CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2016; 37(01): 14-19
DOI: 10.4103/0971-5851.177009

Vitamin D insufficiency among children with cancer in India

Ram Mohan
Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
Gem Mohan
Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
Julius Scott
Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
Aruna Rajendran
Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
Venkatraman Paramasivam
Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
Manipriya Ravindran
Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
› Author Affiliations
Financial support and sponsorship Nil.


Background: Vitamin D plays an important role in regulating various homeostatic mechanisms and has yet untapped potential in cancer prevention and prognosis. Only a few studies have been done worldwide in relating the Vitamin D levels in pediatric cancer patients to the general population but none so far in an Indian setting to the best of our knowledge. Objective: To compare the Vitamin D levels in a group of children with cancer to that of the general pediatric population and to note differences in the prevalence of Vitamin D insufficiency and make inferences arising from demographic and therapeutic variations. Materials and Methods: Vitamin D levels were found by immuno-chemilumino-metric assay in 102 children (51 cases and 51 controls) over a 6 months period. Results: In comparing the Vitamin D levels of children with cancer and controls from a healthy population we found an increased incidence of Vitamin D insufficiency in cancer children (80.39%) when compared to controls (50.98%) and a much lower mean Vitamin D value in cancer children (22.8 ng/ml) when compared to controls (33 ng/dl). It was also found that cancer children above 6 years had a greater chance for developing Vitamin D insufficiency (P = 0.038) as did children suffering from hematological malignancies (P = 0.025). Conclusion: Our study showed an increased prevalence of Vitamin D insufficiency in children with cancer and hence we suggest routine measurement of Vitamin D levels in children with cancer and subsequent supplementation.

