25-Hydroxyvitamin D levels during breast-feeding with or without maternal or infantile supplementation of vitamin D

Serum 25-hydroxyvitamin D (25-OHD), calcium, phosphorus, magnesium, and alkaline phosphatase levels of breast-fed infants and their mothers were studied by following 100 healthy term mother-infant pairs with different supplementation protocols of vitamin D. A pilot study in winter revealed that six of eight breast-fed infants without vitamin D supplementation had serum 25-OHD levels below the risk limit for rickets (5 ng/ml) at the age of 8 weeks. In the main study in winter groups, it was found that the 25-OHD levels were low (5.6 +/- 3.7 ng/ml) at the age of 8 weeks in the unsupplemented breast-fed infants, whose mothers were given vitamin D supplementation of 1,000 IU/day during lactation (group I), compared with the levels of those infants receiving either 400 (18.0 +/- 8.4 ng/ml, group II) or 1,000 IU (22.8 +/- 11.2 ng/ml, group III) vitamin D (group I vs. group II or III, p less than 0.001; group II vs. group III, NS). In group I 10 of 18 infants had serum 25-OHD levels less than 5 ng/ml compared with none of the infants in groups II and III. Yet the infants with 25-OHD levels less than 5 ng/ml showed no signs of clinical or biochemical rickets at the age of 8 or 20 weeks. In summer at delivery the maternal 25-OHD levels were good, but decreased thereafter. Also in summer groups, the infantile 25-OHD concentrations decreased; however, because the levels at delivery were high, they stayed in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum concentrations of vitamin D metabolites in exclusively breast-fed infants at 70 degrees north

The effect of prolonged breast-feeding on the serum concentrations of vitamin D metabolites, calcium, phosphate, and alkaline phosphatase was studied longitudinally in 7 infants from Northern Norway. They were exclusively breast-fed for a median of 7 1/2 months. Three of the mothers were supplemented with vitamin D throughout lactation. All but one of the infants had 25-hydroxyvitamin D (25-OHD) levels in the rachitic range (less than 20 nmol/l) on at least one occasion. Vitamin D supplementation of the mother had no apparent effect on the infants' 25-OHD levels, but the values increased during summer. The infant who had the lowest 25-OHD levels also had decreased 1,25-dihydroxyvitamin D (1,25-(OH)2D) concentrations, while the others maintained 1,25-(OH)2D levels within normal limits. 24,25-(OH)2D concentrations were undetectable when the 25-OHD levels were below 35 nmol/l, but the two metabolites were closely correlated for higher values of 25-OHD. Low 25-OHD levels were associated with decreased phosphate concentrations at 6 months. The calcium levels were normal throughout the study period of one year, as were all but two of the alkaline phosphatase values. Although none of the infants had clinical or biochemical evidence of rickets, the results suggest that the vitamin D supply from human milk is inadequate, and that routine vitamin D supplementation is advisable for breast-fed infants who are deprived of sunlight exposure.     

Diet, clothing, sunshine exposure and micronutrient status of Arab infants and young children

Vitamin C and D levels in Arab women and their newborn infants have been shown to be low. We investigated the prevalence of and risk factors for possible hypovitaminosis C and D in a convenience sample of 51 hospitalized children without clinical features of vitamin C or D deficiency. The mean age was 15.4 months. The serum vitamin C concentration was low in the mothers but normal in the children. Both mothers and children had low serum 25-hydroxyvitamin D (25-OHD) concentrations. Fifty per cent of the mothers and 22% of the infants and children had hypovitaminosis D (serum 25-OHD level < 25 nmol/l). Infants who received dietary vitamin D supplementation had a higher mean (SD) serum 25-OHD concentration than the unsupplemented group (62.5 (29.8) vs 38.5 (27.3), p = 001). Cutaneous light exposure in these children was poor. The children's serum 25-OHD concentration correlated with dietary vitamin D supplementation and maternal serum 25-OHD levels. The results suggest normal vitamin C status but a possible high prevalence of hypovitaminosis D in Arab children and their mothers in UAE. Health education to encourage greater sunshine exposure and improvement in maternal vitamin D stores and the availability of adequate vitamin D supplements would improve children's vitamin D status. The study indicates that hypovitaminosis D continues to be an important maternal and child health problem, despite the abundant sunshine.     

