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Prevalence of Protein and Vitamin D Malnutrition In Pediatric Orthopaedic Trauma Patients

Sunday, October 21, 2012: 10:34 AM
Melrose (Hilton Riverside)
Caitlin Barbarita, BS1, Peter Apel, MD, PhD2, Patrick Whitlock, MD, PhD1 and Bettina Gyr, MD2, (1)School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, (2)Orthopedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC

Purpose: Malnourishment, particularly vitamin D deficiency and proper protein intake are vital to wound healing and represent a modifiable factor that could potentially improve outcomes in both the pediatric and adult trauma patient population. This is a pilot study to determine the baseline prevalence rate of vitamin D and protein malnutrition in pediatric patients who require surgery for fracture management. Information from this study will be used to design future interventional studies.

Methods: This observational study is designed to collect data over the course of a year. Pediatric patients presenting to the Emergency Department with long bone fractures requiring operative intervention are eligible for study participation. Informed consent is obtained from the caregivers of all eligible patients and assent is obtained from patients >6yo before enrollment in study. Blood is collected in the OR and labs are ordered for a CBC w/diff, a CMP, Vit. D 25-hydroxy total screen, and prealbumin. WBC, lymphocyte count (TLC), Albumin, Prealbumin and Vit. D levels are recorded along with demographic information. Vitamin D levels are categorized into insufficiency (20-32 ng/mL) and deficiency (<20 ng/mL). Prealbumin levels are categorized as 20-40mg/dL as normal, 16-19mg/dL as borderline low and <16mg/dL as an indication of protein malnutrition.

Results: Over the course of 8 months, 84 patients were enrolled in the study and 10 of these patients were excluded from data analysis due to incomplete data. The age of the patients ranged from 18 months to 16 years. 59.5% of the children were male and 65% were Caucasian. Data collected is presented in Tables 1 and 2 and Figures 1 and 2.  


Table 1 Mean Lab Values





Vit D







Table 2 Categorization of Patients based on Prealbumin and Vitamin D Levels




Vitamin D





Borderline low






Conclusions: This data suggests that both Vitamin D and protein malnutrition are common and potentially modifiable occurances within the pediatric orthopedic trauma patient population  treated for fractures. Insufficent or deficient Vitamin D levels were found in 61% of our patients and only 19% of our patients have recommended levels of prealbumin. Based on the high prevalence of vitamin D and protein malnutrition, potential interventions can be considered to lower the incidence fractures and improve outcomes within this population.

Figure 1: values of prealbumin plotted against the age of the patient. The navy line marks the lower limit of normal levels (20mg/dL) and the red line marks the lower limit of insufficiency (16mg/dL)

Figure 2: values of vitamin D plotted against the age of the patient. The navy line marks the lower limit of normal levels (32ng/mL) and the red line marks the lower limit of insufficiency (20ng/mL)