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

Authors

  • Choong Yi Fong,

    Corresponding author
    1. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
    • Address correspondence to Choong Yi Fong, Consultant Pediatric Neurologist and Associate Professor, Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. E-mail: cyfong@ummc.edu.my

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  • Ann Nie Kong,

    1. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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  • Bee Koon Poh,

    1. Nutritional Sciences Program, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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  • Ahmad Rithauddin Mohamed,

    1. Pediatric Neurology Unit, Pediatric Institute, Hospital Kuala Lumpur, Malaysia, Malaysia
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  • Teik Beng Khoo,

    1. Pediatric Neurology Unit, Pediatric Institute, Hospital Kuala Lumpur, Malaysia, Malaysia
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  • Rui Lun Ng,

    1. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
    2. Pediatric Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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  • Mazidah Noordin,

    1. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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  • Thiyagar Nadarajaw,

    1. Pediatric Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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  • Lai Choo Ong

    1. Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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Summary

Objective

Long-term use of antiepileptic drugs (AEDs) is a significant risk factor for vitamin D deficiency in children with epilepsy. The aims of our study were to evaluate the prevalence and risk factors for vitamin D deficiency among Malaysian children with epilepsy.

Methods

Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in three tertiary hospitals in Malaysia from April 2014 to April 2015. Detailed assessment of pubertal status, skin pigmentation, sunshine exposure behavior, physical activity, dietary vitamin D and calcium intake, anthropometric measurements and bone health blood tests (vitamin D, alkaline phosphatase, calcium, phosphate, and parathyroid hormone levels) were obtained on all patients. Vitamin D deficiency was defined as 25-hydroxy vitamin D [25(OH)D] levels ≤35 nmol/L and insufficiency as 25(OH)D levels of 36–50 nmol/L.

Results

A total of 244 children (146 male) participated in the study. Ages ranged between 3.7 and 18.8 years (mean 12.3 years). 25(OH)D levels ranged between 7.5 and 140.9 nmol/L (mean 53.9 nmol/L). Vitamin D deficiency was identified in 55 patients (22.5%), and a further 48 (19.7%) had vitamin D insufficiency. Multivariate logistic regression analysis identified polytherapy >1 AED (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.07–4.36), age >12 years (OR 4.16, 95% CI 1.13–15.30), Indian ethnicity (OR 6.97, 95% CI 2.48–19.55), sun exposure time 30–60 min/day (OR 2.44, 95% CI 1.05–5.67), sun exposure time <30 min/day (OR 3.83, 95% CI 1.61–9.09), and female (OR 2.61, 95% CI 1.31–5.20) as statistically significant (p < 0.05) risk factors for vitamin D deficiency.

Significance

Despite living in the tropics, a high proportion of Malaysian children with epilepsy are at risk of vitamin D deficiency. Targeted strategies including vitamin D supplementation and lifestyle advice of healthy sunlight exposure behavior should be implemented among children with epilepsy, particularly for those at high risk of having vitamin D deficiency.

Ancillary