Vitamin D deficiency in Iranian mothers and their neonates: a pilot study

We conducted a pilot study to assess the prevalence of hypovitaminosis D among Iranian women and their newborns. Blood samples were taken from 50 mothers (age 16-40 yr) and their neonates at term delivery in the largest Tehran hospital. The results showed that 80% of the women had 25-hydroxyvitamin D (25-OHD) concentrations of less than 25 nmol/l. Mean maternal plasma calcium and phosphatase alkaline concentrations were in the normal range. The mean maternal serum immunoreactive parathyroid hormone concentration of women with hypovitaminosis D (i.e., 25-OHD levels <25 nmol/l) was above normal range and significantly different from that of women without hypovitaminosis D. CONCLUSION: The mean cord serum 25-OHD concentration was very low (4.94+/-9.4 nmol/l) and that of infants of mother with hypovitaminosis D were almost undetectable (1.2+/-1.2 nmol/l).     

25-hydroxyvitamin D and calcium levels in maternal, cord and infant serum in relation to maternal vitamin D intake

The plasma levels of 25-hydroxyvitamin D (25-OHD), total calcium, phosphorus and proteins were measured in 40 healthy mothers and their infants at the time of delivery during the months of December and January. Calcium, phosphorus and proteins were again measured in the plasma of the infants on the fourth day of life. Vitamin D intake of the mothers during their last 3 months of pregnancy were estimated by interviews. The mean (+/-SE) plasma levels of 25-OHD was 9.0 +/- 0.9 ng/ml in the mothers and 5.05 +/- 0.4 ng/ml in cords. There was a significant correlation between mother and cord plasma levels (r = 0.75, p less than or equal to 0.001). The concentration gradient of 25-OHD plasma levels between mother and cord is higher at high 25-OHD maternal concentrations. This suggests that the placenta plays a regulating role in the 25-OHD transfer between mother and foetus. The 4-day-old infants from mothers having a suboptimal vitamin D intake (less than 150 IU/day) have a lower mean serum plasma level than infants born from mothers with a vitamin D intake of more than 500 IU/day.     

Subclinical hypovitaminosis D among exclusively breastfed young infants

OBJECTIVE: To determine Vitamin D status of mother-newborn diads at birth and of their exclusively breastfed (EBF) infants at 3 months. DESIGN: Longitudinal study. METHODS: Exclusively breastfed infants born at term with birth weight > 2.5 kg to normal, healthy mothers followed till 3 months. Serum calcium, phosphorous, heat labile alkaline phosphatase (HLAP) and 25(OH)D estimated in 42 mother / cord blood diads and in 35 (EBF) infants followed up at 3 months. Twenty five (OH)D < 15 ng/mL was considered low and 15 to 25 ng/mL low to normal. RESULTS: Ca, P, HLAP were significantly higher in cord blood (P < 0.001) but mean 25 (OH)D, 19.36 ng/mL was comparable to maternal level of 22.9 ng/mL (r = 0.82, P < 0.001). At 3 months only HLAP was significantly higher compared to cord blood. Higher 25 (OH)D at 3 months correlated with higher 25 (OH)D values in cord blood (r = +0.616, P < 0.001) as well as higher antenatal maternal levels (r = + 0.552, P < 0.001). Serum 25 (OH)D values < 25 ng/mL was observed in 50 % mothers, 62 % cord blood specimens and 80 % infants at 3 months. CONCLUSIONS: Subnormal maternal vitamin D status is associated with vitamin D deficiency in newborns and persists in exclusively breastfed infants.     

Serum Concentrations of Vitamin D Metabolites in Exclusively Breast-Fed Infants at 70° North

ABSTRACT. The effect of prolonged breast-feeding on the serum concentrations of vitamin D metabolites, calcium, phosphate, and alkaline phosphatase was studied longitudinally in 7 infants from Northern Norway. They were exclusively breast-fed for a median of 71/2 months. Three of the mothers were supplemented with vitamin D throughout lactation. All but one of the infants had 25-hydroxyvitamin D (25-OHD) levels in the rachitic range (< 20 nmol/l) on at least one occasion. Vitamin D supplementation of the mother had no apparent effect on the infants' 25-OHD levels, but the values increased during summer. The infant who had the lowest 25-OHD levels also had decreased 1,25-dihydroxyvitamin D (1,25-(OH)₂D) concentrations, while the others maintained l,25-(OH)₂D levels within normal limits. 24,25-(OH)₂D concentrations were undetectable when the 25-OHD levels were below 35 nmol/l, but the two metabolites were closely correlated for higher values of 25-OHD. Low 25-OHD levels were associated with decreased phosphate concentrations at 6 months. The calcium levels were normal throughout the study period of one year, as were all but two of the alkaline phospatase values. Although none of the infants had clinical or biochemical evidence of rickets, the results suggest that the vitamin D supply from human milk is inadequate, and that routine vitamin D supplementation is advisable for breast-fed infants who are deprived of sunlight exposure.     

