Supplementation For Breastfed Infants Research Articles

Maternal acceptability of iron supplementation in young breastfed rural Gambian infants

AbstractIntroductionA recent analysis of Gambian infants showed that plasma iron concentrations decline rapidly from birth to levels below the 95% reference range within 5 months of age. To address this issue, a clinical trial was initiated to assess the efficacy of early iron supplementation in breastfed infants under 6 months of age (‘Iron Babies’; NCT04751994). To understand if such an intervention is feasible for scaleup, the acceptability, through the lens of local stakeholders and mothers (as the primary caregiver), must be considered.MethodsAn embedded qualitative study, therefore, explored acceptability through focus group discussions with local stakeholders and interviews with mothers. Four focus group discussions with local stakeholders (n = 19) and individual interviews (n = 14) with mothers whose infants were enrolled in the clinical trial were conducted. Qualitative data were analysed with respect to an implementation acceptability framework using Template Analysis.ResultsFrom the focus group discussions, there was a general sense of enthusiasm for the intervention, but also a concern due to confusion around nutritional messaging. The intervention was acceptable to mothers with limited mention of side effects and enthusiasm for participating in clinical trials on iron supplementation. However, when looking at scaleup, there were mixed opinions on the practicality of daily supplementation, as well as concerns around costs. In addition, it was suggested that proper dissemination of information and inclusion of all family members in decision‐making, especially fathers, is key to acceptability.ConclusionThere was no indication that stakeholders or mothers were resistant to iron supplementation of breastfed infants.

Effect of Vitamin D Supplementation on Bone Mass in Infants With 25-Hydroxyvitamin D Concentrations Less Than 50 nmol/L

The dose of supplemental vitamin D needed in infants born with serum 25-hydroxyvitamin D (25[OH]D) concentrations less than 50 nmol/L (ie, 20 ng/mL) is unclear. To determine whether a higher dose (1000 IU vs 400 IU per day) is required in infants born with 25(OH)D concentrations less than 50 nmol/L for bone mineral accretion across infancy. In this prespecified secondary analysis of a double-blinded randomized clinical trial, conducted from March 2016 to March 2019 in a single center in Greater Montreal, Quebec, Canada, a consecutive sample of 139 healthy term singletons were recruited from 866 infants screened for vitamin D status at birth. Data were analyzed from June 2021 to November 2022. Capillary blood was collected 24 to 36 hours after birth to measure serum total 25(OH)D concentrations. Infants with 25(OH)D concentrations less than 50 nmol/L were randomized to receive either 1000 IU or 400 IU per day of oral vitamin D3 supplementation from age 1 to 12 months. Infants with 25(OH)D concentrations of 50 nmol/L or greater formed a reference group. Measures at age 1, 3, 6, and 12 months were preplanned and included whole-body bone mineral content, lumbar spine bone mineral content, and bone mineral density using dual-energy x-ray absorptiometry, and serum 25(OH)D3 using liquid chromatography tandem mass spectrometry. Of 139 included infants, 81 (58.3%) were male, and the median (IQR) gestational age at birth was 39.6 (38.9-40.6) weeks. A total of 49 infants were included in the 1000 IU per day group, 49 infants in the 400 IU per day group, and 41 in the reference group. Mean (SD) whole-body bone mineral content was not different between trial groups over time (1000 IU per day, 173.09 [2.36] g; 400 IU per day, 165.94 [66.08] g). Similarly, no differences were observed in lumbar spine bone mineral content or density. Mean (SD) serum 25(OH)D3 concentrations were significantly higher in the 1000 IU per day group from age 3 to 12 months (3 months, 115.2 [35.3] nmol/L; 6 months, 121.6 [34.4] nmol/L; 12 months, 99.6 [28.8] nmol/L) compared with the 400 IU per day trial group (3 months, 77.4 [23.3] nmol/L; 6 months, 85.1 [18.6] nmol/L; 12 months, 82.3 [14.3] nmol/L). In this study, a higher dose of vitamin D supplementation in infants born with 25(OH)D concentrations less than 50 nmol/L did not present advantages to bone mass in infancy. This study supports a standard dose of 400 IU per day of vitamin D supplementation for breastfed infants in Montreal. ClinicalTrials.gov Identifier: NCT02563015.

