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Buonsenso D, Pata D, Turriziani Colonna A, Ferrari V, Salerno G, Valentini P. Vitamin D and tuberculosis in children: a role in the prevention or treatment of the disease? Monaldi Arch Chest Dis 2022; 92. [PMID: 35352542 DOI: 10.4081/monaldi.2022.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Despite the growing number of published studies, the role of vitamin D in the prevention or treatment of tuberculosis remains unclear. In this review we analyze current scientific literature to provide evidence about the relationship between vitamin D and TB, with a special focus on the pediatric population. While in vitro studies have shown relevant antimycobacterial immune-stimulatory and immunosuppressive effects of vitamin D, this has not panned out in vivo with active TB. On the contrary, there is some evidence that this tool could work as prevention - both against TB infection as well as progression from latent to active infection. However, only a few studies have evaluated this correlation in children. The potential link between tuberculosis and vitamin D levels is promising. If effective, vitamin D supplementation of at-risk populations would be an affordable public health intervention, particularly in light of the worldwide increase in identified TB cases and drug-resistance. Vitamin D might represent a new, affordable, safe and easy to access drug for the prevention and treatment of TB. For stronger evidence, considering the features of infection (relative low incidence of reactivation of latent infection in immunocompetent patients) we need clinical trials with large numbers of participants conducted in endemic regions with a prolonged follow-up time.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome.
| | - Davide Pata
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | | | - Vittoria Ferrari
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | - Gilda Salerno
- Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome; Institute of Pediatrics, Catholic University of Sacred Heart, Rome.
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2
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Shaka MF, Hussen kabthymer R, Meshesha MD, Borde MT. Vitamin D deficiency among apparently healthy children and children with common medical illnesses in Sub-Saharan Africa: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 75:103403. [PMID: 35386789 PMCID: PMC8977889 DOI: 10.1016/j.amsu.2022.103403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mohammed Feyisso Shaka
- Dilla University, College of Health Sciences and Medicine, School of Public Health, Dilla, Ethiopia
| | - Robel Hussen kabthymer
- Dilla University, College of Health Sciences and Medicine, School of Public Health, Dilla, Ethiopia
- Corresponding author.
| | - Meiraf Daniel Meshesha
- Dilla University, College of Health Sciences and Medicine, School of Medicine, Dilla, Ethiopia
| | - Moges Tadesse Borde
- Dilla University, College of Health Sciences and Medicine, School of Public Health, Dilla, Ethiopia
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Kafle S, Basnet AK, Karki K, Thapa Magar M, Shrestha S, Yadav RS. Association of Vitamin D Deficiency With Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e17883. [PMID: 34660082 PMCID: PMC8504877 DOI: 10.7759/cureus.17883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Pulmonary tuberculosis, caused by Mycobacterium tuberculosis, is a significant public health issue, especially in developing countries, affecting millions of people every year. Despite the development of many antitubercular antibiotics and increased awareness of preventive methods, it is still a major cause of mortality worldwide. Vitamin D, a micronutrient known to have a major role in bone and calcium metabolism, has also shown its immunomodulatory effects to suppress mycobacterial growth. We conducted a systematic review and meta-analysis of the available evidence to explore the association between vitamin D levels and tuberculosis. We performed a systematic search for articles from inception to May 2021 in multiple databases. We included 26 studies in our qualitative synthesis and 12 studies in meta-analysis or quantitative synthesis. In our meta-analysis, we used a random-effect model to calculate the odds ratio (OR) of vitamin D deficiency in tuberculosis patients compared to the healthy controls. On pooled analysis, we found that the odds of the participants having vitamin D deficiency was 3.23 times more in tuberculosis patients compared to the healthy group (OR=3.23, CI = 1.91-5.45, p<0.0001). Thus, we concluded that there is an association between low levels of vitamin D and tuberculosis infections. We suggest conducting long-term prospective cohort studies in tuberculosis endemic countries to better understand the causal relationship between vitamin D deficiency and tuberculosis.
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Affiliation(s)
- Sunam Kafle
- Internal Medicine, College of Medical Sciences, Bharatpur, NPL
| | | | - Kumar Karki
- Internal Medicine, National Medical College, Birgunj, NPL
| | | | - Shumneva Shrestha
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, NPL
| | - Randhir S Yadav
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, NPL
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Lamb GS, Cruz AT, Camp EA, Javier M, Montour J, Piper T, Shah UA, Starke JR. Tuberculosis in Internationally Displaced Children Resettling in Harris County, Texas, USA, 2010-2015 1. Emerg Infect Dis 2021; 26. [PMID: 32687465 PMCID: PMC7392435 DOI: 10.3201/eid2608.190793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
US guidelines have recommended testing children emigrating from high tuberculosis-incidence countries with interferon-gamma release assays (IGRAs) or tuberculin skin tests (TSTs). We describe the Harris County (Texas) Public Health Refugee Health Screening Program's testing results during 2010-2015 for children <18 years of age: 5,990 were evaluated, and 5,870 (98%) were tested. Overall, 364 (6.2%) children had >1 positive test: 143/1,842 (7.8%) were tested with TST alone, 129/3,730 (3.5%) with IGRA alone, and 92/298 (30.9%) with both TST and IGRA. Region of origin and younger age were associated with positive TST or IGRA results. All children were more likely to have positive results for TST than for IGRA (OR 2.92, 95% CI 2.37-3.59). Discordant test results were common (20%) and most often were TST+/IGRA- (95.0%), likely because of bacillus Calmette-Guérin vaccination. Finding fewer false positives supports the 2018 change in US immigration guidelines that recommends using IGRAs for recently immigrated children.
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Lahoor Basha S, Suresh S, Ashok Reddy VV, Surya Teja SP. Is the shielding effect of cholecalciferol in SARS CoV-2 infection dependable? An evidence based unraveling. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 9:326-331. [PMID: 33102933 PMCID: PMC7576325 DOI: 10.1016/j.cegh.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Despite being announced as a global health concern and emergency in January by WHO, designing specific treatment for SARS-CoV-2 is still a summit yet to be conquered. Currently, many drugs are being tested in the clinical scenario and vitamins play a significant role in therapeutic management. Based on the available evidence, we postulate that maintaining normal vitamin D3 levels may reduce severity, mortality risk of COVID-19. This review elucidates the alarming need for randomized clinical trials to determine the role of vitamin D in patient prognosis in COVID-19 infection and on latitude bases epidemiological outcome.
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Affiliation(s)
- Shaik Lahoor Basha
- Department of Medical Affairs, HealthMinds, Bengaluru, Karnataka, 560038, India
| | - Sake Suresh
- Department of General Medicine, Andaman & Nicobar Health Services, Port Blair, 744104, India
| | - V V Ashok Reddy
- Department of Emergency Medicine, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
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Soleimani A, Dehghan Tarzejani MH, Hakimi SS, Alishiri N, Torabizadeh R. The Assessment of Vitamin D Serum Level in Patients With Pulmonary and Extra-Pulmonary Tuberculosis in Karaj, Iran, During 2017-2018. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2020. [DOI: 10.34172/ijep.2020.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: It is important to determine the type of tuberculosis and its related factors in order for effectively treating a disease and reducing its side effects in the society. Objective: This study aimed to determine vitamin D level in patients with pulmonary and extra-pulmonary tuberculosis in Karaj, Iran in 2017-2018. Materials and Methods: In this observational study, 102 patients suffering from pulmonary and extra-pulmonary tuberculosis disease were availably selected in Karaj, Iran in 2017-2018. They were examined and, then, their vitamin D level were assessed and compared according to the type of tuberculosis. Results: The study results showed that vitamin D level was normal in 39.2% of the case study population, but it was abnormal in 60.8% of it (18.6% deficiency and 42.2% insufficiency). Vitamin D deficiency was 15.8% in pulmonary tuberculosis patients and it was 22.2% in extra-pulmonary tuberculosis ones, showing no significant difference (P>0.05) statistically. Conclusion: According to the obtained results, hypovitaminosis-D was detected in more than half of the patients with pulmonary and extra pulmonary tuberculosis, which was not associated with the type of tuberculosis. Seemingly, the patients needed the same amount of – or even more – food, medical supplements, sports, and sunlight compared to healthy people.
