Children treated for leukemia with bone marrow transplant (BMT) are exposed to multiple risk factors that have been shown to have direct or secondary effects on vitamin D serum levels and subsequently, bone mineral density (BMD). Vitamin D insufficiency/deficiency has been associated with low bone mass and increased fracture rates in both adult and pediatric BMT recipients. The influence that dietary and supplemental vitamin D intake has on reducing BMD deficits in this specific patient population remains unclear. Our group retrospectively analyzed electronic medical record (EMR) and hard copy data from a population of leukemia survivors who underwent BMT at the UCSF Benioff Children's Hospital, Oakland, over the span of three years post transplantation. Vitamin D intake and serum levels in addition to other dietary, medication, and clinical factors that may have impacted long‐term bone health in this population were analyzed. Preliminary results show that prior to transplantation mean total vitamin D intake did not meet the DRI of 15 mcg/day (12.3 ± 3.2) but was satisfied post BMT, largely due to supplement intake. The total intake of vitamin D greatly increased over time but this observation was not found to be significant (p=0.077). Mean serum vitamin D levels also increased over time, although this was not found to be significant (p=0.187). Spine BMD, Z‐scores and whole body BMD Z‐scores did not significantly change over time, however, whole body BMD did significantly increase over time (p=0.039). Spine BMD was found to have a moderate negative correlation with supplemental vitamin D intake (−0.576 / p=0.0017) at all time points. Spine BMD Z‐scores were found to have a moderate negative correlation with dietary vitamin D intake (−0.477 / p=0.012) at all time points. Whole body BMD Z‐scores were found to have a moderate negative correlation with total vitamin D (diet and supplement) intake (−0.381 / p=0.042) at all time points. Our preliminary analyses investigated single variables over time and suggest that changes in BMD may be attributed to multiple factors such as varied dietary intakes, extent of supplementation, and patient baseline characteristics. More in depth statistical modeling to investigate possible interactions between identified dietary, medication, and clinical variables that can impact BMD will provide a more accurate representation of potential causes and possible solutions in addressing the bone health of this at risk pediatric patient population.
Longitudinal studies of calcium metabolism during pregnancy (PG) have shown that maternal calcium (Ca) absorption increases progressively from the first to the third trimester to meet the needs of the developing fetus. This increase in calcium absorption is directly related to maternal Ca intake. However, even with this increase in absorption, maternal and fetal needs may not be met in women with chronically low Ca intakes (<500 mg/day). Low Ca intakes are not uncommon among women in the USA and may result in maternal bone mobilization. Studies of Ca intake and absorption among racially diverse pregnant women are limited. Thus, this cross‐sectional study was done to determine the effect of racial differences on Ca absorption during the third trimester of pregnancy. Forty women, 10 each from four racial groups (African‐American (AA), Asian, Caucasian, Latina) were recruited between 30–36 weeks gestation. The following outcomes were measured: Ca intake from validated FFQ, Ca absorption, 24 hour urinary Ca excretion, 25OH vitamin D, and bone resorption as assessed by C‐terminal telopeptide (CTx). Ca absorption was measured from a standardized breakfast meal providing 330 mg Ca using the dual stable isotope technique (44Ca oral & 42Ca IV). To date, 34 women have completed the study (6 AA, 8 Asian, 10 Caucasian, 10 Latina) and are presented herein. Preliminary results show that of the 4 groups, only Latina and AA women met the pregnancy Ca RDA. Fasting serum Ca averaged 10.4 ± 0.6 mg/dL in the group as a whole, and it was not associated with CTx or race (r=0.0019, p=NS). Ca absorption ranged from 28.6–80.6% in the whole group of 34 women, and it was not associated with the habitual Ca intake. However, there is an interaction between race, Ca intake and Ca absorption, suggesting that women of different race absorb Ca differently based on Ca intake. 25OH vitamin D was significantly higher (p=0.053) in Caucasian women (29.9 ± 6.5 ng/mL) compared to Asian women (21.3 ± 6.0 ng/mL), and it was inversely related to Ca absorption (p=0.044). 24 hour urinary Ca excretion averaged 163.6 ± 85.5 ug/mL in the whole group; it did not differ by racial group, but it was positively related to Ca absorption (p=0.016). Our preliminary results suggest that in this group of racially diverse women, Ca metabolism is highly variable (intake, absorption, and excretion), which has a larger influence on Ca metabolism parameters than any potential effect due to race.Support or Funding InformationSupported by USDA #2009‐02925
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