Peer-reviewed article
A cross‑sectional analysis of vitamin D status and associated factors in children recovering from severe acute malnutrition in Zambia and Zimbabwe
Tracy Naomi Phiri, Cherlynn Dumbura, Kuda Mutasa, Deophine Ngosa, Nivea Chuulu et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at vitamin D levels in 442 young children recovering from severe acute malnutrition in hospitals in Zambia and Zimbabwe. Researchers measured blood vitamin D at the time children left hospital and checked which factors were linked to low or high levels. Overall, vitamin D deficiency was uncommon, but all cases were found in Zimbabwe rather than Zambia. Younger babies, children with cerebral palsy, and those tested outside the cooler season tended to have lower vitamin D levels. The authors suggest more research is needed on whether current malnutrition treatment foods provide enough vitamin D and whether extra supplementation would help.
Key points
- Vitamin D deficiency was found in 7.5% (33/442) of children, and all deficient cases were in Zimbabwe.
- Children aged 6 months and older had significantly higher vitamin D levels than those under 6 months.
- Testing during the cooler season was linked to higher vitamin D levels.
- Children with cerebral palsy had lower vitamin D levels than those without.
- Living in Zambia was associated with higher vitamin D levels than living in Zimbabwe.
Limitations
The cross-sectional design means the study can show associations but not prove that these factors cause differences in vitamin D levels, and it only covers a few hospitals in two countries at one point in time.
Abstract
Mortality following severe acute malnutrition (SAM) remains high in Africa. Some children with SAM have altered immune responses and impaired neurodevelopment; however, whether vitamin D deficiency contributes to these poor outcomes remains unclear. We conducted a cross-sectional analysis of circulating 25-hydroxyvitamin D [25(OH)D] concentrations at hospital discharge (25(OH)D) in 442 children aged 0-59 months with SAM at one hospital in Lusaka, Zambia, and two hospitals in Harare, Zimbabwe. Also, we investigated the relationship between 25(OH)D concentrations and host factors. In 442 children, plasma 25(OH)D concentrations were measured using ELISA. Vitamin D deficiency was identified in 33/442 (7.5%; 95% CI: 5.2-10.3) children, all of whom were from Zimbabwe. A multivariable regression model that included age, sex, HIV status, season, oedema, cerebral palsy, and country demonstrated significantly higher 25(OH)D levels among children aged 6-11 months (adjusted (adj) ratio; 1.3; 95% CI: 1.1, 1.6; P = 0.003), 12-23 months (adj ratio; 1.5; 95% CI: 1.3, 1.8; P < 0.001), and 24-59 months (adj ratio; 1.5; 95% CI: 1.3, 1.8; P < 0.001) compared with those <6 months. Sampling during the cool season (adj ratio; 1.2; 95% CI: 1.1, 1.3; P = 0.002), absence of cerebral palsy (adj ratio; 1.2; 95% CI: 1.1, 1.4; P = 0.002) and residence in Zambia (adj ratio; 1.2; 95% CI: 1.1, 1.2; P < 0.001) were associated with higher concentrations of 25(OH)D, even after excluding children <6 months. These findings indicate that vitamin D status among children with SAM is significantly influenced by age, seasonality, cerebral palsy, and geographical location. To facilitate management and improve clinical outcomes in these children, we recommend further investigation into whether the current vitamin D content in ready-to-use therapeutic foods is sufficient for all children and whether additional supplementation improves clinical outcomes, especially in high-risk groups. If deficiency is present, we recommend that children be managed in accordance with local guidelines and policies.