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Ren Q, Li K, Li J, Pan J, Liu Y, Chen Y, Xu Y, Xie Q. Longitudinal Changes in Human Milk Minerals and Vitamins in the Chinese Population: A Scoping Review. Nutrients 2024; 16:1710. [PMID: 38892644 PMCID: PMC11174910 DOI: 10.3390/nu16111710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
This scoping review aims to investigate longitudinal changes in minerals and vitamins concentrations in human milk among the Chinese population. Following the PRISMA-ScR guidelines, a comprehensive and systematic literature search was conducted using both English and Chinese databases. Data were extracted and categorized into six defined lactation stages. We found that the concentration of most minerals decreased throughout the lactation period, although calcium (Ca) and magnesium (Mg) fluctuated slightly across lactation periods. Fat-soluble vitamins also showed a decline throughout the lactation period, while water-soluble vitamins exhibited an increasing trend. However, folic acid, biotin, and pantothenic acid demonstrated a downward trend. Overall, this review has identified the longitudinal changes in minerals and vitamins concentrations in human milk among the Chinese population. In order to conduct a more in-depth examination of maternal characteristics and nutritional factors of the composition of human milk, it is recommended to utilize standardized protocols for the collection and analysis of human milk samples.
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Affiliation(s)
- Qiqi Ren
- Heilongjiang Feihe Dairy Co., Ltd., C-16, 10A Jiuxianqiao Rd., Chaoyang, Beijing 100015, China; (Q.R.); (K.L.); (J.L.); (J.P.)
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
| | - Kaifeng Li
- Heilongjiang Feihe Dairy Co., Ltd., C-16, 10A Jiuxianqiao Rd., Chaoyang, Beijing 100015, China; (Q.R.); (K.L.); (J.L.); (J.P.)
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
| | - Jufang Li
- Heilongjiang Feihe Dairy Co., Ltd., C-16, 10A Jiuxianqiao Rd., Chaoyang, Beijing 100015, China; (Q.R.); (K.L.); (J.L.); (J.P.)
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
| | - Jiancun Pan
- Heilongjiang Feihe Dairy Co., Ltd., C-16, 10A Jiuxianqiao Rd., Chaoyang, Beijing 100015, China; (Q.R.); (K.L.); (J.L.); (J.P.)
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
| | - Yang Liu
- Heilongjiang Feihe Dairy Co., Ltd., C-16, 10A Jiuxianqiao Rd., Chaoyang, Beijing 100015, China; (Q.R.); (K.L.); (J.L.); (J.P.)
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
| | - Yong Chen
- Heilongjiang Feihe Dairy Co., Ltd., C-16, 10A Jiuxianqiao Rd., Chaoyang, Beijing 100015, China; (Q.R.); (K.L.); (J.L.); (J.P.)
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
| | - Yajun Xu
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Xueyuan Road 38, Haidian, Beijing 100083, China
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Xueyuan Road 38, Haidian, Beijing 100083, China
| | - Qinggang Xie
- Heilongjiang Feihe Dairy Co., Ltd., C-16, 10A Jiuxianqiao Rd., Chaoyang, Beijing 100015, China; (Q.R.); (K.L.); (J.L.); (J.P.)
- PKUHSC—China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, Xueyuan Road 38, Haidian, Beijing 100083, China
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Reid CG, Graham R. A Case of Rickets and Pediatric Iron Deficiency Anemia in Alabama. Cureus 2024; 16:e60140. [PMID: 38864063 PMCID: PMC11165436 DOI: 10.7759/cureus.60140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
A 15-month-old African American male patient presented to the pediatric clinic to establish care. The patient had been seen and treated by a previous pediatrician who had diagnosed him with failure to thrive, anemia, and hepatosplenomegaly, according to the patient's parents. Upon physical examination, the patient was determined to be less than the first percentile for height and in the eighth percentile for weight. Frontal bossing was also observed. The patient's hemoglobin level was measured in the office to help confirm the previous anemia diagnosis and was determined to be 6.3 g/dL (normal: 10.5-13.0 g/dL). At this point, the patient was sent to a pediatric emergency department for continued treatment and workup. At the emergency department, the patient received an extensive laboratory workup for the evaluation of anemia, revealing iron deficiency anemia (hemoglobin: 5.6 g/dL (normal: 10.5-13 g/dL), mean corpuscular volume: 51.4 fl (normal: 70-84 fl), iron: 18 mcg/dL (normal: 30-70 mcg/dL), total iron binding capacity: 598 mcg/dL (normal: 100-400 mcg/dL), and hematocrit: 23.7% (normal: 33-38%)) and decreased levels of vitamin D (<6 ng/mL, normal: >30 ng/mL), ionized calcium (1.17 mg/dL, normal: 4.4-5.2 mg/dL), and phosphorus (2.4 mg/dL, normal: 2.9-5.9 mg/dL). These studies, paired with X-ray images of the patient's shoulders and wrists, further confirmed the diagnosis of rickets. Rickets is a disease in pediatric patients defined as a condition in which the mineralization of epiphyseal plates is defective. A nutritional deficiency in vitamin D, calcium, or phosphate causes acquired rickets. This condition is most commonly found in developing countries; some predisposing factors include poor sun exposure, high altitude, and breastfeeding. The patient was seen in the outpatient pediatric setting after the hospitalization, in which he received a blood transfusion, where he was managed on supplementation of calcium carbonate suspension, polysaccharide iron complex/novaferrum drops, and cholecalciferol drops with referral to endocrinology, hematology, and dietetics. This case serves as an example of how the diagnosis of nutritional deficiencies, such as rickets, can also be found in developed countries like the United States. Other conditions considered in the differential diagnosis were cystic fibrosis, necrotizing enterocolitis, metabolic disorders, inadequate absorption, and mechanical feeding difficulties, each of which must be ruled out to ensure that even an unlikely finding was not missed.
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Affiliation(s)
- Claudia G Reid
- Pediatrics, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Rhonda Graham
- Pediatrics, Edward Via College of Osteopathic Medicine, Huntsville, USA
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Falize C, Savage M, Jeanes YM, Dyall SC. Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis. Br J Nutr 2024; 131:1196-1224. [PMID: 38053371 PMCID: PMC10918524 DOI: 10.1017/s0007114523002775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/05/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
Maternal diet influences breast milk nutritional profile; however, it is unclear which nutrients and contaminants are particularly responsive to short- and long-term changes in maternal intake, and the impact of specific exclusion diets, such as vegan or vegetarian. This study systematically reviewed the literature on the effects of maternal nutrient intake, including exclusion diets, on both the nutrient and contaminant content of breast milk. The electronic databases, PubMed, CENTRAL, Web of Science and CINALH were systematically searched until 4 June 2023, with additionally searches of reference lists (PROSPERO, CRD42020221577). The quality of the studies was examined using Cochrane Risk of Bias tool and Newcastle-Ottawa scale. Eighty-eight studies (n 6577) met the search criteria. Due to high heterogeneity, meta-analysis was not possible. There was strong evidence of response to maternal intakes for DHA and EPA, vitamins A, E and K, iodine and Se in breast milk composition, some evidence of response for α-linolenic acid, B vitamins, vitamin C and D, ovalbumin, tyrosine and contaminants, and insufficient evidence to identify the effects arachidonic acid, Cu, Fe, Zn and choline. The paucity of evidence and high heterogeneity among studies reflects the need for more high-quality trials. However, this review identified the importance of maternal intake in the nutritional content of breast milk for a wide range of nutrients and supports the recommendation for supplementation of DHA and vitamin B12 for those on restrictive diets.
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Affiliation(s)
- Coralie Falize
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - M. Savage
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Yvonne M. Jeanes
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Simon C. Dyall
- School of Life and Health Sciences, University of Roehampton, London, UK
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Reynolds CJ, Dyer RB, Vizenor BA, Koszewski NJ, Singh RJ, Thacher TD. Analysis of vitamin D 3-sulfate and 25-hydroxyvitamin D 3-sulfate in breastmilk by LC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1232:123954. [PMID: 38101284 PMCID: PMC10872384 DOI: 10.1016/j.jchromb.2023.123954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/17/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Sulfated metabolites of vitamin D have been suggested to be in breastmilk, although current methods to measure sulfated vitamin D compounds in breastmilk by liquid chromatography-tandem mass spectrometry (LC-MS/MS) have not adequately accounted for increased aqueous solubility of these sulfated metabolites. The purpose of this study was to generate a method of LC-MS/MS for measuring vitamin D3-3-sulfate (VitD3-S) and 25-hydroxyvitamin D3-3-sulfate (25OHD3-S) specifically in human breastmilk. The resulting method uses methanol to precipitate protein and solid phase extraction to prepare the samples for LC-MS/MS. The limits of quantification for analytes in solvent were 0.23 ng/mL VitD3-S and 0.2 ng/mL 25OHD3-S. Various experiments observed concentrations ranging 0.53 to 1.7 ng/mL VitD3-S and ≤ 0.29 ng/mL 25OHD3-S. Both analytes were present in aqueous skim milk, demonstrating the enhanced aqueous solubility of these vitamin D sulfates. In conclusion, we describe an effective method for measuring VitD3-S and 25OHD3-S in breastmilk by LC-MS/MS.
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Affiliation(s)
- Carmen J Reynolds
- Mayo Clinic Department of Physiology & Biomedical Engineering, 200 First St. SW, Rochester, MN 55905 USA.
| | - Roy B Dyer
- Mayo Clinic Department of Laboratory Medicine & Pathology, 200 First St. SW, Rochester, MN 55905 USA
| | - Brady A Vizenor
- Mayo Clinic Department of Laboratory Medicine & Pathology, 200 First St. SW, Rochester, MN 55905 USA
| | | | - Ravinder J Singh
- Mayo Clinic Department of Laboratory Medicine & Pathology, 200 First St. SW, Rochester, MN 55905 USA
| | - Tom D Thacher
- Mayo Clinic Department of Family Medicine, 200 First St. SW, Rochester, MN 55905 USA
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Diaz-Thomas A, Iyer P. Global Health Disparities in Childhood Rickets. Endocrinol Metab Clin North Am 2023; 52:643-657. [PMID: 37865479 DOI: 10.1016/j.ecl.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Nutritional rickets is a global health problem reflecting both historical and contemporary health disparities arising from racial, ethnic, environmental, and geopolitical circumstances. It primarily affects marginalized populations and can contribute to long-term morbidity. Deficits in bone health in childhood may also contribute to osteomalacia/osteoporosis. Solutions require a global public health approach.
