{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T01:35:58Z","timestamp":1777080958320,"version":"3.51.4"},"reference-count":37,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,10,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE:<\/jats:title><jats:p>To examine the vitamin D status of 4-month-old exclusively breastfed infants supplemented with 400 IU daily of vitamin D and to determine whether there was any seasonal variation in serum 25-hydroxyvitamin D (25(OH)D) levels of infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>In this cross-sectional study, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels of 143 exclusively breastfed 4-month-old infants supplemented daily with 400 IU of vitamin D were measured in a temperate latitude, Izmir, Turkey, between May 2008 and April 2009. A questionnaire on demographic characteristics of infants and mothers, vitamin D supplementation of infants after birth, mothers' multivitamin supplementation, dressing habits, and consumption of dairy products during pregnancy was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Vitamin D deficiency (\u226450 nmol\/L) and insufficiency (51\u201374 nmol\/L) were determined in 40 (28%) and 55 (38.5%) infants, respectively. During winter days, serum 25(OH)D levels were &amp;lt;20 ng\/mL in 45.4% of infants and &amp;lt;10 ng\/mL in 10.6% of infants. Season of blood sampling, compliance of vitamin D supplementation, maternal education level, and consumption of dairy products were highly predictive of serum 25(OH)D levels in multiple linear regression analysis (P &amp;lt; .05). The use of the Pearson correlation test found a statistically significant negative correlation between 25(OH)D and parathyroid hormone levels (r = \u22120.419, P &amp;lt; .001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Despite supplementation with 400 IU of vitamin D daily, the rate of vitamin D deficiency was worryingly high in 4-month-old exclusively breastfed infants living in Izmir, Turkey. So, additional studies are needed to clarify optimal amount of vitamin D supplementation to the infants, especially during winter days.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2012-0017","type":"journal-article","created":{"date-parts":[[2012,9,25]],"date-time":"2012-09-25T00:27:03Z","timestamp":1348532823000},"page":"e921-e927","source":"Crossref","is-referenced-by-count":15,"title":["Vitamin D Status of Exclusively Breastfed 4-Month-Old Infants Supplemented During Different Seasons"],"prefix":"10.1542","volume":"130","author":[{"given":"Oya","family":"Halicioglu","sequence":"first","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumer","family":"Sutcuoglu","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feyza","family":"Koc","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ege University Medical School, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omur","family":"Yildiz","sequence":"additional","affiliation":[{"name":"Biochemistry, The Ministry of Health Tepecik Teaching and Research Hospital, Izmir, Turkey; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sezin A.","family":"Akman","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadik","family":"Aksit","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ege University Medical School, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2012,10,1]]},"reference":[{"issue":"6","key":"2021120823535475900_B1","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1503\/cmaj.050177","article-title":"Vitamin D deficiency in the 21st century: a persistent problem among Canadian infants 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infants.","volume":"127","author":"Balasubramanian","year":"2008","journal-title":"Indian J Med Res"},{"issue":"5","key":"2021120823535475900_B6","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1542\/peds.2008-1862","article-title":"Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.","volume":"122","author":"Wagner","year":"2008","journal-title":"Pediatrics"},{"issue":"12","key":"2021120823535475900_B7","first-page":"897","article-title":"Subclinical hypovitaminosis D among exclusively breastfed young infants.","volume":"44","author":"Bhalala","year":"2007","journal-title":"Indian Pediatr"},{"issue":"1","key":"2021120823535475900_B8","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1542\/peds.2009-1195","article-title":"Use of supplemental vitamin d among infants breastfed