[Fortified milk and supplements of oral vitamin D. Comparison of the effect of two doses of vitamin D (500 and 1,000 UI/d) during the first trimester of life].
BACKGROUND
Administration of oral vitamin D supplements has been the usual strategy used in France for the prevention of rickets. But this strategy needs reevaluation since the fortification of infant formulas with vitamin D is authorized in this country. We report the effects of oral daily supplements of vitamin D on the calcium metabolism and vitamin D status of infants receiving or not fortified milk during the first trimester of life.


METHODS
Circulating levels of 25-hydroxyvitamin D (25-(OH)D) were measured: 1) in 64 infants aged 1 to 4 months, seen as outpatients between February and October, given oral vitamin D2 (theoretically 1,000 IU/d) and fed infant formulas, fortified or not with vitamin D; 2) in healthy neonates born to unsupplemented (n = 48) or supplemented vitamin D mothers (n = 22), between April and July, followed from birth (n = 70) to 3 months of age (n = 52), fed fortified milk, and given either 500 or 1,000 IU/D of vitamin D2. Serum calcium, phosphate, intact parathyroid hormone levels and alkaline phosphatase activities were simultaneously measured in this second study.


RESULTS
In the first study, the infants who had been seen during the summer and fed fortified milk had 25-(OH)D levels higher than those seen during the winter and fed the unfortified formulas (37.0 +/- 11.2 ng/mL vs 29.1 +/- 9.7 ng/mL, P = 0.013). But when daily supplements of vitamin D2 were strictly controlled (second study), all infants fed the fortified milk had 25-(OH)D levels within the adult range (10 to 37 ng/mL) at 1 and 3 months of age, whatever their vitamin D status at birth and although these infants were seen during the summer. No difference was found between infants given 500 or 1,000 IU/d as regards their mean serum calcium, phosphate and alkaline phosphatase activities. In addition, the percentage of infants with calcemia above 2.60 mM/L was even lower with the 1,000 IU/d vitamin D dosage than with the 500 IU/d dosage.


CONCLUSIONS
Daily supplements of vitamin D2 (500 to 1,000 IU/d) during the first trimester of life do not appear to induce a significant vitamin D overload when fortified milk is given to the infants. These supplementations may thus be maintained, especially when neonates are at risk of vitamin D deficiency.
Vervel
C
C
Service de pédiatrie, université Paris V, hôpital Saint-Vincent-de-Paul, Paris, France.
Zeghoud
F
F
Boutignon
H
H
Tjani
J C
JC
Walrant-Debray
O
O
Garabédian
M
M
D015652:25-Hydroxyvitamin D 2 / Q000097:blood; D000284:Administration, Oral; D000469:Alkaline Phosphatase / Q000097:blood; D000704:Analysis of Variance; D000818:Animals; D002118:Calcium / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D008892:Milk / Q000737:chemistry*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D014807:Vitamin D / Q000008:administration & dosage*
D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D015652:25-Hydroxyvitamin D 2; D000469:Alkaline Phosphatase; D002118:Calcium
Laits enrichis et suppléments oraux en vitamine D. Comparison de l'effet de deux doses de vitamine D (500 et 1,000 UI/j) pendent le premier trimestre de la vie.