Bone mineral content is not reduced despite low vitamin D status in breast milk-fed infants versus cow's milk based formula-fed infants

doi:10.1016/S0022-3476(98)70353-1

The Journal of Pediatrics

Volume 132, Issue 4, April 1998, Pages 641-645

Presented in part at the Annual Meeting of the Society for Pediatric Research, Seattle, Wash., May 2-5, 1994.

https://doi.org/10.1016/S0022-3476(98)70353-1 Get rights and content

Abstract

The effect of low or borderline vitamin D status on bone mineralization of exclusively breast milk-fed infants has not been studied. The low vitamin D status of Korean breast milk-fed infants may theoretically have adverse effects on bone mineralization. Assuming that bone mineral content (BMC) relates in part to vitamin D status, we hypothesized that serum 25-hydroxyvitamin D (25-OHD) concentration and BMC would be low, and serum osteocalcin concentration high, reflecting active bone turnover, in breast milk- versus formula-fed infants born in the winter. Eighteen breast milk- and 17 formula-fed infants were recruited at ages 2 to 5 months. The BMC of the lumbar_1-4 spine region was measured by using dual energy x-ray absorptiometry. The BMC and serum osteocalcin levels were similar for both groups. The serum 25-OHD level was significantly lower in breast milk- than formula-fed infants; 44% of the breast milk group versus 6% of the formula group had serum 25-OHD levels less than 28 nmol/L (11 ng/ml), the lower limit of normal. The BMC did not correlate with the serum 25-OHD level. Thus BMC and serum osteocalcin levels in 2- to 5-month-old infants were not different by type of feeding, despite low vitamin D status in breast milk-fed infants. We speculate that adequate mineral absorption occurs during this period from a predominantly (vitamin D independent) passive transport mechanism. (J Pediatr 1998;132:641-5.)

Section snippets

Subjects

Thirty-five healthy infants were enrolled from the well baby clinic of the Yonsei University Medical Center, Seoul, Korea, during March and April 1993. All infants were term (37 to 41 weeks' gestation) and had appropriate weight for gestational age according to a standard intrauterine growth chart for Korean newborns.⁸ Eighteen infants were fed exclusively breast milk and 17 infants were fed cow's milk based formula. No differences were observed between groups in mean birth weight, body weight,

RESULTS

The BMC was similar between breast milk-fed and cow's milk based formula-fed infants (0.62 ± 0.2 versus 0.65 ± 0.2 gm/cm). The BMC correlated with body weight (r = 0.817, p = 0.001, n = 28) (Figure) and body length (r = 0.511, p = 0.005, n = 28). The relationship between BMC and body weight was not different between breast milk- and formula-fed infants (Figure).

. Relationship between BMC and body weight. BMC = 0.098[body weight] - 0.055 (r = 0.817, p = 0,001, n = 28). BMC was similar between

DISCUSSION

In the current study, we found significantly lower serum 25-OHD concentrations but similar BMC in breast milk-fed versus cow's milk based formula-fed infants. In theory, the low vitamin D status of breast milk-fed infants may have adverse effects on bone mineralization. However, this effect was not demonstrated.

In Korea, pregnant mothers usually do not take supplemental vitamin D during pregnancy. Most Korean infants, especially winter-born infants, appear to have “suboptimal” stores of vitamin

Acknowledgements

We thank Rosa I. Sierra and Kay Ellis for performing serum biochemical measurements, and Ms. Sohn for BMC measurements.