Impact of Maternal Vitamin D Supplementation during Breastfeeding on Infant Serum Vitamin D Levels: A Narrative Review of the Recent Evidence.

Vitamin D supplementation for breastfed infants is recommended due to low levels of vitamin D in human milk and the high prevalence of vitamin D deficiency. The relationship between maternal vitamin D supplementation while breastfeeding and infant serum vitamin D levels is beginning to be described. A literature review was conducted that investigated the impact of maternal supplementation, with at least 4000 IU of vitamin D, on infant serum vitamin D levels. Inclusion criteria were publication between 2016-2022, primary research, exclusively breastfed infants, and mothers taking vitamin D supplements while breastfeeding. Exclusion criteria were publication prior to 2016, review articles, results that did not include infant serum vitamin D levels, and research using participants already included in this review. Over 90% of infants whose mothers took vitamin D supplements while breastfeeding had adequate serum vitamin D levels. The final mean serum vitamin D of all infant participants whose mothers consumed vitamin D supplementation was 66.7 nmol/L, while mean serum vitamin D in those whose mothers did not consume supplements was 33.5 nmol/L. Consumption of vitamin D supplements by lactating women exclusively breastfeeding their infants can lead to adequate serum vitamin D levels in their infants.

Determinants of vitamin D deficiency among Bangladeshi children: A hospital based case-control study


 Background: Risk factors of vitamin D deficiency among children have been identified in many developed countries but not yet in some developing countries like Bangladesh. Therefore, the aim of this study was to identify the determinants of vitamin D deficiency among Bangladeshi children. 
 Methods: This case-control study was conducted at 2 paediatric hospitals in Dhaka city from January to June 2017. We recruited 198 vitamin D deficient cases and 198 apparently healthy controls. Data were analyzed using IBM SPSS, where quantitative variables were analyzed using descriptive statistics. The association between vitamin D deficiency with different lifestyle and dietary factors were analyzed by using Chi-square test. A 2-tailed p-value less than 0.05 were considered as statistically significant. Univariate and multivariate logistic regression analysis were performed to confirm the association. 
 Results: The study revealed that not playing outdoor games (OR=3.09; 95% CI 1.46, 6.54), playing video/ TV/mobile games (OR=4.14; 95% CI 1.97-8.67), no sun exposure (OR=2.42; 95% CI 1.25-4.67), no milk consumption (OR=3.01; 95% CI 1.38-6.57), no sea fish consumption (OR=2.20; 95% CI 1.19-4.08) and not exclusively breastfeeding (OR=2.03; 95% CI 1.14-3.63) were significantly associated with vitamin D deficiency. 
 Conclusion: We concluded that improper lifestyles and nutritional habits are the key determinants of Vitamin D deficiency among Bangladeshi children. Strategy for hypovitaminosis D prevention should be implemented immediately, which includes vitamin D supplementation of breastfed infants and ensuring adequate maternal vitamin D status during pregnancy. Also an awareness program should be initiated to promote a healthy lifestyle and to improve nutritional habits. 

Breastfeeding and vitamin D.

The recent re-emergence of vitamin D deficiency (VDD) and rickets among breastfed infants without adequate sunlight exposure and vitamin D supplementation has been reported worldwide. Breastfed infants are particularly vulnerable to VDD because of the low vitamin D content of breast milk, restricted sunlight exposure, increased pollution, and limited natural dietary sources of vitamin D. The prevalence of VDD in breastfed infants differs vastly between studies and nations at 0.6%–91.1%. The recommended intake of vitamin D for lactating mothers to optimize their overall vitamin D status and, consequently, of their breast milk is 200–2,000 IU/day, indicating a lack of consensus. Some studies have suggested that maternal high-dose vitamin D supplementation (up to 6,400 IU/day) can be used as an alternate strategy to direct infant supplementation. However, concern persists about the safety of maternal high-dose vitamin D supplementation. Direct infant supplementation is the currently available option to support vitamin D status in breastfed infants. The recommended dose for vitamin D supplementation in breastfed infants according to various societies and organizations worldwide is 200–1,200 IU/day. Most international guidelines recommend that exclusively or partially breastfed infants be supplemented with 400 IU/day of vitamin D during their first year of life. However, domestic studies on the status and guidelines for vitamin D in breastfed infants are insufficient. This review summarizes the prevalence of VDD in breastfed infants, vitamin D content of breast milk, and current guidelines for vitamin D supplementation of lactating mothers and infants to prevent VDD in breastfed infants.

