Vitamin D intake of Dutch infants from the combination of (fortified) foods, infant formula, and dietary supplements

European Journal of Nutrition, Nov 2015

Purpose Due to changes in the Dutch fortification policy for vitamin D and the vitamin D supplementation advice for infants (10-μg/d for 0–4 year olds), a partially virtual scenario study was conducted to evaluate the risk of excessive vitamin D intake assigning all infants to a 100 % adherence to the supplementation advice and considering the current fortification practice. Methods Food consumption data from the Nutrition Intake Study (2002; N = 941, 7–19 months) were combined with Dutch food composition data from 2011 to estimate vitamin D intake from (fortified) foods. For infants 0–6 months of age, the consumption volume infant formula was estimated from energy requirement and body weight. All subjects were assigned to take a daily 10 µg vitamin D supplement, according the Dutch supplementation advice for infants. Habitual vitamin D intake was estimated using the Statistical Program to Assess Dietary Exposure and compared with the tolerable upper intake levels (ULs) set by the European Food Safety Authority. Results The median habitual total vitamin D intake was 16–22 µg/day for infants aged 0–6 months (increasing with age) and 13–21 µg/day for infants aged 7–19 months (decreasing with age). About 4–12 % of infants aged 7–11 months exceeded the UL. At the 99th percentile, the intake was 2–4 µg above the UL, depending on age. Infants aged 0–6 and 12–19 months did not exceed the UL. Conclusions In case of combined intake from infant formula, (fortified) foods, and supplements, vitamin D intakes above the UL are possible among some infants during a limited time period.

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Vitamin D intake of Dutch infants from the combination of (fortified) foods, infant formula, and dietary supplements

Eur J Nutr Vitamin D intake of Dutch infants from the combination of (fortified) foods, infant formula, and dietary supplements Janneke Verkaik‑Kloosterman 0 1 Marja H. Beukers 0 1 Martine Jansen‑van der Vliet 0 1 Marga C. Ocké 0 1 0 Abbreviations UL Tolerable upper intake level SPADE Statistical Program to Assess Dietary Exposure EFSA European Food Safety Authority IoM Institute of Medicine NethFIR Netherlands Food Information Resource NEVO Dutch food composition database (in Dutch NEderlands VOedingsstoffenbestand) VIO Nutrient Intake Study (in Dutch: VoedingsstoffenInnameOnderzoek) AI Adequate intake 1 National Institute for Public Health and the Environment , PO Box 1, 3720 BA Bilthoven , The Netherlands Purpose Due to changes in the Dutch fortification policy for vitamin D and the vitamin D supplementation advice for infants (10-μg/d for 0-4 year olds), a partially virtual scenario study was conducted to evaluate the risk of excessive vitamin D intake assigning all infants to a 100 % adherence to the supplementation advice and considering the current fortification practice. Methods Food consumption data from the Nutrition Intake Study (2002; N = 941, 7-19 months) were combined with Dutch food composition data from 2011 to estimate vitamin D intake from (fortified) foods. For infants 0-6 months of age, the consumption volume infant formula was estimated from energy requirement and body weight. All subjects were assigned to take a daily 10 µg vitamin D supplement, according the Dutch supplementation advice for infants. Habitual vitamin D intake was estimated using the Statistical Program to Assess Dietary Exposure and compared with the tolerable upper intake levels (ULs) set by the European Food Safety Authority. Results The median habitual total vitamin D intake was 16-22 µg/day for infants aged 0-6 months (increasing with age) and 13-21 µg/day for infants aged 7-19 months (decreasing with age). About 4-12 % of infants aged 7-11 months exceeded the UL. At the 99th percentile, the intake was 2-4 µg above the UL, depending on age. Infants aged 0-6 and 12-19 months did not exceed the UL. Conclusions In case of combined intake from infant formula, (fortified) foods, and supplements, vitamin D intakes Vitamin D; Infant; Excessive intake; Food; Supplements; Infant formula - * Janneke Verkaik-Kloosterman above the UL are possible among some infants during a limited time period. Vitamin D is important for the development of strong bones. Serious vitamin D deficiency in infants leads to rickets [1, 2]. The Health Council of the Netherlands set the adequate intake (AI) for infants at 10 µg/day (i.e. 400 IU/ day) [1]. Too high vitamin D intake, on the other hand, should be prevented as this may result in risk of hypercalcaemia or hypercalciuria and kidney problems. Both the European Food Safety Authority (EFSA) and the Institute of Medicine (IoM) set a tolerable upper intake level (UL) for vitamin D [2, 3]. For infants 0–6 months of age, the UL is set at 25 µg/day by both EFSA and IoM, and for older infants (6–12 months), the UL is set at 25 µg/day by EFSA and 37.5 µg/day by IoM [2, 3]. The UL for children aged 1 year and older is set at 50 µg/day by EFSA and at 63 µg/ day by the IoM [2, 3]. Vitamin D can be synthesised in the skin by exposure to sunlight. The actual production depends on many factors including latitude, season, time of the day, and exposure duration. In the Netherlands at 52° northern latitude, vitamin D production by the skin is possible between March and November at moments the zenith angle is not oblique (i.e. >45°) [1, 4, 5]. However, infants should be protected from direct sunlight exposure to avoid sunburn and reduce the risk of skin cancer in later life [6]. Consequently, infants rely mostly on their diet for an adequate vitamin D supply. Vitamin D is naturally present in foods. In addition, vitamin D may be added to foods like infant or follow-on formula [7]. There is a history of addition of vitamin D to margarines and baking fats (covenant between Ministry of Health and manufacturers [8, 9]), generally with a level of 7.5 µg/100 g. And since 2007, voluntary fortification of other foods is permitted in the Netherlands up to a maximum of 4.5 µg/100 kcal [10, 11]. Similar to other countries (e.g. [12, 13]), the Dutch Health Council advices vitamin D supplementation for children up to 4 years of age [14], in order to compensate for the minimal exposure to sunlight and generally limited vitamin D levels in food. Since 2008, the advice was to give daily a supplement with 10 µg vitamin D for all young children (0–4 years), except those consuming more than 500 ml infant formula a day [14]. To improve the use of adequate vitamin D supplementation in the group of infants transferring from infant formula to regular milk, the supplementation advice was revised in 2012 to 10 µg/day for all children up to 4 years of age, irrespective of their diet [1]. The vitamin D intake of infants may a (...truncated)


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Janneke Verkaik-Kloosterman, Marja H. Beukers, Martine Jansen-van der Vliet, Marga C. Ocké. Vitamin D intake of Dutch infants from the combination of (fortified) foods, infant formula, and dietary supplements, European Journal of Nutrition, 2015, pp. 581-590, Volume 56, Issue 2, DOI: 10.1007/s00394-015-1102-z