Journal List > Kosin Med J > v.27(1) > 1056975

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

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.

Figures and Tables

Fig. 1
Association between alkaline phosphatase and 25-hydroxycholecalciferol in breast milk feeding infants
kmj-27-17-g001
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.
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Table 1
Clinical profile of the cases of high level of alkaline phosphatase
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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)
kmj-27-17-i002

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
kmj-27-17-i003

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
kmj-27-17-i004

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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