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Affiliation(s)
- Alicia Diaz-Thomas
- Department of Pediatrics, Division of Pediatric Endocrinology, The University of Tennessee Health Science Center, 910 Madison Avenue, Suite 1010, Memphis, TN 38163, USA.
| | - Pallavi Iyer
- Department of Pediatrics, Division of Endocrinology and Diabetes, Medical College of Wisconsin, Children's Corporate Center, Suite 520, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Han SM, Huang F, Derraik JGB, Vickers MH, Devaraj S, Redeuil K, Campos-Giménez E, Pang WW, Godfrey KM, Chan SY, Thakkar SK, Cutfield WS. A nutritional supplement during preconception and pregnancy increases human milk vitamin D but not B-vitamin concentrations. Clin Nutr 2023; 42:2443-2456. [PMID: 38411017 DOI: 10.1016/j.clnu.2023.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND & AIMS Optimal maternal vitamin status during pregnancy and lactation is essential to support maternal and infant health. For instance, vitamin D3 is involved in infant bone development, and B-vitamins are involved in various metabolic processes, including energy production. Through a double-blind randomised controlled trial, we investigated the effects of maternal supplementation from preconception throughout pregnancy until birth on human milk (HM) concentrations of vitamin D3 and B-vitamins. In addition, we aimed to characterise longitudinal changes in milk concentrations of these vitamins. METHODS Both control and intervention supplements contained calcium, iodine, iron, β-carotene, and folic acid, while the intervention also contained zinc, vitamins B2, B6, B12, and D3, probiotics, and myo-inositol. HM samples were collected across 4 time points from 1 week to 3 months post-delivery from 158 mothers in Singapore, and 7 time points from 1 week to 12 months from 180 mothers in New Zealand. HM vitamin D was quantified using supercritical fluid chromatography and B-vitamins with mass spectrometry. Potential intervention effects on HM vitamins D3, B2, B6, and B9, as well as other B-vitamin (B1 and B3) concentrations were assessed using linear mixed models with a repeated measures design. RESULTS Over the first 3 months of lactation, HM 25-hydroxyvitamin D3 concentrations were 20% (95% CI 8%, 33%, P = 0.001) higher in the intervention group, with more marked effects in New Zealand. There were no observed intervention effects on HM concentrations of vitamins B1, B2, B3, B6, and B9. In New Zealand mothers, longitudinally, vitamin D3 concentrations gradually increased from early lactation up to 12 months, while vitamins B1 and B2 peaked at 6 weeks, B3 at 3 weeks, and B6 and B9 at 3 months. CONCLUSIONS Maternal supplementation during preconception and pregnancy increased HM vitamin D, but not B-vitamin concentrations in lactation. Further studies are required to examine the discrete benefits of vitamin D supplementation starting preconception vs during pregnancy, and to further characterise the effects of supplementation on later offspring health outcomes. CLINICAL TRIAL REGISTRATION Registered at ClinicalTrials.gov on the 16 July 2015 (identifier NCT02509988); Universal Trial Number U1111-1171-8056. This study was academic-led by the EpiGen Global Research Consortium.
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Affiliation(s)
- Soo Min Han
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Fang Huang
- Nestlé Research, Société des Produits Nestlé SA, Beijing, China
| | - José G B Derraik
- Liggins Institute, The University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mark H Vickers
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - Karine Redeuil
- Nestlé Research, Société des Produits Nestlé SA, Lausanne, Switzerland
| | | | - Wei Wei Pang
- Global Centre for Asian Women's Health, Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | | | - Wayne S Cutfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand; A Better Start - National Science Challenge, The University of Auckland, Auckland, New Zealand.
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Jones KS, Meadows SR, Koulman A. Quantification and reporting of vitamin D concentrations measured in human milk by LC-MS/MS. Front Nutr 2023; 10:1229445. [PMID: 38035362 PMCID: PMC10687194 DOI: 10.3389/fnut.2023.1229445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Vitamin D is essential for optimal bone health, and vitamin D deficiency has been associated with an increased risk of adverse pregnancy, growth and developmental outcomes. In early life, and in the absence of endogenous vitamin D production from UVB light, infants are reliant on vitamin D stores established in utero and the vitamin D supply from human milk (HM). However, comprehensive data on vitamin D in HM is lacking. Thus, in this review we explore the application of liquid-chromatography tandem mass spectrometry (LC-MS/MS) to the assessment of vitamin D in HM. We discuss the challenges of extracting and measuring multiple vitamin D metabolites from HM including the frequent requirement for a large sample volume, and inappropriate poor sensitivity. Shortcomings in the reporting of experimental procedures and data analysis further hinder advances in the field. Data collated from all studies that have applied LC-MS/MS reveal that, in general, cholecalciferol concentration is greater and more variable than 25-hydroxyvitamin D concentration, and that the vitamin D content of HM is low and less than the currently recommended dietary requirement of infants, although maternal supplementation can increase the vitamin D content of HM. Improvements in analytical methods and their validation and larger, more representative studies are required to better characterize HM milk vitamin D metabolite concentrations and their relationship with maternal status. These data are essential to understand relationships with infant health and to inform public health policies around vitamin D fortification and supplementation.
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Affiliation(s)
- Kerry S. Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Fischer PR, Johnson CR, Leopold KN, Thacher TD. Treatment of vitamin D deficiency in children. Expert Rev Endocrinol Metab 2023; 18:489-502. [PMID: 37861060 DOI: 10.1080/17446651.2023.2270053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Vitamin D deficiency affects from 10% to 50% in various pediatric population groups and causes life-threatening hypocalcemia in infants, crippling rickets in infants and children, and increased risk of subsequent adult metabolic and neurologic problems. AREAS COVERED An English language literature search of PubMed was performed since 1940 as were the authors' personal literature collections. References identified in the reviewed literature are considered. DIAGNOSIS The diagnosis of vitamin D deficiency is based on serum 25-hydroxyvitamin D levels. Clinical features of rickets include bone deformities and elevated alkaline phosphatase. Most children and adolescents who are biochemically vitamin D deficient do not have specific symptoms or signs of deficiency. PREVENTION Prevention of vitamin D deficiency is via exposure to sunshine, food and beverage fortification, and dietary supplementation. TREATMENT Effective treatment of vitamin D deficiency is via oral or injectable administration of vitamin D. Dosing and duration of vitamin D therapy have been described for healthy children and for children with underlying medical conditions, but recommendations vary. EXPERT OPINION Further investigation is needed to determine long-term non-skeletal effects of childhood vitamin D deficiency, benefits of supplementation in asymptomatic individuals with biochemical vitamin D deficiency, and appropriate screening for vitamin D deficiency in asymptomatic children and adolescents.
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Affiliation(s)
- Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- Khalifa University College of Health and Medical Science, Abu Dhabi, UAE
| | - Casey R Johnson
- Pediatric Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MN, USA
| | - Kaitlin N Leopold
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
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Rios-Leyvraz M, Yao Q. Calcium, zinc, and vitamin D in breast milk: a systematic review and meta-analysis. Int Breastfeed J 2023; 18:27. [PMID: 37264448 PMCID: PMC10233556 DOI: 10.1186/s13006-023-00564-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Global estimates of calcium, zinc and vitamin D content in breastmilk are lacking. The objective of this systematic review was to determine the calcium, zinc, and vitamin D content in breast milk. METHODS A systematic search of the online databases Embase, MEDLINE, and CENTRAL was conducted in November 2022 and complemented by searches of the African Journals Online database and the LILACS database, and reference lists. Studies reporting the calcium, zinc and vitamin D content in breast milk of apparently healthy mothers and infants were included. Random effects meta-analyses were conducted. The effect of influencing factors were investigated with sub-group analyses and meta-regressions. RESULTS A total of 154 studies reporting on breast milk calcium were identified, with a mean calcium concentration in breast milk of 261 mg/L (95% CI: 238, 284). Calcium concentration was influenced by maternal health and decreased linearly over the duration of lactation. Calcium concentration at a specific time during lactation could be estimated with the equation: calcium concentration [mg/L] = 282 - 0.2331 ✕ number of days since birth. A total of 242 studies reporting on breast milk zinc were identified, with a mean zinc concentration of 2.57 mg/L (95% CI: 2.50, 2.65). Zinc concentration was influenced by several factors, such as maternal age, gestational age, and maternal diet. Zinc concentration started high in the first weeks post-partum followed by a rapid decrease over the first months. Zinc concentration at a specific time during lactation could be estimated with the equation: zinc concentration [mg/L] = 6 + 0.0005 ✕ days - 2.0266 ✕ log(days). A total of 43 studies reporting on breast milk vitamin D were identified, with a mean total antirachitic activity of breast milk of 58 IU/L (95% CI: 45, 70), which consisted mostly of 25OHD3, and smaller amounts of vitamin D3, 25OHD2 and vitamin D2. Vitamin D concentration showed wide variations between studies and was influenced by vitamin D supplementation, continent and season. CONCLUSIONS This review provides global estimates of calcium, zinc and vitamin D content in breast milk, as well as indications on changes over time and depending on influencing factors.
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Affiliation(s)
- Magali Rios-Leyvraz
- Consultant, Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Qisi Yao
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, USA
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Liu MC, Weng PW, Chen SC, Liu TH, Huang HW, Huang CT, Yang CT, Mishra VK, Yang MT. Immunologic, Anti-Inflammatory, and Anti-Muscle Damage Profile of Supplemented Vitamin D 3 in Healthy Adults on Strenuous Endurance Exercise. BIOLOGY 2023; 12:biology12050657. [PMID: 37237471 DOI: 10.3390/biology12050657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Reportedly, strenuous endurance exercise can depress the immune system and induce inflammation and muscle damage. Therefore, this double-blinded, matched-pair study aimed to investigate the impact of vitamin D3 supplementation on immune response (leukocyte, neutrophil, lymphocyte, CD4+, CD8+, CD19+, and CD56+ counts), inflammatory profile (TNF-α and IL-6), muscle damage (CK and LDH levels), as well as aerobic capacity after strenuous endurance exercise in 18 healthy men taking 5000 IU of vitamin D3 (n = 9) or placebo (n = 9) daily for 4 weeks. Total and differential blood leukocyte counts, levels of cytokines, and muscle damage biomarkers were determined before, immediately after, and 2, 4, and 24 h after exercise. The IL-6, CK, and LDH levels were significantly lower in vitamin D3 group at 2, 4, and 24 h post exercise (p < 0.05). Maximal and average heart rates during exercise were also significantly lower (p < 0.05). In the vitamin D3 group, the CD4+/CD8+ ratio after 4 weeks of supplementation was only significantly lower at post-0 than at baseline and significantly higher at post-2 than at baseline and post-0 (all p < 0.05). Taken together, 5000 IU of daily vitamin D3 supplementation for 4 weeks exhibited positive effects in terms of increased blood 25(OH)D levels, CD4+/CD8+ ratio (immune response), and aerobic capacity while inhibiting inflammatory cytokines and CK and LDH (muscle damage) in people performing strenuous endurance exercise.
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Affiliation(s)
- Ming-Che Liu
- School of Dental Technology, Taipei Medical University, Taipei 110301, Taiwan
- Clinical Research Center, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Urology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Research Center of Urology and Kidney, Taipei Medical University, Taipei 110301, Taiwan
| | - Pei-Wei Weng
- School of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- International Ph.D. Program in Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Sheng-Chang Chen
- School of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Ting-Hao Liu
- Center for General Education, Taipei Medical University, Taipei 110301, Taiwan
| | - Hsiang-Wei Huang
- Department of Medical Education, E-DA Hospital, Kaohsiung 824005, Taiwan
| | - Chang-Ti Huang
- Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 110301, Taiwan
| | - Cheng-Tse Yang
- Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 110301, Taiwan
| | | | - Ming-Ta Yang
- Clinical Research Center, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Center for General Education, Taipei Medical University, Taipei 110301, Taiwan
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Heo JS, Ahn YM, Kim ARE, Shin SM. Breastfeeding and vitamin D. Clin Exp Pediatr 2022; 65:418-429. [PMID: 34902960 PMCID: PMC9441616 DOI: 10.3345/cep.2021.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
The recent re-emergence of vitamin D deficiency (VDD) and rickets among breastfed infants without adequate sunlight exposure and vitamin D supplementation has been reported worldwide. Breastfed infants are particularly vulnerable to VDD because of the low vitamin D content of breast milk, restricted sunlight exposure, increased pollution, and limited natural dietary sources of vitamin D. The prevalence of VDD in breastfed infants differs vastly between studies and nations at 0.6%-91.1%. The recommended intake of vitamin D for lactating mothers to optimize their overall vitamin D status and, consequently, of their breast milk is 200-2,000 IU/day, indicating a lack of consensus. Some studies have suggested that maternal high-dose vitamin D supplementation (up to 6,400 IU/day) can be used as an alternate strategy to direct infant supplementation. However, concern persists about the safety of maternal high-dose vitamin D supplementation. Direct infant supplementation is the currently available option to support vitamin D status in breastfed infants. The recommended dose for vitamin D supplementation in breastfed infants according to various societies and organizations worldwide is 200-1,200 IU/day. Most international guidelines recommend that exclusively or partially breastfed infants be supplemented with 400 IU/day of vitamin D during their first year of life. However, domestic studies on the status and guidelines for vitamin D in breastfed infants are insufficient. This review summarizes the prevalence of VDD in breastfed infants, vitamin D content of breast milk, and current guidelines for vitamin D supplementation of lactating mothers and infants to prevent VDD in breastfed infants.
