Do breastfed infants need supplemental vitamins?

Regenerative Potential of Human Breast Milk: A Natural Reservoir of Nutrients, Bioactive Components and Stem cells

Human milk is a complex fluid that contains carbohydrates, lipids, proteins, and other bioactive molecules (immunoglobulins, lactoferrin, human milk oligosaccharides, lysozyme, leukocytes, cytokines, hormones, and microbiome) which provide nutritional, immunological, and developmental benefits to the infant. In addition to their involvement in the development, these bioactive compounds have a key role in anti-oncogenicity, neuro-cognitive development, cellular communication, and differentiation. As a result of technological advancements, it has been discovered that human breast milk contains cells that display many of the characteristics of stem cells with multilineage differentiation potentials. Do these cells have any specific properties or roles? Research efforts on breast milk cells have been mainly focused on leukocytes based on their immunological perspective in the early postpartum period. This review summarizes the nutritional components in human milk, i.e., the macro and micronutrients required for the growth and development of infants. Further, it discusses the research work reported concerning the purification, propagation, and differentiation of breast milk progenitor cells and highlights the advancements made in this newly emerging field of stem cell biology and regenerative medicine.

Shaping infant development from the inside out: Bioactive factors in human milk

Human breast milk is the optimal nutrition for all infants and is comprised of many bioactive and immunomodulatory components. The components in human milk, such as probiotics, human milk oligosaccharides (HMOs), extracellular vesicles, peptides, immunoglobulins, growth factors, cytokines, and vitamins, play a critical role in guiding neonatal development beyond somatic growth. In this review, we will describe the bioactive factors in human milk and discuss how these factors shape neonatal immunity, the intestinal microbiome, intestinal development, and more from the inside out.

Indoor tanning: Evidence surrounding advertised health claims

Indoor tanning continues to remain common, despite evidence of an increased risk of skin cancer from artificial ultraviolet (UV) radiation. In the hopes of gaining customers, the tanning bed industry has marketed health benefits of indoor tanning such as increased vitamin D production, development of a base tan, enhanced mood, and treatment of certain dermatologic conditions. To better educate their patients, providers need a comprehensive reference reviewing the evidence that support or oppose these claims. In this work, we conducted an evidence-based review of the literature to identify and grade studies that investigate health claims related to UV exposure. Results indicate that there is little evidence to support each of these proposed health benefits. Tanning beds emit primarily UVA radiation, which is relatively ineffective at activating vitamin D or mood enhancing pathways, and the effects are minimal in regard to tanning beds generating a protective base tan or treating dermatologic conditions compared with the increased risk of skin cancer. Health care providers must continue to warn and educate patients about the misleading information propagated by the tanning bed industry as well as about the dangers of artificial UV radiation.

Breastfeeding and Allergic Diseases: What's New?

Asthma and other allergic disorders, such as atopic dermatitis and food allergies, are common chronic health problems in childhood. The rapid rise in the prevalence of these conditions registered over the last few decades has stressed the need to identify the modifiable risk factors associated with the development of these diseases. Breast milk, recognized as the gold standard for healthy growth and development of the newborn, is one of the major factors associated with a lower incidence of allergic and infectious diseases in childhood and young adulthood. Although the underlying mechanisms for these effects are not well understood, breastfeeding leads to immune system maturation. In this narrative review, we summarize existing evidence on breastfeeding and human milk composition in relation to allergic disease prevention or development.

Differences in milk metabolites in Malnad Gidda (Bos indicus) cows reared under pasture-based feeding system

The milk and milk products from cows reared under grazing system are believed to be healthier and hence have high demand compared to milk from cows reared in the non-grazing system. However, the effect of grazing on milk metabolites, specifically lipids has not been fully understood. In this study, we used acetonitrile precipitation and methanol:chloroform methods for extracting the milk metabolites followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) run to identify the different metabolites between the milk of grazing and non-grazing early lactating Malnad Gidda cows. Various carbohydrates, amino acids, nucleosides and vitamin derivatives were found to be differentially abundant in grazing cows. A total of 35 metabolites were differentially regulated (fold change above 1.5) between the two groups. Tyrosyl-threonine, histidinyl-cysteine, 1-methyladenine, L-cysteine and selenocysteine showed fold change above 3 in grazing cows. The lipid profile of milk showed a lesser difference between grazing and non-grazing cows as compared to polar metabolites. To the best of our knowledge, this is the largest inventory of milk metabolomics data of an Indian cattle (Bos indicus) breed. We believe that our study would help to emerge a field of Nutri-metabolomics and veterinary omics research.