for prolonged periods.","volume":"125","author":"Taylor","year":"2010","journal-title":"Pediatrics"},{"issue":"2","key":"2021120823535475900_B9","doi-asserted-by":"crossref","first-page":"529S","DOI":"10.1093\/ajcn\/88.2.529S","article-title":"25-Hydroxyvitamin D: functional outcomes in infants and young children.","volume":"88","author":"Greer","year":"2008","journal-title":"Am J Clin Nutr"},{"issue":"1","key":"2021120823535475900_B10","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/S0899-9007(01)00724-9","article-title":"Risk factors for vitamin D deficiency in breast-fed newborns and their mothers.","volume":"18","author":"Andiran","year":"2002","journal-title":"Nutrition"},{"issue":"3","key":"2021120823535475900_B11","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1093\/ajcn\/60.3.393","article-title":"Vitamin D prophylaxis during infancy: comparison of the long-term effects of three intermittent doses (15, 5, or 2.5 mg) on 25-hydroxyvitamin D concentrations.","volume":"60","author":"Zeghoud","year":"1994","journal-title":"Am J Clin Nutr"},{"issue":"1","key":"2021120823535475900_B12","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/MPG.0b013e318216920f","article-title":"Vitamin D supplementation and status in infants: a prospective cohort observational study.","volume":"53","author":"Pludowski","year":"2011","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"3","key":"2021120823535475900_B13","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/MCO.0b013e32832a1329","article-title":"Vitamin D requirements in the first year of life.","volume":"12","author":"Mimouni","year":"2009","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"7","key":"2021120823535475900_B14","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s00394-010-0097-8","article-title":"Is daily 400\u00a0IU of vitamin D supplementation appropriate for every country: a cross-sectional study.","volume":"49","author":"Onal","year":"2010","journal-title":"Eur J Nutr"},{"issue":"2","key":"2021120823535475900_B15","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1080\/07315724.1999.10718839","article-title":"Perinatal vitamin D and calcium status of northern Canadian mothers and their newborn infants.","volume":"18","author":"Waiters","year":"1999","journal-title":"J Am Coll Nutr"},{"issue":"12","key":"2021120823535475900_B16","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1038\/sj.ejcn.1601275","article-title":"Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D intake does not prevent it.","volume":"55","author":"Vieth","year":"2001","journal-title":"Eur J Clin Nutr"},{"issue":"5","key":"2021120823535475900_B17","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/ajcn\/79.5.717","article-title":"Assessment of dietary vitamin D requirements during pregnancy and lactation.","volume":"79","author":"Hollis","year":"2004","journal-title":"Am J Clin Nutr"},{"issue":"2","key":"2021120823535475900_B18","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0022-3476(89)80784-X","article-title":"Bone mineral content, serum vitamin D metabolite concentrations, and ultraviolet B light exposure in infants fed human milk with and without vitamin D2 supplements.","volume":"114","author":"Greer","year":"1989","journal-title":"J Pediatr"},{"key":"2021120823535475900_B19","unstructured":"Surekli Tip Egitimi Dergisi [Journal of Continuous Medical Education]. www.ttb.org.tr\/STED\/sted0505\/saglik_bakanligi.pdf. Accessed November 30, 2011"},{"issue":"4","key":"2021120823535475900_B20","first-page":"315","article-title":"Maternal vitamin D deficiency and vitamin D supplementation in healthy infants.","volume":"45","author":"Pehlivan","year":"2003","journal-title":"Turk J Pediatr"},{"issue":"1","key":"2021120823535475900_B21","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/j.1365-3016.2011.01238.x","article-title":"Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey.","volume":"26","author":"Halicioglu","year":"2012","journal-title":"Paediatr Perinat Epidemiol"},{"key":"2021120823535475900_B22","unstructured":"General directorate of the state meteorological service, Turkey. Available at: www.dmi.gov.tr. Accessed November 25, 2011"},{"key":"2021120823535475900_B23","unstructured":"Turkish Statistical Agency data base. Available at: www.tuik.gov.tr. Accessed December 1, 2011"},{"key":"2021120823535475900_B24","unstructured":"The nutrition guide for Turkey. Ankara, Turkey: The Ministry