Some parents always ask me on Weibo, is there any difference between vitamin A + D and vitamin D supplementation for babies in what? How long will vitamin D take? In addition to vitamin D, do you need calcium? How big is the baby’s fish oil and calcium supplement? When the baby is two or three years old, many mothers have not made up for it. Why?
Foreign professional pediatricians usually do not recommend infants to supplement extra calcium.
To answer the above questions, Let’s explain three things first: First, domestic pediatricians recommend that babies regularly supplement not [fish oil] but [cod liver oil], [Fish oil] refers to supplements such as DHA, It is not recommended as a conventional supplement. [Cod liver oil] refers to the mixture of vitamin A and vitamin D (such as ikexin, etc.). Second, Pediatricians in Europe, America and other countries recommend that babies receive vitamin D as a routine supplement. They do not recommend vitamin A supplements because they believe that excessive intake of vitamin A will increase the risk of cardiovascular diseases and liver injury. Third, since infants’ main food is dairy products such as breast milk, the diet contains enough calcium, so foreign pediatricians usually do not recommend extra calcium supplements for infants.
From the above facts, it can be seen that pediatricians at home and abroad have the same understanding of vitamin D: vitamin D is recommended for infants. Then why is vitamin D so important to human body? Is the cause of vitamin D deficiency what? What is the amount of vitamins required by different groups? How to supplement vitamin D? I hope the following introduction can answer the questions in parents’ hearts.
Vitamin D is the key to prevent rickets.
Vitamin D promotes intestinal tract to absorb calcium and phosphorus from diet on the one hand; On the other hand, calcium and phosphorus are promoted to deposit in the new bone formation site and the maturity of bone tissue is promoted. For infants, vitamin D intake with sufficient physiological needs is mainly to effectively prevent rickets. For adults, The main purpose of taking enough vitamin D for physiological needs is to effectively prevent osteoporosis. Prevent fractures. Vitamin D is not only good for bones, Some ongoing studies also show that it can improve the functions of muscle system, cardiovascular system, nervous system and immune system. For example, A new study recently completed by the American Sleep Medical Association found that There is an important association between vitamin D levels and daytime sleepiness, Although it is not yet possible to assert that there is a causal relationship between the two, However, it suggests that vitamin D may replace coffee to refresh the mind. Domestic literatures such as < < Meta Analysis of the Relationship between 25-hydroxyvitamin D Level and Cardiovascular Diseases > > published by Li Min et al. In 2011 show that vitamin D nutritional status is related to the incidence of cardiovascular diseases, suggesting that vitamin D supplementation may reduce the incidence of cardiovascular diseases.
Vitamin D is first catalyzed by enzymes in the liver to produce 25-hydroxyvitamin D in the human body. Then the enzyme of kidney catalyzes to produce 1, 25 dihydroxyvitamin D. Usually, Clinically detect whether the human body has the risk of rickets, The reference is not the value of trace elements, It is not the value of bone mineral density, But the value of 25-hydroxyvitamin D in serum, which is less than 20 nanomoles/ml (50 nanomoles/liter), is considered vitamin D deficiency. Some studies in the United States have found that in winter in Boston area (42 north latitude), 32% of healthy people aged 18-29 have a 25-hydroxyvitamin D value less than 20 nanomoles/ml in serum, and the proportion of vitamin D deficiency population should be higher in China.
Vitamin D supplement, light, diet can’t be less
Before talking about the causes of vitamin D deficiency, we need to understand the two natural sources of vitamin D in human body:
One is the synthesis of the human body itself. Exposed to sunlight, Ultraviolet rays in sunlight irradiate human skin, The skin synthesizes vitamin D. The amount of vitamin D it synthesizes depends on age, skin color, exposure time, season, etc. Generally speaking, With the increase of age, White skin synthesizes more than black skin, The longer the exposure time, the more synthesis, Summer is much more synthetic than winter. Studies have shown that in July, when the sun is scorching, healthy young white people can produce about 10,000 units of vitamin D by outdoor exposure in bathing suits for about 15 minutes. However, it is usually not recommended to obtain vitamin D by exposure to the sun because of the risk of skin cancer. In summer, skin protection should be given priority to in hot sun.
The other is dietary intake. Foods rich in vitamin D include fish, egg yolk, milk added with vitamin D, bread added with vitamin D and other foods added with vitamin D.
Thus, the main reasons for vitamin D deficiency are also these two aspects: first, lack of sunlight. Ultraviolet rays in sunlight cannot pass through ordinary glass, and vitamin D production is insufficient for people with less outdoor activities; High-rise buildings block sunlight, and air pollution (such as smoke and dust) absorbs some ultraviolet rays. The reduction of sunlight in winter affects the synthesis of vitamin D. Second, the diet intake is insufficient. The content of vitamin D in natural foods is low, such as milk (including human milk, cow’s milk, goat’s milk, etc.), meat, etc. The content of vitamin D is low, and grains, vegetables and fruits almost do not contain vitamin D.
