Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Vitamin D deficiency in infants aged 1 to 6 months

  • Choi, You Jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Kim, Moon Kyu (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Jeong, Su Jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • Received : 2012.08.11
  • Accepted : 2013.01.25
  • Published : 2013.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to recognize the state of vitamin D among healthy infants aged 1 to 6 months in South Korea, and also to identify the risk factors affecting the level of vitamin D. Methods: A total of 117 infants were enrolled in this study for 12 months, from March 1, 2011 to February 29, 2012. Serum levels of 25-hydroxyvitamin D (25[OH]D), calcium, phosphorus, and alkaline phosphatase were measured and data including birth weight, body weight, sex, feeding pattern, delivery mode, siblings and maternal age and occupation were collected. Data was mainly analyzed with independent t-test model. Results: We determined that the prevalence of vitamin D deficiency (serum 25[OH]D<20 ng/mL [50 mmol/L]) was 48.7% in the population investigated. Particularly in breastfed infants, the prevalence of vitamin D deficiency was strikingly high (90.4%). The mean serum level of 25(OH)D in breastfed infants was lower than that of formula fed infants (9.35 ng/mL vs. 28.79 ng/mL). Also female infants showed lower mean serum level of 25(OH)D than male. Mean serum values of calcium and phosphorus had positive correlation with vitamin D state (P<0.001). Conclusion: Vitamin D deficiency was found to be very common in infants aged 1 to 6 months in South Korea, and breast feeding was the most critical risk factor of vitamin D deficiency. Therefore we suggest to start vitamin D supplementation in South Korea, as soon as possible, to all infants, including breastfed and female infants.

