Effect of combined maternal and infant vitamin D supplementation on vitamin D status of exclusively breastfed infants

Severe vitamin D deficiency in mothers and their breastfed infants is a significant health problem in the Middle East. Supplementation of the breastfed infant alone with the recommended dose of vitamin D may be insufficient in high‐risk population. We investigated the effect of combined maternal and infant vitamin D supplementation on vitamin D status of the breastfed infant. We examined also the effect of supplementation on vitamin D antirachitic activity of breast milk in a subset of mothers. Healthy breastfeeding mothers (n = 90) were randomly assigned to 2000 IU daily (group 1) or 60 000 IU monthly (group 2) of vitamin D₂, and all their infants (n = 92) received 400 IU daily of vitamin D₂ for 3 months. Most infants had vitamin D deficiency – 25‐hydroxyvitamin D [25(OH)D] ≤ 37.5 nmol L^?1– at study entry. Serum 25(OH)D concentrations at 3 months increased significantly from baseline in infants of mothers in group 1 (13.9 ± 8.6 vs. 49.6 ± 18.5 nmol L^?1, P < 0.0001) and group 2 (13.7 ± 12.1 vs. 44.6 ± 15.0 nmol L^?1, P < 0.0001). Maternal and infant serum 25(OH)D concentrations correlated positively at baseline (r = 0.36, P = 0.01) and 3 months (r = 0.46, P = 0.002). Milk antirachitic activity increased from undetectable (<20 IU L^?1) to a median of 50.9 IU L^?1. In conclusion, combined maternal and infant vitamin D supplementation was associated with a threefold increase in infants’ serum 25(OH)D concentrations and a 64% reduction in the prevalence of vitamin D deficiency without causing hypervitaminosis D.     

Vitamin D status of breastfed Pakistani infants

This study was conducted to evaluate the vitamin D status of healthy breastfed Pakistani infants and their nursing mothers. Sixty-two breastfed healthy infants and their nursing mothers belonging to the upper and lower socioeconomic classes were examined. Serum 25-hydroxy vitamin D [25(OH)D], serum calcium, phosphorus and alkaline phosphatase were measured. The mean serum 25(OH)D in infants was 34.59 ± 26.56 nmol/l. Fifty-five percent of infants and 45% of mothers had very low serum 25(OH)D levels (<25 nmol/l). Significantly higher levels were found in infants of lower socioeconomic class ( p < 0:001) and in those living in mud houses ( p = 0:002) and infants > 6 months ( p < 0:001). A high prevalence of vitamin D deficiency was found in breastfed infants and nursing mothers, predominantly among those belonging to the upper socioeconomic class. Infants of the lower socioeconomic class had comparatively higher serum 25(OH)D levels, but even these levels were below the normal range for infants (90 ± 27.5 nmol/l).     

Vitamin D status of mothers and their neonates in Kuwait

BACKGROUND: There has been a resurgence of nutritional rickets in children in many developing countries and some of the developed countries. Children between 6 and 18 months old are commonly affected. In order to find out the association between vitamin D and rickets we studied the vitamin D status of the neonates and their mothers in Kuwait. METHODS: Two hundred and fourteen full-term pregnant mothers and their neonates were selected from two hospitals in Kuwait. All mothers had normal vaginal delivery. On the day of delivery 2.5 mL of maternal blood and 2.5 mL of cord blood samples were withdrawn. Serum 25-hydroxyvitamin D (25OHD) was determined in duplicate by radioimmunoassay using an Incstar kit. Quality control analyses were done using several between and within run experiments. RESULTS: A total of 128 mother-neonate pairs were selected from the Al-Adan hospital and 86 from the Maternity Hospital. The mean age and parity of the mothers were similar in both hospitals. The mean (+/- SD) 25OHD levels of the mothers and the neonates in the Adan hospital were 13.3 (6.5) ng/mL and 8.2 (6.5) ng/mL, respectively. The corresponding values in the Maternity Hospital were 17.6 (12.4) and 8.1 (7.3) ng/mL for the mothers and the neonate, respectively. Serum 25OHD of the mothers and their newborn infants were highly correlated (r = 0.790, P < 0.001). CONCLUSIONS: Results demonstrate that 40% of the mothers and 60% of the neonates are vitamin D deficient on the day of delivery. The vitamin D of the mothers and neonates are highly correlated (r = 0.790, P < 0.001).     

