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

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.780 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S536-S537

Author(s):

D Vranesic Bender ◽

V Domislović ◽

M Brinar ◽

D Ljubas Kelečić ◽

I Karas ◽

...

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

Lower Range ◽

Total Study Population ◽

Vitamin D Levels ◽

Significant Difference ◽

Underweight Patients

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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Vitamin D status in children with inflammatory bowel disease

Voprosy detskoj dietologii ◽

10.20953/1727-5784-2021-1-5-10 ◽

2021 ◽

Vol 19 (1) ◽

pp. 5-10

Author(s):

I.Yu. Pronina ◽

◽

V.S. Tsvetkova ◽

A.S. Potapov ◽

E.L. Semikina ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Vitamin D Status ◽

Vitamin D Levels ◽

Bowel Diseases ◽

Inflammatory Bowel

Objective. To study vitamin D status in children with inflammatory bowel diseases (IBD) depending on the diagnosis, gender, age and a season of examination. Patients and methods. The study included 244 children (130 boys and 114 girls) aged 3 to 18 years. The patients were divided into 2 groups depending on the nosological form of disease: Crohn’s disease (CD) – 130 children, ulcerative colitis (UC) – 114 children. Blood vitamin D levels were determined by the method of competitive electrochemiluminescence. Results. Normal levels of vitamin D (>30 ng/ml) were found only in 11.1% of children with IBD (in 11.5% with CD and 10.5% with UC). Vitamin D status corresponded to deficiency levels in 65.9% of cases, of them 15.2% had deep deficiency (<10 ng/ml). Vitamin D status decreased with increasing age of the patients (ρ = -0.2686). No statistically significant differences were found in vitamin D levels that would be dependent on the season of examination, neither were they found in groups of patients with CD and UC. Conclusion. The study showed an extremely low vitamin D status in patients with IBD. The problem of assessing vitamin D levels in children with IBD and its monitoring as well as development of individual algorithms for supplementation remains topical. Key words: vitamin D, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, children

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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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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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