P652 Underweight patients with Crohn’s disease and without vitamin D supplementation are at high risk of vitamin D deficiency

Abstract Background Vitamin D deficiency is frequently present in inflammatory bowel disease (IBD) with a higher incidence in Crohn’s disease (CD) than in ulcerative colitis (UC). Given the involvement of the alimentary tract, many factors can contribute to vitamin D deficiency. The aim of the study was to investigate the association of vitamin D deficiency according to body mass index (BMI) in adult patients with IBD. Methods A cross-sectional study was conducted on a cohort of 152 IBD patients, 68.1% (n = 104) CD and 31.9% (n = 48) UC. The mean age of the total study population was 37.3±11.8 years and 57.3% (n = 87) were male. All patients were adult, Caucasian and without vitamin D supplementation. Patients were recruited during one year period. Results Out of all IBD patients, 60.5% (n = 92) had vitamin D deficiency, 32.2%, (n = 49) insufficiency and 7.2% (n = 11) sufficiency. According to BMI categories there were 12.5% (n = 19) obese patients, 27.6% (n = 42) overweight, 51.3% (n = 78) with normal body weight, and 8.6% (n = 13) underweight. There was a significant difference in vitamin D levels according to different BMI categories in terms of underweight patients having the lowest vitamin D levels; underweight 29.84±11.94 mmol/l, normal 46 ± 20.7 mmol/l, overweight 48±20.1 mmol/l, obese 51±15.3 mmol/l. In addition, there was a significant correlation of vitamin D levels and BMI values (Rho = 0.212, 95% CI 0.069–0.345, p = 0.004), which was more clearly observed in the lower range of BMI values (Figure 1). Male underweight patients had lower levels of vitamin D compared with female patients (26.6 ± 9 vs. 34.7 ± 5.6, p < 0.05). Both patients with CD and UC had significant positive correlation of vitamin D levels and BMI values (UC Rho=0.40, 95% CI 0.16–0.59, p = 0.001, UC Rho = 0.27, 95% CI 0.01–0.05, p = 0.044). However, when comparing vitamin D levels according to phenotype, a significant difference in vitamin D levels was observed in underweight CD (28.4 ± 11.1) comparing to underweight UC patients (40.6 ± 10.6), p < 0.05. In logistic regression analysis, CD phenotype was risk factor for vitamin D deficiency (OR 2.18 95% CI 1.01–4.72, β = 1.22, p = 0.04). Conclusion Our results on untreated IBD patients show a high proportion of vitamin D deficiency both in CD and UC, and significant correlation of vitamin D levels and BMI values, especially in the lower range of BMI values. Moreover, underweight CD patients have lower vitamin D levels comparing to UC. This suggests the need for regular vitamin D monitoring and supplementation especially in IBD patients at risk.

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

Proceedings of The Nutrition Society ◽

10.1017/s0029665114001591 ◽

2014 ◽

Vol 74 (1) ◽

pp. 56-66 ◽

Cited By ~ 26

Author(s):

Tara Raftery ◽

Maria O'Sullivan

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Vitamin D Deficiency ◽

Innate And Adaptive Immunity ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

Colon Cancer Prevention ◽

25 Hydroxyvitamin D ◽

Skeletal Effects

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.

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Vitamin D Deficiency Is Associated with Endoscopic Severity in Patients with Crohn’s Disease

Gastroenterology Research and Practice ◽

10.1155/2017/4869718 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Lingna Ye ◽

Ziwen Lin ◽

Jing Liu ◽

Qian Cao

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Activity Index ◽

Disease Activity Index ◽

Vitamin D Status ◽

Serum 25Ohd ◽

Vitamin D Levels

Background and Aims. Vitamin D deficiency is common in patients with Crohn’s disease and is associated with disease activity. Relationship between vitamin D and endoscopic disease activity is unknown. The aim of the study is to determine the association between vitamin D status and endoscopic disease activity in CD patients.Methods. Consecutive hospitalized CD patients from 2014 to 2016 who received vitamin D assessment and colonoscopy were retrospectively evaluated. Clinical disease activity was assessed by Crohn’s disease activity index and C-reactive protein. Endoscopic activity was calculated using simple endoscopic score for Crohn’s disease.Results. Median serum 25OHD level of 131 patients was lower than healthy controls [21.1 nmol/L (11.8–32.3) versus 49.9 nmol/L (44.9–57.4),P=0.007]. 125 (95%) patients had vitamin D deficiency and the rest (5%) had vitamin D insufficiency. Serum 25OHD was inversely correlated with CRP (r=−0.308,P<0.001), CDAI (r=−0.582,P<0.001), SES-CD (r=−0.294,P=0.001), and endoscopic severity stratified by SES-CD (P=0.001).Conclusion. Vitamin D deficiency was prevalent among hospitalized CD patients. Vitamin D levels were inversely correlated with endoscopic disease activity. Vitamin D status could be a biomarker in assessing disease activity among hospitalized CD patients in addition to CDAI and CRP.

