Влияние пищевого фактора на сывороточный уровень витамина D у детей с бронхиальной астмой, ювенильным ревматоидным артритом и муковисцидозом

Abstract

Objective. To determine the role of alimentary factors in the development of vitamin D deficiency in children with bronchial asthma, juvenile rheumatoid arthritis, and cystic fibrosis. Patients and methods. A total of 336 children aged 1 to 18 years were examined; of them, 83 patients (53 (64%) boys and 30 (36%) girls aged 12.5 ± 3.8 years) had bronchial asthma (BA), 40 children (19 (47%) boys and 21 (53%) girls aged 13.5 ± 1.8 years) – juvenile rheumatic arthritis (JRA), 213 children (90 (42%) boys and 123 girls (58%) aged 10.5 ± 1.8 years) – cystic fibrosis (CF). Dietary intake of vitamin D was analyzed based on the assessment of actual nutritional status, using a questionnaire method, which consisted in filling out the forms on food consumption over 3 days. Serum vitamin D levels were evaluated using a standard enzyme-linked immunosorbent assay. Results. Vitamin D deficiency was observed in 71% of children with JRA (of which 25% had severe deficiency), in 68% of children with BA (14% with severe deficiency). In children with CF, vitamin D deficiency was registered less frequently: it was observed in 18% of cases (4% had severe deficiency). Evaluation of the actual nutritional status of children with CF, JRA, and BA showed that the intake of vitamin D did not meet the physiological requirements (10 μg per day). There was no correlation between the dietary intake of vitamin D and its concentration in the blood. Conclusion. Using the example of three nosological models (allergic, autoimmune, hereditary-genetic disease), it was shown that children with the autoimmune form of the disease (JRA) were at greater risk of developing serum vitamin D deficiency. Children of all nosological groups had very low levels of vitamin D in consumed food (no more than 15% of the physiological norm). The percentage of children with the optimal concentration of vitamin D in the blood was higher in the group of children with CF, which is explained by medication supplementation. Thus, children with chronic diseases (BA, JRA, CF) need dynamic monitoring of serum vitamin D concentration and pharmacotherapy with vitamin D preparations for preventive and therapeutic purposes. Key words: cystic fibrosis, children, micronutrient status, vitamin D, energy value, macronutrients