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Nakamura Y, Kawai Y, Nagoshi S, Ogawa T, Hasegawa H. Multiple electrolytes imbalances in a patient with inflammatory bowel disease associated with vitamin D deficiency: a case report. J Med Case Rep 2024; 18:26. [PMID: 38246996 PMCID: PMC10802040 DOI: 10.1186/s13256-023-04302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease involves chronic inflammation and ulceration, primarily Crohn's disease and ulcerative colitis. The prevalence of inflammatory bowel disease is rising in industrialized countries. We describe the case of a patient with inflammatory bowel disease and multiple electrolyte disturbances that emphasize the link between a vitamin D deficiency and electrolyte imbalances. CASE An 86-year-old Japanese man with severe hypocalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia was referred to the gastroenterology and hepatology department our university hospital for severe diarrhea and abdominal pain. Based on clinical symptoms and biochemical and endoscopic findings, Crohn's disease, intestinal Behçet's disease, and intestinal tuberculosis were considered as differential diagnoses, but a final diagnosis was not reached. Prednisolone, azathioprine, and metronidazole were administered, and no apparent electrolyte abnormality was observed at the patient's admission to our hospital. On the 80th hospital day, marked hypocalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia were noted and prolonged, despite daily supplementation with Ca and inorganic P. At his consultation with our department, we observed decreased fractional excretion of Ca, tubular reabsorption of phosphate, fractional excretion of K, and fractional excretion of Mg, suggesting the depletion of vitamin D and extrarenal wasting of K and Mg. The patient's serum Ca and inorganic P were quickly elevated in response to treatment with an active form of vitamin D, and his serum levels of K and Mg were restored to the normal range by an intravenous administration of K and Mg. A vitamin D deficiency is not rare in inflammatory bowel disease and is caused primarily by the decreased intestinal absorption of vitamin D. In the management of electrolyte imbalances in patients with inflammatory bowel disease, clinicians must consider the possible development of vitamin D deficiency-related disorders. CONCLUSION Vitamin D deficiency in entero-Behçet's disease leads to severe hypocalcemia and hypophosphatemia, highlighting the importance of awareness in management.
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Affiliation(s)
- Yumiko Nakamura
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Yuichiro Kawai
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Sumiko Nagoshi
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Tomonari Ogawa
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Hajime Hasegawa
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
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Fatahi S, Alyahyawi N, Albadawi N, Mardali F, Dara N, Sohouli MH, Prabahar K, Rohani P, Koushki N, Sayyari A, Hosseini AH, Abu-Zaid A. The association between vitamin D status and inflammatory bowel disease among children and adolescents: A systematic review and meta-analysis. Front Nutr 2023; 9:1007725. [PMID: 36698467 PMCID: PMC9868587 DOI: 10.3389/fnut.2022.1007725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/10/2022] [Indexed: 01/11/2023] Open
Abstract
Aim Vitamin D deficiency is very common among children with IBD. Since there are conflicting results regarding the association of vitamin D with IBD, we conducted this systematic review to confirm the association of vitamin D with IBD. Methods We conducted a systematic search in Scopus, Cochrane Library, Web of Science, PubMed, and Google Scholar to find relevant studies. Articles with cross-sectional and case-control designs that reported the association between vitamin D and IBD among children were included. Results Eventually, 9 studies (with 16 effect sizes) reported the mean and SD or the median and the interquartile range of serum vitamin D levels in both subjects with IBD and control subjects. The random effects meta-analysis revealed that subjects with IBD had -1.159 ng/ml (95% CI: -2.783, 0.464) lower serum vitamin D concentrations compared with their healthy counterparts, but this difference was not significant. A total of 14 studies (with 18 effect sizes) with 2,602 participants provided information for the prevalence of vitamin D deficiency or insufficiency in patients with IBD as 44% (95% CI: 0.34-0.54) with significant heterogeneity noted among studies (p < 0.001; I2 = 97.31%). Conclusion This systematic and meta-analysis study revealed that vitamin D deficiency was associated with IBD. Longitudinal studies should be conducted in the future to confirm our findings. Large randomized controlled trials assessing the doses of supplementation of vitamin D would provide a better understanding of the association between vitamin D and IBD.
