Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Vitamin D Status of Breastfed Filipino Infants Aged Less Than 6 Months in an Urban Community

  • Parian-de los Angeles, Emaluz (Section of Pediatric Gastroenterology, Hepatology and Nutrition, Philippine Children's Medical Center) ;
  • Retoriano, Katherine (Section of Pediatric Gastroenterology, Hepatology and Nutrition, Philippine Children's Medical Center) ;
  • Arnaldo, Hazel (Section of Pediatric Gastroenterology, Hepatology and Nutrition, Philippine Children's Medical Center) ;
  • Ronquillo-Nolasco, Maria Estela (Section of Pediatric Gastroenterology, Hepatology and Nutrition, Philippine Children's Medical Center) ;
  • Urtula, Randy (Section of Pediatric Gastroenterology, Hepatology and Nutrition, Philippine Children's Medical Center)
  • Received : 2020.12.08
  • Accepted : 2021.04.06
  • Published : 2021.07.15
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Abstract

Purpose: This study aimed to determine the serum 25-hydroxy-vitamin D (25(OH)D) status of breastfed infants less than six months old and their mothers, and factors affecting the status. Methods: This cross-sectional study was done on breastfed, term, Filipino infants less than six months old who were seen at local health centers and clinics in an urban area. The serum 25(OH)D levels of these infants and their mothers were determined, and their demographic data, nutritional status, sun exposure behavior, and maternal vitamin D intake were analyzed for correlation using regression models. Results: Among the 131 infants, 101 (77%) had vitamin D deficiency (VDD), which was defined as having 25(OH)D levels <37.5 nmol/L, and 13 (10%) had vitamin D insufficiency (VDI), with levels >37.5-50 nmol/L. Conversely, maternal VDD with levels <50 nmol/L was seen in 31 (24%) mothers and maternal VDI with levels 50-75 nmol/L, in 63 (48%) mothers. Infant age and maternal 25(OH)D status were independent predictors of infant VDD. Infants less than three months old were found to have a six-time increased risk of infant VDD (p=0.004). Infants who had mothers with VDD had a six-time increased risk, whereas those with maternal VDI had a four-time increased risk of infant VDD (p=0.049 and p=0.020, respectively). Conclusion: Both infant and maternal VDD and VDI were seen to be highly prevalent in this tropical, urban community. Young infants and maternal VDD/VDI independently increased the risk of infant VDD, whereas lack of sun exposure of the mothers increased the risk for maternal VDI.

Keywords

Acknowledgement

This study was supported by United Laboratories, Inc. and Philippine Pediatric Society, Inc.

