Vitamin D status in children with cerebral palsy

Authors

  • Sowjan Manohar Department of Pediatrics, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur, Tamil Nadu, India
  • Rajakumar Ponnandai Gangadaran Department of Pediatrics, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20170719

Keywords:

Antiepileptic drugs, Cerebral Palsy, Serum alkaline phosphatase, Vitamin D

Abstract

Background: The aim of the study was to find the prevalence of vitamin D status - vitamin D deficiency and insufficiency in children with cerebral palsy and to compare them with normal children. To identify the risk factors associated with vitamin D deficiency in these children.

Methods: A prospective case control study was done in 200 children in Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur, Tamil Nadu, India over a period of one year from December 2014 to December 2015 after obtaining approval from institutional ethical committee. Study group contained 100 children with cerebral palsy. 100 Age and sex matched children were taken as controls. Children included in the study were between 1 to 12 years. All children were subjected to the following investigations: serum calcium-total, serum phosphorus, serum alkaline phosphatase (SAP) levels. These were determined by an automated analyzer. The 25OH vitamin D levels were estimated by CLIA (chemi luminescence immunoassay) method.

Results: Vitamin D deficiency was observed in 32 (32%) and insufficiency in 61 (61%) of children with cerebral palsy in case group. Similarly, vitamin D status studied in control children was found that majority of them 49 (49%) was normal. While 38 (38%) were vitamin D insufficient, 13 (13%) showed deficient levels (p <0.0000001).

Conclusions: The presence of feeding difficulties, poor sunlight exposure, poor nutritional status, and the use of antiepileptic drugs, type of CP and the functional grade of CP had statistically significant association with Vitamin D deficiency in these children.  

References

Rosen MG, Dickinson JC. The incidence of cerebral palsy. Am J Obstet Gynecol. 1992;167:417-23.

Fishman LN, Bousvaros A. Gastrointestinal issues in the child with cerebral palsy. Int Pedia Gastroenterol Nutrition. 1999;8:1-9.

Klein G. Nutritional rickets. In: Favus MJ, ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. Philadelphia: Lippincott Williams and Wilkins. 1999:315-319.

Hahn T. Bone complications of anticonvulsants. Drugs. 1976;12:201-11.

Ladhani S, Srinivasan L, Buchanan C, Allgrove J. Presentation of vitamin D deficiency. Arch Dis Child. 2004;89(8):781-4.

Hatun S, Ozkan B, Orbak Z. Vitamin D deficiency in early infancy. J Nutr. 2005;135(2):279-82.

Najada AS, Habashneh MS, Khader M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr. 2004;50(6):364-8.

Pawley NJ, Bishop N. Prenatal and infant predictors of bone health: the influence of vitamin D. Am J Clin Nutr. 2004;80(6):1748-51.

Lonstein JE, Beck K. Hip dislocation and subluxation in cerebral palsy. J Pediatr Orthop. 1986;6:521-6.

Sanders KD, Cox K, Cannon R. Growth response to enteral feeding by children with cerebral palsy. J Parenter Enteral Nutr. 1990;14:23-6.

Fried MD, Pencharz PB. Energy and nutrient intakes of children with spastic quadriplegia. J Pediatr. 1991;119:947-9.

Stallings VA, Zemel BS, Davies JC. Energy expenditure of children and adolescents with severe disabilities: a cerebral palsy model. Am J Clin Nutr. 1996;64:627-34.

Reilly S, Skuse D, Poblete X. Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey. J Pediatr. 1996;129:877-82.

Sullivan PB, Juszczak E, Lambert BR. Impact of feeding problems on nutritional intake and growth. Dev Med Child Neurol. 2002;44:461-7.

Fung EB, Fang SL, Stallings VA. Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc. 2002;102:361-8.

Trier E, Thomas AG. Feeding the disabled child. Nutrition. 1998;14:801-5.

Ravelli AM, Milla PJ. Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. J Pediatr Gastroenterol Nutr. 1998;26:56-63.

Sondheimer JM, Morris BA. Gastroesophageal reflux among severely retarded children. J Pediatr. 1979;94:710-4.

Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D. Vitamin D status in Andhra Pradesh: a population based study. Indian J Med Res. 2008;127:211-8.

Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D, Srinivasarao PV, Sarma KV, et al. High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr. 2007;85:1062-7.

Balasubramanian K, Rajeswari J, Gulab, Govil YC, Agarwal AK, Kumar A, et al. Varying role of vitamin D deficiency in the etiology of rickets in young children vs. adolescents in northern India. J Trop Pediatr. 2003;49(4):201-6.

Hendersonn AC. Vitamin D levels in non-institutionalized children with cerebral palsy. J Child Nerol. 1997;12(7):443-7.

Marwaha RK, Tandon N, Reddy DHK, Aggarwal R, Singh R, Sawhney RC, et al. Vitamin D and bone mineral density status of healthy school children in northern India. Am J Clin Nutr. 2005;82:477-82.

Kumar J, Mntner P, Kaskel FJ, Hailpern S, Michaed L. Prevalence and associations of 25 OH vitamin D deficiency in US children NHANES 2001-2004. Pediatrics. 2009;124:302-70.

Akín R, Okutan V, Sarící Ü, Altunbas A, Gokcay E. Evaluation of bone mineral density in children receiving antiepileptic drugs. Pediatr Neurol. 1998;19:129-31.

Pack AM, Olarte L, Morrell M. Bone mineral density in an outpatient population receiving enzyme inducing antiepileptic drugs. Epilepsy Behav. 2003;4:169-74.

Lifshitz F, Maclaren NK. Vitamin D-dependent rickets in institutionalized children receiving anticonvulsant therapy. A survey of 288 patients. J Pediatr. 1973;82:612-20.

Sato Y, Kondo I, Ishida S. Decreased bone mass and increased bone turnover with valproate therapy in adults with epilepsy. Neurology. 2001;57:445-9.

Fischer MH, Adkins WN, Liebl BH, Vancalcar SC, Marlett JA. Bone status in non-ambulant, epileptic, institutionalized youth. Clin Pediatr. l988;27:499-505.

Houhala AM, Korpela R, Koivikko M, Koskinen T, Koskinen M, Koivula T. Long-term anticonvulsant therapy and vitamin D metabolism in ambulatory pubertal children. Neuropediatrics. 1986;17:212-6.

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Published

2017-02-22

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