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Affiliation(s)
- Somaye Fatahi
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Naseem Alyahyawi
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Naryman Albadawi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Farzaneh Mardali
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Naghi Dara
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Koushki
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Sayyari
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Aliakbar Sayyari
| | - Amir Hossein Hosseini
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Amir Hossein Hosseini
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Sun YH, Tian DD, Zhou JM, Ye Q. Association between vitamin D level and pediatric inflammatory bowel disease: A systematic review and meta-analysis. Front Pediatr 2023; 11:1155004. [PMID: 37168807 PMCID: PMC10164952 DOI: 10.3389/fped.2023.1155004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
Background Previous studies have reported that the incidence of pediatric inflammatory bowel disease (IBD) is related to vitamin D, but it is still unclear. This study intends to calculate the relationship between pediatric IBD and vitamin D. Methods A comprehensive literature search from inception to January 2023 was performed in the PubMed, EMBASE, Medline, Web of Science, and Google Scholar databases. Relevant data were extracted as required and used for subsequent calculations. Results Sixteen papers were included, and there was no significant difference between the average vitamin D level in IBD patients and healthy controls. In addition, the overall pooled results showed that C-reactive protein (CRP) was 2.65 higher before vitamin D supplementation than after supplementation [SMD = 2.65, 95% CI = (2.26, 3.04)]. Moreover, patients with IBD in remission were 0.72 higher before vitamin D supplementation than after supplementation [OR = 0.72, 95% CI = (0.52, 1.00)]. Conclusion This study suggested that there was no obvious relationship between pediatric IBD and vitamin D, while vitamin D supplementation can improve disease activity. Therefore, follow-up still needs many prospective studies to confirm the relationship between pediatric IBD and vitamin D.
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Tulewicz-Marti EM, Lewandowski K, Rydzewska G. Bone Metabolism Alteration in Patients with Inflammatory Bowel Disease. J Clin Med 2022; 11:jcm11144138. [PMID: 35887903 PMCID: PMC9316624 DOI: 10.3390/jcm11144138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Metabolic bone disease is a common disorder, but there is a lack of data on it in patients with inflammatory bowel disease (IBD). Methods: In this prospective, one-centre study, we assessed bone mineral and vitamin D alterations in 187 IBD patients (119 with Crohn’s disease (CD) and 68 with ulcerative colitis (UC)). Results: While 81.3% of the patients had vitamin D deficiency, 14.2% of them had a severe deficiency. Elevated serum PTH concentrations were found in 14.9% of the patients. Only in 4.1% of cases was there an elevated level of a serum marker for bone formation (osteocalcin), whereas in 14.4% of cases, the bone resorption marker (CTX) was raised. The concentration of phosphate in urine was higher in the CD than in the UC group (51.20 vs. 31.25; p = 0.003). PTH was negatively associated with vitamin D level. Among the patients receiving corticosteroids, the CTX and CRP median levels were higher (0.49 vs. 0.38; p = 0.013 and 6.45 vs. 2.2; p = 0.029, respectively) compared with the group who did not receive them. Urine phosphate levels were lower (48.60 vs. 26.00; p = 0.005), as were osteocalcin (15.50 vs. 23.80; p < 0.001), and PTH (29.05 vs. 36.05; p = 0.018). Conclusions: Bone mineral alterations were common in patients with IBD, mostly in the CD patients. This may be associated with poor absorption, making CD patients vulnerable to changes in bone mineralization. Vitamin D supplementation remains crucial, especially when taking corticosteroids.