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Affiliation(s)
- Alireza Soleimani
- Department of Infectious Disease, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Niloofar Alishiri
- Alborz University of Medical Sciences, School of Medicine, Karaj, Iran
| | - Roya Torabizadeh
- Alborz University of Medical Sciences, Dietary Supplements and Probiotic Research Center, Karaj, Iran
- Alborz University of Medical Sciences, School of Medicine, Karaj, Iran
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Proença R, Mattos Souza F, Lisboa Bastos M, Caetano R, Braga JU, Faerstein E, Trajman A. Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis. BMC Public Health 2020; 20:838. [PMID: 32493327 PMCID: PMC7268459 DOI: 10.1186/s12889-020-08907-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent. METHODS Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent. RESULTS Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542-2384] and 37% (95% CI = 23-52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I2] = 98.2 and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information. CONCLUSION Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.
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Affiliation(s)
- Raquel Proença
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | - José Ueleres Braga
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Anete Trajman
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- McGill University, Montreal, QC, Canada.
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Zisi D, Challa A, Makis A. The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood. Hormones (Athens) 2019; 18:353-363. [PMID: 31768940 PMCID: PMC7092025 DOI: 10.1007/s42000-019-00155-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Respiratory tract infections (RTIs) are a major cause of illness worldwide and the most common cause of hospitalization for pneumonia and bronchiolitis. These two diseases are the leading causes of morbidity and mortality among children under 5 years of age. Vitamin D is believed to have immunomodulatory effects on the innate and adaptive immune systems by modulating the expression of antimicrobial peptides, like cathelicidin, in response to both viral and bacterial stimuli. The aim of this review is to summarize the more recently published data with regard to potential associations of 25-hydroxyvitamin D [25(OH)D] with infectious respiratory tract diseases of childhood and the possible health benefits from vitamin D supplementation. METHODS The literature search was conducted by using the PubMed, Scopus, and Google Scholar databases, with the following keywords: vitamin D, respiratory tract infection, tuberculosis, influenza, infancy, and childhood. RESULTS Several studies have identified links between inadequate 25(OH)D concentrations and the development of upper or lower respiratory tract infections in infants and young children. Some of them also suggest that intervention with vitamin D supplements could decrease both child morbidity and mortality from such causes. CONCLUSIONS Most studies agree in that decreased vitamin D concentrations are prevalent among most infants and children with RTIs. Also, normal to high-serum 25(OH)D appears to have some beneficial influence on the incidence and severity of some, but not all, types of these infections. However, studies with vitamin D supplementation revealed conflicting results as to whether supplementation may be of benefit, and at what doses.
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Affiliation(s)
- Dimitra Zisi
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece
| | - Anna Challa
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece
| | - Alexandros Makis
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece.
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9
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Baauw A, Kist-van Holthe J, Slattery B, Heymans M, Chinapaw M, van Goudoever H. Health needs of refugee children identified on arrival in reception countries: a systematic review and meta-analysis. BMJ Paediatr Open 2019; 3:e000516. [PMID: 31646192 PMCID: PMC6782036 DOI: 10.1136/bmjpo-2019-000516] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/14/2019] [Accepted: 08/24/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The worldwide number of refugees has considerably increased due to ongoing wars, national instability, political persecution and food insecurity. In Europe, about one-third of all refugees are children, an increasing number of which are travelling alone. There are often no systematic medical health assessments for these refugee children on entry in reception countries despite the fact that they are recognised as an at-risk population due to increased burden of physical and mental health conditions. We aimed to perform a systematic review of the literature to describe the health status of refugee children on entering reception countries. METHODS A systematic search of published literature was conducted using the terms refugee, immigrant or migrant, medical or health, and screening. RESULTS Of the 3487 potentially relevant papers, 53 population-based studies were included in this review. This systematic review showed that refugee children exhibit high estimated prevalence rates for anaemia (14%), haemoglobinopathies (4%), chronic hepatitis B (3%), latent tuberculosis infection (11%) and vitamin D deficiency (45%) on entry in reception countries. Approximately one-third of refugee children had intestinal infection. Nutritional problems ranged from wasting and stunting to obesity. CONCLUSIONS Refugee children entering reception countries should receive comprehensive health assessments based on the outcomes of this systematic review, national budgets, cost-effectiveness and personal factors of the refugees. The health assessment should be tailored to individual child health needs depending on preflight, flight and postarrival conditions.A paradigm shift that places focus on child health and development will help this vulnerable group of children integrate into their new environments. PROSPERO REGISTRATION NUMBER 122561.
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Affiliation(s)
- Albertine Baauw
- Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
- Pediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
- Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
| | - Joana Kist-van Holthe
- Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
| | - Bridget Slattery
- Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Heymans
- Department of Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
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Schrier L, Wyder C, Del Torso S, Stiris T, von Both U, Brandenberger J, Ritz N. Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments. Eur J Pediatr 2019; 178:1449-1467. [PMID: 31240389 DOI: 10.1007/s00431-019-03405-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.
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Affiliation(s)
- Lenneke Schrier
- Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Corinne Wyder
- Kinderaerzte KurWerk, Poststrasse 9, 3400, Burgdorf, Switzerland
- Department of Paediatrics, University of Bern, Bern, Switzerland
| | | | - Tom Stiris
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site, Munich, Germany
- Paediatric Infection and Immunity, Section of Paediatric, Department of Medicine, Imperial College London, London, UK
| | - Julia Brandenberger
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Nicole Ritz
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
- Infectious Diseases and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Australia.
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11
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Buonsenso D, Sali M, Pata D, Masiello E, Salerno G, Ceccarelli M, Delogu G, Valentini P. Vitamin D Levels in Active TB, Latent TB, Non-TB Pneumonia and Healthy Children: A Prospective Observational Study. Fetal Pediatr Pathol 2018; 37:337-347. [PMID: 30260729 DOI: 10.1080/15513815.2018.1509407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Growing evidence suggests that vitamin D deficiency might be implicated in the development of active tuberculosis (TB). We evaluated vitamin D levels in children with active TB compared to children with latent TB infection (LTBI), non-TB pneumonia (NTBP) and healthy controls to determine if there was a difference. METHODS In this prospective study, vitamin D levels were measured and compared between the four groups and adjusted for age, ethnicity, gender and season of sample collection. RESULTS Fifty-seven children were included: 24.6% active TB, 28.1% LTBI, 22.8% NPTB and 24.6% healthy controls. 36.8% of all children tested had an insufficient or deficient vitamin D level. Vitamin D level was significantly lower in active TB compared to other groups (p = 0.004). CONCLUSIONS Our study showed a correlation between hypovitaminosis D and active pulmonary TB.
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Affiliation(s)
- Danilo Buonsenso
- a Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Roma , Italy
| | - Michela Sali
- b Institute of Microbiology, Catholic University of Rome, A. Gemelli Hospital , Roma , Italy
| | - Davide Pata
- a Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Roma , Italy
| | - Enrico Masiello
- c Department of Pediatrics , Catholic University of Rome, A. Gemelli Hospital , Roma , Italy
| | - Gilda Salerno
- c Department of Pediatrics , Catholic University of Rome, A. Gemelli Hospital , Roma , Italy
| | - Manuela Ceccarelli
- c Department of Pediatrics , Catholic University of Rome, A. Gemelli Hospital , Roma , Italy
| | - Giovanni Delogu
- b Institute of Microbiology, Catholic University of Rome, A. Gemelli Hospital , Roma , Italy
| | - Piero Valentini
- a Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Roma , Italy
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12
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Gou X, Pan L, Tang F, Gao H, Xiao D. The association between vitamin D status and tuberculosis in children: A meta-analysis. Medicine (Baltimore) 2018; 97:e12179. [PMID: 30170465 PMCID: PMC6392646 DOI: 10.1097/md.0000000000012179] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vitamin D deficiency (VDD) has been implicated in the pathogenesis of tuberculosis (TB), but most studies have not reported a significant association. We conducted a meta-analysis to explore the association between vitamin D status and TB in children. METHODS Web of Science, Ovid Medline, and EMBASE were searched for studies in English that discussed vitamin D status and TB in children before January 22, 2018. RESULTS From the 585 initially identified studies, we selected those that addressed an association between vitamin D status and TB according to our preselected inclusion criteria. Our meta-analysis included 10 studies. According to the random effects model, TB was significantly associated with VDD (ORs, 1.70; 95% CI, 1.20-2.42; P < .05) in children. Vitamin D levels were significantly lower in TB patients than in controls, with a mean difference d = -5.49 nmol/L (95% CI, -10.42 to -0.55; P < .05), indicating that VDD was significantly associated with TB (OR, 1.78; 95% CI, 1.30-2.44; P < .05) in children. CONCLUSION This study suggests that vitamin D levels are significantly lower in children with TB/latent TB infection than in controls. TB may contribute to VDD in children. Therefore, VDD may be associated with TB in children.
