Browsing by Person "Revuelta Iniesta, Raquel"

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Associations of Ferritin and Folate Status With Clinical Outcomes in Childhood Cancer Patients: A Prospective Cohort Study
(2025-03-07) Withey, Kalum; Brougham, Mark F. H.; Paciarotti, Ilenia; McKenzie, Jane M.; Wilson, David C.; Revuelta Iniesta, Raquel
Background: Given the limited research on folate and ferritin status in children with cancer undergoing treatment, we investigated the prevalence of abnormalities and their impact on clinical outcomes and treatment complications. Methods: This prospective cohort study enrolled children <18 years diagnosed with cancer between August 2010 and February 2014. Data collection occurred at diagnosis, 3, 6, 9, 12 and 18 months. Clinical outcomes were classified as event‐free survival or events (relapse, death, the development of new metastasis, becoming palliative) and treatment complications. Micronutrient status was assessed through clinical and nutritional analyses. Binary logistic regression, multilevel model analysis explored relationships between micronutrient status and clinical outcomes. Results: Eighty‐two patients (median [interquartile range] 3.9 (1.9–8.8) years, 56% males) were recruited. Excess ferritin (85%) and folate deficiency (25.5%) were prevalent micronutrient abnormalities throughout the study. Decreased ferritin levels reduced the odds of events by 83.9% (odd ratios = 0.161, 95% CI = 1.000–1.002, p = 0.032). Higher ferritin was associated with increased number of treatment‐related complications (B = 7.3E−5, 95% CI = 1.5E−5–0.000, p = 0.013). Folate status showed significant association with body mass index category (χ2 = 9.564, p = 0.008), indicating that overweight and obese patients were more prone to deficiency, and methotrexate (F(2.9); p = 0.06; −2LL (1381)). Haematological malignancies (F(2.8); p = 0.05; −2LL (4244)) and medium and high treatment intensity (F(2.4); p = 0.09; −2LL 4262)) were associated with higher ferritin levels over 18 months. Conclusions: Paediatric cancer patients undergoing treatment exhibit high ferritin and reduced folate levels. Elevated ferritin is linked to increased toxicity and negative clinical outcomes, highlighting the importance of regular assessment and monitoring of both folate and ferritin. Implementing routine monitoring for these biomarkers could help mitigate adverse effects associated with treatment. Large‐scale population‐based studies and clinical trials are now warranted.
Systematic Review and Meta-analysis: Associations of Vitamin D with Pulmonary Function in children and young people with Cystic Fibrosis
(Elsevier, 2023-02-21) Revuelta Iniesta, Raquel; Cook, Seren; Oversby, Gemma; Koufaki, Pelagia; van der Linden, Marietta; Vlachopoulos, Dimitris; Williams, Craig A.; Urquhart, Don S.
Backgound Increasing evidence suggests that vitamin D is associated with pulmonary health, which may benefit children and young people diagnosed with Cystic Fibrosis (cypCF). Therefore, the aim of this systematic review was to evaluate primary research to establish associations between 25OHD and pulmonary health in cypCF. Methods Electronic databases were searched with keywords related to CF, vitamin D, children/young people and pulmonary function. Included studies were cypCF (aged ≤ 21 years) treated in a paediatric setting. The primary outcome was lung function [forced expiratory volume in 1 second (FEV1 % predicted)] and secondary outcomes were rate of pulmonary exacerbations, 25OHD status and growth. Evidence was appraised for risk of bias using the CASP tool, and quality using the EPHPP tool. A Meta-analysis was performed. Results Twenty-one studies were included with mixed quality ratings and heterogeneity of reported outcomes. The Meta-analysis including 5 studies showed a significantly higher FEV1 % predicted in the 25OHD sufficiency compared to the deficiency group [FEV1 % predicted mean difference (95% CI) was 7.71 (1.69 – 13.74) %; p = 0.01]. The mean ± SD FEV1 % predicted for the sufficient (≥75 nmol/L) vs. deficient (<50 nmol/L) group was 94.7 ± 31.9 % vs. 86.9 ± 13.2 %; I2 = 0%; χ2 = 0.5; df = 4). Five studies (5/21) found significantly higher rate of pulmonary exacerbations in those who were 25OHD deficient when compared to the sufficient group and negative associations between 25OHD and FEV% predicted. The effects of vitamin D supplementation dosages on 25OHD status (10/21) varied across studies and no study (12/21) showed associations between 25OHD concentration and growth. Conclusion This systematic review suggests that 25OHD concentration is positively associated with lung function and a concentration of >75 nmol/L is associated with reduced frequency of pulmonary exacerbations, which may slow lung function decline in cypCF. Future randomised clinical trials and mechanistic studies are warranted.