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Affiliation(s)
- Edyta Maria Tulewicz-Marti
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
- Correspondence:
| | - Konrad Lewandowski
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
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Diet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease. Nutrients 2022; 14:nu14051029. [PMID: 35268001 PMCID: PMC8912613 DOI: 10.3390/nu14051029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/08/2023] Open
Abstract
In the course of inflammatory bowel disease (IBD) malabsorption may lead to a vitamin D deficiency and calcium–phosphate misbalance. However, the reports on the vitamin D status in children with IBD are few and ambiguous. Here, we are presenting complex analyses of multiple factors influencing 25OHD levels in IBD children (N = 62; Crohn’s disease n = 34, ulcerative colitis n = 28, mean age 14.4 ± 3.01 years, F/M 23/39) and controls (n = 47, mean age 13.97 ± 2.57, F/M 23/24). Additionally, calcium–phosphate balance parameters and inflammatory markers were obtained. In children with IBD disease, activity and location were defined. Information about therapy, presence of fractures and abdominal surgery were obtained from medical records. All subjects were surveyed on the frequency and extent of exposure to sunlight (forearms, partially legs for at least 30 min a day), physical activity (at least 30 min a day) and diet (3 days diary was analyzed with the program DIETA 5). The mean 25OHD level was higher in IBD patients compared to controls (18.1 ng/mL vs. 15.5 ng/mL; p = 0.03). Only 9.7% of IBD patients and 4.25% of controls had the optimal vitamin D level (30–50 ng/mL). Despite the higher level of 25OHD, young IBD patients showed lower calcium levels in comparison to healthy controls. There was no correlation between the vitamin D level and disease activity or location of gastrointestinal tract lesions. Steroid therapy didn’t have much influence on the vitamin D level while vitamin D was supplemented. Regular sun exposure was significantly more common in the control group compared to the IBD group. We found the highest concentration of vitamin D (24.55 ng/mL) with daily sun exposure. There was no significant correlation between the vitamin D level and frequency of physical activity. The analysis of dietary diaries showed low daily intake of vitamin D in both the IBD and the control group (79.63 vs. 85.14 IU/day). Pediatric patients, both IBD and healthy individuals, require regular monitoring of serum vitamin D level and its adequate supplementation.
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Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients. Sci Rep 2020; 10:12316. [PMID: 32704054 PMCID: PMC7378261 DOI: 10.1038/s41598-020-69405-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/22/2020] [Indexed: 01/20/2023] Open
Abstract
This study aimed to investigate the risk of acute kidney injury (AKI) in hospitalized patients based on admission serum ionized calcium levels. This is a cohort study of all hospitalized adult patients, from January 2009 to December 2013 at a tertiary referral hospital, who had available serum ionized calcium at the time of admission. We excluded patients who had end-stage kidney disease or AKI at admission. We stratified admission serum ionized calcium into 6 groups; ≤ 4.39, 4.40-4.59, 4.60-4.79, 4.80-4.99, 5.00-5.19, and ≥ 5.20 mg/dL. We used serum creatinine criterion of KDIGO definition for diagnosis of AKI. We performed logistic regression analysis to assess the risk of in-hospital AKI occurrence based on admission serum ionized calcium, using serum ionized calcium of 5.00-5.19 mg/dL as the reference group. We studied a total of 25,844 hospitalized patients. Of these, 3,294 (12.7%) developed AKI in hospital, and 622 (2.4%) had AKI stage 2 or 3. We observed a U-shaped association between admission serum ionized calcium and in-hospital AKI, with nadir in-hospital AKI was in serum ionized calcium of 5.00-5.19 mg/dL. After adjustment for confounders, low serum ionized calcium of 4.40-4.59, ≤ 4.39 mg/dL and elevated serum ionized calcium ≥ 5.20 mg/dL were associated with increased risk of AKI with odds ratio of 1.33 (95% CI 1.14-1.56), 1.45 (95% CI 1.21-1.74), and 1.26 (95% CI 1.04-1.54), respectively. Both hypocalcemia, and hypercalcemia at the time of admission were associated with an increased risk of hospital-acquired AKI.
