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Vitamin D deficiency and its risk factors in Malaysian children with epilepsy
Choong Yi Fong1, Ann Nie Kong1, Bee Koon Poh2
1Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Insights
Long-term antiepileptic drug use increases vitamin D deficiency risk in children with epilepsy. Malaysian children with epilepsy show high deficiency rates, necessitating targeted supplementation and sun exposure advice.
Area of Science:
- Pediatric Neurology
- Endocrinology
- Public Health
Background:
- Long-term use of antiepileptic drugs (AEDs) is a known risk factor for vitamin D deficiency.
- Children with epilepsy are a vulnerable population requiring assessment for nutritional deficiencies.
- Understanding prevalence and risk factors in specific ethnic groups is crucial for public health initiatives.
Purpose of the Study:
- To determine the prevalence of vitamin D deficiency and insufficiency in Malaysian children with epilepsy.
- To identify key risk factors associated with vitamin D deficiency in this population.
- To inform targeted interventions for preventing vitamin D deficiency.
Main Methods:
- A cross-sectional study was conducted on 244 children with epilepsy on AEDs for over one year in Malaysian tertiary hospitals.
- Data collected included demographics, pubertal status, sun exposure, diet, anthropometry, and biochemical markers (25-hydroxy vitamin D, calcium, etc.).
- Vitamin D deficiency was defined as 25(OH)D ≤35 nmol/L, and insufficiency as 36-50 nmol/L.
Main Results:
- Overall, 22.5% of children had vitamin D deficiency and 19.7% had insufficiency.
- Significant risk factors for deficiency included polytherapy (>1 AED), age >12 years, Indian ethnicity, reduced sun exposure (<60 min/day), and being female.
- Multivariate analysis revealed specific odds ratios for these risk factors.
Conclusions:
- A substantial proportion of Malaysian children with epilepsy are vitamin D deficient, despite living in a tropical region.
- Targeted vitamin D supplementation and education on safe sun exposure are recommended for high-risk children.
- Public health strategies should address nutritional deficiencies in children with epilepsy, considering ethnic and lifestyle factors.
Objective:
Long-term use of antiepileptic drugs (AEDs) is a significant risk factor for vitamin D deficiency in children with epilepsy. The aims of our study were to evaluate the prevalence and risk factors for vitamin D deficiency among Malaysian children with epilepsy.
Methods:
Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in three tertiary hospitals in Malaysia from April 2014 to April 2015. Detailed assessment of pubertal status, skin pigmentation, sunshine exposure behavior, physical activity, dietary vitamin D and calcium intake, anthropometric measurements and bone health blood tests (vitamin D, alkaline phosphatase, calcium, phosphate, and parathyroid hormone levels) were obtained on all patients. Vitamin D deficiency was defined as 25-hydroxy vitamin D [25(OH)D] levels ≤35 nmol/L and insufficiency as 25(OH)D levels of 36-50 nmol/L.
Results:
A total of 244 children (146 male) participated in the study. Ages ranged between 3.7 and 18.8 years (mean 12.3 years). 25(OH)D levels ranged between 7.5 and 140.9 nmol/L (mean 53.9 nmol/L). Vitamin D deficiency was identified in 55 patients (22.5%), and a further 48 (19.7%) had vitamin D insufficiency. Multivariate logistic regression analysis identified polytherapy >1 AED (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.07-4.36), age >12 years (OR 4.16, 95% CI 1.13-15.30), Indian ethnicity (OR 6.97, 95% CI 2.48-19.55), sun exposure time 30-60 min/day (OR 2.44, 95% CI 1.05-5.67), sun exposure time <30 min/day (OR 3.83, 95% CI 1.61-9.09), and female (OR 2.61, 95% CI 1.31-5.20) as statistically significant (p < 0.05) risk factors for vitamin D deficiency.
Significance:
Despite living in the tropics, a high proportion of Malaysian children with epilepsy are at risk of vitamin D deficiency. Targeted strategies including vitamin D supplementation and lifestyle advice of healthy sunlight exposure behavior should be implemented among children with epilepsy, particularly for those at high risk of having vitamin D deficiency.
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