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Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Jang's Hospital, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Son Moon Shin
- Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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12
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Bolus Dose of Vitamin D to Lactating Mother and Calcium Transfer in Human Breastmilk. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Abstract
Purpose of the Review Results from epidemiological studies suggest that vitamin D (VD) deficiency (VDD) may be a cause of hypertension (HTN). However, the results of randomized clinical trials (RCTs) designed to address the impact of VD supplementation on reducing blood pressure (BP) remain equivocal. To determine whether VD might serve as a beneficial treatment option for a specific subset of hypertensive patients, we performed a stratified analysis of RCT data and addressed problems associated with some methodological issues. Recent Findings HTN is caused by multiple factors. VDD may be one of the factors contributing to the development of this disorder. There are more than 70 RCTs that examined the impact of VD supplementation on BP. These RCTs can be classified into four groups based on their respective study populations, including participants who are (1) VD-sufficient and normotensive, (2) VD-deficient and normotensive, (3) VD-sufficient and hypertensive, and (4) VD-deficient and hypertensive. Summary Our evaluation of these studies demonstrates that VD supplementation is ineffective when used to reduce BP in VD-sufficient normotensive subjects. VD supplementation for five years or more may reduce the risk of developing HTN specifically among those with VDD. Interestingly, findings from 12 RCTs indicate that daily or weekly supplementation, as opposed to large bolus dosing, results in the reduction of BP in VD-deficient hypertensive patients. Our ongoing research focused on elucidating the mechanisms of VDD-induced HTN will ultimately provide evidence to support the development of etiology-specific prevention and treatment strategies focused on HTN in the VD-deficient population.
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Andrews L, Phlegar K, Baatz JE, Ebeling MD, Shary JR, Gregoski MJ, Howard CR, Hollis BW, Wagner CL. Comparison of Infant Bone Mineral Content and Density After Infant Daily Oral Vit D 400 IU Supplementation Versus Nursing Mother Oral 6,400 IU Supplementation: A Randomized Controlled Lactation Study. Breastfeed Med 2022; 17:493-500. [PMID: 35271380 PMCID: PMC9234966 DOI: 10.1089/bfm.2021.0281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Vitamin D (vitD) plays a major role in maintenance of bone mineral homeostasis. It is unknown if bone mineral content (BMC) and bone mineral density (BMD) differ between infants who receive direct vitD supplementation and those who receive vitD indirectly via their mother's breast milk, while she received a high dose of vitD. It is hypothesized that there would be no differences in BMC or BMD by treatment group. Design/Methods: Randomized, double-blind trial to compare BMD and BMC of infants who received direct vitD (400 IU vitD3/day) in addition to their mother receiving standard dosage (400 IU vitD3/day) versus infants whose mothers were their only source of vitD and were given high-dose supplementation (6,400 IU vitD3/day). Participants were exclusively breastfeeding mothers and their infant consuming only human milk. Infant BMC and BMD were measured by dual-energy X-ray absorptiometry (DXA) scans of the infant's total body using Hologic Discovery A Densitometer and analyzed using Hologic Infant software at 1, 4, and 7 months of age. Results: Infant BMC and BMD did not differ significantly at 1, 4, or 7 months of age between direct and indirect supplementation arms. The mean difference in BMC from 1 to 7 months was 1.624 and 1.464 g for the 400 and 6,400 IU groups, respectively, (p = 0.5); the mean difference in BMD over this same period was 0.042 and 0.032 g/cm2 for the 400 and 6,400 IU groups, respectively (p = 0.2). Although some differences among races were observed, this did not reflect changes in bone growth between the treatment arms. Conclusion: High-dose vitD supplementation of mothers during lactation provided an efficacious alternative to direct supplementation of infants, as evidenced by noninferior infant BMD and BMC. Clinical Trial Registration number: NCT00412074.
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Affiliation(s)
- Laura Andrews
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristen Phlegar
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John E Baatz
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Myla D Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cynthia R Howard
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
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15
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Corsello A, Milani GP, Giannì ML, Dipasquale V, Romano C, Agostoni C. Different Vitamin D Supplementation Strategies in the First Years of Life: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10061023. [PMID: 35742074 PMCID: PMC9222934 DOI: 10.3390/healthcare10061023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
Vitamin D (VD) is an essential micronutrient with multiple functions for human growth, and adequate intake should be guaranteed throughout life. However, VD insufficiency is observed in infants all over the world. Low VD concentration in the breast milk of non-supplemented mothers and low compliance to VD daily supplementation are the main causes of VD insufficiency, especially in the long term. Furthermore, VD supplementation dosages are still debated and differ by country. We conducted a systematic review to compare the most recent evidence on different postnatal VD supplementation strategies, determining whether supplementation given to the mother is as effective as that administered directly to the child, and whether different dosages and administration schedules differ significantly in terms of efficacy and safety. We identified 18 randomized controlled trials (RCTs) addressing the role of infant (n = 961), maternal (n = 652) or combined infant and maternal VD supplementation (n = 260 pairs). In all studies, similar outcomes emerged in terms of efficacy and safety. According to our findings, alternative approaches of VD supplementation may be adopted, especially in cases where the adherence to daily supplementation strategies is poor. This review shows that different dosages and supplementation strategies result in similar VD sufficiency rates. Therefore, international guidelines may be revised in the future to offer multiple and different options of supplementation for specific settings and ages.
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Affiliation(s)
- Antonio Corsello
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
| | - Gregorio Paolo Milani
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-349-832-0575
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, 98125 Messina, Italy; (V.D.); (C.R.)
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, 98125 Messina, Italy; (V.D.); (C.R.)
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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16
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Breast Milk Monthly D-livery. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Stoffers AJ, Weber DR, Levine MA. An Update on Vitamin D Deficiency in the twenty-first century: nature and nurture. Curr Opin Endocrinol Diabetes Obes 2022; 29:36-43. [PMID: 34839324 PMCID: PMC8849548 DOI: 10.1097/med.0000000000000691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Here, we review the most up-to-date understanding of the pathogenesis, prevention and treatment of vitamin D deficient rickets in children. This will include recent advances in the genetic determinants of abnormal vitamin D metabolism, with the intention of aiding clinicians with establishing the diagnosis and implementing treatment plans for children presenting with vitamin D deficiency rickets. RECENT FINDINGS Vitamin D deficiency rickets is a frequently encountered, but entirely preventable, disorder of bone mineral metabolism. Risk factors for developing vitamin D deficiency rickets include inadequate exposure to sunlight, exclusive breast feeding without vitamin D supplementation and inadequate intake of vitamin D, calcium or phosphorus. Other factors that may influence the development of vitamin D deficiency and/or rickets include genetic alterations or medications that alter vitamin D metabolism. SUMMARY Vitamin D levels in individuals are influenced by environmental factors, as well as genetic factors. A thorough understanding of these factors is critical for the evaluation and treatment of a child presenting with rickets. There remains a great need for additional research to determine ideal vitamin D status across diverse populations, and to better understand how vitamin D status affects overall health.
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Affiliation(s)
- Ashley J Stoffers
- The Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Effect of Maternal Supplementation With Two Different Doses of Vitamin D During Lactation on Vitamin D Status, Anthropometry and Bone Mass of Infants: A Randomized Controlled Trial. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2489-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stable Rates of Low Vitamin D Status Among Children Despite Increased Testing: A Population-Based Study. J Pediatr 2021; 239:212-218.e2. [PMID: 34293368 PMCID: PMC9156447 DOI: 10.1016/j.jpeds.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/29/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the trends in testing and incidence of vitamin D deficiency/insufficiency in Olmsted County, Minnesota over a 16-year period. STUDY DESIGN The Rochester Epidemiology Project (REP) was used to identify Olmsted County, Minnesota residents aged <19 years who had 25-hydroxyvitamin D [25(OH)D] levels measured between January 2, 2002 and December 31, 2017. Using each patient's first 25(OH)D measurement during this period, patients were categorized into 3 groups: <20 ng/mL, 20-50 ng/mL, and >50 ng/mL. Vitamin D deficiency/insufficiency was defined as a total 25(OH)D level of <20 ng/mL. RESULTS There was a 42-fold increase in the proportion of the county's pediatric population tested each year, starting at 3.7 per 10 000 persons in 2002 and increasing to 156.1 per 10 000 persons in 2017. The largest increase in testing occurred in children aged ≥10 years, specifically the females in this age group, in whom we observed a 90-fold increase from 2002 to 2017. During the 16-year period, the incidence of vitamin D deficiency/insufficiency (per 10 000 persons) increased from 1.7 in 2002-2003 to 19.9 in 2016-2017, but the proportion that were tested and had vitamin D deficiency/insufficiency remained stable, with rates of 21.9% (95% CI, 16.1%-29.1%) in 2006-2007 and 18.5% (95% CI, 16.0%-21.2%) in 2016-2017. CONCLUSIONS The proportion of the county's pediatric population who underwent vitamin D testing increased from 2002 to 2017, in parallel to the increased incidence of vitamin D deficiency/insufficiency, but the proportion tested that had vitamin D deficiency/insufficiency remained stable over time.
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20
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Demers-Mathieu V, Lavangnananda S, Medo E. Influence of Vitamin D3 Levels and T Cell-Related Cytokines in Human Milk on Coronavirus Disease 2019 Infection in Lactating Women. Breastfeed Med 2021; 16:995-1003. [PMID: 34388035 DOI: 10.1089/bfm.2021.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Vitamin D deficiency was associated with an increased risk of coronavirus disease 2019 (COVID-19) infection. Vitamin D deficient mothers are more likely to have infants with vitamin D deficiency, affecting their immunity and protection against infection. This study aimed at comparing the concentrations of vitamin D3 and T cell-related cytokines in milk between mothers with confirmed COVID-19 polymerase chain reaction (PCR) test, mothers with viral infections suggestive of COVID-19, and mothers without infection. Materials and Methods: Concentrations of vitamin D3 and T cell-related cytokines in milk samples were determined by ELISA from 10 mothers who had a positive COVID-19 PCR test, 10 mothers with viral symptoms suggestive of COVID-19, and 20 mothers without infection. Results: Vitamin D3 concentration in human milk was higher in women without infection than in women with viral symptoms or COVID-19 PCR. Interleukin-2 level in milk was higher in the no-infection group than the COVID-19 PCR group but it did not differ with the viral symptoms group. Vitamin D3 did not correlate with any cytokines in human milk. Prenatal vitamin intake did not affect the vitamin D3 in human milk. The percentage of milk from mothers with <20 ng/mL of vitamin D3 was 50% in the COVID-19 PCR group, 60% in the viral symptoms group, and 5% in the no-infection group. Conclusions: Vitamin D3 level in breast milk may influence maternal immunity against COVID-19 infection. A larger study is needed to evaluate the relationship between vitamin D3 concentration in breast milk, maternal immune response, and the incidence of COVID-19 infection in lactating mothers.
