Correlation of serum vitamin D levels and anemia in childhood pneumonia: a case control study from rural area

Abstract

INTRODUCTIONPneumonia remains the number one cause for under five deaths worldwide. Out of 6.3 million children dying before 5 years, 0.935 million patients die due to Pneumonia.1 Different approaches have been tried to reduce the morbidity and mortality due to pneumonia such as immunization, vitamin A supplementation and zinc supplementation. 3 The vitamin D converts immune response from TH1 to TH2 response. It also helps in rapid response at the cellular level. It helps in activation of macrophages. 4,5 It is also noted that children with pneumonia had lower vitamin D levels.6-8 They also may have lower dietary vitamin D intake. 9Keeping this in mind, we decided to perform an evaluation of vitamin D levels in patients diagnosed to have pneumonia. We also aimed to investigate impact of severity of vitamin D deficiency on severity of pneumonia. We also investigated the prevalence of ABSTRACT Background: Pneumonia remains number one cause for morbidity and mortality in children. Vitamin D has been shown to have immunomodulatory activity. Hence to find correlation between vitamin D and pneumonia cases the study was carried out. Methods: A case control study was conducted at a rural hospital in Vadgaon. From September 2015 onwards all children under 5 years of age hospitalized with pneumonia were invited to participate in our study. Patients who consented for study underwent serum vitamin 25 (OH) D3 estimation along with other routine investigations as indicated. During the same study period, parents of otherwise healthy children fewer than 5 years age who came to our immunization clinic were invited to participate in the study as a control group. Results: Vitamin 25(OH) D3 levels in pneumonia cases study group (N=40) 12.048±6.015 ng/ml (mean±SD) and in control (N=35) 22.65±11.77 ng/ml (mean±SD) that is statistically significant (P<0.0001) and hemoglobin (Hb) in Cases (N=40) with 8.55±1.27 gm/dl (mean±SD); control group (N=19) with 10.31±0.9 gm/dl (mean±SD)levels was found to be statistically significant (p < 0.0001).All patients with severe pneumonia needing ICU management were found to be deficient in vitamin D levels. Children with pneumonia had higher level of anemia. All children admitted to ICU had Moderate to severe anemia. Conclusions: There is a correlation between Vitamin D deficiency and severity of pneumonia and there is also correlation between level of anemia and severity of pneumonia.

Evaluation of the Relationship between Serum Vitamin D Levels and Acute Febrile Respiratory Infections in Children

“…Consistent with the present study, Kulkarni and Chougule in India found that the relationship between the mean weight of children with pneumonia and the control group was not significant (24). In addition, another study in India, consistent with the results of our study, showed that there was no significant relationship between vitamin D and the location of residence (city or village) (25).…”

“…The height of the case group was lower than the control group, but this difference was not significant. Unlike the present study, another survey demonstrated that the mean height of children with pneumonia was significantly shorter than the control group (24). Also, in a study by Wayse et al, a weak positive relationship was observed between short height and acute lower respiratory infection (ALRI), which may be due to some age mismatch in the case and control groups (26).…”

“…In addition to standard treatment of the disease and without interfering with the treatment process, serum vitamin D levels were determined by 25(OH) vitamin D kit (Ideal Tashkhis Atieh Co. Iran) and ELISA method (Automated ELISA system, Dynex DS2, USA). The Criteria used to define vitamin D deficiency were as follows: <20 ng/mL: Vitamin D deficiency, 20 -30 ng/mL: Vitamin D insufficiency, 30-150 ng/mL: Vitamin D sufficiency, and >150 ng/mL: Vitamin D toxicity (24).…”

Vitamin D Deficiency and its Association with Respiratory Tract Infections in Pediatrics

“…Thus, it was observed that children with vitamin D deficiency had more severe conditions. This was also observed in the study conducted by Kulkarni SP in 2017 19 .This study included the breast feeding status of the children. It was observed that there was not much difference in the vitamin D levels of children who were exclusively breastfed till 4 months of age and 6 months of age (Table 9, Figure 6) .…”

Surveillance of Soil-Transmitted Helminth Infection in Preschool Child Population: Do Changes in Behavior and Immunological Responses Affect Prevalence?

“…Vitamin D also appears to suppress the proliferation and production of T-helper 1 cytokines while promoting the proliferation and production of T-helper 2 cells and the production of regulatory T cells. Given the inflammatory effects of TNF-α, INF-γ, and other Th1 cytokines, optimizing vitamin D status, especially preventing deficiency, can prevent the dysregulation and circulation of more proinflammatory cytokines in infected individuals, which can play a role in decreasing the severity of the disease [ 11 , 12 , 13 ].…”