Duration of exclusive breastfeeding is a positive predictor of iron status in 6‐ to 10‐month‐old infants in rural Kenya

The prevalence of iron‐deficiency anemia (IDA) is high in infants in Sub‐Saharan Africa. Exclusive breastfeeding of infants to 6 months of age is recommended by the World Health Organization, but breast milk is low in iron. Some studies suggest exclusive breastfeeding, although beneficial for the infant, may increase risk for IDA in resource‐limited settings. The objective of this study was to determine if duration of exclusive breastfeeding is associated with anemia and iron deficiency in rural Kenyan infants. This was a cross‐sectional study of 6–10‐month‐old infants (n = 134) in southern coastal Kenya. Anthropometrics, hemoglobin (Hb), plasma ferritin (PF), soluble transferrin receptor (sTfR), and C‐reactive protein were measured. Body iron stores were calculated from the sTfR/PF ratio. Socioeconomic factors, duration of exclusive breastfeeding, nature of complementary diet, and demographic characteristics were determined using a questionnaire. Mean ± SD age of the infants was 7.7 ± 0.8 months. Prevalence of anemia, ID, and IDA were 74.6%, 82.1%, and 64.9%, respectively. Months of exclusive breastfeeding correlated positively with Hb (r = 0.187; p < .05) and negatively with sTfR (r = ?0.246; p < .05). sTfR concentrations were lower in infants exclusively breastfed at least 6 months compared with those exclusively breastfed for less than 6 months (7.6 (6.3, 9) vs. 8.9 (6.7, 13.4); p < .05). Controlling for gender, birth weight, and inflammation, months spent exclusively breastfeeding was a significant negative predictor of sTfR and a positive predictor of Hb (p < .05). The IDA prevalence in rural Kenyan infants is high, and greater duration of exclusive breastfeeding predicts better iron status and higher Hb in this age group.     

日光暴露方式及维生素D摄入与大鼠肾脏维生素D受体表达及骨矿化改变

目的 探讨不同日光暴露方式的紫外线强度变化以及添加维生素D对大鼠骨代谢的影响.方法 选用21 d断乳Wistar大鼠72只,随机分为直接日光暴露、正常饲料组(直晒+D组),直接日光暴露、缺乏维生素D饲料组(直晒缺D组),双层玻璃遮挡下日光暴露、正常饲料组(隔晒+D组),双层玻璃遮挡下日光暴露、缺乏维生素D饲料组(隔晒缺D组),避光正常饲料组(避光+D组)及避光缺乏维生素D饲料组(避光缺D组).实验期60 d.ZQJ-254型紫外线测定仪检测B波紫外线强度.实验结束后检测大鼠肾脏维生素D受体(vitamin D receptor,VDR)表达情况及胫骨骨小梁矿化沉积率(mineral addition rate,MAR)的差异.结果 ①室外紫外线强度为0.042 9 w/m2,双层玻璃遮挡后紫外线强度为0.006 4w/m2,紫外线强度衰减了85.1%.②直晒缺D组的肾脏VDR表达(0.56 ±0.14)与隔晒缺D组(0.56 ±0.08)比较差异无统计学意义,P=0.89;避光+D组(0.46 ±0.07)与避光缺D组(0.47 ±0.08)比较差异无统计学意义,P=0.828.③骨矿化沉积率直晒缺D组[(0.91 ±0.23)μm/d]与隔晒缺D组[(0.72 ±0.18)μm/d]比较差异无统计学意义.P=0.091;避光+D组[(0.71 ±0.19)μm/d]与避光缺D组[(0.64±0.21)μm/d]比较差异无统计学意义,P=0.563;直晒+D组[(1.24 ±0.26)μm/d]与直晒缺D组[(0.91 ±0.23)μm/d]比较差异有明显统计学意义,P=0.004;直晒+D组/避光+D组,P<0.001.结论 日光暴露是大鼠骨矿化的主要影响因素;虽然双层玻璃遮挡后的紫外线强度削减了85.1%,但在暴露时间足够长的情况下,隔着玻璃进行日光浴可以使大鼠肾脏VDR的表达接近直接日光暴露组;添加维生素D可增强日光暴露对骨矿化的作用.     

