Deficiencia de vitamina D y de hierro en niños y adolescentes con parálisis cerebral

Abstract

Introducción: Los niños y adolescentes con parálisis cerebral (PC) tienen mayor riesgo de desnutrición y deficiencias de micronutrientes. Dos de los que podemos estudiar y tratar son la vitamina D (VD) y el hierro. No disponemos de estudios que describan estas deficiencias en Chile. Objetivo: Describir el estado de ambos micronutrientes y evaluar la asociación con algunos factores que favorecen su déficit. Pacientes y método: Estudio descriptivo, corte transversal. Se estudiaron 69 sujetos, de entre 2 a 21 años de edad, de dos hospitales públicos. Se obtuvieron datos demográficos, función motora, uso de sonda de alimentación y fármacos en uso. Se realizó evaluación nutricional según patrones para PC, y se determinó 25-hidroxivitamina D (25OHD), ferritinemia y albuminemia. Resultados: Edad promedio 11,1 ± 4,9 años, 43 (62,3%) varones, 56 (81,2%) tenían PC moderada-severa. Utilizaban sonda nasogástrica y/o gastrostomía 35 (50,7%), el 15,4% estaban con peso bajo y el 73,8% eutróficos, todos con talla normal. Recibían suplementación de VD 20 (29%), y de hierro, 4 (6,1%). La albuminemia fue normal en todos. El promedio de 25OHD fue 24,3 ± 8,8 ng/ml, 33 (47,8%) presentaron insuficiencia y 21 (30,4%) deficiencia. Tuvieron ferritina baja 36 (52,2%). No se encontró asociación entre 25OHD y variables estudiadas. Se encontró asociación entre ferritina baja y mayor edad (p = 0,03), ser hombre (p = 0,006) y uso de sonda de alimentación (p = 0,006).

Introduction: Children and adolescents with cerebral palsy (CP) are at a greater risk of mal-nutrition and micronutrient deficiencies. Two deficiencies that we can study and treat arevitamin D (VD) and iron deficiencies; however, no studies have described these deficiencies inChile.Objective: To describe the status of VD and iron in patients with CP and evaluate the rela-tionship with certain factors associated with deficiencies of these micronutrients.Patients and method:We performed a descriptive, cross-sectional study including 69 patientsaged between 2 and 21 years, from two public hospitals. Data were obtained on demographicvariables, motor function, use of feeding tube, and pharmacological treatment. We perfor-med a nutritional assessment according to patterns of CP and determined 25-hydroxyvitamin D(25[OH]D) ferritin, and albumin levels.Results: Patients’ mean age was 11.1 ± 4.9 years; 43 (62.3%) were male; and 56 (81.2%) hadmoderate-to-severe CP. Thirty-five (50.7%) used a nasogastric tube and/or gastrostomy; 15.4%were underweight and 73.8% were eutrophic, all with normal height. Twenty (29%) and 4 patients(6.2%) received VD and iron supplementation, respectively. Albuminaemia was normal in allpatients. Mean 25(OH)D level was 24.3 ± 8.8 ng/mL; 33 patients (47.8%) had insufficiency and21 (30.4%) deficiency; 36 patients (52.2%) had low ferritin levels. There was no associationbetween 25(OH)D level and the other variables studied. Low ferritin levels were found to beassociated with older age (P = .03), being male (P = .006), and feeding tube use (P = .006).Conclusions: The patients studied mainly had moderate-to-severe CP, with a high frequencyof suboptimal VD values and low plasma ferritin; few patients received VD and/or iron supple-mentation. We suggest monitoring 25(OH)D and ferritin levels due to the high rate of deficiencyof these nutrients; public hospitals should be equipped with drugs to treat these deficiencies.