Maternal Circulating Vitamin Status and Colostrum Vitamin Composition in Healthy Lactating Women-A Systematic Approach

Colostrum is the first ingested sole nutritional source for the newborn infant. The vitamin profile of colostrum depends on the maternal vitamin status, which in turn is influenced by diet and lifestyle. Yet, the relationship between maternal vitamin status and colostrum vitamin composition has not been systematically reviewed. This review was conducted with the aim to generate a comprehensive overview on the relationship between maternal serum (plasma) vitamin concentration and corresponding colostrum composition. Three electronic databases, Embase (Ovid), Medline (Ovid), and Cochrane, were systematically searched based on predefined inclusion and exclusion criteria. Finally, a total of 11 eligible publications were included that examined the vitamins A, C, D, E, and K in both biological fluids. Maternal vitamin A, D, E, and K blood levels were unrelated to colostrum content of the respective vitamins, and serum vitamin A was inversely correlated with colostrum vitamin E. Colostrum versus maternal serum vitamins were higher for vitamins A, C, and K, lower for vitamin D, and divergent results were reported for vitamin E levels. Colostrum appears typically enriched in vitamin A, C, and K compared to maternal serum, possibly indicative of active mammary gland transport mechanisms. Inter-individual and inter-study high variability in colostrum's vitamin content endorses its sensitivity to external factors.

Micronutrients in Human Milk: Analytical Methods

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.

Etiologic risk factors and vitamin D receptor gene polymorphisms in under one-year-old infants with urolithiasis

The incidence of urinary tract stones in infancy has been increasing in Turkey. Risk factors and vitamin D receptor (VDR) gene polymorphisms were investigated in infants aged < 1 year who had stones. Forty infants with urinary tract stones and 80 infants without stones, aged < 1 year were enrolled in this study. Detailed surveys were taken of all infants, metabolic parameters and ApaI and FokI VDR gene polymorphisms were investigated. Infants with stones tended to be more commonly fed formula and multivitamins (vitamins A, C, D) (p < 0.05). Positive family history came into prominence in the stony group (p < 0.05). There were no significant differences in ApaI and FokI VDR gene polymorphisms between the groups with stones and the control groups. However, CA genotype of ApaI polymorphism was associated with family history and C allele of ApaI was related with family history and hypercalciuria (p < 0.05). Hypercalciuria emerged as an underlying metabolic abnormality in the etiology of stones, and was observed at a rate of 38%. Infants who are given formula and multivitamins for vitamin D supplementation are at increased risk for the formation of urinary tract stones. VDR gene polymorphisms cause the formation of urinary tract stones and affect calcium (Ca) metabolism.

Analyzing B-vitamins in Human Milk: Methodological Approaches

According to the World Health Organization (WHO), infants should be exclusively breastfed for the first six months of life. However, there is insufficient information about the concentration of nutrients in human milk. For some nutrients, including B-vitamins, maternal intake affects their concentration in human milk but the extent to which inadequate maternal diets affect milk B-vitamin content is poorly documented. Little is known about infant requirements for B-vitamins; recommendations are generally set as Adequate Intakes (AI) calculated on the basis of the mean volume of milk (0.78 L/day) consumed by infants exclusively fed with human milk from well-nourished mothers during the first six months, and the concentration of each vitamin in milk based on reported values. Methods used for analyzing B-vitamins, commonly microbiological, radioisotope dilution or more recently chromatographic, coupled with UV, fluorometric and MS detection, have rarely been validated for the complex human milk matrix. Thus the validity, accuracy, and sensitivity of analytical methods is important for understanding infant requirements for these nutrients, the maternal intakes needed to support adequate concentrations in breast milk. This review summarizes current knowledge on methods used for analyzing the B-vitamins thiamin, riboflavin, niacin, vitamin B-6 and pantothenic acid, vitamin B-12, folate, biotin, and choline in human milk, their chemical and physical properties, the different forms and changes in concentration during lactation, and the effects of deficiency on the infant.

