1
|
Nyakundi PN, Némethné Kontár Z, Kovács A, Járomi L, Zand A, Lohner S. Fortification of Staple Foods for Household Use with Vitamin D: An Overview of Systematic Reviews. Nutrients 2023; 15:3742. [PMID: 37686773 PMCID: PMC10489979 DOI: 10.3390/nu15173742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Vitamin D deficiency is a global public health concern with significant implications for bone health and chronic disease prevention. Our aim was to summarize the evidence from Cochrane and other systematic reviews evaluating the benefits or harms of vitamin D fortification of staple foods for household use. In April 2023, we systematically searched Ovid MEDLINE, Embase, Epistemonikos and the Cochrane Database of Systematic Reviews for systematic reviews investigating the effects of vitamin D fortification of food in general populations of any age. We used Cochrane methodology and assessed the methodological quality of included studies using AMSTAR (A MeaSurement Tool to Assess Systematic Reviews). We assessed the degree of overlap among reviews. All outcomes included in systematic reviews were assessed. The protocol is registered in PROSPERO (registration number: CRD42023420991). We included 27 systematic reviews out of 5028 records for analysis. Overall, 11 out of 12 systematic reviews calculating pooled estimates reported a significant increase in serum 25(OH)D concentrations. The mean change in serum 25(OH)D concentrations per additional 100 units of vitamin D ranged from 0.7 to 10.8 nmol/L. Fortification of food with vitamin D showed a reduction in the prevalence of vitamin D deficiency based on high-certainty evidence. Parathormone (PTH) levels were described to decrease, bone mineral density to increase, while the effects on other bone turnover markers were inconsistent. Fortification did not significantly impact most anthropometric parameters, but it seemed to positively influence lipid profiles. In summary, fortification of food with vitamin D results in a reduction of vitamin D deficiency and might increase serum 25(OH)D concentrations, to varying extents depending on the fortified vehicle and population characteristics. Additionally, fortification may have a positive impact on bone turnover and lipid metabolism but may only have a limited effect on anthropometric parameters.
Collapse
Affiliation(s)
- Patrick Nyamemba Nyakundi
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | | | - Attila Kovács
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary
| | - Luca Járomi
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Afshin Zand
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Szimonetta Lohner
- Department of Public Health Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, 7623 Pécs, Hungary
| |
Collapse
|
2
|
Corsello A, Spolidoro GCI, Milani GP, Agostoni C. Vitamin D in pediatric age: Current evidence, recommendations, and misunderstandings. Front Med (Lausanne) 2023; 10:1107855. [PMID: 37007781 PMCID: PMC10060648 DOI: 10.3389/fmed.2023.1107855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
In recent years vitamin D has been in the spotlight of many researchers for its possible role in various disorders, including autoimmune and infectious diseases. Even if vitamin D deficiency remains a major public health problem, its symptomatic manifestations are less and less common in clinical practice, and pediatric age represents a “gray area” where vitamin D supplementation is often administered in the absence of an effective evaluation of its status. Moreover, a poor knowledge about different definitions of “deficiency,” “insufficiency,” and similar terms is spread among clinicians, while guidelines are not univocal, especially after the first year of life. The aim of this brief opinion paper is to sum up recent evidence about vitamin D status and its supplementation in pediatrics, in order to better clarify a common definition of its deficiency. The aim of this opinion article is to raise awareness on this topic among clinicians and encourage a discussion on the real need for routine 25-hydroxycholecalciferol serum evaluation and its supplementation.
Collapse
Affiliation(s)
- Antonio Corsello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Gregorio P. Milani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Gregorio P. Milani,
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
3
|
Brooker PG, Rebuli MA, Williams G, Muhlhausler BS. Effect of Fortified Formula on Growth and Nutritional Status in Young Children: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:5060. [PMID: 36501090 PMCID: PMC9737957 DOI: 10.3390/nu14235060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
Previous reviews of the effect of young child formulas on health outcomes in infants and toddlers have been inconclusive. In this study, we undertook a contemporary synthesis of studies investigating the effects of consuming fortified milk beverages (compared to cow’s milk or unfortified comparator formula) on growth and/or nutritional status in children 1−3 years of age. Five electronic databases were searched (PubMed, Web of Science, Scopus, ProQuest, and Cochrane Library) for randomised controlled trials comparing fortified milk against control milk in young children (9−48 months), published between January 1990 and June 2022. Outcomes were growth, body composition, biochemical markers, and/or nutritional status. Mean differences (MD) were pooled using random-effects meta-analysis where there were ≥3 studies. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Nineteen articles (12 studies; n = 4795) met the inclusion criteria. Heterogeneity was substantial, likely attributable to considerable variation in study characteristics. Fortified milk was associated with increased weight gain (MD = 0.14 kg [95% CI 0.06, 021], p = 0.0003) compared with control milk. Subgroup analyses demonstrated increases in weight in lower-income countries, and in studies with intervention periods > 6 months. There were no effects of fortified milks on other anthropometric measures. Haemoglobin (MD = 3.76 g/L [95% CI 0.17, 7.34], p = 0.04) and ferritin (MD = 0.01 nmol/L [95% CI 0.00, 0.02], p = 0.02) concentrations were increased in infants consuming fortified milks. Fortified milk beverages appear to offer a safe and acceptable source of complementary nutrition as a short-term strategy for addressing nutritional deficits and may modestly promote weight gain in vulnerable populations when provided for periods > 6 months. This study was prospectively registered with PROSPERO (CRD42022339920) and funded by the Infant Nutrition Council.
Collapse
Affiliation(s)
- Paige G. Brooker
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, BC 5000, Australia
| | | | | | | |
Collapse
|
4
|
Corsello A, Milani GP, Giannì ML, Dipasquale V, Romano C, Agostoni C. Different Vitamin D Supplementation Strategies in the First Years of Life: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10061023. [PMID: 35742074 PMCID: PMC9222934 DOI: 10.3390/healthcare10061023] [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: 04/06/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
Vitamin D (VD) is an essential micronutrient with multiple functions for human growth, and adequate intake should be guaranteed throughout life. However, VD insufficiency is observed in infants all over the world. Low VD concentration in the breast milk of non-supplemented mothers and low compliance to VD daily supplementation are the main causes of VD insufficiency, especially in the long term. Furthermore, VD supplementation dosages are still debated and differ by country. We conducted a systematic review to compare the most recent evidence on different postnatal VD supplementation strategies, determining whether supplementation given to the mother is as effective as that administered directly to the child, and whether different dosages and administration schedules differ significantly in terms of efficacy and safety. We identified 18 randomized controlled trials (RCTs) addressing the role of infant (n = 961), maternal (n = 652) or combined infant and maternal VD supplementation (n = 260 pairs). In all studies, similar outcomes emerged in terms of efficacy and safety. According to our findings, alternative approaches of VD supplementation may be adopted, especially in cases where the adherence to daily supplementation strategies is poor. This review shows that different dosages and supplementation strategies result in similar VD sufficiency rates. Therefore, international guidelines may be revised in the future to offer multiple and different options of supplementation for specific settings and ages.