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Does vitamin D supplementation improve ovarian reserve in women with diminished ovarian reserve and vitamin D deficiency: a before-and-after intervention study

BMC Endocrine Disorders ◽

10.1186/s12902-021-00786-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shahintaj Aramesh ◽

Touran Alifarja ◽

Ramin Jannesar ◽

Parvin Ghaffari ◽

Raziyeh Vanda ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Ovarian Reserve ◽

Intervention Study ◽

Vitamin D Supplementation ◽

Diminished Ovarian Reserve ◽

Favorable Effect ◽

Vitamin D Levels ◽

Significant Difference ◽

Before And After

Abstract Objective Evaluation of vitamin D supplementation on ovarian reserve in women with diminished ovarian reserve and vitamin D deficiency. Methods The study is a before-and-after intervention study that was performed on women with diminished ovarian reserve referred to Shahid Mofteh Clinic in Yasuj, Iran. Eligible women were prescribed vitamin D tablets at a dose of 50,000 units weekly for up to 3 months. Serum levels of vitamin D and AMH were evaluated at the end of 3 months. Significance level was also considered P ≤ 0.05. Results Our results have been showed there was a statistically significant difference in vitamin D levels of participants before [12.1(6.5)] and after [26(9.15)] the intervention (P < 0.001). Moreover, there was a statistically significant difference in serum AMH levels of participants before [0.50(0.44)] and after [0.79(0.15)] the intervention (P=0.02 ). Conclusion In conclusion, the results of the current study support a possible favorable effect of vitamin D on increase AMH expression by acting on the AMH gene promoter. Therefore, it is possible that vitamin D increases AMH levels without changing the antral follicle count/ovarian reserve.

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Sarcopenia and Vitamin D Deficiency in Patients with Crohn’s Disease: Pathological Conditions That Should Be Linked Together

Nutrients ◽

10.3390/nu13041378 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1378

Author(s):

Francesco Palmese ◽

Rossella Del Toro ◽

Giulia Di Marzio ◽

Pierluigi Cataleta ◽

Maria Giulia Sama ◽

...

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

Nutrient Deficiencies ◽

Pathological Conditions ◽

High Prevalence ◽

The Relationship

Sarcopenia is a prevalent condition in patients with Crohn’s disease (CD), representing an independent predictor factor for the development of major postoperative complications. Thus, a proper assessment of the muscle strength, by using different validated tools, should be deemed an important step of the clinical management of these patients. Patients with CD are frequently malnourished, presenting a high prevalence of different macro- and micro-nutrient deficiencies, including that of vitamin D. The available published studies indicate that vitamin D is involved in the regulation of proliferation, differentiation, and regeneration of muscle cells. The relationship between vitamin D deficiency and sarcopenia has been extensively studied in other populations, with interesting evidence in regards to a potential role of vitamin D supplementation as a means to prevent and treat sarcopenia. The aim of this review was to find studies that linked together these pathological conditions.

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Screening and Treatment of Vitamin D Deficiency in UK Patients with Crohn’s Disease: Self-Reported Practice among Gastroenterologists

Nutrients ◽

10.3390/nu12041064 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1064

Author(s):

Jane Fletcher ◽

Amelia Swift ◽

Martin Hewison ◽

Sheldon C Cooper

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Vitamin D Deficiency ◽

British Society ◽

Dietary Advice ◽

Mean Frequency ◽

Screening Practice ◽

Vitamin D Levels ◽

Bowel Diseases

Currently, there is no UK national recommendation to measure vitamin D levels in patients with inflammatory bowel diseases (IBD). Patients with IBD are at risk of developing vitamin D deficiency with the highest prevalence frequently reported in those with Crohn’s disease (CD). Treating vitamin D deficiency as part of CD management continues to be of interest. Our aim was to identify influences on practice and self-reported practice among British Society of Gastroenterology (BSG)-IBD section members in the screening and the treatment of vitamin D deficiency in patients with CD. A web-based survey was distributed via email to members of the BSG-IBD section. Reported screening practice was generally annual in those with a history of previous surgery related to CD or small bowel CD. A total of 83% of respondents (n = 64) thought that vitamin D levels should be routinely monitored in patients with CD. Treatments for mild/moderate deficiency included increased sunlight exposure (mean frequency = 21, SD = 15) and dietary advice (mean frequency = 22, SD = 14); in moderate/severe deficiency, oral supplementation was recommended (mean frequency = 14, SD = 13). Respondents reported factors most likely to influence practice, including clearer evidence and guidance. Well conducted studies in CD patients with identified vitamin D deficiency are needed to inform national guidance and clinical practice.

