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Published in: BMC Pediatrics 1/2024

Open Access 01-12-2024 | Kawasaki Disease | Research

The effect of vitamin D status on the occurrence of Kawasaki Disease: a meta-analysis

Authors: Haixiang Zhang, Fuyong Jiao, Jiaojiao Wang, Cuixiang Xu, Kejin Zhang

Published in: BMC Pediatrics | Issue 1/2024

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Abstract

Aim

The relationship between vitamin D status and Kawasaki Disease (KD), as well as coronary artery lesion (CAL), has yet to be established.

Methods

A meta-analysis was conducted to assess the correlation between vitamin D status and KD, as well as the impact of vitamin D status on the progression of KD into CAL.

Results

The meta-analysis revealed a consistent and significant association between serum 25(OH)D level and the occurrence KD (studies N = 22; z = -3.51, P < 0.001). Patients with KD had markedly lower levels of vitamin D than healthy controls (SMD: -1.30 ng/mL, 95%CI: -2.05 to -0.55 ng/mL).

Conclusion

The study provided evidence supporting a significant association between lower serum vitamin D levels and the occurrence of KD, particularly within the Chinese population. However, the findings did not suggest a direct impact of vitamin D on the development of CAL in KD patients.
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Literature
1.
go back to reference Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967;16(3):178–222.PubMed Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967;16(3):178–222.PubMed
2.
go back to reference Holman RC, et al. Kawasaki syndrome hospitalizations in the United States, 1997 and 2000. Pediatrics. 2003;112(3 Pt 1):495–501.PubMedCrossRef Holman RC, et al. Kawasaki syndrome hospitalizations in the United States, 1997 and 2000. Pediatrics. 2003;112(3 Pt 1):495–501.PubMedCrossRef
3.
go back to reference Huang GY. Challenges in the diagnosis and treatment of Kawasaki disease. Zhonghua Er Ke Za Zhi. 2022;60(1):3–5.PubMed Huang GY. Challenges in the diagnosis and treatment of Kawasaki disease. Zhonghua Er Ke Za Zhi. 2022;60(1):3–5.PubMed
4.
go back to reference Correction to: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation, 2019. 140(5):e181–e184. Correction to: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation, 2019. 140(5):e181–e184.
5.
go back to reference Baker AL, Newburger JW. Cardiology patient pages Kawasaki disease. Circulation. 2008;118(7):e110–2.PubMedCrossRef Baker AL, Newburger JW. Cardiology patient pages Kawasaki disease. Circulation. 2008;118(7):e110–2.PubMedCrossRef
6.
go back to reference Kato H, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 1996;94(6):1379–85. Kato H, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 1996;94(6):1379–85.
7.
go back to reference Kim DS. Kawasaki disease. Yonsei Med J. 2006;47(6):759–72. Kim DS. Kawasaki disease. Yonsei Med J. 2006;47(6):759–72.
8.
go back to reference L Bishop E, et al. Vitamin D and Immune regulation: antibacterial, antiviral, anti-inflammatory. JBMR Plus. 2021;5(1):e10405.PubMedCrossRef L Bishop E, et al. Vitamin D and Immune regulation: antibacterial, antiviral, anti-inflammatory. JBMR Plus. 2021;5(1):e10405.PubMedCrossRef
10.
go back to reference Saenger AK, et al. Quantification of serum 25-hydroxyvitamin D(2) and D(3) using HPLC-tandem mass spectrometry and examination of reference intervals for diagnosis of vitamin D deficiency. Am J Clin Pathol. 2006;125(6):914–20.PubMedCrossRef Saenger AK, et al. Quantification of serum 25-hydroxyvitamin D(2) and D(3) using HPLC-tandem mass spectrometry and examination of reference intervals for diagnosis of vitamin D deficiency. Am J Clin Pathol. 2006;125(6):914–20.PubMedCrossRef
