Breastfed without vitamin D supplements – a problem for NZ infants Jan 2013

Vitamin D status of exclusively breastfed infants aged 2-3 months.

Arch Dis Child. 2013 Jan 8.
Wall CR, Grant CC, Jones I.
Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, , Auckland, New Zealand.

BACKGROUND: New Zealand in 2008 adopted WHO policy which recommends that all infants are exclusively breast fed until 6 months of age. The benefits of this policy for the infant are undisputed; however, this policy has the potential to adversely impact on infant vitamin D status. A number of countries now recommend that all breastfed infants receive daily vitamin D supplementation of 400 IU to prevent rickets. New Zealand has no policy on the vitamin D supplementation of 'low-risk' breastfed infants. There are no data on the vitamin D status of exclusively breastfed infants in the first few months of life in New Zealand.

AIM:To describe serum 25-hydroxy-vitamin D (25(OH)D) concentrations in exclusively breastfed infants aged 2-3 months.

DESIGN/METHODS: Healthy term exclusively breastfed infants who were receiving no vitamin D supplements were enrolled over a 15-month period. A capillary blood sample was obtained from each infant. Serum 25(OH)D was measured using isotope-dilution liquid chromatography-tandem mass spectrometry.

RESULTS: 94 infants were enrolled (mean age 10 weeks). Median 25(OH)D concentration was 53 nmol/l (IQR 14-100 nmol/l). 23 (24%) infants had serum 25(OH)D concentration <27.5 nmol/l. Infants enrolled during winter had a median (IQR) 25(OH)D serum concentration of 21 nmol/l (14,31). Infants enrolled during summer had a median (IQR) 25(OH)D concentration of 75 nmol/l (55 100) (winter vs summer, p<0.0001).

CONCLUSIONS: Vitamin D deficiency is prevalent in exclusively breastfed infants in New Zealand. Vitamin D supplementation should be considered as part of New Zealand's child health policy.

PMID: 23303428

Comment by VitaminDWiki

Mean vitamin D level of breast fed NZ infants = 8.4 ng during winter
New Zealand made a big mistake.

• Took recommendation for breast feeding
• Did not take recommendation for vitamin D supplementation of infants or mothers - especially while avoiding the sun.

Wonder how many other countries have made the same mistake.

See also VitaminDWiki

• All items in category Australia and Vitamin D 68 items
• 400 IU vitamin D for breastfed - American Association of Pediatrics - Feb 2012
• Breastfed infants in Germany with 250 IU of vitamin D got to 56ng – Sept 2010
• 6400 IU vitamin D is effective during breastfeeding – Oct 2010
• 6000 IU may be needed to get vitamin D in breast milk – systematic review March 2013
• 16% of exclusively breastfed infants so low on vitamin D that they had rickets – June 2010
• Only about 10 percent of breastfed infants get even the minimum recommended vitamin D – April 2010
• All items in Infant-Child 823 items
• Reminder – 400 IU is enough only when infant already had a good level of vitamin D – Nov 2012
• Many infant infections avoided with supplementation with 400 IU of vitamin D – Oct 2012
• Death of Babies in UK due to vitamin D deficiency – Jan 2012
• Unsupplemented infants were 19X more likely to be vitamin D deficient - May 2012
• Sunlight for babies – US Govt 1933
• Infants receiving 1600 IU of vitamin D were safe and healthy – Aug 2012
• Bone health markers generally not improved by 550 IU of vitamin D after birth – July 2012
  probably needed cofactors such as Calcium, Magnesium, Boron, etc.
• 100 IU per kg of infant July 2011, Poland etc. has the following graph