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7
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Li XX, Liu Y, Luo J, Huang ZD, Zhang C, Fu Y. Vitamin D deficiency associated with Crohn's disease and ulcerative colitis: a meta-analysis of 55 observational studies. J Transl Med 2019; 17:323. [PMID: 31547829 PMCID: PMC6757415 DOI: 10.1186/s12967-019-2070-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the association of serum levels of 25(OH)D and 1,25(OH)2D3 in healthy and non-healthy controls with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Three electronic databases: PubMed, EMbase and EBSCOhost CINAHL, were searched for observational studies to measure the relationship between serum levels of vitamin D (VitD) and CD (or UC). RESULTS Fifty-five studies were included in the meta-analysis. We found that mean serum 25(OH)D levels in patients with CD were significantly lower than those in healthy controls (MD: - 3.17 ng/mL; 95% CI - 4.42 to - 1.93). Results from the meta-analysis examining 1,25(OH)2D3 levels in Crohn's patients revealed higher levels in the CD group than in healthy (MD: 3.47 pg/mL; 95% CI - 7.72 to 14.66) and UC group (MD: 5.05 pg/mL; 95% CI - 2.42 to 12.52). Serum 25(OH)D levels were lower in the UC group than in the healthy control group (MD: - 2.52 ng/mL; 95% CI - 4.02 to - 1.02). In studies investigating the level of 1,25(OH)2D3 in UC and healthy control groups, the level of 1,25(OH)2D3 in the UC groups were found to be higher than that in the control groups (MD: 3.76 pg/mL; 95% CI - 8.36 to 15.57). However, the 1,25(OH)2D3 level in patients with UC was lower than that in CD groups (MD: - 6.71 pg/mL; 95% CI - 15.30 to 1.88). No significant difference was noted between CD patients and UC patients in terms of average serum 25(OH)D levels. CONCLUSIONS This study found that VitD levels were inversely related to CD and UC. Serum levels of 25(OH)D were lower in patients with CD and UC than in healthy people, and more than half of the patients had insufficient vitamin D levels. The serum level of 1,25(OH)2D3 in both the CD and UC groups was higher than that in healthy people.
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Affiliation(s)
- Xi-Xi Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.,Zhejiang Chinese Medical University, No. 548, Binwen Road, Zhengjiang, 310053, China
| | - Yang Liu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Jie Luo
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Zhen-Dong Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.
| | - Yan Fu
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.
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Fritz J, Walia C, Elkadri A, Pipkorn R, Dunn RK, Sieracki R, Goday PS, Cabrera JM. A Systematic Review of Micronutrient Deficiencies in Pediatric Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:445-459. [PMID: 30137322 DOI: 10.1093/ibd/izy271] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review critically analyzes the current research on micronutrient deficiency in children with inflammatory bowel disease (IBD) and synthesizes these data to provide evidence-based guidelines for nutritional surveillance in this population. METHODS We searched 5 databases (Ovid Medline, PubMed, Scopus, CINAHL, and Cochrane Library) for studies evaluating micronutrients in patients with IBD using the following inclusion criteria: 1) original research, 2) published 1996 or later; 3) published in English; 4) human subjects; and 5) containing pediatric data. Studies were reviewed and included based on the strength of research methods. Data on the prevalence of micronutrient deficiencies in pediatric patients with IBD and risk factors for micronutrient deficiency in these patients were extracted from included studies and compared and discussed in preparation of the proposed guidelines and manuscript. RESULTS A total of 39 studies were included in the final review. The data presented in these studies show that iron deficiency and vitamin D deficiency are common in pediatric patients with IBD. Vitamin B12 and folate deficiency are rare. Zinc deficiency, while not common, occurs at a higher rate in patients with Crohn's disease than in healthy controls. There was limited data on vitamins A, E, and C, and selenium, but deficiency of these micronutrients seems rare. CONCLUSIONS We recommend annual surveillance of iron and vitamin D in pediatric patients with IBD regardless of disease activity or phenotype. Zinc should be monitored annually in patients with Crohn's disease. There is insufficient evidence to support routine screening for other micronutrient deficiencies.