Collapse
Affiliation(s)
- Antonio Corsello
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
| | - Gregorio Paolo Milani
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-349-832-0575
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, 98125 Messina, Italy; (V.D.); (C.R.)
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, 98125 Messina, Italy; (V.D.); (C.R.)
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (A.C.); (M.L.G.); (C.A.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
5
|
Woźniak D, Cichy W, Dobrzyńska M, Przysławski J, Drzymała-Czyż S. Reasonableness of Enriching Cow’s Milk with Vitamins and Minerals. Foods 2022; 11:foods11081079. [PMID: 35454665 PMCID: PMC9025252 DOI: 10.3390/foods11081079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/10/2022] Open
Abstract
Milk is an exceptional nutritional product that has been used for many millennia in human nutrition. Milk is a source of many valuable nutrients, including calcium, vitamin B, an especially significant amount of vitamin B2 and fat-soluble vitamins, such as A, D and E. Milk is an attractive product for fortification as it has a high nutritional density in a small volume and a relatively low price. Research shows positive health effects of drinking milk and consuming dairy products. Even more health benefits can be obtained from consuming fortified dairy products. A literature review, current nutritional recommendations, medical recommendations and an analysis of the market situation all recommend introducing milk enriched with minerals in combination with vitamins to the market. This concept corresponds to the current market demand and may supplement the missing and expected range of fortified milk and the correct number of recipients.
Collapse
Affiliation(s)
- Dagmara Woźniak
- Department of Bromatology, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (D.W.); (M.D.); (J.P.)
| | - Wojciech Cichy
- Department of Cosmetology, Faculty of Health Sciences, The President Stanisław Wojciechowski State University of Applied Sciences in Kalisz, Nowy Świat 4, 62-800 Kalisz, Poland;
| | - Małgorzata Dobrzyńska
- Department of Bromatology, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (D.W.); (M.D.); (J.P.)
| | - Juliusz Przysławski
- Department of Bromatology, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (D.W.); (M.D.); (J.P.)
| | - Sławomira Drzymała-Czyż
- Department of Bromatology, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (D.W.); (M.D.); (J.P.)
- Correspondence:
| |
Collapse
|
6
|
Verduci E, Di Profio E, Corsello A, Scatigno L, Fiore G, Bosetti A, Zuccotti GV. Which Milk during the Second Year of Life: A Personalized Choice for a Healthy Future? Nutrients 2021; 13:nu13103412. [PMID: 34684413 PMCID: PMC8540900 DOI: 10.3390/nu13103412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023] Open
Abstract
Nutrition in early life is a crucial element to provide all essential substrates for growth. Although this statement may appear obvious, several studies have shown how the intake of micro and macronutrients in toddlers differs a lot from the recommendations of scientific societies. Protein intake often exceeds the recommended amount, while the intake of iron and zinc is frequently insufficient, as well as Vitamin D. Nutritional errors in the first years of life can negatively impact the health of the child in the long term. To date, no clear evidence on which milk is suggested during the second year of life is yet to be established. In this study, we compare the nutrient profiles of cow’s milk and specific formulas as well as nutritional risks in toddlers linked to growth and childhood obesity development. The purpose of this review is to resume the latest clinical studies on toddlers fed with cow’s milk or young children formula (YCF), and the potential risks or benefits in the short and long term.
Collapse
Affiliation(s)
- Elvira Verduci
- Department of Health Sciences, University of Milan, 20146 Milan, Italy
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (A.C.); (L.S.); (G.F.); (A.B.); (G.V.Z.)
- Correspondence:
| | - Elisabetta Di Profio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (A.C.); (L.S.); (G.F.); (A.B.); (G.V.Z.)
- Department of Animal Sciences for Health, Animal Production and Food Safety, University of Milan, 20133 Milan, Italy
| | - Antonio Corsello
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (A.C.); (L.S.); (G.F.); (A.B.); (G.V.Z.)
| | - Lorenzo Scatigno
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (A.C.); (L.S.); (G.F.); (A.B.); (G.V.Z.)
| | - Giulia Fiore
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (A.C.); (L.S.); (G.F.); (A.B.); (G.V.Z.)
| | - Alessandra Bosetti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (A.C.); (L.S.); (G.F.); (A.B.); (G.V.Z.)
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (E.D.P.); (A.C.); (L.S.); (G.F.); (A.B.); (G.V.Z.)
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy
- Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, University of Milan, 20157 Milan, Italy
| |
Collapse
|
7
|
Al Khalifah R, Alsheikh R, Alnasser Y, Alsheikh R, Alhelali N, Naji A, Al Backer N. The impact of vitamin D food fortification and health outcomes in children: a systematic review and meta-regression. Syst Rev 2020; 9:144. [PMID: 32546259 PMCID: PMC7298752 DOI: 10.1186/s13643-020-01360-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Vitamin D (vitD) deficiency is a global childhood health problem. Food fortification is a promising strategy to curb vitD deficiency. We aimed to assess the effectiveness of utilizing vitD fortification in staple foods to improve 25hydroxyvitamin D (25(OH)D) concentration and to reduce the prevalence of vitD deficiency among healthy children. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of vitD fortified food products compared to no fortification among healthy children aged 1-18 years old. We searched Medline, Embase, Global Health, and Cochrane (CENTRAL) databases from database inception until May 2019. Independently, six reviewers in pairs screened titles and abstracts, assessed the full text for eligibility, and performed data extraction and quality assessment. The primary outcome is the impact of fortification on 25(OH)D concentration. The secondary outcomes included the impact of fortification on the prevalence of vitD deficiency, school performance, cognitive function, school absences, infection rate, hospital admission length, and compliance with fortified food product consumption. RESULTS We identified 2229 articles. After assessing eligibility, 20 RCTs met the inclusion criteria. The eligible RCTs assessed the fortification of milk, cereal, juice, bread, yogurt, and cheese compared with no fortification. All RCTs, except for three, had a low risk of bias. Food fortification improved 25(OH)D concentration by a mean difference (MD) of 15.51 nmol/L (95% confidence interval (CI) 6.28, 24.74; I2 = 99%), which resulted in a mean increase of 3 nmol/l for every 100 IU of vitD, when adjusted for baseline 25(OH)D concentration and country latitude. Additionally, the prevalence of vitD deficiency decreased by a risk ratio of 0.53 (95% CI 0.41, 0.69; I2 = 95%), and cognitive function improved by a MD of 1.22 intelligence quotient (IQ) points (95% CI 0.65, 1.79; I2 = 0%). The overall evidence quality was high. CONCLUSION VitD food fortification is an effective way to improve 25(OH)D concentration, prevent vitD deficiency, and improve IQ levels. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017057631.