Maternal vitamin D deficiency and vitamin D supplementation in healthy infants

The objective of this study was to evaluate the common effects of maternal vitamin D deficiency, various doses of vitamin D given to newborns and the effects of these on vitamin D status in early childhood. Seventy-eight pregnant women and 65 infants who were followed up in various health centers were included in the sudy. 25-hydroxyvitamin-D (25-OHvitD), calcium (Ca), phosphorus (P) and alkaline phosphatase levels were measured in blood samples drawn from pregnant women in the last trimester. Infants born to these mothers were given 400 or 800 IU of vitamin D subsequently at the start of the second week. 25-OHvitD, Ca, P and alkaline phosphatase levels of the 65 infants who were brought in for controls (May-September 2000) were measured and hand-wrist X-rays were evaluated. We analyzed the relationship between vitamin D status of the mothers and infants and socio-economic status; mothers' dressing habits (covered vs uncovered), educational level, and number of pregnancies; and sunlight exposure of the house. Covered as a dressing habit meant covering the hair and sometimes part of the face and wearing dresses that completely cover the arms and legs. In 40 infants who were breast-fed and received the recommended doses of vitamin D on a regular basis, the relationship between serum vitamin D levels and supplementation doses given was analyzed. Serum 25-OHvitD level of the mothers was 17.50 +/- 10.30 and 94.8% of the mothers had a 25-OHvitD level below 40 nmol/L (below 25 nmol/L in 79.5%). The risk factors associated with low maternal 25-OHvitD were low educational level (p = 0.042), insufficient intake of vitamin D within diet (p = 0.020) and "covered" dressing habits (p = 0.012). 25-OHvitD level of the infants was 83.70 +/- 53.70 nmol/L, and 24.6% of the infants had 25-OHvitD levels lower than 40 nmol/L. Risk factors for low 25-OHvitD levels in infants were a) not receiving recommended doses of vitamin D regularly (p = 0.002) and b) insufficient sunlight exposure of the house (p = 0.033). There was a pour but significant correlation between maternal vitamin D levels and infants' 25-OHvitD levels at four months (r = 0.365, p < 0.05). No significant correlation was found between 25-OHvitD levels and supplementation doses of vitamin D (19 infants were supplemented with 400 IU/day and 21 with 800 IU/day of vitamin D) (p = 0.873). Severe maternal vitamin D deficiency remains a commonly seen problem in Turkey. However, vitamin D deficiency can be prevented by supplementation of vitamin D to newborns (at least 400 IU). Supplementation of 800 IU vitamin D in the areas of maternal vitamin D deficiency has no greater benefits for the infants.     

High prevalence of moderately severe vitamin D deficiency in preterm infants

Background: The recommended dose of vitamin D supplementation of preterm infants is based on data from populations in which severe vitamin D deficiency is uncommon and may be inadequate for infants in high risk population. However, data on vitamin D status of preterm infants in high‐risk populations, such as Middle Eastern countries is scarce. Methods: This study investigates the vitamin D status of Arab mothers and their preterm infants. Maternal serum and cord blood 25(OH)D, calcium (Ca), phosphorus (P) and alkaline phosphate (ALP) were measured at delivery. Serum 25(OH)D was measured by HPLC while the other biochemical parameters were measured by standard autoanalyzer. Results: Thirty‐four preterm infants were studied. The mean gestational age was 31.4 weeks and birth weight was 1667 g. The median serum 25(OH)D of 17.0 nmol/L in 28 mothers and 14.5 nmol/L in 34 cord blood samples were low. The median maternal and cord blood Ca, P and ALP levels were within normal range. Fifteen (44%) of the infants had moderately severe vitamin D deficiency (serum 25 (OH)D levels <12.5 nmol/L). The median serum 25(OH)D levels of mothers who had reportedly taken prenatal vitamin D supplementation and those who had not were similar (17.3 vs 16.3) nmol/L. The mean serum 25(OH)D levels among preterm infants in this study were low when compared to levels in Caucasians preterm infants on which the current vitamin D recommendations are based. Conclusion: The high prevalence of moderately severe vitamin D deficiency in Arab preterm infants provides a justification to investigate vitamin D requirement of preterm infants in this and other high‐risk populations.     

