The differences of 25-Hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia

Poa Olivera Laurenzia Caroline; Nyoman Suci Widyastiti; Ariosta Ariosta; Rina Pratiwi; Dwi Retnoningrum; Dwi Ngestiningsih; Yetty Movieta Nency

doi:10.15562/bmj.v10i2.2226

The differences of 25-Hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia

Poa Olivera Laurenzia Caroline ,

Nyoman Suci Widyastiti ,

Ariosta Ariosta ,

Rina Pratiwi ,

Dwi Retnoningrum ,

Dwi Ngestiningsih ,

Yetty Movieta Nency ,

PDF |
DOI: https://doi.org/10.15562/bmj.v10i2.2226 |
Published: 2021-07-23

Abstract

Background: Patients with thalassemia major who require regular blood transfusions, have experienced a decline in the level of 25-Hydroxyvitamin D and an increase in oxidative stress biomarkers, one of which is Malondialdehyde (MDA). Both mechanisms are thought to be associated with iron overload seen in transfusion-dependent thalassemia patients. It is necessary to research the differences in 25-hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia patients along with the increasing prevalence of thalassemia. The study aims to prove the differences in 25-hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia patients.

Methods: The study was an observational analytic study with cross sectional approach. Research subjects were 42 children consisting of 21 thalassemia major patients hospitalized at the Dr. R. Soedjati Grobogan Public Hospital and Dr. R. Soetrasno Rembang Public Hospital and 21 healthy children were matched for age. This study was conducted from March to September 2020. 25-Hydroxyvitamin D and malondialdehyde levels were examined using the enzyme-linked immunosorbent assay (ELISA) method and Thiobarbituric acid reactive substances (TBARS) method. Statistical analysis was done using Independent Sample T test and Mann-Whitney test, which p<0.05 was considered significant.

Results: There was no significant difference in the level of 25-hydroxyvitamin D (p = 0.45) in thalassemia major and non-thalassemia patients (25.96 ± 6.36 ng/mL and 27.54 ± 7.09 ng/mL respectively). There was a significant difference in the malondialdehyde level (p = 0.00) in thalassemia major and non-thalassemia patients (0.43 µmol/L and 0.14 µmol/L respectively).

Conclusion: Iron overload in patients with thalassemia major causes a decrease in 25-hydroxyvitamin D level. An insignificant difference in 25-hydroxyvitamin D level among thalassemia major and non-thalasemia indicates that other factors such as nutritional status, nutrient intake, and sun exposure also play an important role in 25-hydroxyvitamin D level. The formation of ROS triggered by iron overload also results in a significant increase of malondialdehyde level in thalassemia major.