11.
go back to reference Xu B, et al. Vitamin D status in children with short stature: accurate determination of serum vitamin D components using high-performance liquid chromatography-tandem mass spectrometry. Front Endocrinol (Lausanne). 2021;12:707283.PubMedCrossRef Xu B, et al. Vitamin D status in children with short stature: accurate determination of serum vitamin D components using high-performance liquid chromatography-tandem mass spectrometry. Front Endocrinol (Lausanne). 2021;12:707283.PubMedCrossRef
12.
go back to reference Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19(2):73–8.PubMedCrossRef Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19(2):73–8.PubMedCrossRef
13.
go back to reference Falcini F, et al. Severe vitamin D deficiency in patients with Kawasaki disease: its possible role in the risk to develop coronary artery damage. Ann Rheum Dis. 2015;74:843–843.CrossRef Falcini F, et al. Severe vitamin D deficiency in patients with Kawasaki disease: its possible role in the risk to develop coronary artery damage. Ann Rheum Dis. 2015;74:843–843.CrossRef
14.
go back to reference Huang J-H, et al. Value of serum 25-Hydroxyvitamin D levels in the prediction of intravenous immunoglobulin resistance in patients with complete Kawasaki disease. J Modern Lab Med. 2022;37(1):5. Huang J-H, et al. Value of serum 25-Hydroxyvitamin D levels in the prediction of intravenous immunoglobulin resistance in patients with complete Kawasaki disease. J Modern Lab Med. 2022;37(1):5.
15.
go back to reference Jiang H-F, Gao J, Han W-N. Study on serum vitamin D level and vitamin D receptor Fok I gene polymorphism in children with Kawasaki disease. Mat Child Health Care China. 2020;35(3):4. Jiang H-F, Gao J, Han W-N. Study on serum vitamin D level and vitamin D receptor Fok I gene polymorphism in children with Kawasaki disease. Mat Child Health Care China. 2020;35(3):4.
16.
go back to reference Okazaki N, et al. The impact of vitamin D on the onset and progress of Kawasaki disease. Pediatr Int. 2022;64(1):e15191.PubMedCrossRef Okazaki N, et al. The impact of vitamin D on the onset and progress of Kawasaki disease. Pediatr Int. 2022;64(1):e15191.PubMedCrossRef
17.
go back to reference Ren J, Wu X. The value of serum 25(OH)D3, NT-proBNP and IL-6 in early diagnosis of Kawasaki diaease in children. Chinese J Woman Child Health. 2021;32(5):4. Ren J, Wu X. The value of serum 25(OH)D3, NT-proBNP and IL-6 in early diagnosis of Kawasaki diaease in children. Chinese J Woman Child Health. 2021;32(5):4.
18.
go back to reference Stagi S, et al. Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities? Clin Rheumatol. 2016;35(7):1865–72.PubMedCrossRef Stagi S, et al. Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities? Clin Rheumatol. 2016;35(7):1865–72.PubMedCrossRef
19.
go back to reference Wen H-Y, Jing X-A. Clinical significance of changes of vitamin A, 25-hydroxyvitamin D in children with Kawasaki disease. Home Medicine. 2018;7:1. Wen H-Y, Jing X-A. Clinical significance of changes of vitamin A, 25-hydroxyvitamin D in children with Kawasaki disease. Home Medicine. 2018;7:1.
20.
go back to reference Zhang X-Y, et al. Changes and clinical significance of serum 25-hydroxyvitamin D levels in children with Kawasaki disease. China Modern Med. 2019;26(5):3. Zhang X-Y, et al. Changes and clinical significance of serum 25-hydroxyvitamin D levels in children with Kawasaki disease. China Modern Med. 2019;26(5):3.