Collapse
Affiliation(s)
- Reem Al Khalifah
- Division of Pediatric Endocrinology, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Rawan Alsheikh
- Pediatric Department, King Saud University, Riyadh, Saudi Arabia
| | - Yossef Alnasser
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, BC Children's Hospital, Vancouver, BC, Canada
| | - Rana Alsheikh
- Pediatric Department, King Saud University, Riyadh, Saudi Arabia
| | - Nora Alhelali
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ammar Naji
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Al Backer
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Division of Developmental-Behavioral Pediatric, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
A comparison of the effect of a Growing Up Milk - Lite (GUMLi) v. cows' milk on longitudinal dietary patterns and nutrient intakes in children aged 12-23 months: the GUMLi randomised controlled trial. Br J Nutr 2020; 121:678-687. [PMID: 30912737 DOI: 10.1017/s0007114518003847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The second year of life is a period of nutritional vulnerability. We aimed to investigate the dietary patterns and nutrient intakes from 1 to 2 years of age during the 12-month follow-up period of the Growing Up Milk - Lite (GUMLi) trial. The GUMLi trial was a multi-centre, double-blinded, randomised controlled trial of 160 healthy 1-year-old children in Auckland, New Zealand and Brisbane, Australia. Dietary intakes were collected at baseline, 3, 6, 9 and 12 months post-randomisation, using a validated FFQ. Dietary patterns were identified using principal component analysis of the frequency of food item consumption per d. The effect of the intervention on dietary patterns and intake of eleven nutrients over the duration of the trial were investigated using random effects mixed models. A total of three dietary patterns were identified at baseline: 'junk/snack foods', 'healthy/guideline foods' and 'breast milk/formula'. A significant group difference was observed in 'breast milk/formula' dietary pattern z scores at 12 months post-randomisation, where those in the GUMLi group loaded more positively on this pattern, suggesting more frequent consumption of breast milk. No difference was seen in the other two dietary patterns. Significant intervention effects were seen on nutrient intake between the GUMLi (intervention) and cows' milk (control) groups, with lower protein and vitamin B12, and higher Fe, vitamin D, vitamin C and Zn intake in the GUMLi (intervention) group. The consumption of GUMLi did not affect dietary patterns, however, GUMLi participants had lower protein intake and higher Fe, vitamins D and C and Zn intake at 2 years of age.
Collapse
|
9
|
Iodine-fortified toddler milk improves dietary iodine intakes and iodine status in toddlers: a randomised controlled trial. Eur J Nutr 2019; 59:909-919. [PMID: 30929067 DOI: 10.1007/s00394-019-01950-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE We aimed to evaluate the effectiveness of consuming iodine-fortified toddler milk for improving dietary iodine intakes and biochemical iodine status in toddlers. METHODS In a 20-week parallel randomised controlled trial, healthy 12-20-month-old children were assigned to: Fortified Milk [n = 45; iodine-fortified (21.1 µg iodine/100 g prepared drink) cow's milk], or Non-Fortified Milk (n = 90; non-fortified cow's milk). Food and nutrient intakes were assessed with 3-day weighed food records at baseline, and weeks 4 and 20. Urinary iodine concentration (UIC) was measured at baseline and 20 weeks. RESULTS At baseline, toddlers' median milk intake was 429 g/day. There was no evidence that milk intakes changed within or between the groups during the intervention. Toddlers' baseline geometric mean iodine intake was 46.9 µg/day, and the median UIC of 43 µg/L in the Fortified Milk group and 55 µg/L in the Non-Fortified Milk group indicated moderate and mild iodine deficiency, respectively, with this difference due to chance. During the intervention, iodine intakes increased by 136% (p < 0.001) and UIC increased by 85 µg/L (p < 0.001) in the Fortified Milk group compared to the Non-Fortified Milk group. The 20-week median UIC was 91 µg/L in the Fortified Milk group and 49 µg/L in the Non-Fortified Milk group. CONCLUSIONS Consumption of ≈ 1.7 cups of iodine-fortified toddler milk per day for 20 weeks can increase dietary iodine intakes and UIC in healthy iodine-deficient toddlers. This strategy alone is unlikely to provide sufficient intake to ensure adequate iodine status in toddlers at risk of mild-to-moderate iodine deficiency.
Collapse
|
10
|
Lovell AL, Davies PSW, Hill RJ, Milne T, Matsuyama M, Jiang Y, Chen RX, Wouldes TA, Heath ALM, Grant CC, Wall CR. Compared with Cow Milk, a Growing-Up Milk Increases Vitamin D and Iron Status in Healthy Children at 2 Years of Age: The Growing-Up Milk-Lite (GUMLi) Randomized Controlled Trial. J Nutr 2018; 148:1570-1579. [PMID: 30281106 DOI: 10.1093/jn/nxy167] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background Iron deficiency (ID) and vitamin D deficiency (VDD) are significant pediatric health issues in New Zealand and Australia and remain prevalent micronutrient deficiencies in young children globally. Objective We aimed to investigate the effect of a micronutrient-fortified, reduced-energy growing-up milk (GUMLi) compared with cow milk (CM) consumed for 1 y on dietary iron and vitamin D intakes and the status of New Zealand and Australian children at 2 y of age. Methods The GUMLi Trial was a multicenter, double-blind, randomized controlled trial in 160 healthy 1-y-old New Zealand and Australian children conducted in 2015-2017. Participants were randomly assigned 1:1 to receive GUMLi (1.7 mg Fe/100 mL; 1.3 µg cholecalciferol/100 mL) or CM (0.02 mg Fe/100 mL; 0.06 µg cholecalciferol/100 mL) for 12 mo. Secondary outcomes, reported here, included change in dietary iron and vitamin D intakes, iron status, and 25-hydroxyvitamin D [25(OH)D] concentrations from blood samples at age 2 y. All regression models were adjusted for baseline outcome and study center. Results GUMLi was a large contributor to dietary intakes of iron and vitamin D after 12 mo when compared with intakes from food and CM. The adjusted mean difference between groups for serum ferritin concentrations was 17.8 µg/L (95% CI: 13.6, 22.0 µg/L; P < 0.0001), and for 25(OH)D it was 16.6 nmol/L (95% CI: 9.9, 23.3 nmol/L; P < 0.0001). After 12 mo, ID was present in 16 (24%) participants in the CM group and 5 (7%) participants in the GUMLi group (P = 0.009), and the prevalence of VDD in the CM group increased to 14% (n = 10) and decreased to 3% (n = 2) (P = 0.03) in the GUMLi group. Conclusion In comparison with CM, GUMLi significantly improved dietary iron and vitamin D intakes and the iron and vitamin D status of healthy children at 2 y of age. This trial was registered with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) as ACTRN12614000918628.
