Hypovitaminosis D is Associated with Greater Body Mass Index and Disease Activity in Pediatric Systemic Lupus Erythematosus

• Published in: The Journal of pediatrics Vol. 155; no. 2; pp. 260 - 265
• Main Authors: Wright, Tracey B., MD, Shults, Justine, PhD, Leonard, Mary B., MD, MSCE, Zemel, Babette S., PhD, Burnham, Jon M., MD, MSCE
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.08.2009; Elsevier
• Subjects: Adolescent; African Continental Ancestry Group; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Biological and medical sciences; Body Mass Index; Calcitriol - blood; Case-Control Studies; Child; Child, Preschool; General aspects; Humans; Immunologic Factors - therapeutic use; Linear Models; Lung Diseases - epidemiology; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - epidemiology; Male; Medical sciences; Mucous Membrane; Parathyroid Hormone - blood; Pediatrics; Rituximab; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; Skin Ulcer - epidemiology; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - epidemiology; Young Adult; CASR; 1,25[OH] 2D; SLE disease activity index; PTH; SLE; Body mass index; SLEDAI; Systemic lupus erythematosus; Parathyroid hormone; 25[OH]D; Calcium-sensing receptor; 25-hydroxy vitamin D; BMI; 1,25-dihydroxy vitamin D; Human; Immunopathology; Connective tissue disease; Pediatrics; Skin disease; Nutrition disorder; Hypovitaminosis; Autoimmune disease; Association; Systemic disease; Evolution; Child
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2009.02.033

Objectives To determine whether pediatric systemic lupus erythematosus (SLE) is associated with alterations in the vitamin D-parathyroid hormone (PTH) axis and to assess the relation between vitamin D deficiency and SLE activity. Study Design 25-hydroxy vitamin D [25(OH)D], 1,25-dihydroxy vitamin D [1,25(OH)2 D], and intact PTH were measured in subjects with SLE (n = 38) and healthy controls (n = 207), ages 5 to 21 years. Vitamin D status and its relation with disease activity were assessed using multivariable logistic and linear regression. Results Severe vitamin D deficiency (25(OH)D <10 ng/ml) was observed in a significantly higher proportion of subjects with SLE (36.8% vs 9.2%, P < .001). In SLE, the odds ratio (OR) for severe deficiency was 2.37 ( P = .09), adjusting for age, sex, race, and season. However, for each 1 SD greater body mass index (BMI) z -score, 25(OH)D levels were 4.2 ng/mL lower ( P = .01) in SLE, compared with controls. Adjusting for 25(OH)D levels, SLE was associated with significantly lower 1,25(OH)2 D ( P < .001) and intact PTH levels ( P = .03). Greater SLE disease activity index scores were observed in those with 25(OH)D <20 ng/mL ( P = .01). Conclusions SLE was associated with vitamin D deficiency, particularly among those subjects with SLE who were overweight. Future studies should assess the effect of vitamin D supplementation on skeletal and nonskeletal outcomes in SLE.