Relation between household food insecurity and breastfeeding in Canada.

Qualitative studies have suggested that food insecurity adversely affects infant feeding practices. We aimed to determine how household food insecurity relates to breastfeeding initiation, duration of exclusive breastfeeding and vitamin D supplementation of breastfed infants in Canada. We studied 10 450 women who had completed the Maternal Experiences - Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey (2005-2014) and who had given birth in the year of or year before their interview. We used multivariable Cox proportional hazards models and logistic regression to examine the relation between food insecurity and infant feeding practices, adjusting for sociodemographic characteristics, maternal mood disorders and diabetes mellitus. Overall, 17% of the women reported household food insecurity, of whom 8.6% had moderate food insecurity and 2.9% had severe food insecurity (weighted percentages). After adjustment for sociodemographic factors, women with food insecurity were no less likely than others to initiate breastfeeding or provide vitamin D supplementation to their infants. Half of the women with food insecurity ceased exclusive breastfeeding by 2 months, whereas most of those with food security persisted with breastfeeding for 4 months or more. Relative to women with food security, those with marginal, moderate and severe food insecurity had significantly lower odds of exclusive breastfeeding to 4 months, but only women with moderate food insecurity had lower odds of exclusive breastfeeding to 6 months, independent of sociodemographic characteristics (odds ratio 0.60, 95% confidence interval 0.39-0.92). Adjustment for maternal mood disorder or diabetes slightly attenuated these relationships. Mothers caring for infants in food-insecure households attempted to follow infant feeding recommendations, but were less able than women with food security to sustain exclusive breastfeeding. Our findings highlight the need for more effective interventions to support food-insecure families with newborns.

Vitamin D supplementation in breastfed infants from Montréal, Canada: 25-hydroxyvitamin D and bone health effects from a follow-up study at 3years of age.

Whether infant vitamin D supplementation may have long-term bone benefits is unclear. In this study, breastfed infants who received vitamin dosages greater than 400IU/day did not have higher bone mineralization at 3years. This study provides important data to inform pediatric public health recommendations for vitamin D. North American health agencies recommend breastfed infants should be supplemented with 400IU of vitamin D/day to support bone health. Few studies examined the long-term benefits of early life vitamin D supplementation on bone mineralization. The objective of this study was to determine if a dose-response relationship exists between infant vitamin D supplementation, vitamin D status, and bone outcomes at 3years of age. This was a double-blind randomized trial of 132, 1-month-old healthy, breastfed infants from Montréal, Canada, between 2007 and 2010. In this longitudinal analysis, 87 infants (66%) returned for follow-up at 3years of age, between 2010 and 2013. At 1month of age, participants were randomly assigned to receive oral cholecalciferol (vitamin D3) supplements of 400, 800, 1200, or 1600IU/day until 12months of age. Lumbar spine vertebrae 1-4 (LS) bone mineral density (BMD), LS and whole body bone mineral content (BMC), and mineral accretion were measured by dual-energy x-ray absorptiometry at 3years. At follow-up, the treatment groups were similar in terms of diet, sun exposure, and demographics. There were no significant differences among the groups in LS or whole body BMC, BMD, or accretion. Although, 25(OH)D concentrations were not different among the groups, higher doses (1200 and 1600IU/day) achieved higher 25(OH)D area under the curve from 1 to 36months vs. 400IU/day. This is the first longitudinal follow-up of an infant vitamin D dose-response study which examines bone mineralization at 3years of age. Dosages higher than 400IU/day do not appear to provide additional benefits to the bone at follow-up. Larger studies with more ethnically diverse groups are needed to confirm these results.

VITALITY trial: protocol for a randomised controlled trial to establish the role of postnatal vitamin D supplementation in infant immune health

IntroductionPostnatal vitamin D supplementation may be associated with a reduction in IgE-mediated food allergy, lower respiratory tract infections and improved bone health. Countries in the Northern hemisphere recommend universal infant...

