Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients

Iniesta, Raquel; Rush, Robert; Paciarotti, Ilenia; Rhatigan, E.; Brougham, F. H. M.; McKenzie, Jane; Wilson, David C.

doi:10.1016/j.clnu.2014.12.023

Cited by 35 publications

(40 citation statements)

References 44 publications

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“…Meanwhile, in agreement with other studies, older age was associated with a reduced 25(OH)D level in our cohort. The prevalence of vitamin D inadequacy in preschool children was 23.3%, compared with 45.4% in school children.…”

Section: Discussionsupporting

confidence: 94%

“…Interestingly, Swedish guidelines for vitamin D supplementation were changed in 2006, recommending general vitamin D supplementation only to children up to two years of age, and not up to five years of age as previously recommended . Our data are in line with the meta‐analysis by Revuelta et al who reported that most studies in children with cancer published after 2000 report a higher prevalence of 25(OH)D inadequacy than those published earlier . In contrast to our results, this negative trend in vitamin D status was not found in the Swedish study on healthy children …”

Section: Discussionsupporting

confidence: 90%

“…The prevalence of vitamin D inadequacy in pediatric cancer patients is high. A previously published meta‐analysis revealed that the prevalence of vitamin D inadequacy is the highest among European children with cancer, 41% (range, 21%‐61.5%) of whom had 25(OH)D levels below 50 nmol/L compared with 24% (range, 24%‐25%) among children in the Middle East and 15% (range, 0%‐16%) in North America . Only a few other studies, including our study, provide data on 25(OH)D levels in children with leukemia at the time of diagnosis.…”

Section: Discussioncontrasting

confidence: 61%

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Vitamin D status in children with leukemia, its predictors, and association with outcome

Jackmann

Mäkitie

Harila‐Saari

et al. 2020

Pediatric Blood & Cancer

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Background Children and adolescents with leukemia are potentially at high risk of vitamin D inadequacy, which may have clinical relevance for skeletal morbidity, infections, and cancer outcome. This study aimed to evaluate vitamin D status at the time of diagnosis to investigate its predictors and association with overall survival in children with leukemia. Procedure We included all 295 children and adolescents diagnosed with leukemia at our institution between 1990 and 2016 who had available serum sample from the time of diagnosis. We analyzed serum 25‐hydroxyvitamin D and parathyroid hormone levels and correlated them with clinical data. Results The 25‐hydroxyvitamin D level was deficient (< 25 nmol/L), insufficient (25‐50 nmol/L), sufficient (50‐75 nmol/L), and optimal (> 75 nmol/L) in 6.4%, 26.8%, 39.7%, and 27.1% of the children, respectively. Older age and a more recent time of sampling (calendar year) predicted lower 25‐hydroxyvitamin D level. In preschool children (age ≤6 years), lower 25‐hydroxyvitamin D level was also associated with acute myeloid leukemia, and a 25‐hydroxyvitamin D level < 50 nmol/L was associated with inferior overall survival. In school‐aged children (age > 6 years), the 25‐hydroxyvitamin D level showed significant seasonal variation. Conclusion It remains unclear whether vitamin D supplementation in pediatric leukemia patients will improve outcome.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 61%

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Vitamin D status in children with leukemia, its predictors, and association with outcome

Jackmann

Mäkitie

Harila‐Saari

et al. 2020

Pediatric Blood & Cancer

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“…Despite vitamin D supplementation guidelines ( 2 , 3 ) , their implementation remains inconsistent ( 4 ) and 25(OH)D inadequacy in healthy children ranges from 14 to 49 % worldwide ( 5 ) . A recent systematic review reported prevalence of plasma 25(OH)D deficiency and insufficiency of 41 and 59 %, respectively, in European paediatric cancer patients, higher than healthy children and paediatric cancer patients from North America (15 and 46 %) and the Middle East (24 and 51 %) ( 6 ) .…”

mentioning

confidence: 99%

“…Most children and adolescents treated for cancer survive into adulthood ( 13 ) , but they have an increased risk of developing the metabolic syndrome, cardiac complications and have a reduced peak bone mass ( 13 ) . Despite the importance of vitamin D to health, the high prevalence of 25(OH)D inadequacy in Europe and the recent call for high-quality population-based longitudinal cohort studies, there are a few published studies in the UK, and none in Scotland, investigating plasma 25(OH)D concentration in paediatric cancer patients ( 6 ) . To address this clinical question, we aimed to investigate both plasma 25(OH)D and parathyroid hormone (PTH) concentrations of paediatric cancer patients at defined time points for 24 months; compare plasma 25(OH)D concentration of healthy children with a paediatric cancer cohort from Scotland; and explore possible factors (age, ethnicity, sex, seasonality, nutritional status, diagnosis, treatment and the use of nutritional support) contributing to plasma 25(OH)D inadequacy at baseline and at 3 and 6 months.…”

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confidence: 99%

5-Hydroxyvitamin D concentration in paediatric cancer patients from Scotland: a prospective cohort study

et al. 2016

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Children with cancer are potentially at a high risk of plasma 25-hydroxyvitamin D (25(OH)D) inadequacy, and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged 75 nmol/l). In all, eighty-two patients (median age 3·9, interquartile ranges (IQR) 1·9-8·8; 56 % males) and thirty-five controls (median age 6·2, IQR 4·8-9·1; 49 % males) were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63 %; 22/35) and in the patients (64 %; 42/65) at both baseline and during treatment (33-50 %). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median ranging from 32·0 (IQR 21·0-46·5) to 45·0 (28·0-64·5) nmol/l. Older age at baseline (R -0·46; P<0·001), overnutrition (BMI≥85th centile) at 3 months (P=0·005; relative risk=3·1) and not being supplemented at 6 months (P=0·04; relative risk=4·3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at a higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however, prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented.

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Can screening for low vitamin D levels prevent bone health complications in paediatric oncology patients?

2021

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Background: No international standards include vitamin D levels at diagnosis or during treatment. It is included in the Children's Oncology Group long-term followup guidelines. However, bone health complications (like osteopenia and atraumatic fractures) can occur at diagnosis or during treatment as well.Cases: In this small case series, we illustrate the complexity of bone health complications among our broad paediatric oncology population. If the vitamin D level is low we supplement the patient with one standard oral dose (150 000 units for 1-2 year olds, 300 000 units for 2-5 year olds and 600 000 units for >5 year olds). We do not adjust depending on diagnosis. Conclusion:Because of the potentially negative outcomes on short, medium and long term, we recommend checking vitamin D levels on diagnosis for all newly diagnosed patients. It is a simple, low cost test and one dose of oral supplementation can easily treat the deficiency.

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Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients

Cited by 35 publications

References 44 publications

Vitamin D status in children with leukemia, its predictors, and association with outcome

Vitamin D status in children with leukemia, its predictors, and association with outcome

5-Hydroxyvitamin D concentration in paediatric cancer patients from Scotland: a prospective cohort study

Can screening for low vitamin D levels prevent bone health complications in paediatric oncology patients?

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