Keywords

References

  1. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M; Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008;122:398-417. https://doi.org/10.1542/peds.2007-1894
  2. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81. https://doi.org/10.1056/NEJMra070553
  3. Taylor JA, Richter M, Done S, Feldman KW. The utility of alkaline phosphatase measurement as a screening test for rickets in breastfed infants and toddlers: a study from the puget sound pediatric research network. Clin Pediatr (Phila) 2010;49:1103-10. https://doi.org/10.1177/0009922810376993
  4. Henderson A. Vitamin D and the breastfed infant. J Obstet Gynecol Neonatal Nurs 2005;34:367-72. https://doi.org/10.1177/0884217505276157
  5. Lawrence RA. Lower breastfeeding rates among supplemental nutrition program for women, infants, and children participants: a call for action. Pediatrics 2006;117:1432-3. https://doi.org/10.1542/peds.2005-2466
  6. Wagner CL, Howard C, Hulsey TC, Lawrence RA, Taylor SN, Will H, et al. Circulating 25-hydroxyvitamin D levels in fully breastfed infants on oral vitamin D supplementation. Int J Endocrinol 2010;2010:235035.
  7. Jain V, Gupta N, Kalaivani M, Jain A, Sinha A, Agarwal R. Vitamin D deficiency in healthy breastfed term infants at 3 months & their mothers in India: seasonal variation & determinants. Indian J Med Res 2011;133:267-73.
  8. Ziegler EE, Hollis BW, Nelson SE, Jeter JM. Vitamin D deficiency in breastfed infants in Iowa. Pediatrics 2006;118:603-10. https://doi.org/10.1542/peds.2006-0108
  9. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics 2009;124:e362-70. https://doi.org/10.1542/peds.2009-0051
  10. Foo LH, Zhang Q, Zhu K, Ma G, Hu X, Greenfield H, et al. Low vitamin D status has an adverse influence on bone mass, bone turnover, and muscle strength in Chinese adolescent girls. J Nutr 2009;139:1002-7. https://doi.org/10.3945/jn.108.102053
  11. Ganmaa D, Tserendolgor U, Frazier L, Nakamoto E, Jargalsaikhan N, Rich-Edwards J. Effects of vitamin D fortified milk on vitamin D status in Mongolian school age children. Asia Pac J Clin Nutr 2008;17:68-71.
  12. Yoon JH, Park CS, Seo JY, Choi YS, Ahn YM. Clinical characteristics and prevalence of vitamin D insufficiency in children less than two years of age. Korean J Pediatr 2011;54:298-303. https://doi.org/10.3345/kjp.2011.54.7.298
  13. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea: a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab 2011;96:643-51. https://doi.org/10.1210/jc.2010-2133
  14. Park SY, Park SW, Kang SK, Jun YH, Kim SK, Son BK, et al. Subclinical rickets in breastfed infants. Korean J Pediatr 2007;50:1188-93. https://doi.org/10.3345/kjp.2007.50.12.1188
  15. Bae SN, Rho EJ, Lim JW, Cheon EJ, Ko KO, Lee YH. A case of hypocalcemia due to vitamin D deficiency in exclusively breastfed infant. J Korean Soc Pediatr Endocrinol 2006;11:205-8.
  16. Seo JY, Kim C, Lee HW, Ahn YM. Eight cases of incidentally diagnosed as subclinical rickets. Korean J Pediatr 2008;51:812-9. https://doi.org/10.3345/kjp.2008.51.8.812
  17. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008;87:1080S-1086S.
  18. Hatun S, Ozkan B, Bereket A. Vitamin D deficiency and prevention: Turkish experience. Acta Paediatr 2011;100:1195-9. https://doi.org/10.1111/j.1651-2227.2011.02383.x
  19. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81:353-73. https://doi.org/10.4065/81.3.353
  20. Arya SC, Agarwal N. Seasonal variation & determinants in vitamin D deficiency in healthy breastfed term infants & their mothers in India. Indian J Med Res 2011;134:123.
  21. Balasubramanian S. Vitamin D deficiency in breastfed infants & the need for routine vitamin D supplementation. Indian J Med Res 2011;133:250-2.
  22. Nickkho-Amiry M, Prentice A, Ledi F, Laskey MA, Das G, Berry JL, et al. Maternal vitamin D status and breast milk concentrations of calcium and phosphorus. Arch Dis Child 2008;93:179.
  23. Sullivan SS, Rosen CJ, Halteman WA, Chen TC, Holick MF. Adolescent girls in Maine are at risk for vitamin D insufficiency. J Am Diet Assoc 2005;105:971-4. https://doi.org/10.1016/j.jada.2005.03.002
  24. Pettifor JM. Rickets and vitamin D deficiency in children and adolescents. Endocrinol Metab Clin North Am 2005;34:537-53, vii. https://doi.org/10.1016/j.ecl.2005.04.002
  25. Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med 2009;169:626-32. https://doi.org/10.1001/archinternmed.2008.604
  26. Saintonge S, Bang H, Gerber LM. Implications of a new definition of vitamin D deficiency in a multiracial US adolescent population: the National Health and Nutrition Examination Survey III. Pediatrics 2009;123:797-803. https://doi.org/10.1542/peds.2008-1195
  27. Mutlu GY, Kusdal Y, Ozsu E, Cizmecioglu FM, Hatun S. Prevention of Vitamin D deficiency in infancy: daily 400 IU vitamin D is sufficient. Int J Pediatr Endocrinol 2011;2011:4. https://doi.org/10.1186/1687-9856-2011-4
  28. Zhu Z, Zhan J, Shao J, Chen W, Chen L, Li W, et al. High prevalence of vitamin D deficiency among children aged 1 month to 16 years in Hangzhou, China. BMC Public Health 2012;12:126. https://doi.org/10.1186/1471-2458-12-126
  29. Wright A, Schanler R. The resurgence of breastfeeding at the end of the second millennium. J Nutr 2001;131:421S-425S. https://doi.org/10.1093/jn/131.2.421S
  30. Ryan AS. The resurgence of breastfeeding in the United States. Pediatrics 1997;99:E12.
  31. McDowell MM, Wang CY, Kennedy-Stephenson J. Breastfeeding in the United States: findings from the national health and nutrition examination surveys, 1999-2006. NCHS Data Brief 2008;(5):1-8.
  32. Schubert L, DeLuca HF. Hypophosphatemia is responsible for skeletal muscle weakness of vitamin D deficiency. Arch Biochem Biophys 2010;500:157-61. https://doi.org/10.1016/j.abb.2010.05.029
  33. Turan S, Topcu B, Gokce I, Guran T, Atay Z, Omar A, et al. Serum alkaline phosphatase levels in healthy children and evaluation of alkaline phosphatase z-scores in different types of rickets. J Clin Res Pediatr Endocrinol 2011;3:7-11. https://doi.org/10.4274/jcrpe.v3i1.02
  34. D'Amour P, Rousseau L, Hornyak S, Yang Z, Cantor T. Influence of secondary hyperparathyroidism induced by low dietary calcium, vitamin D deficiency, and renal failure on circulating rat PTH molecular forms. Int J Endocrinol 2011;2011:469783.
  35. Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D, Srinivasarao PV, Sarma KV, et al. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr 2007;85:1062-7.
  36. Schiele F, Henny J, Hitz J, Petitclerc C, Gueguen R, Siest G. Total bone and liver alkaline phosphatases in plasma: biological variations and reference limits. Clin Chem 1983;29:634-41.
  37. Thacher TD, Fischer PR, Pettifor JM. Rickets: vitamin D and calcium deficiency. J Bone Miner Res 2007;22:638. https://doi.org/10.1359/jbmr.070118
  38. Saliba W, Barnett O, Rennert HS, Lavi I, Rennert G. The relationship between serum 25(OH)D and parathyroid hormone levels. Am J Med 2011;124:1165-70. https://doi.org/10.1016/j.amjmed.2011.07.009
  39. Chung W, Kim H, Nam CM. Breast-feeding in South Korea: factors influencing its initiation and duration. Public Health Nutr 2008;11:225-9.
  40. Kim JY, Hwang SJ, Park HK, Lee HB, Kim NS. Analysis of online breast-feeding consultation on the website of the Korean Pediatric Society. Korean J Pediatr 2008;51:1152-7. https://doi.org/10.3345/kjp.2008.51.11.1152
  41. Shin YH, Kim KE, Lee C, Shin HJ, Kang MS, Lee HR, et al. High prevalence of vitamin D insufficiency or deficiency in young adolescents in Korea. Eur J Pediatr 2012;171:1475-80. https://doi.org/10.1007/s00431-012-1746-0
  42. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51:1-25. https://doi.org/10.3345/kjp.2008.51.1.1

