The effect of antiepileptic drugs in adult and child hypovitaminosis D in a Uruguayan health institution

Authors

  • Valentina Catenaccio Universidad de la República, Facultad de Medicina, Departamento de Farmacología y Terapéutica, Profesora adjunta
  • Silvia Xavier Universidad de la República, Facultad de Medicina, Departamento de Farmacología y Terapéutica, Ex Asistente
  • Agustina De Santis Universidad de la República, Facultad de Medicina, Departamento de Farmacología y Terapéutica, Asistente
  • Noelia Speranza Universidad de la República, Facultad de Medicina, Departamento de Farmacología y Terapéutica, Profesora agregada
  • Andrés Bálsamo Universidad de la República, Facultad de Medicina, Medicina Preventiva y Social, Profesor adjunto
  • Florencia Galarraga Universidad de la República, Facultad de Medicina, Departamento de Farmacología y Terapéutica, Asistente
  • María Eugenia Chaibun Universidad de la República, Facultad de Medicina, Departamento de Neuropediatría, Asistente
  • Luciana Salazar Universidad de la República, Facultad de Medicina, Departamento de Neuropediatría, Asistente
  • Laura Solá Universidad de la República, Facultad de Medicina, Medicina Preventiva y Social, Profesora adjunta
  • Stella Gutiérrez Universidad de la República, Facultad de Medicina, Pediatría, Ex Prof. Agda. CASMU-IAMPP, Departamento de Pediatría, Jefe
  • Ricardo Hermo CASMU-IAMPP, Médico laboratorista
  • Gustavo Tamosiunas Universidad de la República, Facultad de Medicina, Departamento de Farmacología y Terapéutica, Profesor titular

DOI:

https://doi.org/10.29193/RMU.37.2.2

Keywords:

HYPOVITAMINOSIS D, VITAMIN D DEFICIENCY, HYPOCALCEMIA, ANTICONVULSANTS, ANTIEPILEPTICS

Abstract

Introduction: hypovitaminosis D is a highly spread condition worldwide, with clinical consequences that affect bone directly, among other manifestations. Antiepileptic drugs are among factors that cause this deficiency. In Uruguay, there is no information about hypovitaminosis D in children or patients who receive antiepileptic drugs.
Objectives: to learn about the prevalence of hypovitaminosis D in children and adults in a health institution and to compare it with the prevalence in patients receiving antiepileptic drugs.
Method: descriptive, transversal study conducted from March through December, 2017. The following variables were analysed: vitamin D, calcium, phosphorous, alkaline phosphatase and intact parathyroid hormone. Vitamin D insufficiency was defined as vitamin D levels of less than 30 ng per mL and deficiency as D levels of less than 20 ng per mL.
Results: 113 patients were included in the study, 60 of which were children and 53 adults. Global prevalence of vitamin D insufficiency was 89% and deficiency was 60%. In children taking antiepileptic drugs, the average vitamin D value was 17.5 ng/ml and it was 19.6 ng/ml for those not exposed to those drugs. In adults, the average vitamin D value was 18.1 in the population taking antiepileptic drugs and 16.9 in patients not taking that medication. The difference between average values was not statistically significant in children or adults. Calcemia levels observed were significantly lower in both children and adults taking antiepileptic drugs.
Conclusions: vitamin D insufficiency was close to 90% and deficiency was over 50%. No significant differences were found between hypovitaminosis D groups, although reduced calcemia was observed in patients exposed to antiepileptic drugs. Further studies are necessary to analyse factors that cause this condition and its clinical consequences.

