Abstract
Introduction
Many patients with inflammatory bowel disease (IBD) are vitamin D deficient. The purpose of our study was to identify risk factors for vitamin D deficiency in IBD and to assess the impact of vitamin D repletion on disease activity and quality of life (QOL).
Methods
Patients with at least one 25-OH vitamin D level measured between 2004 and 2011 were included. Patients with a level <30 ng/ml at baseline were followed until the time of repletion. QOL and disease activity scores were measured at baseline and repletion.
Results
A total of 255 patients were identified. 33, 29, and 39% had a vitamin D level of ≥30, 20–29, and <20 ng/ml, respectively. When adjusting for disease type and duration, gender, smoking, and race, non-Caucasians had 5.3 (2.3–12.3) and UC patients had a 0.59 (0.33–1.03) odds of having a vitamin D <30 ng/ml. Women were 1.7 times more likely to have a 25-OH vitamin D level <20 ng/ml than men. 55 patients underwent repletion. In CD patients, the HBI and SIBDQ prior to repletion was 5.5 ± 4.9 and 44.3 ± 16.4, respectively; these improved to 3.6 ± 3.4 and 48.6 ± 14.2 after repletion (p = 0.0154 and p = 0.0684).
Conclusions
In this tertiary care IBD cohort, the majority of patients have low vitamin D levels. Non-Caucasian race and female gender are associated with low vitamin D. UC was associated with lower risk of vitamin D insufficiency. In CD, vitamin D repletion is associated with decreased disease activity and increased QOL.
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References
Narula N, Marshall JK. Management of inflammatory bowel disease with vitamin D: beyond bone health. J Crohns Colitis. 2012;6:397–404.
Ulitsky A, Ananthakrishnan AN, Naik A, et al. Vitamin D deficiency in patients with inflammatory bowel disease: association with disease activity and quality of life. JPEN J Parenter Enter Nutr. 2011;35:308–316.
Mouli VP, Ananthakrishnan AN. Review article: vitamin D and inflammatory bowel diseases. Aliment Pharmacol Ther. 2014;39:125–136.
Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011;31:48–54.
Looker AC, Johnson CL, Lacher DA, et al. Vitamin D status: Untied States 2001–2006. NCHS data brief, no 59. Hyattsville, MD: National Center for Health Statistics; 2011.
Castro FD, Magalhaes J, Carvalho PB, et al. Lower levels of vitamin D correlate with clinical disease activity and quality of life in inflammatory bowel disease. Argent Gastroenterol. 2015;52:260–265.
Kabbani TA, Koutroubakis IE, Schoen RE, et al. Association of vitamin D level with clinical status in Inflammatory Bowel Disease: a 5-year Longitudinal Study. Am J Gastroenterol. 2016;111:712–719.
Joseph AJ, George B, Pulimood AB, et al. 25 (OH) vitamin D level in Crohn’s disease: association with sun exposure and disease activity. Indian J Med Res. 2009;130:133–137.
Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2–6 (discussion 16–19).
Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of gastroenterology. Can J Gastroenterol. 2005;19:5–36.
Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet. 1980;1:514.
Walmsley RS, Ayres RC, Pounder RE, et al. A simple clinical colitis activity index. Gut. 1998;43:29–32.
Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn’s Relapse Prevention Trial. Am J Gastroenterol. 1996;91:1571–1578.
Garg M, Rosella O, Lubel JS, et al. Association of circulating vitamin D concentrations with intestinal but not systemic inflammation in inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:2634–2643.
Blanck S, Aberra F. Vitamin d deficiency is associated with ulcerative colitis disease activity. Dig Dis Sci. 2013;58:1698–1702.
Ananthakrishnan AN, Cagan A, Gainer VS, et al. Normalization of plasma 25-hydroxy vitamin D is associated with reduced risk of surgery in Crohn’s disease. Inflamm Bowel Dis. 2013;19:1921–1927.
Miheller P, Muzes G, Hritz I, et al. Comparison of the effects of 1,25 dihydroxyvitamin D and 25 hydroxyvitamin D on bone pathology and disease activity in Crohn’s disease patients. Inflamm Bowel Dis. 2009;15:1656–1662.
Boothe D. High dose vitamin D improved clinical activity in crohn’s disase. Washington, DC: American College of Gastroenterology; 2011.
Jorgensen SP, Agnholt J, Glerup H, et al. Clinical trial: vitamin D3 treatment in Crohn’s disease—a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther. 2010;32:377–383.
Raftery T, Martineau AR, Greiller CL, et al. Effects of vitamin D supplementation on intestinal permeability, cathelicidin, and disease markers in Crohn’s Disease: results from a randomised double-blind placebo-controlled study. United European Gastroenterol J. 2015;3:294–302.
White JH. Vitamin D deficiency and the pathogenesis of Crohn’s disease. J Steroid Biochem Mol Bio. 2016. doi:10.1016/j.jsbmb.2016.12.015.
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Zullow, S., Jambaulikar, G., Rustgi, A. et al. Risk Factors for Vitamin D Deficiency and Impact of Repletion in a Tertiary Care Inflammatory Bowel Disease Population. Dig Dis Sci 62, 2072–2078 (2017). https://doi.org/10.1007/s10620-017-4614-y
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DOI: https://doi.org/10.1007/s10620-017-4614-y