Vitamin D deficiency and its risk factors in Malaysian children with epilepsy

Summary Objective Long‐term use of antiepileptic drugs ( AED s) 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. Methods Cross‐sectional study of ambulant children with epilepsy on long‐term AED s 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. Results 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. Significance 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.