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Affiliation(s)
- Veronique Demers-Mathieu
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories, A Public Benefit Corporation, Boulder City, Nevada, USA
| | - Sirima Lavangnananda
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories, A Public Benefit Corporation, Boulder City, Nevada, USA
| | - Elena Medo
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories, A Public Benefit Corporation, Boulder City, Nevada, USA
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21
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Zhang L, Piao X. Use of 25-hydroxyvitamin D 3 in diets for sows: A review. ACTA ACUST UNITED AC 2021; 7:728-736. [PMID: 34466677 PMCID: PMC8379139 DOI: 10.1016/j.aninu.2020.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 11/21/2020] [Indexed: 12/19/2022]
Abstract
Dietary supplementation with 25-hydroxyvitamin D3 (25OHD3), as an alternative source of vitamin D, is becoming increasingly popular due to its commercialization and more efficient absorbability. The addition of 25OHD3 rather than its precursor vitamin D3 can circumvent the 25-hydroxylation reaction in the liver, indicating that supplementation of 25OHD3 can rapidly improve the circulating vitamin D status of animals. Emerging experiments have reported that maternal 25OHD3 supplementation could increase sow performances and birth outcomes and promote circulating vitamin D status of sows and their offspring. Increased milk fat content was observed in many experiments; however, others demonstrated that adding 25OHD3 to lactating sow diets increased the contents of milk protein and lactose. Although an inconsistency between the results of different experiments exists, these studies suggested that maternal 25OHD3 supplementation could alter milk composition via its effects on the mammary gland. Previous studies have demonstrated that adding 25OHD3 to sow diets could improve the mRNA expressions of insulin-induced gene 1 (INSIG1) and sterol regulatory element-binding protein 1 (SREBP1) in the mammary gland cells from milk and increase the mRNA expressions of acetyl-CoA carboxylase α (ACCα) and fatty acid synthase (FAS) in the mammary gland tissue. Maternal 25OHD3 supplementation promotes skeletal muscle development of piglets before and after parturition, and improves bone properties including bone density and bone breaking force in lactating sows and their piglets. Interestingly, 25OHD3 supplementation in sow diets could improve neonatal bone development via regulation of milk fatty acid composition related to bone metabolism and mineralization. In this review, we also discuss the effects of adding 25OHD3 to sow diets on the gut bacterial metabolites of suckling piglets, and propose that butyrate production may be associated with bone health. Therefore, to better understand the nutritional functions of maternal 25OHD3 supplementation, this paper reviews advances in the studies of 25OHD3 for sow nutrition and provides references for practical application.
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Affiliation(s)
- Lianhua Zhang
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
| | - Xiangshu Piao
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
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Comparison of Vitamin D and 25-Hydroxyvitamin D Concentrations in Human Breast Milk between 1989 and 2016-2017. Nutrients 2021; 13:nu13020573. [PMID: 33572283 PMCID: PMC7915017 DOI: 10.3390/nu13020573] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast milk is considered the optimal source of nutrition during infancy. Although the vitamin D concentration in human breast milk is generally considered poor for infants, vitamin D in breast milk is an important source for exclusively breastfed infants. Increases in vitamin D insufficiency and deficiency in lactating mothers may reduce vitamin D concentrations in breast milk. This study aimed to compare vitamin D and 25-hydroxyvitamin D (25OHD) concentrations in breast milk collected in 1989 and 2016-2017 and simultaneously analyze them with liquid chromatography-tandem mass spectrometry (LC-MS/MS); the association between the lifestyle of recent lactating mothers (2016-2017) and vitamin D status in human breast milk was also evaluated. METHOD Lactating mothers were recruited from three regions of Japan in 1989 (n = 72) and 2016-2017 (n = 90), and milk from 3-4 months was collected in summer and winter. The samples were strictly sealed and stored at -80℃ until measurement. Breast milk vitamin D and 25OHD concentrations were analyzed by LC-MS/MS. Vitamin D intake, sun exposure, and sunscreen use of the lactating mothers in 2016-2017 were assessed. RESULTS Both vitamin D and 25OHD concentrations in breast milk were higher in the summer regardless of the survey year. Significantly lower vitamin D and 25OHD concentrations were observed in 2016-2017 compared with 1989 in summer, but no survey year difference was observed in winter. The stepwise multiple regression analyses identified season, daily outdoor activity, and suntan in the last 12 months as independent factors associated with vitamin D3 concentrations. CONCLUSION The results suggest that low vitamin D status in recent lactating mothers may have decreased vitamin D and 25OHD concentrations in breast milk compared with the 1980s. These results are helpful for developing public health strategies to improve vitamin D status in lactating mothers and infants.
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Keikha M, Shayan-Moghadam R, Bahreynian M, Kelishadi R. Nutritional supplements and mother's milk composition: a systematic review of interventional studies. Int Breastfeed J 2021; 16:1. [PMID: 33397426 PMCID: PMC7780633 DOI: 10.1186/s13006-020-00354-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/14/2020] [Indexed: 12/31/2022] Open
Abstract
Background This study aims to systematically review the effects of maternal vitamin and/or mineral supplementation on the content of breast milk. Methods We systematically searched electronic databases including Medline via PubMed, Scopus and ISI Web of Science till May 24, 2018. The following terms were used systematically in all mentioned databases: (“human milk” OR “breast milk” OR “breast milk composition” OR “human breast milk composition” OR “composition breast milk” OR “mother milk” OR “human breast milk” OR “maternal milk”) AND (“vitamin a” OR “retinol” OR “retinal” OR “retinoic acid” OR “beta-carotene” OR “beta carotene” OR “ascorbic acid” OR “l-ascorbic acid” OR “l ascorbic acid” OR “vitamin c” OR “vitamin d” OR “cholecalciferol” OR “ergocalciferol” OR “calciferol” OR “vitamin e” OR “tocopherol” OR “tocotrienol” OR “alpha-tocopherol” OR “alpha tocopherol” OR “α-tocopherol” OR “α tocopherol” OR “vitamin k” OR “vitamin b” OR “vitamin b complex” OR “zinc” OR “iron” OR “copper” Or “selenium” OR “manganese” OR “magnesium”) and we searched Medline via Medical subject Headings (MeSH) terms. We searched Google Scholar for to increase the sensitivity of our search. The search was conducted on human studies, but it was not limited to the title and abstract. Methodological quality and risk of bias of included studies were evaluated by Jadad scale and Cochrane risk of bias tools, respectively. Results This review included papers on three minerals (zinc, iron, selenium) and 6 vitamins (vitamin A, B, D, C, E and K) in addition to multi-vitamin supplements. Although studies had different designs, e.g. not using random allocation and/or blinding, our findings suggest that maternal use of some dietary supplements, including vitamin A, D, vitamin B1, B2 and vitamin C might be reflected in human milk. Vitamin supplements had agreater effect on breast milk composition compared to minerals. Higher doses of supplements showed higher effects and they were reflected more in colostrum than in the mature milk. Conclusion Maternal dietary vitamin and/or mineral supplementation, particularly fat- soluble vitamins, vitamin B1, B2 and C might be reflected in the breast milk composition. No difference was found between mega dose and single dose administration of minerals.
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Affiliation(s)
- Mojtaba Keikha
- Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Ramin Shayan-Moghadam
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Bahreynian
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. .,Department of Nutrition, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Schaefer E, Demmelmair H, Horak J, Holdt L, Grote V, Maar K, Neuhofer C, Teupser D, Thiel N, Goeckeler-Leopold E, Maggini S, Koletzko B. Multiple Micronutrients, Lutein, and Docosahexaenoic Acid Supplementation during Lactation: A Randomized Controlled Trial. Nutrients 2020; 12:E3849. [PMID: 33339438 PMCID: PMC7765837 DOI: 10.3390/nu12123849] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023] Open
Abstract
Breastfed infants require an adequate supply of critical nutrients for growth, tissue functions, and health. Recommended intakes for several nutrients are considerably higher in lactating than non-lactating women but are not always met with habitual diets. We report a randomized, double-blind clinical trial in 70 healthy lactating women in Germany evaluating the effects of supplementation with multiple micronutrients, lutein, and docosahexaenoic acid (DHA) compared to placebo on maternal nutrient status and milk composition. The primary endpoint was the effect on the change of human milk DHA content (as a proportion of total milk fatty acids) during 12 weeks of supplementation. Maternal blood and milk biomarkers were measured as secondary endpoints. Supplementation increased maternal milk DHA by 30% compared to a decline in the placebo group. Supplementation also increased maternal blood DHA (17%), eicosapentaenoic acid (4%), 25-OH-vitamin D (24%), vitamin B12 (12%), lutein (4%), and beta carotene (49%), while homocysteine decreased. No significant difference in the number of adverse events was observed between supplementation and placebo groups. In conclusion, multi-micronutrient supplementation was safe and increased maternal blood and milk concentrations of selected nutrients in healthy women.
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Affiliation(s)
- Ella Schaefer
- Bayer Consumer Care AG, Peter-Merian-Straße 84, 4002 Basel, Switzerland;
| | - Hans Demmelmair
- Department Paediatrics, Division Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, LMU University Hospitals, Ludwig-Maximilians-Universität Munich, Lindwurmstraße 4, 80337 Munich, Germany; (H.D.); (J.H.); (V.G.); (B.K.)
| | - Jeannie Horak
- Department Paediatrics, Division Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, LMU University Hospitals, Ludwig-Maximilians-Universität Munich, Lindwurmstraße 4, 80337 Munich, Germany; (H.D.); (J.H.); (V.G.); (B.K.)
| | - Lesca Holdt
- Institute of Laboratory Medicine, LMU University Hospitals, Ludwig-Maximilians-Universität Munich, Marchioninistraße 15, 81377 Munich, Germany; (L.H.); (D.T.)
| | - Veit Grote
- Department Paediatrics, Division Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, LMU University Hospitals, Ludwig-Maximilians-Universität Munich, Lindwurmstraße 4, 80337 Munich, Germany; (H.D.); (J.H.); (V.G.); (B.K.)
| | - Karoline Maar
- Gynecology & Obstetrics Specialist, Schloßstraße 2, 13507 Berlin, Germany;
| | - Christoph Neuhofer
- Gynecology & Obstetrics Specialist, Marienplatz 4, 85354 Freising, Germany; (C.N.); (N.T.)
| | - Daniel Teupser
- Institute of Laboratory Medicine, LMU University Hospitals, Ludwig-Maximilians-Universität Munich, Marchioninistraße 15, 81377 Munich, Germany; (L.H.); (D.T.)
| | - Nadja Thiel
- Gynecology & Obstetrics Specialist, Marienplatz 4, 85354 Freising, Germany; (C.N.); (N.T.)
| | | | - Silvia Maggini
- Bayer Consumer Care AG, Peter-Merian-Straße 84, 4002 Basel, Switzerland;
| | - Berthold Koletzko
- Department Paediatrics, Division Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, LMU University Hospitals, Ludwig-Maximilians-Universität Munich, Lindwurmstraße 4, 80337 Munich, Germany; (H.D.); (J.H.); (V.G.); (B.K.)