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Affiliation(s)
| | | | | | | | - Rachel K Dunn
- Peyton Manning Children's Hospital, Ascension Health
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9
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Holmes EA, Rodney Harris RM, Lucas RM. Low Sun Exposure and Vitamin D Deficiency as Risk Factors for Inflammatory Bowel Disease, With a Focus on Childhood Onset. Photochem Photobiol 2018; 95:105-118. [PMID: 30155900 DOI: 10.1111/php.13007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/19/2018] [Indexed: 12/12/2022]
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) are increasing worldwide. Some ecological studies show increasing incidence with increasing latitude. Ambient ultraviolet radiation varies inversely with latitude, and sun exposure of the skin is a major source of vitamin D. Vitamin D deficiency is common in patients with IBD. Sun exposure and vitamin D have immune effects that could plausibly reduce, or be protective for, IBD. One quarter of new IBD cases are diagnosed in childhood or adolescence, but most research is for adult-onset IBD. Here, we review the evidence for low sun exposure and/or vitamin D deficiency as risk factors for IBD, focusing where possible on pediatric IBD, where effects of environmental exposures may be clearer. The literature provides some evidence of a latitude gradient of IBD incidence, and evidence for seasonal patterns of timing of birth or disease onset is inconsistent. High prevalence of vitamin D deficiency occurs in people with IBD, but cannot be interpreted as being a causal risk factor. Evidence of vitamin D supplementation affecting disease activity is limited. Further research on predisease sun exposure and well-designed supplementation studies are required to elucidate whether these potentially modifiable exposures are indeed risk factors for IBD.
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Affiliation(s)
- E Ann Holmes
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Rachael M Rodney Harris
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
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Abstract
BACKGROUND Crohn's disease (CD) frequently manifests in the second and third decades of life. Malnutrition and corticosteroid therapy may affect bone mineralization and delay bone growth. Our aim was to study bone mineral density and factors associated low bone mineral density (BMD) in pediatric CD. METHODS A cross-sectional observational study in children with CD (aged 5 to <18 years) was done. Demographic and treatment details were noted. Vitamin D levels <20 ng/mL were considered as deficiency. Bone mineral density was evaluated with dual-energy X-ray absorptiometry (DEXA) scan and Z score of <-2 SD was considered as low BMD. Data was analyzed descriptively. RESULTS In 30 cases with CD enrolled over 1 year, mean age of the patients was 13.8±3.0 years. Age of onset and diagnosis was 11.4±3.2 years and 13.4±2.8 years, respectively. 73.3% were in the underweight category. All cases received azathioprine whereas 86.7% were receiving corticosteroids. Vitamin D deficiency was seen in 86.7% cases. A low BMD was evident in 70% children. Overall, low BMI (p=0.005) and vitamin D deficiency (p=0.005) were associated with low BMD. However, no association between severity grade of vitamin D deficiency and low BMD was found. Treatment with corticosteroid was associated with low BMD in 76.9% cases (p=0.069). CONCLUSION Low BMD was frequent in children with CD and was associated with low BMI and vitamin D deficiency.
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Venkata KVR, Arora SS, Xie FL, Malik TA. Impact of vitamin D on the hospitalization rate of Crohn's disease patients seen at a tertiary care center. World J Gastroenterol 2017; 23:2539-2544. [PMID: 28465638 PMCID: PMC5394517 DOI: 10.3748/wjg.v23.i14.2539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study the association between vitamin D level and hospitalization rate in Crohn’s disease (CD) patients.
METHODS We designed a retrospective cohort study using adult patients (> 19 years) with CD followed for at least one year at our inflammatory bowel disease center. Vitamin D levels were divided into: low mean vitamin D level (< 30 ng/mL) vs appropriate mean vitamin D level (30-100 ng/mL). Generalized Poisson Regression Models (GPR) for Rate Data were used to estimate partially adjusted and fully adjusted incidence rate ratios (IRR) of hospitalization among CD patients. We also examined IRRs for vitamin D level as a continuous variable.
RESULTS Of the 880 CD patients, 196 patients with vitamin D level during the observation period were included. Partially adjusted model demonstrated that CD patients with a low mean vitamin D level were almost twice more likely to be admitted (IRR = 1.76, 95%CI: 1.38-2.24) compared to those with an appropriate vitamin D level. The fully adjusted model confirmed this association (IRR = 1.44, 95%CI: 1.11-1.87). Partially adjusted model with vitamin D level as a continuous variable demonstrated, higher mean vitamin D level was associated with a 3% lower likelihood of admission with every unit (ng/mL) rise in mean vitamin D level (IRR = 0.97, 95%CI: 0.96-0.98). The fully adjusted model confirmed this association (IRR = 0.98, 95%CI: 0.97-0.99).
