Effect of rapid correction of vitamin D insufficiency on bone health in breastfed infants born with low vitamin D stores: A randomized, double-blind trial in Montreal, Canada
Notice bibliographique
Résumé
Many Canadian infants are born with an insufficient vitamin D status. Maintaining a low serum 25-hydroxyvitamin D [25(OH)D] concentration of less than 50 nmol/L during infancy could have negative impacts on bone health. In order to support a sufficient 25(OH)D concentration, Health Canada currently recommends that all breastfed infants receive a vitamin D supplement of 400 international units per day (IU/d). It has been shown that higher doses of vitamin D allow for a more rapid increase in 25(OH)D which could benefit those born with insufficient status. However, the lack of evidence in this population limits the development of new guidelines. Thus, the primary objective of this thesis was to determine whether current Canadian supplementation guidelines of 400 IU/d are adequate for infants born with vitamin D insufficiency, or if a higher dose (1000 IU/d) is associated with increased bone mineralization. The secondary objective was to test whether a higher status target of 25(OH)D ≥75 nmol/L, irrespective of supplementation dosage, is associated with changes in bone outcomes. In this preliminary analysis from an ongoing double-blinded randomized controlled trial (RCT) (clinicaltrials.gov: NCT02563015), healthy term-born breastfed infants (n=56) were recruited from a hospital in the Montreal area. Infant blood was sampled 24-36 hours after birth for measurement of total serum 25(OH)D concentration (LIAISON, DiaSorin Inc.). Infants with insufficient status <50 nmol/L were randomized to receive either 400 IU/d (n=19) or 1000 IU/d (n=22) cholecalciferol. Infants with sufficient status ≥50 nmol/L (n=15) formed a reference group receiving 400 IU/d. At baseline (≤1 mo), and at 3 mo, bone mineral content (BMC) and bone mineral density (BMD) of the whole body and lumbar spine were measured using dual-energy X-ray absorptiometry (DXA). Anthropometry, demographic and dietary questionnaires were collected. Data were analyzed using a mixed-model ANOVA (SAS, version 9.3). Data are mean ± SD, significance of p<0.05. All mean bone and anthropometric outcomes in the 400 IU/d and 1000 IU/d groups were well within the range of values (mean ± SD) obtained for the reference group from birth to 3 mo, indicating healthy growth. The study population included slightly more male than female infants (32/56) and infants with light skin pigmentation (41/56). Breastfeeding rates were comparable between groups (p=0.32) with 91% (51/56) of infants received breast milk up to 3 mo of age, and of those 82% (42/51) were exclusively breastfed. By 3 mo, serum 25(OH)D concentration was 77 ± 23 nmol/L for the 400 IU/d group and 131 ± 39 nmol/L for the 1000 IU/d group (p<0.0001). No significant differences in absolute or weight-adjusted BMC of the whole body or lumbar spine, or BMD of the lumbar spine were observed between groups. Percent change of total body less head BMC from baseline was significantly higher in the 1000 IU/d group compared to 400 IU/d (46.2 ± 23.5% vs. 37.3 ± 14.8%, p=0.02). Infants in the 1000 IU/d group also had significantly greater length velocity with an average growth rate of 0.5 ± 0.2 cm/mo more than infants receiving 400 IU/d (p=0.03). Additionally, reaching a higher status target of ≥75 nmol/L 25(OH)D was not associated with any differences in bone outcomes. The preliminary results of this study suggest that there may be some advantages in terms of bone mineral accretion and length velocity by 3 mo associated with the use of 1000 IU/d cholecalciferol. Study participants will continue in the trial until 1 y with follow-up to 3 y to assess the longer-term impacts of the interventions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».