Concentrações de vitamina D em lactentes sibilantes e crianças asmáticas: relação com a condição nutricional e o controle da doença
Vitamin D concentrations in wheezing infants and asthmatic children: relationship with nutritional status and disease control
Mirella Regina Cimino Scaff; Fabíola Isabel Suano De-Souza; Roseli Oselka Saccardo Sarni; Igor Luiz Argani; Neusa Falbo Wandalsen
Resumo
Introdução: Deficiência de vitamina D e obesidade foram associadas a um pior controle da asma em países desenvolvidos, embora essa relação ainda não esteja devidamente estabelecida. Assim, o presente estudo visa avaliar a relação entre deficiência de vitamina D, controle da asma e a condição nutricional em crianças menores de 10 anos. Métodos: 46 crianças asmáticas menores de 10 anos foram recrutadas para esse estudo observacional transversal, realizado entre outubro de 2016 e julho de 2018. O controle da asma foi verificado de acordo com o GINA 2016. A condição nutricional foi considerada como eutrófica (Z escore -2 a +1) ou sobrepeso/obesidade (Z score > +1), de acordo com a classificação da Organização Mundial da Saúde. Valores de vitamina D < 20 ng/mL foram considerados deficiência. A análise laboratorial foi realizada pelo laboratório de análises clínicas da Faculdade de Medicina do ABC. Resultados: Não foi encontrada relação estatisticamente significante entre controle da asma e condição nutricional (p = 0,766), controle da asma e níveis de vitamina D (p = 0,880), ou níveis de vitamina D e condição nutricional (p = 0,610). Deficiência de vitamina D foi encontrada em 21,8% das crianças incluídas; 63,5% apresentavam asma não controlada; e 41,3% apresentavam sobrepeso/obesidade. Conclusões: O presente estudo não encontrou associação entre controle da asma, níveis de vitamina D e condição nutricional, questionando a importância dessa relação em crianças com menos de 10 anos.
Palavras-chave
Abstract
Introduction: Vitamin D deficiency and obesity have been associated with poorer asthma control in developed countries, although this relationship has yet to be established. This study aimed to evaluate the relationship between vitamin D deficiency, asthma control, and nutritional status in children younger than 10 years. Methods: 46 asthmatic children younger than 10 years were recruited for a cross-sectional observational study conducted from October 2016 to June 2018. Asthma control was assessed according to the GINA 2016 guidelines. Children were classified as normal weight (Z score -2 to +1) or overweight/ obese (Z score > +1) according to the World Health Organization classification. Vitamin D levels < 20 ng/mL were considered deficient. The laboratory analysis was performed in the Clinical Analysis Laboratory of the ABC Medical School. The statistical analysis was performed with the chi-square test. Results: There was no statistically significant relationship between asthma control and nutritional status (p = 0.766), asthma control and vitamin D levels (p = 0.880), or vitamin D levels and nutritional status (p = 0.610). Vitamin D deficiency was present in 21.8% of children; 63.5% had uncontrolled asthma, and 41.3% were overweight/ obese. Conclusions: The present study found no association between asthma control, vitamin D levels, and nutritional status, questioning the importance of this relationship in children younger than 10 years.
Keywords
References
1. Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ. 2009 Out;27;181(9):E181-90.
2. Busse WW, Lemanske Jr. RF Asthma. N Engl J Med. 2001;1;344(5):350-62.
3. Diretrizes da Sociedade Brasileira de Pneumologia e Tisiologia para o Manejo da Asma. J Bras Pneumol. 2012;38(1):S1-S46.
4. Andıran N, Çelik N, Akça H, Dogan G. Vitamin D deficiency in children and adolescents. J Clin Res Pediatr Endocrinol. 2012;4(1):25-9.
5. Pereira-Santos M, Santos JYGD, Carvalho GQ, Santos DBD, Oliveira AM. Epidemiology of vitamin D insufficiency and deficiency in a population in a sunny country: Geospatial meta-analysis in Brazil. Crit Rev Food Sci Nutr. 2018;8:1-8.