Prevalence and risk factors of vitamin D deficiency rickets in Hokkaido, Japan

Background:  Resurgence of vitamin D deficiency rickets has been recognized worldwide. While many cases of this disease have been reported in Hokkaido, the northern island of Japan, no prevalence data is available. Here, we investigated the prevalence and risk factors of vitamin D deficiency rickets in Hokkaido.
Methods:  A specially designed questionnaire was sent to 84 major pediatric departments of hospitals in Hokkaido to collect information of the confirmed cases between July 1999 and June 2004.
Results:  Sixty-seven hospitals responded to the questionnaire. Of these, 20 hospitals reported 31 confirmed cases. All the patients were infants and toddlers, less than 4 years of age. The prevalence of cases in a recent year was estimated to be nine in 100 000 children under four years of age. Most of the 31 cases in our study were breast-fed. Eleven cases showed signs of malnutrition due to unbalanced diet or dietary restriction. Furthermore, the prevalence of cases was higher in the northeastern region than in the southwestern region. The number of cases increased gradually from the end of winter to spring.
Conclusions:  This is the first report ascertaining the prevalence of vitamin D deficiency rickets in Hokkaido, Japan. Limited exposure to sunlight and inadequate diet in early childhood are key risk factors of this disease. Thus, it is crucial to introduce active recommendations for vitamin D supplementation based on age, residential area, and to advocate public awareness for preventing this disease.     

Vitamin D deficiency rickets due to soybean milk

We describe vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants) instead of cow's milk-based infant formula. Symptoms included irritability and carpopedal spasm when crying. The infant's condition improved with nutrition by vitamin-enriched cow's milk-based infant formula, oral administration 1 alpha-hydroxy vitamin D3 and exposure to sunlight. Content analysis of the milk showed very low calcium, phosphate, magnesium and vitamin D levels compared to cow's milk-based infant milk formulas. This case highlights the unsuitability of soybean milk as the sole provider of infant nutrition and demonstrates the false perception that soybean milk is a healthy food for infants. It is necessary to be cautious about not only health claims for soybean milk, but also today's health and natural food booms. Social enlightenment and correction of such misperceptions are necessary.     

Vitamin D Status of term exclusively breastfed infants and their mothers from India

Objectives: (i) To measure 25‐OH vitamin D levels in term infants at 10 weeks and 6 months and to correlate with maternal vitamin D levels at 10‐week postpartum (ii) To evaluate infants at 6 months for rickets. Patients and methods: A total of 179 exclusively breastfed infant–mother pairs 96 appropriate‐for‐gestational age (Group 1) and 83 small‐ for‐ gestational age infants (Group 2) recruited at 10 weeks. At 6 months, 52 in group 1 and 45 in group 2 were evaluated. Venous blood sample were collected at 10 weeks and 6 months in infants and at 10 weeks in mothers for calcium, phosphorus, alkaline phosphatase and 25‐OH vitamin D estimation. Results: Mean 25‐OH vitamin D levels of infants (n = 97) were 11.55 ± 7.17 ng/mL at 10 weeks and 16.96 ± 13.33 ng/mL at 6 months (p < 0.001). Mean vitamin D levels of infants in group 1 and group 2 did not differ at recruitment and 6 months (p > 0.05)). Maternal vitamin D levels in group 1 and group 2 were 8.89 ± 5.97 and 9.87 ± 6.44 ng/mL, respectively (p = 0.44). Significant correlation was observed between 25‐OH vitamin D of infants and mothers (p < 0.05). At 10 weeks, 55.67% infants, 70% mothers and at 6 months, 44.33% infants had vitamin D < 11 ng/mL. At 6 months, 16.49% infants developed rickets. Conclusions: Exclusively breastfed infants and their mothers are Vitamin D deficient, hence the need to improve vitamin D status.     

High prevalence of vitamin D deficiency in newborn infants of high-risk mothers

Objective

To determine the prevalence of vitamin D deficiency in newborn infants of mothers at risk of vitamin D deficiency because of dark skin or the wearing of concealing clothes (such as a veil) compared with a group presumed not to be at risk. A second aim was to correlate these newborn infants'' vitamin D concentrations with biochemical parameters of vitamin D metabolism and bone turnover at birth.

