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Abstract
How human milk as the ideal infant nutrition lacks vitamin D activity leading to the severe bony deformities and muscle weakness of rickets has stymied scientists and clinicians for centuries. Recent understanding of human vitamin D requirements based on functional indicators of vitamin D activity demonstrate that the majority of humans, including lactating mothers, subsist in a vitamin D insufficient state. In this state, human milk provides inadequate vitamin D supply to the nursing infant. In contrast, with achieving maternal vitamin D sufficiency, human milk attains vitamin D activity equivalent to present infant oral supplementation. Current investigation of the role of vitamin D in diseases beyond bone health is revealing the significance of early life vitamin D sufficiency in establishing lifelong health.
Key teaching points
•With decreased UVB exposure in the modern lifestyle, oral supplementation of vitamin D is a health requirement.
•Current evaluations of adult vitamin D needs based on indicators of vitamin D function in bone health and disease prevention identify circulating 25(OH)D concentrations of 32 ng/ml as the lower limit of vitamin D sufficiency.
•When a lactating mother receives 400 IU per day vitamin D supplementation, her milk contains 33–68 IU/L vitamin D activity which is far below the recommended daily vitamin D intake of 200–800 IU per day for infants.
•In a pilot clinical trial, maternal supplementation of 6400 IU per day vitamin D3 for 6 months was safe and raised the milk vitamin D content from 82 IU/L to 873 IU/L.
•Current evidence points to a vitamin D dose of 400 IU/day as adequate to achieve serum 25(OH)D concentration >11 ng/ml in nearly all infants and >20 ng/ml in many infants, although high-risk populations may need more.
•The Canadian Paediatric Society recommends 2000 IU/day supplementation to a lactating mother with monitoring of her serum 25(OH)D status. This amount of supplementation or greater is likely needed for maternal vitamin D health.
Key teaching points
•With decreased UVB exposure in the modern lifestyle, oral supplementation of vitamin D is a health requirement.
•Current evaluations of adult vitamin D needs based on indicators of vitamin D function in bone health and disease prevention identify circulating 25(OH)D concentrations of 32 ng/ml as the lower limit of vitamin D sufficiency.
•When a lactating mother receives 400 IU per day vitamin D supplementation, her milk contains 33–68 IU/L vitamin D activity which is far below the recommended daily vitamin D intake of 200–800 IU per day for infants.
•In a pilot clinical trial, maternal supplementation of 6400 IU per day vitamin D3 for 6 months was safe and raised the milk vitamin D content from 82 IU/L to 873 IU/L.
•Current evidence points to a vitamin D dose of 400 IU/day as adequate to achieve serum 25(OH)D concentration >11 ng/ml in nearly all infants and >20 ng/ml in many infants, although high-risk populations may need more.
•The Canadian Paediatric Society recommends 2000 IU/day supplementation to a lactating mother with monitoring of her serum 25(OH)D status. This amount of supplementation or greater is likely needed for maternal vitamin D health.
Notes
Disclosure: Dr. Hollis serves as scientific advisor for Diasorin Corporation.