Transcript Bild 1

Nutrients of concern in
exclusively breastfed infants
7th Neonatal Conference, Jeddah
Saudi Arabia, 20-22 Feb 2012
Ted Greiner, Hanyang University
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Ted Greiner
• Vitamin D and iron are
the main nutrients of
public health concern
for all infants, and
special considerations
come into play with
exclusively breastfed
infants
• Vitamin D is actually not
a vitamin but a steroid
hormone.
• It is made in our skin
when exposed to ultraviolet radiation from
the
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sun.
• It is needed for the absorption of
calcium, and maintenance of normal
calcium and phosphorus levels, which
in turn are needed to make bone and
teeth.
• There are receptors for it in most of
the cells in our body so it probably has
other functions as well.
• It must undergo hydroxylation first in
the liver and again in the kidney to be
biologically active in the body as 1,25dihydroxyvitamin D [1,25(OH)2D]
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• Deficiency of
vitamin D and/or
calcium leads to
rickets, a disease
in children
in which the bones
grow soft and
deform in shape.
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2-year old boy
with rickets from
Eastern Cape, RSA
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• In adults this disease is called
osteomalacia. Adequate vitamin D
throughout life may also help
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prevent osteoporosis.
• Vitamin D deficiency (VDD) also
seems to lead to increased
susceptibility to infection.
• It seems to have a role in modulation
of cell growth, neuromuscular and
immune function, and reduction of
inflammation.
• VDD may be associated with an
increased risk of developing diabetes
and colon cancer.
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• Vitamin D is not
present in many
foods. It is in
small amounts
in eggs and
butter but NOT
in milk unless
commercially
fortified.
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• It is present in fatty salt-water fish
that feed near the surface and thus
cod-liver oil was used to provide
supplemental vitamin D before it was
available in synthetic form.
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• Recommended daily allowances
(RDAs) are 400 IU (10 g) per
day for infants <12 mo and 600
IU for others <70 yr.
• Mild adverse effects can in few
cases be seen at the tolerable
upper intake levels (ULs) at
doses of about 1000 IU for
infants < 6mo and 4000 IU a day
for people >9yr. Sun exposure
cannot lead to excess levels.
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• Vitamin D
transferred
placentally
meets the
needs of
newborns until
about 8 weeks
of age if the
mother was
not deficient.
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• Breast milk
usually provides
25-80 IU of bioactive vitamin D
per day
• This can be
increased by
maternal
supplementation
of 2000-4000 IU
per day
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• The required amount can be obtained
from sunlight but how much is
needed depends on:
– Skin colour
– Amount of clothing worn
– Cloudiness, smog or air pollution
– Use of sun screen (when used
effectively, it prevents formation of
vitamin D in skin)
– How high in the sky the sun is, in turn
determined by:
• Latitude
• Time of day
• Season
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Sun exposure may be inadequate
among:
•Women who veil
•Women or children who are
sequestered in the home
•People who are too sick or old
to spend enough time
outdoors
•People who are
institutionalised.
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• Sun exposure is
NOT recommended
< six months old:
–increased risk of
skin cancer later
in life.
• Sun exposure
should be for short,
regular periods.
• Avoid long
exposures and midday exposures.
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• For breast-fed infants
and others consuming
<1L/d of fortified milk,
400 IU per day is
recommended, given as
drops.
• Indeed, all children
should take a
supplement if they do
not consume adequate
fortified
milk
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• Commercial milk products and
some commercial infant foods
are the main foods fortified with
vitamin D.
• This varies by country so you
have to read labels.
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• Rickets is increasing in darkskinned people where exclusive
breastfeeding is increasing (USA
and UK).
• Breast milk has 1/5 the calcium
of cow milk.
• Supplements commonly given to
babies (sugar water; teas)
displace breast milk and calcium
deficiency may result.
• This has received little attention
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Ted Greiner
Professor of Nutrition
Hanyang University
Seoul, South Korea
Ted’s Email:
[email protected]
Ted’s Website:
www.tedgreiner.info
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