Aristizabal Paula, Sherer Michael, Perdomo Bianca P, Castelao Esteban, Thornburg Courtney D, Proudfoot James, Jacobs Elizabeth, Newfield Ron S, Zage Peter, Roberts William, Martinez Maria Elena
Department of Pediatrics, Division of Pediatric Hematology/Oncology University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA, USA.
University of California San Diego Moores Cancer Center, La Jolla, CA, USA.
Pediatr Hematol Oncol. 2020 May;37(4):314-325. doi: 10.1080/08880018.2020.1721629. Epub 2020 Mar 10.
Vitamin D deficiency and insufficiency are associated with serious sequelae in childhood cancer survivors. However, data on vitamin D deficiency in children with newly diagnosed cancer are scarce and the role of sociodemographic factors and vitamin D supplementation is largely unknown. We assessed vitamin D status and its socio-demographic and clinical correlates in 163 children with newly diagnosed cancer, using 25-hydroxy vitamin D (25(OH)D) concentrations and assessed longitudinal changes following vitamin D supplementation. Sixty-five percent of the patients with newly diagnosed cancer had low 25(OH)D concentrations. Fifty-two patients (32%) were vitamin D deficient (≤20 ng/mL 25(OH)D concentration), and 53(33%) were insufficient (21-29 ng/mL 25(OH)D concentration). Age over 10 ( = 0.019), Hispanic ethnicity ( = 0.002), and female sex ( = 0.008) were significantly associated with lower 25(OH)D concentration at diagnosis. Vitamin D supplementation resulted in significant increase in 25(OH)D concentrations ( < 0.001). However, following supplementation in the longitudinal analysis, this increase was less pronounced in Hispanic patients vs. non-Hispanic ( = 0.007), and in children with solid tumors vs. hematological malignancies ( = 0.003). Vitamin D deficiency and insufficiency are common in children with newly diagnosed cancer. Hispanic patients, females and older children were at higher risk for vitamin D deficiency and insufficiency. Although supplementation appeared to increase 25(OH)D concentrations over time, this increase was not as pronounced in certain subsets of patients. Prospective trials of the effects of vitamin D supplementation on bone health in children with newly diagnosed cancer are warranted, particularly in Hispanics and patients with solid tumors.
维生素D缺乏和不足与儿童癌症幸存者的严重后遗症相关。然而,新诊断癌症儿童维生素D缺乏的数据稀缺,社会人口学因素和维生素D补充剂的作用在很大程度上尚不清楚。我们评估了163例新诊断癌症儿童的维生素D状况及其社会人口学和临床相关性,采用25-羟基维生素D(25(OH)D)浓度,并评估了维生素D补充后的纵向变化。65%新诊断癌症患者的25(OH)D浓度较低。52例患者(32%)维生素D缺乏(25(OH)D浓度≤20 ng/mL),53例(33%)不足(25(OH)D浓度为21 - 29 ng/mL)。诊断时年龄超过10岁(P = 0.019)、西班牙裔(P = 0.002)和女性(P = 0.008)与较低的25(OH)D浓度显著相关。维生素D补充剂使25(OH)D浓度显著增加(P < 0.001)。然而,在纵向分析中补充后,西班牙裔患者与非西班牙裔患者相比这种增加不太明显(P = 0.007),实体瘤儿童与血液系统恶性肿瘤儿童相比也是如此(P = 0.003)。维生素D缺乏和不足在新诊断癌症儿童中很常见。西班牙裔患者、女性和年龄较大的儿童维生素D缺乏和不足的风险较高。虽然补充剂似乎随时间增加了25(OH)D浓度,但在某些患者亚组中这种增加并不那么明显。有必要对新诊断癌症儿童补充维生素D对骨骼健康的影响进行前瞻性试验,特别是在西班牙裔和实体瘤患者中。