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recommends that exclusively breast-fed infants receive a supplement of vitamin D,6 and the American Academy of Pediatrics guidelines support supplementation of breastfeeding infants with vitamin D (Gartner and Greer, 2003). Commercial infant formula contains vitamin D, as discussed previously in this chapter.

Childhood and Adolescence

This life stage is characterized by bone accretion. During the rapid growth phase of adolescence, almost 50 percent of the adult skeletal mass will be accumulated. The onset of puberty stimulates increased metabolism of 25OHD levels to calcitriol (Aksnes and Aarskog, 1982) and subsequent increased calcium intestinal absorption, decreased urinary calcium excretion, and greater calcium deposition into bone (Wastney et al., 1996). Information on relationships between 25OHD levels and optimal intestinal absorption of calcium or risk for rickets or fracture in children and adolescents is lacking, although Abrams et al. (2005) found evidence for an indirect relationship between low serum 25OHD and increased calcium absorption in young adolescents. Although a recent set of systematic reviews (Cranney et al., 2007; Chung et al., 2009), to be discussed in Chapter 4, did not report specifically on bone mass for this age group in relation to vitamin D nutriture, the reviews suggested the possibility of a relationship between serum levels of 25OHD and bone mineral density (BMD) in adolescents. A recent analysis of vitamin D intake and BMD in male and female adolescents and adults ages 13 to 36 years found positive correlations between vitamin D intake and bone density from adolescence into adulthood among male but not female subjects (van Dijk et al., 2009).


The life stages associated with younger adults, covering several decades, are characterized by a need for adequate nutrition for bone maintenance. The bone is constantly undergoing remodeling, and the maintenance of normal bone density reduces the risk of skeletal disorders ranging from osteomalacia to the onset of osteoporotic fractures later in life. It is also the time of pregnancy and lactation for some female members of this population.

Older adults, especially those characterized as frail, may have poor dairy and vitamin D intake, decreased sun exposure, reduced dermal conversion of 7-dehydrocholesterol to vitamin D3 and secondary hyperparathy-


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