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.     

Prevalence of vitamin D deficiency among healthy adolescents

BACKGROUND: Although vitamin D deficiency has been documented as a frequent problem in studies of young adults, elderly persons, and children in other countries, there are limited data on the prevalence of this nutritional deficiency among healthy US teenagers. OBJECTIVE: To determine the prevalence of vitamin D deficiency in healthy adolescents presenting for primary care. DESIGN: A cross-sectional clinic-based sample. SETTING: An urban hospital in Boston. PARTICIPANTS: Three hundred seven adolescents recruited at an annual physical examination to undergo a blood test and nutritional and activity assessments. MAIN OUTCOME MEASURES: Serum levels of 25-hydroxyvitamin D (25OHD) and parathyroid hormone, anthropometric data, nutritional intake, and weekly physical activity and lifestyle variables that were potential risk factors for hypovitaminosis D. RESULTS: Seventy-four patients (24.1%) were vitamin D deficient (serum 25OHD level, 相似文献   

Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants

The relationship between serum 25-hydroxyvitamin D (25-OHD) concentrations and sunshine exposure in 61 term, exclusively breast-fed infants younger than 6 months of age was investigated. Sunshine exposure was quantitated using a sunshine and clothing diary, which was verified by infant-adapted ultraviolet dosimetry. By multiple regression techniques, infant serum 25-OHD concentrations were significantly related to UV exposure and maternal serum 25-OHD concentrations. Infant 25-OHD concentrations correlated with sunshine exposure in infants whose mothers had low (less than 35 ng/ml) or high (greater than 35 ng/ml) serum concentrations of 25-OHD (r = 0.70, P less than 0.001 and r = 0.53, P = 0.004, respectively). Estimates were made to determine sunshine exposure conditions necessary to maintain serum 25-OHD concentrations above the lower limit of the normal range (11 ng/ml). A conservative estimate would be 30 minutes per week wearing only a diaper or 2 hours a week fully clothed without a hat.     

Seasonal changes in perinatal vitamin D metabolism: maternal and cord blood biochemistry in normal pregnancies.

Two groups of white, primiparous women and their babies were studied: one group in April 1979 and the other in September 1979. They were selected to be as near normal as possible. In each case maternal and cord blood samples were taken at delivery and analysed for serum 25-hydroxycholecalciferol (25-OHD), calcium, magnesium, phosphate, alkaline phosphatase, total protein, and albumin. Follow-up was by questionnaire at 6 weeks. The study showed a highly significant increase in maternal and cord serum 25-OHD levels in September. The few mothers who had taken vitamin D supplements had significantly higher serum 25-OHD values. Some of the unsupplemented women studied in April had low serum 25-OHD levels suggesting that oral vitamin D supplements should be given to pregnant white women in Britain, at least during the winter.     

Mineral homeostasis in very premature infants: serial evaluation of serum 25-hydroxyvitamin D, serum minerals, and bone mineralization

This study was designed to evaluate the role of vitamin D sufficiency, as reflected in serum 25-hydroxyvitamin D (25-OHD) concentrations, on serum minerals and bone mineralization in very premature infants. Seventy-two infants (mean +/- SD gestation 30.1 +/- 2.5 weeks, mean +/- SD birth weight 1178 +/- 278 gm) were observed serially for the first 3 months of life. Mean serum calcium and phosphorus values, but not magnesium, remained low prior to 12 weeks. The percentage of infants with moderate to severe hypomineralization was 75% at 3 weeks, 55% at 6 weeks, 54% at 9 weeks, and 15% at twelve weeks. Low serum calcium and phosphorus values, high alkaline phosphatase activity, and moderate-severe hypomineralization were more frequent in infants weighing less than 1000 gm and in those with lower mineral intake. With a 400 IU vitamin D supplement, 45% of infants could maintain an initially normal serum 25-OHD concentration or increase low concentrations, whereas 55% had falling or persistently low (less than or equal to 15 ng/ml) 25-OHD concentrations. Birth weight and mineral intakes were comparable in these two groups, yet the group with the lower serum 25-OHD concentration had lower serum calcium and higher alkaline phosphatase values, and a higher percentage of moderate to severe hypomineralization. Regardless of birth weight, mineral intake, or 25-OHD concentration, increases in serum calcium and phosphorus values and in mineralization were seen at postconception term (12 weeks in most infants, nine weeks in those weighing 1250 to 1600 gm). At 12 weeks of age, but not before, serum 25-OHD concentration was directly correlated with serum calcium (r = 0.47, P less than 0.01) and serum phosphorus (r = 0.47, P less than 0.01) and inversely correlated with alkaline phosphatase values (r = -0.71, P less than 0.01). Mineral availability and 25-OHD sufficiency both appear to be important and to act synergistically, with neither totally compensating for the other.     

