Seasonal variability of vitamin D deficiency in patients with inflammatory bowel disease and other chronic diseases
Authors:
P. Horváthová 1*; K. Frivolt 1*; K. Prochotská 1; E. Vitáriušová 1; T. Kyselová 2; J. Šemberová 2; Z. Pribilincová 1; I. Čierna 1; T. Dallos 1; L. Kovács 1
Authors place of work:
Detská klinika Lekárskej fakulty Univerzity Komenského a Detskej fakultnej nemocnice
s poliklinikou, Bratislava
1; Pracovisko klinickej imunológie a alergológie Detskej fakultnej nemocnice s poliklinikou, Bratislava
2
Published in the journal:
Čes-slov Pediat 2017; 72 (4): 232-238.
Category:
Original Papers
*Autori prispeli k tejto práci rovnakým dielom
Summary
Background:
Bone remodelling is regulated by hormones and paracrine factors. Vitamin D deficiency is often present in patients with chronic disease, but also among healthy children.
Aims:
To investigate vitamin D deficiency and other markers of bone metabolism among Slovak out-patients and hospitalized children.
Methods:
In this prospective single center study serum levels of vitamin 25-OH-D3 and bone markers were investigated in spring (march-may) and/or in autumn (september – november) in children aged 6–18 years.
Results:
We enrolled 199 children, in 70 we performed two examinations in spring and in autumn. Serum level of vitamin D in the entire cohort was 22.5±9.3 ng/ml with a significant seasonal variability (20.4±9.1 ng/ml in spring vs. 25.7±8.9 ng/ml in autumn, p<0.0001) that was present in both the control group (n=84) and in children with chronic disease (n=72), except children with inflammatory bowel disease (n=43). Overall, vitamin D deficiency was present in 20.0% of cases, in spring in 27.3% and in autumn in 9.3%. Parathyroid hormone was elevated in 57.1% of patients with vitamin D deficiency and correlated negatively with vitamin D levels (r=-0.541, p=0.001). In adolescent children, vitamin D level correlated positively with osteoprotegerin level (r=0.362, p=0.036) and the OPG/RANKL ratio (r=0.524, p=0.001) and negatively with RANKL level (r=-0.524, p=0.001).
Conclusion:
We found a high prevalence of insufficient vitamin D levels that was associated with increased parathyroid hormone and in adolescents with increased RANKL level with potentially negative impact on bone health. It is important to draw parents´attention to the importance of vitamin D supplementation, particularly in winter, in both, children with chronic diseases as well as healthy ones.
Key words:
children, bone metabolism, chronic diseases, Crohn’s disease, ulcerative colitis, inflammatory bowel disease, vitamin D, parathyroid hormone, osteoprotegerin, RANKL
Zdroje
1. Šašinka MA, Furková K. Slnečný vitamín – Pandémia nedostatku vitamínu D. Bratislava: Herba, 2012.
2. Misra M, Pacaud D, Petryk A, et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008; 122 (2): 398–417.
3. Hlavaty T, Krajcovicova A, Payer J. Vitamin D therapy in inflammatory bowel diseases: who, in what form, and how much? J Crohns Colitis 2015; 9 (2): 198–209.
4. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006; 450: 76–85.
5. Butte NE, Garza C, de Onis M. Evaluation of the feasibility of international growth standards for schoolaged children and adolescents. Food Nutr Bull 2006; 27 (4 Suppl): S169–174.
6. Turner D, Griffiths AM, Walters TD, et al. Mathematical weighting of the Pediatric Crohn´s Disease Activity Index (CDAI) and comparison with its other short versions. Inflamm Bowel Dis 2012;18(55-62.
7. Turner D, Otley AR, Mack D, et al. Development, validation, and evaluation of Pediatric Ulcerative Colitis Activity Index: A prospective multicenter study. Gastroenterology 2007;133: 423–432.
8. Looker AC, Johnson CL, Lacher DA, et al. Vitamin D status: United States, 2001–2006. NCHS Data Brief 2011; 59: 1–8.
9. Andersen R, Molgaard C, Skovgaard LT, et al. Teenage girls and elderly women living in northern Europe have low winter vitamin D status. Eur J Clin Nutr 2005; 59 (4): 533–541.
10. Guillemant J, Le HT, Maria A, et al. Wintertime vitamin D deficiency in male adolescents: effect on parathyroid function and response to vitamin D3 supplements. Osteoporos Int 2001; 12 (10): 875–879.
