Vitamin D and Probability of Developmental Disorders among Perinatally HIV-Affected and Unaffected Ugandan Children
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Published on: September 6, 2019
Jorem E Awadu1, Bruno Giordani2, Alla Sikorskii1
1Department of Psychiatry, Michigan State University, East Lansing, MI 48823, USA.
Insights
Vitamin D deficiency (VDD) is linked to increased developmental disorder risks in pre-adolescent children, particularly those with perinatal HIV infection. This association was not observed in adolescents, highlighting a developmental stage-dependent effect.
Area of Science:
- Pediatrics
- Nutritional Science
- Infectious Diseases
Background:
- Vitamin D deficiency (VDD) is a global health concern with potential impacts on child development.
- Children with perinatal HIV infection (CPHIV) may be at higher risk for nutritional deficiencies and developmental disorders.
- Understanding the interplay between vitamin D status, HIV exposure, and neurodevelopment is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between vitamin D deficiency (VDD) and the probability of developmental disorders in children.
- To examine if this association differs based on HIV status (CPHIV, CHEU, CHUU) and developmental stage (pre-adolescent vs. adolescent).
Main Methods:
- A longitudinal study involving 604 children (6-18 years) across three groups: CPHIV, HIV-exposed uninfected (CHEU), and HIV-unexposed uninfected (CHUU).
- Serum 25-hydroxyvitamin-D (25OHD) levels were measured to categorize vitamin D status (VDD, VDI, VDS).
- Developmental outcomes (autism, ADHD, EBD, functional impairment, resiliency) were assessed using caregiver reports (BASC-3) at baseline and 12-month follow-up.
Main Results:
- Baseline VDD was associated with a higher probability of autism spectrum disorder (ASD), attention deficit & hyperactivity (ADHD), and emotional behavioral disorder (EBD) in pre-adolescents.
- VDD also predicted higher functional impairment (FI) scores in pre-adolescents, with moderate clinical importance.
- No significant association between VDD and developmental disorders or resiliency was found in adolescents, indicating a developmental stage-dependent effect.
Conclusions:
- Vitamin D deficiency is associated with increased risks for specific developmental disorders and functional impairment in pre-adolescent children.
- The observed relationship is dependent on developmental stage, with no significant links found in adolescents.
- Further research is needed to elucidate this relationship and inform targeted interventions for at-risk pediatric populations.
Abstract:
We tested the hypothesis that vitamin D deficiency (VDD) is associated with higher developmental disorder probability in 604 children with perinatal HIV infection (CPHIV, n = 199), HIV exposed and uninfected (CHEU, n = 196), and HIV unexposed uninfected (CHUU, n = 201). Children at 6-18 years old and their adult caregivers were assessed at enrollment, 6, and 12-month follow-ups. Serum 25-hydroxyvitamin-D (25OHD) levels in children quantified per the NHANES protocol were used to define VD categories as VDD (25OHD < 20 ng/mL), VD insufficient (VDI, 20 ≤ 25OHD ≤ 25 ng/mL), and VD sufficient (VDS = reference group if 25OHD > 25 ng/mL). Perinatal HIV status per DNA polymerase chain reaction/HIV rapid diagnostic tests included: CPHIV, CHEU, and CHUU. Developmental stage was defined as pre-adolescent (age < 11) vs. adolescent (age ≥ 11) years. Caregiver responses to standardized questions from Behavioral Assessment System for Children, Third Edition (BASC-3), were used to calculate probability scores for four disorders, namely: autism (ASD), attention deficit & hyperactivity (ADHD), emotional behavioral disorder (EBD), functional impairment (FI), and resiliency at 0, 6 and 12 months. Multivariable longitudinal models estimated VD-associated standardized mean difference (SMD) and corresponding 95% confidence intervals (95% CI) in respective probability scores in Statistical Analysis Software (v.9.4). Baseline VDD vs. VDS predicted higher probability scores of moderate clinical importance for ASD, ADHD, EBD, and higher FI among pre-adolescents (SMD = 0.32 to 0.40, 95% CI: 0.00 to 0.74). VDD was not associated with resiliency or any developmental disorders among adolescents. VDD predicted higher developmental disorder and FI scores over 12 months in a developmental stage-dependent manner. This relationship requires further understanding to appropriately target future interventions.
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