6. Vanlint S. Vitamin D and obesity. Nutrients. 2013 Mar 20;5(3):949‑56.
7. Jat KR, Khairwa A. Vitamin D and asthma in children: A systematic review and meta-analysis of observational studies. Lung India. 2017;34(4):355-63.
8. Turkeli A, Ayaz O, Uncu A, Ozhan B, Bas VN, Tufan AK, et al. Effects of vitamin D levels on asthma control and severity in pre-school children. Eur Rev Med Pharmacol Sci. 2016;20(1):26-36.
9. Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc. 2017;92(2):251-65.
10. Flaherman V, Rutherford GW. A meta-analysis of the effect of high weight on asthma. Arch Dis Child. 2006;91(4):334-9.
11. Wiesenthal EN, Fagnano M, Cook S, Halterman JS. Asthma and overweight/obese: double trouble for urban children. J Asthma. 2016;53(5):485-91.
12. Pradeepan S, Garrison G, Dixon AE. Obesity in asthma: approaches to treatment. Curr Allergy Asthma Rep. 2013;13(5):434-42.
13. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-79.
14. Mohanan S, Tapp H, McWilliams A, Dulin M. Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care. Exp Biol Med (Maywood). 2014;239(11):1531‑40.
15. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452. Referências
16. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2016. Disponível em: www.ginasthma.org.
17. Guilbert TW, Morgan WJ , Zeiger RS, Bacharier LB, Boehmer SJ, Krawiec H, et al. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol. 2004;114(6):1282-7.
18. Sociedade Brasileira de Pediatria. Deficiência de vitamina D em crianças e adolescentes. 2014. Disponível em: https://www.sbp.com. br/fileadmin/user_upload/2015/02/vitamina_d_dcnutrologia2014-2. pdf.
19. Mithal A, 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(11):1807-20.
20. Walsh JS, Bowles S, Evans AL. Vitamin D in obesity. Curr Opin Endocrinol Diabetes Obes. 2017;24(6):389-94.
21. Visness CM, London SJ, Daniels JL, Kaufman JS, Yeatts KB, SiegaRiz AM, et al. Association of obesity with IgE levels and allergy symptoms in children and adolescents: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2009;123(5):1163-9,1169.e1-4.
22. Fitzpatrick S. Obesity is Associated with Elevated IgE levels in an Atopic Population. J Allergy Clin Immunol. 2011;127(2):211.
23. Ahmadizar F, Vijverberg SJ, Arets HG, de Boer A, Lang JE, Kattan M, et al. Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis. Eur Respir J. 2016;48(4):1063‑73.
24. Perez MK, Piedimonte G. Metabolic asthma: is there a link between obesity, diabetes, and asthma?. Immunol Allergy Clin North Am. 2014;34(4):777‑84.
25. Morishita R, Franco Mdo C, Suano-Souza FI, Solé D, Puccini RF, Strufaldi MW. Body mass index, adipokines and insulin resistance in asthmatic children and adolescents. J Asthma. 2016;53(5):478‑84.
26. Hall SC, Agrawal DK. Vitamin D and Bronchial Asthma: An Overview of Data From the Past 5 Years. Clin Ther. 2017;39(5):917‑29.
27. Brown SD, Calvert HH, Fitzpatrick AM. Vitamin D and asthma. Dermatoendocrinol. 2012;1;4(2):137-45.
28. Paul G, Brehm JM, Alcorn JF, Holguín F, Aujla SJ, Celedón JC. Vitamin D and asthma. Am J Respir Crit Care Med. 2012;185(2):124-32.
29. Luo J, Liu D, Liu CT. Can Vitamin D supplementation in addition to asthma controllers improve clinical outcomes in patients with asthma?: A Meta-analysis. Medicine (Baltimore). 2015;94(50):e2185.
30. Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg. 2008;207(6):928‑34.
Submitted date:
09/16/2019
Accepted date:
12/20/2019
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