21.
go back to reference Zhang Y, et al. The significance of changes in endogenous hydrogen sulfide and 25-hydroxyvitamin D3 levels in children with Kawasaki disease. J Imag Res Med. 2018;2(15):3. Zhang Y, et al. The significance of changes in endogenous hydrogen sulfide and 25-hydroxyvitamin D3 levels in children with Kawasaki disease. J Imag Res Med. 2018;2(15):3.
22.
go back to reference Zhang YD, et al. Changes in 25-hydroxyvitamin D3 level and its significance in children with Kawasaki disease. Zhongguo Dang Dai Er Ke Za Zhi. 2016;18(3):211–4.PubMed Zhang YD, et al. Changes in 25-hydroxyvitamin D3 level and its significance in children with Kawasaki disease. Zhongguo Dang Dai Er Ke Za Zhi. 2016;18(3):211–4.PubMed
23.
go back to reference Zhou Z, et al. 1α, 25-dihydroxyvitamin D3 inhibits THP-1 cell inflammatory factor expression induced by Kawasaki disease serum through TLR4 signal pathway. Chinese J Pathophysiol. 2022;38(1):9. Zhou Z, et al. 1α, 25-dihydroxyvitamin D3 inhibits THP-1 cell inflammatory factor expression induced by Kawasaki disease serum through TLR4 signal pathway. Chinese J Pathophysiol. 2022;38(1):9.
24.
go back to reference Zhu J, Peng H. Serum 25 - (OH) D_ (3) Expression of NT-proBNP and IL-6 in children with Kawasaki disease and their correlation analysis. China Med Eng. 2021;29(12):109–11. Zhu J, Peng H. Serum 25 - (OH) D_ (3) Expression of NT-proBNP and IL-6 in children with Kawasaki disease and their correlation analysis. China Med Eng. 2021;29(12):109–11.
25.
go back to reference An X, et al. Significance of serum 25-hydroxyvitamin D(3) and interleukin-6 levels in immunoglobulin treatment of Kawasaki disease in children. Exp Ther Med. 2016;12(3):1476–80.PubMedPubMedCentralCrossRef An X, et al. Significance of serum 25-hydroxyvitamin D(3) and interleukin-6 levels in immunoglobulin treatment of Kawasaki disease in children. Exp Ther Med. 2016;12(3):1476–80.PubMedPubMedCentralCrossRef
26.
go back to reference Chen X-H, et al. Serum 25 hydroxyvitamin D3 in predicting coronary arterial lesions of Kawasaki disease. Chinese J Woman Child Health Res. 2019;30(5):4. Chen X-H, et al. Serum 25 hydroxyvitamin D3 in predicting coronary arterial lesions of Kawasaki disease. Chinese J Woman Child Health Res. 2019;30(5):4.
27.
go back to reference Chen YL, Wang JL, Li WQ. Prediction of the risk of coronary arterial lesions in Kawasaki disease by serum 25-hydroxyvitamin D3. Eur J Pediatr. 2014;173(11):1467–71.PubMedPubMedCentralCrossRef Chen YL, Wang JL, Li WQ. Prediction of the risk of coronary arterial lesions in Kawasaki disease by serum 25-hydroxyvitamin D3. Eur J Pediatr. 2014;173(11):1467–71.PubMedPubMedCentralCrossRef
28.
go back to reference Que XJ, et al. Predictive value of serum PA, NT-proBNP and 25-(OH)D3 levels on the risk of coronary artery disease in children with Kawasaki disease. J North Sichuan Med College. 2022;37(6):4. Que XJ, et al. Predictive value of serum PA, NT-proBNP and 25-(OH)D3 levels on the risk of coronary artery disease in children with Kawasaki disease. J North Sichuan Med College. 2022;37(6):4.
29.
go back to reference Wang Y-L, et al. Changes in serum 25 - (OH) D3 and T cell subsets in children with Kawasaki disease. Chinese J Woman Child Health. 2015;26(2):2. Wang Y-L, et al. Changes in serum 25 - (OH) D3 and T cell subsets in children with Kawasaki disease. Chinese J Woman Child Health. 2015;26(2):2.
30.
go back to reference Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Internal Med. 2009;151(4):264-69. Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Internal Med. 2009;151(4):264-69.
