European Journal of Pediatrics

, Volume 164, Issue 12, pp 724–729 | Cite as

Breastfeeding and vitamin D status in Greece during the first 6 months of life

  • Anna Challa
  • Agathi Ntourntoufi
  • Vasilios Cholevas
  • Maria Bitsori
  • Emmanuel Galanakis
  • Styliani Andronikou
Original Paper

Abstract

Since no foods are vitamin D supplemented in Greece, vitamin D status was assessed in mothers at birth and their infants up to the first 6 months of life, while they were exclusively breast-fed. This was a prospective study. Full-terms ( n =35) born during the summer-autumn months and their mothers were assigned to the summer group and the remainder ( n =31) to the winter group. One week after birth, serum 25-hydroxyvitamin D (25OHD) was significantly lower in the winter-born than in the summer-born neonates (6.7±0.7 vs. 10.1±0.9 ng/ml, P <0.01). The respective levels of parathyroid hormone (iPTH) were 64.9±13.4 and 33.9±4.4 pg/ml ( P <0.01). The mothers had serum 25OHD levels of 10.8±1.0 ng/ml and iPTH levels of 15.2±3.5 pg/ml in the winter and 12.9±1.3 ng/ml and 24.8±4.8 pg/ml in the summer. During the 6-month follow-up, a steady increase in circulating 25OHD (up to 19.4±2.8 ng/ml, P <0.0001) and a decrease in iPTH (to 26.8±3.5 pg/ml, P =0.10) were observed in the infants born in the winter. In the summer-born infants, serum 25OHD did not change but iPTH had increased significantly by the 3rd month (59.4±21.8, P <0.05). Serum calcium (Ca) increased within normal limits during the study period in both groups. Serum phosphorus (Pi) started higher in the winter group (7.43±0.38 vs. 6.27±0.23 mg/dl, P <0.01) but thereafter, it was similar in both groups. Total alkaline phosphatase (ALP) increased in both groups during the study (164±15 vs. 219±17 IU/l, P <0.05 and 189±14 vs. 288±35 IU/l, P <0.001, respectively). Serum osteocalcin (OC) decreased in the winter-born neonates (32.0±3.4 vs. 21.5±3.4 ng/ml, P <0.05) and did not change in the summer group (28.9±3.5 vs. 26.5±2.8 ng/ml). Conclusion:Neonates who are breast-fed exclusively during the first 6 months of life are in need of vitamin D supplementation irrespective of the season even in a sunny country like Greece where foods are not supplemented.