Infant Feeding Practices in a Multi-Ethnic Asian Cohort: The GUSTO Study

The optimal introduction of complementary foods provides infants with nutritionally balanced diets and establishes healthy eating habits. The documentation of infant feeding practices in multi-ethnic Asian populations is limited. In a Singapore cohort study (GUSTO), 842 mother-infant dyads were interviewed regarding their feeding practices when the infants were aged 9 and 12 months. In the first year, 20.5% of infants were given dietary supplements, while 5.7% took probiotics and 15.7% homeopathic preparations. At age 9 months, 45.8% of infants had seasonings added to their foods, increasing to 56.3% at 12 months. At age 12 months, 32.7% of infants were given blended food, although 92.3% had begun some form of self-feeding. Additionally, 87.4% of infants were fed milk via a bottle, while a third of them had food items added into their bottles. At both time points, more than a third of infants were provided sweetened drinks via the bottle. Infants of Indian ethnicity were more likely to be given dietary supplements, have oil and seasonings added to their foods and consumed sweetened drinks from the bottle (p < 0.001). These findings provide a better understanding of variations in infant feeding practices, so that healthcare professionals can offer more targeted and culturally-appropriate advice.

Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial

Background

Exclusive breastfeeding for 6 months is assumed to ensure adequate micronutrients for term infants. Our objective was to investigate the effects of prolonged breastfeeding on B vitamin status and neurodevelopment in 80 infants with subnormal birth weights (2000-3000 g) and examine if cobalamin supplementation may benefit motor function in infants who developed biochemical signs of impaired cobalamin function (total homocysteine (tHcy) > 6.5 μmol/L) at 6 months.

Methods

Levels of cobalamin, folate, riboflavin and pyridoxal 5´-phosphate, and the metabolic markers tHcy and methylmalonic acid (MMA), were determined at 6 weeks, 4 and 6 months (n = 80/68/66). Neurodevelopment was assessed with the Alberta Infants Motor Scale (AIMS) and the parental questionnaire Ages and Stages (ASQ) at 6 months.

At 6 months, 32 of 36 infants with tHcy > 6.5 μmol/L were enrolled in a double blind randomized controlled trial to receive 400 μg hydroxycobalamin intramuscularly (n = 16) or sham injection (n = 16). Biochemical status and neurodevelopment were evaluated after one month.

Results

Except for folate, infants who were exclusively breastfed for >1 month had lower B vitamin levels at all assessments and higher tHcy and MMA levels at 4 and 6 months. At 6 months, these infants had lower AIMS scores (p = 0.03) and ASQ gross motor scores (p = 0.01).

Compared to the placebo group, cobalamin treatment resulted in a decrease in plasma tHcy (p < 0.001) and MMA (p = 0.001) levels and a larger increase in AIMS (p = 0.02) and ASQ gross motor scores (p = 0.03).

Conclusions

The findings suggest that prolonged exclusive breastfeeding may not provide sufficient B vitamins for small infants, and that this may have a negative effect on early gross motor development. In infants with mild cobalamin deficiency at 6 months, cobalamin treatment significantly improvement cobalamin status and motor function, suggesting that the observed impairment in motor function associated with long-term exclusive breastfeeding, may be due to cobalamin deficiency.

Clinical trial registration

ClinicalTrials.gov, number NCT01201005

Temporal plasma vitamin concentrations are altered by fat-soluble vitamin administration in suckling pigs

Piglets are born with purportedly low plasma vitamin D levels. The objective of this study was to investigate the effect of fat-soluble vitamin administration, primarily vitamin D, by different administration routes on plasma vitamin concentrations in suckling pigs. A total of 45 pigs from 5 litters were allotted at birth to 3 treatments within each litter. Pigs were administered 400 IU of α-tocopherol, 40,000 IU of retinyl palmitate, and 40,000 IU of vitamin D at d 1 of age either orally or by i.m. injection and compared with control pigs with no supplemental vitamin administration. Blood samples were collected at d 0 (initial), 1, 2, 3, 4, 6, 9, 14, and 20 after administration. Plasma 25-hydroxycholecalciferol (25OHD), α-tocopherol, retinyl palmitate, and retinol concentrations were analyzed. Except for retinol, the effects of treatment, day, and day × treatment interaction ( < 0.01) were observed on plasma vitamin concentrations. Plasma concentrations of 25OHD and α-tocopherol increased immediately regardless of administration routes to peak at d 2 and 1 after administration, respectively. Plasma retinyl palmitate concentrations increased only with the injection treatment, with the peak at d 1 after administration. Plasma concentrations of 25OHD in both administration treatments and α-tocopherol in the injection treatment were maintained at greater levels than those in the control treatment until d 20 after administration. With regard to the pharmacokinetic parameters for plasma 25OHD concentrations, the injection treatment had greater elimination half-life ( < 0.01), maximum plasma concentrations ( < 0.05), and all area under the curve parameters ( < 0.01) but a lower elimination rate constant ( < 0.01) than the oral treatment. Relative bioavailability of oral administration compared with injection administration was 55.26%. These results indicate that plasma status of 25OHD,α-tocopherol, and retinyl palmitate are differentially changed between types of vitamins administered and between administration routes and that the injection route had a greater increase and slower disappearance of plasma vitamin levels than the oral route during the suckling period.