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Affiliation(s)
- Xiaoyun Gou
- Emergency Department, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lingli Pan
- Emergency Department, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Fajuan Tang
- Emergency Department, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hu Gao
- Emergency Department, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Dongqiong Xiao
- Emergency Department, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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13
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Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I, Chiappini E, de’ Angelis GL, Massari M, Miraglia Del Giudice E, Miraglia Del Giudice M, Peroni D, Terracciano L, Agostiniani R, Careddu D, Ghiglioni DG, Bona G, Di Mauro G, Corsello G. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. Ital J Pediatr 2018; 44:51. [PMID: 29739471 PMCID: PMC5941617 DOI: 10.1186/s13052-018-0488-7] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/16/2018] [Indexed: 02/07/2023] Open
Abstract
Vitamin D plays a pivotal role in the regulation of calcium-phosphorus metabolism, particularly during pediatric age when nutritional rickets and impaired bone mass acquisition may occur.Besides its historical skeletal functions, in the last years it has been demonstrated that vitamin D directly or indirectly regulates up to 1250 genes, playing so-called extraskeletal actions. Indeed, recent data suggest a possible role of vitamin D in the pathogenesis of several pathological conditions, including infectious, allergic and autoimmune diseases. Thus, vitamin D deficiency may affect not only musculoskeletal health but also a potentially wide range of acute and chronic conditions. At present, the prevalence of vitamin D deficiency is high in Italian children and adolescents, and national recommendations on vitamin D supplementation during pediatric age are lacking. An expert panel of the Italian Society of Preventive and Social Pediatrics reviewed available literature focusing on randomized controlled trials of vitamin D supplementation to provide a practical approach to vitamin D supplementation for infants, children and adolescents.
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Affiliation(s)
- Giuseppe Saggese
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | | | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, Novara, Italy
| | - Fabio Cardinale
- Pediatric Unit, Division of Pulmonology, Allergy, and Immunology, AOU Policlinico-Giovanni XXIII, Bari, Italy
| | - Irene Cetin
- Department of Mother and Child, Hospital Luigi Sacco, University of Milano, Milan, Italy
| | - Elena Chiappini
- Pediatric Infectious Disease Unit, Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Gian Luigi de’ Angelis
- Gastroenterology and Digestive Endoscopy Unit and Clinical Paediatrics Unit, Department of Paediatrics and Maternal Medicine, University of Parma Hospital Trust, Parma, Italy
| | - Maddalena Massari
- Department of Mother and Child, Hospital Luigi Sacco, University of Milano, Milan, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Luigi Terracciano
- Pediatric Primary Care, National Pediatric Health Care System, Milan, Italy
| | | | - Domenico Careddu
- Pediatric Primary Care, National Pediatric Health Care System, Novara, Italy
| | - Daniele Giovanni Ghiglioni
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianni Bona
- Division of Pediatrics, University of Piemonte Orientale, Novara, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, Neonatal Intensive Care Unit, AOUP, University of Palermo, Palermo, Italy
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Moustaki M, Loukou I, Priftis KN, Douros K. Role of vitamin D in cystic fibrosis and non-cystic fibrosis bronchiectasis. World J Clin Pediatr 2017; 6:132-142. [PMID: 28828295 PMCID: PMC5547424 DOI: 10.5409/wjcp.v6.i3.132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/27/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
Bronchiectasis is usually classified as cystic fibrosis (CF) related or CF unrelated (non-CF); the latter is not considered an orphan disease any more, even in developed countries. Irrespective of the underlying etiology, bronchiectasis is the result of interaction between host, pathogens, and environment. Vitamin D is known to be involved in a wide spectrum of significant immunomodulatory effects such as down-regulation of pro-inflammatory cytokines and chemokines. Respiratory epithelial cells constitutively express 1α-hydroxylase leading to the local transformation of the inactive 25(OH)-vitamin D to the active 1,25(OH)2-vitamin D. The latter through its autocrine and paracrine functions up-regulates vitamin D dependent genes with important consequences in the local immunity of lungs. Despite the scarcity of direct evidence on the involvement of vitamin D deficiency states in the development of bronchiectasis in either CF or non-CF patients, it is reasonable to postulate that vitamin D may play some role in the pathogenesis of lung diseases and especially bronchiectasis. The potential contribution of vitamin D deficiency in the process of bronchiectasis is of particular clinical importance, taking into consideration the increasing prevalence of vitamin D deficiency worldwide and the significant morbidity of bronchiectasis. Given the well-established association of vitamin D deficiency with increased inflammation, and the indicative evidence for harmful consequences in lungs, it is intriguing to speculate that the administration of vitamin D supplementation could be a reasonable and cost effective supplementary therapeutic approach for children with non-CF bronchiectasis. Regarding CF patients, maybe in the future as more data become available, we have to re-evaluate our policy on the most appropriate dosage scheme for vitamin D.
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Agarwal A, Dabla PK, Mishra M, Kumar A, Shaharyar A. Vitamin D levels among pediatric tuberculosis patients - Does it alter following antitubercular treatment? A prospective study in 19 children. J Clin Orthop Trauma 2017; 8:31-33. [PMID: 28360493 PMCID: PMC5359505 DOI: 10.1016/j.jcot.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 04/21/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES It is still unknown whether altered vitamin D levels observed with osteoarticular tuberculosis change during treatment in a child or modify the disease course. To find a possible answer to the above query, we investigated serial serum 25 hydroxy vitamin D concentrations in children suffering from osteoarticular tuberculosis treated with multidrug antitubercular drugs. METHODS The prospective study enrolled 19 untreated immunocompetent children with an established diagnosis of osteoarticular tuberculosis. None of the patients were offered any therapeutic vitamin D supplementation at initiation or during the treatment. The patients were followed for response to multidrug antitubercular therapy (DOTS) at 2 months interval. Mean values of vitamin D were calculated at 0, 2, and 6 months and statistically compared. The following laboratory references for defining the vitamin D status were used: <30 nmol/L = deficiency; 30-75 nmol/L = insufficiency; >75 nmol/L = sufficiency. RESULTS All the patients responded to antitubercular therapy. Out of the enrolled children, 73.67% had low vitamin D levels at initial presentation. There was no statistically significant difference in vitamin D levels in affected children at either 0-2 (p = 0.452), 2-6 (p = 0.240), or 0-6 months (p = 0.854) following antitubercular treatment. Although the mean vitamin D levels were higher in male patients when compared to female patients at all times, there was no statistically significant difference in vitamin D levels during treatment stages in either sex. CONCLUSIONS Vitamin D levels were low at initiation of treatment and did not significantly improve during multidrug antitubercular treatment. Further, tuberculosis healed well with antitubercular therapy despite persistence of low serum levels of vitamin D.