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Tan ML, Abrams SA, Osborn DA. Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. Cochrane Database Syst Rev 2020; 12:CD013046. [PMID: 33305822 PMCID: PMC8812278 DOI: 10.1002/14651858.cd013046.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vitamin D deficiency is common worldwide, contributing to nutritional rickets and osteomalacia which have a major impact on health, growth, and development of infants, children and adolescents. Vitamin D levels are low in breast milk and exclusively breastfed infants are at risk of vitamin D insufficiency or deficiency. OBJECTIVES To determine the effect of vitamin D supplementation given to infants, or lactating mothers, on vitamin D deficiency, bone density and growth in healthy term breastfed infants. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to 29 May 2020 supplemented by searches of clinical trials databases, conference proceedings, and citations. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs in breastfeeding mother-infant pairs comparing vitamin D supplementation given to infants or lactating mothers compared to placebo or no intervention, or sunlight, or that compare vitamin D supplementation of infants to supplementation of mothers. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently extracted data. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 19 studies with 2837 mother-infant pairs assessing vitamin D given to infants (nine studies), to lactating mothers (eight studies), and to infants versus lactating mothers (six studies). No studies compared vitamin D given to infants versus periods of infant sun exposure. Vitamin D supplementation given to infants: vitamin D at 400 IU/day may increase 25-OH vitamin D levels (MD 22.63 nmol/L, 95% CI 17.05 to 28.21; participants = 334; studies = 6; low-certainty) and may reduce the incidence of vitamin D insufficiency (25-OH vitamin D < 50 nmol/L) (RR 0.57, 95% CI 0.41 to 0.80; participants = 274; studies = 4; low-certainty). However, there was insufficient evidence to determine if vitamin D given to the infant reduces the risk of vitamin D deficiency (25-OH vitamin D < 30 nmol/L) up till six months of age (RR 0.41, 95% CI 0.16 to 1.05; participants = 122; studies = 2), affects bone mineral content (BMC), or the incidence of biochemical or radiological rickets (all very-low certainty). We are uncertain about adverse effects including hypercalcaemia. There were no studies of higher doses of infant vitamin D (> 400 IU/day) compared to placebo. Vitamin D supplementation given to lactating mothers: vitamin D supplementation given to lactating mothers may increase infant 25-OH vitamin D levels (MD 24.60 nmol/L, 95% CI 21.59 to 27.60; participants = 597; studies = 7; low-certainty), may reduce the incidences of vitamin D insufficiency (RR 0.47, 95% CI 0.39 to 0.57; participants = 512; studies = 5; low-certainty), vitamin D deficiency (RR 0.15, 95% CI 0.09 to 0.24; participants = 512; studies = 5; low-certainty) and biochemical rickets (RR 0.06, 95% CI 0.01 to 0.44; participants = 229; studies = 2; low-certainty). The two studies that reported biochemical rickets used maternal dosages of oral D3 60,000 IU/day for 10 days and oral D3 60,000 IU postpartum and at 6, 10, and 14 weeks. However, infant BMC was not reported and there was insufficient evidence to determine if maternal supplementation has an effect on radiological rickets (RR 0.76, 95% CI 0.18 to 3.31; participants = 536; studies = 3; very low-certainty). All studies of maternal supplementation enrolled populations at high risk of vitamin D deficiency. We are uncertain of the effects of maternal supplementation on infant growth and adverse effects including hypercalcaemia. Vitamin D supplementation given to infants compared with supplementation given to lactating mothers: infant vitamin D supplementation compared to lactating mother supplementation may increase infant 25-OH vitamin D levels (MD 14.35 nmol/L, 95% CI 9.64 to 19.06; participants = 269; studies = 4; low-certainty). Infant vitamin D supplementation may reduce the incidence of vitamin D insufficiency (RR 0.61, 95% CI 0.40 to 0.94; participants = 334; studies = 4) and may reduce vitamin D deficiency (RR 0.35, 95% CI 0.17 to 0.72; participants = 334; studies = 4) but the evidence is very uncertain. Infant BMC and radiological rickets were not reported and there was insufficient evidence to determine if maternal supplementation has an effect on infant biochemical rickets. All studies enrolled patient populations at high risk of vitamin D deficiency. Studies compared an infant dose of vitamin D 400 IU/day with varying maternal vitamin D doses from 400 IU/day to > 4000 IU/day. We are uncertain about adverse effects including hypercalcaemia. AUTHORS' CONCLUSIONS For breastfed infants, vitamin D supplementation 400 IU/day for up to six months increases 25-OH vitamin D levels and reduces vitamin D insufficiency, but there was insufficient evidence to assess its effect on vitamin D deficiency and bone health. For higher-risk infants who are breastfeeding, maternal vitamin D supplementation reduces vitamin D insufficiency and vitamin D deficiency, but there was insufficient evidence to determine an effect on bone health. In populations at higher risk of vitamin D deficiency, vitamin D supplementation of infants led to greater increases in infant 25-OH vitamin D levels, reductions in vitamin D insufficiency and vitamin D deficiency compared to supplementation of lactating mothers. However, the evidence is very uncertain for markers of bone health. Maternal higher dose supplementation (≥ 4000 IU/day) produced similar infant 25-OH vitamin D levels as infant supplementation of 400 IU/day. The certainty of evidence was graded as low to very low for all outcomes.
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Affiliation(s)
- May Loong Tan
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - David A Osborn
- Central Clinical School, School of Medicine, The University of Sydney, Sydney, Australia
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Wagner CL, Hollis BW. Early-Life Effects of Vitamin D: A Focus on Pregnancy and Lactation. ANNALS OF NUTRITION AND METABOLISM 2020; 76 Suppl 2:16-28. [PMID: 33232956 DOI: 10.1159/000508422] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/19/2022]
Abstract
Vitamin D is an endocrine regulator of calcium and bone metabolism. Yet, its effects include other systems, such as innate and adaptive immunity. Unique to pregnancy, circulating 1,25-dihydroxyvitamin D (1,25[OH]2D) increases early on to concentrations that are 2-3 times prepregnant values. At no other time during the lifecycle is the conversion of 25-hydroxyvitamin D (25[OH]D) to 1,25(OH)2D directly related and optimized at ≥100 nmol/L. Vitamin D deficiency appears to affect pregnancy outcomes, yet randomized controlled trials of vitamin D supplementation achieve mixed results depending on when supplementation is initiated during pregnancy, the dose and dosing interval, and the degree of deficiency at the onset of pregnancy. Analysis of trials on an intention-to-treat basis as opposed to the use of 25(OH)D as the intermediary biomarker of vitamin D metabolism yields differing results, with treatment effects often noted only in the most deficient women. Immediately after delivery, maternal circulating 1,25(OH)2D concentrations return to prepregnancy baseline, at a time when a breastfeeding woman has increased demands of calcium, beyond what was needed during the last trimester of pregnancy, making one question why 1,25(OH)2D increases so significantly during pregnancy. Is it to serve as an immune modulator? The vitamin D content of mother's milk is directly related to maternal vitamin D status, and if a woman was deficient during pregnancy, her milk will be deficient unless she is taking higher doses of vitamin D. Because of this relative "deficiency," there is a recommendation that all breastfed infants receive 400 IU vitamin D3/day starting a few days after birth. The alternative - maternal supplementation with 6,400 IU vitamin D3/day, effective in safely raising maternal circulating vitamin D, that of her breast milk, and effective in achieving sufficiency in her recipient breastfeeding infant - remains a viable option. Additional research is needed to understand vitamin D's influence on pregnancy health and the effect of maternal supplementation on breast milk's immune signaling.
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Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA,
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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27
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Campion-Smith TJ, Kerac M, McGrath M, Berkley JA. Antimicrobial and micronutrient interventions for the management of infants under 6 months of age identified with severe malnutrition: a literature review. PeerJ 2020; 8:e9175. [PMID: 32974089 PMCID: PMC7487149 DOI: 10.7717/peerj.9175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/21/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Infants under 6 months (U6M) contribute a significant proportion of the burden and mortality of severe malnutrition globally. Evidence of underlying aetiology in this population is sparse, but it is known that the group includes ex-preterm and low birthweight (LBW) infants. They represent a unique population given their dependence on breastmilk or a safe, secure alternative. Nutrition agencies and health providers struggle to make programming decisions on which interventions should be provided to this group based upon the 2013 WHO Guidelines for the 'Management of Severe Acute Malnutrition in Infants and Young Children' since there are no published interventional trial data focussed on this population. Interim guidance for this group might be informed by evidence of safety and efficacy in adjacent population groups. METHODOLOGY A narrative literature review was performed of systematic reviews, meta-analyses and randomised controlled trials of antimicrobial and micronutrient interventions (antibiotics, deworming, vitamin A, vitamin D, iron, zinc, folic acid and oral rehydration solution (ORS) for malnutrition) across the population groups of low birthweight/preterm infants, infants under 6 months, infants and children over 6 months with acute malnutrition or through supplementation to breastfeeding mothers. Outcomes of interest were safety and efficacy, in terms of mortality and morbidity. RESULTS Ninety-four articles were identified for inclusion within this review. None of these studied interventions exclusively in severely malnourished infants U6M. 64% reported on the safety of studied interventions. Significant heterogeneity was identified in definitions of study populations, interventions provided, and outcomes studied. The evidence for efficacy and safety across population groups is reviewed and presented for the interventions listed. CONCLUSIONS The direct evidence base for medical interventions for severely malnourished infants U6M is sparse. Our review identifies a specific need for accurate micronutrient profiling and interventional studies of micronutrients and oral fluid management of diarrhoea amongst infants U6M meeting anthropometric criteria for severe malnutrition. Indirect evidence presented in this review may help shape interim policy and programming decisions as well as the future research agenda for the management of infants U6M identified as malnourished.
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Affiliation(s)
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom
| | | | - James A. Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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28
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Nguyen MTT, Kim J, Lee H, Won S, Kim Y, Jung JA, Li D, To XHM, Huynh KTN, Le TV, Israr B, An HJ, Kim J. A Comparison of Vitamin and Lutein Concentrations in Breast Milk from Four Asian Countries. Nutrients 2020; 12:E1794. [PMID: 32560305 PMCID: PMC7353211 DOI: 10.3390/nu12061794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 01/12/2023] Open
Abstract
Vitamins are the essential elements for human life and, particularly, for infant health. Human milk is the best source of nutrients for newborns, however, the information of vitamins in Asian maternal milk is still limited. In this study, we have collected 580 Asian maternal milk samples from Korea (n = 254), China (n = 137), Pakistan (n = 92), and Vietnam (n = 97). The vitamin concentrations, including vitamin B-groups (8 vitamins), fat-soluble vitamin (retinol, D, E, K) and lutein in the breast milk of were investigated. The concentration of thiamin (B1), biotin (B7), and folic acid (B9) in mother's milk of four countries were not considerably different, while riboflavin (B2), pantothenic acid (B5), and pyridoxine (B6) level in Vietnam samples were significantly lower than those in other countries. In contrast, retinol (A) and tocopherol (E) were found to be higher levels in Vietnamese maternal milk. Korean and Chinese maternal milk had low concentrations of retinol that may cause vitamin A deficiency in children. However, Chinese mother's milk was distinguished with a high concentration of lutein. Pakistani mother's milk was observed as having a significant problem of folic acid (B9) deficiency. Regardless of the country, vitamin B12, K, and D did not seem to be provided sufficiently through maternal milk. The moderate positive correlations were found between vitamin concentrations in each country and the pooled sample. The data obtained in this study were able to provide vital information to assess the nutritional status of breast milk in Asian countries and contributed to the efforts of ensuring the best nutrition for Asian children.
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Affiliation(s)
- My Tuyen Thi Nguyen
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea; (M.T.T.N.); (J.K.); (H.L.); (S.W.)
