The Study in Vitamin D Concentration in the Blood for Infants with High Level of Alkaline Phosphatase

Ji Sung Kim; Jae Yong Choi; Kyun Woo Lee; Ick Jin Song; Cheol Am Kim; Byeong Hee Son; Jung Hyun Lee

doi:10.7180/kmj.2012.27.1.17

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Kim, Choi, Lee, Song, Kim, Son, and Lee: The Study in Vitamin D Concentration in the Blood for Infants with High Level of Alkaline Phosphatase

Original Article

Kosin Medical Journal

Kosin Medical Journal 2012; 27(1): 17-24.

Published online: 11 June 2012

DOI: https://doi.org/10.7180/kmj.2012.27.1.17

The Study in Vitamin D Concentration in the Blood for Infants with High Level of Alkaline Phosphatase

Ji Sung Kim¹, Jae Yong Choi¹, Kyun Woo Lee¹, Ick Jin Song¹, Cheol Am Kim¹, Byeong Hee Son¹, Jung Hyun Lee²

¹Department of Pediatrics, Dae-Dong Hospital, Busan, Korea.

²Department of Pediatrics, College of Medicine, Kosin University, Busan, Korea.

Corresponding Author: Kyun Woo Lee, Department of Pediatrics, Dae-Dong Hospital, 187 Chungyel-daero, Dongrae-gu, Busan, 607-711, Korea. TEL: 051) 550-9257, FAX: 051) 553-7575, pedrics@hanmail.net

Received 29 November 2011 Revised 16 February 2012 Accepted 23 February 2012

Abstract

Objectives

Nowadays most infants on exclusively breast feeding have vitamin D deficiency due to the increase of breast feeding. However, domestic research lacks appropriate materials. Therefore, we researched practical clinical aspects of vitamin D deficiency related to breast milk feeding for infants who have a high amount of alkaline phosphatase (> 500 IU/L).

Methods

The subjects of the study were 31 infants with high alkaline phosphatase level. We tested with 25-hydroxycholecalciferol (25-OHD₃), parathyroid hormone, calcium, ionized calcium, phosphorus in their blood and with a wrist x-ray. Then, we divided them into two groups of breast feeding and formula feeding and compared the results.

Results

Eighteen infants (58%) out of 31 infants that have high alkaline phosphatase were vitamin D insufficiency or deficiency, and 16 (100%) breast feeding infants of them showed vitamin D deficiency or insufficiency. However, only 2 (13%) of 15 formula feeding infants were at insufficiency. There was a correlation between alkaline phosphatase and 25-OHD₃ concentration in multiple regression analysis, but no correlation in other variables was found in group of breast milk feeding infants. There was neither correlation between vitamin D concentration and alkaline phosphatase nor other correlated variables in the group of formula milk feeding infants.

Conclusions

In this study, there was a high probability of vitamin D deficiency in the breast feeding infants with a high alkaline phosphatase level. Therefore, it is considered to be worth utilizing alkaline phosphatase as a screening test for vitamin D deficiency or rickets for breast feeding infants.

Keywords: Alkaline phosphatase, Vitamin D deficiency, Breast feeding

Figures and Tables

Fig. 1

Association between alkaline phosphatase and 25-hydroxycholecalciferol in breast milk feeding infants

Fig. 2

Radiograph of wrist in a patient of asymptomatic rickets. there are cupping, spraying and fraying in ulna and radius. It is grade 2, moderate.

Table 1

Clinical profile of the cases of high level of alkaline phosphatase

Mo: Month, M: Male, F: Female, BMF: Breast milk feeding, FMF: Formula milk feeding, AGE: Acute gastroenteritis, APT: Acute pharyngotosilits, UTI: Urinary track infection, Dz: Disease, H-F-M: Hand foot mouth.

Table 2

Comparison of clinical profile between breast feeding infants and formula milk feeding infants (n=31)

^†Data are expressed as mean ± standard deviation (range).

P < 0.05 is significant.

n: numbers, Mo: Month, M: Male, F: Female, Ca²⁺: ionized calcium, Ca: Calcium, P: Phosphorus, ALP: Alkaline phosphatase, PTH: intact parathyroid hormone, 25-OHD3: 25-hydroxycholecalciferol

Table 3

Univariate analysis between 25-hydroxycholecalciferol and the variables

Spearman correlation, Sex (male=1, female=2), P < 0.05 is significant.

Mo: Month, Ca²⁺: ionized calcium, Ca: CALCIUm, P: Phosphorus, PTH: intact-parathyroid hormone, ALP: Alkaline phosphatase

Table 4

Predictors for 25-hydroxycholecalciferol in multiple regression analysis in breast milk feeding group

Multiple regression analysis (stepwise method), Sex (male=1, female=2), P < 0.05 is significant.

Mo: Month, Ca²⁺: ionized calcium, Ca: Calcium, P: Phosphorus, PTH: intact-parathyroid hormone, ALP: Alkaline phosphatase

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