Risk Factors for Vitamin D Deficiency and Impact of Repletion in a Tertiary Care Inflammatory Bowel Disease Population

Zullow, Samantha; Jambaulikar, Guruprasad; Rustgi, Ankur; Quezada, Sandra; Cross, Raymond K.

doi:10.1007/s10620-017-4614-y

Cited by 19 publications

(13 citation statements)

References 17 publications

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“…More than half of the patients (58.4%) in our study population had vitamin D deficiency, and one-third of patients (32.4%) had vitamin D insufficiency. This is in line with other similar studies, which report high proportion of patients who were vitamin D deficient or insufficient [23][24][25][26] . In addition, the average BMI of our cohort was in the normal range, so the patients were not malnourished, which could also be a reason for low vitamin D levels.…”

Section: Discussionsupporting

confidence: 93%

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High Prevalence of Untreated and Undertreated Vitamin D Deficiency and Insufficiency in Patients with Inflammatory Bowel Disease

2020

ACC

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-Inflammatory bowel disease (IBD) patients with vitamin D deficiency show an increased risk of hospital admission, surgery, and loss of response to biologic therapy while high vitamin D levels are identified as a protective factor. Our goal was to investigate the prevalence of untreated and undertreated vitamin D deficiency and factors associated with vitamin D deficiency. In this cross-sectional study, we measured serum vitamin D in a random sample of Caucasian IBD patients. Vitamin D deficiency was defined as <50 nmol/L and insufficiency as 50-75 nmol/L. Supplementation was defined as taking 800-2000 IU vitamin D daily. Untreated patients were defined as not taking supplementation and undertreated group as receiving supplementation but showing vitamin D deficiency or insufficiency despite treatment. Our study included 185 IBD patients, i.e. 126 (68.1%) with Crohn's disease (CD) and 59 (31.9%) with ulcerative colitis (UC). Overall, 108 (58.4%) patients had vitamin D deficiency and 60 (32.4%) patients vitamin D insufficiency. There were 16 (14.8%) and 11 (18.3%) treated patients in vitamin D deficiency and vitamin D insufficiency group, respectively. The rate of untreated patients was 81.7% (n=49) in vitamin D deficiency group and 85.2% (n=92) in vitamin D insufficiency group. Tumor necrosis factor alpha inhibitors were associated with higher serum vitamin D levels in CD and UC, and ileal involvement, ileal and ileocolonic resection with lower levels. In conclusion, not only is vitamin D deficiency common in IBD patients but the proportion of untreated and undertreated patients is considerably high. We suggest regular monitoring of vitamin D levels in IBD patients regardless of receiving vitamin D supplementation therapy.

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Section: Discussionsupporting

confidence: 93%

“…Zullow et al . found the prevalence of vitamin D deficiency of 38.8% and vitamin D insufficiency of 28.6% ( 24 ). Finally, Zator et al .…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Untreated and Undertreated Vitamin D Deficiency and Insufficiency in Patients with Inflammatory Bowel Disease

2020

ACC

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“…A close monitoring of BMD, better control of disease activity, physical activity, and dietary intake of calcium and vitamin D are recommended to diminish the loss of bone mass in patients with CD and UC [ 151 , 152 ]. European Crohn's and Colitis Organisation (ECCO) recommends weight-bearing exercise, smoking cessation, and maintaining adequate dietary calcium > 1 g/day to prevent bone loss in patients with IBD [ 153 ].…”

Section: The Asian Working Group Guidelines Regarding Diet In Inflammmentioning

confidence: 99%

Diet and inflammatory bowel disease: The Asian Working Group guidelines

Sood

Ahuja

Kedia

et al. 2019

Indian J Gastroenterol

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Introduction These Asian Working Group guidelines on diet in inflammatory bowel disease (IBD) present a multidisciplinary focus on clinical nutrition in IBD in Asian countries. Methodology The guidelines are based on evidence from existing published literature; however, if objective data were lacking or inconclusive, expert opinion was considered. The conclusions and 38 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. Results Diet has an important role in IBD pathogenesis, and an increase in the incidence of IBD in Asian countries has paralleled changes in the dietary patterns. The present consensus endeavors to address the following topics in relation to IBD: (i) role of diet in the pathogenesis; (ii) diet as a therapy; (iii) malnutrition and nutritional assessment of the patients; (iv) dietary recommendations; (v) nutritional rehabilitation; and (vi) nutrition in special situations like surgery, pregnancy, and lactation. Conclusions Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 38 recommendations.

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“…A research on a cohort of 201 CD patients in Canada stated that CRP was significantly lower in patients with vitamin D deficiency [33]. Other studies did not reach such an agreement [19, 20, 35, 36]. A study conducted by Garg et al found a correlation between 25(OH)D3 levels and calprotectin with Pearson's r = −0.35 but no correlation with systemic inflammatory markers like CRP and PLT.…”

Section: Discussionmentioning

confidence: 99%

A New Model Based on 25-Hydroxyvitamin D3 for Predicting Active Crohn’s Disease in Chinese Patients

Lin

Wang

et al. 2018

Mediators of Inflammation

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Background The association between vitamin D3 and activity of Crohn's disease (CD) is unclear in Chinese patients. In this study, we aimed to evaluate the correlations between serum levels of 25-hydroxyvitamin D3 (25(OH)D3) and disease activity and predict active disease based on vitamin D status. Methods Between January 2014 and December 2017, 346 CD patients from the First Affiliated Hospital of Sun Yat-sen University were recruited and categorized into a group with 25(OH)D3 ≤ 20 ng/ml and a group with 25(OH)D3 > 20 ng/ml. The clinical characteristics, medication, and health-care needs were compared between the groups. The correlations among 25(OH)D3 and routine serum biomarkers and disease activity were examined. The predictive efficiency of 25(OH)D3 and other biomarkers for active diseases was also explored using receiver-operating characteristic (ROC) curve analysis. A new predictive model, −(5∗25(OH)D3 + 2∗Hb) + ESR, and a nomogram were established using Logistic Regression. Results Patients with 25(OH)D3 ≤ 20 ng/ml had higher serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and platelets (PLT) and lower levels of hemoglobin (Hb) and albumin (ALB). Serum levels of 25(OH)D3 were inversely correlated with the score of Crohn's Disease Activity Index (CDAI) (rs = −0.608). ROC analysis showed a better predictive value of −25(OH)D3 and the new model with areas under curve (AUC) of 0.804 and 0.879, respectively, than those of CRP (0.693) and ESR (0.713) in disease activity. A nomogram for prediction was established with a c-index of 0.882. Conclusions Serum levels of 25(OH)D3 negatively correlated with CD activity in Chinese patients. The new model and a nomogram based on 25(OH)D3 showed a better efficiency in predicting disease activity in CD patients but warrants further study.

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Risk Factors for Vitamin D Deficiency and Impact of Repletion in a Tertiary Care Inflammatory Bowel Disease Population

Cited by 19 publications

References 17 publications

High Prevalence of Untreated and Undertreated Vitamin D Deficiency and Insufficiency in Patients with Inflammatory Bowel Disease

High Prevalence of Untreated and Undertreated Vitamin D Deficiency and Insufficiency in Patients with Inflammatory Bowel Disease

Diet and inflammatory bowel disease: The Asian Working Group guidelines

A New Model Based on 25-Hydroxyvitamin D3 for Predicting Active Crohn’s Disease in Chinese Patients

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