The VINE study: vitamin D in newborns: a randomized controlled trial comparing daily and bolus supplementation in breastfed infants of vitamin D deficient mothers

The VINE study: vitamin D in newborns: a randomized controlled trial comparing daily and bolus supplementation in breastfed infants of vitamin D deficient mothers

Vitamin D in infancy

Journal of Paediatrics and Child HealthVolume 50, Issue 7 p. 570-570 Heads UpFree Access Vitamin D in infancy First published: 07 July 2014 https://doi.org/10.1111/jpc.12670 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat New Zealand recommends exclusive breastfeeding until 6 months of age, but not routine infant vitamin D supplements, although some countries recommend vitamin D ‘to prevent rickets’ in breastfed infants. A study of 94 healthy breastfed New Zealand infants aged 2–3 months found marked seasonal variation.1 The median vitamin D level was 53 nmol/L but the range was 14–100. Vitamin D deficiency, defined as <27.5 nmol/L, was found in 23 infants (24%), mainly in winter. There was no significant difference in levels in European and non-European infants. The authors recommended considering routine vitamin D supplementation of breastfed infants. However, a study from birth to age 24 months of 21 initially breastfed Malawi infants who were not vitamin D supplemented found that the children's vitamin D levels were 36% of adult levels at birth, 60% at 2 months old, but equal to adult levels at 12 months and maintained at 24 months.2 Vitamin D levels in breast milk were low. Although breastfed infants' vitamin D levels are low in early infancy, the Malawi study suggests that levels will rise with time and that supplementation is unnecessary. References 1Wall CR et al. Arch. Dis. Child. 2013; 98: 176– 179. CrossrefPubMedWeb of Science®Google Scholar 2Amukele TK et al. Arch. Dis. Child. 2013; 98: 180– 183. CrossrefPubMedWeb of Science®Google Scholar Reviewer: David Isaacs, Children's Hospital at Westmead (david.isaacs@health.nsw.gov.au). Seasonal variation in breastfed infants' vitamin D levels. Volume50, Issue7July 2014Pages 570-570 ReferencesRelatedInformation

Vitamin D supplementation of breastfed infants: a randomized dose–response trial

Breastfed infants require supplementation with vitamin D (vD), but little is known about the necessary dose. This double blind trial evaluated four different doses of vD. Exclusively breastfed infants (N = 213) were randomized at 1 mo to one of four doses, which they received through 9 mo while receiving no formula. The supplements provided daily 200 IU, 400 IU, 600 IU, or 800 IU of vD. The primary endpoint was plasma 25(OH)D level, and secondary outcomes were plasma parathyroid hormone and calcium, and illness incidence. The study was conducted during winter at 41° N. Most infants had low (<50 nmol/l) 25(OH)D levels at 1 mo, but with supplementation levels rose. Overall, levels of 25(OH)D differed significantly in proportion to vD dose. There were no effects of vD on illness incidence or growth. Low levels were common, with 7.8% of levels being <50 nmol/l and 15 infants having 2 to 4 low levels. The four doses of vD produced different plasma levels of 25(OH)D. The higher doses were somewhat more efficacious in maintaining vD sufficiency in breastfed infants. The findings support the recommended dose of 400 IU/d, and stress the need to start supplementation at birth.

Human milk benefits and breastfeeding

Human milk is uniquely superior for infant feeding and represents the perfect example of individualization in Pediatrics. Human milk is not a uniform body fluid but a secretion of the mammary gland of changing composition. Foremilk differs from hindmilk, and colostrum is strikingly different from transitional and mature milk. Milk changes with time of day and during the course of lactation. Extensive research has demonstrated health, nutritional, immunologic, developmental, psychological, social, economic and environmental benefits of human milk. Breastfeeding results in improved infant and maternal health outcomes in both the industrialized and developing world. Some specific topics will be discussed such as the preventive effect of human milk on infections, overweight, obesity and diabetes, malignant disease, neurodevelopmental outcomes, reduction of necrotizing enterocolitis. Important health benefits of breastfeeding and lactation are also described for mothers. Finally, contraindications to breastfeeding and supplementation of breastfed infants are presented. Interventions to promote breastfeeding are relatively simple and inexpensive. Infant feeding should not be regarded as a lifestyle choice but rather as a basic health issue.