Collapse
Affiliation(s)
| | - Peter S W Davies
- Children's Nutrition Research Center, UQ Child Health Research Center, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Rebecca J Hill
- Children's Nutrition Research Center, UQ Child Health Research Center, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Misa Matsuyama
- Children's Nutrition Research Center, UQ Child Health Research Center, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | | | | | | | - Cameron C Grant
- Department of Pediatrics, Child and Youth Health.,Center for Longitudinal Research He Ara ki Mua, University of Auckland, Auckland, New Zealand.,General Pediatrics, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | | |
Collapse
|
11
|
Red Meat Consumption and Serum Lipids and Fatty Acids in Toddlers: Secondary Outcomes of a Randomized Controlled Trial. J Pediatr Gastroenterol Nutr 2018; 67:395-400. [PMID: 29738346 DOI: 10.1097/mpg.0000000000002018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The aim of the study was to examine the effects of promoting increased lean red meat consumption on serum concentrations of total and high-density lipoprotein (HDL) cholesterol, and serum fatty acid composition, among toddlers. In a 20-week randomized controlled trial healthy 12 to 20-month-old children were assigned to: red meat (n = 90; parents were encouraged to add 56 g/day of lean red meat to their toddler's usual diet), or control (n = 90) groups. Food and nutrient intakes were assessed with 3-day weighed food records (baseline, week 4, and week 20). Serum was analyzed for total and HDL cholesterol concentrations, and fatty acid composition (baseline and week 20). At week 20, relative to control, the red meat group had higher intakes of red meat, all meat, and carbohydrate; and lower intakes of milk, energy, cholesterol, and total, saturated, and monounsaturated fat (P = 0.043 for energy, all others P ≤ 0.002). No effects associated with the intervention were found for total cholesterol, HDL cholesterol, total to HDL cholesterol ratio, or serum fatty acid composition (all P ≥ 0.059) aside from pentadecanoic acid (P = 0.047). An ∼3-fold increase in lean red meat intake, from ∼10 to ∼30 g/day, resulted in no consistent changes in serum lipids or fatty acid composition, suggesting that the addition of ∼2 tablespoons/day of lean red meat to toddlers' diets will likely not adversely affect serum lipids or serum fatty acids.
Collapse
|
12
|
Ganji V, Martineau B, Van Fleit WE. Association of serum vitamin D concentrations with dietary patterns in children and adolescents. Nutr J 2018; 17:58. [PMID: 29866150 PMCID: PMC5987485 DOI: 10.1186/s12937-018-0365-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background Because children have been advised on the dangers of sun exposure, diet is an important contributor of serum 25 hydroxyvitamin D [25(OH)D] concentrations. Aim of this study was to determine whether serum 25(OH)D concentrations were associated with any specific dietary patterns in US children. Methods Data from 2 cycles of National Health and Nutrition Examination Survey (NHANES) 2003–2004 and 2005–2006 for individuals aged 2 to ≤19 y, were used to study relation between dietary patterns and serum 25(OH)D. We derived 2 major dietary patterns based on the food frequency questionnaire data. These were labeled as High-Fat-Low-Vegetable Dietary (HFLVD) pattern and Prudent Dietary (PD) pattern. Results In multivariate adjusted analysis, there was no significant relationship between serum 25(OH)D concentrations and tertiles of HFLVD and PD dietary pattern scores in all subjects, boys, and girls. When dietary patterns scores were used as a continuous variable in adjusted analysis, children (all) with higher PD contribution scores to overall diet showed a significant positive relation with serum 25(OH)D (β = 59.1, P = 0.017). When data were stratified by sex, a significant positive relation was observed in girls between serum 25(OH)D concentration and PD pattern scores (β = 82.1, P = 0.015). A significant negative relation was observed in girls between serum 25(OH)D and HFLVD pattern scores (β = − 88.5, P = 0.016). Conclusion Overall, serum 25(OH)D were associated with PD pattern but not with HFLVD pattern in US children. In public health perspective, it is important to encourage children, especially girls who are consuming HFLVD pattern to shift to healthier diet.
Collapse
Affiliation(s)
- Vijay Ganji
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar.
| | | | | |
Collapse
|
13
|
Hodgkinson AJ, Wallace OA, Boggs I, Broadhurst M, Prosser CG. Gastric digestion of cow and goat milk: Impact of infant and young child in vitro digestion conditions. Food Chem 2018; 245:275-281. [DOI: 10.1016/j.foodchem.2017.10.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/04/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
|
14
|
Abstract
Young child formulae (YCF) are milk-based drinks or plant protein-based formulae intended to partially satisfy the nutritional requirements of young children ages 1 to 3 years. Although widely available on the market, their composition is, however, not strictly regulated and health effects have not been systematically studied. Therefore, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a systematic review of the literature to review the composition of YCF and consider their role in the diet of young children. The review revealed limited data but identified that YCF have a highly variable composition, which is in some cases inappropriate with very high protein and carbohydrate content and even high amounts of added sugars. Based on the evidence, ESPGHAN CoN suggests that the nutrient composition of YCF should be similar to that of follow-on formulae with regards to energy and nutrients that may be deficient in the diets of European young children such as iron, vitamin D, and polyunsaturated fatty acids (n-3 PUFAs), whereas the protein content should aim toward the lower end of the permitted range of follow-on formulae if animal protein is used. There are data to show that YCF increase intakes of vitamin D, iron, and n-3 PUFAs. However, these nutrients can also be provided via regular and/or fortified foods or supplements. Therefore, ESPGHAN CoN suggests that based on available evidence there is no necessity for the routine use of YCF in children from 1 to 3 years of life, but they can be used as part of a strategy to increase the intake of iron, vitamin D, and n-3 PUFA and decrease the intake of protein compared with unfortified cow's milk. Follow-on formulae can be used for the same purpose. Other strategies for optimizing nutritional intake include promotion of a healthy varied diet, use of fortified foods, and use of supplements.
Collapse
|
15
|
Effect of the dietary delivery matrix on vitamin D3 bioavailability and bone mineralisation in vitamin-D3-deficient growing male rats. Br J Nutr 2017; 119:143-152. [PMID: 29268806 DOI: 10.1017/s0007114517003518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study assessed bioavailability and utilisation of vitamin D3 in two feeding trials using young, growing Sprague-Dawley male rats. Trial one fed animals standard AIN-93G diet (casein protein) containing no vitamin D3 and goat or cow skimmed milk supplemented with vitamin D3. Trial two fed animals modified dairy-free AIN-93G diet (egg albumin) containing no vitamin D3 and goat or cow skimmed or full-fat milk supplemented with vitamin D3. Control groups received AIN-93G diets with or without vitamin D, and water. At 8 weeks of age, blood samples were collected for vitamin and mineral analysis, and femurs and spines were collected for assessment of bone mineralisation and strength. In both trials, analyses showed differences in bioavailability of vitamin D3, with ratios of serum 25-hydroxyvitamin D3 to vitamin D3 intake more than 2-fold higher in groups drinking supplemented milk compared with groups fed supplemented solid food. Bone mineralisation was higher in groups drinking supplemented milk compared with groups fed supplemented solid food, for both trials (P<0·05). There was no difference in the parameters tested between skimmed milk and full-fat milk or between cow milk and goat milk. Comparison of the two trials suggested that dietary protein source promoted bone mineralisation in a growing rat model: modified AIN-93G with egg albumin produced lower bone mineralisation compared with standard AIN-93G with casein. Overall, this study showed that effects of vitamin D3 deficiency in solid diets were reversed by offering milk supplemented with vitamin D3, and suggests that using milk as a vehicle to deliver vitamin D is advantageous.