- College of Agriculture, Can Tho University, Can Tho City 900000, Vietnam
| | - Jieun Kim
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea; (M.T.T.N.); (J.K.); (H.L.); (S.W.)
| | - Hyunjun Lee
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea; (M.T.T.N.); (J.K.); (H.L.); (S.W.)
| | - Soyoon Won
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea; (M.T.T.N.); (J.K.); (H.L.); (S.W.)
| | - Yongki Kim
- Central Research Laboratory, Maeil Co., Ltd., 63 Jinwiseo-ro, Jinwi-myeon Pyeongtaek, Gyeonggi-do 17706, Korea; (Y.K.); (J.A.J.)
| | - Ji A. Jung
- Central Research Laboratory, Maeil Co., Ltd., 63 Jinwiseo-ro, Jinwi-myeon Pyeongtaek, Gyeonggi-do 17706, Korea; (Y.K.); (J.A.J.)
| | - Dan Li
- College of Food Science and Engineering, Changchun University, Changchun 130022, China;
| | - Xuan Hong Mai To
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam; (X.H.M.T.); (K.T.N.H.)
| | - Khanh Trang Nguyen Huynh
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam; (X.H.M.T.); (K.T.N.H.)
| | - Thanh Van Le
- Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam;
| | - Beenish Israr
- Faculty of Food, Nutrition and Home Science, University of Agriculture, Faisalabad 38000, Pakistan;
| | - Hyun Joo An
- Graduate School of Analytical Science and Technology, Chungnam National University, Daejeon 34134, Korea;
| | - Jaehan Kim
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea; (M.T.T.N.); (J.K.); (H.L.); (S.W.)
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29
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Loyal J, Cameron A. Vitamin D in Children: Can We Do Better? Pediatrics 2020; 145:peds.2020-0504. [PMID: 32424079 DOI: 10.1542/peds.2020-0504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jaspreet Loyal
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Annette Cameron
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
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30
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Simon AE, Ahrens KA. Adherence to Vitamin D Intake Guidelines in the United States. Pediatrics 2020; 145:peds.2019-3574. [PMID: 32424077 PMCID: PMC7263053 DOI: 10.1542/peds.2019-3574] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The American Academy of Pediatrics (AAP) revised its infant vitamin D intake guidelines in 2008. We aimed to examine previously unexplored trends in meeting vitamin D intake guidelines among US infants since 2009 and whether there were differences across demographic subgroups. METHODS We analyzed dietary recall data for infants 0 to 11 months in the 2009-2016 NHANES. We estimated the percentage meeting 2008 AAP vitamin D guidelines, defined as consuming ≥1 L of infant formula and/or receiving a vitamin D supplement of ≥400 IU. We used Poisson regressions to assess trends over time and differences across demographic subgroups. RESULTS Overall, 27.1% (95% confidence interval [CI]: 24.3%-29.8%) of US infants in 2009-2016 met vitamin D intake guidelines, with nonbreastfeeding infants (31.1% [95% CI: 27.6%-34.5%]) more likely to meet guidelines than breastfeeding infants (20.5% [95% CI: 15.4%-25.5%]; P < .01). From 2009-2010 to 2015-2016, overall and for both breastfeeding and nonbreastfeeding infants, there were no significant changes over time in the percentage of infants who met the guidelines (P > .05). Among breastfeeding infants, those with a family income ≥400% of the federal poverty level, with a college graduate head of household, and with private insurance were more likely to meet guidelines. CONCLUSIONS Among US infants, we observed no increase in meeting AAP vitamin D intake guidelines since 2009. Less than 40% of infants met guidelines in nearly all demographic subgroups. These findings suggest renewed consideration of how to best meet vitamin D intake guidelines.
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Affiliation(s)
- Alan E. Simon
- Environmental Influences on Child Health Outcomes
Program, Office of the Director, National Institutes of Health, Rockville,
Maryland; and
| | - Katherine A. Ahrens
- Muskie School of Public Service, University of
Southern Maine, Portland, Maine
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31
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Siafarikas A, Simm P, Zacharin M, Jefferies C, Lafferty AR, Wheeler BJ, Tham E, Brown J, Biggin A, Hofman P, Woodhead H, Rodda C, Jensen D, Brookes D, Munns CF. Global consensus on nutritional rickets: Implications for Australia. J Paediatr Child Health 2020; 56:841-846. [PMID: 32567782 DOI: 10.1111/jpc.14941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 03/22/2020] [Accepted: 04/20/2020] [Indexed: 01/19/2023]
Abstract
In 2016, a global consensus on the prevention, diagnosis and management of nutritional rickets was published. The bone and mineral working group of the Australasian Paediatric Endocrine Group provides a summary and highlights differences to previous Australian and New Zealand (ANZ) guidelines on vitamin D deficiency and their implications for clinicians. Key points are: (i) The International Consensus document is focused on nutritional rickets, whereas the ANZ guidelines were focused on vitamin D deficiency. (ii) Definitions for the interpretation of 25-hydroxy vitamin D (25OHD) levels do not differ between statements. (iii) The global consensus recommends that routine 25OHD screening should not be performed in healthy children and recommendations for vitamin D supplementation are not based solely on 25OHD levels. The Australasian Paediatric Endocrine Group bone and mineral working group supports that screening for vitamin D deficiency should be restricted to populations at risk. (iv) Recommendations from the global consensus for vitamin D dosages for the therapy of nutritional rickets (diagnosed based on history, physical examination, biochemical testing and a confirmation by X-rays) are higher than in ANZ publications. (v) The global consensus recommends the implementation of public health strategies such as universal supplementation with vitamin D from birth to 1 year of age and food fortification. We conclude that updated global recommendations for therapy of nutritional rickets complement previously published position statements for Australia and New Zealand. Screening, management and the implementation of public health strategies need to be further explored for Australia.
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Affiliation(s)
- Aris Siafarikas
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia.,Telethon Kids Institute for Child Health Research and Division of Paediatrics, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Peter Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Craig Jefferies
- Starship Children's Health, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Antony R Lafferty
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Paediatrics and Child Health, ANU Medical School, Canberra, Australian Capital Territory, Australia
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Elaine Tham
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Justin Brown
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, Children's Hospital Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Helen Woodhead
- Sydney Children's Hospital, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of NSW, Sydney, New South Wales, Australia
| | - Christine Rodda
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,North West Academic Centre, AIMSS, The University of Melbourne, Melbourne, Victoria, Australia.,Western Centre for Health Research and Education Western Health Sunshine Hospital, Melbourne, Victoria, Australia
| | - Diane Jensen
- Children's Health Queensland, Hospital and Health Services District, Brisbane, Queensland, Australia.,Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
| | - Denise Brookes
- QUT Centre for Children's Health Research, Brisbane, Queensland, Australia
| | - Craig F Munns
- Institute of Endocrinology and Diabetes, Children's Hospital Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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32
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Trivedi M, Faridi MMA, Aggarwal A, Madhu SV, Malhotra RK. Oral Vitamin D Supplementation to Mothers During Lactation-Effect of 25(OH)D Concentration on Exclusively Breastfed Infants at 6 Months of Age: A Randomized Double-Blind Placebo-Controlled Trial. Breastfeed Med 2020; 15:237-245. [PMID: 32181677 DOI: 10.1089/bfm.2019.0102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Exclusively breastfed infants are at risk of vitamin D deficiency. Objective: To find out proportion of exclusively breastfed infants having serum 25(OH)D concentration <11 ng/mL at 6 months of age with or without oral supplementation of vitamin D3 to lactating mothers. Methods: Randomized placebo-controlled study included 132 mothers and infants divided into two groups. Mothers received either vitamin D3 60,000 IU between 24 and 48 hours postpartum and at 6, 10, and 14 weeks amounting to 240,000 IU of vitamin D3 or placebo. Serum 25(OH)D concentration in the mothers was measured at recruitment and that of infants, at birth and 6 months. Infants were evaluated for rickets at 6 months. Findings: Total 114 mother-infant dyads followed. Subjects in both groups were comparable in basic characteristics. At 6 months of age, serum 25(OH)D concentration in infants was 18.93 (5.12) ng/mL in the intervention group and 6.43 (3.76) ng/mL in the control group (mean difference = 12.5; 95% CI = 10.80-14.17; p < 0.001) and vitamin D deficiency and insufficiency was corrected in 93.1% and 38% infants, respectively, in the intervention group. There was no change in the vitamin D status of infants in the control group. In 60.3% infants (RR = 0.519; 95% CI = -0.485 to 0.735) of the intervention group 25(OH)D concentration was <20 ng/mL at 6 months of age. Six infants in the control group suffered from biochemical rickets. Radiological rickets developed in one infant in the intervention group and two infants in the control group. Conclusion: Serum 25(OH)D concentration of exclusively breastfed infants rise significantly when mothers are orally supplemented with 240,000 IU of vitamin D3 during lactation in comparison with the infants of unsupplemented mothers with 94.6% and 48.1% reduction in the risk of vitamin D deficiency and insufficiency, respectively, at 6 months of age.
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Affiliation(s)
- Maharshi Trivedi
- Department of Pediatrics, University College of Medical Sciences and GTB Hospital, Delhi, India
| | | | - Anju Aggarwal
- Department of Pediatrics, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Rajiv Kumar Malhotra
- Department of Biostatistics, University College of Medical Sciences and GTB Hospital, Delhi, India
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33
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Wagner CL. Oral Maternal Vitamin D Megadoses to Prevent Vitamin Deficiency in Breastfeeding Mothers and Their Infants. Breastfeed Med 2020; 15:187-188. [PMID: 32105501 DOI: 10.1089/bfm.2020.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Carol L Wagner
- Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina
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34
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O'Callaghan KM, Taghivand M, Zuchniak A, Onoyovwi A, Korsiak J, Leung M, Roth DE. Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation. Adv Nutr 2020; 11:144-159. [PMID: 31552417 PMCID: PMC7442322 DOI: 10.1093/advances/nmz098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023] Open
Abstract
Daily oral vitamin D supplementation (400 IU) is recommended for breastfeeding infants (≤1 y). Recent studies have examined alternative approaches to preventing vitamin D deficiency in this population. This systematic review and meta-analysis aimed to estimate the effects of maternal postpartum (M-PP) or infant intermittent (I-INT) vitamin D supplementation on infant 25-hydroxyvitamin D [25(OH)D] concentrations in comparison to routine direct infant daily (I-D) oral supplementation (400 IU). MEDLINE, MEDLINE In-Process, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to December 2018. Inclusion criteria consisted of published, peer-reviewed, vitamin D intervention trials involving lactating women and/or exclusively or partially breastfed term infants. Two reviewers independently extracted study characteristics (e.g., sample size, intervention dose, and duration and mode of administration) and related biochemical and clinical outcomes. Of 28 included trials, 5 randomized controlled trials were incorporated in meta-analyses examining infant 25(OH)D. Overall, M-PP supplementation resulted in modestly lower infant 25(OH)D compared with I-D supplementation (weighted mean difference = -8.1 nmol/L; 95% CI: -15.4, -0.9; I2 = 45%; P = 0.14; 3 trials), but the 2 most recent trials found M-PP to achieve similar infant 25(OH)D as I-D. Comparison of I-INT with I-D was confined to 2 trials with contradictory findings, and it was considered inappropriate for pooled analysis. Meta-analysis was therefore limited by a small number of eligible trials with variable quality of analytically derived 25(OH)D data and inconsistent reporting of safety outcomes, including effects on calcium homeostasis. Considering all 28 included trials, this systematic review highlights M-PP and I-INT regimens as plausible substitutes for routine daily infant vitamin D supplementation, but evidence remains too weak to support a policy update. Dose-ranging, adequately powered trials are required to establish the efficacy, safety, and feasibility of alternative strategies to prevent vitamin D deficiency in breastfeeding infants. This review was registered with PROSPERO as CRD42017069905.
