Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial
BMC Pediatrics volume 21, Article number: 378 (2021) https://doi.org/10.1186/s12887-021-02849-z
Chayatat Ruangkit, Sukrit Suwannachat, Pornchanok Wantanakorn, Napapailin Sethaphanich, Surapat Assawawiroonhakarn & Oraporn Dumrongwongsiri
| >20 ng/ml | |
| Control group | 43% |
| 400 IU added | 93% |
Most countries believe sufficiency is >30 ng not >20 ng
Many researchers believe that >40 ng is needed
400 IU is usually enough to treat rickets in infants, but not much else
- Breastfed infants: 90 percent had less than 20 ng of vitamin D, formula-fed: 15 percent – May 2013
- Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013
- Vitamin D required for breastfed infants – daily or monthly, infant or mother – Jan 2017
- 1,000 IU daily for infant
- 16 pages in VitaminDWiki had BREASTFE in title as of Aug 2021
- Is 50 ng of vitamin D too high, just right, or not enough
- 400 IU of Vitamin D provided no benefit to children (not a surprise) – RCT March 2018
- Children getting 60,000 IU monthly got to vitamin D level of 33 ng – Sept 2015
- Newborn Vitamin D - single 50,000 IU is better than daily – RCT Sept 2016
- Vitamin D for infants – 100,000 IU monthly is better than 400 IU daily – RCT Oct 2020
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Background
Many international medical organizations recommend vitamin D supplementation for infants, especially exclusively breastfed infants. In Thailand, however, data regarding the vitamin D status in Thai infants are lacking. Such data would help to support physician decisions and guide medical practice.
Methods
Full-term, exclusively breastfed infants were randomized into two groups at 2 months of age to continue exclusive breastfeeding either without vitamin D supplementation (control group, n = 44) or with vitamin D3 supplementation at 400 IU/day (intervention group, n = 43) until 6 months of age. At 6 months, the serum vitamin D (25OHD) of the infants and their mothers, serum bone marker, and infants’ growth parameters were compared between the two groups.
Results
The infants’ serum 25OHD concentration was lower in the control group than intervention group (20.57 ± 12.66 vs. 46.01 ± 16.42 ng/mL, p < 0.01). More infants had vitamin D sufficiency (25OHD of > 20 ng/mL) in the intervention group than control group (93.0% vs. 43.2%, p < 0.01). There were no significant differences in the maternal 25OHD concentrations between the control and intervention groups (25.08 ± 7.75 vs. 23.75 ± 7.64 ng/mL, p = 0.42). Serum calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase, and infants’ growth parameters were comparable between the two groups. After adjustment for the confounding factors, 25OHD concentration in the intervention group was 25.66 ng/mL higher than the control group (95% confidence interval, 19.07–32.25; p < 0.001). Vitamin D supplement contributed to an 88.7% decrease in the prevalence of vitamin D insufficiency/deficiency (relative risk, 0.11; 95% confidence interval, 0.04–0.35; p < 0.01).
Conclusions
Most full-term, exclusively breastfed Thai infants have serum vitamin D concentration below sufficiency level at 6 months of age. However, vitamin D supplementation (400 IU/day) improves their vitamin D status and prevents vitamin D deficiency.