CONCLUSION Normal or adequate vitamin D stores may be protective in the clinical course of CD. However, this role needs to be further characterized and understood.
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Dolatshahi S, Pishgar E, Jamali R. Does serum 25 hydroxy vitamin D level predict disease activity in ulcerative colitis patients? Acta Clin Belg 2016; 71:46-50. [PMID: 27075790 DOI: 10.1080/17843286.2015.1110895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIM There are controversial results regarding the relationship of serum 25 hydroxy vitamin D [25(OH)D] and ulcerative colitis (UC) activity. To address this issue, the current study was designed to evaluate the correlation of serum 25(OH)D level and disease activity in patients with UC. METHOD All consecutively selected UC outpatients referred to a gastroenterology clinic were enrolled in 2014. UC was diagnosed based on clinical, colonoscopic and histologic findings by a gastroenterologist. The exclusion criteria consisted of the factors that might influence plasma 25(OH)D concentration including inadequate exposure or intake, reduced absorption and abnormal metabolism. Disease activity was assessed by 'Truelove and Witts' classification'. RESULTS Fifty UC patients with mean age of 36.98 (± 11.81) years were evaluated. Mean serum 25(OH)D concentrations were significantly higher in 'mild disease activity' group (27.06 ± 6.56 ng/ml) than 'moderate disease activity' group (11.14 ± 4.03 ng/ml). Lower serum 25(OH)D concentration was associated with an increased likelihood of exhibiting moderate disease activity [β = 0.37, 95% confidence interval (CI): 0.15-0.94, p value = 0.04]. CONCLUSION Lower serum 25(OH)D level might be associated with higher disease activity in UC patients with mild-to-moderate activity.
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Sadeghian M, Saneei P, Siassi F, Esmaillzadeh A. Vitamin D status in relation to Crohn's disease: Meta-analysis of observational studies. Nutrition 2015; 32:505-14. [PMID: 26837598 DOI: 10.1016/j.nut.2015.11.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Inconsistent findings have been published regarding vitamin D status among patients with Crohn's disease (CD) and the association with disease severity. We aimed to perform a meta-analysis evaluating serum 25-hydroxy vitamin D and 1,25 dehydroxyvitamin D among CD patients compared with healthy and non-healthy controls, the prevalence of vitamin D deficiency, and the association with disease. METHODS We searched MEDLINE, SCOPUS, EMBASE, and Google Scholar up to March 2015 for observational studies assessing serum vitamin D levels in CD patients. A total of 63 studies were included in the following four meta-analyses: 1) a meta-analysis on the mean difference of 25(OH)D levels in CD patients compared with healthy (number of studies = 27) and non-healthy (n = 25) controls; 2) a meta-analysis on the mean difference of 1,25(OH)2 D3 levels in CD patients compared with healthy (n = 7) and non-healthy (n = 8) controls; 3) a meta-analysis on the prevalence of vitamin D deficiency (n = 34); 4) a meta-analysis on the correlation coefficients between vitamin D status severity of CD (n = 6). Subgroup analysis and meta-regression were used to discover possible sources of between-study heterogeneity. RESULTS It was found that CD patients had lower levels of 25(OH)D compared with healthy (-3.99 ng/mL; 95% confidence interval [CI]: -5.91 to -2.08) but not non-healthy controls (-1.07 ng/mL; 95% CI: -2.84 to 0.70). There was also no significant mean difference for 1,25(OH)2 D3 for both healthy and non-healthy controls. Meta-analysis on the prevalence of vitamin D deficiency showed an overall prevalence of 57.7% (95% CI: 0.502-0.649). An inverse association was observed between serum vitamin D and severity of CD (-0.36; 95% CI: -0.48 to -0.24). Meta-regression showed that mean levels of 25(OH)D were decreased 0.09 for each unit change of latitude among CD patients compared with healthy controls (B = -0.09, P = 0.004, I(2) residual = 86.08%). CONCLUSIONS We found that patients with Crohn's disease had lower serum 25(OH)D concentrations compared with their healthy counterparts, and more than half of them have hypovitaminosis D. Moreover, there was an inverse correlation between circulating 25(OH)D concentrations and severity of Crohn's disease.
