Vitamin D deficiency and its risk factors in Malaysian children with epilepsy

Fong, Choong Yi; Kong, Ann Nie; Poh, Bee Koon; Mohamed, Ahmad Rithauddin; Khoo, Teik Beng; Ng, Rui Lun; Noordin, Mazidah; Nadarajaw, Thiyagar; Ong, Lai Choo

doi:10.1111/epi.13443

Cited by 46 publications

(51 citation statements)

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“…The type of seizures, either focal or generalized were not associated with the vitamin D level in this study. Similar findings were reported in cross sectional studies of children with epilepsy conducted in Australia and Malaysia [34,40]. The data from this study further supports that seizure type is not associated with the vitamin D level.…”

Section: Discussionsupporting

confidence: 90%

“…Children with epilepsy on enzyme-inducing ASDs had also higher parathyroid hormone levels compared to the control group. Similar findings were shown in cross sectional studies in Malaysia and Australia where children with epilepsy on ASMs had elevated parathyroid hormone levels [34,40]. In our study, serum vitamin D levels were significantly lower in children on cytochrome P450 enzyme-inducing ASMs compared to the control group.…”

Section: Discussionsupporting

confidence: 90%

“…Similar to the studies conducted in Australia and Malaysia, this study showed no difference in the dietary intake between children with epilepsy with vitamin D deficiency and those without [34,40]. The primary source of vitamin D is sunshine and dietary intake contributes less than 10% of the requirement [44].…”

Section: Discussionsupporting

confidence: 79%

“…This is the first study to report that children on enzyme-inducing ASMs have lower levels of 25(OH)D 2 and 24,25(OH) 2 D 3 levels probably as result of increased destruction of vitamin D. The median duration of ASMs was five and a half years so the group had established time period of epilepsy and prolonged time period of prescribed ASMs. However, this study did not show difference in the number of ASMs used between children with vitamin D deficiency and those without, compared to other studies which have shown polytherapy to be associated with lower vitamin D levels [19,21,22,27,28,40,42,43]. Our cohort was recruited from a tertiary center which manages a greater proportion of children with severe forms of epilepsy requiring multiple ASMs.…”

Section: Discussioncontrasting

confidence: 55%

“…Studies from South East Asia have shown that ethnicity does affect the vitamin D levels. A hospital based cross sectional study in Malaysia showed children of Indian ethnicity had lower vitamin D levels compared to the other ethnic groups [40]. A multinational study conducted in Indonesia, Thailand, Vietnam and Malaysia also showed children of Indian ethnicity had lower vitamin D levels compared to the other ethnic groups [46].…”

Section: Discussionmentioning

confidence: 99%

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Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa.

Kija

Gidal

Shapson-Coe

et al. 2019

Seizure

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A B S T R A C TPurpose: The effects of antiseizure medications (ASMs) on bone metabolism is inconsistent. Most studies are in high income settings and none from sub-Saharan Africa.Methods: A hospital based cross-sectional study in a paediatric epilepsy service with a comparison group assessed vitamin D metabolism.Results: Seventy-five children with epilepsy and 75 comparison group were recruited. Median age for children with epilepsy was 9 years (range 1-17 years) and controls 3 years (range 1-12 years). Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD 2 (p = 0.0018), vitaminD 3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products.Conclusions: Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzymeinducing ASMs have lower levels of Vitamin D 2 and D 3 levels, probably as result of increased destruction of vitamin D. Improved vitamin D intake for children in vulnerable settings is important.in the liver to form 25-hydroxyvitamin D 3 and subsequently 1α hydroxylation in the kidneys to form 1α, 25 dihydroxy-vitamin D 3 . The degradation of Vitamin D 3 in the kidneys occurs through an enzyme CYP24 to form the metabolites 24, 25 dihydroxy-vitamin D 3 and 1α, 24, 25 trihydroxy-vitamin D 3 [6,7]. In vitro studies support that CYP3A4 catalyzes the hydroxylation of 125 dihydroxy vitamin D 3 into inactive metabolites in the liver and small intestines, where CYP24A1 is nearly absent, which results in decreased intestinal calcium uptake. Notably, CYP3A4 also contributes to the catabolism of 25 hydroxy vitamin D 3 by catalyzing its hydroxylation into 425 dihydroxy vitamin D 3 [8].ASMs induce hepatic cytochrome P450 enzymes, especially https://doi.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 79%