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Affiliation(s)
- Karen M O'Callaghan
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Mahgol Taghivand
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anna Zuchniak
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Akpevwe Onoyovwi
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Jill Korsiak
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Michael Leung
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Geohagan J, de Gaston D, Sadler A, Palmer P. Does oral maternal Vitamin D supplementation normalize the Vitamin D level in exclusively breastfed infants? THE JOURNAL OF THE OKLAHOMA STATE MEDICAL ASSOCIATION 2018; 111:870-871. [PMID: 31474765 PMCID: PMC6716612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Jenna Geohagan
- Great Plains Family Medicine Residency Program, Oklahoma City, OK
| | - David de Gaston
- Great Plains Family Medicine Residency Program, Oklahoma City, OK
| | - Amanda Sadler
- Great Plains Family Medicine Residency Program, Oklahoma City, OK
| | - Philip Palmer
- Great Plains Family Medicine Residency Program, Oklahoma City, OK
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The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102241. [PMID: 30322097 PMCID: PMC6210343 DOI: 10.3390/ijerph15102241] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 12/19/2022]
Abstract
Vitamin D deficiency is common and there exists a huge gap between recommended dietary vitamin D intakes and the poor vitamin D supply in the general population. While vitamin D is important for musculoskeletal health, there are accumulating data suggesting that vitamin D may also be important for fertility, pregnancy outcomes and lactation. Significant changes in vitamin D metabolism during pregnancy such as increased production of the “active vitamin D hormone” calcitriol support the important role of vitamin D in this setting. Observational studies show that vitamin D deficiency is a risk marker for reduced fertility and various adverse pregnancy outcomes and is associated with a low vitamin D content of breast milk. Meta-analyses of randomized controlled trials (RCTs) document that physiological vitamin D supplementation during pregnancy is safe and improves vitamin D and calcium status, thereby protecting skeletal health. Although certain RCTs and/or meta-analyses reported some other beneficial effects, it is still not clear whether vitamin D supplementation improves fertility or decreases the risk of adverse pregnancy outcomes such as low birth weight, pre-eclampsia and neonatal mortality, or reduces wheeze/asthma in the infants. Nevertheless, vitamin D supplementation in pregnant women is frequently required to achieve a sufficient vitamin D status as recommended by nutritional vitamin D guidelines. In this review, we provide an overview of systematic reviews, meta-analyses and large trials reporting clinical data on the role of vitamin D for fertility, pregnancy and lactation.
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Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, Calvo MS, Cashman KD, Combs G, De-Regil LM, Jefferds ME, Jones KS, Kapner H, Martineau AR, Neufeld LM, Schleicher RL, Thacher TD, Whiting SJ. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci 2018; 1430:44-79. [PMID: 30225965 DOI: 10.1111/nyas.13968] [Citation(s) in RCA: 281] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 12/15/2022]
Abstract
Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.
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Affiliation(s)
- Daniel E Roth
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - John Aloia
- NYU Winthrop Hospital, Mineola, New York
| | - Gilles Bergeron
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | - Megan W Bourassa
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | | | - Mona S Calvo
- Retired, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, University College Cork, Cork, Ireland
| | | | | | | | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | | | - Adrian R Martineau
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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Vitamin D Postpartum Concentrations: Relationship with Nutritional Condition and Morbidities during Pregnancy. J Pregnancy 2018; 2018:1070528. [PMID: 30245881 PMCID: PMC6139194 DOI: 10.1155/2018/1070528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/01/2018] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate postpartum vitamin D deficiency/insufficiency and to relate it to pregestational BMI, gestational weight gain, and sociodemographic variables. Methods This is a cross-sectional study with 225 full-term pregnant women. Data collected are as follows: maternal health, socioeconomic status, pregestational body mass index (BMI), and gestational weight gain. Laboratory evaluation included vitamin D [25(OH)D], calcium, phosphorus, magnesium, and alkaline phosphatase. Results The mean age of women was 25.6±6.6 years. Dark skin color, low education, and work in the urban region were predominant. Regular sun exposure, photoprotection, and vitamin D supplementation were reported by 144 (64.0%), 44 (19.6%), and 5 (2.2%) women, respectively. The mean plasma concentrations of 25(OH)D were 26.0±6.8 ng/mL. Levels compatible with deficiency (<20 ng/mL) and insufficiency (20-30 ng/mL) were observed in 43 (19.1%) and 124 (55.1%) women, respectively. The increase of 1 ng/mL in 25(OH)D concentrations was associated with an increase of 0.16 mg/dL (95%CI 0.19 to 2.02; p=0.018) for calcium. There were no associations with 25(OH)D concentrations with pregestational BMI and with gestational weight gain. Conclusions The high frequency of postpartum vitamin D deficiency/insufficiency in women with a full-term pregnancy in a region with a large and permanent sun exposure reminds us of the need for intervention policies aimed at preventing vitamin D deficiency during pregnancy.
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Ketha H, Thacher TD, Oberhelman SS, Fischer PR, Singh RJ, Kumar R. Comparison of the effect of daily versus bolus dose maternal vitamin D 3 supplementation on the 24,25-dihydroxyvitamin D 3 to 25-hydroxyvitamin D 3 ratio. Bone 2018; 110:321-325. [PMID: 29486367 PMCID: PMC5878742 DOI: 10.1016/j.bone.2018.02.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/09/2018] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Supplementing lactating mothers with high doses of vitamin D3 can adequately meet vitamin D requirements of the breastfed infant. We compared the effect of bolus versus daily vitamin D3 dosing in lactating mothers on vitamin D3 catabolism. We hypothesized that catabolism of 25(OH)D3 to 24,25(OH)2D3 would be greater in the bolus than in the daily dose group. DESIGN, SETTING AND PATIENTS Randomized controlled trial (clinicaltrials.govNCT01240265) in 40 lactating women. INTERVENTIONS Subjects were randomized to receive vitamin D3 orally, either a single dose of 150,000IU or 5000IU daily for 28days. Vitamin D metabolites were measured in serum and breast milk at baseline, 1, 3, 7, 14 and 28days. MAIN OUTCOME MEASURE Temporal changes in the serum 24,25(OH)2D3/25(OH)D3 ratio. RESULTS The concentration of serum 24,25(OH)2D3 was directly related to that of 25(OH)D in both groups (r2=0.63; p<0.001). The mean (±SD) 24,25(OH)2D3/25(OH)D3 ratio remained lower at all time points than baseline values in the daily dose group (0.093±0.024, 0.084±0.025, 0.083±0.024, 0.080±0.020, 0.081±0.023, 0.083±0.018 at baseline, 1, 3, 7, 14, and 28days, respectively). In the single dose group, the increase in 24,25(OH)2D3 lagged behind that of 25(OH)D, but the 24,25(OH)2D3/25(OH)D3 values (0.098±0.032, 0.067±0.019, 0.081±0.017, 0.092±0.024, 0.103±0.020, 0.106±0.024, respectively) exceeded baseline values at 14 and 28days and were greater than the daily dose group at 14 and 28days (p=0.003). The 24,25(OH)2D3/25(OH)D3 ratio remained in the normal range with both dosing regimens. Greater breast milk vitamin D3 values in the single dose group were inversely associated with the 24,25(OH)2D3/25(OH)D3 ratio (r2=0.14, p<0.001), but not with daily dosing. CONCLUSIONS After a 14-day lag, a single high dose of vitamin D led to greater production of 24,25(OH)2D3, presumably via induction of the 24-hydroxylase enzyme (CYP24A1), relative to the 25(OH)D3 value than did daily vitamin D supplementation, and this effect persisted for at least 28days after vitamin D administration. A daily dose of vitamin D may have more lasting effectiveness in increasing 25(OH)D3 with lesser diversion of 25(OH)D3 to 24,25(OH)2D3 than does larger bolus dosing.
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Affiliation(s)
- Hemamalini Ketha
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States; Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States
| | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN, 55905, United States.
| | - Sara S Oberhelman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, 55905, United States
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, United States
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, United States
| | - Rajiv Kumar
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States; Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, United States; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, 55905, United States
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Oberhelman SS, Cozine EW, Umaretiya PJ, Maxson JA, Thacher TD. Vitamin D and the Breastfeeding Infant: Family Medicine Clinicians' Knowledge, Attitudes, and Practices. J Hum Lact 2018; 34:331-336. [PMID: 29596761 DOI: 10.1177/0890334418755338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The American Academy of Pediatrics and the National Academy of Medicine recommend vitamin D supplementation for breastfeeding infants. However, compliance with this recommendation is poor. Maternal supplementation with vitamin D is a safe and effective alternative to achieving vitamin D sufficiency in breastfeeding infants, and mothers have indicated a preference for self-supplementation over infant supplementation. Research aim: We sought to explore Family Medicine clinicians' knowledge, attitudes, and practices regarding vitamin D supplementation recommendations for breastfeeding dyads. METHODS Fifty-six Family Medicine clinicians (including faculty physicians, resident physicians, and nurse practitioners/physician assistants) completed an online, anonymous survey regarding their knowledge and practices concerning vitamin D supplementation for breastfeeding infants. RESULTS The vast majority of clinicians (92.9%) correctly identified the American Academy of Pediatrics' 2008 recommended dose for vitamin D supplementation in breastfeeding infants and estimated recommending vitamin D supplementation of exclusively breastfeeding infants 70.1% of the time. If all options were equivalent, clinicians would prefer to offer maternal or infant supplementation (50%) or maternal supplementation (37.5%) over infant supplementation (12.5%). Most (69.6%) preferred daily over monthly supplementation regimens. CONCLUSION Family Medicine clinicians are knowledgeable regarding current recommendations for vitamin D supplementation in breastfeeding infants. They are also open to recommending maternal supplementation or offering parents a choice of maternal or infant vitamin supplementation.
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Affiliation(s)
| | | | - Puja J Umaretiya
- 2 Mayo Clinic School of Medicine, Rochester, MN, USA.,3 Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Julie A Maxson
- 1 Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tom D Thacher
- 1 Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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Abstract
Exclusive breastfeeding is recommended by the WHO for the first 6 mo of life because human milk protects against gastrointestinal infections and supplies balanced and adequate nutrient contents to the infant. However, reliable data on micronutrient concentrations in human milk are sparse, especially because some micronutrients are affected by maternal diet. Microbiological and competitive protein-binding assays, nuclear magnetic resonance or inductively coupled plasma spectroscopy, and chromatographic analyses are among the methods that have been applied to human-milk micronutrient analysis. However, the validation or evaluation of analytical methods in terms of their suitability for the complex human-milk matrix has been commonly ignored in reports, even though the human-milk matrix differs vastly from blood, plasma, or urine matrixes. Thus, information on the validity, accuracy, and sensitivity of the methods is essential for the estimation of infant and maternal intake requirements to support and maintain adequate milk micronutrient concentrations for healthy infant growth and development. In this review, we summarize current knowledge on methods used for analyzing water- and fat-soluble vitamins as well as iron, copper, zinc, iodine, and selenium in human milk and their different forms in milk; the tools available for quality control and assurance; and guidance for preanalytical considerations. Finally, we recommend preferred methodologic approaches for analysis of specific milk micronutrients.
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Affiliation(s)
- Daniela Hampel
- US Department of Agriculture, Agricultural Research Service,Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Daphna K Dror
- US Department of Agriculture, Agricultural Research Service,Western Human Nutrition Research Center, Davis, CA
| | - Lindsay H Allen
- US Department of Agriculture, Agricultural Research Service,Western Human Nutrition Research Center, Davis, CA
- Department of Nutrition, University of California, Davis, Davis, CA
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Jorde R, Grimnes G. Serum cholecalciferol may be a better marker of vitamin D status than 25-hydroxyvitamin D. Med Hypotheses 2018; 111:61-65. [DOI: 10.1016/j.mehy.2017.12.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/12/2017] [Accepted: 12/12/2017] [Indexed: 11/15/2022]
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Taylor SN. ABM Clinical Protocol #29: Iron, Zinc, and Vitamin D Supplementation During Breastfeeding. Breastfeed Med 2018; 13:398-404. [PMID: 30016173 DOI: 10.1089/bfm.2018.29095.snt] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or influence, for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine , New Haven, Connecticut
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Prentice S. They Are What You Eat: Can Nutritional Factors during Gestation and Early Infancy Modulate the Neonatal Immune Response? Front Immunol 2017; 8:1641. [PMID: 29234319 PMCID: PMC5712338 DOI: 10.3389/fimmu.2017.01641] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022] Open
Abstract
The ontogeny of the human immune system is sensitive to nutrition even in the very early embryo, with both deficiency and excess of macro- and micronutrients being potentially detrimental. Neonates are particularly vulnerable to infectious disease due to the immaturity of the immune system and modulation of nutritional immunity may play a role in this sensitivity. This review examines whether nutrition around the time of conception, throughout pregnancy, and in early neonatal life may impact on the developing infant immune system.
