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Weiler HA, Fu WH, Razaghi M, Gharibeh N, Vanstone CA. Parathyroid hormone-vitamin D dynamics vary according to the definition of vitamin D deficiency in newborn infants. Bone 2023; 175:116862. [PMID: 37524294 DOI: 10.1016/j.bone.2023.116862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Parathyroid hormone (PTH) is an indirect functional indicator of vitamin D status. Risk of vitamin D deficiency, assessed using circulating 25-hydroxyvitamin D (25(OH)D), is defined as <30 nmol/L by the National Academy of Medicine and alternatively <25 nmol/L in the global consensus recommendation on prevention and management of nutritional rickets. OBJECTIVE To test PTH concentrations and the odds for elevated values according to vitamin D deficiency cut-points (<30 nmol/L, or <25 nmol/L) in newborn infants. METHODS Healthy term-born infants (n = 858) were recruited from Montreal, Canada (2016-2019). Obstetric data were obtained from medical records, and demographic factors surveyed. Immunoassays were used to measure newborn (24-36 h) serum PTH and 25(OH)D; 25(OH)D was standardized to National Institute of Standards and Technology (NIST) standard reference materials. Serum PTH was log-transformed before comparing serum 25(OH)D groups (<30 vs. ≥30; or <25 vs. ≥25 nmol/L) using ANCOVA adjusted for infant sex, type of delivery, parity, race, and family income. The odds of elevated PTH (>71.48 pg/mL) were tested using logistic regression, adjusted for the same covariates. RESULTS Infants (50.2 % female) were 39.6 ± 1.0 weeks gestational age (mean ± SD), and 3.41 ± 0.38 kg. Median serum 25(OH)D was 45.4 (IQR 23.2) nmol/L; 20.5 % had serum 25(OH)D < 30 nmol/L, and 12.4 % <25 nmol/L. Median serum PTH was 30.72 (IQR 33.90) pg/mL, elevated in 12.7 % overall, and higher in infants born with serum 25(OH)D < 25 vs. ≥25 nmol/L (35.96 (IQR 39.20) vs. 30.36 (IQR 32.93) pg/mL, p = 0.0158). The odds of elevated PTH were higher when serum 25(OH)D was <25 nmol/L (ORadj 2.13, 95 % CI: 1.23, 3.69). PTH concentration and the odds of being elevated did not differ according to the 30 nmol/L cut-point. CONCLUSIONS Based on this study, the definition of vitamin D deficiency relative to bone health as set by the National Academy of Medicine (<30 nmol/L) exceeds the threshold at which PTH is elevated in newborn infants.
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Affiliation(s)
- Hope A Weiler
- Nutrition Research Division, Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, ON, Canada; School of Human Nutrition, McGill University, Ste Anne de Bellevue, QC, Canada.
| | - Wen Hsuan Fu
- Nutrition Research Division, Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, ON, Canada
| | - Maryam Razaghi
- School of Human Nutrition, McGill University, Ste Anne de Bellevue, QC, Canada
| | - Nathalie Gharibeh
- School of Human Nutrition, McGill University, Ste Anne de Bellevue, QC, Canada
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Perrone S, Caporilli C, Grassi F, Ferrocino M, Biagi E, Dell’Orto V, Beretta V, Petrolini C, Gambini L, Street ME, Dall’Asta A, Ghi T, Esposito S. Prenatal and Neonatal Bone Health: Updated Review on Early Identification of Newborns at High Risk for Osteopenia. Nutrients 2023; 15:3515. [PMID: 37630705 PMCID: PMC10459154 DOI: 10.3390/nu15163515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Bone health starts with maternal health and nutrition, which influences bone mass and density already in utero. The mechanisms underlying the effect of the intrauterine environment on bone health are partly unknown but certainly include the 'foetal programming' of oxidative stress and endocrine systems, which influence later skeletal growth and development. With this narrative review, we describe the current evidence for identifying patients with risk factors for developing osteopenia, today's management of these populations, and screening and prevention programs based on gestational age, weight, and morbidity. Challenges for bone health prevention include the need for new technologies that are specific and applicable to pregnant women, the foetus, and, later, the newborn. Radiofrequency ultrasound spectrometry (REMS) has proven to be a useful tool in the assessment of bone mineral density (BMD) in pregnant women. Few studies have reported that transmission ultrasound can also be used to assess BMD in newborns. The advantages of this technology in the foetus and newborn are the absence of ionising radiation, ease of use, and, above all, the possibility of performing longitudinal studies from intrauterine to extrauterine life. The use of these technologies already in the intrauterine period could help prevent associated diseases, such as osteoporosis and osteopenia, which are characterised by a reduction in bone mass and degeneration of bone structure and lead to an increased risk of fractures in adulthood with considerable social repercussions for the related direct and indirect costs.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Caporilli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Federica Grassi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Mandy Ferrocino
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Eleonora Biagi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Valentina Dell’Orto
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Virginia Beretta
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Lucia Gambini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Maria Elisabeth Street
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Andrea Dall’Asta
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Tullio Ghi
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
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Preterm Infants on Early Solid Foods and Vitamin D Status in the First Year of Life—A Secondary Outcome Analysis of a Randomized Controlled Trial. Nutrients 2022; 14:nu14153105. [PMID: 35956281 PMCID: PMC9370713 DOI: 10.3390/nu14153105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Preterm birth places infants at high risk for mineral and micronutrient deficiencies important for bone health. The aim of this study was to examine whether two timepoints for the introduction of solid foods in preterm infants have an impact on vitamin D status in the first year of life. This is a secondary outcome analysis of a prospective, randomized trial on very low birth weight (VLBW) infants, randomized to an early (10–12th week corrected age) or a late (16–18th week corrected age) complementary-feeding group. Vitamin D status was assessed by blood samples taken at 6 weeks, 6, and 12 months corrected age. In total, 177 infants were randomized (early group: n = 89, late group: n = 88). There was a tendency toward lower levels of serum 25-OH-vitamin D in the early group throughout the first year of life (p = not significant (n.s.)); no differences were detected in the other parameters. At 6 months corrected age, infants of the early group had a significantly higher incidence of vitamin D deficiency. The timepoint of the introduction of solid foods had no impact on the serum 25-OH-vitamin D levels and other parameters important for bone health but showed a tendency toward lower levels in the early-feeding group.
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