Factors associated with vitamin D deficiency in a multicultural inflammatory bowel disease cohort

Chatu, Sukhdev; Chhaya, Vivek; Holmes, R.; Neild, P; Kang, Jin-Yong; Pollok, Richard; Poullis, Andrew

doi:10.1136/flgastro-2012-100231

Cited by 32 publications

(25 citation statements)

References 20 publications

(23 reference statements)

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“…The prevalence of vitamin D deficiency varies from 8% to 90% in IBD patients. Those with a longer disease duration, increased accumulated corticosteroids dose, bowel resection and pancolitis tend to have higher prevalence of vitamin D deficiency. Serum vitamin D concentration was negatively associated with the disease activity of IBD, although the assessment method of disease activity differed among previous studies .…”

Section: Diet In the Pathogenesis Of Ibdmentioning

confidence: 99%

The role of dietary factors in inflammatory bowel diseases: New perspectives

Zhou

Yan

2018

J of Digest Diseases

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The current review aimed to elucidate the role of diet in every stage of inflammatory bowel diseases, from aspects of prevention, treatment and rehabilitation. Western diet, characterized by overconsumption of refined sugar and saturated fat and low consumption of dietary fiber, may partly be blamed for its pathogenesis. Some immune‐modulated nutrients (fibers, monounsaturated fatty acids, n‐3 polyunsaturated fatty acids and vitamin D) exert their potential beneficial effects on gut microbiota and immune function, resulting in clinical remission and/or preventing relapse. However, data is limited to conclude optimal micronutrient levels and therapeutic implications. Further, diet itself is complex; therefore, it is reasonable to evaluate diet as a whole rather than a single type of food. Some specific dietary patterns are generated for the management of inflammatory bowel diseases with controversial results. Only exclusive enteral nutrition has been widely recommended for pediatric patients with non‐stricturing active Crohn's disease. Self‐monitoring, avoidance of certain types of foods, limited intake of alcohol and smoking, supplementation of minerals and vitamins if deficiency is confirmed, and adherence to the diet enriched in vegetables and fruits and low in animal food and un‐digested fiber during flares are the most common dietary recommendation. Further clinical trials with a high evidence rank are warranted.

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Section: Diet In the Pathogenesis Of Ibdmentioning

confidence: 99%

The role of dietary factors in inflammatory bowel diseases: New perspectives

Zhou

Yan

2018

J of Digest Diseases

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“…Our Institution serves an ethnically mixed population in South London and we have described previously un-know ethnicity differences in colonic polyp prevalence, 1 intestinal metaplasia in Barrett's oesophagus 2 and vitamin D deficiency in inflammatory bowel disease. 3 Methods A retrospective study on 530 patients who underwent FE testing from September 2011 to September 2015 was carried out. Patient demographics were retrieved from hospital records.…”

Section: Disclosure Of Interest None Declaredmentioning

confidence: 99%

“…We examined patient demographics, ASA and UGIB risk scores, shock index (SI; heart rate/systolic BP), referral times to endoscopy and breach rates, anaesthetic and operator details, endoscopic findings and therapy (blood product use, interventional radiology and surgery), procedural documentation, re-bleed plans, discharge location, complications and inpatient mortality. (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). 64% were classified as theatre urgency 1 (U1; within 60 mins) and 25% U3 (within 180 mins).…”

mentioning

confidence: 99%

PWE-151 Alcohol-Related Admissions to A Central London Hospital: Too Little Coding; Too Much Resource: Abstract PWE-151 Table 1

