PURPOSE: Vitamin D (VD) plays an important role in inflammatory and immune reactions and may be critical in the human tuberculosis (TB) response. With the increased prevalence of TB in the aboriginal (A) population, especially those residing in Northern Manitoba (NM) we sought to identify how frequently children seen in the TB Clinic were VD deficient (VDD).
METHODS: VD levels were drawn (as part of routine baseline blood work as per clinic protocol after few patients failed to exhibit inadequate response to usual treatment) from patients referred to the TB clinic for contact investigation, school/immigration screening or treatment of primary/pulmonary disease from July 1, 2006 to June 30, 2008. The normal reference value used was 75-250nmol/L. VD insufficiency (VDI) was when the level was 25-75nmol/L and VDD was diagnosed in those with levels <25nmol/L. Results were analyzed using chi-square test and one way ANOVA. Data were analyzed by using SAS 9.2 software. Significance level considered at ≤ 0.05. Log 10 transformations were done for the variables that were not Gaussian.
RESULTS: 358 children had blood levels drawn during the 24 month period. The prevalence of VDD as to gender, ethnicity (aboriginal population versus other ethnicities) were similar but was significantly higher in the older age group( >14 years), and in those residing outside of Winnipeg. There was marginally significant difference in levels associated with seasonal variation, being more prevalent in the fall to winter. As expected, PTH levels were significantly higher in those with VDD.
CONCLUSIONS: VDD is common in the aboriginal and immigrant populations seen in our clinic. What role and contribution genetics, diet and environment play require further study, especially as to whether the prevention of VDD may reduce the risk of developing TB. Analysis of VD levels in patients subsequently found to be tuberculin negative will provide more information.
CLINICAL IMPLICATIONS: VD as an addition to anti-TB medications may be indicated to reduce risk and to facilitate treatment response.
DISCLOSURE: The following authors have nothing to disclose: Lamya Bouhasan, Raquel Consunji-Araneta
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