Keywords

Breastfeeding Full-term infants Vitamin D 

Abbreviations

ALP

total alkaline phosphatase

Ca

calcium

CHL

crown-heel length

25OHD

25-hydroxyvitamin D

iPTH

intact parathyroid hormone

OC

osteocalcin

Pi

inorganic phosphorus

References

  1. 1.
    Baroncelli GI, Berteloni S, Ceccarelli C, Amato V, Saggese G (2000) Bone turnover in children with vitamin D deficiency rickets before and during treatment. Acta Paediatr 89: 513–518CrossRefPubMedGoogle Scholar
  2. 2.
    Brooke OG, Brown IR, Bone CD, Carter ND, Cleeve HJ, Maxwell JD, Robinson VP, Winder SM (1980) Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. BMJ 280: 751–754PubMedGoogle Scholar
  3. 3.
    Brooke OG, Butters F, Wood C (1981) Intrauterine vitamin D nutrition and postnatal growth in Asian infants. BMJ 283: 1024PubMedGoogle Scholar
  4. 4.
    Canadian Pediatric Society. Nutrition for healthy term infants: statement of the joint working group. Available at:http://www.caringforkids.cps.ca/babies/Vitamin D.htm
  5. 5.
    Cantorna MT (2000) Vitamin D and autoimmunity: is vitamin D status an environmental factor affecting autoimmune disease prevalence? Proc Soc Exp Biol Med 223: 230–233CrossRefPubMedGoogle Scholar
  6. 6.
    Challa A, Bevington A, Anger C, Asbury A, Preston C, Russell R (1985) A technique for the measurement of orthophosphate in human erythrocytes, and some studies of its determinants. Clin Sci 285: 763–768Google Scholar
  7. 7.
    Dawodu A, Agarwal M, Hossain M, Kochiyil J, Zayed R (2003) Hypovitaminosis D and vitamin D deficiency in exclusively breast-fed infants and their mothers in summer: a justification for vitamin D supplementation of breast-feeding infants. J Pediatr 142: 169–173CrossRefPubMedGoogle Scholar
  8. 8.
    Delvin EE, Salle BL, Glorieux FH, Adeleine P, David LS (1986) Vitamin D supplementation during pregnancy: effect on neonatal calcium homeostasis. J Pediatr 109: 328–334PubMedGoogle Scholar
  9. 9.
    Dewey KG (2001) Nutrition, growth and complementary feeding of the breastfed infant. Pediatr Clin North Am 48: 87–104CrossRefPubMedGoogle Scholar
  10. 10.
    Gartner LM, Greer FR (2003) American Academy of Pediatrics Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 111: 908–910CrossRefPubMedGoogle Scholar
  11. 11.
    Gertner JM, Glassman MS, Coustan DR, Goodman DB (1980) Fetomaternal vitamin D relationship at term. J Pediatr 97: 637–640PubMedGoogle Scholar
  12. 12.
    Gessner BD, Plotnik J, Muth PT (2003) 25-hydroxyvitamin D levels among healthy children in Alaska. J Pediatr 143: 434–437CrossRefPubMedGoogle Scholar
  13. 13.
    Greer FR (2001) Do breastfed infants need supplemental vitamins? Pediatr Clin North Am 48: 415–423PubMedGoogle Scholar
  14. 14.
    Greer FR (2003). Vitamin D deficiency—it’s more than rickets. J Pediatr 143: 422–423CrossRefPubMedGoogle Scholar
  15. 15.
    Greer FR, Marshall S (1989) Bone mineral content, serum vitamin D metabolite concentrations and ultraviolet B light exposure in infants fed human milk with and without vitamin D2 supplements. J Pediatr 114: 204–212PubMedGoogle Scholar
  16. 16.
    Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22: 142–146PubMedGoogle Scholar
  17. 17.
    Holick MF (2004) Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease and osteoporosis. Am J Clin Nutr 79: 362–371PubMedGoogle Scholar
  18. 18.
    Hoogenboezem T, Degenhart HJ, De Muinck Keizer-Schrama SM, Bouillon R, Grose WF, Hackeng WH, Visser HK (1989) Vitamin D metabolism in breast-fed infants and their mothers. Pediatr Res 25: 623–628PubMedGoogle Scholar
  19. 19.
    Institute of Medicine, Food and Nutrition Board, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (1997) Vitamin D. In: Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D and fluoride. National Academy Press, Washington, pp 250–287Google Scholar
  20. 20.
    Lebrun JB, Moffatt ME, Mundy RJ, Sangster RK, Postl BD, Dooley JP, Dilling LA, Godel JC, Haworth JC (1993) Vitamin D deficiency in a Manitoba community. Can J Public Health 84: 394–396PubMedGoogle Scholar
  21. 21.
    Mallet E, Gugi B, Brunelle P, Henocq A, Basuyau JP, Lemeur H (1986) Vitamin D supplementation in pregnancy: a controlled trial of two methods. Obstet Gynecol 68: 300–304PubMedGoogle Scholar
  22. 22.
    Markestad T, Kolmannskog S, Arntzen E, Toftegaard L, Haneberg B, Asknes L (1984) Serum concentrations of vitamin D metabolites in exclusively breast-fed infants at 70 degrees north. Acta Paediatr Scand 73: 29–32PubMedGoogle Scholar
  23. 23.
    McMurray DN, Bartow RA, Mintzer CL, Hernadez-Frontera E (1990) Micronutrient status and immune function in tuberculosis. Ann N Y Acad Sci 587: 59–69PubMedGoogle Scholar
  24. 24.
    Muhe L, Lulseged S, Mason KE, Simoes EA (1997) Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet 349: 1801–1804CrossRefPubMedGoogle Scholar
  25. 25.
    Nikiforuk G, Fraser D (1981) The etiology of enamel hypoplasia: a unifying concept. J Pediatr 98: 888–893PubMedGoogle Scholar
  26. 26.
    Rothberg AD, Pettifor JM, Coben DF, Sonnendecker EW, Ross FP (1982) Maternal infant vitamin D relationships during breast-feeding. J Pediatr 101: 500–503PubMedGoogle Scholar
  27. 27.
    Salle BL, Delvin EE, Lapillonne A, Bishop NJ, Glorieux FH (2000) Perinatal metabolism of vitamin D. Am J Clin Nutr 71[Suppl 5]: 1317S–1324SGoogle Scholar
  28. 28.
    Wharton B, Bishop N (2003) Rickets. Lancet 362: 1389–1400CrossRefPubMedGoogle Scholar
  29. 29.
    Wilkinson RJ, Llewelyn M, Toossi Z, Patel P, Pasvol G, Lalvani A, Wright D, Latif M, Davidson RN (2000) Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case control study. Lancet 355: 618–621CrossRefPubMedGoogle Scholar
  30. 30.
    Zeghoud F, Vervel C, Guillozo H, Walrant-Debray O, Boutignon H, Garabedian M (1997) Subclinical vitamin D deficiency in neonates: definition and response to vitamin D supplements. Am J Clin Nutr 65: 771–778PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Anna Challa
    • 1
  • Agathi Ntourntoufi
    • 2
  • Vasilios Cholevas
    • 1
  • Maria Bitsori
    • 3
  • Emmanuel Galanakis
    • 3
  • Styliani Andronikou
    • 2
  1. 1.Department of Child HealthUniversity of Ioannina Medical SchoolIoannina Greece
  2. 2.Neonatology Division, Department of Child HealthUniversity of Ioannina Medical SchoolIoannina Greece
  3. 3.Department of PaediatricsMedical School, University of CreteHeraklion Greece

Personalised recommendations