American Journal of Epidemiology Advance Access originally published online on July 1, 2008
American Journal of Epidemiology 2008 168(3):353; doi:10.1093/aje/kwn199
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LETTERS TO THE EDITOR |
RE: "RISK OF CHILDHOOD LEUKEMIA ASSOCIATED WITH VACCINATION, INFECTION, AND MEDICATION USE IN CHILDHOOD: THE CROSS-CANADA CHILDHOOD LEUKEMIA STUDY"
1 Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
2 Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
3 Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
4 Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
5 University of Michigan Medical School, Ann Arbor, Michigan
(e-mail: hanauer{at}med.umich.edu)
The Journal article by MacArthur et al. (1) reports interesting associations regarding childhood leukemia. We are concerned, however, about the association between childhood leukemia and vitamin intake. The authors do not define what constitutes a vitamin supplement in this study, and definitions for such supplements can be variable (2). It is unclear from their article whether a distinction is made between true vitamins and what parents may report as being vitamins, such as dietary supplements. Such a distinction is important.
Maternal vitamin intake during pregnancy has been associated with a decreased risk of childhood leukemia (3), and vitamin D intake in children is thought to potentially have anticancer benefits (4). The authors reported that breastfeeding for more than 6 months confers a protective benefit, yet any infant exclusively breastfed should be receiving vitamin D supplementation to prevent rickets, as recommended by both the American Academy of Pediatrics (5) and the Canadian Pediatric Society (6). A concern about vitamin intake being associated with leukemia could prompt parents to stop giving, or clinicians to stop recommending, vitamin D supplementation for exclusively breastfed infants. Nutritional rickets from vitamin D deficiency continues to be a problem in both Canada and the United States (7, 8), and we hope that the current article does not result in an increase in this preventable disorder.
Dietary supplementation, including vitamins, in young children has been found to be common (9), and although we accept that some supplements may confer a risk of leukemia, we wonder whether the authors could clarify their findings regarding the vitamins for which an association was found. We would also be interested to know whether the odds ratios for leukemia among breastfeed infants differed between those who were and those who were not taking vitamins.
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ACKNOWLEDGMENTS |
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Conflict of interest: none declared.
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References |
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 TOP References |
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- MacArthur AC, McBride ML, Spinelli JJ, et al. Risk of childhood leukemia associated with vaccination, infection, and medication use in childhood: the Cross-Canada Childhood Leukemia Study. Am J Epidemiol (2008) 167(5):598–606.
[Abstract/Free Full Text] - Yetley EA. Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. Am J Clin Nutr. (2007) 85(1):269S–276S.
[Abstract/Free Full Text] - Goh YI, Bollano E, Einarson TR, et al. Prenatal multivitamin supplementation and rates of pediatric cancers: a meta-analysis. Clin Pharmacol Ther (2007) 81(5):685–691.[CrossRef][Web of Science][Medline]
- Stallings VA. Childhood cancer and vitamins: prevention and treatment. Pediatr Blood Cancer. (2008) 50((suppl)):442–444.[CrossRef][Web of Science][Medline]
- Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics. (2003) 111:908–910. (4 pt 1).
[Abstract/Free Full Text] - Canadian Pediatric Society. Vitamin D supplementation: recommendations for Canadian mothers and infants. Paediatr Child Health (2007) 12(7):583–589.
- Ward LM, Gaboury I, Ladhani M, et al. Vitamin D-deficiency rickets among children in Canada. CMAJ (2007) 177(2):161–166.
[Abstract/Free Full Text] - Lazol JP, Cakan N, Kamat DM. 10-Year case review of nutritional rickets in children's Hospital of Michigan. Clin Pediatr (Phila) (2008) 47(4):379–384.
[Abstract/Free Full Text] - Eichenberger Gilmore JM, Hong L, Broffitt B, et al. Longitudinal patterns of vitamin and mineral supplement use in young white children. J Am Diet Assoc (2005) 105(5):763–772.[CrossRef][Web of Science][Medline]
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  A. C. MacArthur and M. L. McBride THE FIRST TWO AUTHORS REPLY Am. J. Epidemiol., August 1, 2008; 168(3): 353 - 354. [Full Text] [PDF]
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