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

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.
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Abstract

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.

Keywords

Childhood cancer - India - Vitamin D


Publication History

Article published online:
12 July 2021

© 2016. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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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.