Newly diagnosed Children with Cancer have low vitamin D, especially if black - May 2022

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Newly Diagnosed Children with Cancer Have Lower 25-Vitamin D Levels than Their Cancer-Free Peers: A Comparison across Age, Race, and Sex

Cancers 2022,14, 2378. https://doi.org/10.3390/cancers14102378
Michell Fullmer 1, Annelise Su 2©, Steven Bachrach 3, Jobayer Hossain 4 and Heidi H. Kecskemethy 5'*

• 1 Nemours Center for Cancer and Blood Disorders, Nemours Children's Health, Wilmington, DE 19803, USA; michell.fullmer at nemours.org
• 2 University of Richmond, Richmond, VA 23173, USA; annelise.su at richmond.edu
• 3 Department of Pediatrics, Nemours Children's Health, Wilmington, DE 19803, USA; steven.bachrach at nemours.org
• 4 Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE 19803, USA; jhossain at nemours.org
• 5 Department of Radiology, Nemours Children's Health, Wilmington, DE 19803, USA * Correspondence: hkecskem at nemours.org; Tel.: +1-302-651-4673

Simple Summary: In this cross-sectional retrospective review of serum 25(OH)D levels in 544 children, children newly diagnosed with cancer (n = 136) had significantly lower 25(OH)D levels at diagnosis than their age-, sex-, and race-matched peers without cancer from the same geographic region of the US (n = 408). Significant differences were evident: older children exhibited lower 25(OH)D levels, children of color displayed higher levels of insufficiency, and black children were most deficient.

Children with cancer have a greater risk for vitamin D concerns because of compromised health before diagnosis, the disease itself, and treatments for the cancer. This IRB-approved retrospective, matched case-control study of children with and without cancer included three race categories: black, other, and Caucasian. This is the first study to directly compare serum 25-hydroxy vitamin D (25(OH)D) levels and status in newly diagnosed pediatric cancer patients with age-, sex-, and race-matched cancer-free children from the same geographic region of the US, all of whom are free from other conditions that negatively impact 25(OH)D levels. Univariable and multivariable ordinal logistic regressions were performed. In the 544 children (mean age of 8.5 years, 53% female), there were 136 newly diagnosed children with cancer and 408 matched non-cancer controls. Serum 25(OH)D levels at cancer diagnosis were lower (22.4 ng/mL) than in controls (30.1 ng/mL; p < 0.0001). Differences persisted across race (p < 0.001) and age (p < 0.001), but not sex. Older children exhibited lower 25(OH)D levels. Only 18.4% of the children with cancer had sufficient levels. Black children with cancer had the greatest rate of deficiency (39%). Race differences were evident: children of color (other and black) displayed higher levels of insufficiency; black children were most deficient.
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Conclusions

This paper adds to the increasing evidence that children newly diagnosed with cancer are at greater risk for a compromised vitamin D status, and it underscores the importance of prompt evaluation of 25(OH)D levels when a child is diagnosed with cancer. Because of these findings, and other similar studies, institutions caring for children with cancer are beginning to consider and evaluate the implementation of vitamin D testing at the time of diagnosis as a part of standard care 39. Within our own pediatric health care system, we have observed varying practices regarding vitamin D testing at the time of cancer diagnosis in children. The implementation of a care pathway, including serum 25(OH)D testing upon a cancer diagnosis, will allow for the prompt identification of patients who require a correction of vitamin D deficiency or insufficiency to improve patient health and response to treatment, and to help prevent the known bone health problems that children with cancer often develop.
This study shows that children with cancer of all races demonstrated significantly lower 25(OH)D levels at diagnosis than their age-, sex-, and race-matched non-oncology peers. Risk factors for compromised 25(OH)D status were older age and cancer diagnosis. Patients of color exhibited a greater incidence of vitamin D insufficiency, and black children had the greatest levels of deficiency. The significance of this finding relative to the development or progression of cancer is unclear, but worthy of further investigation.

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