Vitamin D, insulin-like growth factor-1, and stunting in children with transfusion-dependent thalassemia

• Published in: Paediatrica Indonesiana Vol. 62; no. 2; pp. 98 - 103
• Main Authors: Pratiwi, I Gusti Ayu Putu Eka, Irawan, Roedi, Ugrasena, I Dewa Gede, Faizi, Muhammad
• Format: Journal Article
• Language: English
• Published: Indonesian Pediatric Society Publishing House 01-03-2022
• Subjects: transfusion-dependent thalassemia; stunting, igf-1; vitamin d
• ISSN: 0030-9311; 2338-476X
• DOI: 10.14238/pi62.2.2022.98-103

Background Transfusion-dependent thalassemia (TDT) has a major impact on a child’s growth and is associated with stunting, risk of vitamin D deficiency, and decreased insulin-like growth factor-1 (IGF-1). To date, the relationship between vitamin D levels and stunting in TDT remains unclear. Futhermore, the role of vitamin D and IGF-1 in mediating stunting in TDT patients is still unknown. 
Objective To investigate the relationship between stunting and vitamin D as well as IGF-1 levels in children with TDT.
Methods This cross-sectional study involved 50 TDT children aged 5 to 18 years, included consecutively from the Pediatric Hemato-oncology Outpatient Clinic, Dr. Soetomo Hospital, Surabaya, East Java. Subjects were divided into two groups: stunted (S) and not stunted (NS). Vitamin D and IGF-1 were evaluated by antibody competitive immunoassay and sandwich-enzyme-linked immunosorbent assay (ELISA), respectively. Age, sex, and duration of repeated transfusion were analyzed as confounding factors.
Results Median IGF-1 levels were 91.43 (13.67-192.86) ng/mL and 161.53 (17.99-363.01) ng/mL in the S and NS groups, respectively (P=0.011). Mean vitamin D levels were 20 (+ 5.71) ng/mL and 20.46 (5.25) ng/mL in the S and NS groups, respectively (P=0.765). The correlation coefficient (r) of vitamin D and IGF-I levels was not significant. Multivariate analysis showed that low IGF-1 levels, male, and longer duration of repeated transfusions were associated with stunting in children with TDT. 
Conclusion Low IGF-1 level is associated with stunting in children with TDT. Vitamin D is not significantly associated with either stunting or IGF-1 in children with TDT.