25-hydroxyvitamin D serum level in children of different ethnicity living in Italy.

UNLABELLED: Several factors including ethnicity are known to influence 25(OH)D levels. The purpose of our study was to assess 25(OH)D levels among 1374 pediatric subjects of different ethnicity and to determine the prevalence of vitamin D deficiency and insufficiency among different ethnic groups. The prevalence of 25(OH)D ≤ 20 ng/ml was 44.2, 65.2, 69.2, 54.0, and 44.8 % among Caucasians, Africans, North Africans, Indians, and others, respectively (P < 0.001). The median of 25(OH)D was 21.0 ng/ml (IQR = 14.0-29.6 ng/ml) for the cohort. Season of blood sampling, age, ethnicity, gestational age, birth weight, and z-score BMI were associated with 25(OH)D levels. Caucasians had higher median 25(OH)D levels than sub-Saharan Africans (P < 0.001), North Africans (P < 0.001), and Indians (P < 0.001). There were no significant differences in the median 25(OH)D levels between ethnic groups among infants, whereas for children older than 1 year we found significant differences in 25(OH)D levels in the different ethnic groups, compared to Caucasians. CONCLUSION: Ethnicity was correlated with 25(OH)D levels among children older than 1 year. We found a high prevalence of vitamin D deficiency and insufficiency after the first year of life, and this was more remarkable in non-Caucasian children.

Vitamin D at the onset of type 1 diabetes in Italian children.

UNLABELLED: Low vitamin D levels have been reported in multiple immune disorders such as type 1 diabetes mellitus (T1DM). The purpose of our study was to determine vitamin D levels in children at the onset of T1DM compared with children with other diseases and to test the hypothesis that low vitamin D may increase the odds for developing diabetes. All the children (n = 58) that were consecutively admitted to our clinic at T1DM onset between May 2010 and July 2012 were compared with a control group of children (n = 166) hospitalized for other diseases, matched for sex, season of visit, and age. For each subject, we considered clinical and anthropometric data, the season at time of hospitalization, and serum 25-hydroxyvitamin D (25(OH)D), which were analyzed and compared using multivariable conditional logistic regression. Median 25(OH)D was significantly lower in the diabetic patients (36.2 nmol/l, range = 7.5-121.0 nmol/l) than in controls (48.7 nmol/l, range = 7.5-190.2 nmol/l), p = 0.010. Low 25(OH)D levels seem to increase the odds for developing T1DM (odds ratio (OR) = 3.45 for 25(OH)D 51-74 nmol/l, OR = 5.56 for 25(OH)D ≤ 50 nmol/l). There was no seasonal effect on the risk of developing T1DM. Median 25(OH)D level was significantly lower in patients admitted with diabetic ketoacidosis (30.2 nmol/l, range = 7.5-101.8 nmol/l) than in patients without ketoacidosis (40.7 nmol/l, range = 15.2-121.1 nmol/l), p = 0.019; but when adjusted for season, the p value was 0.116. CONCLUSIONS: Children at onset of T1DM have lower vitamin D serum levels than those with other diseases. Further longitudinal studies on children before the onset of T1DM will allow clinicians to explore the causal relationship between vitamin D and T1DM.

Intranasal corticosteroids and adrenal suppression.

Allergic rhinitis is a common condition that frequently coexists with asthma and atopic dermatitis. It is commonly treated with intranasal corticosteroids which may increase the potential inception of side effects of the same type of drugs used for the treatment of other allergic diseases. A method to assess the systemic effect of corticosteroids is the evaluation of their effect on the hypothalamic-pituitary-adrenal (HPA) axis. However, it is not clear which test is best for detection of clinically relevant HPA axis suppression in children Morning plasma cortisol levels are twice that of late afternoon and evening values and a delay in the time of onset in peak cortisol levels has been observed in children treated with inhaled corticosteroids. Single morning cortisol level has a low sensitivity for detecting adrenal insufficiency in children. 24-Hour plasma cortisol is a good test because it is a non-invasive measure of the biologically active free cortisol levels for the entire day. For research purposes, the 24-hour integrated concentration plasma cortisol test is preferred. Studies that have looked at HPA axis suppression with intranasal corticosteroids indicate that overall, intranasal corticosteroids have a minimal effect on the HPA axis. A review of the literature reveals one study in which there was a decreased output of urinary cortisol during treatment with either budesonide or fluticasone propionate in adults. Other studies with fluticasone propionate or budesonide have shown no effect on the HPA axis in children. Beclomethasone dipropionate was shown to affect urinary cortisol output in one study on healthy volunteers. However, in a long-term study in children, no effect on the HPA axis was found. Mometasone furoate has been extensively studied in more than 20 trials of adults and children. No effects on the HPA axis were detected in either children or adults. Fluticasone furoate nasal spray was not associated with HPA axis suppression. It is unlikely that children are more sensitive to corticosteroids than adults. There is no reason to perform routine monitoring of adrenal function in children who are treated with intranasal corticosteroid unless those drugs are used concomitantly with inhaled corticosteroids and/or steroid ointments for the possible concomitant presence of asthma and/or atopic dermatitis.