References

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Bakta I. Overview of clinical hematology. Jakarta: EGC; 2013.
Taher AT, Weatherall DJ, Cappellini MD. Thalassemia. Lancet Publishing Group. 2018;391:155–67.
Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5(1):1–15.
Setianingsih I, Harahap A, Nainggolan IM. Alpha thalassemia in Indonesia: phenotypes and molecular defects. Adv Exp Med Biol. 2003;531:47-56. doi: 10.1007/978-1-4615-0059-9_4.
Langhi D, Ubiali EMA, Marques JFC, Verissimo M de A, Loggetto SR, Silvinato A, et al. Guidelines on beta-thalassemia major – regular blood transfusion therapy. Rev Bras Hematol Hemoter. 2016;38(4):341–5.
Thachil J, Owusu-Ofori S, Bates I. Haematological Diseases in the Tropics. Manson's Tropical Infectious Diseases. 2014:894–932.e7. doi: 10.1016/B978-0-7020-5101-2.00066-2.
Inati A, Noureldine MA, Mansour A, Abbas HA. Endocrine and bone complications in ?-thalassemia intermedia: current understanding and treatment. Biomed Res Int. 2015;2015:813098. doi: 10.1155/2015/813098.
Umar M, Sastry KS, Chouchane AI. Role of Vitamin D Beyond the Skeletal Function: A Review of the Molecular and Clinical Studies. Int J Mol Sci. 2018;19(6):1618. doi: 10.3390/ijms19061618.
Yu U, Chen L, Wang X, Zhang X, Li Y, Wen F, Liu S. Evaluation of the vitamin D and biomedical statuses of young children with ?-thalassemia major at a single center in southern China. BMC Pediatr. 2019;19(1):375. doi: 10.1186/s12887-019-1744-8.
Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol Rev. 2016;96(1):365-408. doi: 10.1152/physrev.00014.2015.
Shazia Q, Mohammad ZH, Rahman T, Shekhar HU. Correlation of oxidative stress with serum trace element levels and antioxidant enzyme status in Beta-thalassemia major patients: a review of the literature. Anemia. 2012;2012:270923. doi: 10.1155/2012/270923.
Ayala A, Muñoz MF, Argüelles S. Lipid peroxidation: production, metabolism, and signaling mechanisms of malondialdehyde and 4-hydroxy-2-nonenal. Oxid Med Cell Longev. 2014;2014:360438. doi: 10.1155/2014/360438.
Nasir C, Rosdiana N, Lubis AD. Correlation between 25-hydroxyvitamin D and lipid profile among children with beta-thalassemia major. Open Access Maced J Med Sci. 2018;6(10):1790–4.
Permatasari TD, Riyanti R, Wisudanti DD. The relationship between ferritin levels and malondialdehyde in ? major thalassemia patients at RSD dr. Soebandi Jember. Pustaka Kesehatan. 2020;7(1):52-59.
Maria Domenica Cappellini, Alan Cohen, John Porter, Ali Taher VV. Guidelines for the management of transfusion dependent thalassaemia (TDT) 3rd edition. Thalassaemia International Federation; 2014.
Abbassy HA, Elwafa RAA, Omar OM. Bone Mineral Density and Vitamin D Receptor Genetic Variants in Egyptian Children with Beta Thalassemia Major on Vitamin D Supplementation. Mediterr J Hematol Infect Dis. 2019;11(1):e2019013. doi: 10.4084/MJHID.2019.013.
Madhu PK, Bhagwan B. Biochemical indices and radiological examination to evaluate bone health in children with ?-thalassemia major. Int J Contemp Pediatr. 2019;6(2):549-554.
Herawati Y, Nugraha GI, Gurnida DA. Nutritional intake , sun exposure and vitamin D level in childrens with thalassemia major. 2020;142:180–94.
Qi Q, Zheng Y, Huang T, Rood J, Bray GA, Sacks FM, Qi L. Vitamin D metabolism-related genetic variants, dietary protein intake and improvement of insulin resistance in a 2 year weight-loss trial: POUNDS Lost. Diabetologia. 2015;58(12):2791-9. doi: 10.1007/s00125-015-3750-1.
Barja FS, Aguilera CM, Martínez Silva I, Vazquez R, Gil Campos M, Olza J, et al. 25-Hydroxyvitamin D levels of children are inversely related to adiposity assessed by body mass index. J Physiol Biochem. 2018;74(1):111–8.
Soliman A, De Sanctis V, Yassin M. Vitamin d status in thalassemia major: an update. Mediterr J Hematol Infect Dis. 2013;5(1):e2013057. doi: 10.4084/MJHID.2013.057.
Sengsuk C, Tangvarasittichai O, Chantanaskulwong P, Pimanprom A, Wantaneeyawong S, Choowet A, Tangvarasittichai S. Association of Iron Overload with Oxidative Stress, Hepatic Damage and Dyslipidemia in Transfusion-Dependent ?-Thalassemia/HbE Patients. Indian J Clin Biochem. 2014;29(3):298-305. doi: 10.1007/s12291-013-0376-2.
Mahdi EA. Relationship between oxidative stress and antioxidant status in beta-thalassemia major patients. Acta Chim. Pharm. Indica. 20144(3):137-145.
Cighetti G, Duca L, Bortone L, Sala S, Nava I, Fiorelli G, Cappellini MD. Oxidative status and malondialdehyde in beta-thalassemia patients. Eur J Clin Invest. 2002;32 Suppl 1:55-60. doi: 10.1046/j.1365-2362.2002.0320s1055.x.
Tamam M, Hadisaputro S, Setianingsih I, Soemantri A, Semarang K, Yogyakarta S, et al. Correlation between oxidative stress and hemoglobin level of thalassemia. Medical Journal. 2012;27(1):38–42.

[1] Atmakusuma D, Setyaningsih I. Thalassemia basics: a type of hemoglobinopathy 4th edition. Jakarta: Center of Publishing in Internal Medicine Universitas Indonesia; 2014.

[2] Bakta I. Overview of clinical hematology. Jakarta: EGC; 2013.

[3] Taher AT, Weatherall DJ, Cappellini MD. Thalassemia. Lancet Publishing Group. 2018;391:155–67.

[4] Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5(1):1–15.

[5] Setianingsih I, Harahap A, Nainggolan IM. Alpha thalassemia in Indonesia: phenotypes and molecular defects. Adv Exp Med Biol. 2003;531:47-56. doi: 10.1007/978-1-4615-0059-9_4.

[6] Langhi D, Ubiali EMA, Marques JFC, Verissimo M de A, Loggetto SR, Silvinato A, et al. Guidelines on beta-thalassemia major – regular blood transfusion therapy. Rev Bras Hematol Hemoter. 2016;38(4):341–5.

[7] Thachil J, Owusu-Ofori S, Bates I. Haematological Diseases in the Tropics. Manson's Tropical Infectious Diseases. 2014:894–932.e7. doi: 10.1016/B978-0-7020-5101-2.00066-2.

