Division of General Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA.
J Hum Lact. 2012 May;28(2):159-66. doi: 10.1177/0890334411434802.
Concerns over vitamin D deficiency in infants and children recently prompted the American Academy of Pediatrics to recommend increased supplementation. Few studies have examined vitamin D status in the same infants over time. Also, while many researchers label "breastfeeding" as a risk factor for vitamin D deficiency, few differentiate between any breastfeeding, exclusive breastfeeding, and supplemented or unsupplemented breastfeeders.
To determine predictors of 25(OH)D deficiency at 4 months in a group of children previously tested at birth.
We enrolled newborns from 2005 to 2007 at an urban Boston hospital. Maternal and infant blood samples were collected within 72 hours of birth. At 4 months, we obtained a second infant blood sample.
At 4 months, 11.9% of the 177 infants were vitamin D deficient compared to 37.5% at birth (25(OH)D <20 ng/mL). Median 25(OH)D was 35.2 ng/mL (range, 5-100.8; 95% confidence interval [CI], 32.8-37.6). At 4 months, 40% of unsupplemented infants were deficient. Lack of supplementation was significantly associated with increased risk of deficiency (adjusted odds ratio [AOR], 19.3; 95% CI, 4.80-77.2). Being outside at least 10 minutes a day, once per week, was protective (AOR, 0.12; 95% CI, 0.02-0.66), as was increasing gestational age (AOR, 0.36; 95% CI, 0.19-0.69). In 48.4% of patients, physicians failed to prescribe vitamin D at 2 months.
Despite inconsistent supplementation, a smaller proportion of infants were vitamin D deficient at 4 months than at birth. While supplemented breastfed infants were not at risk of deficiency, unsupplemented exclusively breastfed infants were at high risk of severe deficiency.
最近，人们对婴儿和儿童维生素 D 缺乏的担忧促使美国儿科学会建议增加补充剂的摄入量。很少有研究随时间观察同一批婴儿的维生素 D 状况。此外，虽然许多研究人员将“母乳喂养”标记为维生素 D 缺乏的一个危险因素，但很少有人区分任何母乳喂养、纯母乳喂养、补充或未补充母乳喂养者。
确定一组先前在出生时接受过检查的儿童在 4 个月时 25（OH）D 缺乏的预测因素。
我们在波士顿一家城市医院招募了 2005 年至 2007 年的新生儿。在出生后 72 小时内采集母婴血液样本。在 4 个月时，我们采集了第二份婴儿血液样本。
在 177 名婴儿中，有 11.9%的婴儿在 4 个月时维生素 D 缺乏，而在出生时为 37.5%（25（OH）D<20ng/mL）。中位 25（OH）D 为 35.2ng/mL（范围为 5-100.8；95%置信区间[CI]为 32.8-37.6）。在 4 个月时，40%未补充维生素 D 的婴儿缺乏维生素 D。未补充维生素 D 与缺乏的风险增加显著相关（调整后的优势比[AOR]，19.3；95%CI，4.80-77.2）。每周至少外出 10 分钟一次是一种保护因素（AOR，0.12；95%CI，0.02-0.66），胎龄增加也是一种保护因素（AOR，0.36；95%CI，0.19-0.69）。在 48.4%的患者中，医生在 2 个月时未能开出维生素 D 处方。
尽管补充剂不一致，但在 4 个月时婴儿维生素 D 缺乏的比例低于出生时。虽然补充母乳喂养的婴儿没有维生素 D 缺乏的风险，但未补充母乳喂养的婴儿则有严重缺乏的高风险。
