Vitamin D levels and status amongst asthmatic and non-asthmatic adolescents in Cyprus: a comparative cross-sectional study

BMC Public Health

Panayiotis K Yiallouros⁴  Polyxeni Nicolaidou³  Vasilios Raftopoulos¹  Christiana Kouta¹  Nicos Middleton¹  Anna Papadopoulou³  Ourania Kolokotroni² 

[1] Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus;St George University of London Medical Programme at the University of Nicosia Medical School, Nicosia, Cyprus;3rd Department of Pediatrics, Attikon University Hospital, University of Athens Medical School, Athens, Greece;Cyprus International Institute for Environmental & Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus

关键词: Vitamin D status;    Vitamin D levels;    Asthma severity;    Asthma;    Adolescents;   

Others  :  1122815
DOI  :  10.1186/s12889-015-1385-2

 received in 2014-10-02, accepted in 2015-01-09,  发布年份 2015

【 摘 要 】

Background

Emerging evidence suggests that vitamin D might be implicated in asthma pathophysiology. This study aims to compare Vitamin D mean serum levels and status between asthmatic and non-asthmatic adolescents and investigate the association of vitamin D with asthma severity.

Methods

In a cohort of adolescents aged 16–17 years, those reporting wheezing in the past 12 months and Ever asthma on the ISAAC questionnaire were invited to participate and formed the Active Asthmatics group. Controls were selected amongst Never Wheezers/Never Asthmatics (NWNA). Differences in mean 25(OH)D serum levels and vitamin D status between AA and NWNA were examined in multivariate linear and logistic regression models respectively, adjusting for potential confounders. Within AA, differences in vitamin D levels were assessed across asthma severity indicators.

Results

A total of 69 AA and 671 NWNA participated in the study. Unadjusted mean 25(OH)D serum levels were 22.90 (SD 6.41), and 21.15 (SD 5.59) ng/mL in NWNA and AA respectively (p = 0.03). In adjusted models, mean 25(OH)D levels remained significantly lower amongst AA compared to NWNA (adjusted beta coefficient −1.68, 95% CI −3.24, −0.13). Severe (<12 ng/mL), moderate (<25 ng/mL) or insufficient (<30 ng/mL) vitamin D status was more prevalent among AA who were 1.6 times (95% CI 1.01, 2.53) more likely to belong to a lower vitamin D category compared to NWNA. Within AA, there was a negative trend between vitamin D levels and the number of reported asthma severity indicators.

Conclusions

Levels of vitamin D tend to be lower among asthmatic compared to non-asthmatic children and in those with severe asthma independent of important confounders.

