Association of Serum Vitamin A and Vitamin D Levels with Oral Mucositis Severity in Pediatric Cancer Patients: A Single-Center Retrospective Observational Study

Abstract

Background: Mucositis is a frequent complication of chemotherapy (CT) and radiotherapy (RT), causing painful oral lesions that may disrupt treatment continuity. Vitamins A and D are important for mucosal integrity. This study aimed to evaluate whether serum vitamin A and vitamin D levels are associated with mucositis severity in pediatric cancer patients with established mucositis.

Materials and Methods: This single-center retrospective observational study included 30 pediatric cancer patients (20 males, 10 females; mean age 8.1 years, range 1–18 years) treated at Dr. Sami Ulus Hospital between September 2016 and June 2017 and diagnosed with mucositis. Serum vitamin A and vitamin D levels were measured at mucositis diagnosis. Two control groups of 40 healthy children each were used for comparison. Associations between vitamin levels and mucositis stage, frequency, and duration were analyzed.

Results: Serum vitamin A levels were significantly lower in the mucositis group than controls. Vitamin A deficiency was more frequent among patients with severe mucositis (stages 3–4) than those with mild mucositis (stages 1–2) (p = 0.02). No significant association was observed between serum vitamin D levels and mucositis severity (p = 0.31). However, longer vitamin D supplementation during infancy was associated with lower mucositis severity (p = 0.025).

Conclusion: Lower serum vitamin A levels were associated with greater mucositis severity among pediatric oncology patients. No significant association was observed between serum vitamin D levels and mucositis severity. The relationship between vitamin D supplementation duration in infancy and mucositis severity should be considered exploratory and hypothesis-generating. Given the retrospective design, cross-sectional vitamin assessment, heterogeneous malignancies and treatment regimens, and absence of an oncology control group without mucositis, these findings should be interpreted cautiously. Prospective multicenter studies are needed to clarify the relationship between vitamin status and mucositis severity in pediatric oncology patients.