Human milk composition: nutrients and bioactive factors

This article provides an overview of the composition of human milk, its variation, and its clinical relevance. The composition of human milk is the biological norm for infant nutrition. Human milk also contains many hundreds to thousands of distinct bioactive molecules that protect against infection and inflammation and contribute to immune maturation, organ development, and healthy microbial colonization. Some of these molecules (eg, lactoferrin) are being investigated as novel therapeutic agents. Human milk changes in composition from colostrum to late lactation, within feeds, by gestational age, diurnally, and between mothers. Feeding infants with expressed human milk is increasing.

[Solar protection products: efficacy and risks]

Solar protection products (SPP) containing chemical filters and/or mineral filters are extensively used today in photoprotection; however, concerns continue to be voiced about their efficacy and about their possible dangers. A rapid review of photoprotection strategies shows that SPP owe their photoprotective effect to the absence of other photoprotection methods having clearly established efficacy in healthy subjects; in addition, they exhibit real protective efficacy against the majority of harmful effects of solar radiation, provided they have been devised in keeping with the specifications clearly set out in the recommendations of the French Medicines Agency (Afssaps). Such efficacy is dependent on their correct usage, recently reiterated by Afssaps in its recommendations to end-users concerning the good use of solar products: application of adequate quantities of such products, selection of the appropriate photoprotection class based on phototype and conditions of exposure, and regular renewal of applications in the event of prolonged exposure and after bathing or profuse sweating. Solar filters have long been known to cause contact allergic dermatitis, irritative dermatitis and photosensitisation, and a particular risk has appeared with the use of octocrylene. However, debate has centred primarily on the risk of endocrine disturbance potentially induced by chemical filters, certain of which exhibit established transcutaneous penetration. The risk of mimicry of an effect of oestradiol has been raised on the basis of a series of studies, almost all of which were carried out by the same team, and which mainly concerned 4-methylbenzylidene-camphor (4-MBC) following oral absorption in the rat. The risk of this type of effect with SPPs under normal conditions of use seems fairly remote according to the current state of knowledge; in any event, within the context of the "National Fertility Action Plan", Afssaps has been formally requested to analyse the risk associated with cosmetic substances that are "reprotoxic" and/or affect endocrine function, as a result of which various filters are currently being reassessed for such risk. The greater alleged safety of mineral filters, based on the absence of introduction of risk of photosensitisation (as a result of which they are preferred for use in young children), no longer seems so clear since the introduction of titanium dioxide (TiO2) and zinc oxide (ZnO) in the form of nanoparticles. Afssaps drew up a risk assessment report concerning cutaneous penetration, genotoxicity and oncogenesis for TiO(2) and ZnO in nanoparticle form; further studies are needed before any general conclusions may be drawn. The European Scientific Committee on Consumer Safety (SCCS) is also carrying out an evaluation of the use of TiO(2) and of ZnO as UV filters. Finally, current data do not suggest that SPPs exert any harmful effects by inhibiting the beneficial effects of the sun, in particular, vitamin D synthesis.

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

OBJECTIVES

(i) To measure 25-OH vitamin D levels in term infants at 10 weeks and 6 months and to correlate with maternal vitamin D levels at 10-week postpartum (ii) To evaluate infants at 6 months for rickets.

