Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Abstract

OBJECTIVES-Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report (1) the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration ≤15 ng/mL) in a large population with inflammatory bowel disease, (2) factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration.PATIENTS AND METHODS-A total of 130 patients (8-22 years of age) with inflammatory bowel disease, 94 with Crohn disease and 36 with ulcerative colitis, had serum 25-hydroxyvitamin D, intact parathyroid hormone, and lumbar spine bone mineral density (using dual-energy x-ray absorptiometry) measured at Children's Hospital Boston. RESULTS-The prevalence of vitamin D deficiency was 34.6%. Mean serum 25-hydroxyvitamin D concentration was similar in patients with Crohn disease and ulcerative colitis, 52.6% lower among patients with dark skin complexion, 33.4% lower during the winter months (December 22 to March 21), and 31.5% higher among patients who were taking vitamin D supplements. Serum 25-hydroxy-vitamin D concentration was positively correlated with weight and BMI z score, disease duration, and serum albumin concentration and negatively correlated with erythrocyte sedimentation rate. Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it. Serum 25-hydroxyvitamin concentration was not associated with lumbar spine bone mineral density z score or serum parathyroid hormone concentration.CONCLUSIONS-Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn disease. The long-term significance of hypovitaminosis D for this population is unknown at present and merits additional study. Copyright © 2006 by the American Academy of PediatricsAddress correspondence to Helen M. Pappa, MD, MPH, Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. helen.pappa@childrens.harvard.edu. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2011 November 1. Available reports on the vitamin D status of adults with CD place the prevalence of 25OHD concentration ≤15 ng/mL between 22% and 70%, depending on the study. 21-31 Serum 25OHD concentration was found to be <10 ng/mL in 8% to 45% of adults with CD. 21,22,24,26 One study reports a negative relationship among disease duration, Crohn Disease Activity Index, ferritin, C-reactive protein, cholesterol, 24 and 25OHD concentration.Other studies report that smoking 21 and small bowel resection 30,32 are also negativel...

Intestinal epithelial vitamin D receptor signaling inhibits experimental colitis

“…The biological activity of 1,25(OH) 2 D 3 is mediated by the vitamin D receptor (VDR), a member of the nuclear hormone receptor superfamily (19). A growing body of epidemiological data has documented an association between vitamin D deficiency and increased risk of IBD (20)(21)(22), including both CD and UC (23)(24)(25)(26)(27)(28)(29)(30). A high prevalence of vitamin D deficiency was reported in patients with established as well as newly diagnosed IBD (31)(32)(33).…”

The Role of Vitamin D3 in Inflammatory Bowel Diseases

“…The deficiency appeared mostly in winter and autumn and was not connected with the location and the severity of the disease [22]. Whereas in the studies conducted in Boston among children with IBD, the deficit of vitamin D3 was found in 34.6% with the similar frequency in the group with CD and UC (ulcerative colitis), more frequently among black patients, in winter, with the affected upper part of alimentary tract, and among those who were not supplemented with vitamin D3, with more severe course of disease -low BMI, low concentration of albumins, high ESr, and at the beginning of the disease [23]. Ethnic factors may also play a part in the status of vitamin D3 among patients with IBD -more frequent deficits were found among black children as well as among adults of the southern-Asian origin compared to the Caucasians [23,24].…”

Hypovitaminosis D and Low Bone Mineral Density in Inflammatory Bowel Disease Patients

“…This lack of correlation has been reported in the literature by several authors [18,19] who, among other mechanisms, also suggest a possible important role of vitamin D at the intestinal level that would allow a greater absorption of vitamin D secondary to the beneficial effects of a longer therapy and therefore a better control of the activity of the disease itself. In contrast, other authors have found an inverse correlation between the duration of disease and serum levels of vitamin D, especially in patients with Crohn's disease [20].…”