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Indian Pediatr 2017;54: 511 |
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Going
Solar is Good but Caution Needed!
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*G Karthikeyan and #GK
Monish
Department of Pediatrics, Karuna Medical College,
Palakkad and #Coimbatore Medical College,
Coimbatore; India.
Email:
[email protected]
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We read with interest the recent article exploring augmentation of
vitamin D levels in predominantly breastfed infants the natural way –
that is exposure to sunlight [1]. In the accompanying editorial in the
same issue, cost of medicinal way of augmentation is put forth as a
justification for exploring the solar option [2]. We have following
comments:
1. How neutrality was maintained while requiring
the mothers to maintain sun exposure charts. At the study end point,
only 10% of infants were vitamin D sufficient. Were 90% of the
infants with insufficient vitamin D status given vitamin D
supplementation at the end of study period till 1 year?
2. Apart from sun exposure, maternal vitamin D
level at enrolment was a significant predictor of infant vitamin D
statusin this study. Antenatal calcium supplements, which 93% of
these mothers received, obviously did not have any effect, and thus
it is vitamin D supplementation that matters.
3. The sun exposure details of the study group
mothers is not given. It will be interesting to find why 90% of them
were vitamin D deficient (whether it is despite reasonable sun
exposure).
Why not treat the mother-infant dyad, rather than
infant alone, as achieving vitamin D sufficiency is equally important
for the mothers. Compliance with daily oral vitamin D supplementation of
infants is documented to be very poor even in the West [4,5]. Exposing
infants to sunlight may be a more difficult proposition than medicinal
supplements. While the natural way of augmenting the vitamin D levels
can be studied, the logistics and safety of such an approach has to be
established firmly before disbanding the currently recommended regimen
of daily 400IU Vitamin D to infants of predominantly breastfed infants.
References
1. Meena P, Dabas A, Shah D, Malhotra RK, Madhu SV,
Gupta P. Sunlight exposure and vitamin D status in breastfed infants.
Indian Pediatr. 2017;54:105-11.
2. Goswamy R, Sachdev HPS. Vitamin D sufficiency
through sunshine in infants? Indian Pediatr. 2017;54:103-4.
3. Shaw NJ, Mughal MZ. Vitamin D and child health:
Part 1. Arch Dis Child. 2013; 98:363-7.
4. Perrina CG, Sharma AJ, Jefferds ME, Serdula MK,
Scanlon KS. Adherence to vitamin D recommendations among US infants.
Pediatrics. 2010;125:627-32.
5. Millette M, Sharma A, Weiler H, Sheehy O, Berard A, Rodd C.
Program to provide Quebec infants with free vitamin D supplements failed
to encourage participation or adherence. Acta Pediatr. 2014;103:444-9.
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