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Pediatricians Double Recommended Vitamin D Intake, Suggest Earlier Use

This article was originally published in The Tan Sheet

Executive Summary

The American Academy of Pediatrics doubles its recommendation for daily vitamin D intake by infants, children and adolescents to 400 IU and advises earlier supplementation with the vitamin

The American Academy of Pediatrics doubles its recommendation for daily vitamin D intake by infants, children and adolescents to 400 IU and advises earlier supplementation with the vitamin.

The academy announced Oct. 13 it advocates all infants, children and adolescents consume at least 400 international units of vitamin D daily beginning in the first few days of life.

AAP previously recommended 200 IU of vitamin D daily for these groups beginning within two months of birth (1 (Also see "Supplemental Vitamin D Recommended For Breastfed Infants By AAP" - Pink Sheet, 14 Apr, 2003.), p. 16).

According to a report prepared for the November 2008 Pediatrics journal, the academy revised the guidelines because historical data show 400 IU of vitamin D daily is safe.

The Institute of Medicine's current recommendation for dietary reference intake - an indication for an adequate level - for infants up to 1 year old is 200 IU. IoM does not establish a recommended daily allowance for vitamin D, but sets a Tolerable Upper Intake Level of 1,000 IU (2 'The Tan Sheet' Sept. 1, 2008, p. 12).

AAP also says new clinical data show the higher daily intake not only can prevent rickets, but also treat the bone-softening disease that is linked to vitamin D deficiency and continues to affect children in the U.S. and western countries.

"Vitamin D supplementation has the potential to help prevent these serious diseases," considering "the current diet and lifestyle habits of young children who are not consuming enough fortified milk, are drinking more caffeinated beverages and are not getting enough outdoor sunlight," said Andrew Shao, VP of scientific and regulatory affairs at the Council for Responsible Nutrition.

Like CRN, the Natural Products Association commends AAP for the change. "This signals that they are pretty aware of the situation and know what needs to be done," said Dan Fabricant, NPA's VP of scientific and regulatory affairs.

Differences On Recommended Levels

The National Osteoporosis Foundation also pointed to diet and less exposure to sunlight in its 2007 recommendation for increased vitamin D intake for elderly people.

NOF updated its recommendation for daily adequate intake of vitamin D by adults 50 years of age and older from 400 IU to 800-1,000. The group said sufficient evidence exists to make the recommendation and not wait until after the Department of Agriculture raises its recommended daily allowance from the current level of 400 IU (3 (Also see "Osteoporosis Foundation Discusses Evidence To Increase Vitamin D RDA" - Pink Sheet, 14 May, 2007.), p. 10).

However, during a 2007 National Institutes of Health meeting on vitamin D, some experts stressed the lack of safety data precludes the development of new recommendations.

Further, staff from NIH's Office of Dietary Supplements determined that more research is needed in certain areas before the IoM could revisit and amend the current DRI (4 (Also see "“All-Time High” Vitamin D Awareness May Make New DRI Less Relevant – CRN" - Pink Sheet, 1 Sep, 2008.), p. 12).

Most At Risk

The AAP report emphasizes that breastfed infants are most at risk of vitamin D deficiency, and should take a 400 IU supplement daily.

The guidance explains that "when the breast feeding mother has marginal vitamin D status or frank deficiency ... concentrations are very low in unsupplemented infants, particularly in the winter months in latitudes further from the equator."

Infants fed formula exclusively are less at risk of deficiency because all formulas sold in the U.S. have at least 400 IU/L of vitamin D, the report says.

However, infants who consume less than 1 liter of formula daily should be supplemented, AAP said.

Infant supplementation is necessary in part because it is not a safe option for nursing mothers to take extra high doses of vitamin D supplements to increase the concentration in their milk, according to the report.

Researchers need to validate and demonstrate the safety of high-dose supplements in larger populations of lactating women and infants, the report says.

Assess Levels During Pregnancy

The academy also recommends health care professionals assess pregnant women's vitamin D concentrations regularly because when a woman deficient in the substance gives birth, the child also will be deficient and at higher risk for rickets.

In addition, "adequate nutritional vitamin D status during pregnancy is important for fetal skeletal development, tooth enamel formation and perhaps general fetal growth and development," the AAP report says.

For example, for every additional 40 IU of vitamin D a pregnant woman takes, there is an associated 11-gram increase in her child's birth weight, the guidance notes.

Even if the mother consumes enough vitamin D for herself, it makes sense that "when you are eating for two your levels for baseline vitamin D go down," making supplementation necessary, said NPA's Fabricant.

Continual Supplementation

Finally, the academy recommends continual vitamin D supplementation through adolescence at a level that guarantees consumption of at least 400 IU daily.

Vitamin D deficiency "covers the life span, with periods of vulnerability that mirror periods of accelerated growth or physiologic change," according to the report.

The increased recommendation also offers "many opportunities for dietary supplement manufacturers, as well as food manufacturers, to develop more products with vitamin D, particularly products that target this population," said Shao.

Already aware of research that showed infants benefit from higher than 200 IU of vitamin D daily, Carlson Laboratories last July launched Baby Ddrops (5 (Also see "New Dietary Supplement Products In Brief" - Pink Sheet, 14 Jul, 2008.), p. 10).

The liquid vitamin D3 supplements provide infants with a 400 IU dose of vitamin D3 in each drop, said Melissa Wilson, Carlson's quality assurance coordinator. She added that the 400 IU dose is well within the conservative practice, considering the safe upper limit for infants for vitamin D is 1,000 IU daily.

- Elizabeth Crawford ([email protected])

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