Correlation of Vitamin D and nutritional status in pediatric systemic lupus erythematosus

Main Article Content

Muhammad Zulfikar Mahfudz
Harjoedi Adji Tjahjono
Irfan Agus Salim
Fadilah Mutaqin

Keywords

vitamin D, nutritional status, SLE

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune illness affecting various organ systems, including the skin, joints, kidneys, cardiovascular, and neurological systems. Because of its immunomodulatory properties, vitamin D has been linked to the etiology and therapy of SLE. The link between vitamin D and nutritional status in pediatric systemic lupus erythematosus (pSLE) is complicated and multifaceted. This study aims to see if there is a link between vitamin D and nutritional status in children with systemic lupus erythematosus.


Method: This study design was cross-sectional to determine factors influencing children with SLE. The study was conducted at Saiful Anwar Hospital in Malang from January 1, 2021, to June 30, 2022, and was approved by the hospital's research ethics committee. Statistical analysis was performed using the Shapiro-Wilk test for normality and Pearson correlation with SPSS 25 statistical analysis software.


Results: All samples (32 children) were female, with a mean age of 14.1 ± 1.5 years. The mean vitamin D level was 18.32 ± 2.15 ng/mL, mean body mass index (BMI) was 19.51 ± 1.49 kg/m2. Regarding the nutritional status of children with SLE, 10 children were classified as malnourished (30%), while 19 children had good/normal nutritional status (60%). Three children had overweight (10%). There was a positive correlation between BMI and vitamin D in children with SLE (p=0.000, r=0.630).


Conclusion: The majority of SLE youngsters have inadequate vitamin D levels. Vitamin D and the nutritional health of children with pediatric systemic lupus erythematosus have a significant favorable association.

