Association Between Reduced Plasma 25-Hydroxy Vitamin D and Increased Risk of Cancer in Patients With Inflammatory Bowel Diseases

Abstract

Background & Aims Vitamin D deficiency is common among patients with inflammatory bowel diseases (IBD) (Crohn’s disease or ulcerative colitis). The effects of low plasma 25-hydroxy vitamin D (25[OH]D) on outcomes other than bone health are understudied in patients with IBD. We examined the association between plasma level of 25(OH)D and risk of cancers in patients with IBD. Methods From a multi-institutional cohort of patients with IBD, we identified those with at least 1 measurement of plasma 25(OH)D. The primary outcome was development of any cancer. We examined the association between plasma 25(OH)D and risk of specific subtypes of cancer, adjusting for potential confounders in a multivariate regression model. Results We analyzed data from 2809 patients with IBD and a median plasma level of 25(OH)D of 26 ng/mL. Nearly one-third had deficient levels of vitamin D (<20 ng/mL). During a median follow-up period of 11 y, 196 patients (7%) developed cancer, excluding non-melanoma skin cancer (41 cases of colorectal cancer). Patients with vitamin D deficiency had an increased risk of cancer (adjusted odds ratio=1.82; 95% CI, 1.25–2.65) compared to those with sufficient levels. Each 1 ng/mL increase in plasma 25(OH)D was associated with an 8% reduction in risk of colorectal cancer (odds ratio=0.92; 95% CI, 0.88–0.96). A weaker inverse association was also identified for lung cancer. Conclusion In a study of from 2809 patients with IBD, low plasma level of 25(OH)D was associated with an increased risk of cancer—especially colorectal cancer.

Serum 25-hydroxyvitamin D concentration is inversely associated with mucosal inflammation in patients with ulcerative colitis,

“…In concordance, both the National Geriatric Society and International Osteoporosis Foundation recommend maintaining serum 25(OH)D .30 ng/mL, a concentration at which parathyroid hormone concentrations begin to plateau in relation to 25(OH)D (39)(40)(41). Although these categorical recommendations for defining vitamin D deficiency and sufficiency are mainly based on investigations focused on bone metabolism, most studies to our knowledge that have examined patients with IBD have used a similar definition of a 25(OH)D concentration ,20 ng/mL to represent vitamin D deficiency (12,14,31,(42)(43)(44).…”

Vitamin D Therapy in Inflammatory Bowel Diseases: Who, in What Form, and How Much?

“…102 A review of prospective cohort data on CRC prevention suggested that achieving a 25(OH)D serum concentration of 30-44ng/mL had the greatest benefits. 99 Analysis of the incidence of malignancies in 2 809 IBD patients with a median follow-up of 11 years found that patients with vitamin D deficiency (~33%) were at increased risk of cancer (adjusted OR, 1.82; 95% CI, 1.25-2.65) compared with patients with sufficient vitamin D. 103 Each 1 ng/mL increase in 25(OH)D plasma concentration was associated with an 8% reduction in the risk of CRC.…”

The Search for Causative Environmental Factors in Inflammatory Bowel Disease

“…In patients with vitamin D deficiency, in both CD and UC, the risk of having a flare is about 2-fold increased [41] , whereas substitution in CD was shown to reduce relapse risk in quiescent CD [42] . Moreover, lower vitamin D serum levels were also revealed to be associated with an increased risk of colorectal cancer in IBD patients [43] .…”