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Vitamin D status in children undergoing allogeneic hematopoietic stem cell transplantation: A prospective exploratory
Janne Anita Kvammen1,2, Rut Anne Thomassen1,2, Jochen Buechner3
1Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway.
Insights
Children undergoing allogeneic hematopoietic stem cell transplantation (HSCT) face high vitamin D deficiency risks, especially early post-transplant. Increased vitamin D intake is crucial for these patients, necessitating monitoring and supplementation.
Area of Science:
- Pediatric Hematology
- Transplantation Immunology
- Nutritional Science
Background:
- Allogeneic hematopoietic stem cell transplantation (HSCT) carries significant nutritional risks.
- Vitamin D status and intake are critical factors in patient recovery and outcomes post-HSCT.
Purpose of the Study:
- To assess vitamin D status (25(OH)D and 1,25(OH)2D) and intake in pediatric HSCT recipients.
- To compare vitamin D levels and intake between HSCT patients and healthy children.
- To identify the prevalence and timing of vitamin D deficiency in children undergoing HSCT.
Main Methods:
- Prospective observational study design.
- Measurement of serum 25(OH)D and 1,25(OH)2D at baseline, 3 months, and 1 year post-HSCT.
- Dietary assessment of vitamin D intake using a 4-day food record at 3 months and 1 year.
Main Results:
- Higher prevalence of vitamin D deficiency in HSCT patients at baseline (36%) and 3 months (24%) compared to healthy children (2%).
- Lower median 1,25(OH)2D levels observed in HSCT patients at early post-transplant visits.
- Significantly higher vitamin D intake in HSCT patients at 3 months (18.1 µg/day) and 1 year (25 µg/day) compared to controls (5.3 µg/day).
Conclusions:
- Children undergoing HSCT exhibit an elevated risk of vitamin D deficiency, particularly in the early post-transplant period.
- Despite increased intake, vitamin D deficiency can persist, indicating higher requirements in HSCT patients.
- Regular monitoring and adequate vitamin D supplementation are essential for pediatric HSCT recipients.
Objectives:
Allogeneic hematopoietic stem cell transplantation (HSCT) is associated with nutritional risks. This study describes vitamin D status and intake in children undergoing HSCT and compares results to healthy children.
Methods:
In a prospective observational study, vitamin 25(OH)D and 1,25(OH)2D were assessed at hospital admission before HSCT (baseline), at 3-month and 1-year post-transplant. Vitamin D deficiency was defined as 25(OH)D < 50 nmol/L. A 4-day diet record assessed vitamin D intake at 3-months and 1-year. Healthy children were assessed once.
Results:
Twenty-eight HSCT patients (mean age: 10.3-years, standard deviation [SD]: 4.0) and 50 healthy children (mean age: 10.0-years, SD: 3.6) were included. Vitamin D deficiency was more prevalent in patients at baseline (36%, p < 0.001) and 3-months (24%, p = 0.007) but not at 1-year (14%, p = 0.084) than in healthy children (2%). Median 1,25(OH)2D was significantly lower than in healthy children at the two first visits (p < 0.001) but not at 1-year (p = 0.198). Median vitamin D provision was higher at 3-months (18.1 µg/day) and 1-year (25 µg/day) compared to healthy children (5.3 µg/day, p < 0.001).
Conclusions:
Children undergoing HSCT were at a high risk of vitamin D deficiency at baseline and 3-month post-transplant, but not at 1-year compared to healthy children. Vitamin D intake was higher after transplantation than in healthy children. These findings indicate that vitamin D requirements are elevated in HSCT patients, emphasizing the need for monitoring and adequate supplementation.
Trial Registration:
Clinical Trials AEV2017/1. 2016/391/REK sør-øst B.
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