Digestive Diseases and Sciences

, Volume 56, Issue 3, pp 830–836 | Cite as

Vitamin D Deficiency in Children with Inflammatory Bowel Disease

  • Alon D. Levin
  • Veena Wadhera
  • Steven T. Leach
  • Helen J. Woodhead
  • Daniel A. Lemberg
  • A. Czarina Mendoza-Cruz
  • Andrew S. Day
Original Article

Abstract

Background

Osteopenia and osteoporosis are commonly seen in inflammatory bowel disease (IBD). Vitamin D deficiency potentially contributes to diminished bone acquisition in childhood.

Objectives

The objectives of this study were to assess vitamin D in a group of Australian children with IBD and to ascertain associations between vitamin D status and key clinical factors, for example disease location and severity.

Methods

Data were obtained retrospectively from the records of children with IBD who had at least one measurement of serum 25-hydroxyvitamin D (25(OH)D) over a two-year period. Demographic variables, disease activity, inflammatory markers, disease location, duration, and therapy were recorded. Moderate and severe deficiency were defined as 25(OH)D <51 nmol/l and <30 nmol/l, respectively. Insufficiency was defined as 25(OH)D between 51 and 75 nmol/l.

Results

Overall, the mean 25(OH)D level in 78 children (104 measurements) was 71.2 (SD ± 26.5) nmol/l. Fifteen (19%) children were vitamin D deficient and 30 (38%) children were insufficient. Levels of 25(OH)D were not associated with disease location or use of immunosuppressive drugs. Children with vitamin D deficiency had greater corticosteroid exposure than those with normal status (P = 0.001). The mean 25(OH)D of 38 children treated with nutritional therapy at diagnosis was higher than for 17 children initially treated with corticosteroids (P = 0.04).

Conclusions

A high proportion of these Australian children with IBD were vitamin D deficient. This emphasizes the importance of monitoring vitamin D status, and treating deficiency, in the management of pediatric IBD. The possible benefit of nutritional therapy in protection against vitamin D deficiency requires further prospective study.

Keywords

Inflammatory bowel disease Crohn’s disease Children Vitamin D deficiency Corticosteroids Exclusive enteral nutrition 

