Prevalence and factors influencing sub-optimal serum levels of 25-hydroxyvitamin D among children with sickle cell anaemia in south-west Nigeria
Background: Sub-optimal levels of vitamin D worsens morbidity in sickle cell anaemia (SCA). Increased frequency of pain episodes and haemolysis have been linked with the deficiency and or insufficiency of vitamin D among individuals with SCA. In Nigeria, the country with the highest SCA burden, data on the prevalence and risk factors for sub-optimal vitamin D in SCA is scanty.
Objectives: The objectives of this study were to determine the prevalence of depressed vitamin D and examine the influence of sociodemographic characteristics and anthropometric parameters on the serum levels of 25-hydroxyvitamin D (25-OHD) among Nigerian children with SCA.
Methods: In this cross-sectional comparative study, serum 25-OHD levels of 95 children with SCA and 75 age- and gender-matched haemoglobin AA control were quantified by high performance liquid chromatography over a six-month period.
Results: A higher proportion of children with SCA had sub-optimal 25-OHD compared with the controls: 12.6% vs. 2.7%, p = 0.013, 95% CI = 1.1–24.4. The mean serum 25-OHD of the children with SCA was also significantly lower (41.8 ± 9.8ng/mL vs. 45.2 ±8.1ng/mL, p = 0.017, 95% CI = 1.6 – 6.1). Serum 25-OHD was not related to age, sex, social class, presence of underweight, overweight/obesity and stunting in both bivariate and multivariate analyses.Conclusion: The prevalence of low serum vitamin D was higher among SCA patients than the matched controls. The serum level was not influenced by their sociodemographic and nutritional status.
2. Buison AM, Kawchak DA, Schall J, Ohene-Frempong K, Stallings VA, Zemel BS. Low vitamin D status in children with sickle cell disease. J Pediatr 2004: 145: 622-27.
3. Tayo BO, Akingbola TS, Salako BL, McKenzie CA, Reid M, Layden J, et al. Vitamin D levels are low in adult patients with sickle cell disease in Jamaica and West Africa. BMC Hematol 2014; 14: 12.
4. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-81.
5. Mithal A, Wad DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009; 20: 1807–20.
6. Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in a developing country. West Afr J Med 1985; 4: 205-12.
7. WHO. WHO Child Growth Standards; Methods and development: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. World Health Organization, Geneva. 2006.
8. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC growth charts: United States. Advance data from vital and healthstatistics; no. 314. Hyattsville, Maryland: National Center for Health Statistics, 2000.
9. Frisancho A. Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor, MI: University of Michigan Press, 1990.
10. Pfitzner MA, Thacher TD, Pettifor JM, Zoakah AI, Lawson JO, Isichei CO, et al. Absence of vitamin D deficiency in young Nigerian children. J Pediatr 1998; 133: 740-44.
11. Oginni LM, Worsfold M, Oyelami OA, Sharp CA, Powell DE, Davie MWJ. Etiology of rickets in Nigerian children. J Pediatr 1996; 128: 692-94.
12. Osunkwo I, Ziegler TR, Alvanez J, McCracken C, Cherry K, Osunkwo CE, et al. High dose vitamin D therapy for chronic pain in children and adolescents with sickle cell disease: results of a randomised double blind pilot study. Br J Haematol 2012; 159(2): 211-15.
13. Rovner AJ, Stallings VA, Kawchak DA, Schall JI, Ohene-Frempong K, Zemel BS. High risk of vitamin D deficiency in children with sickle cell disease. J Am Diet Assoc 2008; 108: 1512-16.
14. Jackson TC, Krauss MJ, DeBaun MR, Strunk RC, Arbeláez AM. Vitamin-D deficiency and comorbidities in children with sickle cell anemia. Pediatr Hematol Oncol 2012; 29: 261-66.
15. Garrido C, Cela E, Beléndez C, Mata C, Huerta J. Status of vitamin D in children with sickle cell disease living in Madrid, Spain. Eur J Pediatr 2012; 171: 1793-98.
16. Ozen S, Unal S, Ercetin N, Tasdelen B. Frequency and risk factors of endocrine complications in Turkish children and adolescents with sickle cell anemia. Turk J Haematol 2013; 30: 25–31.
17. Mohammed S, Addae S, Suleiman S, Adzaku F, Annobil S, Kaddoumi O, et al. Serum calcium, parathyroid hormone, and vitamin D status in children and young adults with sickle cell disease. Ann Clin Biochem 1993; 30 Pt 1: 45–51.
18. van der Dijs FP, van der Klis FR, Muskiet FD, Muskiet FA. Serum calcium and vitamin D status of patients with sickle cell disease in Curacao. Ann Clin Biochem 1997; 34 Pt 2: 170–72.
19. de Oliveira JF, Vicente NG, Santos JP, Weffort VR. Vitamin D in children and adolescents with SCD: an integrative review. Rev Paul Pediatr 2015; 33(3): 349-54.
20. Lal A, Fung EB, Pakbaz Z, Hackney-Stephens E, Vichinsky EP. Bone mineral density in children with sickle cell anaemia. Pediatr Blood Cancer 2006; 47: 901-06.
21. Peters BSE, dos Santos LC, Fisberg M, Wood RJ, Martini LA. Prevalence of vitamin D insufficiency in Brazilian adolescents. Ann Nutr Metab 2009; 54: 15-21.
22. van der Gaag, Brekhoff L. Effects of food and vitamin D supplements on the serum 25(OHD)3 concentration in children during winter months. Foods 2014; 3: 632–41.