Association of Vitamin D Level With Clinical Status in Inflammatory Bowel Disease: A 5-Year Longitudinal Study

Kabbani, Toufic; Koutroubakis, Ioannis E.; Schoen, Robert E.; Ramos-Rivers, Claudia; Shah, Nilesh; Swoger, Jason M.; Regueiro, Miguel; Barrie, Arthur; Schwartz, Marc; Hashash, Jana G.; Baidoo, Leonard; Dunn, Michael A.; Binion, David G.

doi:10.1038/ajg.2016.53

Cited by 163 publications

(147 citation statements)

References 28 publications

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“…These results suggest that low levels of vitamin D are linked to high disease activity. There is no consensus on this issue in the literature, although many studies have already reported a relation between low levels of vitamin D and more clinical activity [6,[16][17][18][19][20][21], while others have not [22][23][24]. This relation is more consistently reproduced when activity is subjectively measured, by clinical indices, than when activity is objectively measured, by systemic inflammation markers, such as CRP or ESR (as fecal calprotectin is measured in almost none of the studies).…”

Section: Discussionmentioning

confidence: 99%

“…It included 14 studies with a total of 1,891 patients and reported that patients with IBD had 64% higher odds of vitamin D deficiency when compared with controls [15]. An association with disease activity has been described more inconsistently, with some authors arguing that there is a relation between lower levels of vitamin D and higher disease activity [6,[16][17][18][19][20][21], while others have not found any relation [22][23][24]. There are 2 published Portuguese studies on this subject, both from the north of the country.…”

Section: Introductionmentioning

confidence: 99%

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Vitamin D Deficiency in a Portuguese Cohort of Patients with Inflammatory Bowel Disease: Prevalence and Relation to Disease Activity

Branco

Cardoso

Anapaz

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Vitamin D deficiency is more common in inflammatory bowel disease (IBD) patients than in the general population. However, there are conflicting data about predictive factors of vitamin D deficiency and its potential association with disease activity. The aims of this study were to determine the prevalence and predictive factors of vitamin D deficiency and to evaluate a possible association with disease activity. Methods: A prospective observational study was conducted, including patients with IBD from January to July 2016. The Endocrine Society guidelines were considered for defining levels of serum 25-hydroxyvitamin D (25-OH-D) as follows: deficient (< 20 ng/mL, < 10 ng/mL being severe deficiency), insufficient (21–29 ng/mL), and adequate (> 30 ng/mL). Results: A total of 152 patients (52% men; 47.2 ± 17.3 years) were included, of whom 70% had Crohn’s disease (CD). Thirty-seven percent of patients were on immunosuppressors and 17% were on biologics. The majority were outpatients (88.2%). Mean 25-OH-D levels were 17.1 ± 8 ng/mL (CD: 16.7 ± 8 ng/mL vs. ulcerative colitis: 17.6 ± 7 ng/mL, p = 0.1). Inadequate levels were present in 90.8% of patients (deficiency: 68.4%; insufficiency: 22.4%). A significant negative correlation between 25-OH-D levels and age (r = –0.2, p = 0.04), C-reactive protein (CRP) levels (r = –0.22, p = 0.004), and Harvey-Bradshaw index (HBi) (r = –0.32, p = 0.001) was found. Patients with severe deficiency showed a higher CRP (0.6 vs. 1.4 mg/dL, p = 0.03), erythrocyte sedimentation rate (ESR) (22 vs. 31 mm/h, p = 0.03), and HBi (2 vs. 5, p < 0.001) and lower hemoglobin (13.6 vs. 12.7 g/dL, p = 0.02). There was no association between vitamin D deficiency and gender, type, extent, and duration of disease, surgery, and other measures of disease activity, such as ESR, hemoglobin (these 2 items except for severe deficiency), fecal calprotectin, or Truelove and Witts classification. Conclusions: There is a high prevalence of inadequate levels of vitamin D in IBD patients, particularly deficiency (68.4%). There seems to exist an association between lower levels of vitamin D and higher disease activity, especially in CD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vitamin D Deficiency in a Portuguese Cohort of Patients with Inflammatory Bowel Disease: Prevalence and Relation to Disease Activity

Branco

Cardoso

Anapaz

et al. 2018

GE Port J Gastroenterol

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“…Calcium deficiency and low vitamin D levels occurred as a result of small intestinal dysfunction in the present patient. A previous 5-year study identified that low vitamin D levels are common in patients with IBD, and IBD patients with low mean vitamin D levels demonstrated worse disease activity, worse pain and higher requirement for steroids (4). The use of vitamin D may improve osteoporosis (12); however, this was not the case for the present patient.…”

Section: Discussionmentioning

confidence: 59%

“…Another study involving 70 patients with IBD demonstrated that osteoporosis was observed in 13.2% of patients and osteopenia in 46.1% (3). The dominant risk factors leading to osteoporosis in IBD are considered to be age, intestinal malabsorption, long-term use of steroids, lack of exercise or supplementation of calcium and vitamin D, and smoking (4). In addition, inflammation and proinflammatory cytokines serve a key role in bone loss and increase the risk of fracture (5), including interleukin (IL)-6 and tumor necrosis factor (TNF) (6).…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis as an initial manifestation in a patient with Crohn's disease: A case report

et al. 2018

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“…In this issue of the American Journal of Gastroenterology , Kabbani et al ( 15 ) from the University of Pittsburgh present an elegant longitudinal study examining the 5-year course of 965 patients with IBD under the care who had vitamin D levels measured systematically and supplemented using a standard protocol. Low vitamin D was defi ned as levels below 30 ng/ml.…”

Section: Guarantormentioning

confidence: 99%

Editorial: Vitamin D and IBD: Can We Get Over the “Causation” Hump?

Ananthakrishnan

2016

American Journal of Gastroenterology

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Vitamin D defi ciency is common in patients with infl ammatory bowel diseases and may even precede the disease onset contributing to an increased risk. Using comprehensive data from a large, referral IBD cohort, Kabbani et al. establish that low vitamin D levels are associated with greater disease activity, increased risk of surgery and hospitalizations, and lower health-related quality of life in patients with IBD. This expands the evidence base supporting such an association. However, there is a need for this fi eld to evolve to interventional studies with vitamin D supplementation to confi rm that vitamin D has a true therapeutic role for treating disease activity in IBD.

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Association of Vitamin D Level With Clinical Status in Inflammatory Bowel Disease: A 5-Year Longitudinal Study

Abstract: Low vitamin D levels are common in IBD patients and are associated with higher morbidity and disease severity, signifying the potential importance of vitamin D monitoring and treatment.

Cited by 163 publications

References 28 publications

Vitamin D Deficiency in a Portuguese Cohort of Patients with Inflammatory Bowel Disease: Prevalence and Relation to Disease Activity

Vitamin D Deficiency in a Portuguese Cohort of Patients with Inflammatory Bowel Disease: Prevalence and Relation to Disease Activity

Osteoporosis as an initial manifestation in a patient with Crohn's disease: A case report

Editorial: Vitamin D and IBD: Can We Get Over the “Causation” Hump?

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