Prevalence and management of vitamin D deficiency in children with newly diagnosed coeliac disease: cohort study. (2nd October 2021)

• Record Type: Journal Article
• Authors: G, Akhshayaa; Seth, Anju; Kumar, Praveen; Jain, Anju
• Is Part Of: Paediatrics and international child health. Volume 41:Number 4(2021)
• Page Start: 247
• Page End: 252
• Publication Date: 2021-10-02
• Subjects: Coeliac disease -- vitamin D deficiency -- malabsorption -- gluten-free diet; Pediatrics -- Developing countries -- Periodicals; Children -- Health and hygiene -- Developing countries -- Periodicals; Children -- Diseases -- Developing countries -- Periodicals; 618.920009172405
• DOI: 10.1080/20469047.2021.1996089
• Languages: English
• ISSNs: 2046-9047

Abstract

ABSTRACT: Background: Coeliac disease (CD) causes deficiency of various micronutrients including vitamin D, and there are no specific guidelines for treatment. Aims: To determine the prevalence of vitamin D deficiency in children newly diagnosed with CD and the role of oral high-dose vitamin D in its treatment. Methods: Calcium intake, sun exposure and biochemical and radiological parameters related to vitamin D deficiency were compared between 60 children aged 0–18 years diagnosed with CD and 60 healthy age- and sex-matched controls. The cases with serum 25(OH)D (<20 ng/ml) were given oral vitamin D (60, 000 IU/week) and calcium (500 mg/day) for 12 weeks, along with a gluten-free diet (GFD); they were re-evaluated within a week of completion. The primary outcome measure was the serum 25(OH)D level, and secondary measures included serum calcium, phosphorus, alkaline phosphatase, parathormone and clinical and/or radiological rickets. Results: The prevalence of vitamin D deficiency (25(OH)D <20 ng/ml) was significantly greater in the cases ( n =38, 63.3%) than in the controls ( n =27, 45.0%). Upon treatment, all 38 cases with vitamin D deficiency showed a significant rise in 25(OH)D levels along with normalisation of other biochemical abnormalities. Two children had 25(OH)D levels >100 ng/ml with no other feature suggestive of vitamin D toxicity. Conclusions: Vitamin D deficiency is more prevalent in children with CD. Administration of oral high-dose vitamin D for 12 weeks along with a GFD leads to a robust response, indicating rapid mucosal recovery. The vitamin D dosage recommended for malabsorption states may be excessive in CD. Abbreviations: ALP: alkaline phosphatase; CaBP: calcium-binding proteins; CD: coeliac disease; GFD: gluten-free diet; PTH: parathormone; RU: reproducibility units; 25(OH)D: 25 hydroxy vitamin D