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Mo1911 - Higher Vitamin D Levels Correlate with Reduced Risk of Post-Operative Recurrence in Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(18)32875-0 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-849

Author(s):

Akihiro Yamada ◽

Yuga Komaki ◽

Fukiko Komaki ◽

Dejan Micic ◽

Joel R. Pekow ◽

...

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Vitamin D Levels ◽

Reduced Risk

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The Correlation between Vitamin D Levels and the Risk of Postoperative Recurrence in Crohn’s Disease

Digestion ◽

10.1159/000513589 ◽

2021 ◽

pp. 1-9

Author(s):

Akihiro Yamada ◽

Yuga Komaki ◽

Fukiko Komaki ◽

Haider Haider ◽

Dejan Micic ◽

...

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Postoperative Recurrence ◽

Recurrence Rates ◽

Reactive Protein ◽

Endoscopic Recurrence ◽

Vitamin D Levels ◽

Endoscopic Remission ◽

The University

Background and Aims: Vitamin D deficiency has been associated with disease activity in Crohn’s disease (CD). We assessed whether there is a correlation between vitamin D levels and the risk of postoperative recurrence in CD. Methods: CD patients who underwent surgery were identified from a prospectively maintained database at the University of Chicago. The primary endpoint was the correlation of serum 25-hydroxy vitamin D levels measured at 6–12 months after surgery and the proportion of patients in endoscopic remission, defined as a simple endoscopic score for CD of 0. Clinical, biological (C-reactive protein), and histologic recurrences were also studied. Results: Among a total of 89 patients, 17, 46, and 26 patients had vitamin D levels of <15, 15–30, and >30 ng/mL, respectively. Patients with higher vitamin D levels were significantly more likely to be in endoscopic remission compared to those with lower levels (23, 42, and 67% in ascending tertile order; p = 0.028). On multivariate analysis, vitamin D >30 ng/mL (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.07–0.66, p = 0.006) and anti-tumor necrosis factor agent treatment (OR 0.25, 95% CI 0.08–0.83, p = 0.01) were associated with reduced risk of endoscopic recurrence. Rates of clinical, biological, and histologic remission trended to be higher in patients with higher vitamin D levels (p = 0.17, 0.55, 0.062, respectively). Conclusion: In the present study, higher vitamin D level was associated with lower risk of postoperative endoscopic CD recurrence. Further, studies are warranted to assess the role of vitamin D in postoperative CD recurrence.

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Sa1197 Effects of Vitamin D Supplementation on Intestinal Permeability, Plasma Cathelicidin and Human Beta-Defensin-2 in Crohn's Disease: Results From a Randomised Double-Blind Placebo-Controlled Study

Gastroenterology ◽

10.1016/s0016-5085(13)60803-3 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-226-S-227 ◽

Cited By ~ 1

Author(s):

Tara C. Raftery ◽

Adrian Martineau ◽

Claire Greiller ◽

Chun Seng Lee ◽

Deirdre McNamara ◽

...

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Permeability ◽

Vitamin D Supplementation ◽

Controlled Study ◽

Double Blind ◽

Double Blind Placebo

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To Supplement or not to Supplement? The Rationale of Vitamin D Supplementation in Systemic Lupus Erythematosus

The Open Rheumatology Journal ◽

10.2174/1874312901812010226 ◽

2018 ◽

Vol 12 (1) ◽

pp. 226-247 ◽

Cited By ~ 1

Author(s):

Alessandra Nerviani ◽

Daniele Mauro ◽

Michele Gilio ◽

Rosa Daniela Grembiale ◽

Myles J. Lewis

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Vitamin D Supplementation ◽

Current Evidence ◽

Systemic Lupus ◽

Vitamin D Receptors ◽

Vitamin D Levels

Background: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterised by abnormal activation of the immune system, chronic inflammation and organ damage. Lupus patients are more prone to be vitamin D deficient. However, current evidence is not conclusive with regards to the role played by vitamin D in SLE development, progression, and clinical manifestations. Objective: Here, we will summarise the current knowledge about vitamin D deficiency prevalence, risk factors, molecular effects, and potential pathogenic role in SLE. We will focus on the link between vitamin D deficiency and lupus clinical manifestations, and on the clinical trials assessing the effects of vitamin D supplementation in SLE. Method: A detailed literature search was performed exploiting the available databases, using “vitamin D and lupus/SLE” as keywords. The relevant interventional trials published over the last decade have been considered and the results are reported here. Conclusion: Several immune cells express vitamin D receptors. Thus, an immunomodulatory role for vitamin D in lupus is plausible. Numerous observational studies have investigated the relationship between vitamin D levels and clinical/serological manifestations of SLE with contrasting results. Negative correlations between vitamin D levels and disease activity, fatigue, renal and cardiovascular disease, and anti-dsDNA titres have been described but not conclusively accepted. In experimental models of lupus, vitamin D supplementation can improve the disease. Interventional trials have assessed the potential therapeutic value of vitamin D in SLE, but further larger studies are needed.

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