الفهرس 
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Abstract
Both the D2 and D3 forms of vitamin D are commonly used in human supplementation. But there is controversy regarding the effect of vitamin D2 and D3 in elevating and sustaining 25 (OH) D.
This study aims to evaluate the difference between the effect of enteral vitamin D2 and vitamin D3 administration in raising serum 25(OH)D in pediatric patients.
This experimental randomized controlled clinical trial was conducted at tertiary care hospital at Pediatric Endocrinology Unit, Children’s Hospital, Ain Shams University from January 2022 till December 2022 and performed on total 60 patients who diagnosed with vitamin D deficient children with age ranged from 5 to 10 years. All the included subjects in both groups had normal baseline total serum calcium, serum phosphorus, serum alkaline phosphatase, and serum parathyroid hormone measured using commercially available kits and compared to age-adjusted references. While all the included subjects had inadequate serum levels of total 25 (OH) D upon enrollment (< 30 ng/ml).
The recruited subjects were divided into 2 groups by sequential randomization:
1- group A will receive oral vitamin D2 2400 IU daily for 3 months
2- group B will take oral vitamin D3 2400 IU daily for 3 months (Özkan, 2010).
Summary
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The monthly increment in 25(OH)D level were significantly higher in vitamin D3 group than in vitamin D2 group after 2nd, and 3rd months of treatment furthermore, there was a negative correlation between baseline serum 25(OH)D and increment after 1 month in group A (p value=0.000) .
Following vitamin D supplementation of 2400 units vitamin D daily for 3 months, all cases obtained a favorable serum level. The final levels reached (54.14 ± 11.33), (47.45 ± 8.82), and (54.00 ± 10.57) ng/ml, in individuals with baseline vitamin D levels below 10 ng/ml, (10–20) ng/ml and (20–30) ng/ml, respectively. The changes in 25(OH) vitamin D in all three groups were highly significant (p value= 0.001) The increment in vitamin D levels were (46.36 ± 11.39), (34.77 ± 10.30) and (32.38 ± 10.73) ng/ml(p value= 0.001) in individuals with baseline vitamin D levels below 10 ng/ml, 10–20 ng/ml and 20–30 ng/ml, respectively from baseline . Furthermore, in our study we revealed that the monthly increment in patients who received vitamin D3 was greater than in patients who received vitamin D2 after 2nd and 3rd . This could be related to the good compliance with vitamin D3 oral drops, where vitamin D2 was oral tablets.
As regards the percentage of patients who reached sufficiency after 1st , 2nd , and 3rd month of treatment, our study results revealed that all participants who received enteral vitamin D3 reached a sufficient level (30-100) ng/ml of 25 (OH) D after 2 months, while only 17 out of 30 participants in group A who received enteral vitamin D2 reached a sufficient 25 (OH) D
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level after 2 months and 6 participants reached a sufficient 25 (OH) D level after 3 months (p value= 0.017).
The strength points of this study:
The strength points of this study are that it is prospective study design and having no patients lost to follow-up in three months. It is the first study in Ain Shams University Hospital to compare effectiveness of oral Vitamin D3 compared with Vitamin D2 in raising of serum 25(OH)D concentrations in ensuring a sufficient vitamin D status in pediatric patients. This study is considered to be a key investigation because of the widespread perception that ergocalciferol and cholecalciferol are equally efficacious in their respective abilities to raise serum 25(OH)D concentrations (Holick et al., 2006).
The limitations of the study:
The limitations of the study are including relatively smaller sample size relative to the previous studies, not being a multicentric study and this represents a significant risk of publication bias. Another limitation is the lack of analysis of vitamin D metabolites, such as the vitamin D–binding protein and key hydroxylation enzymes, which may provide a more detailed context in which to evaluate the metabolism of vitamins D2 and D3.