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ARS Home » Southeast Area » Little Rock, Arkansas » Arkansas Children's Nutrition Center » Research » Publications at this Location » Publication #195463
Title: BREAST FED INFANTS CONSUME INADEQUATE AMOUNTS OF VITAMIN D EVEN AFTER INTRODUCTION OF TABLE FOODS

Author
item WRAY, AMANDA - ACNC
item Gilchrist, Janet
item SMITH, STACEE - ACNC
item BADGER, THOMAS - ACNC/UAMS

Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 3/17/2006
Publication Date: 4/6/2006
Citation: Wray, A., Gilchrist, J.M., Smith, S., Badger, T.M. 2006. Breast fed infants consume inadequate amounts of Vitamin D even after introduction of table foods [abstract]. In: Proceedings of Arkansas Dietetic Association Annual Meeting, April 6-7, 2006, Little Rock, Arkansas.

Interpretive Summary: Doctors are reporting more cases of rickets among infants, even in the U.S. Rickets is caused by Vitamin D deficiency. Poor Vitamin D intake does not always have symptoms. If not treated, poor Vitamin D intake can lead to chronic diseases, such as bone disease, heart disease, diabetes, and some cancers. Breast-fed (BF) infants are at risk for poor Vitamin D intake, since human breast milk is a poor source of Vitamin D. In the past, mothers took their infants out into the sun to make Vitamin D. Concerns about skin cancer have reduced this practice. The use of sunscreen is thought to block skin production of Vitamin D. In light of this, the American Academy of Pediatrics (AAP) advises a daily Vitamin D supplement for all BF infants. We looked at dietary data from 9- and 12-month-old BF infants in our Beginnings study to assess Vitamin D intake. The Dietary Reference Intakes suggest an Adequate Intake of Vitamin D for infants is 200 - 400 IU/day. Most of our BF infants had intakes of less than 200 IU/day. Few of our BF infants received a Vitamin D supplement. If these infants also did not receive sunlight to make Vitamin D, they may be at risk for rickets or long-term health problems. Healthy People 2010 set a goal of having at least 75% of all infants in the U.S. breastfed throughout the first year of life. As more women chose to breastfeed their infants, the number of infants at risk for poor Vitamin D status also increases. This has major public health implications.

Technical Abstract: Recent research suggests that Vitamin D (VitD) deficiency disease, rickets, is making a comeback among infants in the United States (US). In the absence of deficiency symptoms, VitD inadequacy can be easily over looked. If left untreated, long term VitD inadequacy may also contribute to chronic diseases such as osteomalacia, osteoporosis, type I diabetes mellitus, heart disease, and certain types of cancer. All infant formulas in the US are fortified with 400 IU/L VitD, ensuring that most formula-fed infants consume adequate VitD. However, breast milk is not a good source of VitD, with an estimated VitD content of only 123 IU/L (USDA SR 17). In past generations, many infants met their VitD requirements from sunlight exposure or cod liver oil supplements. Today, these practices have fallen out of favor. Due to the risk of skin cancer, the American Academy of Pediatrics (AAP) recommends no extended sun exposure for the first 6 months of life and encourages the use of sunscreen for older infants, which may block the ultraviolet-B rays needed to synthesize VitD. Therefore, the AAP recommends that all breast-fed (BF) infants receive a daily VitD supplement. As part of the Beginnings study, we are following a cohort of healthy BF infants. Infants are exclusively BF for 4 to 6 months, at which time parents may begin to introduce complementary foods. Most BF infants transition to table foods between 9 and 12 months. Parents provided 3-day written food records at 9 and 12 months, which were input and analyzed using NDS-R software (version 2005). Group average VitD intake was less than the AI (200 - 400 IU) at both 9 (118 IU) and 12 months (175 IU). Two-thirds of BF infants in our sample were consuming <200 IU day (32/44 at 9 months and 25/39 at 12 months), which may put them at risk for decreased VitD status. One of the Healthy People 2010 goals is to increase the number of BF infants to 75% of all infants. This will increase the pool of infants at risk for VitD inadequacy. Dietetic professionals need to be aware that the majority of healthy BF infants may not consume adequate VitD throughout the first year of life, even after the introduction of table foods. R.D.s should be familiar with the AAP recommendations for infant VitD supplementation and should encourage mothers of BF infants to provide a VitD supplement.