Astımlı Çocukların Serum D Vitamini ve Çinko Düzeyleri ile Klinik Bulguları Arasında Bir İlişki Var mı?

Öz

Amaç: Vitamin D ve çinko eksikliğinin astım ile ilişkili olduğu bildirilmektedir. Bu çalışmada astımlı

çocukların klinik bulguları ile vitamin D ve çinko düzeyleri arasındaki ilişkiyi araştırmayı istedik.

Materyal ve Metot: Bu prospektif çalışmaya yaşları 5‐17 arasında değişen 149 astımlı ve 97 sağlıklı çocuk

dahil edildi. Tüm katılımcıların serum 25 hidroksivitamin D (25(OH)D) ve çinko düzeyleri ölçüldü, diyet

alışkanlıkları, bir yıldaki solunum yolu enfeksiyonu sıklıkları, hastane başvuruları ve güneş ışığına

maruziyet süreleri sorgulandı.

Bulgular: Astımlı çocukların serum D vitamini ve çinko düzeyleri sırasıyla (7,7±5,29 ng/ml), (64±16,3

mcg/dl) sağlıklı çocuklardan (12,3±12,87 ng/ml), (69±26,2 mcg/dl) belirgin şekilde düşük bulundu (p

<0,001) (p <0,015). Serum D vitamini düzeyinin 10ng/ml'nin altında olması ile enfeksiyon sıklığı arasında

ilişki bulunurken çinko düzeyi ile ilişki saptanmadı. Pulmoner fonksiyonlar, beslenme ile D vitamini

düzeyi arasında ilişki saptanmadı. Ancak güneşe maruziyet ile D vitamini düzeyi arasında bir ilişki

saptandı.

Sonuç: Sonuç: Bizim sonuçlarımız astımlı çocukların sağlıklı çocuklardan daha düşük D vitamini ve

çinko düzeyine sahip olduğunu göstermektedir. D vitamininin çok düşük düzeylerde olması artmış

enfeksiyon riski, daha çok tedavi ihtiyacı ve hastane yatışı ile ilişkili ulundu.

Anahtar Kelimeler

• Astımlı çocuk,vitamin D düzeyi,çinko düzeyi,klinik bulgular

Is There a Relationship between Clinical Symptoms of Asthmatic Children and Serum Levels of Vitamin D and Zinc?

Abstract

Objectives: It is reported that deficiencies in vitamin D and zinc are associated with asthma. In this study we aimed to investigate the relationship between clinic findings of asthmatic children and vitamin D and zinc levels.
Materials and Methods: This prospective study included a total of 149 asthmatics and 97 healthy children with an age range of 5 to 17 years. All of the participants were evaluated for serum levels of 25 -hydroxyvitamin D (25(OH)D) and zinc, dietary habits, the rate of respiratory tract infections, hospital visits and levels of sunlight exposure.
Results: Serum vitamin D and zinc levels in asthmatic children (7.7±5.29 ng/ml), (64±16.3 mcg/dl) were significantly lower than that in healthy children (12.3±12.87 ng/ml), (69±26.2 mcg/dl) (p< 0.015), respectively. A relationship was detected between the frequency of infection and vitamin D level’s being <10ng/ml (p < 0.001), while no relationship was detected between the frequency of infection and zinc level. No relationship was detected between pulmonary function, nutrition and the levels of vitamin D and zinc. However, a relationship was detected between vitamin D levels and exposure to sunlight.
Conclusion: Our results showed that asthmatic children had lower vitamin D and zinc levels than healthy children. Very low levels of vitamin D were found to be associated with an increased rate of infection and required more medication and hospitalization

Keywords

• Asthmatic children,level of vitamin D,level of zinc,clinical symptoms

References

1. 1. Asher I, Pearce. Global burden of asthma among children. Int J Tuberc Lung Dis 2014;18:1269–78.
2. 2. Asher MI, Montefort S, Björkstén B et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368:733–43.
3. 3. Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol 2007;120:1031-5.
4. 4. Wjst M, Dold S. Genes, factor X, and allergens: What causes allergic diseases? Allergy 1999;54:757-9.
5. 5. Litonjua AA, Rifas-Shiman SL, Ly NP, et al. Maternal antioxidant intake in pregnancy and wheezing illnesses at 2 y of age. Am J Clin Nutr 2006;84:903–11.
6. 6. Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis. J Allergy Clin Immunol 2011;127:724–33.
7. 7. Devereux G, Turner SW, Craig LC et al. Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children. Am J Respir Crit Care Med 2006;174:499 –507.
8. 8. Damera G, Fogle HW, Lim P, et al. Vitamin D inhibits growth of human airway smooth muscle cells through growth factor-induced phosphorylation of retinoblastoma protein and checkpoint kinase 1. Br J Pharmacol 2009;158:1429–41.