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Affiliation(s)
- Sarah Prentice
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Fiscaletti M, Stewart P, Munns CF. The importance of vitamin D in maternal and child health: a global perspective. Public Health Rev 2017; 38:19. [PMID: 29450091 PMCID: PMC5809824 DOI: 10.1186/s40985-017-0066-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/21/2017] [Indexed: 12/12/2022] Open
Abstract
Vitamin D and calcium are important nutrients for skeletal growth and bone health. Children and pregnant women are particularly vulnerable to 25-hydroxy vitamin D deficiency (VDD). VDD, with or without dietary calcium deficiency, can lead to nutritional rickets (NR), osteomalacia, and disturbances in calcium homeostasis. Multiple studies have linked VDD to adverse health outcomes in both children and pregnant women that extend beyond bone health. VDD remains an important global public health concern, and an important differentiation must be made between the impact of VDD on children and adults. Reports of increased incidence of NR continue to emerge. NR is an entirely preventable condition, which could be eradicated in infants and children worldwide with adequate vitamin D and calcium supplementation. The desire and necessity to put in place systems for preventing this potentially devastating pediatric disease should not elicit dispute. VDD and NR are global public health issues that require a collaborative, multi-level approach for the implementation of feasible preventative strategies. This review highlights the history, risk factors, and controversies related to VDD during pregnancy and childhood with a particular focus on global NR prevention.
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Affiliation(s)
- M Fiscaletti
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - P Stewart
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - CF Munns
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Vitamin D Modulation of TRAIL Expression in Human Milk and Mammary Epithelial Cells. Sci Rep 2017; 7:4362. [PMID: 28659589 PMCID: PMC5489519 DOI: 10.1038/s41598-017-04521-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/26/2017] [Indexed: 12/19/2022] Open
Abstract
The vitamin D levels in mothers affect the health status of both the mother and breastfeeding infant. Vitamin D deficient mothers’ infants are prone to rickets. While tumor necrosis factor-related apoptosis inducing ligand (TRAIL) has been implicated in cellular growth/apoptosis, immune cell function and bone-resorbing osteoclast formation, the expression of TRAIL in human milk as a function of vitamin D status in mothers remains unknown. We hypothesized that vitamin D deficiency alters TRAIL protein levels in human breast milk and mammary epithelial cells. Milk from vitamin D deficient mothers showed high levels of TRAIL (α and β) proteins compared to milk from vitamin D replete women. Western blot analysis of total cell lysate obtained from normal human mammary epithelial (HME-1) cells treated with variable doses (0–20 nM) of vitamin D for 24 h demonstrated that low levels (0.5 to 5 nM) significantly increased the TRAIL α but no change in β expression. In contrast, vitamin D at 20 nM concentration suppressed the expression of both TRAIL α and β proteins. Consistently, vitamin D regulated TRAIL mRNA expression in HME-1 cells. Our results indicate that vitamin D status in mothers modulates TRAIL expression in breast milk, which may have implications for both mother and infant health.
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Creo AL, Thacher TD, Pettifor JM, Strand MA, Fischer PR. Nutritional rickets around the world: an update. Paediatr Int Child Health 2017; 37:84-98. [PMID: 27922335 DOI: 10.1080/20469047.2016.1248170] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Worldwide, nutritional rickets continues to be an evolving problem with several causes. This paper provides an updated literature review characterising the prevalence, aetiology, pathophysiology and treatment of nutritional rickets worldwide. A systematic review of articles on nutritional rickets from various geographical regions was undertaken. For each region, key information was extracted, including prevalence, cause of rickets specific to the region, methods of confirming the diagnosis and current treatment and preventive measures. Calcium deficiency continues to be a major cause of rickets in Africa and Asia. Vitamin D deficiency rickets is perhaps increasing in the Americas, Europe and parts of the Middle East. There continues to be a distinct presentation of calcium-predominant versus vitamin D predominant rickets, although there are overlapping features. More careful diagnosis of rickets and reporting of 25-OHD concentrations has improved accurate knowledge of rickets prevalence and better delineated the cause. Nutritional rickets continues to be an evolving and multi-factorial problem worldwide. It is on a spectrum, ranging from isolated vitamin D deficiency to isolated calcium deficiency. Specific areas which require emphasis include a consistent community approach to screening and diagnosis, vitamin D supplementation of infants and at-risk children, prevention of maternal vitamin D deficiency and the provision of calcium in areas with low calcium diets.
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Affiliation(s)
- Ana L Creo
- a Department of Pediatric and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
| | - Tom D Thacher
- b Department of Family Medicine , Mayo Clinic , Rochester , MN , USA
| | - John M Pettifor
- c Wits/SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics , University of the Witwatersrand , Johannesburg , South Africa
| | - Mark A Strand
- d Pharmacy Practice, Department of Public Health , North Dakota State University , Fargo , ND , USA
| | - Philip R Fischer
- a Department of Pediatric and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
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Ozcan A, Kendirci M, Kondolot M, Kardas F, Akın L. Evaluation of vitamin D prophylaxis in 3-36-month-old infants and children. J Pediatr Endocrinol Metab 2017; 30:543-549. [PMID: 28328529 DOI: 10.1515/jpem-2016-0223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/28/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vitamin D (VD) deficiency (VDD) is still a population-based health problem that affects people at different ages. The aim of this study was to evaluate VD prophylaxis for the prevention of VDD in (3-36)-month-old infants and children. METHODS Infants and children aged between 3 and 36 months, with different etiologies, admitted to outpatient and inpatient clinics from October 2010 to October 2011 at the Children's Hospital of Erciyes University, were enrolled for the study. Their VD intake (if used; time of initiation, dosage and compliance) and nutritional status (breast-fed, formula or complementary fed) were noted. In order to study seasonal VD changes, the levels of serum calcium, phosphorus and magnesium, alkaline phosphatase activity (PLA), plasma parathyroid hormone (PTH) and 25 hydroxyvitamin 25(OH)D levels were measured at the beginning of VD supplementation during the four seasons. RESULTS A total of 316 subjects were enrolled in the study, consisting of 202 (63.9%) outpatient and 114 (26.1%) inpatient groups. From these subjects, 304 (96.2%) were supplemented with VD; whereas 12 (3.8%) were not. Out of the subjects supplemented with VD, 237 (75%) initiated VD after the second week of life, 267 (87.8%) were given three drops of VD daily and 209 (66.1%) had taken VD regularly. The plasma 25(OH)D levels were found to be lower in the inpatient group than the outpatient group (29.35 ng/mL and 34.35 ng/mL, respectively). The plasma 25(OH)D levels were lower during the spring and winter. VDD and VD insufficiency (VDI) was found in 31 (9.8%) and 30 (9.5%) subjects, respectively. CONCLUSIONS The plasma 25(OH)D levels were lower in inpatient and breast-fed only subjects and in winter and spring. The national VD augmentation program seems to be beneficial for the prevention of VDD, but VDD/VDI seems to still be an important health problem.
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Zhao Y, Yu Y, Li H, Chang Z, Li Y, Duan Y, Wang J, Jiang S, Yang Z, Yin SA. Vitamin D status and the prevalence of deficiency in lactating women from eight provinces and municipalities in China. PLoS One 2017; 12:e0174378. [PMID: 28334009 PMCID: PMC5363952 DOI: 10.1371/journal.pone.0174378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Vitamin D deficiency has become prevalent worldwide in recent years. However, less evidence was available for lactating women. OBJECTIVE The purpose of the study was to understand vitamin D status and prevalence of deficiency in lactating women and associated risk factors for vitamin D deficiency from eight provinces and municipalities in China. METHODS Lactating women within 1-10 months postpartum were recruited in 2011-2013 from eight provinces and municipalities in China. Radioimmunoassay was used to measure serum 25-hydroxyvitamin D [25(OH)D] concentration. Standardized questionnaire was used to collect information on season, living site, ethnicity and socio-demographic characteristics. RESULTS Totally 2004 lactating women were recruited. The median (p25, p75) of 25(OH)D was 15.8 (10.5, 24.0) nmol/L. The prevalence of vitamin D deficiency was 85.3% as 25(OH)D <30nmol/L. Serum 25(OH)D levels of lactating women were significantly lower during October-January (14.0nmol/L) than during February-May (18.0nmol/L) (P<0.001), and were significantly higher in Dai ethnicity (22.5nmol/L) than in Hui ethnicity (Chinese Muslims) (9.0nmol/L) (P<0.001). For every 10,000 CNY annual income per capita increasing, serum 25(OH)D levels significantly increased 1.04 times (P<0.001). The odds of vitamin D deficiency in winter were 2.56 times higher than that in spring (OR 2.56, 95%CI: 1.91-3.43). CONCLUSIONS Vitamin D deficiency of lactating women was highly prevalent in the eight provinces and municipalities in China. It is urgent to study the strategy and intervention ways for improving vitamin D status of lactating women, especially for certain population groups during low sunlight exposure season.
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Affiliation(s)
- Yao Zhao
- Beijing Center for Disease Control and Prevention, Beijing, China PR
- Beijing Research Center for Preventive Medicine, Beijing, China PR
| | - Yingjie Yu
- Beijing Center for Disease Control and Prevention, Beijing, China PR
- Beijing Research Center for Preventive Medicine, Beijing, China PR
| | - Hong Li
- Beijing Center for Disease Control and Prevention, Beijing, China PR
- Beijing Research Center for Preventive Medicine, Beijing, China PR
| | - Zhirong Chang
- Beijing Dongcheng Center for Disease Control and Prevention, Beijing, China PR
| | - Yongjin Li
- Beijing Shunyi Center for Disease Control and Prevention, Beijing, China PR
| | - Yifan Duan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China PR
| | - Jie Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China PR
| | - Shan Jiang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China PR
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China PR
| | - Shi-an Yin
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China PR
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Umaretiya PJ, Oberhelman SS, Cozine EW, Maxson JA, Quigg SM, Thacher TD. Maternal Preferences for Vitamin D Supplementation in Breastfed Infants. Ann Fam Med 2017; 15:68-70. [PMID: 28376463 PMCID: PMC5217846 DOI: 10.1370/afm.2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/01/2016] [Accepted: 10/16/2016] [Indexed: 11/09/2022] Open
Abstract
Daily vitamin D supplementation is recommended for breastfed infants, but alternative methods include enriching breast milk with vitamin D through maternal supplementation or intermittent high-dose vitamin D. We determined maternal preferences for vitamin D supplementation in 140 mothers with exclusively breastfed infants, and 44 who used both breast and formula milk. Only 101 (55%) supplemented their infants with vitamin D. One hundred sixty (88%) preferred supplementing themselves rather than their infants, and 102 (57%) preferred daily to monthly supplementation. Safety was most important in choosing a method of supplementation. Taking maternal preferences into consideration may improve adequate intakes of vitamin D in breastfed infants.
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Affiliation(s)
- Puja J Umaretiya
- Mayo Medical School, Rochester, Minnesota.,Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Julie A Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
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