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Affiliation(s)
- Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Pradeep Kumar Dabla
- Department of Biochemistry, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Madhusudan Mishra
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Anubrat Kumar
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Abbas Shaharyar
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
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16
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Huang SJ, Wang XH, Liu ZD, Cao WL, Han Y, Ma AG, Xu SF. Vitamin D deficiency and the risk of tuberculosis: a meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 11:91-102. [PMID: 28096657 PMCID: PMC5207333 DOI: 10.2147/dddt.s79870] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM To conduct meta-analyses of all published studies on various aspects of association between vitamin D and tuberculosis (TB). METHODS PubMed and Web of Knowledge were searched for all properly controlled studies on vitamin D and TB. Pooled odds ratio, mean difference or standardized mean difference, and its corresponding 95% confidence interval were calculated with the Cochrane Review Manager 5.3. RESULTS A significantly lower vitamin D level was found in TB patients vs controls; vitamin D deficiency (VDD) was associated with an increased risk of TB, although such an association was lacking in the African population and in the human immunodeficiency virus-infected African population. A significantly lower vitamin D level was found in human immunodeficiency virus-TB-coinfected African patients receiving antiretroviral treatment who developed TB-associated immune reconstitution inflammatory syndrome vs those who did not develop TB-associated immune reconstitution inflammatory syndrome. VDD was associated with an increased risk of developing active TB in those subjects with latent TB infection and with an increased risk of tuberculin skin test conversion/TB infection conversion, and the trend toward a lower vitamin D level in active TB patients vs latent TB infection subjects did not reach statistical significance, indicating that VDD was more likely a risk factor than a consequence of TB. This concept was further strengthened by our result that anti-TB treatment did not affect vitamin D level in TB patients receiving the treatment. CONCLUSION Our analyses revealed an association between vitamin D and TB. VDD is more likely a risk factor for TB than its consequence. More studies are needed to determine whether vitamin D supplementation is beneficial to TB prevention and treatment.
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Affiliation(s)
- Shao-Jun Huang
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xian-Hua Wang
- Department of Nutrition and Food Hygiene, Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, People's Republic of China
| | - Zhi-Dong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wen-Li Cao
- Department of Pulmonary Medicine, Beijing Geriatric Hospital, Beijing, People's Republic of China
| | - Yi Han
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ai-Guo Ma
- Department of Nutrition and Food Hygiene, Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, People's Republic of China
| | - Shao-Fa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
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17
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Yakoob MY, Salam RA, Khan FR, Bhutta ZA, Cochrane Infectious Diseases Group. Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database Syst Rev 2016; 11:CD008824. [PMID: 27826955 PMCID: PMC5450876 DOI: 10.1002/14651858.cd008824.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin D is a micronutrient important for bone growth and immune function. Deficiency can lead to rickets and has been linked to various infections, including respiratory infections. The evidence on the effects of supplementation on infections in children has not been assessed systematically. OBJECTIVES To evaluate the role of vitamin D supplementation in preventing pneumonia, tuberculosis (TB), diarrhoea, and malaria in children under five years of age. This includes high-, middle-, and low-income countries. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, MEDLINE, EMBASE, LILACS, the WHO International Clinical Trials Registry Platform (ICTRP; http://www.who.int/ictrp/en/) , ClinicalTrials.gov and the ISRCTN registry (http://www.isrctn.com/) up to 16 June 2016. SELECTION CRITERIA We included randomized controlled trials (RCTs) that evaluated preventive supplementation of vitamin D (versus placebo or no intervention) in children under five years of age. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts, extracted the data, and assessed the risk of bias of included trials. MAIN RESULTS Four trials met the inclusion criteria, with a total of 3198 children under five years of age, and were conducted in Afghanistan, Spain, and the USA. Prevalence of vitamin D deficiency varied widely in these populations (range: 73.1% in Afghanistan, 10 to 12% in USA, and 6.2% in Spain). The included trials evaluated mortality (two trials), pneumonia incidence (two trials), diarrhoea incidence (two trials), hospitalization (two trials), and mean serum vitamin D concentrations (four trials).We do not know whether vitamin D supplementation impacts on all-cause mortality because this outcome was underpowered due to few events (risk ratio (RR) 1.43, 95% confidence interval (CI) 0.54 to 3.74; one trial, 3046 participants, low quality evidence).For pneumonia, episodes of 'radiologically confirmed' first or only episode of pneumonia were little different in the supplemented and unsupplemented group (Rate Ratio: 1.06, 95% confidence interval (CI) 0.89 to 1.26; two trials, 3134 participants, moderate quality evidence), and similarly for children with confirmed or unconfirmed pneumonia (RR 0.95, 95% CI 0.87 to 1.04; one trial, 3046 participants). In these two trials there were no obvious differences between supplemented and unsupplemented children regarding episodes of diarrhoea.In the single large trial from Afghanistan, the trial authors reported that vitamin D supplementation was associated with an increase in repeat episodes of pneumonia confirmed by chest radiograph (RR 1.69, 95% CI 1.28 to 2.21; one trial, 3046 participants), but not reflected in the outcome of confirmed or unconfirmed pneumonia (RR 1.06, 95% CI 1.00 to 1.13; one trial, 3046 participants).For hospital admission measured in one small trial, there was no difference detected (RR 0.86, 95% CI 0.20 to 3.62; one trial, 88 participants; very low quality evidence).The mean serum vitamin D concentrations were higher in supplemented compared to unsupplemented children at the end of supplementation (MD 7.72 ng/mL, 95% CI 0.50 to 14.93; four trials, 266 participants, low quality evidence). These results were driven primarily by two smaller trials with large magnitudes of effect. In the other two bigger trials, serum vitamin D concentrations were elevated in the intervention group for most of the trial duration but not at the end of supplementation. This may be due to time elapsed at measurement from the last dose, incomplete compliance, or increased need of vitamin D with infant age.We did not find any trial that reported on the incidence of TB, malaria or febrile illness, duration of pneumonia, duration of diarrhoea, severity of infection, and cause-specific mortality (due to TB, diarrhoea, or malaria). AUTHORS' CONCLUSIONS Evidence from one large trial did not demonstrate benefit of vitamin D supplementation on the incidence of pneumonia or diarrhoea in children under five years. To our knowledge, trials that evaluated supplementation for preventing other infections, including TB and malaria, have not been performed.
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Affiliation(s)
- Mohammad Y Yakoob
- Harvard School of Public HealthDepartments of Epidemiology and Nutrition677 Huntington AvenueBostonMAUSA02115
| | - Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan74800
| | - Farhan R Khan
- Aga Khan University HospitalDepartment of SurgeryStadium RoadPO Box 3500KarachiSindhPakistan74800
| | - Zulfiqar A Bhutta
- Hospital for Sick ChildrenCenter for Global Child HealthTorontoONCanadaM5G A04
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18
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Dabla PK, Agarwal A, Mishra M, Sharma S. Vitamin D deficiency among pediatric osteoarticular tuberculosis patients. J Clin Orthop Trauma 2016; 7:147-149. [PMID: 28053376 PMCID: PMC5197442 DOI: 10.1016/j.jcot.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 09/15/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES We prospectively investigated serum 25 hydroxy vitamin D concentrations in children suffering from osteoarticular tuberculosis. The age or sex correlation to vitamin D levels in affected subjects was also calculated. METHODS Twenty five untreated children with osteoarticular tuberculosis were taken as cases along with equal number of age and sex matched 'healthy' controls. The following laboratory references for defining the vitamin D status were used (<30 nmol/L = deficiency; 30-75 nmol/L = insufficiency; > 75 nmol/L = sufficiency). The cases were further grouped based on gender differences and age (<5 or >5 years). RESULTS Out of 25 cases, there were 14 (56%) with deficiency of vitamin D. In 'apparently' healthy subjects, all 25 controls (100%) had hypovitaminosis D. The osteoarticular tuberculosis patients had significant lower levels of vitamin D when compared with their healthy peers irrespective of gender or age differences. CONCLUSIONS The osteoarticular tuberculosis cases had low serum vitamin D levels compared to healthy controls. The low vitamin D levels were persistent irrespective of gender and age in osteoarticular tuberculosis children. There was widespread vitamin D insufficiency in apparently healthy controls.
