COMBINED DEFICIENCIES OF 25-HYDROXYVITAMIN D AND ANEMIA IN PRESCHOOL CHILDREN WITH SEVERE EARLY CHILDHOOD CARIES: A CASE-CONTROL STUDY

BACKGROUND: Severe early childhood caries (S-ECC) is common and has adverse effects on health including pain, sleep disturbance and altered eating habits. Children with S-ECC have been shown to have anemia, lower iron status or vitamin D deficiency. At this time, it is not clear if the observed altered nutritional status is secondary to restricted intake or other factors. Many child of lower socioeconomic status (SES) are often at higher risk for S-ECC. No studies have looked at the presence of combined nutritional deficiencies in children with S-ECC. OBJECTIVES: The objective of this study was to examine whether those with S-ECC had a higher prevalence of combined anemia and low 25-hydroxy-vitamin D (25(OH)D) compared to caries-free controls. Additionally, we examined covariates associated with elevated parathyroid hormone (PTH) previously noted in those with S-ECC. DESIGN/METHODS: This is a re-analyses of a previously described case-control study; data were collected 2009-2011 in Winnipeg. Children with S-ECC were recruited on the day of their dental surgery and controls from the community. Blood was drawn for complete blood count, ferritin, 25(OH)D, calcium and PTH. Families completed a questionnaire about nutritional intake, supplements and family income. RESULTS: A total of 266 children (51.5% male) participated (S-ECC n=144); the mean age was 40.8 ± 14.1 months. As previously noted, children with S-ECC were more likely to have low 25(OH)D, hemoglobin, ferritin, elevated PTH, or iron-deficiency anemia compared to controls. Significant differences between groups were seen for a combined deficiency of low hemoglobin (<110 g/L) and 25(OH)D < 50 nmol/L; controls (0/114-0%) vs. S-ECC (15/140-10.7%: p < 0.001). In an adjusted regression model, PTH was negatively associated with 25(OH)D (p<0.001) and higher income (p=0.017); it was positively associated with less regular milk consumption (p=0.001). Post-adjustment, PTH concentrations were persistently elevated in the S-ECC group. CONCLUSION: Combined deficiencies of vitamin D and anemia are more prevalent in children with S-ECC; the etiology remains unclear. Interestingly, iron-dependent enzymes are needed for activation of vitamin D and 25(OH)D may play a role in erythropoiesis. Combined deficiencies may not just be related to lower SES, poorer intake secondary to pain but intertwined synthetic processes. Elevated PTH concentrations can be noted in inflammatory conditions, which may explain this finding in those with S-ECC, even post-adjustment in the regression model. A detailed diet history is key in those with S-ECC to assess risks for deficiencies of iron, vitamin D or possibly calcium.

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