High-Dose Vitamin D Intervention in Infants-Effects on Vitamin D Status, Calcium Homeostasis, and Bone Strength
High-Dose Vitamin D Intervention in Infants-Effects on Vitamin D Status, Calcium Homeostasis, and Bone Strength
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DOI：
10.1210/jc.2012-1575
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发表时间：
2012-11-01
影响因子：
5.8
通讯作者：
Makitie, Outi
中科院分区：
文献类型：
--
作者：
Holmlund-Suila, Elisa;Viljakainen, Heli;Makitie, Outi
背景：芬兰的指南建议所有婴儿每天服用10毫克维生素D3。最近的观察表明，这可能不足以维持最佳的血清25-羟基维生素D （S-25-OHD）。目的：本研究的目的是评估不同维生素D剂量的影响，并确定确保没有维生素D过量迹象的婴儿S-25-OHD至少为80 nmol/l的剂量。设计：我们进行了一项随机双盲干预研究。S-25-OHD在出生时采集脐带血；113名婴儿从2周到3个月随机接受维生素D3 10、30或40 μ g/d。背景：在芬兰赫尔辛基的一家妇产医院进行了一项由研究者发起的研究。主要结局指标：3个月大时，通过外周定量计算机断层扫描评估S-25-OHD、钙稳态和骨骼特征。结果：三组的S-25-OHD基线相似（中位数为53 nmol/l）。3个月时，10、30、40 μ g组S-25-OHD平均值分别为88、124、153 nmol/l，最小值分别为46、57、86 nmol/l（方差分析，P < 0.001）。未发生高钙血症；两组间血浆钙、血清甲状旁腺素和尿钙排泄量相似。外周定量计算机断层扫描显示，维生素D剂量越大，胫骨总骨和皮质骨面积越大。结论：在2周至3个月期间补充40 μ g/d的维生素D3是安全的，不会引起高钙血症或高钙尿症。40 μ g剂量使所有婴儿S-25-OHD维持在80 nmol/l以上。需要更广泛和更长期的干预研究来评估长期影响。[J] .中华内分泌杂志，2012,31(4):447 - 447。
Context: Guidelines in Finland recommend 10 mu g of vitamin D3 daily for all infants. Recent observations suggest that this may be insufficient to maintain optimal serum 25-hydroxyvitamin D (S-25-OHD).Objective: The aim of the study was to evaluate effects of various vitamin D doses and determine a dose ensuring S-25-OHD of at least 80 nmol/liter in infants without signs of vitamin D excess.Design: We conducted a randomized double-blind intervention study. Cord blood was obtained at birth for S-25-OHD; 113 infants were randomized to receive vitamin D3 10, 30, or 40 mu g/d from age 2 wk to 3 months.Setting: An investigator-initiated study was performed in a single maternity hospital in Helsinki, Finland.Main Outcome Measures: S-25-OHD, calcium homeostasis, and skeletal characteristics were evaluated with peripheral quantitative computed tomography at age 3 months.Results: Baseline S-25-OHD was similar in all three groups (median, 53 nmol/liter). At 3 months, the mean S-25-OHD values were 88, 124, and 153 nmol/liter, and the minimum values were 46, 57, and 86 nmol/liter in the groups receiving 10, 30, and 40 mu g (ANOVA; P < 0.001). No hypercalcemia occurred; plasma calcium, serum PTH, and urine calcium excretion was similar between the groups. Peripheral quantitative computed tomography showed a trend toward larger tibial total bone and cortical bone area with higher vitamin D doses.Conclusion: Vitamin D3 supplementation with up to 40 mu g/d from age 2 wk to 3 months was safe and caused no hypercalcemia or hypercalciuria. The 40-mu g dose maintained S-25-OHD above 80 nmol/liter in all infants. More extensive and longer intervention studies are necessary to assess long-term effects. (J Clin Endocrinol Metab 97: 4139-4147, 2012)