Correction of neonatal vitamin D status using 1000 IU vitamin D/d increased lean body mass by 12 months of age compared with 400 IU/d: a randomized controlled trial

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ABSTRACT

Background

Intrauterine exposure to maternal vitamin D status <50 nmol/L of serum 25-hydroxyvitamin D [25(OH)D] may adversely affect infant body composition. Whether postnatal interventions can reprogram for a leaner body phenotype is unknown.

Objectives

The primary objective was to test whether 1000 IU/d of supplemental vitamin D (compared with 400 IU/d) improves lean mass in infants born with serum 25(OH)D <50 nmol/L.

Methods

Healthy, term, breastfed infants (Montréal, Canada, March 2016–2019) were assessed for serum 25(OH)D (immunoassay) 24–36 h postpartum. Infants with serum 25(OH)D <50nmol/L at 24–36 h were eligible for the trial and randomly assigned at baseline (1 mo postpartum) to 400 (29 males, 20 females) or 1000 IU/d (29 males, 20 females) of vitamin D until 12 mo. Infants (23 males, 18 females) with 25(OH)D ≥50 nmol/L (sufficient) formed a nonrandomized reference group provided 400 IU/d. Anthropometry, body composition (DXA), and serum 25(OH)D concentrations were measured at 1, 3, 6, and 12 mo.

Results

At baseline, mean ± SD serum 25(OH)D concentrations in infants allocated to the 400 and 1000 IU/d vitamin D groups were 45.8 ± 14.1 and 47.6 ± 13.4, respectively; for the reference group it was 69.2 ± 16.4 nmol/L. Serum 25(OH)D concentration increased on average to ≥50 nmol/L in the trial groups at 3–12 mo. Lean mass varied differently between groups over time; at 12 mo it was higher in the 1000 IU/d vitamin D group than in the 400 IU/d group (mean ± SD: 7013 ± 904.6 compared with 6690.4 ± 1121.7 g, P = 0.0428), but not the reference group (mean ± SD: 6715.1 ± 784.6 g, P = 0.19). Whole-body fat mass was not different between the groups over time.

Conclusions

Vitamin D supplementation (400 or 1000 IU/d) during infancy readily corrects vitamin D status, whereas 1000 IU/d modestly increases lean mass by 12 mo. The long-term implications require further research. This trial was registered at clinicaltrials.gov as NCT02563015.

Keywords:

infant
vitamin D status
vitamin D supplementation
lean mass
randomized controlled trial

Abbreviations used:

AGA
appropriate weight for gestational age
AI
Adequate Intake
CAD
Canadian dollars
CLIA
chemiluminescence immunoassay
F
Fitzpatrick
FMI
fat mass index
IGFBP-3
insulin-like growth factor binding protein 3
IGF-1
insulin-like growth factor 1
IOM
Institute of Medicine
LMI
lean mass index
NIST
National Institute of Standards and Technology
25(OH)D
25-hydroxyvitamin D.

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Supported by Canadian Institutes of Health Research grant #MOP-142391 (to HAW), and Canada Foundation for Innovation Project 202820 (to HAW) which provided funding for infrastructure. At the time of the research, HAW was funded by Canada Research Chairs Program 2015–2018 salary award 950-230633; MR and NG received Graduate Excellence Fellowships from McGill University. The funding agencies were not involved in the study design; collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Supplemental Figures 1 and 2 and Supplemental Tables 1–4 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/ajcn/.