WebMD Medical News
Laura J. Martin, MD
March 22, 2010 -- As few as one in five formula-fed babies and one in 20
breastfed babies are getting as much vitamin
D in their diets as the nation's leading pediatricians' group now calls
for, the CDC says.
In 2008, the American Academy of Pediatrics doubled its recommended daily
intake of the vitamin for infants and children from 200 to 400 international
units (IU) a day.
But according to the CDC estimate, only 5% to 13% of breastfed infants and
20% to 37% of formula-fed babies are getting enough vitamin D to meet the new
CDC researchers analyzed data from a nationwide survey of infant feeding practices
conducted between 2005 and 2007 to estimate how many babies were getting enough
vitamin D in their diets during their first year of life.
The investigation found vitamin D supplementation to be quite low, even
among exclusively breastfed babies.
Just 1% to 4% of the formula-fed babies and 5% to 13% of babies getting only
breast milk were receiving vitamin D supplements.
Because breast milk contains very low levels of vitamin D, supplementation
Babies who drink 34 ounces (1 liter) a day of formula get enough of the
vitamin to meet the new recommendations. But only a third of the babies in the
survey drank this much formula, says the CDC’s Cria G. Perrine, PhD, who led
the study team.
“Breastfed infants definitely need a vitamin D supplement, and most
formula-fed infants probably need supplementation too to get 400 IU a day,” she
Food sources of vitamin D include fatty fish, eggs, and milk. But even
adults have a hard time getting the recommended levels of the vitamin through
The body also makes its own vitamin D when exposed to ultraviolet B (UBV)
rays from the sun.
But the American Academy of Pediatrics recommends that children under
the age of 6 months avoid sun exposure and wear protective clothing and sunscreen when in the sun to avoid burning.
While some have questioned these guidelines, Perrine says they are not
likely to change because of concerns about the dangers of early-life sun
Vitamin D has long been associated with bone health, but a growing body of
research has found it to be protective against many diseases common in adults,
including heart disease and certain
There are also suggestions that vitamin D deficiency increases
the risk for respiratory infection and type 1
diabetes in children.
According to the CDC research, exclusively breastfed babies got the least
vitamin D in their diets, followed by babies who drank both breast milk and
formula. Babies who were exclusively formula-fed got the most vitamin D.
The American Academy of Pediatrics recommends vitamin D supplementation
of 400 IU for all breastfed babies and those who are drinking less than 1 liter
a day of formula.
But pediatrician Frank R. Greer, MD, who headed the committee that came up
with the new guidelines, says pediatricians are not selling the message to new
“I am frankly surprised that more pediatricians are not recommending
supplementation, especially to new moms who are breastfeeding,” he says.
The CDC study appears in the April issue of Pediatrics, along with
another study, which finds a high rate of vitamin D deficiency among new
mothers and their babies living in Boston.
Overall, more than half of the infants and more than a third of the mothers
were considered vitamin D deficient. More than a third of the infants (38%) and
a fifth of the mothers (23%) were considered severely deficient.
Study researcher Anne Merewood, MPH, says she was most surprised by the
high rate of deficiency among the moms.
“Many of these women were taking prenatal vitamins, but this did not ensure
that they had adequate vitamin D levels,” she says.
Merewood points out that supplementation may be especially important for
darker-skinned people who absorb less light from the sun and for lighter
skinned people who have little exposure to the sun.
SOURCES:Perrine, C.G. Pediatrics, March 22, 2010; vol 125: pp
627-632.Merewood, A. Pediatrics, March 22, 2010; vol 125: pp
640-647. Cria G. Perrine, PhD, investigator, Division of Nutrition, Physical Activity
and Obesity, CDC, Atlanta.Anne Merewood, MPH, assistant professor of pediatrics, Boston University
School of Medicine.Frank R. Greer, MD, professor of pediatrics, University of Wisconsin-Madison
School of Medicine; chairman, American Academy of Pediatrics Committee on
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