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Affiliation(s)
- Mehdi Sadeghian
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereydoun Siassi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Del Pinto R, Pietropaoli D, Chandar AK, Ferri C, Cominelli F. Association Between Inflammatory Bowel Disease and Vitamin D Deficiency: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2015; 21:2708-17. [PMID: 26348447 PMCID: PMC4615394 DOI: 10.1097/mib.0000000000000546] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin D plays a role in several immune-mediated diseases, but its association with inflammatory bowel disease (IBD) is unclear. We conducted a systematic review and meta-analysis to assess the association between IBD and vitamin D deficiency. METHODS We searched electronic databases from inception to December 2014 for observational studies reporting the presence of vitamin D deficiency (defined as serum 25-hydroxycholecalciferol [25(OH)D] level of ≤20 ng/mL) in IBD patients and having a control group without IBD. Odds ratios (ORs) were combined using a random-effects model. Meta-regression was performed using latitude as a moderator. Study quality was assessed using the Newcastle-Ottawa scale. RESULTS Out of 816 citations, 14 eligible studies were identified, comprising 1891 participants (938 IBD cases and 953 controls). Meta-analysis showed that patients with IBD had 64% higher odds of vitamin D deficiency when compared with controls (OR = 1.64; 95% confidence interval, 1.30-2.08; I = 7%; P < 0.0001). Patients with ulcerative colitis had more than double the odds of vitamin D deficiency when compared with normal controls (OR = 2.28; 95% confidence interval, 1.18-4.41; I = 41%; P = 0.01). Latitude did not influence the association between IBD and vitamin D deficiency (P = 0.34). Generalizability of our results might be limited as we summarized unadjusted ORs, because of nonavailability of adjusted ORs in individual studies. CONCLUSIONS IBD is significantly associated with having higher odds of vitamin D deficiency. Well-designed randomized controlled trials and longitudinal studies are needed to further explain the role of vitamin D in IBD pathogenesis and its therapy.
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Affiliation(s)
- Rita Del Pinto
- University of L’Aquila, Division of Internal Medicine, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, Italy
- Case Western Reserve University, Division of Gastroenterology and Liver Disease, Cleveland, OH
| | - Davide Pietropaoli
- Case Western Reserve University, Division of Gastroenterology and Liver Disease, Cleveland, OH
- University of L’Aquila, Division of Dentistry, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, Italy
| | - Apoorva Krishna Chandar
- Case Western Reserve University, Division of Gastroenterology and Liver Disease, Cleveland, OH
- University Hospitals Case Medical Center, Digestive Health Institute, Cleveland, OH
| | - Claudio Ferri
- University of L’Aquila, Division of Internal Medicine, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, Italy
| | - Fabio Cominelli
- Case Western Reserve University, Division of Gastroenterology and Liver Disease, Cleveland, OH
- University Hospitals Case Medical Center, Digestive Health Institute, Cleveland, OH
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15
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Antonoglou GN, Knuuttila M, Niemelä O, Ylöstalo P, Raunio T, Hiltunen L, Karttunen R, Tervonen T. Serum parathyroid hormone and active vitamin D in chronic periodontitis. J Clin Periodontol 2015. [DOI: 10.1111/jcpe.12436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Georgios N. Antonoglou
- Department of Periodontology and Geriatric Dentistry; Research Group of Oral Health Sciences; University of Oulu; Oulu Finland
| | - Matti Knuuttila
- Department of Periodontology and Geriatric Dentistry; Research Group of Oral Health Sciences; University of Oulu; Oulu Finland
- Medical Research Center; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Onni Niemelä
- Medical Research Unit; Seinäjoki Central Hospital and University of Tampere; Tampere Finland
| | - Pekka Ylöstalo
- Department of Periodontology and Geriatric Dentistry; Research Group of Oral Health Sciences; University of Oulu; Oulu Finland
- Insitute of Dentistry; University of Eastern Finland; Kuopio Finland
- Department of Oral and Maxillofacial Surgery; Kuopio University Hospital; Kuopio Finland