Design

A prospective study conducted between April 2004 and February 2006 including women delivering during this period and their newborn infants.

Setting

The outpatient clinic of the obstetrics department, Sint Franciscus Gasthuis, Rotterdam, the Netherlands.

Patients

Eighty seven newborn infants of healthy mothers with either dark skin and/or concealing clothing (risk group) or light skin (control group).

Results

We found a significant difference in the prevalence of vitamin D deficiency (25‐hydroxyvitamin D₃ <25 nmol/l) between newborn infants of mothers at risk and those of mothers in the control group (63.3% vs 15.8%; p<0.001). Mean alkaline phosphatase concentrations were significantly higher in the at risk group.

Conclusions

Newborn infants of mothers with dark skin or wearing concealing clothes are at great risk of vitamin D deficiency at birth. The clinical implications are unknown. Further research is necessary to determine the long‐term consequences of maternal and neonatal vitamin D deficiency so that guidelines on vitamin D supplementation during pregnancy can be issued.     

Association of vitamin D supplementation with respiratory tract infection in infants

Vitamin D deficiency has been reported to be associated with respiratory tract infection (RTI). However, evidence regarding the effects of vitamin D supplementation on susceptibility of infants to RTI is limited. In this prospective birth cohort study, we examined whether vitamin D supplementation reduced RTI risk in 2,244 infants completing the follow‐up from birth to 6 months of age. The outcome endpoint was the first episode of paediatrician‐diagnosed RTI or 6 months of age when no RTI event occurred. Infants receiving vitamin D supplements at a daily dose of 400–600 IU from birth to the outcome endpoint were defined as vitamin D supplementation and divided into four groups according to the average frequency of supplementation: 0, 1–2, 3–4, and 5–7 days/week. We evaluated the relationship between vitamin D supplementation and time to the first episode of RTI with Kaplan–Meier plots. The associations of vitamin D supplementation with infant RTI, lower RTI (LRTI), and RTI‐related hospitalization were assessed using modified Poisson regression. The median time to first RTI episode was 60 days after birth (95% CI [60, 90]) for infants without supplementation and longer than 6 months of age for infants with supplementation (p < .001). We observed inverse trends between supplementation frequency and risk of RTI, LRTI, and RTI‐related hospitalization (p for trend < .001), with the risk ratios in the 5–7 days/week supplementation group of 0.46 (95% CI [0.41, 0.50]), 0.17 (95% CI [0.13, 0.24]), and 0.18 (95% CI [0.12, 0.27]), respectively. These associations were significant and consistent in a subgroup analysis stratified by infant feeding.     

The effect of tailor-made information on vitamin D status of immigrant mothers in Norway: a cluster randomized controlled trial

A high prevalence of vitamin D deficiency has been reported in non-Western immigrants in Norway. Our objective was to test whether written information about how to improve vitamin D status could improve the vitamin D status in immigrants mothers attending child health clinics. In this cluster randomized controlled trial in eight child health clinics in Oslo, mothers aged 18-43 years with Pakistani, Turkish, or Somali background were included when their infants were 6 weeks old. The public health nurses gave the intervention group a brochure with information on how to improve vitamin D status, written in their native language. They were compared with a control group receiving usual care, consisting of oral information only. The principal outcome measure was increase in serum 25-hydroxyvitamin D [s-25(OH) D] in mothers 7 weeks later. Forty-four mothers completed the study. Mean baseline s-25(OH) D was 29.1 (14.8) nmol l(-1) in the intervention and 19.4 (9.2) in the control group. There was no significant increase in s-25(OH) D from baseline to follow-up in the intervention [6.3 (95%CI: -1.9, 14.4) nmol l(-1) )] or in the control group [2.9 (95% CI [confidence interval]: -1.2, 7.0) nmol l(-1) ]. When adjusting for baseline s-25(OH) D concentration the mean difference in increase between the intervention and control group was 1.4 (95% CI: -18.7, 21.4) nmol l(-1) (P = 0.87). Adjustment for ethnicity, season and mother's educational background did not alter the results. In sum, providing immigrant mothers with written information about how to improve their vitamin D status did not have an effect on the mothers' vitamin D status.     

