Nayma Rahman¹* and Mohuya Mondal²

¹Resident, Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

*Corresponding Author: Nayma Rahman, Resident, Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Received: August 18, 2023; Published: September 06, 2023

Abstract

Background: Chronic liver disease (CLD) is a major cause of morbidity and mortality all over the world, it accounts for about 2% of all deaths in Europe (170,000/year) with increasing mortality rates in several countries. Vitamin D deficiency has been reported highly prevalent in chronic liver disease patients. The lower level of vitamin D is associated with severity of CLD, mortality and increased risk for infections. So, the aim of the present study was to evaluate the serum vitamin D status in patients with CLD.

Objective: To detect the serum Vitamin D status and its correlation with severity in children with CLD.

Methods: This cross-sectional analytical study was conducted at department of Paediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2019 through January 2021. A total of 20 cases diagnosed as CLD were studied who fulfilled inclusion and exclusion criteria. 20 patients other than CLD patients cough, common cold, constipation cases were included as controls. The detailed history, physical examination findings and investigation reports were recorded in a predesigned standard data sheet. Blood was collected from patients with chronic liver disease for investigation eg. s. albumin, prothrombin time, 25-hydroxyvitamin D and s. alkaline phosphatase. Blood was also collected from controls for 25-hydroxyvitamin D and s. alkaline phosphatase. 25-hydroxyvitamin D levels of <20, 21 to 30 and >31 ng/ml were defined as vitamin D ‘‘deficiency’’, ‘‘insufficiency’’ and “sufficiency” respectively. Severity was assessed by Child Pugh score.

Results: Twenty patients and 20 controls were evaluated. Mean age in cases and controls were 101.03 ± 67.31 months and 94.6 ± 50.15 months respectively. Wilson disease was found to be the commonest cause 10 (50.0%), followed by biliary cirrhosis 3 (15.0%) and 5 (25.0%) others .The mean PT was 24.49 ± 18.71 (sec) in cases and 12.35 ± 0.49 (sec) in controls. The mean INR was 2.35 ± 1.73 in cases and 1 ± 0 in controls. The mean serum albumin was 25.2 ± 6.24 (gm/dl) in cases and 39.95 ± 3.66 (gm/dl) in controls. Majority 17(85.0%) patients had deficiency of vitamin D level <20 ng/mL in cases and 16 (80.0%) in controls. The mean serum 25-hydroxy vitamin D level was 12.22 ± 6.21 (ng/mL) in cases and 16.91 ± 6.11 (ng/mL) in controls. The difference is statistically significant (p < 0.05) between two groups. The mean Child Pugh Score was 10.29 ± 2.08 in deficient, 10.67 ± 0.58 in insufficient group of vitamin D level. The difference were statistically not significant (p > 0.05) among three groups. The mean Vitamin D level was 11.52 ± 3.3 ng/mL in B class and 12.6 ± 7.43 ng/mL in C class. The difference was statistically not significant (p > 0.05) among two groups. There was negative not significant Pearson’s correlation (r = -0.148; p = 0.123) between serum Vitamin D and Child Pugh Score and INR (r = -0.316; p = 0.312).

Conclusion: Blood levels of 25-hydroxyvitamin D in patients with chronic liver disease were found lower than those of controls. Serum Vitamin D had an inverse not significant correlation with Child Pugh Score and INR.

 Keywords: Vitamin D Status; Chronic Liver Disease; Bangladesh

References

1. Nightingale S and Ng VL. “Optimizing nutritional management in children with chronic liver disease”. Pediatric Clinics of North America 56 (2009): 1161-1183.
2. Christos Konstantakis., et al. “Vitamin D deficiency in patients with liver cirrhosis”. Annals of Gastroenterology 29 (2016): 1-10.
3. Ji Yeon Lee., et al. “A Review on Vitamin D deficiency treatment in paediatric patients”. The Journal of Pediatric Pharmacololy Theraputics 4 (2013): 277-291.
4. Suchy FJ. “Medical and nutritional Management of cholestasis in infants and children”. 3^rd edition, Liver disease in children, Cambridge University Press 190-231.
5. Behairy OG., et al. “Association between vitamin D status and depression in children with chronic liver disease”. Egyptian Liver Journal 10.1 (2020): 1-8.
6. Jamil Z., et al. “Vitamin D deficiency and its relationship with Child-Pugh class in patients with chronic liver disease”. Journal of Clinical and Translational Hepatology 6.2 (2018): 135.
7. Lee WS., et al. “Vitamin D non-sufficiency is prevalent in children with chronic liver disease in a tropical country”. Pediatrics and Neonatology 60.1 (2019): 12-18.
8. Ashish Kumar Jha., et al. “Vitamin D deficiency in decompensated liver cirrhosis’ World Journal of Gastrointestinal Pathophysioly3 (2017): 133-14.

      9.  Buonomo AR., et al. “Vitamin D deficiency is a risk factor for infections in patients affected by HCV-related liver cirrhosis”. International Journal of Infectious Diseases 63 (2017):  23-29.

10. Yazdanpanah K., et al. “Serum vitamin D levels and severity of liver dysfunction in cirrhotic patients”. International Journal of Clinical Medicine 8.6 (2017): 402.
11. Bal Kishan Gupta., et al. “Evaluation of Vitamin D Deficiency in Patients with Chronic Liver Disease and its Clinical Significance”. International Journal of Nutrition2 (2016): 29-35.
12. Jamil Z., et al. “Vitamin D deficiency and its relationship with Child-Pugh class in patients with chronic liver disease”. Journal of Clinical and Translational Hepatology 6.2 (2018): 135.
13. Targher G., et al. “Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease”. Nutrition, Metabolism and Cardiovascular Diseases 17.7 (2007): 517-524.
14. Barchetta I., et al. “Strong association between nonalcoholic fatty liver disease (NAFLD) and low 25 (OH) vitamin D levels in an adult population with normal serum liver enzymes”. BMC Medicine 1 (2011): 1-7.
15. Christos Konstantakis., et al. “Vitamin D deficiency in patients with liver cirrhosis”. Annals of Gastroenterology 29 (2016): 1-10.

Citation

Citation: Nayma Rahman and Mohuya Mondal. “A Study on Vitamin D Status and its Correlation with Severity in Children with Chronic Liver Disease Attending a Tertiary Care Hospital in Bangladesh". Acta Scientific Gastrointestinal Disorders 6.10 (2023): 03-12.

Copyright

Copyright: © 2023 Nayma Rahman and Mohuya Mondal. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.