Vitamin D status and its association with functional levels among children with cerebral palsy

Children with cerebral palsy (CP) are more susceptible to deficiency of vitamin D due to less sunlight exposure, poor dietary intake, and long-term use of anti-epileptic drugs, which disrupt their metabolism, resulting in changes in bone mineral density, osteopenia, and rickets. The aim of this study was to investigate the correlation between functional levels and vitamin D status in CP children. A cross-sectional study was conducted among cerebral palsy patients aged 2–6 years at Haji Adam Malik Hospital, Medan, Indonesia, from November 2022 to April 2023. Gross motor function classification system (GMFCS) levels were classified into two groups: ambulatory (GMFCS I, II, III) and non-ambulatory (GMFCS IV, V). Vitamin D status was defined based on serum 25(OH)D levels as normal (30–100 ng/mL), insufficiency (21–29 ng/mL), and deficiency (<20 ng/mL). A total of 85 children were included in this study, with a mean vitamin D level of 21.92±9.07 ng/L. As many as 54.1% (n=46) of the total children were categorized as vitamin D deficient, followed by insufficient (n=25, 29.4%) and normal vitamin D level (n=14, 16.5%). We found that vitamin D status was not associated with age (p=0.310), sex (p=0.590), nutritional status (p=0.269), or types of cerebral palsy (p=0.271). However, there was a significant association between circulating vitamin D levels and GMFCS levels (p<0.001). In a logistic regression model, children classified as ambulatory were more likely to have better vitamin D status, with odds ratios of 12.30 (95%CI: 3.61–41.90) for deficient versus insufficient and 10.93 (95%CI: 2.67–44.69) for deficient versus normal. In conclusion, there was a significant association between functional levels and vitamin D status in children with cerebral palsy.