维生素D缺乏与早产儿坏死性小肠结肠炎的相关性

目的 评估维生素D水平对早产儿坏死性小肠结肠炎（NEC）的影响。方法 选取2016年1~12月于生后2 h内入新生儿科住院治疗的胎龄 < 36周的早产儿429例为研究对象,依据患儿是否发生NEC,将429例患儿分为NEC组（n=22）和非NEC组（n=407）。采集早产儿及其母亲入院时外周静脉血进行25-羟基维生素D（25-OHD）水平检测,比较两组早产儿和母亲血清25-OHD水平,Pearson相关分析早产儿和母亲血清25-OHD水平相关性,比较两组早产儿维生素D缺乏情况,单因素logistic回归分析早产儿NEC影响因素。结果 NEC组母亲和早产儿血清25-OHD水平均显著低于非NEC组（P < 0.001）。两组母亲和早产儿之间血清25-OHD水平均呈正向关（P < 0.001）。非NEC组与NEC组早产儿维生素D水平在正常、不足、缺乏、严重缺乏等状况的分布上比较差异有统计学意义（P < 0.001）。单因素logistic回归分析结果显示：胎龄、出生体重、母亲和早产儿25-OHD水平、机械通气持续时间、用氧持续时间和住院时间可能是NEC发生的影响因素（P < 0.05）。结论 母亲和早产儿低血清25-OHD水平与早产儿NEC的发生可能具有相关性,提示母孕期补充维生素D对于预防早产儿NEC的发生有重要意义。     

Absorption, dosage, and effect on mineral homeostasis of 25-hydroxycholecalciferol in premature infants: comparison with 400 and 800 IU vitamin D2 supplementation

Because the efficiency of vitamin D absorption or hepatic uptake and 25-hydroxylation appears decreased in very premature infants, the routine use of 25-hydroxycholecalciferol (25-OHD3) supplementation has been suggested. Absorption studies of a 3 micrograms/kg orally administered dose of 25-OHD3 showed peak serum 25-hydroxyvitamin D2 and -vitamin D3 (25-OHD) concentrations at 4 to 8 hours similar in timing but of lesser magnitude to those seen in adults. Administration of 1 microgram/kg birth weight/day of 25-OHD3 corrected moderately low, but not very low serum (25-OHD) concentrations, and 2 micrograms/kg BW/day resulted in rapid and sustained increase in serum 25-OHD. Administration of 800 IU ergocalciferol (D2) also produced significantly higher serum 25-OHD concentrations than those in infants given 400 IU vitamin D2, but increases in serum 25-OHD were more gradual than in infants given 25-OHD3. In treatment trials with infants weighing less than 1500 gm, those given 800 IU D2, compared with those given 400 IU D2, had higher serum calcium concentrations and less frequent moderate or severe hypomineralization. Infants given 2 micrograms/kg BW 25-OHD3 had a significant increase in serum phosphorus values, but a decrease in serum calcium and magnesium concentrations, and parathyroid hormone also was suppressed to low normal values. The frequency of moderate to severe hypomineralization remained the same as in infants given 400 IU D2. In a subgroup of infants, serum 1,25-dihydroxyvitamin D was elevated over adult values, both in infants given 25-OHD3 (68.5 +/- 8.4 pg/ml) and in infants given vitamin D2 (60 +/- 6.7 pg/ml). Serum vitamin D concentrations were undetectable in four of six infants receiving 25-OHD3, but were elevated (5 to 31 ng/ml) in four infants receiving vitamin D2. Although 800 to 1000 IU D2 can be recommended as routine vitamin D supplementation in very premature infants fed standard formula, the use of 25-OHD3 requires further study.     

