BOSTON — All children should get at least 400 IU of vitamin D daily, either through dietary intake or supplementation, beginning within days of birth and continuing through adolescence.
New guidelines from the American Academy of Pediatrics double its 2003 vitamin D intake recommendation in an effort to prevent the development of rickets in specific pediatric populations and take advantage of the potential long-term health benefits associated with adequate intake of the fat-soluble nutrient, Dr. Frank Greer, chairman of the academy's National Committee on Nutrition and coauthor of the report, said at the AAP's annual meeting.
The new guidelines are “logical” amid continued reports of rickets in infants and adolescents in the United States and mounting clinical evidence that 200 IU a day may not sufficiently prevent deficiency-related conditions, said Dr. Greer, professor of pediatrics at the University of Wisconsin, Madison.
Increasing evidence in the adult literature has also implicated vitamin D in the prevention of infection; autoimmune diseases; some forms of cancer; osteoporosis; and type 2 diabetes.
The 2003 guidelines suggested vitamin D supplementation primarily for babies who were breastfed exclusively, with the belief that most other children would be able to meet the 200-IU/day recommendation through normal diet and milk consumption. But, Dr. Greer said, “now that we're at 400 IU, we are strongly recommending supplementation across the board because the presence of vitamin D as a natural ingredient in food in most diets is limited.”
Specific points in the guidelines include:
▸ Breastfed and partially breastfed babies should be supplemented with 400 IU of vitamin D daily beginning in the first few days of life.
▸ Infants and children who consume less than one quart of vitamin D-fortified formula or milk daily should receive a 400-IU supplement.
▸ Adolescents who do not get 400 IU of vitamin D through diet should take a daily supplement of that amount.
▸ Children at increased risk of vitamin D deficiency, such as those with chronic fat malabsorption and those taking certain antiseizure medications, may require higher doses of vitamin D.
African American babies are at particularly increased risk for vitamin D deficiency because dark skin pigmentation interferes with the penetration of ultraviolet light and with vitamin D production.
Adolescents, whose intake of vitamin D-fortified milk and vitamin D-rich foods such as fatty fish is generally insufficient, are also at risk. “It's not clear, especially in adolescents, whether 400 IU of vitamin D is enough … but we're concerned about recommending more than 400 IU because of the likelihood that vitamin D is going to start showing up in all sorts of foods, thanks to the [Food and Drug Administration's] allowance of qualified health care claims on food packaging,” Dr. Greer said, “Vitamin D is a prohormone that acts directly on cells to promote gene transcription. It's a powerful nutrient, so we have to be careful.”
The guidelines will be published in the November issue of Pediatrics (2008;122:1142-52).
Dr. Greer reported no conflicts of interest with respect to his presentation.