Research published in Epilepsia found that despite living in the tropics, a high proportion of Malaysian children taking antiepileptic drugs (AEDs) have vitamin D deficiency.
From an assessment of 244 hospital-based children, vitamin D deficiency was identified in 55 patients (22.5%), and a further 48 (19.7%) had vitamin D insufficiency.
The University of Malaya researchers also noted the lack of Vitamin D fortification in food across Southeast Asia.
The authors said the findings reinforced the latest vitamin D supplementation guidelines, which recommend that children on AEDs should receive two to three times more vitamin D supplementation than normal (1,200–3,000 international units per day).
The study also found that those most at risk were female, under 12, of Indian ethnicity and also experienced reduced daily sunlight exposure.
“Our findings highlight the importance of clinicians, being vigilant of assessing vitamin D status among children with epilepsy in Malaysia,” researchers wrote.
“We recommend targeted strategies including vitamin D supplementation with the latest guidance recommending that children on AEDs should be receiving two to three times more vitamin D supplementation (1200–3000 IU/day) and implementation of healthy sunlight exposure lifestyle advice for children with epilepsy.”
First Asia study
This is the largest paediatric epilepsy study to date evaluating vitamin D status in children on long-term AEDs and the first to be conducted in the tropical Asian region.
It is also the first to also explore potentially confounding factors of lifestyle and dietary intake that may affect vitamin D status, which have not been addressed by previous epilepsy studies.
“We attempted to maintain a homogenous cohort of epilepsy patients by excluding patients who are non-ambulant due to… the difficulty of accurately assessing lifestyle behaviour in this subgroup of patients,” stated the researchers.
On a wider level, a key finding of the study was that Indian ethnicity is a significant risk factor for vitamin D deficiency. The authors point out this is highly relevant when formulating policies for vitamin D supplementation in many Southeast Asian countries with multi-ethnic populations that include a sizeable proportion of Indians.
They add the possibility of intrinsic genetic risk factors among Indians that may predispose them to vitamin D deficiency needs to be explored further, especially because they did not find considerable difference in intake levels across different ethnicities.
“In Southeast Asia, due to lack of fortification of vitamin D, there are very few types of foods that have high vitamin D content, making it unlikely that there is an ethnicity difference in vitamin D intake. This was further supported by the mean vitamin D intake among the three ethnicities in our study, which was not significantly different.”
Exposure to sunlight remains the major determining factor for vitamin D status. Studies have stated that under ideal conditions, 20 to 30 minutes of daily sunlight exposure to minimum of 27–30% of body surface area is sufficient for adequate vitamin D production.
However, it has been shown that in South Asian adults with darker skin pigmentation this recommendation is not sufficient and South Asians would require longer sunshine exposure of around 51 minutes per day.
“Vitamin D deficiency and its risk factors in Malaysian children with epilepsy”
Authors: Choong Yi Fong, et al