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

Article information

Kosin Med J. 2012;27(1):17-24
Publication date (electronic) : 2012 June 11
doi : https://doi.org/10.7180/kmj.2012.27.1.17
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 2011 November 29; Revised 2012 February 16; Accepted 2012 February 23.

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

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Copyright © 2012 Kosin University College of Medicine

Fig. 1

Fig. 1

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

Fig. 2

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

Table 1

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)

Table 2

†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

Table 3

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

Table 4

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