Vitamin D in Children With Inflammatory Bowel Disease

Abstract

Background: Vitamin D has anti-inflammatory and immune regulatory functions. Goals: The authors investigated the effect of vitamin D supplementation in children with inflammatory bowel disease (IBD) and hypovitaminosis D on disease activity, quality of life (QOL), inflammatory markers, and cytokines. Study: This randomized double-blinded controlled clinical trial included 120 children with IBD and hypovitaminosis D; 22 of them were excluded later. Patients were randomized to receive either oral vitamin D3 in a dose of 2000 IU/day or placebo for 6 months. The primary outcome was to evaluate the effect of vitamin D supplementation on the IBD activity score. The secondary outcomes were to assess the QOL, inflammatory markers, cytokines, the safety of vitamin D, and to correlate serum vitamin D level with various clinical and laboratory variables. Results: Vitamin D supplementation significantly decreased the IBD activity score in the vitamin D group compared with the placebo group. Moreover, QOL significantly improved after vitamin D supplementation. Inflammatory markers, for example, erythrocyte sedimentation rate, C-reactive protein, and fecal calprotectin and interleukin-2 IL-12, IL-17, IL-23, and tumor necrosis factor-alpha significantly decreased in the vitamin D group. However, IL-10 significantly increased after vitamin D supplementation. Vitamin D was significantly inversely correlated with the activity score, QOL score, levels of all inflammatory markers, the frequency of hospitalization, and emergency department visits. Conclusion: Vitamin D supplementation may have a beneficial effect in children with IBD.

Gut Microbiota Is a Potential Biomarker in Inflammatory Bowel Disease

“…Of these biomarkers, fecal calprotectin (FC) correlates best with the number of active inflammation sites reported from biopsy than serum CRP and white blood cell count (15). Erythrocyte sedimentation rate (ESR), platelet count, and serum albumin level are also used to help assess IBD inflammation (54,55), though they are not particularly accurate measures of the disease.…”

Pharmacological Modulation of Immune Responses by Nutritional Components

“…Vitamin D has the ability to inhibit the Th1 response related to the observed decreased in Th1related cytokines observed in their clinical study and previously performed in vitro studies (Sharifi et al, 2019). In contrary, vitamin D supplementation had clinical benefit in patients with both IBD and hypovitaminosis D, since the release of proinflammatory cytokines IL-2, IL-12, IL-13, and IL-17 were downregulated, suggesting suppression of the Th17 phenotype, whereas TNF-a levels were decreased, in contrast to the results of Sharifi et al (2019) (El Amrousy et al, 2020). Furthermore, vitamin D supplementation lowered the incidence of upper airway infections caused by the influenza virus investigated in patients with IBD (Arihiro et al, 2019).…”

Dietary Management in Pediatric Patients with Crohn’s Disease

“…Low serum vitamin D levels have been demonstrated to be associated with disease activity and with poorer clinical course in adult patients with IBD [ 109 ]. Recently, El Amrousy et al [ 110 ] conducted a double-blinded, randomized clinical trial on 120 children and adolescents affected by IBD and hypovitaminosis D who were randomized to receive either oral vitamin D3 in a dose of 2000 IU/day or placebo for 6 months. The authors reported that vitamin D supplementation was significantly inversely associated with clinical activity scores (PCDAI: 13.6 ± 3.1 in treatment group vs. 27.5 ± 3.5 in placebo group; PUCAI: 11.1 ± 2.4 in treatment group vs. 21.8 ± 2.9 in placebo group; p = 0.001) and with serum and fecal inflammatory markers (C-reactive protein (CRP), fecal calprotectin (FC) and pro-inflammatory cytokines).…”