title: Vitamin D deficiency and its risk factors in Malaysian children with epilepsy.
abstract: Long-term use of antiepileptic drugs (AEDs) is a significant risk factor for vitamin D deficiency in children with epilepsy. The aims of our study were to evaluate the prevalence and risk factors for vitamin D deficiency among Malaysian children with epilepsy.
  
  
  
  Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in three tertiary hospitals in Malaysia from April 2014 to April 2015. Detailed assessment of pubertal status, skin pigmentation, sunshine exposure behavior, physical activity, dietary vitamin D and calcium intake, anthropometric measurements and bone health blood tests (vitamin D, alkaline phosphatase, calcium, phosphate, and parathyroid hormone levels) were obtained on all patients. Vitamin D deficiency was defined as 25-hydroxy vitamin D [25(OH)D] levels ≤35 nmol/L and insufficiency as 25(OH)D levels of 36-50 nmol/L.
  
  
  
  A total of 244 children (146 male) participated in the study. Ages ranged between 3.7 and 18.8 years (mean 12.3 years). 25(OH)D levels ranged between 7.5 and 140.9 nmol/L (mean 53.9 nmol/L). Vitamin D deficiency was identified in 55 patients (22.5%), and a further 48 (19.7%) had vitamin D insufficiency. Multivariate logistic regression analysis identified polytherapy >1 AED (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.07-4.36), age >12 years (OR 4.16, 95% CI 1.13-15.30), Indian ethnicity (OR 6.97, 95% CI 2.48-19.55), sun exposure time 30-60 min/day (OR 2.44, 95% CI 1.05-5.67), sun exposure time <30 min/day (OR 3.83, 95% CI 1.61-9.09), and female (OR 2.61, 95% CI 1.31-5.20) as statistically significant (p < 0.05) risk factors for vitamin D deficiency.
  
  
  
  Despite living in the tropics, a high proportion of Malaysian children with epilepsy are at risk of vitamin D deficiency. Targeted strategies including vitamin D supplementation and lifestyle advice of healthy sunlight exposure behavior should be implemented among children with epilepsy, particularly for those at high risk of having vitamin D deficiency.
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Choong Yi
authors.initials: CY
authors.lastname: Fong
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ann Nie
authors.initials: AN
authors.lastname: Kong
authors.affiliation: Nutritional Sciences Program, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Bee Koon
authors.initials: BK
authors.lastname: Poh
authors.affiliation: Pediatric Neurology Unit, Pediatric Institute, Hospital Kuala Lumpur, Malaysia, Malaysia.
authors.forename: Ahmad Rithauddin
authors.initials: AR
authors.lastname: Mohamed
authors.affiliation: Pediatric Neurology Unit, Pediatric Institute, Hospital Kuala Lumpur, Malaysia, Malaysia.
authors.forename: Teik Beng
authors.initials: TB
authors.lastname: Khoo
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.|Pediatric Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
authors.forename: Rui Lun
authors.initials: RL
authors.lastname: Ng
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Mazidah
authors.initials: M
authors.lastname: Noordin
authors.affiliation: Pediatric Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
authors.forename: Thiyagar
authors.initials: T
authors.lastname: Nadarajaw
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Lai Choo
authors.initials: LC
authors.lastname: Ong
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000886:Anthropometry; D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013472:Sunlight; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Anticonvulsant; Antiepileptic drug; Bone health; Nutrition; Pediatric