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Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation.
Adv Nutr. 2020 01 01; 11(1):144-159.AN

Abstract

Daily oral vitamin D supplementation (400 IU) is recommended for breastfeeding infants (≤1 y). Recent studies have examined alternative approaches to preventing vitamin D deficiency in this population. This systematic review and meta-analysis aimed to estimate the effects of maternal postpartum (M-PP) or infant intermittent (I-INT) vitamin D supplementation on infant 25-hydroxyvitamin D [25(OH)D] concentrations in comparison to routine direct infant daily (I-D) oral supplementation (400 IU). MEDLINE, MEDLINE In-Process, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to December 2018. Inclusion criteria consisted of published, peer-reviewed, vitamin D intervention trials involving lactating women and/or exclusively or partially breastfed term infants. Two reviewers independently extracted study characteristics (e.g., sample size, intervention dose, and duration and mode of administration) and related biochemical and clinical outcomes. Of 28 included trials, 5 randomized controlled trials were incorporated in meta-analyses examining infant 25(OH)D. Overall, M-PP supplementation resulted in modestly lower infant 25(OH)D compared with I-D supplementation (weighted mean difference = -8.1 nmol/L; 95% CI: -15.4, -0.9; I2 = 45%; P = 0.14; 3 trials), but the 2 most recent trials found M-PP to achieve similar infant 25(OH)D as I-D. Comparison of I-INT with I-D was confined to 2 trials with contradictory findings, and it was considered inappropriate for pooled analysis. Meta-analysis was therefore limited by a small number of eligible trials with variable quality of analytically derived 25(OH)D data and inconsistent reporting of safety outcomes, including effects on calcium homeostasis. Considering all 28 included trials, this systematic review highlights M-PP and I-INT regimens as plausible substitutes for routine daily infant vitamin D supplementation, but evidence remains too weak to support a policy update. Dose-ranging, adequately powered trials are required to establish the efficacy, safety, and feasibility of alternative strategies to prevent vitamin D deficiency in breastfeeding infants. This review was registered with PROSPERO as CRD42017069905.

Authors+Show Affiliations

Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada.Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada.Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada.Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada.Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada. Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31552417

Citation

O'Callaghan, Karen M., et al. "Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation." Advances in Nutrition (Bethesda, Md.), vol. 11, no. 1, 2020, pp. 144-159.
O'Callaghan KM, Taghivand M, Zuchniak A, et al. Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation. Adv Nutr. 2020;11(1):144-159.
O'Callaghan, K. M., Taghivand, M., Zuchniak, A., Onoyovwi, A., Korsiak, J., Leung, M., & Roth, D. E. (2020). Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation. Advances in Nutrition (Bethesda, Md.), 11(1), 144-159. https://doi.org/10.1093/advances/nmz098
O'Callaghan KM, et al. Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation. Adv Nutr. 2020 01 1;11(1):144-159. PubMed PMID: 31552417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D in Breastfed Infants: Systematic Review of Alternatives to Daily Supplementation. AU - O'Callaghan,Karen M, AU - Taghivand,Mahgol, AU - Zuchniak,Anna, AU - Onoyovwi,Akpevwe, AU - Korsiak,Jill, AU - Leung,Michael, AU - Roth,Daniel E, PY - 2019/07/19/received PY - 2019/08/19/revised PY - 2019/08/23/accepted PY - 2019/9/26/pubmed PY - 2021/1/8/medline PY - 2019/9/26/entrez KW - 25-hydroxyvitamin D KW - micronutrient supplementation KW - rickets KW - vitamin D KW - vitamin D supplementation SP - 144 EP - 159 JF - Advances in nutrition (Bethesda, Md.) JO - Adv Nutr VL - 11 IS - 1 N2 - Daily oral vitamin D supplementation (400 IU) is recommended for breastfeeding infants (≤1 y). Recent studies have examined alternative approaches to preventing vitamin D deficiency in this population. This systematic review and meta-analysis aimed to estimate the effects of maternal postpartum (M-PP) or infant intermittent (I-INT) vitamin D supplementation on infant 25-hydroxyvitamin D [25(OH)D] concentrations in comparison to routine direct infant daily (I-D) oral supplementation (400 IU). MEDLINE, MEDLINE In-Process, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to December 2018. Inclusion criteria consisted of published, peer-reviewed, vitamin D intervention trials involving lactating women and/or exclusively or partially breastfed term infants. Two reviewers independently extracted study characteristics (e.g., sample size, intervention dose, and duration and mode of administration) and related biochemical and clinical outcomes. Of 28 included trials, 5 randomized controlled trials were incorporated in meta-analyses examining infant 25(OH)D. Overall, M-PP supplementation resulted in modestly lower infant 25(OH)D compared with I-D supplementation (weighted mean difference = -8.1 nmol/L; 95% CI: -15.4, -0.9; I2 = 45%; P = 0.14; 3 trials), but the 2 most recent trials found M-PP to achieve similar infant 25(OH)D as I-D. Comparison of I-INT with I-D was confined to 2 trials with contradictory findings, and it was considered inappropriate for pooled analysis. Meta-analysis was therefore limited by a small number of eligible trials with variable quality of analytically derived 25(OH)D data and inconsistent reporting of safety outcomes, including effects on calcium homeostasis. Considering all 28 included trials, this systematic review highlights M-PP and I-INT regimens as plausible substitutes for routine daily infant vitamin D supplementation, but evidence remains too weak to support a policy update. Dose-ranging, adequately powered trials are required to establish the efficacy, safety, and feasibility of alternative strategies to prevent vitamin D deficiency in breastfeeding infants. This review was registered with PROSPERO as CRD42017069905. SN - 2156-5376 UR - https://www.unboundmedicine.com/medline/citation/31552417/Vitamin_D_in_Breastfed_Infants:_Systematic_Review_of_Alternatives_to_Daily_Supplementation_ L2 - https://academic.oup.com/advances/article-lookup/doi/10.1093/advances/nmz098 DB - PRIME DP - Unbound Medicine ER -