Study investigates potential effects of neonatal vitamin D on eczema into adulthood

In a recent study published in the journal nutrients, Australian researchers investigated the potential relationship between vitamin D levels in newborns and the development of eczema longitudinally up to the age of 25 years. We found that higher vitamin D levels in newborns were associated with a lower probability of early-onset persistent eczema and an increased risk of early-onset and resolving eczema.

Study: Association between neonatal vitamin D and long-term changes in eczema up to age 25 years. Image credit: marishkaSm / Shutterstock

background

Atopic dermatitis, or eczema, is a common inflammatory skin disease thought to result from immune impairment or dysfunction of the skin barrier, but its underlying pathophysiology remains unclear. Evidence suggests that vitamin D levels during childhood may play a role in the development of eczema. Areas with less sunlight have a higher prevalence of vitamin D deficiency and eczema. Vitamin D receptors in immune cells suggest that vitamin D receptors are involved in the regulation of immune responses. Evidence from cohort studies suggests an association between high cord blood vitamin D levels and reduced risk of eczema in childhood. However, clinical trials in women who supplemented with vitamin D during pregnancy have yielded inconsistent results. Current guidelines do not uniformly recommend such supplements due to limited evidence regarding their effects on allergic diseases in offspring.

Despite the recognition of different eczema phenotypes, we investigated the association between longitudinal eczema onset or phenotype and neonatal vitamin D or its most stable circulating form, 25(OH)D3 There are no studies that have done so. Therefore, researchers in this study investigated how neonatal serum 25(OH)D3 levels relate to eczema prevalence at different ages from 1 to 25 years and to eczema phenotype by 25 years. The purpose was to investigate.

About research

The Melbourne Atopy Cohort Study (MACS) followed 223 infants from birth to age 25 with a self-reported family history of allergic diseases, including asthma, allergic rhinitis, eczema, and severe food allergies. The infants had Australian-born parents and were of high socio-economic status. Data collection included a telephone survey, clinical examination, and skin puncture testing (SPT) at 6 months, 1 year, 2 years, 12 years, 18 years, and 25 years. The participant consented to have access to a newborn screening card to measure her 25(OH)D3 levels in newborns via dried blood spot (DBS) at the time of her 18 years of age.

Prevalent eczema was defined based on parent or self-report of a diagnosis of eczema or a rash treated with topical steroids. The longitudinal eczema phenotype was identified using latent class analysis, resulting in the following subclasses: early-onset resolved eczema, early-onset persistent eczema, mid-onset resolved eczema, and intermediate-onset persistent eczema. eczema, and minimal or no eczema. Eczema/sensitization phenotype was determined based on eczema and allergen (milk, egg white, peanut, dust mite, cat dander, rye grass) sensitization, and participants were classified as atopic eczema, non-atopic eczema, or asymptomatic sensitization. The patient was classified as either active or asymptomatic. each age group.

Statistical analyzes included logistic regression models, odds ratios, generalized estimating equations (GEE), likelihood ratio tests, Wald tests, directed acyclic graphs, and sensitivity analyses.

Results and discussion

The peak of eczema prevalence was found to be in infancy (31.2%), decreasing to 15.9% at 6 years of age and increasing to 26% at 25 years of age. The median serum-adjusted 25(OH)D3 level in DBS samples was found to be 32.5 nmol/L. Consistent with expectations, a significant association between vitamin D levels and birth season was observed (p < 0.001), indicating lower her 25(OH)D3 levels in children born in winter. In sensitivity analyzes adjusting for time of birth, higher neonatal vitamin D levels were associated with lower risk of eczema at 1 to 2 years of age. Maternal smoking during pregnancy was found to modify this association. Additionally, higher neonatal vitamin D levels were found to be associated with a lower risk of eczema at 2 years of age in participants with a history of maternal smoking compared to those without.

Neonatal vitamin D (25(OH)D3) levels in 223 MACS participants. Median level was 32.5 nmol/L. P25 was 21.6 nmol/L, P75 was 44.7 nmol/L, and the mean was 35.9 ± 18.6 nmol/L.

Higher vitamin D levels in newborns are associated with a decreased risk of early-onset persistent eczema (aMOR = 0.74) and an increased risk of early-onset persistent eczema (aMOR = 1.30) compared to newborns. It turns out that it is. Minimal/none eczema subclasses by age 12. Similar trends persisted for eczema phenotypes for up to 25 years. Maternal place of birth influences this association – higher neonatal vitamin D levels were associated with lower odds of early-onset persistent eczema by age 12 in children of non-Australian/New Zealand-born mothers However, this was not the case for children whose mothers were born in Australia/New Zealand. Paternal education and maternal prenatal smoking were also found to modify the association with eczema phenotype by up to 25 years.

This study is strengthened by the control of various confounders and a prospective design. However, this study is limited by small sample size, attrition over time, potential reduction in estimation precision, and low generalizability beyond high-allergy-risk cohorts. .

conclusion

In conclusion, this study shows that elevated vitamin D levels in neonates potentially increase the likelihood of early-onset persistent eczema, while being influenced by potential changes due to maternal smoking during pregnancy and birth. This indicates that there is a possibility of deterioration. Further observational studies in diverse populations are needed to validate these findings. Furthermore, well-designed clinical trials are warranted to investigate the effectiveness of maternal vitamin D supplementation in preventing eczema, especially early-onset persistent cases.