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Affiliation(s)
| | - Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Madhusudan Mishra
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Shikha Sharma
- Department of Biochemistry, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
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19
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Ludmir J, Mazhani L, Cary MS, Chakalisa UA, Pettifor JM, Molefi M, Redwood A, Stallings VA, Gross R, Steenhoff AP. Vitamin D Status in Botswana Children Under 2 Years Old With and Without Active Tuberculosis. Am J Trop Med Hyg 2016; 94:971-4. [PMID: 26976889 DOI: 10.4269/ajtmh.15-0864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/05/2016] [Indexed: 11/07/2022] Open
Abstract
Additional strategies are needed to prevent and treat tuberculosis (TB). Although vitamin D may have antimycobacterial effects, it is unknown whether low vitamin D status confers a risk for active TB in African children. This case-control study assessed serum 25-hydroxyvitamin D (25(OH)D) concentration in children with and without active TB in Gaborone, Botswana. A total of 80 children under 2 years old with and without active TB, seen at hospitals and clinics in the greater Gaborone area between September 2010 and November 2012, were enrolled. Of these, 39 cases did not differ from the 41 controls in median 25(OH)D levels (P = 0.84). The 25(OH)D was < 20 ng/mL in 8/39 (21%) cases and 7/41 (17%) controls (P = 0.69, χ(2)). Univariate analyses of subject clinical characteristics (other than 25(OH)D levels) showed that any degree of weight loss was associated with a diagnosis of TB (P = 0.047). Other clinical characteristics, including age (P = 0.08) or weight below third percentile (P = 0.58), showed no association with TB. There was no significant difference in vitamin D status between children under 2 years old with and without active TB. Lower vitamin D status did not appear to be a risk factor for TB in this small Gaborone cohort.
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Affiliation(s)
- Jonathan Ludmir
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Loeto Mazhani
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark S Cary
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Unoda A Chakalisa
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John M Pettifor
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mooketsi Molefi
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abiona Redwood
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia A Stallings
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Gross
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew P Steenhoff
- Botswana-UPenn Partnership, Gaborone, Botswana; University of Maryland Medical Center, Baltimore, Maryland; Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana; Department of Public Health Medicine Unit, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-Harvard Partnership, Gaborone, Botswana; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Internal Medicine-Pediatrics, University of Miami/Jackson Memorial Hospital, Miami, Florida; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Nama N, Menon K, Iliriani K, Pojsupap S, Sampson M, O’Hearn K, Zhou L(L, McIntyre L, Fergusson D, McNally JD. A systematic review of pediatric clinical trials of high dose vitamin D. PeerJ 2016; 4:e1701. [PMID: 26966655 PMCID: PMC4782742 DOI: 10.7717/peerj.1701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/27/2016] [Indexed: 12/21/2022] Open
Abstract
Background. Due to inadequate UV exposure, intake of small quantities of vitamin D is recommended to prevent musculoskeletal disease. Both basic science and observational literature strongly suggest that higher doses may benefit specific populations and have non-musculoskeletal roles. Evaluating the evidence surrounding high dose supplementation can be challenging given a relatively large and growing body of clinical trial evidence spanning time, geography, populations and dosing regimens. Study objectives were to identify and summarize the clinical trial literature, recognize areas with high quality evidence, and develop a resource database that makes the literature more immediately accessible to end users. Methods. Medline (1946 to January 2015), Embase (1974 to January 2015), and Cochrane databases (January 2015), were searched for trials. All pediatric (0-18 years) trials administering doses higher than 400 IU (<1 year) or 600 IU (≥1 year) were included. Data was extracted independently by two of the authors. An online searchable database of trials was developed containing relevant extracted information (http://www.cheori.org/en/pedvitaminddatabaseOverview). Sensitivity and utility were assessed by comparing the trials in the database with those from systematic reviews of vitamin D supplementation including children. Results. A total of 2,579 candidate papers were identified, yielding 169 trials having one or more arms meeting eligibility criteria. The publication rate has increased significantly from 1 per year (1970-1979) to 14 per year (2010-2015). Although 84% of the total trials focused on healthy children or known high risk populations (e.g., renal, prematurity), this proportion has declined in recent years due to the rise in trials evaluating populations and outcomes not directly related to the musculoskeletal actions of vitamin D (27% in 2010s). Beyond healthy children, the only pediatric populations with more than 50 participants from low risk of bias trials evaluating a clinically relevant outcome were prematurity and respiratory illness. Finally, we created and validated the online searchable database using 13 recent systematic reviews. Of the 38 high dose trials identified by the systematic review, 36 (94.7%) could be found within the database. When compared with the search strategy reported in each systematic review, use of the database reduced the number of full papers to assess for eligibility by 85.2% (±13.4%). Conclusion. The pediatric vitamin D field is highly active, with a significant increase in trials evaluating non-classical diseases and outcomes. Despite the large overall number there are few high quality trials of sufficient size to provide answers on clinical efficacy of high-dose vitamin D. An open access online searchable data should assist end users in the rapid and comprehensive identification and evaluation of trials relevant to their population or question of interest.
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Affiliation(s)
- Nassr Nama
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kusum Menon
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Supichaya Pojsupap
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Department of Volunteers, Communication and Information Resources, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Katie O’Hearn
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - James D. McNally
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Principi N, Galli L, Lancella L, Tadolini M, Migliori GB, Villani A, Esposito S. Recommendations Concerning the First-Line Treatment of Children with Tuberculosis. Paediatr Drugs 2016; 18:13-23. [PMID: 26612773 DOI: 10.1007/s40272-015-0155-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This document describes the recommendations of a group of scientific societies concerning the first-line therapeutic approach to paediatric tuberculosis (TB). The treatment of pulmonary TB should be based on the existence of parenchymal involvement and the risk of antibiotic resistance. The treatment of extra-pulmonary TB is based on the regimens used for severe pulmonary TB. The administration of corticosteroids is recommended only in cases of miliary TB, tuberculous meningitis and tuberculous pericarditis. Vitamin B6 may be indicated in the case of isoniazid-treated TB in breastfeeding infants, severely malnourished subjects, or patients with other diseases at high risk of vitamin deficiency. Once having started treatment, children with TB should be carefully followed up in order to evaluate compliance, the response to treatment, the need for treatment changes, and the presence of drug-related adverse events. Primary care paediatricians can support reference centres in providing family healthcare education and encouraging treatment compliance.
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Affiliation(s)
- Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milano, Italy
| | - Luisa Galli
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
| | - Laura Lancella
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Marina Tadolini
- Section of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Alberto Villani
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milano, Italy.
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Agarwal A, Mishra M, Dabla PK, Sharma S. Vitamin D status in pediatric osteoarticular tuberculosis. J Clin Orthop Trauma 2015; 6:227-229. [PMID: 26566334 PMCID: PMC4600843 DOI: 10.1016/j.jcot.2015.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Tubercular patients, in general, have been demonstrated with lower serum levels of vitamin D, but the levels in osteoarticular tuberculosis (TB) in children are largely unknown. We aimed to determine serum vitamin D status in pediatric cases with osteoarticular TB. METHODS The values of serum vitamin D were estimated in 100 children with osteoarticular TB. The patients were divided into three groups based on gender, age, and site to assess variations of vitamin D levels in pediatric osteoarticular TB. RESULTS Hypovitaminosis D was associated with active osteoarticular TB in children. The mean vitamin D levels were 42.165 nmol/L. There were no statistical difference between mean vitamin D levels in boys and girls (p value = 0.6143); age groups <5 and 5-12 years (p value = 0.3857); or spinal and non-spinal osteoarticular groups (p value = 0.8350). CONCLUSIONS Active osteoarticular TB in children was also associated with hypovitaminosis D. The correlation between hypovitaminosis D and osteoarticular TB appears to be more disease specific rather than host specific.
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Affiliation(s)
- Anil Agarwal
- Specialist, Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Madhusudan Mishra
- Senior Resident, Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Pradeep Kumar Dabla
- Assistant Professor, Department of Biochemistry, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
| | - Shikha Sharma
- Senior Resident, Department of Biochemistry, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
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Abstract
BACKGROUND High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. OBJECTIVES We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. METHODS We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. RESULTS Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). LIMITATIONS The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. CONCLUSION Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.