31.
go back to reference Ayusawa M, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int. 2005;47(2):232–4.PubMedCrossRef Ayusawa M, et al. Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int. 2005;47(2):232–4.PubMedCrossRef
32.
go back to reference Editorial Committee of Chinese Journal of Pediatrics C.G.o.C.P.S, Immunology Group of Chinese Peediatric Society. Summary of Kawasaki Disease Symposium. Chinese Journal of Pediatrics. 2007;45(11):5. Editorial Committee of Chinese Journal of Pediatrics C.G.o.C.P.S, Immunology Group of Chinese Peediatric Society. Summary of Kawasaki Disease Symposium. Chinese Journal of Pediatrics. 2007;45(11):5.
33.
go back to reference Wells GA, D O’Connell SB, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Non-Randomised Studies in Meta-Analyses. in Symposium on Systematic Reviews: Beyond the Basics. 2014. Wells GA, D O’Connell SB, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Non-Randomised Studies in Meta-Analyses. in Symposium on Systematic Reviews: Beyond the Basics. 2014.
34.
35.
go back to reference Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1–48.CrossRef Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1–48.CrossRef
36.
go back to reference Cuijpers P. Meta-analyses in mental health research. A practical guide. Amsterdam, the Netherlands: Pim Cuijpers Uitgeverij. 2016. Cuijpers P. Meta-analyses in mental health research. A practical guide. Amsterdam, the Netherlands: Pim Cuijpers Uitgeverij. 2016.
37.
go back to reference Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
38.
go back to reference Harrer M, et al. Doing Meta-Analysis in R: A Hand-on Guide. 2019. Harrer M, et al. Doing Meta-Analysis in R: A Hand-on Guide. 2019.
39.
go back to reference Dong Y, et al. Effects of vitamin D(3) and marine omega-3 fatty acids supplementation on biomarkers of systemic inflammation: 4-year findings from the VITAL randomized trial. Nutrients. 2022;14(24):5307.PubMedPubMedCentralCrossRef Dong Y, et al. Effects of vitamin D(3) and marine omega-3 fatty acids supplementation on biomarkers of systemic inflammation: 4-year findings from the VITAL randomized trial. Nutrients. 2022;14(24):5307.PubMedPubMedCentralCrossRef
40.
go back to reference Ribeiro VR, et al. Vitamin D modulates the transcription factors of T cell subsets to anti-inflammatory and regulatory profiles in preeclampsia. Int Immunopharmacol. 2021;101(Pt B):108366.PubMedCrossRef Ribeiro VR, et al. Vitamin D modulates the transcription factors of T cell subsets to anti-inflammatory and regulatory profiles in preeclampsia. Int Immunopharmacol. 2021;101(Pt B):108366.PubMedCrossRef
41.
go back to reference Qi XL, et al. 1,25-Dihydroxyvitamin D3 regulates T lymphocyte proliferation through activation of P53 and inhibition of ERK1/2 signaling pathway in children with Kawasaki disease. Eur Rev Med Pharmacol Sci. 2017;21(16):3714–22.PubMed Qi XL, et al. 1,25-Dihydroxyvitamin D3 regulates T lymphocyte proliferation through activation of P53 and inhibition of ERK1/2 signaling pathway in children with Kawasaki disease. Eur Rev Med Pharmacol Sci. 2017;21(16):3714–22.PubMed
42.
go back to reference Shahbaznejad L, et al. Epidemiological data of national Kawasaki disease registry in Iran, 2007–2019. Front Pediatr. 2022;10:988371.PubMedCrossRef Shahbaznejad L, et al. Epidemiological data of national Kawasaki disease registry in Iran, 2007–2019. Front Pediatr. 2022;10:988371.PubMedCrossRef
43.