References

1) Vitamina D: evidencias y controversias. Bol INFAC 2012; 20(2):1-6. Disponible en: https://www.euskadi.eus/contenidos/informacion/cevime_infac_2012/es_def/adjuntos/INFAC_Vol_20_n_2.pdf [Consulta: 12 enero 2018].
2) Mithal D, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009; 20:1807-20.
3) Ganji V, Zhang X, Tangpricha V. Serum 25-hydroxivitamin D concentrations and prevalence estimates of hypovitaminosis D in the U.S. population based on assay-adjusted data. J Nutr 2012; 142(3):498-507.
4) Aparicio A, López-Sobaler A, López Plaza B, Perea J, Ortega R. Ingesta de vitamina D en una muestra representativa de la población española de 7 a 16 años: diferencias en el aporte y las fuentes alimentarias de la vitamina en función de la edad. Nutr Hosp 2013; 28(5):1657-65.
5) Ruiz-Ocaña P, Carrasco-Fernández C, Zopeque-García N, Saez-Benito A, Novalbos-Ruiz J, Lechuga-Sancho A. Niveles de vitamina D al final de la estación invernal en una población escolar sana. Rev Esp Endocrinol Pediatr 2014; 5:19-27.
6) Puche R. Sobre la prevalencia de hipovitaminosis D en Argentina. Medicina (Buenos Aires) 2015;75(3):183-6.
7) Bagattini J, Barrios E, Barañano R, Moratorio G, Montes J, Laporte S, et al. Estado de la vitamina D en adultos uruguayos aparentemente saludables, en invierno y en Montevideo. Rev Méd Urug 2017; 33(2):126-37.
8) Solá L, Leyún N, Díaz JC, González S, Sehabiague C, Parodi K, et al. Asociación de déficit de vitamina D y anemia en pacientes en hemodiálisis crónica. Rev Méd Urug 2014; 30(3):157-63.
9) Gómez F, Bottaro S, Cóppola F, Tomasso G, Rocha V, Giménez C. Prevalencia del déficit de vitamina D en una población de embarazadas que se asisten en el Centro Hospitalario Pereira Rossell. Rev Méd Urug 2016; 32(2):87-97.
10) Mendoza B, Ronco A. Estacionalidad de la vitamina D plasmática: su importancia en la clínica y en la salud. Rev Méd Urug 2016; 32(2):80-6.
11) De Santis A, Catenaccio V, Speranza N. Hipovitaminosis D y antiepilépticos: revisión de la evidencia y recomendaciones. Rev Méd Urug 2019; 35(3):224-31.
12) Beerhost K, Van der Kruijs S, Verschuure P, Tan IY, Aldenkamp A. Bone disease during chronic antiepileptic drug therapy: general versus specific risk factors. J Neurol Sci 2013; 331:19-25.
13) 13. Tomita S, Ohnishi J, Nakano M, Ichikawa Y. The effect of anticonvulsant drugs on vitamin D3-activating cytochrome P-450-linked monooxygenase systems. J Steroid Biochem Mol 1991; 39:479-85.
14) Farhat G, Yamout B, Mikati MA, Demirjian S, Sawaya R, El-Hajj Fuleihan G. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology 2002; 58:1348-53.
15) Borusiak P, Langer T, Heruth M, Karenfort M, Bettendorf U, Jenke A. Antiepileptic drugs and bone metabolism in children: data from 128 patients. J Child Neurol 2012; 28(2):176-83.
16) Gniatkowska-Nowakowska A. Fractures in epilepsy children. Seizure 2010; 19(6):324-5.
17) Teagarden D, Meador K, Loring D. Low vitamin D levels are common in patients with epilepsy. Epilepsy Res 2014; 108(8): 1352-6.
18) Miratashi S, Abbasi M, Miratashi S. Epilepsy and vitamin D: a comprehensive review of current knowledge. Rev Neurosci 2017; 28(2):185-201.
19) Organización Mundial de la Salud. 10 datos sobre la obesidad. Disponible en: https://www.who.int/features/factfiles/obesity/facts/es/ [Consulta: 2 noviembre 2020].