Vitamin D supplement is relatively safe and is not easy to be poisoned excessively.
According to data released by the American Institute of Medicine in 2010, The daily physiological needs of people of different ages are as follows: Infants and young children before the age of 1 need 400 international units, People between the ages of 1 and 70 need 600 international units, People over the age of 70 need 800 international units. The daily physiological demand for vitamin D refers to the sum of food intake, sunlight exposure and vitamin D fortified foods. The insufficient part needs vitamin D supplements. Infants two weeks after birth can use vitamin D supplements to supplement the insufficient amount of vitamin D. However, it is not recommended for infants to get vitamin D in the sun, because sun exposure has the risk of skin cancer in infants.
The editorial board of the Chinese Journal of Pediatrics reached a consensus with the Children’s Health Care Group of the Pediatrics Branch of the Chinese Medical Association and the National Rickets Prevention and Control Research Cooperation Group: Since rickets is mostly found in infants under 3 years old, rickets prevention should start from pregnancy, focus on infants under 1 year old, and should be systematically managed until 3 years old. Their suggestions are as follows:
First, pregnant mothers should often take outdoor activities and eat foods rich in calcium and phosphorus. Women in autumn and winter in the late pregnancy should be properly supplemented with vitamin D 400 ~ 1000 international units every day. When using vitamin A and vitamin D mixture, vitamin A poisoning should be avoided, and vitamin A intake should be less than 10,000 international units every day.
Second, infants and young children should take outdoor activities as soon as possible, gradually reaching 1-2 hours of outdoor activities every day, and exposing as much body parts as possible such as head, face, hands and feet, etc.
Third, infants (especially those who are exclusively breastfed) receive vitamin D 400 international units per day for two weeks after birth to the age of two. The 400 international unit supplement should be the sum of food intake, sunlight exposure, vitamin D supplements and vitamin D fortified foods. For example, infants take 500 milliliters of vitamin D-added formula milk per day. The intake of vitamin D is about 200 international units, and with appropriate outdoor activities (especially when outdoor activities are more in summer), it is not necessary to supplement vitamin D supplements.
Fourth, high-risk groups such as premature infants, low birth weight infants and twin fetuses should be supplemented with 800-1000 international units of vitamin D per day after birth, and 400 international units per day after 3 months.
No matter the United States or China, The recommended daily vitamin D intake given by the Medical Professional Committee is the total amount. Therefore, for individuals with different eating habits and outdoor activities, the amount of vitamin D supplements used varies from person to person. Since China’s food standard labeling began this year, people can calculate the amount of vitamin D according to the labeling when eating, thus estimating the amount of additional supplements needed.
According to the 2010 data of the American Medical Research Institute, the maximum amount of vitamin D that the human body can tolerate every day also varies with age. See the following table for the specific values.
Table Recommended Intake of Vitamin D and Maximum Tolerance of Vitamin D for People of Different Ages (International Units/Day)
| 人群 | 推荐摄入量 | 上限 |
| 0 ～6 月龄 | 400 | 1000 |
| 6 ～12 月龄 | 400 | 1500 |
| 1 ～3 岁 | 600 | 2500 |
| 4 ～8 岁 | 600 | 3000 |
| 9 ～13 岁 | 600 | 4000 |
| 14 ～18 岁 | 600 | 4000 |
| 19 ～30 岁 | 600 | 4000 |
| 31 ～50 岁 | 600 | 4000 |
| 51 ～70 岁(男) | 600 | 4000 |
| 51～70 岁(女) | 600 | 4000 |
| >70 岁 | 800 | 4000 |
Note: The data in the above table are from the American Institute of Medicine (2010)
It is recorded that the amount of vitamin D poisoning in adults is 60,000 international units per day, which shows that vitamin D is a relatively safe nutritional supplement and is not easy to be excessively poisoned.
Vitamin D is a fat-soluble vitamin, Therefore, it is recommended to take it with meals. Fat in food can promote its absorption. At present, vitamin D supplements for infants and young children in China mostly exist in the form of soft capsules. The capsule needs to be cut open to squeeze vitamin D into a small spoon. Then feed the baby a little bit with a spoon. Some instructions may suggest squeezing it directly into the baby’s mouth. I do not recommend this, Because one thousand parents don’t hold it firmly, the capsule shell is easy to fall into the baby’s mouth, one thousand stuck in the airway will cause suffocation. There are also parents who try to save trouble and directly squeeze the vitamin D in the capsule into the bottle and feed it together with formula milk. I also don’t recommend this method, because fat-soluble vitamin D is easy to stick to the bottle wall, and the baby can’t eat the full dose of vitamin D.
This article is taken from the book “Ji Lianmei Talk: Chinese Should Use Drugs This Way”, which is reprinted by the author’s authorized clove garden.