Maternal vitamin D supplementation to optimize the vitamin D status of breastfed infants

Vitamin D supplementation of breastfed infants is recommended because breast milk levels are low. We sought to determine if maternal supplementation would increase breast milk levels to achieve sufficiency in their infants. Forty mothers with exclusively breastfed infants were randomized to receive oral cholecalciferol (vitamin D3) 5000 IU/d for 28 days or 150,000 IU once. Maternal serum, breast milk and urine were collected on days 0, 1, 3, 7, 14 and 28 and infant serum on days 0 and 28. In mothers receiving daily vitamin D, serum and breast milk cholecalciferol attained steady levels of 18 and 8 ng/ml, respectively, from day 3 through 28. In mothers given the single dose, serum and breast milk cholecalciferol peaked at 160 and 40 ng/ml, respectively at day 1, before rapidly declining. Breast milk and maternal serum cholecalciferol were related (r=0.87). Infant serum 25OHD (mean±SD) increased from 17±13 to 39±6 ng/ml in the single dose group and from 16±12 to 39±12 ng/ml in the daily dose group (P= 0.88). All infants achieved sufficient 25OHD serum levels (≥20ng/mL). This study suggests that maternal supplementation can achieve sufficient infant serum levels of 25OHD via breastfeeding. A large single dose of vitamin D was equivalent to daily dosing for optimizing infant vitamin D status. This research was funded by the National Center for Research Resources and Mayo Clinic.Grant Funding Source: NCRR and Mayo Clinic

Exclusive Breastfeeding in the Hospital

Accurate hospital exclusive breastfeeding (EBF) rates, a core indicator of hospital performance, are important. The aim of this study was to assess the accuracy of hospital infant feeding data by comparing EBF rates obtained from standard charts in which once-daily observations are recorded with new infant feeding charts in which every feed was documented. In this cross-sectional study, 157 healthy mother-infant pairs were enrolled at the University Hospital of Split, Croatia, between February and May 2008. Infant feeding data were gathered from 4 sources: (1) standard once-daily observations recorded by pediatricians; (2) new, every-feed observations recorded by nursing staff; (3) interview with the mother before discharge; and (4) Newborn Examination Form, completed on discharge by the pediatrician. WHO definitions were used to determine EBF during the first 48 hours and from birth until discharge. Only 3% of infants were EBF throughout the hospital stay when calculated with the every-feed method, as opposed to 56% and 82%, with the once-daily and newborn examination methods, respectively (P < .001). Maternal report confirmed the finding that 97% of infants were supplemented with formula, indicating that most formula supplements are not recorded in the standard once-daily charts. Accurate documentation of infant feeding practices is essential for obtaining reliable EBF rates. This study shows that once-daily recordings of infant feeding practices grossly underestimate the prevalence of formula supplementation in breastfed infants, resulting in significantly higher, erroneous EBF rates.

Maternal Supplementation for Prevention and Treatment of Vitamin D Deficiency in Exclusively Breastfed Infants

Current research links newborn and infant vitamin D deficiency with various clinical outcomes, including rickets, failure to thrive, type 1 diabetes, and other immune-related diseases. Breastfed infants are often at a greater risk of developing deficiency due to their mothers' low vitamin D status. Human milk reflects the vitamin D status of the mother and often contains inadequate levels of 25-hydroxyvitamin D for infant nutrition. In 2008 the American Academy of Pediatrics (AAP) recommended 400 IU of vitamin D supplementation of all infants. However, research has indicated low levels of compliance of vitamin D supplementation of breastfed infants and a high incidence of vitamin D deficiency in the United States. Many breastfeeding advocates believe that the AAP's recommendations undermine breastfeeding, implying that human milk is inadequate for infant nutrition. Lactating mothers are also reluctant to add any supplements to their breastmilk. The literature review will examine the effectiveness and safety of maternal vitamin D supplementation for prevention and/or treatment of vitamin D deficiency in breastfed infants and lactating mothers. This method of prevention and intervention provides pediatric providers and certified lactation consultants with an alternative approach for education, counseling, promotion of breastfeeding, and treatment to improve maternal and infant health.

A Treatment Trial of Vitamin D Supplementation in Breast-fed Infants: Universal Supplementation Is Not Necessary for Rickets Prevention in Southern Louisiana

This study was conducted to determine if vitamin D supplementation is required to prevent rickets in breast-fed infants. Breast-feeding rates are increasing, and there are concerns about whether the vitamin D content of breast milk is sufficient. There are a few treatment trials of vitamin D supplementation in breast-fed infants; these were conducted in northern climates. The authors therefore performed a prospective clinical trial comparing vitamin D supplementation with placebo as control in southern Louisiana. Blood samples and questionnaires were collected at birth, 2, 4, and 6 months of age. There were no cases of rickets observed, and no differences in alkaline phosphatase levels between groups. Thus, there was no evidence that vitamin D supplementation reduced rickets risk in the authors' study population. This suggests that the current recommendations for universal vitamin D supplementation of breast-fed infants throughout the United States may need to be revised.

