6 Prevention

6.1 Vitamin D-supplementation

Persons who come to Europe as immigrants have a higher chance of vitamin-D deficiency, with a prevalence of about 40 – 80%. In individuals with darker skin-color, the penetration of sunlight to the lower stratum of the skin, where vitamin-D is produced, is decreased (Benson and Skull, 2007). Additional possibilities for vitamin-D deficit are reduced sun contact owing to lack of time spent outside and extensive covering by clothing. Further risks for vitamin-D deficit are nutrition lacking in vitamin D, like the current western diet, but also grain and legumes, traditional food in some ethnic groups (Benson and Skull, 2007).

For children and adolescents measurement of 25-OHD in serum should be considered. For groups at risk already serum-concentrations of < 30 ng/ml daily elevated substitution is reasonable to prevent vitamin deficiency.

A general substitution after arrival and in winter months is recommended for all children and adolescents. Infants should get a routine supplementation according to the usual supplementation recommendation for all infants born in Austria. (see table below)

6.2 Iron-deficiency anaemia

Iron deficiency is the most common nutritious deficiency in the world, and persons with a higher demand, like pregnant women, infants and young children, may profit from screening and supplementation.
If anaemia is present, other causes such as malaria or haemoglobinopathies must be ruled out. Research among newly arrived immigrant children has shown that sole breastfeeding after the first six months of life is a risk factor for iron deficiency. Furthermore, consumption of cow’s milk or non-fortified infant formula, timely and regular drinking of tea and comparatively rare eating of meat are also important causes (Hassan et al., 1997).

Recommendation for Vitamin D-Substitution

Alter	Tägliche Dosis bei  Mangel	Dauer	Tägliche Dosis Prevention
0–12 Monate	1000-3000 IU	4-8 Wochen	400 IU
1–13 Jahre	6000 IU	4-8 Wochen	600 I
14–18 Jahre	10.000 IU	4-8 Wochen	600 IU

6.3 Neonatal screening

In Austria every new born is routinely screened for innate metabolic disorders. This basic assessment should be caught up for those that were not screened after birth. The test-card is available at the Stoffwechsellabor in Vienna, AKH Wien (Währinger Gürtel 18 -20, 1090 Wien; phone +43-1-40400-32100). If there is suspicion, only examinations regarding hypothyreosis and adrenogenital syndrome should be conducted in local laboratories. The results of the test-cards for these illnesses are not reliable for children.

In the case of clinical suspicion for cystic fibrosis, a referral to a tertiary centre is mandatory; IRT measuring in children is not consistent as well.

That applies also to any metabolic disorder; if there is clinical suspicion referral to a tertiary centre is necessary.