Collapse
|
16
|
Akkermans MD, Eussen SR, van der Horst-Graat JM, van Elburg RM, van Goudoever JB, Brus F. A micronutrient-fortified young-child formula improves the iron and vitamin D status of healthy young European children: a randomized, double-blind controlled trial. Am J Clin Nutr 2017; 105:391-399. [PMID: 28052885 DOI: 10.3945/ajcn.116.136143] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 12/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) and vitamin D deficiency (VDD) are common among young European children because of low dietary intakes and low compliance to vitamin D supplementation policies. Milk is a common drink for young European children. Studies evaluating the effect of milk fortification on iron and vitamin D status in these children are scarce. OBJECTIVE We aimed to investigate the effect of a micronutrient-fortified young-child formula (YCF) on the iron and vitamin D status of young European children. DESIGN In this randomized, double-blind controlled trial, healthy German, Dutch, and English children aged 1-3 y were allocated to receive either YCF (1.2 mg Fe/100 mL; 1.7 μg vitamin D/100 mL) or nonfortified cow milk (CM) (0.02 mg Fe/100 mL; no vitamin D) for 20 wk. Blood samples were taken before and after the intervention. The primary and secondary outcomes were change from baseline in serum ferritin (SF) and 25-hydroxyvitamin D [25(OH)D], respectively. ID was defined as SF <12 μg/L in the absence of infection (high-sensitivity C-reactive protein <10 mg/L) and VDD as 25(OH)D <50 nmol/L. Statistical adjustments were made in intention-to-treat analyses for sex, country, age, baseline micronutrient status, and micronutrient intake from food and supplements (and sun exposure in the case of vitamin D outcomes). RESULTS The study sample consisted of 318 predominantly Caucasian (∼95%) children. The difference in the SF and 25(OH)D change between the treatment groups was 6.6 μg/L (95% CI: 1.4, 11.7 μg/L; P = 0.013) and 16.4 nmol/L (95% CI: 9.5, 21.4 nmol/L; P < 0.001), respectively. The probability of ID (OR 0.42; 95% CI:0.18, 0.95; P = 0.036) and VDD (OR 0.22; 95% CI: 0.01, 0.51; P < 0.001) after the intervention was lower in the YCF group than in the CM group. CONCLUSION Micronutrient-fortified YCF use for 20 wk preserves iron status and improves vitamin D status in healthy young children in Western Europe. This trial was registered at www.trialregister.nl as NTR3609.
Collapse
Affiliation(s)
- Marjolijn D Akkermans
- Department of Pediatrics, Juliana Children's Hospital/Haga Teaching Hospital, The Hague, Netherlands;
| | | | | | - Ruurd M van Elburg
- Danone Nutricia Research, Utrecht, Netherlands.,Department of Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; and
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; and.,Department of Pediatrics, VU University Medical Center, Amsterdam, Netherlands
| | - Frank Brus
- Department of Pediatrics, Juliana Children's Hospital/Haga Teaching Hospital, The Hague, Netherlands
| |
Collapse
|
17
|
Low vitamin D deficiency in Irish toddlers despite northerly latitude and a high prevalence of inadequate intakes. Eur J Nutr 2016; 57:783-794. [DOI: 10.1007/s00394-016-1368-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
|
18
|
Kehoe L, Walton J, McNulty BA, Nugent AP, Flynn A. Dietary strategies for achieving adequate vitamin D and iron intakes in young children in Ireland. J Hum Nutr Diet 2016; 30:405-416. [PMID: 27990698 DOI: 10.1111/jhn.12449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inadequate intakes of vitamin D and iron have been reported in young children in Ireland. The present study aimed to identify the main foods determining vitamin D and iron intakes and to model the impact of dietary strategies to improve adequacy of these micronutrients in young children. METHODS The present study is based on the Irish National Pre-School Nutrition Survey (NPNS), which estimated food and nutrient intakes in a representative sample (n = 500) of children (aged 1-4 years) using a 4-day weighed food record. Dietary strategies were modelled using DaDiet© software (Dazult Ltd, Co. Kildare, Republic of Ireland) and the usual intake distribution, prevalence of inadequate intakes and risk of excessive intakes were estimated using the National Cancer Institute method. RESULTS Fortified foods and nutritional supplements were the key foods influencing the intakes of vitamin D and iron. Adding a 5 μg day-1 vitamin D supplement, fortifying cow's milk (CM) with vitamin D or replacing CM with growing-up milk (GUM) would modestly increase intakes of vitamin D. A combined strategy of fortifying CM with vitamin D or replacing CM with GUM plus a 5 μg day-1 vitamin D supplement would increase mean intakes of vitamin D (from 3.5 μg day-1 at baseline to ≥11 μg day-1 ) and substantially reduce the prevalence of inadequate intakes (from >95% to 12-36%). Fortifying CM with iron or replacing CM with GUM would increase mean intakes of iron (from 7.3 mg day-1 to >10 mg day-1 ), achieving adequate intakes across all ages. CONCLUSIONS Based on real food consumption data in a representative sample of Irish children, we have shown that through targeted dietary strategies adequate intakes of iron are achievable and intakes of vitamin D could be greatly improved.
Collapse
Affiliation(s)
- L Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - J Walton
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - B A McNulty
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland
| | - A P Nugent
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Flynn
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| |
Collapse
|
19
|
Effect of fortified milk on growth and nutritional status in young children: a systematic review and meta-analysis. Public Health Nutr 2016; 20:1214-1225. [DOI: 10.1017/s1368980016003189] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractObjectiveAdequate nutrition is critical for optimal growth and development. However, young children may be at risk of nutrient deficiencies when transitioning to weaning foods for a variety of reasons. Supplementation with fortified milk may provide potentially lacking essential nutrients, but effects on growth and nutritional status are yet to be established.DesignFive databases were searched for randomised controlled trials using fortified milk against control milk in young children. Outcomes were growth, body composition and/or biochemical markers. Pooled differences in means were calculated for continuous outcomes and odds ratios for binary outcomes.SettingRandomised controlled trials set in any country.SubjectsOtherwise healthy children aged 6–47 months.ResultsFifteen articles met the eligibility criteria. Fortification varied from Fe, Zn, vitamins, essential fatty acids, to pre- and/or probiotics. Frequently reported outcomes were weight, height and Fe status. Studies varied in geographical location, sample size and duration. Fortified milk had minimal effects on weight gain (mean difference=0·17 kg; 95 % CI 0·02, 0·31 kg) compared with control milk. The risk of anaemia was reduced in fortified milk groups (OR=0·32; 95 % CI 0·15, 0·66) compared with control groups. There were no significant effects on height gain, changes in body composition or Hb concentration.ConclusionsFortified milk is an effective source of complementary nutrition to supplement children in need when consumed in appropriate amounts in addition to a normal diet. Due to compositional differences, further research on fortified milk is warranted before making global recommendations on benefits for growth and nutritional outcomes in young children.