References

  1. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008;87:1080S-6S. https://doi.org/10.1093/ajcn/87.4.1080S
  2. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81. https://doi.org/10.1056/NEJMra070553
  3. 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;122:1142-52. https://doi.org/10.1542/peds.2008-1862
  4. Aranow C. Vitamin D and the immune system. J Investig Med 2011;59:881-6. https://doi.org/10.2310/JIM.0b013e31821b8755
  5. 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
  6. Rubin R. Sorting out whether vitamin D deficiency raises COVID-19 risk. JAMA 2021;325:329-30. https://doi.org/10.1001/jama.2020.24127
  7. Dawodu A, Davidson B, Woo JG, Peng YM, Ruiz-Palacios GM, de Lourdes Guerrero M, 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;7:1081-93. https://doi.org/10.3390/nu7021081
  8. Leerbeck E, Sondergaard H. The total content of vitamin D in human milk and cow's milk. Br J Nutr 1980;44:7-12. https://doi.org/10.1079/BJN19800004
  9. Food and Nutrition Research Institute, Department of Science and Technology. Philippine dietary reference intakes 2015: summary of recommendations. Taguig: FNRI, 2017.
  10. Wang LL, Wang HY, Wen HK, Tao HQ, Zhao XW. Vitamin D status among infants, children, and adolescents in southeastern China. J Zhejiang Univ Sci B 2016;17:545-52. https://doi.org/10.1631/jzus.B1500285
  11. Vitamin D supplementation: recommendations for Canadian mothers and infants. Paediatr Child Health 2007;12:583-98. https://doi.org/10.1093/pch/12.7.583
  12. Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, et al.; ESPGHAN Committee on Nutrition. Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013;56:692-701. https://doi.org/10.1097/MPG.0b013e31828f3c05
  13. Food and Nutrition Research Institute, Department of Science and Technology (FNRI-DOST). Philippine nutrition facts and figures 2013: 8th national nutrition survey overview. Taguig: FNRI-DOST, 2015.
  14. Arnaldo HV, Urtula RP, Nolasco MER. Association of vitamin D levels with physical and sociocultural factors among selected Filipino high school students in Quezon City. Int J Gastroenterol Hepatol Transpl Nutr 2016;1:8-15.
  15. Philippine Pediatric Society (PPS) Committee on Nutrition, the Philippine Society for Pediatric Gastroenterology Hepatology and Nutrition (PSPGHAN). First 1000 days: a position paper by the Philippine Pediatric Society, Inc. Quezon City: Philippine Pediatric Society (PPS) Committee on Nutrition, the Philippine Society for Pediatric Gastroenterology Hepatology and Nutrition (PSPGHAN), 2017.
  16. Pharande P, Pammi M, Collins CT, Zhou SJ, Abrams SA. Vitamin D supplementation for prevention of vitamin D deficiency in preterm and low birth weight infants. Cochrane Database Syst Rev 2015;2:CD011529.
  17. Choi YJ, Kim MK, Jeong SJ. Vitamin D deficiency in infants aged 1 to 6 months. Korean J Pediatr 2013;56:205-10. https://doi.org/10.3345/kjp.2013.56.5.205
  18. Pershing LK, Tirumala VP, Nelson JL, Corlett JL, Lin AG, Meyer LJ, et al. Reflectance spectrophotometer: the dermatologists' sphygmomanometer for skin phototyping? J Invest Dermatol 2008;128:1633-40. https://doi.org/10.1038/sj.jid.5701238
  19. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988;124:869-71. https://doi.org/10.1001/archderm.1988.01670060015008
  20. Cobb J, Sullivan S, Rosen CJ, Holick MF, Chen T, Kimlin M, et al. Validation of a sun-exposure questionnaire for adolescent girls. Paper presented at: 6th International Arnold Rikli Symposium on the Biologic Effects of Light; 2001 Jun 16-18; Boston, USA. p. 145-8.
  21. Dawodu A, Zalla L, Woo JG, Herbers PM, Davidson BS, Heubi JE, et al. Heightened attention to supplementation is needed to improve the vitamin D status of breastfeeding mothers and infants when sunshine exposure is restricted. Matern Child Nutr 2014;10:383-97. https://doi.org/10.1111/j.1740-8709.2012.00422.x
  22. Barger-Lux MJ, Heaney RP. Effects of above average summer sun exposure on serum 25-hydroxyvitamin D and calcium absorption. J Clin Endocrinol Metab 2002;87:4952-6. https://doi.org/10.1210/jc.2002-020636
  23. Hutchinson K, Healy M, Crowley V, Louw M, Rochev Y. Verification of Abbott 25-OH-vitamin D assay on the architect system. Pract Lab Med 2017;7:27-35. https://doi.org/10.1016/j.plabm.2017.01.001
  24. Yang D, Hwang H. Comparison of three commercially available assays for measurement of vitamin D. Lab Med Online 2017;7:120-7. https://doi.org/10.3343/lmo.2017.7.3.120
  25. Bogar AM, Tangkilisan HA, Lestari H. Comparison of 25-hydroxyvitamin D levels in exclusively and non-exclusively breastfed infants. Paediatr Indones 2012;52:157-60. https://doi.org/10.14238/pi52.3.2012.157-60
  26. Salameh K, Al-Janahi NS, 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 Womens Health 2016;8:529-35. https://doi.org/10.2147/IJWH.S107707
  27. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am 2013;60:49-74. https://doi.org/10.1016/j.pcl.2012.10.002
  28. Hollis BW. Individual quantitation of vitamin D2, vitamin D3, 25-hydroxyvitamin D2, and 25-hydroxyvitamin D3 in human milk. Anal Biochem 1983;131:211-9. https://doi.org/10.1016/0003-2697(83)90157-4
  29. Hoogenboezem T, Degenhart HJ, de Muinck Keizer-Schrama SM, Bouillon R, Grose WF, Hackeng WH, et al. Vitamin D metabolism in breast-fed infants and their mothers. Pediatr Res 1989;25:623-8. https://doi.org/10.1203/00006450-198906000-00014
  30. Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr 2004;79:717-26.
  31. Gellert S, Strohle A, Hahn A. Breastfeeding woman are at higher risk of vitamin D deficiency than non-breastfeeding women - insights from the German VitaMinFemin study. Int Breastfeed J 2017;12:19. https://doi.org/10.1186/s13006-017-0105-1