20) WHO Collaborating Centre for Drugs Statistics Methodology. ATC/DDD Index 2021. Disponible en: http://www.whocc.no/atc_ddd_index/ [Consulta: 10 mayo 2020].
21) García-Peñas J, Jiménez-Legido M. Politerapia racional en epilepsia infantil. Pediátr Panamá 2017; 46(2):82-6.
22) Holick M, Binkley N, Bischoff-Ferrari H, Gordon C, Hanley D, Heaney R, et al. Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011; 96(7):1911-30.
23) Sánchez A, Oliveri B, Mansur J, Fradinger E. Diagnóstico, prevención y tratamiento de la hipovitaminosis D. RAEM 2013; 50(2):142-57.
24) Uruguay. Ministerio de Salud Pública, Dirección General de la Salud. Programa Nacional del Adulto Mayor. Montevideo: MSP, 2005: 36p. Disponible en: https://www.gub. uy/ministerio-salud-publica/sites/ministerio-salud-publica/files/documentos/publicaciones/Programa%20Adulto%20Mayor.pdf. [Consulta: 16 febrero 2020].
25) Serrano J, Latorre J, Gatz M. Spain: promoting the welfare of older adults in the context of population aging. Gerontologist 2014; 54(5):733-40.
26) Uruguay. Ministerio de Salud Pública. Suplementación con vitamina D en niños. Montevideo: MSP, 2017. Disponible en: https://www.gub.uy/ministerio-salud-publica/comunicacion/comunicados/suplementacion-con-vitamina-d-en-ninos [Consulta: 22 febrero 2020].
27) Atención pediátrica: normas nacionales de diagnóstico, tratamiento y prevención. 8 ed. Montevideo: Oficina del Libro FEFMUR, 2014.
28) Aaberg K, Gunnes N, Inger J. Incidence and prevalence of childhood epilepsy: a nationwide cohort study. Pediatrics 2017; 139(5):1-9.
29) De Souza Silva J, Pereira SE, Saboya Sobrinho CJ, Ramalho A. Obesity, related diseases and their relationship with vitamin D deficiency in adolescents. Nutr Hosp 2016; 33:381.
30) Santos Araújo EPD, Queiroz DJM, Neves JPR, Lacerda LM, Gonçalves MDC, Carvalho AT. Prevalence of hypovitaminosis D and associated factors in adolescent students of a capital of northeastern Brazil. Nutr Hosp 2017; 34:1416-23.
31) Nicolaidou P, Georgouli H, Kotsalis H, Matsinos Y, Papadopoulou A, Fretzayas A. Effects of anticonvulsant therapy on vitamin D status in children: prospective monitoring study. J Child Neurol 2006; 21(3):205-9.
32) Fong CY, Kong AN, Poh BK, Mohamed AR, Khoo TB, Ng RL, et al. Vitamin D deficiency and its risk factors in Malaysian children with epilepsy. Epilepsia 2016; 57(8):1271-9.
33) Baek J, Seo Y, Kim G, Kim M, Eun B. Vitamin D levels in children and adolescents with antiepileptic drug treatment. Yonsei Med J 2014; 55(2):417-21.
34) Pack A, Gidal B, Vazquez B. Bone disease associated with antiepileptic drugs. Cleve Clin J Med 2004; 71(Suppl 2):S42-8.
35) Hamed S. Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs. Expert Rev Clin Pharmacol 2016; 9:267-86.
36) Golden NH, Abrams SA; Committee on Nutrition. Optimizing bone health in children and adolescents. Pediatrics 2014; 134(4):e1229-43.

Published

2021-05-18

How to Cite

1.
Catenaccio V, Xavier S, De Santis A, Speranza N, Bálsamo A, Galarraga F, et al. The effect of antiepileptic drugs in adult and child hypovitaminosis D in a Uruguayan health institution. Rev. Méd. Urug. [Internet]. 2021 May 18 [cited 2024 Nov. 25];37(2):e37203. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/704

Most read articles by the same author(s)

<< < 1 2 3 4