Publication History

Article published online:
12 July 2021

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  • References

  • 1 Kriegel MA, Manson JE, Costenbader KH. Does Vitamin D affect risk of developing autoimmune disease? A systematic review. Semin Arthritis Rheum 2011;40:512-31.e8.
  • 2 Camargo CA Jr., Rifas-Shiman SL, Litonjua AA, Rich-Edwards JW, Weiss ST, Gold DR, et al. Maternal intake of Vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr 2007;85:788-95.
  • 3 Brehm JM, Acosta-Pérez E, Klei L, Roeder K, Barmada M, Boutaoui N, et al. Vitamin D insufficiency and severe asthma exacerbations in Puerto Rican children. Am J Respir Crit Care Med 2012;186:140-6.
  • 4 Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 2004;79:820-5.
  • 5 Ganji V, Zhang X, Shaikh N, Tangpricha V. Serum 25-hydroxyvitamin D concentrations are associated with prevalence of metabolic syndrome and various cardiometabolic risk factors in US children and adolescents based on assay-adjusted serum 25-hydroxyvitamin D data from NHANES 2001-2006. Am J Clin Nutr 2011;94:225-33.
  • 6 Holick MF. Vitamin D: Importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 2004;79:362-71.
  • 7 Temmerman JC. Vitamin D and cardiovascular disease. J Am Coll Nutr 2011;30:167-70.
  • 8 El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J, Salamoun M, Khalife H, et al. Effect of Vitamin D replacement on musculoskeletal parameters in school children: A randomized controlled trial. J Clin Endocrinol Metab 2006;91:405-12.
  • 9 Holick MF. Resurrection of Vitamin D deficiency and rickets. J Clin Invest 2006;116:2062-72.
  • 10 Holick MF, Garabedian M. Vitamin D: Photobiology, metabolism, mechanism of action, and clinical applications. In: Favus MJ, editor. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 6 th ed. Washington, DC: American Society for Bone and Mineral Research; 2006. p. 129-37.
  • 11 Bilariki K, Anagnostou E, Masse V, Elie C, Grill J, Valteau-Couanet D, et al. Low bone mineral density and high incidences of fractures and Vitamin D deficiency in 52 pediatric cancer survivors. Horm Res Paediatr 2010; 74:319-27.
  • 12 Simmons JH, Chow EJ, Koehler E, Esbenshade A, Smith LA, Sanders J, et al. Significant 25-hydroxyvitamin D deficiency in child and adolescent survivors of acute lymphoblastic leukemia: Treatment with chemotherapy compared with allogeneic stem cell transplant. Pediatr Blood Cancer 2011;56:1114-9.
  • 13 Sinha A, Avery P, Turner S, Bailey S, Cheetham T. Vitamin D status in paediatric patients with cancer. Pediatr Blood Cancer 2011;57:594-8.
  • 14 Haddy TB, Mosher RB, Reaman GH. Late effects in long-term survivors after treatment for childhood acute leukemia. Clin Pediatr (Phila) 2009;48:601-8.
  • 15 Huh SY, Gordon CM. Vitamin D deficiency in children and adolescents: Epidemiology, impact and treatment. Rev Endocr Metab Disord 2008;9:161-70.
  • 16 El-Hajj Fuleihan G, Nabulsi M, Choucair M, Salamoun M, Hajj Shahine C, Kizirian A, et al. Hypovitaminosis D in healthy schoolchildren. Pediatrics 2001;107:E53.
  • 17 Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of Vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 2004;158:531-7.
  • 18 DeLuca HF. Overview of general physiologic features and functions of Vitamin D. Am J Clin Nutr 2004;80 6 Suppl:1689S-96S.
  • 19 Bouillon R. Vitamin D: From photo- synthesis, metabolism, and action to clinical applications. In: DeGroot LJ, Jameson JL, editors. Endocrinology. Philadelphia: WB Saunders; 2001. p. 1009-28.
  • 20 Saintonge S, Bang H, Gerber LM. Implications of a new definition of Vitamin D deficiency in a multiracial us adolescent population: The national health and nutrition examination survey III. Pediatrics 2009;123:797-803.
  • 21 Holick MF. Vitamin D deficiency. N Engl J Med 2007;357: 266-81.
  • 22 Hollis BW, Wagner CL. Assessment of dietary Vitamin D requirements during pregnancy and lactation. Am J Clin Nutr 2004;79:717-26.
  • 23 Lee JM, Smith JR, Philipp BL, Chen TC, Mathieu J, Holick MF. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila) 2007;46:42-4.
  • 24 Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM. High prevalence of Vitamin D insufficiency in black and white pregnant women residing in the Northern United States and their neonates. J Nutr 2007;137:447-52.
  • 25 Lamberg-Allardt C. Vitamin D in foods and as supplements. Prog Biophys Mol Biol 2006;92:33-8.
  • 26 Natri AM, Salo P, Vikstedt T, Palssa A, Huttunen M, Kärkkäinen MU, et al. Bread fortified with cholecalciferol increases the serum 25-hydroxyvitamin D concentration in women as effectively as a cholecalciferol supplement. J Nutr 2006;136:123-7.
  • 27 Babu US, Calvo MS. Modern India and the Vitamin D dilemma: Evidence for the need of a national food fortification program. Mol Nutr Food Res 2010;54:1134-47.
  • 28 Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006;84:18-28.
  • 29 Ruza E, Sotillo E, Sierrasesúmaga L, Azcona C, Patiño-García A. Analysis of polymorphisms of the Vitamin D receptor, estrogen receptor, and collagen Ialpha1 genes and their relationship with height in children with bone cancer. J Pediatr Hematol Oncol 2003;25:780-6.
  • 30 te Winkel ML, van Beek RD, de Muinck Keizer-Schrama SM, Uitterlinden AG, Hop WC, Pieters R, et al. Pharmacogenetic risk factors for altered bone mineral density and body composition in pediatric acute lymphoblastic leukemia. Haematologica 2010;95:752-9.
  • 31 Verstuyf A, Carmeliet G, Bouillon R, Mathieu C. Vitamin D: A pleiotropic hormone. Kidney Int 2010;78:140-5.
  • 32 Harel Z, Flanagan P, Forcier M, Harel D. Low Vitamin D status among obese adolescents: Prevalence and response to treatment. J Adolesc Health 2011;48:448-52.
  • 33 Madden K, Feldman HA, Smith EM, Gordon CM, Keisling SM, Sullivan RM, et al. Vitamin D deficiency in critically ill children. Pediatrics 2012;130:421-8.
  • 34 Jenab M, Bueno-de-Mesquita HB, Ferrari P, van Duijnhoven FJ, Norat T, Pischon T, et al. Association between pre-diagnostic circulating Vitamin D concentration and risk of colorectal cancer in European populations: A nested case-control study. BMJ 2010;340:b5500.
  • 35 Giovannucci E, Liu Y, Rimm EB, Hollis BW, Fuchs CS, Stampfer MJ, et al. Prospective study of predictors of Vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst 2006;98:451-9.
  • 36 Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, et al. The role of Vitamin D in cancer prevention. Am J Public Health 2006;96:252-61.
  • 37 Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, et al. Sun exposure and mortality from melanoma. J Natl Cancer Inst 2005;97:195-9.
  • 38 Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, et al. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol 2005;97:179-94.
  • 39 Chang ET, Smedby KE, Hjalgrim H, Porwit-MacDonald A, Roos G, Glimelius B, et al. Family history of hematopoietic malignancy and risk of lymphoma. J Natl Cancer Inst 2005;97:1466-74.
  • 40 Holick MF. Vitamin D status: Measurement, interpretation, and clinical application. Ann Epidemiol 2009;19:73-8.
  • 41 Shin YH, Kim KE, Lee C, Shin HJ, Kang MS, Lee HR, et al. High prevalence of Vitamin D insufficiency or deficiency in young adolescents in Korea. Eur J Pediatr 2012;171:1475-80.
  • 42 Robien K, Strayer LG, Majhail N, Lazovich D, Baker KS, Smith AR, et al. Vitamin D status among long-term survivors of hematopoietic cell transplantation. Bone Marrow Transplant 2011;46:1472-9.
  • 43 Balasubramanian S, Dhanalakshmi K, Amperayani S. Vitamin D deficiency in childhood - A review of current guidelines on diagnosis and management. Indian Pediatr 2013;50:669-75.
  • 44 Harinarayan CV, Joshi SR. Vitamin D status in India - its implications and remedial measures. J Assoc Physicians India 2009;57:40-8.
  • 45 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of Vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30.
  • 46 Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:204-10.
  • 47 Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics 2009;124:e362-70.
  • 48 Helou M, Ning Y, Yang S, Irvine P, Bachmann LM, Godder K, et al. Vitamin D deficiency in children with cancer. J Pediatr Hematol Oncol 2014;36:212-7.