Global summary of maternal and newborn vitamin D status – a systematic review

Pregnant women and newborns are at increased risk of vitamin D deficiency. Our objective was to create a global summary of maternal and newborn vitamin D status. We completed a systematic review (1959–2014) and meta‐analysis of studies reporting serum 25‐hydroxyvitamin D [25(OH)D] concentration in maternal and newborn populations. The 95 identified studies were unevenly distributed by World Health Organization (WHO) region: Americas (24), European (33), Eastern Mediterranean (13), South‐East Asian (7), Western Pacific (16) and African (2). Average maternal 25(OH)D concentrations (nmol L^?1) by region were 47–65 (Americas), 15–72 (European), 13–60 (Eastern Mediterranean), 20–52 (South‐East Asian), 42–72 (Western Pacific) and 92 (African). Average newborn 25(OH)D concentrations (nmol L^?1) were 35–77 (Americas), 20–50 (European), 5–50 (Eastern Mediterranean), 20–22 (South‐East Asian), 32–67 (Western Pacific) and 27–35 (African). The prevalences of 25(OH)D <50 and <25 nmol L^?1 by WHO region in pregnant women were: Americas (64%, 9%), European (57%, 23%), Eastern Mediterranean (46%, 79%), South‐East Asian (87%, not available) and Western Pacific (83%, 13%). Among newborns these values were: Americas (30%, 14%), European (73%, 39%), Eastern Mediterranean (60%, not available), South‐East Asian (96%, 45%) and Western Pacific (54%, 14%). By global region, average 25(OH)D concentration varies threefold in pregnant women and newborns, and prevalence of 25(OH)D <25 nmol L^?1 varies eightfold in pregnant women and threefold in newborns. Maternal and newborn 25(OH)D concentrations are highly correlated. Addressing vitamin D deficiency in pregnant women and newborns should be a global priority. To protect children from the adverse effects of vitamin D deficiency requires appropriate interventions during both pregnancy and childhood.     

Predictors of vitamin D status in New Zealand preschool children

Vitamin D deficiency has adverse health effects in young children. Our aims were to determine predictors of vitamin D status and then to use these factors to develop a practical tool to predict low 25(OH)D concentrations in preschool New Zealand children. A cross‐sectional sample of 1329 children aged 2 to <5 years were enrolled from throughout New Zealand in late‐winter to spring 2012. 25‐Hydroxyvitamin D (25(OH)D) was measured on dried blood spot (DBS) samples collected using finger‐prick sampling. Caregivers completed a questionnaire. Mean (SD) DBS 25(OH)D concentration was 52(19)nmol/L. 25(OH)D < 25 nmol/L was present in 86(7%), 25(OH)D < 50 nmol/L in 642(48%), 25(OH)D 50‐ < 75 nmol/L in 541(41%) and 25(OH)D > 75 nmol/L in 146(11%) of children. Factors independently associated with the risk of 25(OH)D < 25 nmol/L were female gender (OR 1.92,95%CI 1.17–3.14), other non‐European ethnicities (not including Māori or Pacific) (3.51,1.89–6.50), had olive‐dark skin colour (4.52,2.22–9.16), did not take vitamin D supplements (2.56,1.06–6.18), had mothers with less than secondary‐school qualifications (5.00,2.44–10.21) and lived in more deprived households (1.27,1.06–1.53). Children who drank toddler milk (vitamin D fortified cow's milk formula marketed to young children) had a zero risk of 25(OH)D < 25 nmol/L. The predictive tool identified children at risk of 25(OH)D < 25 nmol/L with sensitivity 42%, specificity 97% and ROC area‐under‐curve 0.76(95%CI 0.67–0.86, p < 0.001). Predictors of low vitamin D status were consistent with those identified in previous studies of New Zealand children. The tool had insufficient predictive ability for use in clinical situations, and suggests a need to promote safe, inexpensive testing to determine vitamin D status in preschool children.     

早期补充维生素AD改善早产儿预后的研究进展

维生素AD作为人体必需营养素,可维持机体视觉、免疫、呼吸道和胃肠上皮及神经系统等多个系统的正常功能。早产儿由于产前体内维生素AD储存量少、经食物摄取量少、能量代谢旺盛等特点,容易出现维生素AD缺乏。研究表明,补充维生素AD可以促进早产儿的生长发育。该文主要就补充维生素AD改善早产儿视网膜病、支气管肺发育不良、坏死性小肠...