Collapse
|
20
|
Cribb VL, Northstone K, Hopkins D, Emmett PM. Sources of vitamin D and calcium in the diets of preschool children in the UK and the theoretical effect of food fortification. J Hum Nutr Diet 2015; 28:583-92. [PMID: 25280181 PMCID: PMC4780273 DOI: 10.1111/jhn.12277] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Dietary intakes of vitamin D are very low in the UK. Dietary calcium is also necessary to promote bone health. The fortification of foods with vitamin D could be a safe and effective way of increasing intake. METHODS Diets of preschool children, 755 at 18 months and 3.5 years, from the Avon Longitudinal Study of Parents and Children were assessed using dietary records completed by parents. Energy, vitamin D and calcium intakes were calculated. Multinomial logistic regression was used to estimate the odds ratio for being in the highest/lowest quartile of intake. Intakes were recalculated to test different fortification regimes. RESULTS Vitamin D intakes were low; all children were below the UK and US dietary recommendations. Calcium intakes decreased between the two ages as a result of reduced milk consumption. Children in the lowest quartile for vitamin D intake at 18 months were twice as likely to remain in that quartile at 3.5 years (odds ratio = 2.35; 95% confidence interval = 1.56-3.55). The majority of foods provide no vitamin D with fat spreads and milk as the main sources. The contribution from breakfast cereals increased, from 6% to 12%, as a result of the increased consumption of fortified cereals. Dairy foods provided the highest contribution to calcium at 18 months but were less important at 3.5 years. Theoretical intakes from different fortification regimens suggest that milk fortified at 2 μg 100 g(-1) vitamin D would provide most children with adequate but not excessive intakes. CONCLUSIONS Dietary vitamin D intakes were very low and calcium intakes were mostly adequate. Fortification of milk with vitamin D could be a good way to boost intakes.
Collapse
Affiliation(s)
- V. L. Cribb
- Centre for Child and Adolescent HealthSchool for Social and Community MedicineUniversity of BristolBristolUK
| | - K. Northstone
- School for Social and Community MedicineUniversity of BristolBristolUK
| | - D. Hopkins
- Nutrition and Dietetic DepartmentSouthampton General HospitalHampshireUK
| | - P. M. Emmett
- Centre for Child and Adolescent HealthSchool for Social and Community MedicineUniversity of BristolBristolUK
| |
Collapse
|
21
|
Affiliation(s)
- Sina Gallo
- Nutrition and Food Studies (Gallo), George Mason University, Fairfax, Va.; Department of Pediatrics (Rodd), Children's Hospital, and Department of Pediatrics and Child Health (Rodd), University of Manitoba, Winnipeg, Man.
| | - Celia Rodd
- Nutrition and Food Studies (Gallo), George Mason University, Fairfax, Va.; Department of Pediatrics (Rodd), Children's Hospital, and Department of Pediatrics and Child Health (Rodd), University of Manitoba, Winnipeg, Man
| |
Collapse
|
22
|
Lee GJ, Birken CS, Parkin PC, Lebovic G, Chen Y, L'Abbé MR, Maguire JL. Consumption of non-cow's milk beverages and serum vitamin D levels in early childhood. CMAJ 2014; 186:1287-93. [PMID: 25332367 DOI: 10.1503/cmaj.140555] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vitamin D fortification of non-cow's milk beverages is voluntary in North America. The effect of consuming non-cow's milk beverages on serum 25-hydroxyvitamin D levels in children is unclear. We studied the association between non-cow's milk consumption and 25-hydroxyvitamin D levels in healthy preschool-aged children. We also explored whether cow's milk consumption modified this association and analyzed the association between daily non-cow's milk and cow's milk consumption. METHODS In this cross-sectional study, we recruited children 1-6 years of age attending routinely scheduled well-child visits. Survey responses, and anthropometric and laboratory measurements were collected. The association between non-cow's milk consumption and 25-hydroxyvitamin D levels was tested using multiple linear regression and logistic regression. Cow's milk consumption was explored as an effect modifier using an interaction term. The association between daily intake of non-cow's milk and cow's milk was explored using multiple linear regression. RESULTS A total of 2831 children were included. The interaction between non-cow's milk and cow's milk consumption was statistically significant (p = 0.03). Drinking non-cow's milk beverages was associated with a 4.2-nmol/L decrease in 25-hydroxyvitamin D level per 250-mL cup consumed among children who also drank cow's milk (p = 0.008). Children who drank only non-cow's milk were at higher risk of having a 25-hydroxyvitamin D level below 50 nmol/L than children who drank only cow's milk (odds ratio 2.7, 95% confidence interval 1.6 to 4.7). INTERPRETATION Consumption of non-cow's milk beverages was associated with decreased serum 25-hydroxyvitamin D levels in early childhood. This association was modified by cow's milk consumption, which suggests a trade-off between consumption of cow's milk fortified with higher levels of vitamin D and non-cow's milk with lower vitamin D content.
Collapse
Affiliation(s)
- Grace J Lee
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Catherine S Birken
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Patricia C Parkin
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Gerald Lebovic
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Yang Chen
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Mary R L'Abbé
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Jonathon L Maguire
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
| | | |
Collapse
|
23
|
Vandenplas Y, De Ronne N, Van De Sompel A, Huysentruyt K, Robert M, Rigo J, Scheers I, Brasseur D, Goyens P. A Belgian consensus-statement on growing-up milks for children 12-36 months old. Eur J Pediatr 2014; 173:1365-71. [PMID: 24764116 DOI: 10.1007/s00431-014-2321-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/10/2014] [Accepted: 04/10/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Growing-up milks (GUM) are milk-based drinks with low protein and added minerals and vitamins intended for children 12-36 months. Since the advantages of GUM are heavily debated, we reviewed the literature. A literature search was done using the classic databases (Pubmed, Embase, Cochrane) on the use of GUM in 12- to 36-month-old young children. Only limited data are available. GUM have a highly variable composition as their marketing is not regulated. Nevertheless, all papers conclude that GUM help to cover nutritional requirements of 12- to 36-month-old infants. CONCLUSION Appropriate intakes of macro- and micronutrients in 1- to 3-year-old children have long-term health benefits. Present diets offered to toddlers do in general not meet the requirements. Supplemented foods are therefore helpful, of which GUM is a possibility.