11. Furková K, Hrachová J, Najdeková I, et al. Koncentrácie vitamínu D u detí a adolescentov sledovaných v nefrologickej ambulancii. Lek Obz 2010; 59 (6): 216–220.
12. Košturiak R, Jeseňák M. Vitamín D a jeho vzťah k vybraným imunologickým parametrom. Pediatria (Bratisl) 2016; 11 (1): 11–16.
13. Janíková K, Vojarová L, Michnová Z, et al. Hladiny vitamínu D u zdravých detí. Pediatria (Bratisl) 2013; 8 (1): 29–33.
14. Pappa HM, Langereis EJ, Grand RJ, et al. Prevalence and risk factors for hypovitaminosis D in young patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2011; 53 (4): 361–364.
15. Braegger C, Campoy C, Colomb V, et al. Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013; 56 (6): 692–701.
16. Smotkin-Tangorra M, Purushothaman R, Gupta A, et al. Prevalence of vitamin D insufficiency in obese children and adolescents. J Pediatr Endocrinol Metab 2007; 20 (7): 817–823.
17. Schwarz J. S Incidence idiopatických střevních zánětů u dětí a dospívajících v Plzeňském kraji v letech 2001–2011: Prospektivní studie. Čes-slov Pediat 2013; 68 (3): 149–156.
18. Pozler O, Malý J, Bónová O, et al. Idiopatické střevní záněty u dětí a dospívajících v ČR v letech 1990–2001. Čes-slov Pediat 2004; 59 (2): 63–69.
19. Pappa HM, Gordon CM, Saslowsky TM, et al. Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics 2006; 118 (5): 1950–1961.
20. Sentongo TA, Semaeo EJ, Stettler N, et al. Vitamin D status in children, adolescents, and young adults with Crohn disease. Am J Clin Nutr 2002; 76 (5): 1077–1081.
21. Levin AD, Wadhera V, Leach ST, et al. Vitamin D deficiency in children with inflammatory bowel disease. Dig Dis Sci 2011; 56 (3): 830–836.
22. Hlavaty T, Krajcovicova A, Koller T, et al. Higher vitamin D serum concentration increases health related quality of life in patients with inflammatory bowel diseases. World J Gastroenterol 2014; 20 (42): 15787–15796.
23. Adamcová M, Bajer M, Bajerová K, et al. Doporučení Pracovní skupiny dětské gastroenterologie a výživy ČPS pro diagnostiku a léčbu nespecifických střevních zánětů u dětí. Čes-slov Pediat 2012; 67 (Suppl 2): 3–48.
24. Alkhouri RH, Hashmi H, Baker RD, et al. Vitamin and mineral status in patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2013; 56 (1): 89–92.
25. Tajika M, Matsuura A, Nakamura T, et al. Risk factors for vitamin D deficiency in patients with Crohn's disease. J Gastroenterol 2004; 39 (6): 527–533.
26. Werkstetter KJ, Ullrich J, Schatz SB, et al. Lean body mass, physical activity and quality of life in paediatric patients with inflammatory bowel disease and in healthy controls. J Crohns Colitis 2012; 6 (6): 665–673.
27. Kuwabara A, Tanaka K, Tsugawa N, et al. High prevalence of vitamin K and D deficiency and decreased BMD in inflammatory bowel disease. Osteoporos Int 2009; 20 (6): 935–942.
28. Lamb EJ, Wong T, Smith DJ, et al. Metabolic bone disease is present at diagnosis in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2002; 16 (11): 1895–1902.
29. Laakso S, Valta H, Verkasalo M, et al. Impaired bone health in inflammatory bowel disease: a case-control study in 80 pediatric patients. Calcif Tissue Int 2012; 91 (2): 121–130.
30. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997; 7 (5): 439–443.
31. Outila TA, Karkkainen MU, Lamberg-Allardt CJ. Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr 2001; 74 (2): 206–210.
32. Moschen AR, Kaser A, Enrich B, et al. The RANKL/OPG system is activated in inflammatory bowel disease and relates to the state of bone loss. Gut 2005; 54 (4): 479–487.
33. Wasilewska A, Rybi-Szuminska AA, Zoch-Zwierz W. Serum osteoprotegrin (OPG) and receptor activator of nuclear factor kappaB (RANKL) in healthy children and adolescents. J Pediatr Endocrinol Metab 2009; 22 (12): 1099–1104.
Štítky
Neonatology Paediatrics General practitioner for children and adolescentsČlánok vyšiel v časopise
Czech-Slovak Pediatrics
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