Vitamin D is essential for regulating calcium and phosphate metabolism in the body, and global studies have shown that the prevalence of vitamin D deficiency in children from African, Asian, Turkish and Moroccan backgrounds is , has been shown to be higher compared to Western ethnic groups. Factors that affect vitamin D levels include geographic location, season, skin pigmentation, and diet.
Previous studies in Hong Kong have found significant rates of vitamin D deficiency and deficiency among infants and pregnant women. Recommendations recommend that healthy infants receive 400 IU of vitamin D per day, with higher doses recommended for infants with deficiencies. Furthermore, despite efforts to promote breastfeeding, breast milk alone does not provide enough vitamin D, especially in areas like Hong Kong.
Results less than D-lightful
In 2019, the Hong Kong Department of Health commissioned a study to assess vitamin D status in infants, young children, and pregnant women. The study, conducted by the Department of Pediatrics and Adolescent Medicine at the University of Hong Kong, revealed the prevalence of persistent vitamin D deficiency in healthy infants, especially those who are exclusively breastfed. We also aimed to assess the natural history of vitamin D deficiency in infants and identify associated factors contributing to its persistence.
Researchers followed 131 subjects (66% of whom were boys) at six major maternal and child health centers (MCHCs) and seven hospitals in Hong Kong from January 1, 2019 to December 31, 2021. The first serum 25(OH)D test was performed. Performed at median age of 87.5 days. None of the infants received high-dose vitamin D supplements, but some infants received the recommended 400 IU of vitamin D daily.
This study used the gold standard method of liquid chromatography-tandem mass spectrometry to identify vitamin D deficiency at 25(OH)D (25-hydroxyvitamin D) concentrations below 25 nmol/L and deficiency at 25-49.9 nmol. /L is defined. Infants and young children with vitamin D deficiency were advised to take commercial vitamin D supplements, and infants and young children with vitamin D deficiency were referred for further management and evaluation by a pediatric endocrinologist.
At reassessment at a median age of 252.5 days, 15 infants continued to show persistent vitamin D deficiency, and 26 fell into the vitamin D insufficiency range. Of note, none of the participants showed clinical signs of rickets, a condition associated with severe vitamin D deficiency.
However, one girl was found to have biochemical rickets. She was exclusively breastfed and her vitamin D was not supplemented. Her serum 25(OH)D level was very low and she exhibited symptoms such as hypophosphatemia, hyperphosphatasia, and secondary hyperparathyroidism. However, her condition improved significantly with high-dose vitamin D treatment.
Further analysis revealed that 27% of exclusively breastfed children had persistent vitamin D deficiency. The researchers therefore identified exclusive breastfeeding and inadequate neonatal vitamin D supplementation as significant risk factors for vitamin D deficiency, with adjusted odds ratios of 22.4 and 4.2, respectively.
Recommendations, supplements, and conclusions
The study’s policy recommendations advocate universal vitamin D supplementation for infants in Hong Kong. Key points supporting this recommendation include the prevalence of vitamin D deficiency in exclusively breastfed infants, the benefits of the recommended 400 IU daily intake, and the need for accurate assessment of serum 25(OH)D This includes the need for measurement.
Other supporting factors include the risk of vitamin D deficiency due to limited exposure to sunlight and the significant impact of maternal vitamin D status on fetal health. However, infants with vitamin D deficiency require significantly higher doses of 2000-3000 IU per day to address the deficiency.
The researchers concluded that “persistent vitamin D deficiency is common in infants who are exclusively breastfed, and infants who do not receive vitamin D supplements should use serum 25(OH)D to guide subsequent management. “Concentration measurements should be considered.”
“On the other hand, vitamin D deficiency is common among infants in Hong Kong. To prevent vitamin D deficiency, a policy for universal vitamin D supplementation for breastfed infants from immediately after birth should be implemented.”
sauce: National Center for Biotechnology Information
“Natural history of infants with vitamin D deficiency in Hong Kong”
https://doi.org/10.6133/apjcn.202312_32(4).0004
Author: Joanna Yuet-Ling Tung, other.
