An examination of parental compliance with vitamin D recommendations and the physiological responses to vitamin D isoform and dosage in breastfed infants from greater Montréal
Bibliographic record
Abstract
Vitamin D is important to maintain calcium homeostasis and promote healthy bone development. Breastfed newborns are at heightened risk of vitamin D deficiency because breast milk contains insufficient amounts of vitamin D. Canadian health policy recommends all breastfed infants receive 400 IU/d of vitamin D starting at birth and continuing until infants can obtain this amount through diet. Both dietary and endogenous production of vitamin D are commonly measured using the 25-hydroxyvitamin D metabolite (25(OH)D), as it has a longer half-life and is less hormonally regulated than the active form, 1,25-dihydroxyvitamin D. The Institute of Medicine (IOM) defines the amount necessary to meet the needs of 97.5% of a population group as the Recommended Dietary Allowance (RDA), however due to insufficient supportive data for the 0-12 mo age group an Adequate Intake (AI) level of 400 IU/d was established instead. This amount is thought to maintain circulating 25(OH)D concentrations in the range of 40-50 nmol/L, sufficient for bone health. Others argue concentrations >75 nmol/L are necessary and that some infants and children may require 800 IU/d of vitamin D supplementation. Despite these recommendations, many infants in Canada have low circulating 25(OH)D concentrations. It is unclear whether these low concentrations are due to a lack of compliance or that the recommendations are insufficient to achieve the desired circulating 25(OH)D concentrations. In addition, whether intakes of vitamin D >400 IU/d in infancy are associated with better bone mineral accrual has not been systematically tested. There are two isoforms of vitamin D which are available as supplements in Canada, cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). Controversy exists regarding the biological effectiveness of both forms to increase 25(OH)D concentrations. Health Canada's 2004 recommendation states vitamin D2 is less effective than D3 for supplementation, yet no studies have directly compared the efficacy these isoforms in infants. The global objectives of this thesis are to: (1) describe vitamin D supplementation practices of mothers of newborns from a large Canadian urban center; (2) compare the biological response to supplemental vitamin D2 and D3 isoforms in breastfed infants from 1 to 4 mo of life; and (3) define the dosage requirement of vitamin D3 based on (a) the amount necessary to raise plasma 25(OH)D to ≥75 nmol/L in 97.5% of infants (as used in setting the RDA) and (b) using measures of mineral homeostasis, growth and bone mass. Study 1 consisted of a telephone survey with 342 mothers who delivered at the Royal Victoria Hospital (Montréal, Québec), representing ~10% of all annual births at this center. Mothers were contacted 6-12 mo post-partum and asked about vitamin D supplementation practices including the amount and frequency of dosage as well as reasons for non-adherence. Study 2 was a randomized clinical trial (RCT) of 52 breastfed infants. At 1 mo of age, infants received 400 IU/d of either vitamin D2 or D3 for 3 mo. The change in plasma 25(OH)D concentrations as well as the proportion of infants which achieved ≥50 and ≥75 nmol/L plasma 25(OH)D targets were compared between groups. Study 3 was a RCT in which 132 healthy, breastfed 1 mo old infants were randomly assigned to receive one of 4 vitamin D dosages (400, 800, 1200 or 1600 IU/d of vitamin D3).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".