Collapse
Affiliation(s)
- Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium,
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Stagi S, Pelosi P, Strano M, Poggi G, Manoni C, de Martino M, Seminara S. Determinants of Vitamin D Levels in Italian Children and Adolescents: A Longitudinal Evaluation of Cholecalciferol Supplementation versus the Improvement of Factors Influencing 25(OH)D Status. Int J Endocrinol 2014; 2014:583039. [PMID: 25435877 PMCID: PMC4243588 DOI: 10.1155/2014/583039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/06/2014] [Accepted: 08/25/2014] [Indexed: 12/29/2022] Open
Abstract
Objective. This paper aims to assess 25(OH)D levels in Italian children and adolescents identifying risk factors for 25(OH)D deficiency and to evaluate whether a normal 25(OH)D value can be restored in 25(OH)D-deficient patients. Methods. We evaluated 25(OH)D levels in 679 Italian children and adolescents (≤10, 11-20, 21-30, and >30 ng/mL were defined as severe deficiency, deficiency, insufficiency, and sufficiency, resp.). Of these, 365 25(OH)D-deficient were followed up for 1 year; 205 were treated with cholecalciferol (Arm A: 400 I.U.) and 160 by improving the environmental variables influencing 25(OH)D levels (Arm B). Results. At cross-sectional evaluation, 11.3% showed sufficiency, 30.0% insufficiency, and 58.7% 25(OH)D deficiency. Mean 25(OH)D was 19.08 ± 8.44 ng/mL. At the enrollment time (T 0), no difference was found between Arms A and B with respect to distribution and 25(OH)D levels. At end time (T 1) 26.0% (29.7% in Arm A versus 20.6% in Arm B) showed sufficiency, 38.4% (42.0% versus 34.4%) insufficiency, and 35.6% (28.3% versus 45.0%) 25(OH)D deficiency. Mean 25(OH)D level was 23.71 ± 6.83 ng/mL. Conclusions. Neither changes of lifestyle nor 400 I.U. cholecalciferol supplementation alone appears to be sufficient to restore adequate 25(OH)D levels.
Collapse
Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
- Pediatric Endocrinology Unit, Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- *Stefano Stagi:
| | - Paola Pelosi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Massimo Strano
- Pediatric Unit, Mugello Hospital, Borgo San Lorenzo, 50032 Florence, Italy
| | - Giovanni Poggi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Cristina Manoni
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Maurizio de Martino
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Salvatore Seminara
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| |
Collapse
|
25
|
Dror DK, Allen LH. Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev 2013; 72:68-81. [DOI: 10.1111/nure.12078] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Daphna K Dror
- Allen Laboratory; US Department of Agriculure, Agricultural Research Service Western Human Nutrition Research Center; Davis California USA
| | - Lindsay H Allen
- Allen Laboratory; US Department of Agriculure, Agricultural Research Service Western Human Nutrition Research Center; Davis California USA
| |
Collapse
|
26
|
Walton J, Flynn A. Nutritional adequacy of diets containing growing up milks or unfortified cow's milk in Irish children (aged 12-24 months). Food Nutr Res 2013; 57:21836. [PMID: 24319407 PMCID: PMC3849623 DOI: 10.3402/fnr.v57i0.21836] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/23/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Growing up milks (GUM) are milk-based drinks with added vitamins and minerals intended for children aged 12-36 months. Few data are available on the consumption of GUM and their role in the diets of young children. OBJECTIVE To determine the nutritional adequacy of two groups of 12-24-month-old Irish children by type of milk consumption (consumers or non-consumers of GUM). DESIGN Using data from a cross-sectional study of Irish children, the National Pre-School Nutrition Survey (2010-2011), two groups of children were defined. The groups included children aged 12-24 months with an average daily total milk intake of at least 300 g and consuming GUM (≥100 g/day) together with cow's milk (n=29) or cow's milk only (n=56). RESULTS While average total daily energy intakes were similar in both consumers and non-consumers of GUM, intakes of protein, saturated fat, and vitamin B12 were lower and intakes of carbohydrate, dietary fibre, iron, zinc, vitamins C and D were higher in consumers of GUM. These differences in nutrient intakes are largely attributable to the differences in composition between GUM and cow's milk. For both consumers and non-consumers of GUM, intakes of carbohydrate and fat were generally in line with recommendations while intakes of protein, dietary fibre and most micronutrients were adequate. For children consuming cow's milk only, high proportions had inadequate intakes of iron and vitamin D; however, these proportions were much lower in consumers of GUM. CONCLUSIONS Consumption of GUM reduced the risk of inadequacies of iron and vitamin D, two nutrients frequently lacking in the diets of young children consuming unfortified cow's milk only.
Collapse
Affiliation(s)
- Janette Walton
- School of Food & Nutritional Sciences, University College Cork, Cork, Ireland
| | | |
Collapse
|
27
|
Hower J, Knoll A, Ritzenthaler KL, Steiner C, Berwind R. Vitamin D fortification of growing up milk prevents decrease of serum 25-hydroxyvitamin D concentrations during winter: a clinical intervention study in Germany. Eur J Pediatr 2013; 172:1597-605. [PMID: 23851699 DOI: 10.1007/s00431-013-2092-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
Abstract
Vitamin D plays an important role in human health. Current recommendations for vitamin D intake and endogenous supply through sun exposure are not met in German pre-school children, and suboptimal serum 25-hydroxyvitamin D concentrations, especially during the winter months, are common. Consequently, vitamin D supplementation or fortification have gained increased acceptance. The KiMi trial (Kindermilch=growing up milk) was a prospective, randomized, and double-blind study in which young children (2-6 years of age, n=92) were assigned to receive either vitamin D-fortified growing up milk (2.85 μg/100 ml) or semi skimmed cow's milk without added vitamin D. Daily consumption of fortified growing up milk contributed to the prevention of an otherwise frequently observed decrease in serum 25-hydroxyvitamin D concentration during winter (before winter: median 21.5 ng/mL (10.1-43.0 ng/mL) intervention vs. median 18.4 ng/mL (11.0-44.9 ng/mL) control; after winter: median 24.8 ng/mL (7.0-48.2 ng/mL) intervention vs. median 13.6 ng/mL (7.0-36.8 ng/mL) control) and proved to be safe during summer (median 27.6 ng/mL (18.8-40.5 ng/mL) intervention vs. median 27.4 ng/mL (17.8-38.7 ng/mL) control). Due to the high prevalence of vitamin D deficiency, fortification of growing up milk with vitamin D at a level used in this study could be an effective measure to improve vitamin D status.
