Doubling of Vitamin D for Children Is Urged
By THE ASSOCIATED PRESS
Published: October 12, 2008
CHICAGO (AP) ― The country’s leading group of pediatricians is recommending that children receive double the usually suggested amount of vitamin D because of evidence that it might help prevent serious diseases.
To meet the new recommendation of 400 units daily, millions of children will need to take vitamin D supplements each day, the American Academy of Pediatrics said. That includes breast-fed infants ― even those who get some formula ― and many teenagers who drink little or no milk.
Baby formula contains vitamin D, so infants fed only formula generally do not need supplements. However, the academy recommends breast-feeding for at least the first year of life, and breast milk is sometimes deficient.
Most commercially available milk is fortified with vitamin D, but most children do not drink enough of it ― four cups daily would be needed ― to meet the new requirement, said Dr. Frank Greer, who helped write the report.
The new advice is based on mounting research about potential benefits from vitamin D besides keeping bones strong, including suggestions that it might reduce the risk for cancer, diabetes and heart disease. But the evidence is not conclusive, and there is no consensus on how much of the vitamin would be needed for disease prevention.
The advice replaces a 2003 academy recommendation for 200 units daily. That is the amount the government recommends for people up to age 50; 400 units is recommended for adults ages 51 to 70, and 600 units for those 71 and older. Vitamin D is sold in capsules and tablets, as well as in drops for young children.
The Institute of Medicine, a government advisory group that sets dietary standards, is discussing with federal agencies whether the recommendations should be changed based on the new research, said a spokeswoman, Christine Stencel.
The recommendations were to be released Monday at an academy conference in Boston. They will be published in the November issue of the academy’s journal, Pediatrics.
NEW GUIDELINES DOUBLE THE AMOUNT OF RECOMMENDED VITAMIN D
Below is a news release on a press briefing at the 2008 National Conference and Exhibition (NCE) of the American Academy of Pediatrics (AAP). Frank Greer, MD, FAAP, chairman of the AAP National Committee on Nutrition and a lead author of the AAP Clinical Report “Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents,” will present the key recommendations in the report at 10:45 a.m. Monday, Oct. 13 in the press briefing room 307 of the Hynes Convention Center. Carol C. Wagner, MD, FAAP, a member of the AAP Section on Breastfeeding Executive Committee and co-author of the report, will be available for telephone interviews. The report is embargoed until Monday, Oct. 13 at 12:01 a.m. ET.
For Release: Monday, Oct. 13, 2008, 12:01 am ET
BOSTON - The American Academy of Pediatrics (AAP) is doubling the amount of vitamin D it recommends for infants, children and adolescents. The new clinical report, "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents," recommends all children receive 400 IU a day of vitamin D, beginning in the first few days of life. The previous recommendation, issued in 2003, called for 200 IU per day beginning in the first two months of life.
The change in recommendation comes after reviewing new clinical trials on vitamin D and the historical precedence of safely giving 400 IU per day to the pediatric population. Clinical data show that 400 units of vitamin D a day will not only prevent rickets, but treat it. This bone-softening disease is preventable with adequate vitamin D, but dietary sources of vitamin D are limited, and it is difficult to determine a safe amount of sunlight exposure to synthesize vitamin D in a given individual. Rickets continues to be reported in the United States in infants and adolescents. The greatest risk for rickets is in exclusively breastfed infants who are not supplemented with 400 IU of vitamin D a day.
Adequate vitamin D throughout childhood may reduce the risk of osteoporosis. In adults, new evidence suggests that vitamin D plays a role in the immune system and may help prevent infections, autoimmune diseases, cancer and diabetes.
"We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits," said Frank Greer, MD, FAAP, chair of the AAP Committee on Nutrition and co-author of the report. “Supplementation is important because most children will not get enough vitamin D through diet alone.”
"Breastfeeding is the best source of nutrition for infants. However, because of vitamin D deficiencies in the maternal diet, which affect the vitamin D in a mother’s milk, it is important that breastfed infants receive supplements of vitamin D,” said Carol Wagner, MD, FAAP, member of the AAP Section on Breastfeeding Executive Committee and co-author of the report. “Until it is determined what the vitamin D requirements of the lactating mother-infant dyad are, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day.”
The new recommendations include:
* Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.
* All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.
* Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount.
* Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D.
Given the growing evidence that adequate vitamin D status during pregnancy is important for fetal development, the AAP also recommends that providers who care for pregnant women consider measuring vitamin D levels in this population.
Dr. Greer will be leading an educational session on vitamin D deficiency from 9:30 to 10:15 a.m. Monday, Oct. 13, in room 203 of the Hynes Convention Center. The presentation will include a discussion of the increase in vitamin D-deficient rickets and a review of studies on vitamin D supplementation during pregnancy, lactation and childhood. This presentation will be repeated from 4 to 4:45 p.m. Monday.
Editor’s Note: Also in October, the AAP will publish the sixth edition of its Pediatric Nutrition Handbook, which details the latest evidence-based guidelines on feeding children and adolescents and updates the previous version published in 2004. The new edition covers advances and developments in breastfeeding, fast food, vegetarian diets, newborn diarrhea, food labeling, preterm infant nutrition, chronic obesity and other topics.
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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults.
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