Skip to main content

Advertisement

SpringerLink
Log in

Sunlight Exposure vs Oral Vitamin D Supplementation for Prevention of Vitamin D Deficiency in Infancy: A Randomized Controlled Trial

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To compare the efficacy of sunlight exposure and oral vitamin D3 supplementation to achieve vitamin D sufficiency in infants at 6 months of age.

Design

Open-label randomized controlled trial.

Setting

Public hospital in Northern India (28.7°N).

Participant

Breastfed infants at 6–8 weeks of age.

Intervention

Randomized to receive sunlight exposure (40% body surface area for a minimum of 30 minutes/week) or oral vitamin D3 supplementation (400 IU/day) till 6 months of age.

Outcome

Primary — proportion of infants having vitamin D sufficiency (>20 ng/mL). Secondary — proportion of infants developing vitamin D deficiency (<12ng/mL) and rickets in both the groups at 6 months of age.

Results

Eighty (40 in each group) infants with mean (SD) age 47.8 (4.5) days were enrolled. The proportion of infants with vitamin D sufficiency increased after intervention in the vitamin D group from 10.8% to 35.1% (P=0.01) but remained the same in sunlight group (13.9%) and was significant on comparison between both groups (P=0.037). The mean (SD) compliance rate was 72.9 (3.4)% and 59.7 (23.6)% in the vitamin D and sunlight group, respectively (P=0.01). The geometric mean (95% CI) serum 25(OH) D levels in the vitamin D and sunlight group were 16.23 (13.58–19.40) and 11.89 (9.93–14.23) ng/mL, respectively; (P=0.02), after adjusting baseline serum 25(OH)D with a geometric mean ratio of 1.36 (1.06–1.76). Two infants in sunlight group developed rickets.

Conclusion

Oral vitamin D3 supplementation is more efficacious than sunlight in achieving vitamin D sufficiency in breastfed infants during the first 6 months of life due to better compliance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ministry of Health and Family Welfare, Government of India. Comprehensive National Nutrition Survey (CNNS) 2016–2018. Accessed March 9, 2020. Available from: https://nhm.gov.in/WriteReadData/1892s/1405796031571201348.pdf

  2. Obbagy JE, English LK, Wong YP, et al. Complementary feeding and bone health: a systematic review. Am J Clin Nutr. 2019; 109: S872–S878.

    Article  Google Scholar 

  3. Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016; 101: 394–415.

    Article  CAS  Google Scholar 

  4. Gupta P, Dabas A, Seth A, et al. Indian Academy of Pediatrics Revised (2021) guidelines on prevention and treatment of vitamin D deficiency and rickets. Indian Pediatr. 2022;59:142–58.

    Article  Google Scholar 

  5. Joh HK, Hwang SS, Cho B, Lim CS, Jung SE. Effect of sun exposure versus oral vitamin D supplementation on serum 25-hydroxyvitamin D concentrations in young adults: A randomized clinical trial. Clin Nutr. 2020;39:727–736.

    Article  CAS  Google Scholar 

  6. Lee YM, Kim SA, Lee DH. Can current recommendations on sun exposure sufficiently increase serum vitamin D level?: one-month randomized clinical trial. J Korean Med Sci. 2020;35:e50.

    Article  CAS  Google Scholar 

  7. Cho SH, Yun JM, Lee JE, Lee H, Joh HK, Cho B. Comparison of two strategies to increase serum vitamin d levels in a real-world setting: Sunlight exposure and oral supplementation. J Nutr Sci Vitaminol (Tokyo). 2021;67: 384–90.

    Article  CAS  Google Scholar 

  8. Wu T, Luo H, Wang R, et al. Effect of vitamin D supplementation and outdoor time on the 25(OH)D level in adolescents. Wei Sheng Yan Jiu. 2017; 46:207–12 [article in Chinese].

    Google Scholar 

  9. Moradi S, Shahdadian H, Rouhani MH. A comparison of the effect of supplementation and sunlight exposure on serum vitamin D and parathyroid hormone: A systematic review and meta-analysis. Critical Rev Food Sci Nutr. 2020; 60: 1881–89.

    Article  CAS  Google Scholar 

  10. Meena P, Dabas A, Shah D, et al. Sunlight exposure and vitamin D status in breastfed infants. Indian Pediatr. 2017;54:105–11.

    Article  Google Scholar 

  11. Specker BL, Ho ML, Oestreich A, et al. Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants. J Pediatr. 1985; 107:372–76.

