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

Abstract

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.

Self-Prescribed Dietary Restrictions are Common in Inflammatory Bowel Disease Patients and Are Associated with Low Bone Mineralization

“…An inadequate calcium intake was confirmed in 80% of the overall patients, and in 97% of women, and this is in line with previous studies showing that most IBD patients did not achieve the recommended intake of calcium with diet [36,38]. Accordingly, mean serum levels of vitamin D were found insufficient, with no difference among UC and CD patients, confirming that IBD patients display frequently low serum vitamin D concentrations [39,40]. The clinical relevance of the above-mentioned nutritional deficit involves mainly bone health, as a high rate of osteoporosis and osteopenia have been reported among IBD patients compared with the general population [41,42].…”

Plasma 25-Hydroxyvitamin D Concentrations and Serum and Salivary C-Reactive Protein in the Osteoporosis and Periodontal Disease Study

“…Furthermore, limited research has investigated associations between blood concentrations of 25(OH)D and biomarkers of inflammation within the oral cavity, and this research has not appeared to include measures of salivary CRP [ 17 , 18 , 19 , 20 ]. For our analyses, we hypothesized that 25(OH)D concentrations would be inversely associated with serum CRP, as previously observed in other studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ], and that 25(OH)D concentrations would also be inversely associated with salivary CRP concentrations.…”

“…CRP is a non-specific marker of inflammation, and few studies have assessed the role of salivary CRP independent of CVD risk [ 40 , 41 , 42 , 43 ]. Vitamin D is thought to have anti-inflammatory properties [ 9 , 10 , 11 ], and some studies have observed that higher concentrations of 25(OH)D are associated with lower concentrations of systemic CRP [ 21 , 22 , 23 , 24 , 25 ]. However, few studies have investigated the relationship between 25(OH)D and salivary CRP, specifically in humans.…”

Assessment of Vitamin D in Colonic Diseases (Inflammatory Bowel Diseases and Irritable Bowel Syndrome)

“…According to a study done by Branco et al 2019 (20) , a total of 152 patients (52% men; 47.2 ± 17.3 years) were included, of whom 70% had Crohn's disease (CD). Mean 25-OH-D levels were 17.1 ± 8ng/mL (CD: 16.7 ± 8ng/mL vs. ulcerative colitis: 17.6 ± 7ng/mL).…”