Cited by

  1. Comparison of the serum vitamin D level between breastfed and formula-fed infants: several factors which can affect serum vitamin D concentration vol.56, pp.5, 2013, https://doi.org/10.3345/kjp.2013.56.5.202
  2. The Role of Toll‐Like Receptors and Vitamin D in Diabetes Mellitus Type 1 – A Review vol.80, pp.2, 2013, https://doi.org/10.1111/sji.12188
  3. Formula fed twin infants with recurrent hypocalcemic seizures with vitamin D deficient rickets and hyperphosphatemia vol.20, pp.2, 2015, https://doi.org/10.6065/apem.2015.20.2.102
  4. Severe vitamin D deficiency in preterm infants: maternal and neonatal clinical features vol.58, pp.11, 2013, https://doi.org/10.3345/kjp.2015.58.11.427
  5. Total Duration of Breastfeeding, Vitamin D Supplementation, and Serum Levels of 25-Hydroxyvitamin D vol.106, pp.4, 2013, https://doi.org/10.2105/ajph.2015.303021
  6. Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors vol.6, pp.2, 2013, https://doi.org/10.3343/lmo.2016.6.2.70
  7. Maternal Supplementation of Vitamin D During Lactation to Support Infant Vitamin D Needs: A Systematic Review vol.8, pp.3, 2013, https://doi.org/10.4236/ojped.2018.83027
  8. Vitamin D Status in Infants during the First 9 Months of Age and its Effect on Growth and Other Biochemical Markers: A Prospective Cohort Study vol.9, pp.1, 2020, https://doi.org/10.4103/abr.abr_242_19
  9. Correlation of serum levels of Vitamin D 3 with serum parathormone in nursing mothers and infants 1-6 months’ age from South Punjab, Pakistan vol.36, pp.5, 2013, https://doi.org/10.12669/pjms.36.5.2150
  10. An Assessment of Risk Factors for Insufficient Levels of Vitamin D during Early Infancy vol.13, pp.4, 2021, https://doi.org/10.3390/nu13041068
  11. Vitamin D Status and Factors Associated with Vitamin D Deficiency during the First Year of Life in Preterm Infants vol.13, pp.6, 2013, https://doi.org/10.3390/nu13062019
  12. Vitamin D Status of Breastfed Filipino Infants Aged Less Than 6 Months in an Urban Community vol.24, pp.4, 2013, https://doi.org/10.5223/pghn.2021.24.4.403
  13. Prevalence of Vitamin D Deficiency in Exclusively Breast Fed Infants in Suburban Area Lucknow, Uttar Pradesh vol.10, pp.44, 2013, https://doi.org/10.14260/jemds/2021/755