The differential response to vitamin D supplementation in neonates born with low vitamin D stores according to skin pigmentation
Bibliographic record
Abstract
Vitamin D is a fat-soluble vitamin that can be obtained endogenously by exposing the skin to ultraviolet beta radiation from sunlight or exogenously from food and supplements. Due to the recommendation that infants should not be exposed to sunlight, and low vitamin D content in breast milk, this age group is recommended to be given a vitamin D supplement until a sufficient amount can be obtained from their diet. The Canadian Paediatric Surveillance Program (2002-2004) estimated a total of 104 confirmed cases of vitamin D deficiency rickets, most of which were diagnosed in the north or immigrant families. From the confirmed cases, 92 (89%) were children with intermediate to dark skin color, and 98 (94%) were children who were breastfed without suitable vitamin D supplementation. Given that vitamin D supplementation is highly recommended for infants with dark skin, how these infants respond to vitamin D supplementation if they are born with low vitamin D stores, and if a higher dosage is needed to overcome the deficiency is important to explore. Previous studies are difficult to interpret because either they studied infants with sufficient vitamin D status or lacked an objective method to measure skin color if any. The primary research objective of this thesis is to investigate if there is a difference in the response of serum 25-hydroxyvitamin D (25(OH)D) to vitamin D supplementation in neonates born with low vitamin D stores (25(OH)D <50 nmol/L) according to skin pigmentation, and if a higher dose of vitamin D supplementation will result in a faster rate of improvement of vitamin D status in infants with dark skin. Healthy term born breastfed infants were recruited from the Lakeshore General Hospital in the Greater Montreal area, latitude 45.5ᵒN (NCT02563015). Infants were screened for low serum 25(OH)D (Liaison, DiaSorin, Stillwater, MN 55082, USA) at birth and then randomized to a treatment group: 400 IU/d (n=36) or 1000 IU/d (n=36). Infants were stratified by skin pigmentation in male and female blocks. At baseline, 3, and 6 months, anthropometry, body composition, skin pigmentation, and biochemistry measurements were examined. The study sample was 50% male, 24% infants with dark skin color, and 65% breastfed until 6 months; compliance rate was 70% overall. After 6 months of supplementation, all groups had mean serum 25(OH)D concentration above the 50 nmol/L threshold as suggested by the Institute of Medicine for achievement of bone health. Overall, infant skin color did not affect the infant serum 25(OH)D response to vitamin D supplement at any time point (p=0.40). The 1000 IU/d group had a significantly higher mean concentration than the 400 IU/d group at 3 and 6 months. This study shows that skin pigmentation was not a significant determinant of infant serum 25(OH)D concentration at 3 or 6 months of age. Given the high rate of compliance observed in this study, public health efforts to improve vitamin D status in infants of all skin colors might be best focused towards improving compliance through educational means.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".