【 授权许可】

   
2015 Kolokotroni et al.; licensee BioMed Central.

【 参考文献 】

• [1]Dong Y, Pollock N, Stallmann-Jorgensen IS, Gutin B, Lan L, Chen TC, et al.: Low 25-hydroxyvitamin D levels in adolescents: race, season, adiposity, physical activity, and fitness. Pediatrics 2010, 125(6):1104-11.
• [2]González-Gross M, Valtuena J, Breidenassel C, Moreno LA, Ferrari M, Kersting M, et al.: Vitamin D status among adolescents in Europe: the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Br J Nutr 2011, 1(1):1-10.
• [3]Levis S, Gomez A, Jimenez C, Veras L, Ma F, Lai S, et al.: Vitamin D deficiency and seasonal variation in an adult South Florida population. J Clin Endocrinol Metabol 2005, 90(3):1557-62.
• [4]Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al.: Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006, 368(9537):733-43.
• [5]Custovic A, Marinho S, Simpson A: Gene-environment interactions in the development of asthma and atopy. Expert Rev Respir Med 2012, 6(3):301-8.
• [6]Bozzetto S, Carraro S, Giordano G, Boner A, Baraldi E: Asthma, allergy and respiratory infections: the vitamin D hypothesis. Allergy 2011, 67(1):10-7.
• [7]Holick MF: Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004, 80(6):1678S-88.
• [8]Brehm JM, Acosta-Pérez E, Klei L, Roeder K, Barmada M, Boutaoui N, et al.: Vitamin D insufficiency and severe asthma exacerbations in Puerto Rican children. Am J Respir Crit Care Med 2012, 186(2):140-6.
• [9]Alyasin S, Momen T, Kashef S, Alipour A, Amin R: The relationship between serum 25 hydroxy vitamin D levels and asthma in children. Allergy Asthma Immunol Res 2011, 3(4):251-5.
• [10]Bener A, Ehlayel MS, Tulic MK, Hamid Q: Vitamin D deficiency as a strong predictor of asthma in children. Int Arch Allergy Immunol 2011, 157(2):168-75.
• [11]Chinellato I, Piazza M, Sandri M, Peroni DG, Cardinale F, Piacentini GL, et al.: Serum vitamin D levels and exercise-induced bronchoconstriction in children with asthma. Eur Respir J 2011, 37(6):1366-70.
• [12]Ehlayel M, Bener A, Sabbah A: Is high prevalence of vitamin D deficiency evidence for asthma and allergy risks? Eur Ann Allergy Clin Immunol 2011, 43(3):81-8.
• [13]Freishtat RJ, Iqbal SF, Pillai DK, Klein CJ, Ryan LM, Benton AS, et al.: High prevalence of vitamin D deficiency among inner-city African American youth with asthma in Washington, DC. J Pediatr 2010, 156(6):948-52.
• [14]Hamzaoui A, Maalmi H, Berraïes A, Tanguouru E, Ammar J, Abid H, et al.: The impact of vitamin D deficiency on immune T cells in asthmatic children: a case–control study. J Asthma Allergy 2012, 5:11-9.
• [15]Menon J, Maranda L, Nwosu BU: Serum 25-hydroxyvitamin D levels do not correlate with asthma severity in a case-controlled study of children and adolescents. J Pediatr Endocrinol Metab 2012, 25(7–8):673-9.
• [16]Tolppanen A, Sayers A, Granell R, Fraser WD, Henderson J, Lawlor DA: Prospective Association of 25-Hydroxyvitamin D3 and D2 with Childhood Lung Function, Asthma, Wheezing, and Flexural Dermatitis. Epidemiology 2013, 24(2):310-9.
• [17]Van Oeffelen A, Bekkers M, Smit H, Kerkhof M, Koppelman G, Haveman‐Nies A, et al.: Serum micronutrient concentrations and childhood asthma: the PIAMA birth cohort study. Pediatr Allergy Immunol 2011, 22(8):784-93.
• [18]Hollams E, Hart P, Holt B, Serralha M, Parsons F, de Klerk N, et al.: Vitamin D and atopy and asthma phenotypes in children: a longitudinal cohort study. Eur Respir J 2011, 38(6):1320-7.
• [19]Back O, Blomquist HK, Hernell O, Stenberg B: Does vitamin D intake during infancy promote the development of atopic allergy? Acta Derm Venereol 2009, 89(1):28-32.
• [20]HYPPöNEN E, SOVIO U, WJST M, PATEL S, PEKKANEN J, HARTIKAINEN A, et al.: Infant vitamin D supplementation and allergic conditions in adulthood: northern Finland birth cohort 1966. Ann N Y Acad Sci 2004, 1037(1):84-95.
• [21]Tolppanen AM, Fraser A, Fraser WD, Lawlor DA: Risk factors for variation in 25-hydroxyvitamin D(3) and D(2) concentrations and vitamin D deficiency in children. J Clin Endocrinol Metab 2012, 97(4):1202-10.
• [22]Kolokotroni O, Papadopoulou A, Yiallouros PK, Raftopoulos V, Kouta C, Lamnisos D, et al.: Association of vitamin D with adiposity measures and other determinants in a cross-sectional study of Cypriot adolescents. Public Health Nutr 2015, 18(01):112-21.
• [23]Yiallouros PK, Lamnisos D, Kolokotroni O, Moustaki M, Middleton N: Associations of body fat percent and body mass index with childhood asthma by age and gender. Obesity 2013, 21(9):E474-82.
• [24]Brehm JM, Celedón JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, et al.: Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med 2009, 179(9):765-71.
• [25]Searing DA, Zhang Y, Murphy JR, Hauk PJ, Goleva E, Leung DY: Decreased serum vitamin D levels in children with asthma are associated with increased corticosteroid use. J Allergy Clin Immunol 2010, 125(5):995-1000.
• [26]Kolokotroni O, Middleton N, Nicolaou N, Pipis S, Priftis KN, Milton DK, et al.: Temporal changes in the prevalence of childhood asthma and allergies in urban and rural areas of Cyprus: results from two cross sectional studies. BMC Public Health 2011, 11:858-2458-11-858. BioMed Central Full Text
• [27]Savva SC, Tornaritis MJ, Chadjigeorgiou C, Kourides YA, Siamounki M, Kafatos A: Prevalence of overweight and obesity among 11‐year‐old children in Cyprus, 1997–2003. Int J Pediatr Obes 2008, 3(3):186-92.
• [28]International Physical Activity Questionnaire Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire. 2005. http://www.ipaq.ki.se/scoring.pdf.
• [29]Chatzi L, Melaki V, Sarri K, Apostolaki I, Roumeliotaki T, Georgiou V, et al.: Dietary patterns during pregnancy and the risk of postpartum depression: the mother–child ‘Rhea’cohort in Crete, Greece. Public Health Nutr 2011, 14(9):1663.
• [30]Dwyer T, Blizzard L, Gies P, Ashbolt R, Roy C: Assessment of habitual sun exposure in adolescents via questionnaire–a comparison with objective measurement using polysulphone badges. Melanoma Res 1996, 6(3):231.
• [31]Bruske I, Flexeder C, Heinrich J: Body mass index and the incidence of asthma in children. Curr Opin Allergy Clin Immunol 2014, 14(2):155-60.
• [32]Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF: Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000, 72(3):690-3.
• [33]Almqvist C, Worm M, Leynaert B: Impact of gender on asthma in childhood and adolescence: a GA2LEN review. Allergy 2008, 63(1):47-57.
• [34]Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, Zeiger RS, et al.: Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol 2010, 126(1):52-8. e5
• [35]Bikle DD: Vitamin D and immune function: understanding common pathways. Curr Osteoporos Rep 2009, 7(2):58-63.
• [36]Bosse Y, Maghni K, Hudson TJ: 1alpha,25-dihydroxy-vitamin D3 stimulation of bronchial smooth muscle cells induces autocrine, contractility, and remodeling processes. Physiol Genomics 2007, 29(2):161-8.
• [37]Raby BA, Lazarus R, Silverman EK, Lake S, Lange C, Wjst M, et al.: Association of vitamin D receptor gene polymorphisms with childhood and adult asthma. Am J Respir Crit Care Med 2004, 170(10):1057-65.