    Article  CAS  Google Scholar 

  12. World Health Organization. WHO Child growth standards. Accessed August 5, 2019. Available from: https://www.who.int/childgrowth/standards/Technical_report.pdf

  13. AnthroCalapplication. Accessed March 12, 2019. Available from: https://play.google.com/store/apps/details?id=appinventor.ai_aditya_mits13.anthroCalc&hl=en_IN

  14. Sachdeva S. Fitzpatrick skin typing: Applications in dermatology. Indian J Dermatol Venereol Leprol. 2009; 75:93–6.

    Article  Google Scholar 

  15. Hettiaratchy S, Papini R. Initial management of a major burn: II—assessment and resuscitation. BMJ. 2004; 329:1013.

    Article  Google Scholar 

  16. Gallo S, Comeau K, Vanstone C, et al. Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants. JAMA. 2013; 309:1785–92.

    Article  CAS  Google Scholar 

  17. Jager N, Schöpe J, Wagenpfeil S, et al. The impact of UV-dose, body surface area exposed and other factors on cutaneous vitamin D synthesis measured as serum 25(OH)D concentration: Systematic review and meta-analysis. Anticancer Res. 2018; 38:1165–71.

    CAS  Google Scholar 

  18. Said NA, Kamenwa RW, Limbe MS, et al. Prevalence of vitamin D deficiency in exclusively breastfed infants at a tertiary healthcare facility in Nairobi, Kenya. Arch Endocrinol Metab. 2021;64:726–34

    Google Scholar 

  19. Veleva BI, Caljouw MAA, van der Steen JT, et al. The effect of ultraviolet B irradiation compared with oral vitamin D supplementation on the well-being of nursing home residents with dementia: a randomized controlled trial. Int J Environ Res Public Health. 2020;17:1684.

    Article  CAS  Google Scholar 

  20. Datta P, Philipsen PA, Olsen P, et al. Serum 25(OH)D levels after oral vitamin D3 supplementation and UV-B exposure correlate. Photodermatol Photoimmunol Photomed. 2019; 35:344–53.

    Article  CAS  Google Scholar 

  21. Patwardhan VG, Mughal ZM, Padidela, et al. Randomized control trial assessing impact of increased sunlight exposure versus vitamin D supplementation on lipid profile in Indian vitamin D deficient men. Indian J Endocrinol Metab. 2017; 21:393–8.

    Article  CAS  Google Scholar 

  22. Ray R, Dabas A, Shah D, et al. Seasonal variation in serum 25-hydroxy vitamin D and its association with clinical morbidity in healthy infants from Northern India. Indian Pediatr. 2019; 56:1020 1024.

    Article  Google Scholar 

  23. Gedamu H, Tafere Y. Assessment of knowledge, attitude, and practice of sunlight exposure of infants among mothers attending in governmental health facilities in Fartadistrict, South Gondar Zone, North West Ethiopia, 2018. Int J Reprod Med. 2018; 2638190.

  24. Mutlu GY, Kusdal Y, Ozsu E, Cizmecioglu FM, Hatun S. Prevention of vitamin D deficiency in infancy: Daily 400 IU vitamin D is sufficient. Int J Pediatr Endocrinol. 2011; 2011:4.

    Article  Google Scholar 

  25. Dabas A, Bharadwaj M, Shah D, et al. Online survey of vitamin D supplementation practices in children and adolescents. Indian Pediatr. 2020; 57:749–50.

    Article  Google Scholar 

Download references

Funding

Funding: Intramural grant from the University College of Medical Sciences, Delhi

Author information

Authors and Affiliations

  1. Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095, India

    Anisha Goyal, Dheeraj Shah, Pooja Dewan &  Piyush Gupta

  2. Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India

    Aashima Dabas

  3. Delhi Cancer Registry, Dr BRA-InstituteRotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

    Rajeev Kumar Malhotra

  4. Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

    S. V. Madhu

Authors
  1. Anisha Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aashima Dabas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dheeraj Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajeev Kumar Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pooja Dewan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. V. Madhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Piyush Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Contributions: PG, DS: Study conception, data analysis, manuscript review and final editing; AG, AD: Data collection and analysis, manuscript drafting and writing; RKM: Data analysis, manuscript writing and review; PD: Study conception, manuscript drafting; SVM: Laboratory analysis, manuscript review and editing; All authors have read and approve the final contents of the manuscript.

Corresponding author

Correspondence to Piyush Gupta.

Ethics declarations

Ethics approval: Ethics Committee of University College of Medical Sciences; No. HR/2018/36/105, dated Oct 15, 2018.

Competing interests: None stated.

Additional information

Note: Additional material related to this study is available with the online version at https://www.indianpediatrics.net

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goyal, A., Dabas, A., Shah, D. et al. Sunlight Exposure vs Oral Vitamin D Supplementation for Prevention of Vitamin D Deficiency in Infancy: A Randomized Controlled Trial. Indian Pediatr 59, 852–858 (2022). https://doi.org/10.1007/s13312-022-2642-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-022-2642-y

Keywords

Search

Navigation