Low vitamin D status in children with sickle cell disease

OBJECTIVES: To examine vitamin D status in children with sickle cell disease (SCD)-SS and its relation to season and dietary intake. STUDY DESIGN: Growth, dietary intake, 25-hydroxyvitamin D (25-OHD), and parathyroid hormone levels were measured. Children with low and normal vitamin D status were compared. Low vitamin D status was defined as a serum concentration of 25-OHD <27.5 nmol/L. Serum 25-OHD and parathyroid hormone levels were compared among children with SCD-SS and healthy children. RESULTS: Children with SCD-SS (n=65), 5 to 18 years of age, were evaluated. Mean (+/-SD) serum 25-OHD concentration was 25.5 +/- 12.8 nmol/L; 65% of subjects had low vitamin D status. Low vitamin D prevalence was highest during spring (100%). Children with SCD-SS were at higher risk for low vitamin D status than healthy children. Vitamin D intake was lower in subjects with SCD-SS and low vitamin D than those with normal serum vitamin D status (P <.05). CONCLUSIONS: Low serum vitamin D status was highly prevalent in black children with SCD-SS. Vitamin D status was associated with season and dietary intake.     

Minimal vitamin D and high calcium and phosphorus needs of preterm infants receiving parenteral nutrition

Preterm infants (birth weight, 1,089 +/- 91 g; gestational age, 28.9 +/- 0.7 weeks; mean +/- SEM) with mixed medical and surgical indications for parenteral nutrition (PN) were observed to determine the adequacy of infusates with fixed, low-dose vitamin D (25 IU/dl) and two combinations of calcium and phosphorus. The duration of low-dose vitamin D PN ranged from 5 to 52 days, with a median of 27 days. Twelve infants were randomly assigned to low (standard) Ca and P doses (5 mM each; 20 mg/dl of Ca and 15.5 mg/dl of P) and 13 high Ca and P doses (15 mM each; 60 mg/dl of Ca and 46.5 mg/dl of P). The maximum daily vitamin D intake was similar for both groups (31 +/- 1.3 versus 33 +/- 1.2 IU/kg). Vitamin D status in either group, as indicated by serum 25-hydroxyvitamin D (25-OHD) concentrations, was normal. There was no significant difference in observed changes of serial measurements of serum calcium, magnesium, phosphorus, alkaline phosphatase, creatinine (Cr), 25-OHD, and vitamin D-binding protein concentrations or urinary Ca:Cr and Mg:Cr ratios. In the low-dose Ca and P group, the serum P level was consistently less than 4 mg/dl in five infants, serum 1,25-dihydroxyvitamin D concentrations were higher, and tubular reabsorption of phosphorus was consistently greater than 95% and significantly higher than in the high-dose Ca and P groups. Severe bone demineralization apparent on X-ray occurred in two infants, with a fractured distal left ulna in one of the two infants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Higher prevalence of vitamin D deficiency in mothers of rachitic than nonrachitic children

Vitamin D deficiency [serum 25-hydroxyvitamin D <25 nmol/L (<10 ng/mL)] was identified in 92% of rachitic Arab children and 97% of their mothers compared with 22% of nonrachitic children and 52% of their mothers. There was a positive correlation between maternal and child vitamin D levels. We conclude that mothers of rachitic children should be investigated and treated for vitamin D deficiency.     

Effects of antiepileptic drug therapy on vitamin D status and biochemical markers of bone turnover in children with epilepsy

Reports of decreased serum 25-hydroxyvitamin D (25-OHD) and altered bone metabolism associated with antiepileptic drug (AED) treatment are inconsistent and predominantly restricted to adults. In this cross-sectional observational study, the aim was to evaluate the influence of AED treatment on vitamin D status and markers of bone turnover in children with epilepsy. In 38 children taking AEDs and 44 healthy control subjects, blood samples were collected to determine the levels of serum 25-OHD, intact parathyroid hormone (iPTH), calcium (Ca), phosphate (P), bone alkaline phosphatase (BAP), osteocalcin (OC) and C terminal telopeptide of type I collagen (ICTP). More than 75% of the patients were vitamin D deficient (serum 25-OHD<20 ng/mL) and 21% of the patients had an insufficient vitamin D status (serum 25-OHD=20–30 ng/mL). In the patients, the serum levels of OC (p = 0.002) and BAP (p < 0.001) were significantly increased, but ICTP (p = 0.002) concentrations were significantly decreased compared with the control group. When patients where divided into two groups according to their medication (mono- or polytherapy), significantly lower 25-OHD (p = 0.038) and ICTP (p = 0.005) levels and elevated BAP (p = 0.023) concentrations were found in patients under polytherapy. An association between 25-OHD and the measured bone markers could not be determined. Our results indicate that the prevalence of vitamin D deficiency in epilepsy patients under AED treatment is high, especially under polytherapy, and alteration markers of bone formation and resorption suggests an accelerated skeletal turnover. The routine monitoring of serum 25-OHD and vitamin D supplementation on an individual basis should be considered.