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References

1. Alvarez JA, Ashraf A. Role of vitamin d in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol. 2010;2010:351385. Available from: https://pubmed.ncbi.nlm.nih.gov/20011094
2. Aparicio-Soto M, Sánchez-Hidalgo M, Alarcón-de-la-Lastra C. An update on diet and nutritional factors in systemic lupus erythematosus management. Nutr Res Rev. 2017;30(1):118–37. Available from: http://dx.doi.org/10.1017/s0954422417000026
3. Mackie FE, Kainer G, Adib N, Boros C, Elliott EJ, Fahy R, et al. The national incidence and clinical picture of SLE in children in Australia – a report from the Australian Paediatric Surveillance Unit. Lupus. 2014;24(1):66–73. Available from: http://dx.doi.org/10.1177/0961203314552118
4. Hiraki LT, Feldman CH, Liu J, Alarcón GS, Fischer MA, Winkelmayer WC, et al. Prevalence, incidence, and demographics of systemic lupus erythematosus and lupus nephritis from 2000 to 2004 among children in the US Medicaid beneficiary population. Arthritis Rheum. 2012;64(8):2669–76. Available from: https://pubmed.ncbi.nlm.nih.gov/22847366
5. Kamphuis S, Silverman ED. Prevalence and burden of pediatric-onset systemic lupus erythematosus. Nat Rev Rheumatol. 2010;6(9):538–46. Available from: http://dx.doi.org/10.1038/nrrheum.2010.121
6. Huang JL, Yeh KW, Yao TC, Huang YL, Chung HT, Ou LS, et al. Pediatric lupus in Asia. Lupus. 2010;19(12):1414–8. Available from: http://dx.doi.org/10.1177/0961203310374339
7. Malaviya AN, Singh RR, Singh YN, Kapoor SK, Kumar A. Prevalence of Systemic Lupus Erythematosus in India. Lupus. 1993;2(2):115–8. Available from: http://dx.doi.org/10.1177/096120339300200209
8. HIRAKI LT, BENSELER SM, TYRRELL PN, HARVEY E, HEBERT D, SILVERMAN ED. Ethnic Differences in Pediatric Systemic Lupus Erythematosus. J Rheumatol. 2009;36(11):2539–46. Available from: http://dx.doi.org/10.3899/jrheum.081141
9. Levy DM, Peschken CA, Tucker LB, Chédeville G, Huber AM, Pope JE, et al. Influence of ethnicity on childhood-onset systemic lupus erythematosus: results from a multiethnic multicenter Canadian cohort. Arthritis Care Res (Hoboken). 2013;65(1):152–60. Available from: https://pubmed.ncbi.nlm.nih.gov/22744999
10. Tucker LB, Uribe AG, Fernández M, Vilá LM, McGwin G, Apte M, et al. Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case-control study within LUMINA, a multiethnic US cohort (LUMINA LVII). Lupus. 2008;17(4):314–22. Available from: https://pubmed.ncbi.nlm.nih.gov/18413413
11. Valenzuela-Almada MO, Hocaoglu M, Dabit JY, Osei-Onomah SA, Basiaga ML, Orandi AB, et al. Epidemiology of Childhood-Onset Systemic Lupus Erythematosus: A Population-Based Study. Arthritis Care Res (Hoboken). 2022;74(5):728–32.
12. Setiabudiawan B, Ghrahani R. 423 Indonesian epidemiologic data of paediatric systemic lupus erythematosus. In: Poster Session. Lupus Foundation of America; 2017. p. A201.1-A201.
13. Hassanalilou T, Khalili L, Ghavamzadeh S, Shokri A, Payahoo L, Bishak YK. Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation. Vol. 9, Autoimmunity Highlights. Springer-Verlag Italia s.r.l.; 2018.
14. Harris JG, Maletta KI, Kuhn EM, Olson JC. Evaluation of quality indicators and disease damage in childhood-onset systemic lupus erythematosus patients. Clin Rheumatol. 2016;36(2):351–9. Available from: http://dx.doi.org/10.1007/s10067-016-3518-0
15. Borba VZC, Vieira JGH, Kasamatsu T, Radominski SC, Sato EI, Lazaretti-Castro M. Vitamin D deficiency in patients with active systemic lupus erythematosus. Osteoporosis International. 2008;20(3):427–33. Available from: http://dx.doi.org/10.1007/s00198-008-0676-1
16. vinh quốc Lương K, Nguyễn LTH. The beneficial role of vitamin D in systemic lupus erythematosus (SLE). Clin Rheumatol. 2012;31(10):1423–35. Available from: http://dx.doi.org/10.1007/s10067-012-2033-1
17. Massias JS, Smith EM, Al-Abadi E, Armon K, Bailey K, Ciurtin C, et al. Clinical and laboratory phenotypes in juvenile-onset Systemic Lupus Erythematosus across ethnicities in the UK. Lupus. 2021/01/07. 2021;30(4):597–607. Available from: https://pubmed.ncbi.nlm.nih.gov/33413005
18. Milanese C, Sandri M, Cavedon V, Zancanaro C. The role of age, sex, anthropometry, and body composition as determinants of physical fitness in nonobese children aged 6-12. PeerJ. 2020;8:e8657–e8657. Available from: https://pubmed.ncbi.nlm.nih.gov/32211229
19. Mitchell EA, Stewart AW, Braithwaite I, Murphy R, Hancox RJ, Wall C, et al. Factors associated with body mass index in children and adolescents: An international cross-sectional study. PLoS One. 2018;13(5):e0196221–e0196221. Available from: https://pubmed.ncbi.nlm.nih.gov/29718950
20. Pang R, Rieder M, Berard R, Miller M, Demirkaya E. 95 Baseline body-mass-index and risk for obesity in children with rheumatic disease starting high-dose prednisone therapy. Paediatrics & Child Health. 2021;26(Supplement_1):e68–9. Available from: http://dx.doi.org/10.1093/pch/pxab061.077
21. Rekvig OP. Autoimmunity and SLE: Factual and Semantic Evidence-Based Critical Analyses of Definitions, Etiology, and Pathogenesis. Front Immunol. 2020;11:569234. Available from: https://pubmed.ncbi.nlm.nih.gov/33123142
22. Nguyen MH, Bryant K, O’Neill SG. Vitamin D in SLE: a role in pathogenesis and fatigue? A review of the literature. Lupus. 2018;27(13):2003–11. Available from: http://dx.doi.org/10.1177/0961203318796293
23. Pang R, Rieder M, Berard R, Miller M, Demirkaya E. 95 Baseline body-mass-index and risk for obesity in children with rheumatic disease starting high-dose prednisone therapy. Paediatrics & Child Health. 2021;26(Supplement_1):e68–9. Available from: http://dx.doi.org/10.1093/pch/pxab061.077
24. Rekvig OP. Autoimmunity and SLE: Factual and Semantic Evidence-Based Critical Analyses of Definitions, Etiology, and Pathogenesis. Front Immunol. 2020;11:569234. Available from: https://pubmed.ncbi.nlm.nih.gov/33123142
25. Smith EMD, Lythgoe H, Midgley A, Beresford MW, Hedrich CM. Juvenile-onset systemic lupus erythematosus: Update on clinical presentation, pathophysiology and treatment options. Clinical Immunology. 2019;209:108274. Available from: http://dx.doi.org/10.1016/j.clim.2019.108274
26. Stagi S, Cavalli L, Bertini F, Martino M de, Cerinic MM, Brandi ML, et al. Vitamin D levels in children, adolescents, and young adults with juvenile-onset systemic lupus erythematosus: a cross-sectional study. Lupus. 2014;23(10):1059–65. Available from: http://dx.doi.org/10.1177/0961203314532564
27. Wen L, Chen Z, Jin Z, Pan W, Liu L, Wu M, et al. Clinical and laboratorial outcome of different age-onset systemic lupus erythematosus patients in Jiangsu, China: a multicentre retrospective study. Sci Rep. 2022;12(1).