go back to reference Holman RC, et al. Racial/ethnic differences in the incidence of Kawasaki syndrome among children in Hawaii. Hawaii Med J. 2010;69(8):194–7.PubMedPubMedCentral Holman RC, et al. Racial/ethnic differences in the incidence of Kawasaki syndrome among children in Hawaii. Hawaii Med J. 2010;69(8):194–7.PubMedPubMedCentral
44.
46.
go back to reference Lee J, Lee YJ, Kim Y. A high prevalence of prediabetes and vitamin D deficiency are more closely associated in women: results of a cross-sectional study. J Int Med Res. 2021;49(7):3000605211033384.PubMedCrossRef Lee J, Lee YJ, Kim Y. A high prevalence of prediabetes and vitamin D deficiency are more closely associated in women: results of a cross-sectional study. J Int Med Res. 2021;49(7):3000605211033384.PubMedCrossRef
47.
go back to reference Varghese SB, Benoit J, McIntyre T. Vitamin D Levels in Ethnic Minority Adolescents in Primary Care. J Pediatr Health Care. 2022;36(5):443–8.PubMedCrossRef Varghese SB, Benoit J, McIntyre T. Vitamin D Levels in Ethnic Minority Adolescents in Primary Care. J Pediatr Health Care. 2022;36(5):443–8.PubMedCrossRef
48.
go back to reference Yin X, et al. Association between vitamin D serum levels and insulin resistance assessed by HOMA-IR among non-diabetic adults in the United States: results from NHANES 2007–2014. Front Nutr. 2022;9:883904.PubMedPubMedCentralCrossRef Yin X, et al. Association between vitamin D serum levels and insulin resistance assessed by HOMA-IR among non-diabetic adults in the United States: results from NHANES 2007–2014. Front Nutr. 2022;9:883904.PubMedPubMedCentralCrossRef
49.
50.
go back to reference Smolders J, et al. Letter to the Editor: Vitamin D deficiency in COVID-19: mixing up cause and consequence. Metabolism. 2021;115:154434.PubMedCrossRef Smolders J, et al. Letter to the Editor: Vitamin D deficiency in COVID-19: mixing up cause and consequence. Metabolism. 2021;115:154434.PubMedCrossRef
53.
go back to reference Wang L, et al. Kawasaki disease- management strategies given symptoms overlap to COVID-19: a review. JNMA J Nepal Med Assoc. 2021;59(236):417–24.PubMedPubMedCentral Wang L, et al. Kawasaki disease- management strategies given symptoms overlap to COVID-19: a review. JNMA J Nepal Med Assoc. 2021;59(236):417–24.PubMedPubMedCentral
54.
go back to reference Men Q-X, Li X-M, Zhao N. Influencing factos of coronary artery disease in children with Kawasaki disease. Clin Med. 2022;42(7):3. Men Q-X, Li X-M, Zhao N. Influencing factos of coronary artery disease in children with Kawasaki disease. Clin Med. 2022;42(7):3.
55.
go back to reference Stounbjerg NG, et al. Vitamin D status of 3-year-old children in Denmark: determinants and associations with bone mineralisation and blood lipids. Eur J Nutr. 2023;62(3):1441–51.PubMedCrossRef Stounbjerg NG, et al. Vitamin D status of 3-year-old children in Denmark: determinants and associations with bone mineralisation and blood lipids. Eur J Nutr. 2023;62(3):1441–51.PubMedCrossRef
56.
go back to reference Makino N, et al. Descriptive epidemiology of Kawasaki disease in Japan, 2011–2012: from the results of the 22nd nationwide survey. J Epidemiol. 2015;25(3):239–45.PubMedCrossRef Makino N, et al. Descriptive epidemiology of Kawasaki disease in Japan, 2011–2012: from the results of the 22nd nationwide survey. J Epidemiol. 2015;25(3):239–45.PubMedCrossRef
Metadata
Title
The effect of vitamin D status on the occurrence of Kawasaki Disease: a meta-analysis
Authors
Haixiang Zhang
Fuyong Jiao
Jiaojiao Wang
Cuixiang Xu
Kejin Zhang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2024
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-024-04768-1

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