Blad¹,

Lovendoski

et al. 2016

Gut

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IntroductionAlcohol-related harm costs the NHS £3.6 billion per year, of which 78% is costs to the hospital.1 Alcohol is traditionally poorly coded in UK hospitals and so estimating alcohol-related admissions and the resources they consume can be challenging. Underestimation may adversely influence service requirements and underestimate the impact of cost reduction measures.MethodsHospital admissions to a Central London Hospital for a 101 day period were identified from four sources:A search of 25 alcohol-related ICD-10 discharge diagnosis codes;Patients reviewed by the alcohol liaison nurse;All CT Head scans completed were analysed for evidence of alcohol misuse;Patients attending The Accident and Emergency Department (A&E) with alcohol misuse.ResultsOver this 101 day period, 537 admissions in 349 individual patients with harmful/hazardous alcohol use were identified with a total of 2,855 inpatient bed days and 104 day case procedures. 237 (44%) of these admissions did not have an alcohol-related discharge code. The mean admission length was 5.3 days. Fifty-eight percent of these patients had presented to the hospital at least once in the previous year with a total of 914 attendances, resulting in 518 admissions. This estimates 1,941 admissions per year in patients who drink to excess and a total of 10,318 inpatient bed days, equating to 28 inpatients per day. Eighty percent of these were emergencies accounting for 9.5% of all emergency admissions to the hospital.The table lists the resources used by this cohort both during the index admission and over the past 12 months:Abstract PWE-151 Table 1Investigations/ProceduresIndex admissionLast 12 monthsCT Head12387Ultrasound Abdomen/Liver3766Endoscopy4067Operation9936MRI2324Other CT6781Other Ultrasound (including ECHO)7292Other Procedures8699ITU/HDU Admission148Over the same period, A&E ordered 464 CT Head scans, of which 112 (24%) were due to alcohol with head injuries being the commonest indication (34.4% alcohol-related). Alcohol was involved in 133 (22.2%) scans done within 24 hours of admission, estimating almost 500 scans per year.ConclusionOur data demonstrates that alcohol admissions are poorly coded and therefore the extent of alcohol-related resource use is likely to be an underestimation. We expect there to be further admissions not picked up using the above methods. Alcohol-related admissions account for high resource use and the costs, in bed days alone, exceed £3,500,000 per year in a single hospital. Accurately coding admissions is crucial to ensure that this group of patients, with high resource use, can be identified so that measures can be taken to treat their alcohol misuse and reduce the burden on healthcare.Reference1 Statistics on Alcohol: England, 2013. Health and Social Care Information Centre. 2013.Disclosure of InterestNone Declared

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Section: Vitamin D and Crohn's Diseasementioning

confidence: 99%

“…Modifiable determinants which may result in suboptimal vitamin D in the CD patient include; malnutrition (reduced dietary intake), malabsorption secondary to surgical resection or diseased mucosa (predominantly in the ileum), 214 protein losing enteropathy, reduced physical activity, prolonged corticosteroid use, 215 anticonvulsant therapy, 216 smoking, 217 and reduced sunlight exposure (seasonal variation) 208 because of illness (Table 3). 16,209,213,[218][219][220] Although somewhat counterintuitive, malnutrition in a CD patient can coexist with overweight or obesity (body mass index [BMI] >30), a scenario that is becoming increasingly prevalent in many CD patients. 221 Obesity has been associated with a higher risk of relapsing disease in the CD patient, and adipose tissue itself is now recognized for its proinflammatory actions and resultant low grade inflammatory state within the body.…”

Section: Deficiency In Crohn's Diseasementioning

confidence: 99%

Vitamin D and Crohn's Disease in the Adult Patient

Basson

2013

J Parenter Enteral Nutr

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Crohn's disease (CD) is characterized as a chronic immune-mediated inflammatory disorder of the gastrointestinal tract. Current consensus surrounding the cause of the disease suggests a complex interplay between genetic susceptibility, the intestinal microbiome and environmental factors, leading to the aberrant Th1 and Th17 immune cell mediated response. Vitamin D deficiency is common in CD patients, and long-standing deficiency has been associated with reduced bone mineral density (BMD). Accumulating evidence now suggests that in addition to maintaining skeletal integrity, vitamin D also plays an integral role in regulating the general immune response, a function employed via its genomic actions on the vitamin D receptor (VDR). The VDR is expressed in all immune cells and both directly and indirectly targeted by the bioactive form of vitamin D, 1,25-Dihydroxyvitamin D (1,25[OH]2D). Impaired regulation or deficiency of the vitamin has been linked to the promotion of self-reactive T cell development, loss of immune tolerance to self-structures, and experimental colitis in animal models, whereas the subsequent administration of the vitamin in these models resulted in the improvement of immune-mediated symptoms. In addition, low vitamin D has been associated with disease activity in CD patients, and supplementation appears to be beneficial in improving clinical scores and reducing inflammation. Therefore, the primary aims of this article were to review the molecular evidence supporting the immunoregulatory roles of vitamin D and its supplementation in the CD patient, based on existing literature. The physiological processes, accepted serum concentration values, and its well-recognized role in bone health were also summarized.

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Factors associated with vitamin D deficiency in a multicultural inflammatory bowel disease cohort

Cited by 32 publications

References 20 publications

The role of dietary factors in inflammatory bowel diseases: New perspectives

The role of dietary factors in inflammatory bowel diseases: New perspectives

PWE-151 Alcohol-Related Admissions to A Central London Hospital: Too Little Coding; Too Much Resource: Abstract PWE-151 Table 1

Vitamin D and Crohn's Disease in the Adult Patient

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