Just over a quarter of infants are meeting AAP guidelines on vitamin D intake, leaving many vulnerable to rickets, according to a new study.
In 2008, the AAP began recommending infants under 1 year receive 400 international units of vitamin D daily, which it reiterated in a 2014 clinical report. Breastfed infants and formula-fed infants who consume less than 32 ounces of formula daily should take a supplement to prevent softening of children’s bones, according to the AAP.
To gauge adherence to the recommendations, researchers looked at 2009-2016 data from the National Health and Nutrition Examination Surveys. Parents provided information on the diet and supplement intake for 1,435 infants, and the data were reported today in “Adherence to Vitamin D Intake Guidelines in the United States,” (Simon AE, Ahrens KA. Pediatrics. May 18, 2020, https://doi.org/10.1542/peds.2019-3574).
The data showed only 27% met the guidelines — 31% of non-breastfeeding infants and 20.5% of breastfeeding infants. Intake did not improve significantly over time.
In almost all demographic groups, the rate of adherence was 40% or less.
Black infants and those in a small racial category that included Asian, American Indian, Alaska Native, Native Hawaiian and Pacific Islander infants were more likely to meet guidelines than non-Hispanic white infants. Adjusted analysis found the higher rates remained significant for the small racial group, and authors said the findings may be due to higher formula intake among these groups.
Raw data also show among breastfed infants, those whose parents were more educated and had a higher income were more likely to meet the guidelines. Education remained a significant factor in the adjusted analysis.
Overall, low rates of vitamin D intake may be due to rickets being uncommon, a lack of communication with caregivers, or physicians being unaware of or disagreeing with the guidelines, according to the study. Caregivers also simply may not follow their doctors’ recommendations.
Authors of a related commentary discussed possible alternatives to liquid supplements such as dissolving filmstrips or supplementing mothers of exclusively breastfed infants. Some countries have mandated vitamin D fortification in some foods. Electronic health record alerts and finding additional opportunities for counseling on the need for supplements also may help improve rates.
“The study is a call to action for the pediatric community to rethink and to reassess its approaches to optimizing vitamin D supplementation for infants,” they wrote. “Additional research is needed to better understand prescribing patterns, barriers to adherence by parents of infants, and alternate strategies for vitamin D supplementation to inform novel public health programs in the United States.”