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Esposito S, Lelii M. Vitamin D and respiratory tract infections in childhood. BMC Infect Dis 2015; 15:487. [PMID: 26521023 PMCID: PMC4628332 DOI: 10.1186/s12879-015-1196-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/08/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) remain among of the most important causes of morbidity and mortality among children. Several studies have associated vitamin D deficiency with an increased risk of RTIs, and vitamin D supplementation has been proposed as a possible preventive measure against RTIs in children. The main aim of this review is to summarize the current evidence from the literature about the link between vitamin D and RTIs in children. DISCUSSION Several recent studies have shown that vitamin D has different immunomodulatory properties associated with the risk of RTIs in childhood. In this regard, it is very important to understand the definition of deficiency and insufficiency of vitamin D and when and how to treat this condition. Unfortunately, there is no consensus, although a level of at least 10 ng/mL 25-hydroxycholecalciferol (25[OH]D) is thought to be necessary to promote bone mineralization and calcium homeostasis, and a concentration between 20 ng/mL and 50 ng/mL is considered adequate to provide an immunomodulatory effect. Available data support a role for vitamin D deficiency in the risk of pediatric tuberculosis, recurrent acute otitis media, and severe bronchiolitis, whereas further studies are needed to confirm an association in children with recurrent pharyngotonsillitis, acute rhinosinusitis and community-acquired pneumonia. CONCLUSIONS Maintenance of adequate vitamin D status may be an effective and inexpensive prophylactic method against some RTIs, but the supplementation regimen has not been clearly defined. Further clinical trials are needed to determine the 25(OH)D concentrations associated with an increased risk of RTIs and optimal vitamin D supplementation regimen according to the type of RTI while also taking into consideration vitamin D receptor polymorphisms.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
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Facchini L, Venturini E, Galli L, Martino MD, Chiappini E. Vitamin D and tuberculosis: a review on a hot topic. J Chemother 2015; 27:128-38. [DOI: 10.1179/1973947815y.0000000043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Zeng J, Wu G, Yang W, Gu X, Liang W, Yao Y, Song Y. A serum vitamin D level <25nmol/l pose high tuberculosis risk: a meta-analysis. PLoS One 2015; 10:e0126014. [PMID: 25938683 PMCID: PMC4418705 DOI: 10.1371/journal.pone.0126014] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/27/2015] [Indexed: 01/08/2023] Open
Abstract
Background Low serum Vitamin D is considered to be associated with tuberculosis while the “dangerous” level was not clear. The aim of this study was to identify the association between tuberculosis and serum Vitamin D levels via synthesis of available evidence. Methods A search of EMBASE, Medline, ISI Web of knowledge, and Pubmed was conducted. The number of subjects of tuberculosis and no-tuberculosis groups in four Vitamin D range. Meta-analyses were performed and presented by odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results A total of 15 studies involving 1440 cases and 2558 controls were included. A significantly increased risk of tuberculosis was found in two ranges: ≤ 12.5 nmol/L: pooled OR = 4.556, 95% CI = 2.200-9.435; 13-25 nmol/L: pooled OR = 3.797, 95% CI = 1.935-7.405. No statistically significant risk of tuberculosis was found in the range of 26–50 nmol/L (pooled OR = 1.561, 95% CI =0.997-2.442). In range 51–75 nmol/L, no positive association was found (pooled OR =1.160, 95% CI = 0.708-1.900). Conclusions This study found that a serum Vitamin D level ≤ 25 nmol/L was significantly associated with an increased risk of tuberculosis while the range of 51–75 nmol/L was not. The range 26-50nmol/L posed potential high tuberculosis risk. Future large-scale, well-designed studies are needed to verify these results.
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Affiliation(s)
- Junli Zeng
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University (Guangzhou), Nanjing, China 210002
| | - Guannan Wu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Xiaoling Gu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Wenjun Liang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Yanwen Yao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University (Guangzhou), Nanjing, China 210002
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China 210002
- * E-mail:
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Campbell JR, Chen W, Johnston J, Cook V, Elwood K, Krot J, Marra F. Latent Tuberculosis Infection Screening in Immigrants to Low-Incidence Countries: A Meta-Analysis. Mol Diagn Ther 2015; 19:107-17. [DOI: 10.1007/s40291-015-0135-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Venturini E, Facchini L, Martinez-Alier N, Novelli V, Galli L, de Martino M, Chiappini E. Vitamin D and tuberculosis: a multicenter study in children. BMC Infect Dis 2014; 14:652. [PMID: 25494831 PMCID: PMC4272523 DOI: 10.1186/s12879-014-0652-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/21/2014] [Indexed: 01/28/2023] Open
Abstract
Background The aim of this study is to evaluate vitamin D levels in children with latent and active TB compared to healthy controls of the same age and ethnical background. Methods A multicenter observational study has been conducted in three tertiary care paediatric centres: Anna Meyer Children's University Hospital, Florence, Italy; Evelina London Children's Hospital, London, United Kingdom and Great Ormond Street Hospital, London, United Kingdom. Vitamin D was considered deficient if the serum level was <25 nmol/L, insufficient between 25 and 50 nmol/L and sufficient for a level >50 nmol/L. Results The study population included 996 children screened for TB, which have been tested for vitamin D. Forty-four children (4.4%) had active TB, 138 (13.9%) latent TB and 814 (81.7%) were controls. Our study confirmed a high prevalence of hypovitaminosis D in the study population. A multivariate analysis confirmed an increased risk of hypovitaminosis D in children with latent and active TB compared to controls [(P = 0.018; RR = 1.61; 95% CI: 1.086-2.388), (P < 0.0001; RR = 4.587; 95% CI:1.190-9.608)]. Conclusions Hypovitaminosis D was significantly associated with TB infection in our study. Further studies are needed to evaluate a possible role of vitamin D in the treatment and prevention of tuberculosis in children. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0652-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabetta Venturini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, viale Pieraccini 24, I-50139, Florence, Italy.
| | - Ludovica Facchini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, viale Pieraccini 24, I-50139, Florence, Italy.
| | - Nuria Martinez-Alier
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Vas Novelli
- Department of Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, viale Pieraccini 24, I-50139, Florence, Italy.
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, viale Pieraccini 24, I-50139, Florence, Italy.
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, viale Pieraccini 24, I-50139, Florence, Italy.
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Lodha R, Mukherjee A, Singh V, Singh S, Friis H, Faurholt-Jepsen D, Bhatnagar S, Saini S, Kabra SK, Grewal HMS. Effect of micronutrient supplementation on treatment outcomes in children with intrathoracic tuberculosis: a randomized controlled trial. Am J Clin Nutr 2014; 100:1287-1297. [PMID: 25332327 DOI: 10.3945/ajcn.113.082255] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Micronutrients play an important role in immune function. To our knowledge, there have been no comprehensive studies on the role of micronutrient supplementation in children with tuberculosis. OBJECTIVE We assessed the effect of micronutrient supplementation in children treated with antituberculosis therapy (ATT). DESIGN A randomized, double-blind, placebo-controlled trial that used a 2 × 2 factorial design was undertaken at 2 teaching hospitals in Delhi. Children with newly diagnosed intrathoracic tuberculosis were enrolled, and they received ATT together with daily supplementation for 6 mo with either zinc alone, micronutrients without zinc, micronutrients in combination with zinc, or a placebo. Main outcomes were weight gain and an improvement in a chest X-ray (CXR) lesion assessed at 6 mo of treatment. RESULTS A total of 403 children were enrolled and randomly assigned. A microbiological diagnosis of tuberculosis was confirmed in 179 children (44.4%). The median (95% CI) increase in weight-for-age z score at 6 mo was not significantly different between subjects who received micronutrients [0.75 (0.66, 0.84)] and those who did not receive micronutrients [0.76 (0.67, 0.85)] and between subjects who received zinc [0.76 (0.68, 0.85)] and those who did not receive zinc [0.75 (0.66, 0.83)]. An improvement in CXR was observed in 285 children, but there was no difference between those receiving zinc and no zinc or between those receiving micronutrients and no micronutrients after 6 mo of ATT. However, children who received micronutrients had a faster gain in height over 6 mo than did those who did not receive micronutrients (height-for-age z score Δ = 0.08; P = 0.014). CONCLUSIONS Micronutrient supplementation did not modify the weight gain or clearance of lesions on CXR in children with intrathoracic tuberculosis. However, micronutrient supplementation during treatment may improve height gain in children with intrathoracic tuberculosis. This trial was registered at clinicaltrials.gov as NCT00801606.
