1. 28/08/2015Ted Greiner Nutrients of concern in exclusively breastfed infants 7th Neonatal Conference, Jeddah Saudi Arabia, 20-22 Feb 2012 Ted Greiner, Hanyang University

2. 28/08/2015Ted Greiner Vitamin D and iron are the main nutrients of public health concern for all infants, and special considerations come into play with exclusively breastfed infants Vitamin D is actually not a vitamin but a steroid hormone. It is made in our skin when exposed to ultra- violet radiation from the sun.

3. 28/08/2015Ted Greiner It is needed for the absorption of calcium, and maintenance of normal calcium and phosphorus levels, which in turn are needed to make bone and teeth. There are receptors for it in most of the cells in our body so it probably has other functions as well. It must undergo hydroxylation first in the liver and again in the kidney to be biologically active in the body as 1,25- dihydroxyvitamin D [1,25(OH)2D]

4. 28/08/2015Ted Greiner Deficiency of vitamin D and/or calcium leads to rickets, a disease in children in which the bones grow soft and deform in shape. 2-year old boy with rickets from Eastern Cape, RSA

5. 28/08/2015Ted Greiner

6. 28/08/2015Ted Greiner In adults this disease is called osteomalacia. Adequate vitamin D throughout life may also help prevent osteoporosis.

7. 28/08/2015Ted Greiner Vitamin D deficiency (VDD) also seems to lead to increased susceptibility to infection. It seems to have a role in modulation of cell growth, neuromuscular and immune function, and reduction of inflammation. VDD may be associated with an increased risk of developing diabetes and colon cancer.

8. 28/08/2015Ted Greiner Vitamin D is not present in many foods. It is in small amounts in eggs and butter but NOT in milk unless commercially fortified.

9. 28/08/2015Ted Greiner It is present in fatty salt-water fish that feed near the surface and thus cod-liver oil was used to provide supplemental vitamin D before it was available in synthetic form.

10. 28/08/2015Ted Greiner Recommended daily allowances (RDAs) are 400 IU (10 g) per day for infants <12 mo and 600 IU for others <70 yr. Mild adverse effects can in few cases be seen at the tolerable upper intake levels (ULs) at doses of about 1000 IU for infants 9yr. Sun exposure cannot lead to excess levels.

11. 28/08/2015Ted Greiner Vitamin D transferred placentally meets the needs of newborns until about 8 weeks of age if the mother was not deficient.

12. 28/08/2015Ted Greiner Breast milk usually provides 25-80 IU of bio- active vitamin D per day This can be increased by maternal supplementation of 2000-4000 IU per day

13. 28/08/2015Ted Greiner The required amount can be obtained from sunlight but how much is needed depends on: –Skin colour –Amount of clothing worn –Cloudiness, smog or air pollution –Use of sun screen (when used effectively, it prevents formation of vitamin D in skin) –How high in the sky the sun is, in turn determined by: Latitude Time of day Season

14. 28/08/2015Ted Greiner Sun exposure may be inadequate among: Women who veil Women or children who are sequestered in the home People who are too sick or old to spend enough time outdoors People who are institutionalised.

15. 28/08/2015Ted Greiner Sun exposure is NOT recommended < six months old: –increased risk of skin cancer later in life. Sun exposure should be for short, regular periods. Avoid long exposures and mid- day exposures.

16. 28/08/2015Ted Greiner For breast-fed infants and others consuming <1L/d of fortified milk, 400 IU per day is recommended, given as drops. Indeed, all children should take a supplement if they do not consume adequate fortified milk

17. 28/08/2015Ted Greiner Commercial milk products and some commercial infant foods are the main foods fortified with vitamin D. This varies by country so you have to read labels.

18. 28/08/2015Ted Greiner Rickets is increasing in dark- skinned people where exclusive breastfeeding is increasing (USA and UK). Breast milk has 1/5 the calcium of cow milk. Supplements commonly given to babies (sugar water; teas) displace breast milk and calcium deficiency may result. This has received little attention

19. 28/08/2015Ted Greiner Professor of Nutrition Hanyang University Seoul, South Korea Ted’s Email: tedgreiner@yahoo.com Ted’s Website: www.tedgreiner.info www.tedgreiner.info