PATIENTS AND METHODS

A total of 179 exclusively breastfed infant-mother pairs 96 appropriate-for-gestational age (Group 1) and 83 small- for- gestational age infants (Group 2) recruited at 10 weeks. At 6 months, 52 in group 1 and 45 in group 2 were evaluated. Venous blood sample were collected at 10 weeks and 6 months in infants and at 10 weeks in mothers for calcium, phosphorus, alkaline phosphatase and 25-OH vitamin D estimation.

RESULTS

Mean 25-OH vitamin D levels of infants (n = 97) were 11.55 ± 7.17 ng/mL at 10 weeks and 16.96 ± 13.33 ng/mL at 6 months (p < 0.001). Mean vitamin D levels of infants in group 1 and group 2 did not differ at recruitment and 6 months (p > 0.05)). Maternal vitamin D levels in group 1 and group 2 were 8.89 ± 5.97 and 9.87 ± 6.44 ng/mL, respectively (p = 0.44). Significant correlation was observed between 25-OH vitamin D of infants and mothers (p < 0.05). At 10 weeks, 55.67% infants, 70% mothers and at 6 months, 44.33% infants had vitamin D < 11 ng/mL. At 6 months, 16.49% infants developed rickets.

CONCLUSIONS

Exclusively breastfed infants and their mothers are Vitamin D deficient, hence the need to improve vitamin D status.

Vitamin D supplementation of Canadian infants: practices of Montreal mothers

Health policy in North America advocates that all breastfed infants receive a vitamin D supplement of 400 IU per day for the primary prevention of rickets. Despite this recommendation, rickets still occurs in Canada. It is not known whether vitamin D deficiency in the Canadian population is solely attributable to inadequacies in vitamin supplementation. Thus, the evaluation of current practices, including awareness and compliance with recommendations, is clearly needed. The objective of this study was to describe the vitamin D supplementation practices of mothers of newborns living in the Montreal area. This was a cross-sectional telephone survey of 343 mothers delivering a healthy term infant from December 2007 to May 2008 at the Royal Victoria Hospital (Montreal, Que.). Ninety percent of all mothers breastfed their infants during the first 6 months; 53% did so exclusively. Of mothers exclusively breastfeeding, 74% reported meeting the Health Canada recommendation. The main reason for not adhering to the recommendation was the assumption by mothers who began to feed fortified formula (400 IU.L-1) that supplementation was no longer necessary. Fifty percent of infants receiving mixed feedings without supplementation prior to 6 months did not achieve the recommended intake. Receiving advice about supplementation and the higher education of mothers were significant positive determinants of supplementation practices. This work identified infants consuming mixed feedings and those consuming only formula in the first 6 months as groups at high risk for not meeting the recommended 400 IU.day-1 of vitamin D. Therefore there may still be gaps in knowledge regarding vitamin D supplementation.

Older women and suntanning: the negotiation of health and appearance risks

This paper examines older women's experiences and perceptions of sunbathing, sun avoidance, and suntanned appearances. Using data from in-depth interviews with 36 women aged 71 to 94, we elucidate the motivations behind the women's sunbathing practices. Specifically, we explore how the women responded to the health and appearance risks associated with exposure to and avoidance of ultraviolet radiation as well as extant feminine beauty norms. The majority of women put their experiences of sunbathing in an emergent historical context. Although most of the women suggested that suntanned appearances were indicative of health and beauty, sunbathers tended to downplay their health risks by distancing themselves from those they considered to be most at risk, namely tanning bed users and individuals who acquired overly dark suntans. Sunbathers also emphasised the benefits of sun exposure for adequate vitamin D absorption. In contrast, the women who did not suntan tended to have experienced negative health and appearance consequences from their past sunbathing practices. Thus, these women emphasised the importance of future health over immediate appearance dividends. We discuss our findings in relation to the extant research on suntanning and the literature pertaining to health, risk, and beauty work.

Retinol and alpha-tocopherol concentrations in breast milk of Turkish lactating mothers under different socio-economic status

Retinol and alpha-tocopherol levels in breast milk of Turkish mothers under different socioeconomic status were investigated. Mature milk samples were collected from 92 lactating mothers living in Izmir and in Manisa, cities of Turkey, who were at 60-90 days of the lactating period. Socio-economic, anthropometric, and dietary data were collected by means of a questionnaire. The body mass index was used to determine the nutritional status. The retinol and alpha-tocopherol contents of breast milk were determined by high-performance liquid chromatography; the concentration of alpha-tocopherol was 9.84 microg/ml whereas retinol levels were 81.5 microg/100 ml. The questionnaire survey was used to determine the level of these vitamins in the daily ration of the women. No significant differences were found in terms of milk retinol and alpha-tocopherol levels for the variables income, educational level and mothers' body mass index.