9. 9. Bozzetto S, Carraro S, Giordano G, Boner A, Baraldi E. Asthma, allergy and respiratory infections: the vitamin D hypothesis. Allergy 2012;67:10–17.
10. 10. Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169:384–90.
11. 11. Black PN, Scragg R. Relationship between serum 25-hydroxyvitamin D and pulmonary function in the third national health and nutrition examination survey. Chest 2005;128:3792–98.
12. 12. Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr 2007;85:788–95.
13. 13. Ginde AA, Sutherland RE. Vitamin D in asthma: Panacea or true promise? J Allergy Clin Immunol 2010;126:59–60.
14. 14. Brehm JM, Celedo´n JC, Soto-Quiros ME, et al. Serum Vitamin D Levels and Markers of Severity of Childhood Asthma in Costa Rica. Am J Respir Crit Care Med 2009;179:765–71.
15. 15. Brehm JM, Schuemann B, Fuhlbrigge AL, et al. Childhood Asthma Management Program Research Group. Serum vitamin D levels and severe asthma exacerbations in the childhood asthma management program study. J Allergy Clin Immunol 2010;126:52–8. 16. Hughes DA, Norton R. Vitamin D and respiratory health. Clin Exp Immunol 2009;158:20–5.
16. 17. Walker VP, Modlin RL. The vitamin D connection to pediatric infections and immune function. Pediatr Res 2009;65:106–13.
17. 18. Bener A, Ehlayel MS, Tulic MK, Hamid Q. Vitamin D deficiency as a strong predictor of asthma in children. Int Arch Allergy Immunol 2012;157:168–75.
18. 19. Arik Yılmaz E, Ozmen S, Bostancı I, Misirlioglu ED, Ertan U. Erythrocyte zinc levels in children with bronchial asthma. Pediatric Pulmonology 2011;4612:1189–93.
19. 20. Park SY, Birkhold SG, Kubena LF, Nisbet DJ, Ricke SC. Review on the role of dietary zinc in poultry nutrition, immunity, and reproduction. Biol Trace Elem Res 2004;101:147–63.
20. 21. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and association of 25-hydroxyvitamin D deficiency in US children: NHANES III. 2001-2004. Pediatrics 2009;124:362–70.
21. 22. Uysalol M, Uysalol EP, Yilmaz Y, et al. Serum level of vitamin D and trace elements in children with recurrent wheezing a cross-sectional study. BMC Pediatrics 2014;14:270.
22. 23. Türe M, Zeyrek DC, Koçyiğit A. Hışıltılı çocuklarda serum D vitamini, folik asit ve B12 düzeyi. Asthma Allergy Immunol 2013;11:169–77.
23. 24. Gultekin A, Ozalp I, Hasanoglu A, Unal A. Serum 25-hydroxycholecalciferol levels in children and adolescents. Turk J Pediatr 1987;29:155-62.
24. 25. Taneli B. Zinc in Anatolian Population. Ege J Med 2005;44:1–10.
25. 26. Hodge L, Salome CM, Hughes JM, et al. Effects of dietary intake of omega-3 and omega-6 fatty acids on severity of asthma in children. Eur Respir J 1998;11: 361–65.
26. 27. Turkeli A, Ayaz O, Uncu A, et al. Effects of vitamin D levels on asthma control and severity in pre-school children. Eur Rev Med Pharmacol Sci 2016;20(1):26-36.
27. 28. Xystrakis E, Kusumakar S, Boswell S, et al. Reversing the defective induction of IL–10-secreting regulatory T cells in glucocorticoid-resistant asthma patients. J Clin Invest 2006;116:146–55. .
28. 29. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in school children. Am J Clin Nutr 2010;91:1255–60.
29. 30. Majak P, Olszowiec-Chlebna M, Smejda K, Stelmach I. Vitamin D supplementation in children may prevent asthma exacerbation triggered by acute respiratory infection. J Allergy Clin Immunol 2011;127:1294–96.
30. 31. Jolliffe DA, Greenberg L, Hooper RL et al. Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data. Lancet Respir Med. 2017;11:881-90.
31. 32. Ghaffari J, Khalilian A, Salehifar E, Khorasani E, Rezaii MS. Effect of zinc supplementation in children with asthma: a randomized, placebo-controlled trial in northern Islamic Republic of Iran. East Mediterr Health J 2014;20:391-96.