of Health, General Directorate of Primary Health Care Services, and Hacettepe University Department of Nutrition and Dietetics; 2004;. Available at: www.saglik.gov.tr\/extras\/birimler\/temel\/beslenme_rehberi.pdf. Accessed October 26, 2011"},{"issue":"5","key":"2021120823535475900_B25","doi-asserted-by":"crossref","first-page":"268","DOI":"10.5694\/j.1326-5377.2006.tb00558.x","article-title":"Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement.","volume":"185","author":"Munns","year":"2006","journal-title":"Med J Aust"},{"key":"2021120823535475900_B26","volume-title":"Dietary Reference Intakes for Calcium and Vitamin D","author":"Institute of Medicine","year":"2011"},{"issue":"4","key":"2021120823535475900_B27","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1136\/adc.2006.113829","article-title":"Free vitamin D supplementation for every infant in Turkey.","volume":"92","author":"Hatun","year":"2007","journal-title":"Arch Dis Child"},{"issue":"4","key":"2021120823535475900_B28","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1210\/jc.2009-1391","article-title":"Maternal vitamin D status determines bone variables in the newborn.","volume":"95","author":"Viljakainen","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2021120823535475900_B29","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1177\/0884217505276157","article-title":"Vitamin D and the breastfed infant.","volume":"34","author":"Henderson","year":"2005","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"issue":"4","key":"2021120823535475900_B30","doi-asserted-by":"crossref","first-page":"1080S","DOI":"10.1093\/ajcn\/87.4.1080S","article-title":"Vitamin D deficiency: a worldwide problem with health consequences.","volume":"87","author":"Holick","year":"2008","journal-title":"Am J Clin Nutr"},{"key":"2021120823535475900_B31","first-page":"73","article-title":"Review of the concept of vitamin D \"sufficiency and insufficiency\"","volume":"23","author":"G\u00f3mez Alonso","year":"2003","journal-title":"Nefrologia"},{"issue":"10","key":"2021120823535475900_B32","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1017\/S1368980009004820","article-title":"Vitamin D deficiency in early childhood: prevalent in the sunny South Pacific.","volume":"12","author":"Grant","year":"2009","journal-title":"Public Health Nutr"},{"issue":"2","key":"2021120823535475900_B33","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1542\/peds.2006-0108","article-title":"Vitamin D deficiency in breastfed infants in Iowa.","volume":"118","author":"Ziegler","year":"2006","journal-title":"Pediatrics"},{"issue":"12","key":"2021120823535475900_B34","first-page":"751","article-title":"Vitamin D insufficiency in a sunny environment: a demographic and seasonal analysis.","volume":"12","author":"Oren","year":"2010","journal-title":"Isr Med Assoc J"},{"issue":"3","key":"2021120823535475900_B35","first-page":"267","article-title":"Vitamin D deficiency in healthy breastfed term infants at 3 months & their mothers in India: seasonal variation & determinants.","volume":"133","author":"Jain","year":"2011","journal-title":"Indian J Med Res"},{"issue":"1","key":"2021120823535475900_B36","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1687-9856-2011-4","article-title":"Prevention of Vitamin D deficiency in infancy: daily 400 IU vitamin D is sufficient.","volume":"2011","author":"Mutlu","year":"2011","journal-title":"Int J Pediatr Endocrinol"},{"issue":"1","key":"2021120823535475900_B37","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/0009922806289311","article-title":"Vitamin D deficiency in a healthy group of mothers and newborn infants.","volume":"46","author":"Lee","year":"2007","journal-title":"Clin Pediatr (Phila)"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/130\/4\/e921\/1087847\/peds_2012-0017.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/130\/4\/e921\/1087847\/peds_2012-0017.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T10:19:15Z","timestamp":1744193955000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/130\/4\/e921\/30256\/Vitamin-D-Status-of-Exclusively-Breastfed-4-Month"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,10,1]]},"references-count":37,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2012,10,1]]},"published-print":{"date-parts":[[2012,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2012-0017","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,10,1]]}}}