Quantification of fat-soluble vitamins in human breast milk by liquid chromatography-tandem mass spectrometry

Sensitive quantification method for fat-soluble vitamins in human breast milk by liquid chromatography-tandem mass spectrometry was developed. Vitamins A, D and E were extracted from 10.0 mL of breast milk after saponifying by basic condition. Vitamin K derivatives were extracted from 3.0 mL of breast milk after lipase treatment. The corresponding stable isotope-labeled compounds were used as internal standards. For the determination of vitamin D compounds, derivatization with a Cookson-type reagent was performed. All fat-soluble vitamins were determined by liquid chromatography-tandem mass spectrometry in the positive ion mode. The detection limits of all analytes were 1-250 pg per 50 microL. The recoveries of fat-soluble vitamins were 91-105%. Inter-assay CV values of each vitamin were 1.9-11.9%. The mean concentrations of retinol, vitamin D3, 25-hydroxyvitamin D3, alpha-tocopherol, phylloquinone and menaquinone-4 were 0.455 microg/mL, 0.088 ng/mL, 0.081 ng/mL, 5.087 microg/mL, 3.771 ng/mL, and 1.795 ng/mL, respectively (n=82). This method makes possible to determine fat-soluble vitamins with a wide range of polarities in human breast milk. The assay may be useful for large-scale studies.

Allaitement maternel : les bénéfices pour la santé de l'enfant et de sa mère

Breast milk contains hormones, growth factors, cytokines, cells, etc., and offers many advantages over cow's milk or soy protein infant formulae. The composition of breast milk is influenced by gestational and postnatal age. Prevalence of breastfeeding in France is one of the lowest in Europe: in 2003, only 58% of infants were breastfed when leaving the maternity ward, for a median duration of 10 weeks. Breastfeeding allows normal growth until at least 6 months of age, and can be prolonged until the age of 2 years or more, provided that complementary feeding is started after 6 months. Breastfeeding is associated with slightly enhanced performance on tests of cognitive development. Exclusive breastfeeding for at least 3 months is associated with a lower incidence and severity of diarrhoea, otitis media and respiratory infection. Exclusive breastfeeding for at least 6 months is associated with a lower incidence of allergic disease in at-risk infants (infants with at least one first-degree relative presenting with allergy). Breastfeeding is also associated with a lower incidence of obesity during childhood and adolescence, as well as with a lower incidence of hypertension and hypercholesterolemia in adulthood. Maternal infection with hepatitis B and C virus is not a contraindication to breastfeeding, as opposed to HIV infection and galactosemia. A supplementation with vitamin D and K is necessary in the breastfed infant. Very few medications contraindicate breastfeeding. Premature babies can be breastfed and/or receive mother's milk and/or bank milk, provided they receive energy, protein and mineral supplements. Return to prepregnancy weight is earlier in breastfeeding mothers. Breastfeeding is also associated with a decreased risk of breast and ovarian cancer in the premenopausal period, and of hip fractures and osteoporosis in the postmenopausal period.

Breastfeeding and vitamin D status in Greece during the first 6 months of life

Since no foods are vitamin D supplemented in Greece, vitamin D status was assessed in mothers at birth and their infants up to the first 6 months of life, while they were exclusively breast-fed. This was a prospective study. Full-terms (n =35) born during the summer-autumn months and their mothers were assigned to the summer group and the remainder (n =31) to the winter group. One week after birth, serum 25-hydroxyvitamin D (25OHD) was significantly lower in the winter-born than in the summer-born neonates (6.7+/-0.7 vs. 10.1+/-0.9 ng/ml, P <0.01). The respective levels of parathyroid hormone (iPTH) were 64.9+/-13.4 and 33.9+/-4.4 pg/ml (P <0.01). The mothers had serum 25OHD levels of 10.8+/-1.0 ng/ml and iPTH levels of 15.2+/-3.5 pg/ml in the winter and 12.9+/-1.3 ng/ml and 24.8+/-4.8 pg/ml in the summer. During the 6-month follow-up, a steady increase in circulating 25OHD (up to 19.4+/-2.8 ng/ml, P <0.0001) and a decrease in iPTH (to 26.8+/-3.5 pg/ml, P =0.10) were observed in the infants born in the winter. In the summer-born infants, serum 25OHD did not change but iPTH had increased significantly by the 3rd month (59.4+/-21.8, P <0.05). Serum calcium (Ca) increased within normal limits during the study period in both groups. Serum phosphorus (Pi) started higher in the winter group (7.43+/-0.38 vs. 6.27+/-0.23 mg/dl, P <0.01) but thereafter, it was similar in both groups. Total alkaline phosphatase (ALP) increased in both groups during the study (164+/-15 vs. 219+/-17 IU/l, P <0.05 and 189+/-14 vs. 288+/-35 IU/l, P <0.001, respectively). Serum osteocalcin (OC) decreased in the winter-born neonates (32.0+/-3.4 vs. 21.5+/-3.4 ng/ml, P <0.05) and did not change in the summer group (28.9+/-3.5 vs. 26.5+/-2.8 ng/ml).