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Affiliation(s)
- Rakesh Lodha
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Aparna Mukherjee
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Varinder Singh
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Sarman Singh
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Henrik Friis
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Daniel Faurholt-Jepsen
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Shinjini Bhatnagar
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Savita Saini
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Sushil K Kabra
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
| | - Harleen M S Grewal
- From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG)
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Khandelwal D, Gupta N, Mukherjee A, Lodha R, Singh V, Grewal HM, Bhatnagar S, Singh S, Kabra S, Delhi Pediatric TB Study Group. Vitamin D levels in Indian children with intrathoracic tuberculosis. Indian J Med Res 2014; 140:531-537. [PMID: 25488448 PMCID: PMC4277140 DOI: pmid/25488448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & OBJECTIVES Deficiency of vitamin D, an immunomodulator agent, is associated with increased susceptibility to tuberculosis in adults, but only limited studies are available in the paediatric age group, especially regarding association of vitamin D with type and outcome of tuberculosis. We conducted this study to determine the baseline 25-hydroxy vitamin D levels in children suffering from intrathoracic tuberculosis and its association with type and outcome of tuberculosis. METHODS Children with intrathoracic tuberculosis, diagnosed on the basis of clinico-radiological criteria, were enrolled as part of a randomized controlled trial on micronutrient supplementation in paediatric tuberculosis patients. Levels of 25-hydroxy vitamin D were measured in serum samples collected prior to starting antitubercular therapy by chemiluminescent immunoassay technology. RESULTS Two hundred sixty six children (mean age of 106.9 ± 43.7 months; 57.1% girls) were enrolled. Chest X-ray was suggestive of primary pulmonary complex, progressive disease and pleural effusion in 81 (30.5%), 149 (56%) and 36 (13.5%) subjects, respectively. Median serum 25-hydroxy vitamin D level was 8 ng/ml (IQR 5, 12). One hundred and eighty six (69.9%) children were vitamin D deficient (serum 25-hydroxy vitamin D <12 ng/ml), 55 (20.7%) were insufficient (12 to <20 ng/ml) and 25 (9.4%) were vitamin D sufficient (≥ 20 ng/ml). Levels of 25-hydroxy vitamin D were similar in all three types of intrathoracic tuberculosis, and in microbiologically confirmed and probable cases. Levels of 25-hydroxy vitamin D did not significantly affect outcome of the disease. Children who were deficient or insufficient were less likely to convert (become smear/culture negative) at two months as compared to those who were 25-hydroxy vitamin D sufficient ( p <0.05). INTERPRETATION & CONCLUSIONS Majority of Indian children with newly diagnosed intrathoracic tuberculosis were deficient in vitamin D. Type of disease or outcome was not affected by 25-hydroxy vitamin D levels in these children. However, children who did not demonstrate sputum conversion after intensive phase of antitubercular therapy had lower baseline 25-hydroxy vitamin D levels as compared to those who did.
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Affiliation(s)
- Deepchand Khandelwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Varinder Singh
- Department of Pediatrics, Kalawati Saran Children Hospital & Lady Hardinge Medical College, New Delhi, India
| | - Harleen M.S. Grewal
- Section of Microbiology & Immunology, Gade Institute, University of Bergen, Bergen, Norway; Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Shinjini Bhatnagar
- Pediatric Biology Center, Translational Health Sciences & Technology Institute, Gurgaon, India
| | - Sarman Singh
- Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S.K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Pettengill MA, van Haren SD, Levy O. Soluble mediators regulating immunity in early life. Front Immunol 2014; 5:457. [PMID: 25309541 PMCID: PMC4173950 DOI: 10.3389/fimmu.2014.00457] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/08/2014] [Indexed: 12/15/2022] Open
Abstract
Soluble factors in blood plasma have a substantial impact on both the innate and adaptive immune responses. The complement system, antibodies, and anti-microbial proteins and peptides can directly interact with potential pathogens, protecting against systemic infection. Levels of these innate effector proteins are generally lower in neonatal circulation at term delivery than in adults, and lower still at preterm delivery. The extracellular environment also has a critical influence on immune cell maturation, activation, and effector functions, and many of the factors in plasma, including hormones, vitamins, and purines, have been shown to influence these processes for leukocytes of both the innate and adaptive immune systems. The ontogeny of plasma factors can be viewed in the context of a lower effectiveness of immune responses to infection and immunization in early life, which may be influenced by the striking neonatal deficiency of complement system proteins or enhanced neonatal production of the anti-inflammatory cytokine IL-10, among other ontogenic differences. Accordingly, we survey here a number of soluble mediators in plasma for which age-dependent differences in abundance may influence the ontogeny of immune function, particularly direct innate interaction and skewing of adaptive lymphocyte activity in response to infectious microorganisms and adjuvanted vaccines.
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Affiliation(s)
- Matthew Aaron Pettengill
- Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA , USA ; Harvard Medical School , Boston, MA , USA
| | - Simon Daniël van Haren
- Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA , USA ; Harvard Medical School , Boston, MA , USA
| | - Ofer Levy
- Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA , USA ; Harvard Medical School , Boston, MA , USA
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Jubulis J, Kinikar A, Ithape M, Khandave M, Dixit S, Hotalkar S, Kulkarni V, Mave V, Gupte N, Kagal A, Jain S, Bharadwaj R, Gupta A. Modifiable risk factors associated with tuberculosis disease in children in Pune, India. Int J Tuberc Lung Dis 2014; 18:198-204. [PMID: 24429313 PMCID: PMC4487622 DOI: 10.5588/ijtld.13.0314] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases. OBJECTIVE To assess the association between novel modifiable risk factors and TB in Indian children. DESIGN Cases were children aged ≤ 5 years with confirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged ≤ 5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (IAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2). RESULTS Sixty cases and 118 controls were enrolled. Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03-91.81), household food insecurity (aOR 11.55, 95%CI 3.33-40.15) and IAP exposure (aOR 2.67, 95%CI 1.02-6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38-2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and IAP remained associated with TB. CONCLUSIONS Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB.
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Affiliation(s)
- J Jubulis
- Johns Hopkins University, Baltimore, Maryland, USA; Maine Medical Center, Portland, Maine, USA
| | - A Kinikar
- Byramji Jeejeebhoy Medical College (BJMC), Pune, India
| | - M Ithape
- BJMC Clinical Trials Unit, Pune, India
| | | | - S Dixit
- Byramji Jeejeebhoy Medical College (BJMC), Pune, India
| | | | | | - V Mave
- BJMC Clinical Trials Unit, Pune, India
| | - N Gupte
- BJMC Clinical Trials Unit, Pune, India
| | - A Kagal
- BJMC Clinical Trials Unit, Pune, India
| | - S Jain
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - A Gupta
- Johns Hopkins University, Baltimore, Maryland, USA
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Dyson A, Pizzutto SJ, MacLennan C, Stone M, Chang AB. The prevalence of vitamin D deficiency in children in the Northern Territory. J Paediatr Child Health 2014; 50:47-50. [PMID: 24147637 DOI: 10.1111/jpc.12413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2013] [Indexed: 11/29/2022]
Abstract
AIMS The primary aim of this study was to determine the frequency of vitD deficiency/insufficiency in an opportunistic sample of Northern Territory (NT) children. The secondary aim was to evaluate whether: (i) 25(OH)vitD (25(OH)D) levels differ between Indigenous/non-Indigenous children; and (ii) VitD insufficiency is associated with increased acute/infective hospitalisations. METHODS Twenty-five (OH)D levels were measured in 98 children <16 years between August 2011 and January 2012 (children hospitalised acutely/non-acutely and well children from other studies based in Darwin). VitD deficiency was defined as 25(OH)D < 50 nmol/L, and insufficiency was postulated to be <75 nmol/L. Demographic data were collected, and computer records were reviewed. RESULTS Median age was 59 months (range 2-161); 3.1% were vitD deficient, 19.4% insufficient. There was no significant difference in mean 25(OH)D level between Indigenous (93.2, standard deviation (SD) 21.9, n = 42) and non-Indigenous (97.3, SD 27.9, n = 56) children (P = 0.32). Median number of hospitalisations/year were similar (P = 0.319) between vitD sufficient (0.34, range 0-12, n = 76) and insufficient (0.22, 0-6, n = 22) children. There was no significant difference between number of infective admissions per year between vitD sufficient/insufficient groups (P = 0.119). CONCLUSIONS Compared with US data (19% deficient, 65% insufficient) fewer NT children are vitD deficient/insufficient. In our limited sample, being vitD insufficient was not associated with increased acute/infective hospitalisations, but a larger unbiased sample of NT children is needed. More information is needed about the optimum level of vitD for non-bone-related health in children.
