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High risk of vitamin D deficiency in children with sickle cell disease
Alisha J Rovner1, Virginia A Stallings, Deborah A Kawchak
1Division of Epidemiology, Statistics and Prevention, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
Insights
Children with sickle cell disease (SCD-SS) have significantly lower vitamin D levels and a higher risk of deficiency compared to healthy peers. This highlights a critical need for monitoring vitamin D status in this vulnerable pediatric population.
Area of Science:
- Pediatric Hematology
- Nutritional Science
- Public Health
Background:
- Children with homozygous sickle cell disease (SCD-SS) face increased risks for vitamin D deficiency due to factors like higher melanin levels, reduced physical activity, and inadequate dietary intake.
- Understanding vitamin D status in children with SCD-SS is crucial for their overall health and development, especially in diverse populations.
- Previous research indicates potential disparities in nutrient status among children with chronic health conditions.
Purpose of the Study:
- To compare the vitamin D status of children with SCD-SS to that of healthy African-American children residing in the same geographic area.
- To assess the prevalence of vitamin D deficiency and insufficiency in both groups.
- To determine the risk factors associated with poor vitamin D status in children with SCD-SS.
Main Methods:
- A comparative study involving 61 African-American children with SCD-SS and 89 healthy African-American control subjects, aged 5-18 years.
- Measurements included growth parameters, dietary intake, serum 25-hydroxyvitamin D [25(OH)D] levels, and intact parathyroid hormone (iPTH) concentrations.
- Statistical analyses were performed to compare vitamin D status and adjust for potential confounders like season and age.
Main Results:
- Children with SCD-SS exhibited significantly lower median serum 25(OH)D levels (15 ng/mL) compared to healthy controls (21 ng/mL) (P<0.0002).
- Vitamin D deficiency [25(OH)D<11 ng/mL] was observed in 33% of SCD-SS subjects versus 9% of controls (P<0.001).
- The risk of vitamin D deficiency was 5.3 times greater in children with SCD-SS compared to controls, even after adjusting for season and age.
Conclusions:
- Poor vitamin D status, including deficiency and insufficiency, is highly prevalent in children with SCD-SS.
- Children with SCD-SS are at a substantially increased risk for vitamin D deficiency compared to their healthy peers.
- These findings underscore the importance of routine vitamin D monitoring and intervention strategies for children with SCD-SS.
Abstract:
Vitamin D is a particularly concerning nutrient for children with homozygous SS sickle cell disease (SCD-SS) due to their increased skin melanin concentrations, reduced levels of physical activity, and poor vitamin D intake. The goal of this study was to compare the vitamin D status of children with SCD-SS to healthy African-American children living in the same geographic area. Growth, dietary intake, serum 25-hydroxyvitamin D [25(OH)D], and intact parathyroid hormone (iPTH) concentrations were measured in 61 African-American subjects with SCD-SS and 89 healthy African-American control subjects age 5 to 18 years from the Philadelphia, PA, region (latitude 39.95 degrees N). Median serum 25(OH)D concentrations were 15 ng/mL (95% confidence interval [CI]: 13, 17) in subjects with SCD-SS and 21 ng/mL (95% CI: 18, 22) in healthy control subjects (P<0.0002). Vitamin D deficiency [25(OH)D<11 mg/mL] was found in 33% of subjects with SCD-SS and 9% of healthy control subjects (P<0.001); 25% of subjects with SCD-SS and 17% of healthy control subjects had elevated iPTH [(>59 rhog/mL), P<0.05]. Ninety-three percent of subjects with SCD-SS and 90% of healthy subjects had vitamin D insufficiency [25(OH)D<30 mg/mL]. The risk of vitamin D deficiency among subjects with SCD-SS was 5.3 (95% CI: 2.5, 8.2) times greater than control subjects, adjusted for season and age. Poor vitamin D status was prevalent in children with SCD-SS and healthy African-American children living in the same geographic area. However, children with SCD-SS were at greater risk for vitamin D deficiency than healthy African-American children.
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