Vitamin D deficiency and its risk factors in Malaysian children with epilepsy.
OBJECTIVE
Long-term use of antiepileptic drugs (AEDs) is a significant risk factor for vitamin D deficiency in children with epilepsy. The aims of our study were to evaluate the prevalence and risk factors for vitamin D deficiency among Malaysian children with epilepsy.


METHODS
Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in three tertiary hospitals in Malaysia from April 2014 to April 2015. Detailed assessment of pubertal status, skin pigmentation, sunshine exposure behavior, physical activity, dietary vitamin D and calcium intake, anthropometric measurements and bone health blood tests (vitamin D, alkaline phosphatase, calcium, phosphate, and parathyroid hormone levels) were obtained on all patients. Vitamin D deficiency was defined as 25-hydroxy vitamin D [25(OH)D] levels ≤35 nmol/L and insufficiency as 25(OH)D levels of 36-50 nmol/L.


RESULTS
A total of 244 children (146 male) participated in the study. Ages ranged between 3.7 and 18.8 years (mean 12.3 years). 25(OH)D levels ranged between 7.5 and 140.9 nmol/L (mean 53.9 nmol/L). Vitamin D deficiency was identified in 55 patients (22.5%), and a further 48 (19.7%) had vitamin D insufficiency. Multivariate logistic regression analysis identified polytherapy >1 AED (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.07-4.36), age >12 years (OR 4.16, 95% CI 1.13-15.30), Indian ethnicity (OR 6.97, 95% CI 2.48-19.55), sun exposure time 30-60 min/day (OR 2.44, 95% CI 1.05-5.67), sun exposure time <30 min/day (OR 3.83, 95% CI 1.61-9.09), and female (OR 2.61, 95% CI 1.31-5.20) as statistically significant (p < 0.05) risk factors for vitamin D deficiency.


SIGNIFICANCE
Despite living in the tropics, a high proportion of Malaysian children with epilepsy are at risk of vitamin D deficiency. Targeted strategies including vitamin D supplementation and lifestyle advice of healthy sunlight exposure behavior should be implemented among children with epilepsy, particularly for those at high risk of having vitamin D deficiency.
['Fong|Choong Yi|CY|', 'Kong|Ann Nie|AN|', 'Poh|Bee Koon|BK|', 'Mohamed|Ahmad Rithauddin|AR|', 'Khoo|Teik Beng|TB|', 'Ng|Rui Lun|RL|', 'Noordin|Mazidah|M|', 'Nadarajaw|Thiyagar|T|', 'Ong|Lai Choo|LC|']
D000293:Adolescent D000367:Age Factors D000886:Anthropometry D000927:Anticonvulsants D002648:Child D002675:Child, Preschool D003430:Cross-Sectional Studies D004827:Epilepsy D005260:Female D006801:Humans D008296:Malaysia D008297:Male D015995:Prevalence D012307:Risk Factors D013472:Sunlight D014807:Vitamin D D014808:Vitamin D Deficiency D055815:Young Adult
Antiepileptic drug Bone health Anticonvulsant Nutrition Pediatric