Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Child Health Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
PLoS One. 2020 Oct 5;15(10):e0239603. doi: 10.1371/journal.pone.0239603. eCollection 2020.
Vitamin D deficiency in infants has been associated with an increased risk of a number of diseases but there are limited data on the prevalence and determinants of vitamin D deficiency from tropical settings with high infant morbidity and mortality.
To determine the prevalence and determinants of vitamin D deficiency in infants at birth and at six months of age in Yogyakarta province, Indonesia.
Serum vitamin D of eligible infants was measured in cord blood at birth and at six months of age. Factors associated with vitamin D deficiency (serum 25-hydroxyvitamin D <50 nmol/L) were collected prospectively monthly from birth and concentrations measured by liquid chromatography-tandem mass spectrometry. Independent risk factors were identified by multiple logistic regression.
Between December 2015 to December 2017, 350 maternal-newborn participants were recruited and followed up. Vitamin D deficiency was detected in 90% (308/344) of cord blood samples and 13% (33/255) of venous blood samples at six months. Longer time outdoors (≥2 hours per day) and maternal multivitamin intake containing vitamin D during pregnancy were protective against vitamin D deficiency at birth (AOR: 0.10, 95% CI: 0.01-0.90 and AOR: 0.21, 95% CI: 0.06-0.68, respectively). Risk factors for vitamin D deficiency at six months included lower cumulative skin-sun exposure score (AOR: 1.12, 95% CI: 1.04-1.20), severe vitamin D deficiency at birth (AOR: 7.73, 95% CI: 1.20-49.60) and exclusive breastfeeding (AOR: 2.64, 95% CI: 1.07-6.49) until six months. Among exclusively breast fed (EBF) infants, a higher skin-sun exposure score was associated with reduced vitamin D deficiency risk.
In equatorial regions, the role of 'safe' morning sun exposure in infants and mothers in populations with medium to dark brown skin pigmentation and effective interventions to prevent vitamin D deficiency in newborns and EBF infants, need further consideration and evaluation.
婴儿维生素 D 缺乏与多种疾病的风险增加有关，但在婴儿发病率和死亡率较高的热带地区，关于维生素 D 缺乏的患病率和决定因素的数据有限。
在印度尼西亚日惹省确定婴儿出生时和 6 个月时维生素 D 缺乏的患病率和决定因素。
在出生时和 6 个月时测量合格婴儿的脐带血血清维生素 D。每月从出生开始前瞻性收集与维生素 D 缺乏（血清 25-羟维生素 D <50nmol/L）相关的因素，并通过液相色谱-串联质谱法测量浓度。通过多元逻辑回归确定独立的危险因素。
在 2015 年 12 月至 2017 年 12 月期间，招募并随访了 350 名母婴参与者。在 344 份脐带血样本中发现 90%（308/344）和 255 份静脉血样本中 13%（33/255）存在维生素 D 缺乏。室外时间较长（每天≥2 小时）和孕妇在怀孕期间服用含有维生素 D 的多种维生素可预防出生时维生素 D 缺乏（OR：0.10，95%CI：0.01-0.90 和 OR：0.21，95%CI：0.06-0.68）。6 个月时维生素 D 缺乏的危险因素包括累积皮肤阳光暴露评分较低（OR：1.12，95%CI：1.04-1.20）、出生时严重维生素 D 缺乏（OR：7.73，95%CI：1.20-49.60）和 6 个月时纯母乳喂养（OR：2.64，95%CI：1.07-6.49）。在纯母乳喂养（EBF）婴儿中，较高的皮肤阳光暴露评分与降低维生素 D 缺乏风险相关。
在赤道地区，在皮肤色素沉着为中等至深棕色的人群中，“安全”晨晒对婴儿和母亲的作用以及预防新生儿和 EBF 婴儿维生素 D 缺乏的有效干预措施，需要进一步考虑和评估。
