Optimal vitamin D levels in Crohn's disease: a review

Abstract

Vitamin D deficiency is common among patients with Crohn's disease. Serum 25-hydroxyvitamin D (25(OH)D) is the best measure of an individual's vitamin D status and current cut-off ranges for sufficiency are debatable. Several factors contribute to vitamin D deficiency in Crohn's disease. These include inadequate exposure to sunlight, inadequate dietary intake, impaired conversion of vitamin D to its active metabolite, increased catabolism, increased excretion and genetic variants in vitamin D hydroxylation and transport. The effects of low 25(OH)D on outcomes other than bone health are understudied in Crohn's disease. The aim of the present review is to discuss the potential roles of vitamin D and the possible levels required to achieve them. Emerging evidence suggests that vitamin D may have roles in innate and adaptive immunity, in the immune-pathogenesis of Crohn's disease, prevention of Crohn's disease-related hospitalisations and surgery, in reducing disease severity and in colon cancer prevention. The present literature appears to suggest that 25(OH)D concentrations of ≥75 nmol/l may be required for non-skeletal effects; however, further research on optimal levels is required.

Malnutrition Universal Screening Tool (MUST) predicts disease activity in patients with Crohn’s disease

“…Multivariable analysis revealed a significant association between elevated MUST score and a lower 25-hydroxy vitamin D level (p=0.032). The relationship between IBD and vitamin D has recently become a controversial topic of intense research, summarized well in several recent reviews [23][24][25][26]. In general, epidemiologic studies have demonstrated a high prevalence of vitamin D deficiency/insufficiency among patients with IBD (regardless threshold level used) and conversely, a higher vitamin D level is associated with a lower risk of CD [22].…”

Restoration of the anti-proliferative and anti-migratory effects of 1,25-dihydroxyvitamin D by silibinin in vitamin D-resistant colon cancer cells

“…Multiple observational studies have established that vitamin D exerts a protective effect in the colon through its active metabolite 1,25D [42–45]. Vitamin D deficiency is associated with increased hospitalization and surgery in IBD patients [46]. Vitamin D supplementation prevents relapse via an effect on intestinal permeability and improves muscle strength, fatigue, and quality of life in patients with Crohn’s disease [46].…”

“…Vitamin D deficiency is associated with increased hospitalization and surgery in IBD patients [46]. Vitamin D supplementation prevents relapse via an effect on intestinal permeability and improves muscle strength, fatigue, and quality of life in patients with Crohn’s disease [46]. A correlation exists between serum levels of 25D as a result of nutritional intake and/or exposure to sunlight and incidence of CRC, and higher plasma vitamin D levels are correlated with a reduced risk of CRC [47,48].…”

Aktualisierte S3-Leitlinie Colitis ulcerosa der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…In bestimmten Situationen, beispielsweise bei Adipositas, bei Einnahme von Antikonvulsiva oder unter Glukokortikoidtherapie, kann diese Dosis verdoppelt oder sogar verdreifacht werden. Gerade unter einer Glukokortikoidtherapie kann der Vitamin-D-Spiegel sinken, sodass er entweder kontrolliert werden sollte oder täglich 1000 IE 25-OH-Vitamin D supplementiert werden sollten [726,727]. [728].…”