ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: JAMA Pediatr 2018;172(7):646-654

Vitamin D deficiency in infants can lead to impaired bone mineralization and rickets. Since the 1920s, vitamin D has been used to prevent and treat rickets, but the optimal supplementation dose for bone health was unclear. Similarly, potential extra-skeletal benefits of vitamin D in childhood have been inadequately explored. Acute infections in infants are a major cause of global morbidity and mortality. Observational studies have reported independent associations between low serum concentrations of 25-hydroxyvitamin D (25OHD) and susceptibility to infection. Vitamin D supplementation is widely used but the dosing is not based on evidence from randomized trials.

The aim of this study was to investigate if a higher dose (1200 IU) of supplemental vitamin D₃ administered to healthy infants from age 2 weeks to 2 years increases bone strength or decreases incidence of infections compared with the standard dose (400 IU). This randomized clinical trial of 975 infants found no difference in bone strength or incidence of infections between intervention groups at 24 months of age. Thus, study suggests that in healthy infants of northern European decent, daily supplementation with 1200 IU of vitamin D₃ provides no additional benefits compared with supplementation with 400 IU for bone strength or incidence of infections in early childhood. This study used peripheral quantitative computed tomography (pQCT), which is superior to dual-energy x-ray absorptiometry, to assess bone density and strength parameters. However, it should be noted that most infants were vitamin D sufficient at baseline and compliance was high. The outcome of a similar intervention might have been different in a vitamin D deficient cohort of infants, as demonstrated in recent meta-analysis by Martineau et al. (1). In any case, this study, the first of its kind, brings important, solid evidence to guide in establishing population-based vitamin D dose guidelines.

1. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Ginde AA, Goodall EC, Grant CC, Griffiths CJ, Janssens W, Laaksi I, Manaseki-Holland S, Mauger D, Murdoch DR, Neale R, Rees JR, Simpson S Jr, Stelmach I, Kumar GT, Urashima M, Camargo CA Jr. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017 Feb 15;356:i6583.