Vitamin D Supplementation in Breast-Fed Infants

Breast-fed infants are at risk for rickets. In 2008, the American Academy of Pediatrics increased the recommendation for vitamin D supplementation from 200 to 400 IU/day for infants who are predominantly breast-fed. To examine vitamin D supplementation in breast-fed infants, investigators in Seattle surveyed 44 pediatricians …

Use of Supplemental Vitamin D Among Infants Breastfed for Prolonged Periods

To determine the rate of vitamin D supplementation in predominantly breastfed children. To identify patient characteristics, parental beliefs, and practitioner policies associated with supplementation. A prospective observational study was conducted in a practice-based research network. Network pediatricians completed a survey regarding their policy on vitamin D supplementation for breastfed infants. Parents of children 6 to 24 months old completed a survey on the initial type of feeding given to the child, length of breastfeeding, formula supplementation, and use of multivitamins. Parents indicated their level of agreement with statements regarding vitamin D supplementation. Among 44 responding pediatricians, 36.4% indicated that they recommended vitamin D supplementation for all breastfed infants. A total of 2364 surveys were completed on age-eligible children; 1140 infants were breastfed for at least 6 months with little or no formula supplementation. The rate of vitamin D use for these infants was 15.9%. Use of vitamin D was significantly associated with parental agreement that their child's pediatrician recommended supplementation (odds ratio [OR]: 7.8), and that vitamins are unnecessary because breast milk has all needed nutrition (OR: 0.12). Among parents of predominantly breastfed infants who indicated that their child's doctor recommended vitamin D, 44.6% gave the supplementation to their child. Conversely, 67% of parents agreed that breast milk has all needed nutrition, and only 3% of these parents gave vitamin D to their children. A minority of breastfed infants received vitamin D supplementation. Educational efforts directed at both physicians and parents are needed to increase compliance with vitamin D supplementation guidelines.

Impact of long-term oral iron supplementation in breast-fed infants

To weigh benefits of oral iron supplements on infant's growth against its potential hazards. 248 exclusively breast-fed infants aged 4-6 months were consecutively enrolled and divided into treatment group given iron containing multivitamin (TG = 198) and control group (placebo, PG = 50) given the same multivitamin but without is subdivided according to clinical assessment into group A (well nourished) and group B (malnourished); both were further stratified according to basal blood iron status. Assessment was done after 6 and 12 months with concurrent collection of morbidity parameters (diarrhea and fever). Data were normalized and analyzed using SPSS and Eurogrowth softwares. After 6 months treatment, weight and length gain was better in TG compared to placebo especially evident in anemic malnourished infants (P 0.05). Morbidity risk was linked to immunologic background of infant; odds ratio for diarrhea and fever was higher in malnourished compared to well nourished (P 0.05) or iron therapy (P for well-nourished non-anemic treatment vs PG > 0.05). Oral iron supplementation resulted in better effects on growth velocity of breast fed infants especially those who were initially malnourished and anemic or at least iron depleted, with less marked morbidity than in iron replete infants.

Got milk?

The recent folderol regarding vitamin D supplementation for breastfed infants has reawakened interest in the vitamin D status of other groups of children. In this issue of The Journal, Buison and colleagues from the Children's Hospital of Philadelphia remind us of another group of children at risk for vitamin D deficiency: those with sickle cell disease (SSD). In this study from their Comprehensive Sickle Cell Center, 65% of children had low vitamin D status. This was a much higher prevalence than that found in otherwise healthy black children. The importance of the finding was reinforced by the fact that the children with SSC had higher serum concentrations of PTH than did healthy black children, and that PTH levels and vitamin D levels were directly correlated. The authors remind us of several potential reasons for vitamin D deficiency in this population, indirectly advocating for supplementation. Low vitamin D status in children with sickle cell diseaseThe Journal of PediatricsVol. 145Issue 5PreviewTo examine vitamin D status in children with sickle cell disease (SCD)-SS and its relation to season and dietary intake. Full-Text PDF