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Tanto el calcio como la vitamina D son nutrientes esenciales y con una función determinante en la salud ósea. En los últimos años hemos asistido a una animada controversia sobre los aportes necesarios para asegurar un adecuado estado de salud, dando lugar a numerosas publicaciones y posicionamientos dentro de la comunidad pediátrica. Para la vitamina D, en poco tiempo hemos visto como se ha pasado de la indicación de 400 U diarias, a 200 U y de nuevo a las 400 U, con algunos pronunciamientos que han tenido en cuenta no sólo su influencia sobre el tejido esquelético, sino también sobre el desarrollo de enfermedades crónicas, lo que ha generado nuevas expectativas. Este comentario quiere proporcionar a los pediatras una actualización sobre este tema y proponer unas recomendaciones para la ingesta de ambos nutrientes a la vista de las informaciones más recientes. Para la vitamina D este comité propone el aporte de 400 U/día en el niño menor de 1 año y de 600 U/día a partir de esa edad.
Both calcium and vitamin D are essential nutrients with a crucial role in bone health, although in recent years there has been much controversy about the contributions required from both molecules to ensure adequate health. For vitamin D, in a short time, we have seen how it has gone from a recommendation of 400 IU daily, to 200 IU and again to 400 IU, with some statements that not only its influence on skeletal tissue has been taken into account, but also on the development of chronic diseases, which has led to new expectations. Our goal is to provide an update to paediatricians on this issue and propose recommendations for intake in the light of the latest information. For vitamin D the Committee proposes an intake of 400 IU/day in children under 1 year and 600 IU/day after that age.
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We did not collect information on prenatal supplement use over the course of pregnancy which would have been informative with respect to supplemental vitamin D intake. In addition, while neonatal vitamin D status was not assessed in this cohort, maternal vitamin D status has been shown to have adverse consequences on both vitamin D status of the newborn and fetal bone mineralization.55–58 The fetus is dependent on maternal vitamin D status for neonatal endowment of this nutrient; it is therefore essential to insure optimal maternal vitamin D status across pregnancy.
Recent attention has focused on vitamin D insufficiency but few data exist on vitamin D status among pregnant minority youth.
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Urban prenatal clinic.
Eighty pregnant African American adolescents (≤ 18 y of age).
Vitamin D status, STDs, hemoglobin, season, birth weight
Serum 25(OH)D in this group averaged 21.6 ± 8 ng/mL (age 16.5 ± 1.1 y, n = 80), and did not significantly differ between the second (20.95 ± 8.2 ng/mL, n = 44) and third trimester cohorts (22.5 ± 7.9 ng/mL, n = 36). Vitamin D insufficiency (< 20 ng/mL) was evident in 46.25% and vitamin D deficiency (<15 ng/mL) was evident in 21.25% of those studied. Significant predictors of suboptimal vitamin D status included sampling during the winter months (P = 0.004), lower hemoglobin concentration (P = 0.019), and higher second trimester leptin levels (P = 0.018). Inverse associations between 25(OH)D and bacterial vaginosis were evident when controlled for season of sampling (P = 0.02, n = 80).
Vitamin D insufficiency was prevalent among urban pregnant minority adolescents. Further studies are needed to address the impact of this finding on maternal and neonatal calcium homeostasis and bone health.
25-Hydroxyvitamin D levels in infants. Relation with breast-feeding
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Determinar la prevalencia de la deficiencia subclínica de vitamina D en lactantes del área de Valencia, España (latitud 39,5° N) y su relación con la lactancia materna.
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To determine the prevalence of subclinical vitamin D deficiency among infants in Valencia, Spain (latitude 39.5 degrees N) and its relation with breast- feeding.
Serum levels of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25-OHD) and intact parathyroid hormone (PTH) were measured in 60 term infants aged between 1 and 6 months (mean age: 3.9 months), with no known bone, gastrointestinal or renal disease (33 exclusively breast-fed, 27 bottle-fed). Data on vitamin D supplementation and weekly direct sunlight exposure were also gathered.
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Growth in exclusively breastfed infants
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^☆: From the Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea; and Children's Center for Bone Research and Health, Perinatal Research Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

^☆☆: Reprint requests: Mi Jung Park, MD, Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital, 761-1 Sanggye-dong, Nowon-ku, Seoul, Korea, 139-207.

^★: 9/21/85383

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Bone mineral content is not reduced despite low vitamin D status in breast milk-fed infants versus cow's milk based formula-fed infants☆,☆☆,★

Abstract

Section snippets

Subjects

RESULTS

DISCUSSION

Acknowledgements

J Pediatr

J Pediatr

J Pediatr

J Pediatr

Vitam Horm

J Pediatr

J Pediatr

J Pediatr

J Nutr

J Pediatr

Am J Clin Nutr

J Pediatr

Calcium, vitamin D and parathyroid hormone relationship in pregnant Caucasian and Asian women and their neonates

Ann Clin Biochem

Low serum osteocalcin and 1,25-dihydroxyvitamin D, and high serum parathyroid hormone concentrations in winter versus summer in Korean pregnant women: evidence of decreased bone formation in winter [abstract]

J Bone Miner Res

A study on intrauterine growth standard

J Korean Pediatr Soc