Suplementação com vitamina D em lactentes: que evidência?

 

Marisa Carvalho* e Sílvio Barge**

*Interna do internato médico de Medicina Geral e Familiar, USF Mais Saúde.

**Interno do internato médico de Medicina Geral e Familiar, USF Lethes.

Endereço para Correspondência

 

Resumo

Objectivo: Determinar se existe evidência de benefícios clínicos na suplementação com vitamina D nos lactentes.

Fontes de dados: Base de dados MEDLINE e sítios electrónicos de Medicina Baseada na Evidência.

Métodos de revisão: Pesquisa de normas de orientação clínica, meta-análises, revisões sistemáticas, revisões baseadas na evidência e ensaios clínicos, publicados até Janeiro de 2010, em inglês, francês, espanhol e português, utilizando os termos MeSH: vitamin D, dietary supplements. Para avaliar a qualidade dos estudos e a força de recomendação, foi utilizada a escala Strength of Recommendation Taxonomy da American Family Physician.

Resultados: Foram identificados 340 artigos, tendo sido seleccionados nove que cumpriam a totalidade dos critérios de inclusão, dos quais três normas de orientação clínica, duas revisões sistemáticas, uma revisão baseada na evidência, dois consensos de peritos e um estudo de coorte. Não existe consenso acerca da necessidade de suplementação com vitamina D nos lactentes, nem da dose a utilizar. Suplementação com 400UI/L/dia de vitamina D a todos os lactentes em aleitamento materno exclusivo ou que ingiram menos de 1L de leite artificial por dia parece ser benéfica e segura.

Conclusão: Neste momento, o mais consensual é a recomendação de suplementação com 400UI/L/dia de vitamina D a todos os lactentes em aleitamento materno exclusivo, ou até que ingiram pelo menos 1L de leite artificial por dia, para prevenir o raquitismo. São necessários mais estudos controlados, aleatorizados, de longa duração e boa qualidade que avaliem as necessidades de vitamina D em diferentes populações.

Palavras-chave: Vitamina D; Suplementos Dietéticos; Lactente.

 

Vitamin D supplementation in infants: what is the evidence?

Abstract

Objective: To determine if there is evidence of clinical benefit for vitamin D supplementation in infants.

Sources: MEDLINE data base and Evidence Based Medicine electronic sites.

Review methods: A search for clinical practice guidelines, meta-analyses, systematic reviews, evidence-based reviews and clinical trials published before January 2010, in English, French, Spanish and Portuguese was performed using the MeSH terms: “vitamin D” and “dietary supplements”. The Strength of Recommendation Taxonomy scale of the American Family Physician was used to assess the quality of the studies and the strength of the recommendation.

Results: We identified 340 articles, but only nine met all of our inclusion criteria. These consisted of three clinical practice guidelines, two systematic reviews, an evidence-based review, a consensus statement of two experts and one cohort study. No agreement was found regarding the need for vitamin D supplements or the recommended dose. Vitamin D supplementation with 400 IU per day for all infants who are exclusively breastfed or who ingest less than one liter of formula milk per day seems beneficial and safe.

Conclusion: Currently, the most common recommendation for preventing rickets is the provision of 400 IU of vitamin D per day to infants who are exclusively breastfed, or who are fed with at least one liter of milk a day. Additional controlled, randomized, long-term high quality studies are necessary to assess the need for vitamin D supplementation in different populations.

Keywords: Vitamin D; Dietary Supplements, Infant.

 

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CONFLITOS DE INTERESSE

As autoras declaram não possuir qualquer tipo de conflito de interesses.

 

ENDEREÇO PARA CORRESPONDÊNCIA

Marisa Rocha Carvalho

Loteamento do Campo de Golfe, n.^o 56 B

Santo Amaro – Fornelos

4990-620 Ponte de Lima

E-mail: marisacarvalho6@gmail.com

 

Recebido em 05/11/2010

Aceite para publicação em 01/05/2011