Serum vitamin D status in children with protein-energy malnutrition admitted to Mulago Hospital

Abstract

Background Vitamin D deficiency is a world-wide epidemic with recent estimates indicating that greater than 50% of the global population is at risk. Protein-energy malnutrition (PEM) is much more likely to be associated with vitamin D intake deficiency. The prevalence of vitamin D deficiency in Uganda has not been documented, despite the clinical entity of rickets being observed and diagnosed routinely. This study will assist in bridging the knowledge gap of this problem in our setting. Aims To assess serum vitamin D status in Children admitted with protein-energy malnutrition in Mulago Hospital. Methods This was a cross sectional study, carried out from February 2011 to September 2012 among children attending or admitted to the acute care unit, pediatrics in-patient wards, out-patient clinics and the old Mulago immunization clinic. Consecutive sampling was done, with 158 children enrolled following informed consent. Malnourished and non malnourished children were matched for age, with three cases to one control. A physical examination was carried out and serum vitamin D, serum calcium and serum phosphate levels were assayed. Data entry and cleaning was done using Epidata version 3.02, and analysis with STATA version 11.1. Results were presented in tables and graphs.

Results One hundred fifty eight children were enrolled; 41 non malnourished and 117 malnourished. There were 91(57.6) males and 67 (42.4%) females, aged 6 to 24 months. The mean serum vitamin D level among the malnourished was 32.5 mmol/L (+ 12.0 SD) and 32.2 mmol/l (+ 10.9 SD) among the non malnourished, p=0.868. Fifteen (36.6%) of the non malnourished children had sub optimal serum vitamin D levels while 51 (43.6%) of the malnourished had sub optimal serum vitamin D levels, p-value 0.689. Conclusion The mean serum vitamin D levels in both the malnourished and non malnourished children were found to be within the normal range. A proportion of children in both these groups were found to have vitamin D deficiency. Clinicians should actively screen children for serum vitamin D levels regardless of nutritional status. More studies are recommended to ascertain the magnitude of this problem in the general population