Vitamin D Status of Exclusively Breastfed 4-Month-Old Infants Supplemented During Different Seasons

Pediatrics Published online September 24, 2012
Oya Halicioglu, MD a, Sumer Sutcuoglu, MD a, Feyza Koc, MD b, Omur Yildiz, MD c, Sezin A. Akman, MD a, and Sadik Aksit, MD b
Departments of a Pediatrics, and
C Biochemistry, The Ministry of Health Tepecik Teaching and Research Hospital, Izmir, Turkey;
B Department of Pediatrics, Ege University Medical School, Izmir, Turkey

OBJECTIVE: To examine the vitamin D status of 4-month-old exclusively breastfed infants supplemented with 400 IU daily of vitamin D and to determine whether there was any seasonal variation in serum 25-hydroxyvitamin D (25(OH)D) levels of infants.

METHODS: In this cross-sectional study, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels of 143 exclusively breastfed 4-month-old infants supplemented daily with 400 IU of vitamin D were measured in a temperate latitude, Izmir, Turkey, between May 2008 and April 2009. A questionnaire on demographic characteristics of infants and mothers, vitamin D supplementation of infants after birth, mothers' multivitamin supplementation, dressing habits, and consumption of dairy products during pregnancy was used.

RESULTS: Vitamin D deficiency (<50 nmol/L) and insufficiency (51–74 nmol/L) were determined in 40 (28%) and 55 (38.5%) infants, respectively.
During winter days, serum 25(OH)D levels were <20 ng/mL in 45.4% of infants and <10 ng/mL in 10.6% of infants.
Season of blood sampling, compliance of vitamin D supplementation, maternal education level, and consumption of dairy products were highly predictive of serum 25(OH)D levels in multiple linear regression analysis (P < .05). The use of the Pearson correlation test found a statistically significant negative correlation between 25(OH)D and parathyroid hormone levels (r = ?0.419, P < .001).

CONCLUSIONS: Despite supplementation with 400 IU of vitamin D daily, the rate of vitamin D deficiency was worryingly high in 4-month-old exclusively breastfed infants living in Izmir, Turkey. So, additional studies are needed to clarify optimal amount of vitamin D supplementation to the infants, especially during winter days.
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Summary with 400 IU of vitamin D in winter

45% < 20ng
11% < 10 ng
(Note: US in 2010 voted that 600 IU of vitamin D is needed)

See also VitaminDWiki

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• 400 IU vitamin D for breastfed - American Association of Pediatrics - Feb 2012
• Breastfed infants in Germany with 250 IU of vitamin D got to 56ng – Sept 2010
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• 16% of exclusively breastfed infants so low on vitamin D that they had rickets – June 2010
• Overview of Rickets and Vitamin D
• All items in Infant-Child 854 items
• Reminder – 400 IU is enough only when infant already had a good level of vitamin D – Nov 2012
• Many infant infections avoided with supplementation with 400 IU of vitamin D – Oct 2012
• Breastfed without vitamin D supplements – a problem for NZ infants Jan 2013
• 100 IU per kg of infant July 2011, Poland etc. has the following graph