Is low serum 25(OH) vitamin D a risk factor for childhood pneumonias?

Öz

Objectives: 25(OH) vitamin D receptors have been described in immune system cells, particularly those producing antibodies, such as T and B lymphocytes, macrophages and dendritic cells. This study aimed to investigate serum 25(OH) vitamin D levels in children hospitalized with pneumonia. Materials and methods: Eighty patients, 40 male and 40 female, aged between 1 and 15 months and hospitalized with a diagnosis of pneumonia were included. Forty healthy children, 19 female and 21 male, comprised the control group. Patient and control groups were compared in terms of serum 25(OH) vitamin D, calcium, alkaline phosphatase, parathyroid hormone and CD4/CD8 ratio and bone mineral densitometry. Patients\' fever, coughing, pulmonary auscultation findings, time to amelioration of radiological appearances and duration of treatment were also compared. Results: 25(OH) vitamin D levels were below 20 ng/mL in 54.7% (n=43) of the patient group and 25% (n=10) of the controls (p

Anahtar Kelimeler

• Vitamin D, pneumonia, immune system

Serum 25(OH) D vitamin düşüklüğü çocukluk çağı pnömonileri için bir risk faktörü müdür?

Öz

Amaç: 25(OH) D vitamini reseptörleri T ve B lenfositler, makrofajlar ve dendritik hücreler gibi özellikle antijen sunan hücreler başta olmak üzere tüm immun sistem hücrelerinde tanımlanmıştır. Bu çalışmada pnömoni tanısı ile hastanede yatırılan hastalarda serum 25(OH) D vitamin düzeylerinin araştırılması amaçlandı. Gereç ve yöntem: Çalışmaya, pnömoni tanısı ile yatırılan yaşları 1 ay–15 yıl arasında 40\'ı kız 40\'ı erkek olmak üzere toplam 80 hasta alındı. Kontrol grubu olarak sağlıklı çocuklardan oluşan 19\'u kız 21\'i erkek olmak üzere toplam 40 vaka alındı. Vakalar ve kontrol grupları serum 25(OH) D vitamini, kalsiyum, alkalen fosfataz, paratiroid hormon ve CD4/CD8 oranı ve kemik mineral dansitometrisi bakımından karşılaştırıldı. Hastalarda ateş, öksürük, akciğer dinleme bulguları, radyolojik görünümlerin düzelme süreleri ve hastaların tedavi süreleri karşılaştırıldı. Bulgular: Vaka grubundaki hastaların %54,7\'sinin (n=43), kontrol grubununsa %25\'nin (n=10) 25(OH) D vitamin düzeyi 20 ng/mL\'nin altında idi (p

Anahtar Kelimeler

• 25(OH) D vitamini, pnömoni, immun sistem

Kaynakça

1. Özkan B. Nutritional rickets. J Clin Res Pediatr Endocrinol 2010;2(4):137-43.
2. Oren Y, Shapira Y, Agmon-Levin N, et al. Vitamin D insuf- ficiency in a sunny environment: A demographic and sea- sonal analysis; Isr Med Assoc J 2010;12(12): 751-6.
3. Holick MF. Vitamin D: Extraskeletal health. Endocrinol Metab Clin North Am 2010; 39(2): 381-400.
4. Holick MF. Chen TC. Vitamin D deficiency: a worldwide problem with health consequnces. Am J Clin Nutr 2008; 87(4): 1080S-6S.
5. Pasquali M, Mandanici G, Conte C, Muci ML, Mazzaferro S. Understanding the different functions of vitamin D. G Ital Nefrol 2009;26 Suppl 46:53-7.
6. Barger-Lux MJ, Heaney RP. Effects of above average sum- mer sun exposure on serum 25OH vitamin D and calcium absorption. J Clin Endocrinol Metab 2002; 87(11): 4952-6.
7. Penna G, Amuchastegui S, Giarratana N, et al. 1,25-Dihy- droxyvitamin D3 selectively modulates tolerogenic proper- ties in myeloid but not plasmacytoid dendritic cells. J Im- munol 2007;178(1):145-53.
8. Yim S. Dhawan P. Ragunath C, et al. Induction of cathelici- dine in normal and CF bronchial cells by 1,25(OH)2D. J Cyst Fibros 2007; 6(6): 403-10.

9. Bouillon R, Carmeliet G, Verlinden L, et al. Vitamin D nad human health: Lessons from vitamin D receptor null mice. Endocr Rev 2008; 29(6):726-76.
10. Ni Cheallaigh C, Keane J, Lavelle EC, et al. Autophagy in the immun response to tuberculosis:clinical perspectives. Clin Exp Immunol 2011; 164(3):291-300.
11. Bikle D. Vitamin D: Newly discovered actions require re- consideration of physiologic requirements. Trends Endocri- nol Metab 2010;21(6):375-84.
12. Davies PD. Brown RC. Woodhead JD. Serum concentra- tions vitamin D metabolits in untreated tuberculosis. Tho- rax 1985; 40(3): 187-90.
13. Rehman PK. Subclinic rickets and recurrent infections. J Trop Pediatr 1994; 40(1): 58.
14. Edfelt K, Liu PT, Chun R, et al. T cell cytokines differ- ently control human monocyte antimicrobial responses by regulating vitamin D metabolism. Proc Natl Acad Sci USA 2010: 28;107(52):22593-8.
15. Doğan M, Erol M, Cesur Y, et al. The effect of 25-hydroxy- vitamin D3 on the immunsystem. J Pediatr Endocrinol Metab 2009:22(10):929-35.
16. Karatekin G, Kaya A, Salihoğlu O, et al. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 2009;63(4):473-7.
17. Muhe L, Lulseged S, Mason KE, et al. Case-control study of the role of nutritional rickets in the risk of developing pnö- monia in Ethiopian children, Lancet 1997;349(9068):1801- 4.
18. Najada AS, Habashneh MS, Khader M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory infection diseases. J Trop Pediatr 2004;50(6):364-8
19. Raghuramulu N, Reddy V. Serum 25-hyrdoxy-vitamin D levels in malnourished children with rickets. Arch Dis Child. 1980;55(4):285-7.
20. Lips P, Duang T, Oleksik A, et al. A global study of vita- min D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evolution clinical trial. J Clin En- docr Metob 2001;86(3);1212-21
21. Roth DE, Jones AB, Prosser C, et al. Vitamin D status is not associated with the risk of hospitalization for acute bronchi- olitis in early childhood. Eur J Clin Nutr 2009;63(2):297-9.