Top

Published in:

Open Access 01-12-2021 | Vitamin D Deficiency | Research

Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial

Authors: Chayatat Ruangkit, Sukrit Suwannachat, Pornchanok Wantanakorn, Napapailin Sethaphanich, Surapat Assawawiroonhakarn, Oraporn Dumrongwongsiri

Published in: BMC Pediatrics | Issue 1/2021

Abstract

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.

Trial registration

The study was pre-registered in the Thai Clinical Trials Registry (TCTR20190622001) on 22/06/2019.

Bouillon R, Marcocci C, Carmeliet G, Bikle D, White JH, Dawson-Hughes B, et al. Skeletal and extraskeletal actions of vitamin D: current evidence and outstanding questions. Endocr Rev. 2019;40(4):1109–51. https://doi.org/10.1210/er.2018-00126.CrossRefPubMed

Creo AL, Thacher TD, Pettifor JM, Strand MA, Fischer PR. Nutritional rickets around the world: an update. Paediatr Int Child Health. 2017;37(2):84–98. https://doi.org/10.1080/20469047.2016.1248170.CrossRefPubMed

Rojroongwasinkul N, Kijboonchoo K, Wimonpeerapattana W, Purttiponthanee S, Yamborisut U, Boonpraderm A, et al. SEANUTS: the nutritional status and dietary intakes of 0.5–12-year-old Thai children. Br J Nutr. 2013;110(Suppl 3):S36–44. https://doi.org/10.1017/S0007114513002110.CrossRefPubMed

World Health Organization, UNICEF. Global strategy for infant and young child feeding. http://whqlibdoc.who.int/publications/2003/9241562218.pdf (Accessed 25 Dec 2020).

Dawodu A, Tsang RC. Maternal vitamin D status: effect on milk vitamin D content and vitamin D status of breastfeeding infants. Adv Nutr. 2012;3(3):353–61. https://doi.org/10.3945/an.111.000950.CrossRefPubMedPubMedCentral

Stoutjesdijk E, Schaafsma A, Nhien NV, Khor GL, Kema IP, Hollis BW, et al. 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;118(10):804–12. https://doi.org/10.1017/S000711451700277X.CrossRefPubMed

Wagner CL, Greer FR. American Academy of Pediatrics section on breastfeeding, American Academy of Pediatrics Committee on nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142–52. https://doi.org/10.1542/peds.2008-1862.CrossRefPubMed

Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;101(2):394–415. https://doi.org/10.1210/jc.2015-2175.CrossRefPubMedPubMedCentral

Uday S, Kongjonaj A, Aguiar M, Tulchinsky T, Högler W. Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence. Endocr Connect. 2017;6(8):667–75. https://doi.org/10.1530/EC-17-0193.CrossRefPubMedPubMedCentral

10.

Simon AE, Ahrens KA. Adherence to vitamin D intake guidelines in the United States. Pediatrics. 2020;145(6):e20193574. https://doi.org/10.1542/peds.2019-3574.CrossRefPubMed

11.

Sherman EM, Svec RV. Barriers to vitamin D supplementation among military physicians. Mil Med. 2009;174(3):302–7. https://doi.org/10.7205/milmed-d-01-4708.CrossRefPubMed

12.

Challa A, Ntourntoufi A, Cholevas V, Bitsori M, Galanakis E, Andronikou S. Breastfeeding and vitamin D status in Greece during the first 6 months of life. Eur J Pediatr. 2005;164(12):724–9. https://doi.org/10.1007/s00431-005-1757-1.CrossRefPubMed

13.

Chan KC, Tam WH, Chan MH, Chan RS, Li AM. Vitamin D deficiency among healthy infants in Hong Kong: a pilot study. Hong Kong Med J. 2018;24(Suppl 3):32–5.PubMed

14.

Meena P, Dabas A, Shah D, Malhotra RK, Madhu SV, Gupta P. Sunlight exposure and vitamin D status in breastfed infants. Indian Pediatr. 2017;54(2):105–11. https://doi.org/10.1007/s13312-017-1010-9.CrossRefPubMed

15.

Chen C-M, Mu S-C, Chen Y-L, Tsai L-Y, Kuo Y-T, Cheong I-M, et al. Infants’ vitamin D nutritional status in the first year of life in northern Taiwan. Nutrients. 2020;12(2):404. https://doi.org/10.3390/nu12020404.CrossRefPubMedCentral

16.