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Affiliation(s)
- Amanda Dyson
- Paediatrics Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Abstract
BACKGROUND New Zealand accepts 750 refugees annually who enter via the Mangere Refugee Resettlement Centre. AIMS To evaluate the health needs of refugee children less than 5 years of age. METHODS Retrospective audit on the outcomes of health screening and referrals in children less than 5 years of age at the Mangere Refugee Resettlement Centre between 2007 and 2011. RESULTS Of the 343 children, the most common infectious diseases were latent tuberculosis (15%) and parasitic infections (15%). In those older than 1 year old who had rubella and measles serology information, immunity was found in 50% and 59%, respectively. Hepatitis B immunity was found in 68%. Complete vaccination certificates were available for 66% on arrival to New Zealand. Vaccinations were administered to 73% while at the Mangere Refugee Resettlement Centre. Iron deficiency and vitamin D deficiency were the main noninfectious diseases found and were present in 33% and 12%, respectively. The total requiring referral for further medical assessment or support was 58% with 19% requiring referral to more than one service. CONCLUSIONS Screening identified health needs in otherwise asymptomatic newly arriving refugee children. A proportion of children required access to multiple specialized medical services and may benefit from a comprehensive pediatric service.
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Shin YH, Shin HJ, Lee YJ. Vitamin D status and childhood health. KOREAN JOURNAL OF PEDIATRICS 2013; 56:417-23. [PMID: 24244209 PMCID: PMC3827489 DOI: 10.3345/kjp.2013.56.10.417] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/20/2013] [Indexed: 02/06/2023]
Abstract
Vitamin D is an essential component of bone and mineral metabolism; its deficiency causes growth retardation and skeletal deformities in children and osteomalacia and osteoporosis in adults. Hypovitaminosis D (vitamin D insufficiency or deficiency) is observed not only in adults but also in infants, children, and adolescents. Previous studies suggest that sufficient serum vitamin D levels should be maintained in order to enhance normal calcification of the growth plate and bone mineralization. Moreover, emerging evidence supports an association between 25-hydroxyvitamin D (25[OH]D) levels and immune function, respiratory diseases, obesity, metabolic syndrome, insulin resistance, infection, allergy, cancers, and cardiovascular diseases in pediatric and adolescent populations. The risk factors for vitamin D insufficiency or deficiency in the pediatric population are season (winter), insufficient time spent outdoors, ethnicity (non-white), older age, more advanced stage of puberty, obesity, low milk consumption, low socioeconomic status, and female gender. It is recommended that all infants, children, and adolescents have a minimum daily intake of 400 IU (10 µg) of vitamin D. Since the vitamin D status of the newborn is highly related to maternal vitamin D levels, optimal vitamin D levels in the mother during pregnancy should be maintained. In conclusion, given the important role of vitamin D in childhood health, more time spent in outdoor activity (for sunlight exposure) and vitamin D supplementation may be necessary for optimal health in infants, children, and adolescents.
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Affiliation(s)
- Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Hye Jung Shin
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Thornton KA, Marín C, Mora-Plazas M, Villamor E. Vitamin D deficiency associated with increased incidence of gastrointestinal and ear infections in school-age children. Pediatr Infect Dis J 2013; 32:585-93. [PMID: 23340562 DOI: 10.1097/inf.0b013e3182868989] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Vitamin D deficiency (VDD) is highly prevalent among children worldwide. The effects of VDD include alterations of the immune response and increased risk of infection but little evidence exists in school-age children. We investigated the association of vitamin D status with morbidity in a prospective study of school-age children from Bogotá, Colombia. METHODS We measured plasma 25-hydroxyvitamin D (25(OH)D) concentrations in a random sample of 475 children (mean ± standard deviation age: 8.9 ± 1.6 years) and followed them for an academic year. Caregivers were asked to record daily information on the incidence of morbidity episodes using pictorial diaries. Baseline vitamin D status was classified according to 25(OH)D concentrations as deficient (<50 nmol/L), insufficient (≥50 and <75 nmol/L) or sufficient (≥75 nmol/L). We used Poisson regression to estimate incidence rate ratios and 95% confidence intervals for days with diarrhea, vomiting, diarrhea with vomiting, cough with fever and earache or discharge with fever, comparing vitamin D-deficient with vitamin D-sufficient children. Estimates were adjusted for child's age, sex and household socioeconomic status. RESULTS The prevalence of VDD was 10%; an additional 47% of children were vitamin D-insufficient. VDD was associated with increased rates of diarrhea with vomiting (adjusted incidence rate ratio: 2.05; 95% confidence interval: 1.19, 3.53) and earache/discharge with fever (adjusted incidence rate ratio: 2.36; 95% confidence interval: 1.26, 4.44). VDD was not significantly related to cough with fever. CONCLUSIONS These results suggest that VDD is related to increased incidence of gastrointestinal and ear infections in school-age children. The effect of correcting VDD on reducing risk of these infections needs to be tested in supplementation trials.
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Affiliation(s)
- Kathryn A Thornton
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Abstract
Vitamin D is a key nutrient for both healthy children and those with chronic illnesses. Understanding its roles in health and disease has become one of the most important issues in the nutritional management of children. Formal guidelines related to nutrient requirements for vitamin D in healthy children, recommending dietary intakes of 400 IU per day for infants and 600 IU per day for children over 1 year of age, were released by the Institute of Medicine in November 2010. However, application of these guidelines to children with acute and chronic illnesses is less clear. In this Review, we consider major illness categories and specific examples of conditions in children that might be affected by vitamin D. This information can be used in developing both model systems of investigation and clinical trials of vitamin D in children with acute and chronic illnesses.
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Affiliation(s)
- Steven A Abrams
- United States Department of Agriculture/Agriculture Research Service, Children's Nutrition Research Center Department of Pediatrics, Baylor College of Medicine, TX 77030, USA.
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Esposito S, Baggi E, Bianchini S, Marchisio P, Principi N. Role of Vitamin D in Children with Respiratory Tract Infection. Int J Immunopathol Pharmacol 2013; 26:1-13. [DOI: 10.1177/039463201302600101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It has recently been shown that vitamin D (VitD) plays an important role in host defences, inflammation and immunity. We reviewed PubMed and selected all of the studies published over the last 15 years concerning VitD deficiency and VitD supplementation in children with respiratory tract infections. Our analysis showed that VitD seems to be very important because of its part in the complexity of the immune system. However, there are few pediatric studies and most have various limitations. First of all, the literature mainly refers to studies concerning the prevalence of VitD insufficiency and deficiency in specific pathologies. Secondly, it is extremely difficult to identify a common specific range of normal, insufficient and deficient VitD levels. Thirdly, the available studies of VitD supplementation often combined VitD with the use of other micronutrients, thus obscuring the role of VitD itself. Finally, different doses have been used for VitD supplementation. These observations clearly highlight the fact that further studies are needed to evaluate the impact of VitD deficiency and insufficiency in terms of the epidemiology and outcomes of pediatric respiratory tract infection, and whether VitD supplementation favours a positive outcome.
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Affiliation(s)
- S. Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E. Baggi
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S. Bianchini
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Marchisio
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - N. Principi
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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