CONCLUSION

Neonates who are breast-fed exclusively during the first 6 months of life are in need of vitamin D supplementation irrespective of the season even in a sunny country like Greece where foods are not supplemented.

The indoor UV tanning industry: A review of skin cancer risk, health benefit claims, and regulation

BACKGROUND

Nearly 30 million people tan indoors in the United States annually, including 2.3 million adolescents. Despite increased evidence on the dangers of artificial UV radiation, the popularity of indoor tanning is growing.

OBJECTIVES

We aim to assess the following 3 entities: (1) the association of indoor tanning with skin cancer; (2) statements regarding the health benefits of indoor tanning, especially regarding the production of vitamin D; and (3) current regulation of the tanning industry in the United States.

METHODS

We conducted a narrative review of the literature.

RESULTS

Indoor tanning poses great risks. Studies support the role of artificial UV radiation in cutaneous carcinogenesis. Despite claims by the tanning industry, artificial tanning is not a safe or necessary way to increase systemic vitamin D levels. The National Institutes of Health and the World Health Organization have acknowledged the risks of indoor tanning. Nonetheless, regulations limiting tanning in the United States are surprisingly sparse.

LIMITATIONS

Systematic review of the literature was not performed.

CONCLUSIONS

Health care providers must increase efforts to warn and educate the public and government about the dangers of UV radiation.

Vitamin K in human milk--still not enough

The breastfed infant has limited sources of vitamin K, as it is transmitted poorly across the placenta and is present in very low concentrations in human milk. The author of this paper reports a concentration of vitamin K in human milk (0.517 +/- 1.521 microg/dl) that is about twice the average of earlier reports (0.25 microg/dl). About half of the increased concentration (0.235 +/- 0.144 microg/dl) is accounted for by vitamin K2 (menaquinone) rather than vitamin K1 (phylloquinone); the latter generally thought to be more important in human nutrition. The significance of these findings is discussed.

Nutrition, growth, and complementary feeding of the breastfed infant

Although additional research is needed on many of the issues discussed herein, the following conclusions are well substantiated by the evidence available to date: Breast milk alone can meet nutrient needs during the first 6 months, with the possible exception of vitamin D in certain populations and iron in infants of relatively low birth weight. Complementary foods offered before 6 months of age tend to displace breast milk and do not confer any growth advantage over exclusive breastfeeding. Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins. Breastfed infants tend to gain less weight and usually are leaner than are formula-fed infants in the second half of infancy. This difference does not seem to be the result of nutritional deficits but rather infant self-regulation of energy intake. New growth charts based on infants breastfed throughout the first year of life are being developed by WHO. The nutrients most likely to be limiting in the diets of breastfed infants are minerals, such as iron, zinc, and calcium. Using the following guidelines can help to ensure that the nutrient needs of the breastfed child are met: Continue to breastfeed as often as the infant desires. Aim for a variety of complementary foods, with fruits, vegetables, and animal products (e.g., meat, fish, poultry, or egg) offered daily. Iron-fortified cereals and meats can provide adequate iron. Calcium can be obtained from cheese, yogurt, and other dairy products (although fresh cow's milk is not recommended before 12 mo). Avoid giving too much juice. Be alert to any signs that the child's appetite, growth, or development is impaired. When in doubt, a balanced vitamin-mineral supplement is advisable. Make mealtimes enjoyable.