Salameh K, Al-Janahi NSA, Reedy AM, Dawodu A. Prevalence and risk factors for low vitamin D status among breastfeeding mother-infant dyads in an environment with abundant sunshine. Int J Women's Health. 2016;8:529–35. https://doi.org/10.2147/IJWH.S107707.CrossRef

17.

Nakano S, Suzuki M, Minowa K, Hirai S, Takubo N, Sakamoto Y, et al. Current vitamin D status in healthy Japanese infants and young children. J Nutr Sci Vitaminol (Tokyo). 2018;64(2):99–105. https://doi.org/10.3177/jnsv.64.99.CrossRef

18.

Merewood A, Mehta SD, Grossman X, Chen TC, Mathieu J, Holick MF, et al. Vitamin D status among 4-month-old infants in New England: a prospective cohort study: a prospective cohort study. J Hum Lact. 2012;28(2):159–66. https://doi.org/10.1177/0890334411434802.CrossRefPubMed

19.

Said NA, Kamenwa RW, Limbe MS, Okumu MO, Macharia WM. Prevalence of vitamin D deficiency in exclusively breastfed infants at a tertiary healthcare facility in Nairobi, Kenya. Arch Endocrinol Metab. 2020;64(6):726–34. https://doi.org/10.20945/2359-3997000000281.CrossRef

20.

Oktaria V, Graham SM, Triasih R, Soenarto Y, Bines JE, Ponsonby A-L, et al. The prevalence and determinants of vitamin D deficiency in Indonesian infants at birth and six months of age. PLoS One. 2020;15(10):e0239603. https://doi.org/10.1371/journal.pone.0239603.CrossRefPubMedPubMedCentral

21.

Gallo S, Comeau K, Vanstone C, Agellon S, Sharma A, Jones G, et al. Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: a randomized trial. JAMA. 2013;309(17):1785–92. https://doi.org/10.1001/jama.2013.3404.CrossRefPubMed

22.

Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG, et al. Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics. 2015;136(4):625–34. https://doi.org/10.1542/peds.2015-1669.CrossRefPubMedPubMedCentral

23.

Ziegler EE, Nelson SE, Jeter JM. Vitamin D supplementation of breastfed infants: a randomized dose-response trial. Pediatr Res. 2014;76(2):177–83. https://doi.org/10.1038/pr.2014.76.CrossRefPubMedPubMedCentral

24.

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(12):CD013046. https://doi.org/10.1002/14651858.CD013046.pub2.CrossRefPubMed

25.

Huey SL, Acharya N, Silver A, Sheni R, Yu EA, Peña-Rosas JP, et al. Effects of oral vitamin D supplementation on linear growth and other health outcomes among children under five years of age. Cochrane Database Syst Rev. 2020;12(3):CD012875. https://doi.org/10.1002/14651858.CD012875.pub2.CrossRefPubMed

26.

Pratumvinit B, Wongkrajang P, Wataganara T, Hanyongyuth S, Nimmannit A, Chatsiricharoenkul S, et al. Maternal vitamin D status and its related factors in pregnant women in Bangkok. Thailand PLoS One. 2015;10(7):e0131126. https://doi.org/10.1371/journal.pone.0131126.CrossRefPubMed

27.

Dawodu A, Davidson B, Woo JG, Peng Y-M, Ruiz-Palacios GM, de Lourdes GM, et al. Sun exposure and vitamin D supplementation in relation to vitamin D status of breastfeeding mothers and infants in the global exploration of human milk study. Nutrients. 2015;7(2):1081–93. https://doi.org/10.3390/nu7021081.CrossRefPubMedPubMedCentral

28.

Wagner CL, Hollis BW. Early-life effects of vitamin D: A focus on pregnancy and lactation. Ann Nutr Metab. 2020;76(Suppl 2):16–28. https://doi.org/10.1159/000508422.CrossRefPubMed

Title: Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial
Authors: Chayatat Ruangkit
Sukrit Suwannachat
Pornchanok Wantanakorn
Napapailin Sethaphanich
Surapat Assawawiroonhakarn
Oraporn Dumrongwongsiri
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Vitamin D Deficiency
Published in: BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-02849-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2021

A Chinese patient with developmental and epileptic encephalopathies (DEE) carrying a TRPM3 gene mutation: a paediatric case report

Urate-lowering therapy for gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

Walking onset: a poor predictor for motor and cognitive skills in healthy preschool children

Parents’ experiences of caring for a young child with type 1 diabetes: a systematic review and synthesis of qualitative evidence

Acute development of syringomyelia following TBM in a pediatric case

Concentrations of oligosaccharides in human milk and child growth