References

  1. 1.
    Murch SH, Baldassano R, Buller H, et al. Inflammatory bowel disease: Working Group report of the second World Congress of pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr. 2004;39:S647–S654.CrossRefPubMedGoogle Scholar
  2. 2.
    Kucharzik T, Maaser C, Lugering A, et al. Recent understanding of IBD pathogenesis: Implications for future therapies. Inflamm Bowel Dis. 2006;12:1068–1083.CrossRefPubMedGoogle Scholar
  3. 3.
    Bernstein CN, Blanchard JF, Leslie W, Wajda A, Yu BN. The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann Intern Med. 2000;133:795–799.PubMedGoogle Scholar
  4. 4.
    Vestergaard P, Mosekilde L. Fracture risk in patients with celiac disease, Crohn’s disease, and ulcerative colitis: a nationwide follow-up study of 16, 416 patients in Denmark. Am J Epidemiol. 2002;156:1–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Sylvester FA. IBD and skeletal health: Children are not small adults!. Inflamm Bowel Dis. 2005;11:1020–1023.CrossRefPubMedGoogle Scholar
  6. 6.
    Bernstein CN, Leslie WD. The pathophysiology of bone disease in gastrointestinal disease. Eur J Gastroenterol Hepatol. 2003;15:857–864.CrossRefPubMedGoogle Scholar
  7. 7.
    Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142–146.PubMedGoogle Scholar
  8. 8.
    Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281.CrossRefPubMedGoogle Scholar
  9. 9.
    Jahnsen J, Falch JA, Mowinckel P, Aadland E. Vitamin D status, parathyroid hormone and bone mineral density in patients with inflammatory bowel disease. Scand J Gastroenterol. 2002;37:192–199.CrossRefPubMedGoogle Scholar
  10. 10.
    Nic Shuibne T, Healy M, Cox G, et al. High risk of vitamin D deficiency in wintertime in adults with Crohn’s disease. Gastroenterology. 2007;132:662.Google Scholar
  11. 11.
    Pappa HM, Gordon CM, Saslowsky TM, et al. Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics. 2006;118:1950–1961.CrossRefPubMedGoogle Scholar
  12. 12.
    Sentongo TA, Semaeo EJ, Stettler N, Piccoli DA, Stallings VA, Zemel BS. Vitamin D status in children, adolescents, and young adults with Crohn disease. Am J Clin Nutr. 2002;76:1077–1081.PubMedGoogle Scholar
  13. 13.
    von Scheven E, Gordon CM, Wypij D, Wertz M, Gallagher KT, Bachrach L. Variable deficits of bone mineral despite chronic glucocorticoid therapy in pediatric patients with inflammatory diseases: a Glaser Pediatric Research Network study. J Pediatr Endocrinol. 2006;19:821–830.Google Scholar
  14. 14.
    Pappa HM, Grand RJ, Gordon CM. Report on the vitamin D status of adult and pediatric patients with inflammatory bowel disease and its significance for bone health and disease. Inflamm Bowel Dis. 2006;12:1162–1174.CrossRefPubMedGoogle Scholar
  15. 15.
    Thayu M, Leonard MB, Hyams JS, et al. Improvement in biomarkers of bone formation during infliximab therapy in pediatric Crohn’s disease: results of the REACH study. Clin Gastroenterol Hepatol. 2008;6:1378–1384.CrossRefPubMedGoogle Scholar
  16. 16.
    Whitten K, Leach S, Bohane T, Woodhead H, Day AS. Effect of exclusive enteral nutrition on bone metabolism in children with Crohn’s disease. J Gastroenterol. 2010;45:399–405.CrossRefPubMedGoogle Scholar
  17. 17.
    Hyams JS, Ferry GD, Mandel FS, et al. Development and validation of a pediatric Crohn’s disease activity index. J Pediatr Gastroenterol Nutr. 1991;12:439–447.PubMedGoogle Scholar
  18. 18.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: Controversies, consensus, and implications. Gut. 2006;55:749–753.CrossRefPubMedGoogle Scholar
  19. 19.
    Munns C, Zacharin MR, Rodda CP, et al. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust. 2006;185:268–272.Google Scholar
  20. 20.
    Day AS, Whitten KE, Lemberg DA, et al. Exclusive enteral feeding as primary therapy for Crohn’s disease in Australian children and adolescents: A feasible and effective approach. J Gastroenterol Hepatol. 2006;21:1609–1614.CrossRefPubMedGoogle Scholar
  21. 21.
    Rufo PA, Bousvaros A. Current therapy of inflammatory bowel disease in children. Paediatr Drugs. 2006;8:279–302.CrossRefPubMedGoogle Scholar
  22. 22.
    Binkley N, Krueger D, Cowgill CS, et al. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinal Metab. 2004;89:3152–3157.CrossRefGoogle Scholar
  23. 23.
    Vieth R, Bischoff-Ferrari H, Boucher BJ, et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr. 2007;85:649–650.PubMedGoogle Scholar
  24. 24.
    Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr. 2004;80.Google Scholar
  25. 25.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713–716.CrossRefPubMedGoogle Scholar
  26. 26.
    Kimlin MG, Olds WJ, Moore MR. Location and vitamin D synthesis: Is the hypothesis validated by geophysical data? J Photochem Photobiol B. 2007;86:234–239.CrossRefPubMedGoogle Scholar
  27. 27.
    Chen TC, Chimeh F, Lu Z, et al. Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys. 2007;460:213–217.CrossRefPubMedGoogle Scholar
  28. 28.
    Borrelli O, Cordischi L, Cirulli M, et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease: A randomised controlled open-label trial. Clin Gastroenterol Hepatol. 2006;4:744–753.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alon D. Levin
    • 1
  • Veena Wadhera
    • 1
  • Steven T. Leach
    • 1
  • Helen J. Woodhead
    • 2
  • Daniel A. Lemberg
    • 1
    • 3
  • A. Czarina Mendoza-Cruz
    • 2
  • Andrew S. Day
    • 1
    • 3
    • 4
  1. 1.School of Women’s & Children’s HealthThe University of New South WalesSydneyAustralia
  2. 2.Department of EndocrinologySydney Children’s HospitalRandwick, SydneyAustralia
  3. 3.Department of GastroenterologySydney Children’s HospitalRandwick, SydneyAustralia
  4. 4.Department of PaediatricsUniversity of Otago (Christchurch)ChristchurchNew Zealand

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