[8] Inati A, Noureldine MA, Mansour A, Abbas HA. Endocrine and bone complications in ?-thalassemia intermedia: current understanding and treatment. Biomed Res Int. 2015;2015:813098. doi: 10.1155/2015/813098.

[9] Umar M, Sastry KS, Chouchane AI. Role of Vitamin D Beyond the Skeletal Function: A Review of the Molecular and Clinical Studies. Int J Mol Sci. 2018;19(6):1618. doi: 10.3390/ijms19061618.

[10] Yu U, Chen L, Wang X, Zhang X, Li Y, Wen F, Liu S. Evaluation of the vitamin D and biomedical statuses of young children with ?-thalassemia major at a single center in southern China. BMC Pediatr. 2019;19(1):375. doi: 10.1186/s12887-019-1744-8.

[11] Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol Rev. 2016;96(1):365-408. doi: 10.1152/physrev.00014.2015.

[12] Shazia Q, Mohammad ZH, Rahman T, Shekhar HU. Correlation of oxidative stress with serum trace element levels and antioxidant enzyme status in Beta-thalassemia major patients: a review of the literature. Anemia. 2012;2012:270923. doi: 10.1155/2012/270923.

[13] Ayala A, Muñoz MF, Argüelles S. Lipid peroxidation: production, metabolism, and signaling mechanisms of malondialdehyde and 4-hydroxy-2-nonenal. Oxid Med Cell Longev. 2014;2014:360438. doi: 10.1155/2014/360438.

[14] Nasir C, Rosdiana N, Lubis AD. Correlation between 25-hydroxyvitamin D and lipid profile among children with beta-thalassemia major. Open Access Maced J Med Sci. 2018;6(10):1790–4.

[15] Permatasari TD, Riyanti R, Wisudanti DD. The relationship between ferritin levels and malondialdehyde in ? major thalassemia patients at RSD dr. Soebandi Jember. Pustaka Kesehatan. 2020;7(1):52-59.

[16] Maria Domenica Cappellini, Alan Cohen, John Porter, Ali Taher VV. Guidelines for the management of transfusion dependent thalassaemia (TDT) 3rd edition. Thalassaemia International Federation; 2014.

[17] Abbassy HA, Elwafa RAA, Omar OM. Bone Mineral Density and Vitamin D Receptor Genetic Variants in Egyptian Children with Beta Thalassemia Major on Vitamin D Supplementation. Mediterr J Hematol Infect Dis. 2019;11(1):e2019013. doi: 10.4084/MJHID.2019.013.

[18] Madhu PK, Bhagwan B. Biochemical indices and radiological examination to evaluate bone health in children with ?-thalassemia major. Int J Contemp Pediatr. 2019;6(2):549-554.

[19] Herawati Y, Nugraha GI, Gurnida DA. Nutritional intake , sun exposure and vitamin D level in childrens with thalassemia major. 2020;142:180–94.

[20] Qi Q, Zheng Y, Huang T, Rood J, Bray GA, Sacks FM, Qi L. Vitamin D metabolism-related genetic variants, dietary protein intake and improvement of insulin resistance in a 2 year weight-loss trial: POUNDS Lost. Diabetologia. 2015;58(12):2791-9. doi: 10.1007/s00125-015-3750-1.

[21] Barja FS, Aguilera CM, Martínez Silva I, Vazquez R, Gil Campos M, Olza J, et al. 25-Hydroxyvitamin D levels of children are inversely related to adiposity assessed by body mass index. J Physiol Biochem. 2018;74(1):111–8.

[22] Soliman A, De Sanctis V, Yassin M. Vitamin d status in thalassemia major: an update. Mediterr J Hematol Infect Dis. 2013;5(1):e2013057. doi: 10.4084/MJHID.2013.057.

[23] Sengsuk C, Tangvarasittichai O, Chantanaskulwong P, Pimanprom A, Wantaneeyawong S, Choowet A, Tangvarasittichai S. Association of Iron Overload with Oxidative Stress, Hepatic Damage and Dyslipidemia in Transfusion-Dependent ?-Thalassemia/HbE Patients. Indian J Clin Biochem. 2014;29(3):298-305. doi: 10.1007/s12291-013-0376-2.

[24] Mahdi EA. Relationship between oxidative stress and antioxidant status in beta-thalassemia major patients. Acta Chim. Pharm. Indica. 20144(3):137-145.

[25] Cighetti G, Duca L, Bortone L, Sala S, Nava I, Fiorelli G, Cappellini MD. Oxidative status and malondialdehyde in beta-thalassemia patients. Eur J Clin Invest. 2002;32 Suppl 1:55-60. doi: 10.1046/j.1365-2362.2002.0320s1055.x.

[26] Tamam M, Hadisaputro S, Setianingsih I, Soemantri A, Semarang K, Yogyakarta S, et al. Correlation between oxidative stress and hemoglobin level of thalassemia. Medical Journal. 2012;27(1):38–42.

The differences of 25-Hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia

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References

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