Milk vitamin D in relation to the 'adequate intake' for 0-6-month-old infants: a study in lactating women with different cultural backgrounds, living at different latitudes.
Br J Nutr. 2017 Nov 6:1-9. doi: 10.1017/S000711451700277X. [Epub ahead of print]
Stoutjesdijk E1, Schaafsma A2, Nhien NV3, Khor GL4, Kema IP1, Hollis BW5, Dijck-Brouwer DAJ1, Muskiet FAJ1.
1 Laboratory Medicine, University Medical Center Groningen and University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
2 FrieslandCampina, PO Box 1551, 3800 BNAmersfoort,The Netherlands.
3 National Institute of Food Control,65 - Pham Than Duat - Cau Giay, Hanoi, Vietnam.
4 International Medical University, No. 126, Jalan Jalil Perkasa 19,Bukit Jalil, 57000,Kuala Lumpur, Malaysia.
5 Medical University of South Carolina,171 Ashley Avenue, Charleston, SC 29425, USA.
|Country||Avg Vit D|
|Avg as % |
|Vietnam: Halong Bay||58||11 %|
|Phu Tho||28||5 %|
|Tien Giang||63||12 %|
|Malaysia-Kuala Lumpur||14||3 %|
639 items in the category Infant/Child
- breastfed 962 items as of Sept 2017
- Breastfed infants 6 times more likely to deficient in Vitamin D and Iron – Aug 2015
- 16% of exclusively breastfed infants so low on vitamin D that they had rickets – June 2010
- Breastfeeding mother getting 6400 IU of Vitamin D is similar to infant getting 400 IU – RCT Sept 2015
- Breastfed infant bones not helped by 800 IU of Vitamin D (not enough) – RCT Dec 2017
Monthly dosing for infant or mother works well
- Breastfeeding mothers and Vitamin D: supplement only themselves usually, 4 out of 10 used monthly rather than daily – Jan 2017
- Newborn Vitamin D - single 50,000 IU is better than daily – RCT Sept 2016
- Monthly 120,000 IU of Vitamin D during lactation worked well - May 2016
- Children getting 60,000 IU monthly got to vitamin D level of 33 ng – Sept 2015
Even more vitamin D is needed if mother or infant is at high-risk of vitamin D deficiency
- Obese moms who breastfeed (without Vitamin D) had low bone density in infants – Aug 2017
- Preemies getting 800 IU of vitamin D were 3X less likely to have low bone density 4 weeks later – RCT Oct 2017
- Preemies need 1,000 IU of vitamin D – RCT Sept 2017
- Vitamin D needed to get children to just 20 ng in winter 800 IU white skin, 1100 IU dark (Sweden) – RCT June 2017
Note: Even if cows milk is fortified avoid low fat - 2.5X less vitamin D gets into the body
Note: Formula only has 400 IU/liter - which is no longer enough - even if infant is not at high risk
Breast-fed infants are susceptible to vitamin D deficiency rickets. The current vitamin D 'adequate intake' (AI) for 0-6-month-old infants is 10 µg/d, corresponding with a human milk antirachitic activity (ARA) of 513 IU/l. We were particularly interested to see whether milk ARA of mothers with lifetime abundant sunlight exposure reaches the AI. We measured milk ARA of lactating mothers with different cultural backgrounds, living at different latitudes. Mature milk was derived from 181 lactating women in the Netherlands, Curaçao, Vietnam, Malaysia and Tanzania. Milk ARA and plasma 25-hydroxyvitamin D (25(OH)D) were analysed by liquid-chromatography-MS/MS; milk fatty acids were analysed by GC-flame ionisation detector (FID). None of the mothers reached the milk vitamin D AI. Milk ARA (n; median; range) were as follows:
- Netherlands (n 9; 46 IU/l; 3-51),
- Curaçao (n 10; 31 IU/l; 5-113),
- Vietnam: Halong Bay (n 20; 58 IU/l; 23-110),
- Phu Tho (n 22; 28 IU/l; 1-62),
- Tien Giang (n 20; 63 IU/l; 26-247),
- Ho-Chi-Minh-City (n 18; 49 IU/l; 24-116),
- Hanoi (n 21; 37 IU/l; 11-118),
- Malaysia-Kuala Lumpur (n 20; 14 IU/l; 1-46) and
- Tanzania-Ukerewe (n 21; 77 IU/l; 12-232) and
- Maasai (n 20; 88 IU/l; 43-189).
We collected blood samples of these lactating women in Curaçao, Vietnam and from Tanzania-Ukerewe, and found that 33·3 % had plasma 25(OH)D levels between 80 and 249·9 nmol/l, 47·3 % between 50 and 79·9 nmol/l and 19·4 % between 25 and 49·9 nmol/l. Milk ARA correlated positively with maternal plasma 25(OH)D (range 27-132 nmol/l, r 0·40) and milk EPA+DHA (0·1-3·1 g%, r 0·20), and negatively with latitude (2°S-53°N, r -0·21).
Milk ARA of mothers with lifetime abundant sunlight exposure is not even close to the vitamin D AI for 0-6-month-old infants. Our data may point at the importance of adequate fetal vitamin D stores.
PMID: 29103383 DOI: 10.1017/S000711451700277X Publisher wants $35 for the PDFBreast milk rarely now has even 20 percent of needed vitamin D – even in sunny climates – Nov 2017
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