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Correlation Between Vitamin E Levels and Cholesterol, Vitamin D, and Frequency of Pulmonary Exacerbations in Children
Hasan M Isa1,2, Fatema A Alkharsi2, Zahra S Mohamed2
1Department of Pediatrics, Arabian Gulf University, Manama, BHR.
Insights
Vitamin E deficiency is common in children with cystic fibrosis (CF), affecting over a quarter of those studied. This deficiency may increase the risk of hemolytic anemia but does not appear to impact pulmonary exacerbations.
Area of Science:
- Pediatrics
- Nutritional Science
- Pulmonology
Background:
- Children with cystic fibrosis (CF) experience lipid maldigestion and malabsorption of fat-soluble vitamins due to pancreatic insufficiency.
- Vitamin E deficiency is a potential complication in this population, necessitating assessment of its prevalence and impact.
Purpose of the Study:
- To determine the prevalence of vitamin E deficiency in children with CF.
- To investigate the correlation between vitamin E levels and demographic data, laboratory findings, and pulmonary exacerbations.
- To identify predictors of vitamin E deficiency in pediatric CF patients.
Main Methods:
- A prospective cohort study involving 35 children with CF from July 2017 to April 2019.
- Measurement of vitamin E, vitamin D, and fasting serum cholesterol levels from light-protected blood samples.
- Comparison of vitamin E-deficient patients with sufficient patients regarding clinical and laboratory parameters, including pulmonary exacerbations.
Main Results:
- Vitamin E deficiency was observed in 25.7% of the studied pediatric CF patients.
- Vitamin E levels showed a significant negative correlation with white blood cell (WBC) count.
- Vitamin E-deficient patients exhibited lower weight, hemoglobin, and salbutamol use, but higher reticulocyte percentage and WBC count compared to sufficient patients.
Conclusions:
- Vitamin E deficiency is prevalent in children with CF in Bahrain and may be linked to an increased risk of hemolytic anemia.
- The study found no correlation between vitamin E levels and the frequency of pulmonary exacerbations in this cohort.
- Prompt management of vitamin E deficiency is crucial in pediatric CF patients to prevent irreversible complications.
Abstract:
Introduction Children with cystic fibrosis (CF) have lipid maldigestion due to pancreatic insufficiency, which causes malabsorption of fat-soluble vitamins. The primary objective of this study was to assess the prevalence of vitamin E deficiency among children with CF. The secondary objective was to examine the correlation between vitamin E levels with demographic data, laboratory findings, and the number of pulmonary exacerbations. Furthermore, the study aimed to identify potential predictors of vitamin E deficiency in this population. Methods A prospective cohort study was conducted from July 1, 2017, to April 30, 2019. Medical records of children diagnosed with CF at the Department of Pediatrics, Salmaniya Medical Complex, Bahrain were reviewed. Patients who didn't receive fat-soluble vitamin supplementation for at least three days were recruited for the study. Light-protected blood samples were tested for vitamin E and D levels and fasting serum cholesterol levels. Patients with vitamin E deficiency were compared with those without regarding demography, laboratory results, and number of pulmonary exacerbations. Results Of 109 patients with CF, 35 (32.1%) fulfilled the inclusion criteria. Eighteen (51.4%) were males. The mean age was 6.8 ± 4.7 years. Eleven (31.4%) patients were symptomatic. Vitamin E and D were deficient in nine (25.7%) and 28/34 (82.4%) patients, respectively. Cholesterol was low in 29 (82.9%). The mean vitamin E level in the deficient group was significantly lower (3.2 ± 1.7 mg/L) than that (10.3 ± 3.1 mg/L) of the vitamin E-sufficient group (P < 0.0001). A significant negative correlation was noted between vitamin E levels and white blood cell (WBC) count (r = -0.408; P = 0.015). However, no correlation was found between vitamin E levels and cholesterol, vitamin D levels, or the number of pulmonary exacerbations. Vitamin E-deficient patients had lower weight at presentation (P = 0.045), hemoglobin level (P = 0.001), and salbutamol use (P = 0.022), but higher reticulocyte percentage (P = 0.034) and WBC count (P = 0.001) compared to the vitamin E-sufficient group. Conclusion Vitamin E deficiency is common among patients with CF in Bahrain and may increase the risk of hemolytic anemia. This deficiency did not seem to affect the frequency of pulmonary exacerbations. Management of vitamin E deficiency in patients with CF should be hastened to avoid irreversible complications.
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