Serum 1,25-dihydroxyvitamin D levels in the diagnosis and pathogenesis of nutritional rickets - a multivariable re-analysis of a case-control study.

Autor: Fischer PR; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States, Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates and Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates. Electronic address: fischer.phil@mayo.edu., Sempos CT; Vitamin D Standardization Program LLC, Havre de Grace, MD, United States., Pettifor JM; Department of Pediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa., Fraser DR; Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, Australia., Munns CF; Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia and Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia., Durazo-Arvizu RA; Biostatistical Core, The Sabin Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States., Thacher TD; Department of Family Medicine, Jos University Teaching Hospital, Jos, Nigeria.
Jazyk: angličtina
Zdroj: The American journal of clinical nutrition [Am J Clin Nutr] 2023 May; Vol. 117 (5), pp. 998-1004. Date of Electronic Publication: 2023 Feb 18.
DOI: 10.1016/j.ajcnut.2023.02.011
Abstrakt: Background: A multivariable logistic regression model resulting from a case-control study of nutritional rickets in Nigerian children suggested that higher levels of serum 25(OH)D may be required to prevent nutritional rickets in populations with low-calcium intakes.
Objectives: This current study evaluates if adding serum 1,25-dihydroxyvitamin D [1,25(OH) 2 D] to that model shows that increased levels of serum 1,25(OH) 2 D are independently associated with risk of children on low-calcium diets having nutritional rickets.
Methods: Multivariable logistic regression analysis was used to model the association between serum 1,25(OH) 2 D and risk of having nutritional rickets in cases (n = 108) and controls (n = 115) after adjusting for age, sex, weight-for age z-score, religion, phosphorus intake and age began walking and the interaction between serum 25(OH)D and dietary calcium intake (Full Model).
Results: Serum 1,25(OH) 2 D levels were significantly higher (320 pmol/L vs. 280 pmol/L) (P = 0.002), and 25(OH)D levels were lower (33 nmol/L vs. 52 nmol/L) (P < 0.0001) in children with rickets than in control children. Serum calcium levels were lower in children with rickets (1.9 mmol/L) than in control children (2.2 mmol/L) (P < 0.001). Dietary calcium intakes were similarly low in both groups (212 mg/d) (P = 0.973). In the multivariable logistic model, 1,25(OH) 2 D was independently associated with risk of having rickets [coefficient = 0.007 (95% confidence limits: 0.002-0.011)] after adjusting for all variables in the Full Model.
Conclusions: Results confirmed theoretical models that in children with low dietary calcium intake, 1,25(OH) 2 D serum concentrations are higher in children with rickets than in children without rickets. The difference in 1,25(OH) 2 D levels is consistent with the hypothesis that children with rickets have lower serum calcium concentrations which prompt the elevation of PTH levels resulting in an elevation of 1,25(OH) 2 D levels. These results support the need for additional studies to identify dietary and environmental risks for nutritional rickets.
(Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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