Collapse
Affiliation(s)
- Jürgen Hower
- Überörtliche Gemeinschaftspraxis für Kinder- und Jugendmedizin Standort Dümpten, Mellinghofer Straße 256, 45475, Mülheim an der Ruhr, Germany,
| | | | | | | | | |
Collapse
|
28
|
Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA J 2013. [DOI: 10.2903/j.efsa.2013.3408] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
29
|
Madsen KH, Rasmussen LB, Andersen R, Mølgaard C, Jakobsen J, Bjerrum PJ, Andersen EW, Mejborn H, Tetens I. Randomized controlled trial of the effects of vitamin D–fortified milk and bread on serum 25-hydroxyvitamin D concentrations in families in Denmark during winter: the VitmaD study. Am J Clin Nutr 2013; 98:374-82. [PMID: 23783292 DOI: 10.3945/ajcn.113.059469] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Vitamin D intakes are lower than dietary recommendations in most populations, and thus, a low vitamin D status is widespread, especially during winter. OBJECTIVE We investigated the effects of increasing vitamin D intake to the recommended amount by fortification of milk and bread on serum 25-hydroxyvitamin D [25(OH)D] concentrations in families during winter in Denmark. DESIGN The study was a randomized controlled trial in 782 children and adults (4-60 y old) recruited as 201 families. Families were randomly assigned to vitamin D-fortified or nonfortified milk and bread for 6 mo starting in September. The milk and bread replaced the participants' usual consumptions of products. RESULTS Median (IQR) vitamin D intakes (habitual diet plus fortified products) were 9.4 mg/d (6.5, 12.3 mg/d) and 2.2 mg/d (1.5, 3.0 mg/d) in fortification and control groups, respectively. Geometric mean (IQR) serum 25(OH)D concentrations decreased from 73.1 nmol/L (61.9, 88.5 nmol/L) to 67.6 nmol/L (56.2, 79.4 nmol/L) in the fortification group and from 71.1 nmol/L (61.2, 85.9 nmol/L) to 41.7 nmol/L (29.5, 58.9 nmol/L) in the control group (both P , 0.001). The final 25(OH)D concentration was significantly higher in the fortification group than in the control group (P , 0.001). By the end of the study, ,1% of subjects in the fortification group and 25% of subjects in the control group had 25(OH)D concentrations ,30 nmol/L and 16% and 65% of subjects, respectively, had 25(OH)D concentrations ,50 nmol/L. CONCLUSION Vitamin D fortification of milk and bread reduces the decrease in serum 25(OH)D concentrations during winter and ensures 25(OH)D concentrations .50 nmol/L in children and adults in Denmark.
Collapse
Affiliation(s)
- Katja H Madsen
- Division of Nutrition, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860 Søborg, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Jäpelt RB, Jakobsen J. Vitamin D in plants: a review of occurrence, analysis, and biosynthesis. FRONTIERS IN PLANT SCIENCE 2013; 4:136. [PMID: 23717318 PMCID: PMC3651966 DOI: 10.3389/fpls.2013.00136] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/22/2013] [Indexed: 05/20/2023]
Abstract
The major function of vitamin D in vertebrates is maintenance of calcium homeostasis, but vitamin D insufficiency has also been linked to an increased risk of hypertension, autoimmune diseases, diabetes, and cancer. Therefore, there is a growing awareness about vitamin D as a requirement for optimal health. Vitamin D3 is synthesized in the skin by a photochemical conversion of provitamin D3, but the necessary rays are only emitted all year round in places that lie below a 35° latitude. Unfortunately, very few food sources naturally contain vitamin D and the general population as a results fail to meet the requirements. Fish have the highest natural content of vitamin D expected to derive from an accumulation in the food chain originating from microalgae. Microalgae contain both vitamin D3 and provitamin D3, which suggests that vitamin D3 exist in the plant kingdom and vitamin D3 has also been identified in several plant species as a surprise to many. The term vitamin D also includes vitamin D2 that is produced in fungi and yeasts by UVB-exposure of provitamin D2. Small amounts can be found in plants contaminated with fungi and traditionally only vitamin D2 has been considered present in plants. This review summarizes the current knowledge on sterol biosynthesis leading to provitamin D. It also addresses the occurrence of vitamin D and its hydroxylated metabolites in higher plants and in algae and discusses limitations and advantages of analytical methods used in studies of vitamin D and related compounds including recent advances in analytical technologies. Finally, perspectives for a future production of vitamin D biofortified fruits, vegetables, and fish will be presented.
Collapse
Affiliation(s)
- Rie B. Jäpelt
- Division of Food Chemistry, National Food Institute, Technical University of DenmarkSøborg, Denmark
| | | |
Collapse
|
31
|
Rajasekaran A, Kalaivani M. Designer foods and their benefits: A review. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2013; 50:1-16. [PMID: 24425882 PMCID: PMC3550947 DOI: 10.1007/s13197-012-0726-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 04/02/2012] [Accepted: 04/27/2012] [Indexed: 02/07/2023]
Abstract
Designer foods are normal foods fortified with health promoting ingredients. These foods are similar in appearance to normal foods and are consumed regularly as a part of diet. In this article we have reviewed the global regulatory status and benefits of available designer foods such as designer egg, designer milk, designer grains, probiotics, designer foods enriched with micro and macronutrients and designer proteins. Designer foods are produced by the process of fortification or nutrification. With the advances in the biotechnology, biofortification of foods using technologies such as recombinant DNA technology and fermentation procedures are gaining advantage in the industry. The ultimate acceptability and extensive use of designer foods depend on proper regulation in the market by the regulatory authorities of the country and by creating consumer awareness about their health benefits through various nationwide programs.
Collapse
Affiliation(s)
- A. Rajasekaran
- />KMCH College of Pharmacy, Kalapatti Road, Coimbatore, 641 048 Tamil Nadu India
| | - M. Kalaivani
- />Indian Pharmacopoeia Commission, Sector-23, Raj Nagar, Ghaziabad-201002, Uttar Pradesh India
| |
Collapse
|
32
|
Maguire JL, Lebovic G, Kandasamy S, Khovratovich M, Mamdani M, Birken CS, Parkin PC. The relationship between cow's milk and stores of vitamin D and iron in early childhood. Pediatrics 2013; 131:e144-51. [PMID: 23248224 DOI: 10.1542/peds.2012-1793] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the association between cow's milk intake on both vitamin D and iron stores in healthy urban preschoolers. METHODS Healthy children 2 to 5 years of age were recruited from December 2008 through December 2010 through the TARGet Kids! practice-based research network. Cow's milk intake was measured by parental report. Vitamin D and iron stores were measured by using serum 25-hydroxyvitamin D and ferritin. Bivariate multivariable linear regression was used to examine the effect of cow's milk intake simultaneously on 25-hydroxyvitamin D and serum ferritin. Analyses were stratified by important clinical variables including skin pigmentation, bottle feeding, vitamin D supplementation, and season. RESULTS Among 1311 children, increasing cow's milk consumption was associated with decreasing serum ferritin (P < .0001) and increasing 25-hydroxyvitamin D (P ≤ .0001). Two cups (500 mL) of cow's milk per day maintained 25-hydroxyvitamin D >75 nmol/L with minimal negative effect on serum ferritin for most children. Children with darker skin pigmentation not receiving vitamin D supplementation during the winter required 3 to 4 cups of cow's milk per day to maintain 25-hydroxyvitamin D >75 nmol/L. Cow's milk intake among children using a bottle did not increase 25-hydroxyvitamin D and resulted in more dramatic decreases in serum ferritin. CONCLUSIONS There is a trade-off between increasing 25-hydroxyvitamin D and decreasing serum ferritin with increasing milk intake. Two cups of cow's milk per day appears sufficient to maintain healthy vitamin D and iron stores for most children. Wintertime vitamin D supplementation was particularly important among children with darker skin pigmentation.
Collapse
Affiliation(s)
- Jonathon L Maguire
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Nishi Y, Hatano S, Aihara K, Kihara M. [Significance of copper analysis in clinical tests]. Mol Nutr Food Res 1990; 60:119-33. [PMID: 2622002 DOI: 10.1002/mnfr.201500243] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 12/14/2022]
|