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Vitamin D Status in Pediatric Oncology Patients in Lebanon: A Comparison With Non-oncology Controls in a Case-Control Study

Published on Tuesday, 20 October 2026

Abstract

Background and objective: Children diagnosed with cancer are more likely to have vitamin D problems due to compromised health before diagnosis, the disease itself, and cancer treatments. Previous studies, although limited in scope, have shown an elevated prevalence of vitamin D deficiency in pediatric oncology patients. This study aimed to describe the prevalence of vitamin D insufficiency among children with cancer in Lebanon.

Design and methods: This was an unmatched case-control study comparing vitamin D levels among children living in Lebanon diagnosed with cancer (cases) with those of children without cancer (controls) in Lebanon. Serum vitamin D levels were determined for both cases and controls. Patients were classified according to the Endocrine Society recommendations: deficiency (25(OH)D ≤ 20 ng/mL), insufficiency (25(OH)D 21-29 ng/mL), and normal levels (25(OH)D ≥ 30 ng/mL). Vitamin D status was evaluated by categorizing patients into two groups: hypovitaminosis D, defined as 25(OH)D levels < 30 ng/mL, and normal levels, defined as 25(OH)D levels ≥ 30 ng/mL.

Results: This unmatched case-control study included a total of 268 patients, with 67 oncology pediatric patients (cases) and 201 participants who were non-oncology pediatric patients (controls). The prevalence of vitamin D insufficiency and deficiency among children with cancer was 11 (16.45%) and 54 (80.6%), respectively. In contrast, among non-oncology patients, 103 (51.2%) showed vitamin D insufficiency, and 57 (28.4%) had vitamin D deficiency. There was a significant association between having cancer and vitamin D hypovitaminosis. Age was significantly associated with vitamin D levels among children with cancer, with older children having lower vitamin D levels.

Conclusion: Among children diagnosed with cancer, a high prevalence of vitamin D deficiency is observed, underscoring the significance of early detection and supplementation in this specific population.

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About this publication.

- The Di Bella Method (A Fixed Part - Dihydrotachysterol, Alfacalcidol, synthetic Vitamin D3 - Preferably the blood concentration value should be around the middle between 75ng/ml and 100ng/ml);

- Vitamin D (analogues and/or derivatives) and cancer - In vitro, review and in vivo publications;

- The Di Bella Method (A Fixed Part - Vitamin C/Ascorbic Acid, 2–4 grams, twice a day orally);

- The Di Bella Method (A Fixed Part - Alpha tocopheryl acetate/Vitamin E, approximately 20 grams per day orally);

- Cancer and Vitamin E (analogues and/or derivatives) and cancer - In vitro, review and in vivo publications;

- Solution of retinoids in vitamin E in the Di Bella Method biological multitherapy;

- The Di Bella Method (A Fixed Part - All-Trans Retinoic Acid, Analogues and/or Derivatives - Approximately 60mg per day orally: 40mg per day Beta-Carotene/β-Carotene, 10mg per day ATRA and 10mg per day Axerophthol palmitate);

- All-Trans-Retinoic Acid (ATRA - analogues and/or derivatives) - In vitro, review and in vivo publications;

- The Di Bella Method (A Fixed Part - Cyclophosphamide 50mg tablets and/or Hydroxyurea 500mg tablets, one or two per day);

The Di Bella's Method: Use of Vitamin D analogues and/or derivatives with pseudo-Metronomic Chemotherapy Cyclophosphamide and/or Hydroxyurea - together with others chemical compounds: the dosage and administration schedule must be individualised for each patient - in several Oncological Pathologies:

- A retrospective observational clinical study of triple negative breast cancer cases treated with Di Bella Method: A preliminary data;

- The Synergism of Somatostatin, Melatonin, Vitamins Prolactin and Estrogen Inhibitors Increased Survival, Objective Response and Performance Status In 297 Cases of Breast Cancer;

- Complete objective response, stable for 5 years, with the Di Bella Method, of multiple-metastatic carcinoma of the breast;

- Evaluation of the safety and efficacy of the first-line treatment with somatostatin combined with melatonin, retinoids, vitamin D3, and low doses of cyclophosphamide in 20 cases of breast cancer: a preliminary report;

- The Di Bella Method (DBM) improved survival, objective response and performance status in a retrospective observational clinical study on 122 cases of breast cancer;

- Complete objective response to biological therapy of plurifocal breast carcinoma;

- A retrospective observational study on cases of anaplastic brain tumors treated with the Di Bella Method: A rationale and effectiveness;

- Recurrent Glioblastoma Multiforme (grade IV – WHO 2007): a case of complete objective response achieved by means of the concomitant administration of Somatostatin and Octreotide – Retinoids – Vitamin E – Vitamin D3 – Vitamin C – Melatonin – D2 R agonists (Di Bella Method – DBM) associated with Temozolomide;

- The Di Bella Method DBM improved survival objective response and performance status in a retrospective observational clinical study on 23 tumours of the head and neck;

- Chronic Lymphocytic Leukemia: Long-Lasting Remission with Combination of Cyclophosphamide, Somatostatin, Bromocriptine, Retinoids, Melatonin, and ACTH;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in advanced non-small-cell lung cancer patients with low performance status;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in chemotherapy-pretreated patients with advanced lung adenocarcinoma and low performance status;