suggests that the bone loss observed in burn victims may involve other chemicals or hormones. Nonetheless, parents of children with severe burn injuries should consider giving their child supplemental vitamin D to prevent deficiency. A physician should be consulted for specific intake amounts, as the amount necessary to correct vitamin D deficiency may depend on the degree of deficiency.

Darin Ingels, ND, MT (ASCP), received his bachelor’s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of The Natural Pharmacist: Lowering Cholesterol (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice at New England Family Health Associates located in Southport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.

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