| | - Taina Raunio
- Specialist Dental Health Care Unit; City of Oulu; Oulu Finland
| | | | - Riitta Karttunen
- Institute of Diagnostics; Department of Medical Microbiology and Immunology; University of Oulu; Oulu Finland
- Department of Bacteriology and Immunology; Haartman Institute; Laboratory Division (HUSLAB); Helsinki University Central Hospital; University of Helsinki; Helsinki Finland
| | - Tellervo Tervonen
- Department of Periodontology and Geriatric Dentistry; Research Group of Oral Health Sciences; University of Oulu; Oulu Finland
- Medical Research Center; Oulu University Hospital and University of Oulu; Oulu Finland
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16
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Lu C, Yang J, Yu W, Li D, Xiang Z, Lin Y, Yu C. Association between 25(OH)D Level, Ultraviolet Exposure, Geographical Location, and Inflammatory Bowel Disease Activity: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0132036. [PMID: 26172950 PMCID: PMC4501705 DOI: 10.1371/journal.pone.0132036] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/09/2015] [Indexed: 12/20/2022] Open
Abstract
Background There is no consensus on the vitamin D levels and inflammatory bowel disease (IBD). Aim To conduct a systematic review and meta-analysis to analyze the relationship between IBD and 25(OH)D, sun exposure, and latitude, and to determine whether vitamin D deficiency affects the severity of IBD. Methods We searched the PubMed, EBSCO, and ClinicalTrials.gov databases to identify all studies that assessed the association between 25(OH)D, sun exposure, latitude, and IBD through November 1, 2014, without language restrictions. Studies that compared 25(OH)D levels between IBD patients and controls were selected for inclusion in the meta-analysis. We calculated pooled standardized mean differences (SMDs) and odds ratios (ORs). Results Thirteen case-control studies investigating CD and 25(OH)D levels were included, and eight studies part of above studies also investigated the relationship between UC and 25(OH)D. Both CD patients (SMD: 0.26 nmol/L, 95% confidence interval [CI]: 0.09–0.42 nmol/L) and UC patients (SMD: 0.5 nmol/L, 95% CI: 0.15–0.85 nmol/L) had lower levels of 25(OH)D than controls. In addition, CD patients and UC patients were 1.95 times (OR, 1.95; 95% CI, 1.48–2.57) and 2.02 times (OR, 2.02; 95% CI, 1.13–3.60) more likely to be 25(OH)D deficient than controls. We also included 10 studies investigating the relationship between CD activity and vitamin D. Results showed that patients with active CD (CD Activity Index≥150) were more likely to have low vitamin D levels. In addition, whether low sun exposure and high latitude were related to a high morbidity of CD need to be provided more evidence. Conclusion Our study shows that IBD patients have lower vitamin D levels. For active CD patients, vitamin D levels were low. These findings suggest that vitamin D may play an important role in the development of IBD, although a direct association could not be determined in our study.
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Affiliation(s)
- Chao Lu
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jun Yang
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Weilai Yu
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Dejian Li
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zun Xiang
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yiming Lin
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Chaohui Yu
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
- * E-mail:
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Straub RH, Cutolo M, Pacifici R. Evolutionary medicine and bone loss in chronic inflammatory diseases--A theory of inflammation-related osteopenia. Semin Arthritis Rheum 2015; 45:220-8. [PMID: 26044543 DOI: 10.1016/j.semarthrit.2015.04.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/02/2015] [Accepted: 04/24/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Bone loss is typical in chronic inflammatory diseases such as rheumatoid arthritis, psoriasis, ankylosing spondylitis, systemic lupus erythematosus, multiple sclerosis, inflammatory bowel diseases, pemphigus vulgaris, and others. It is also typical in transplantation-related inflammation and during the process of aging. While we recognized that bone loss is tightly linked to immune system activation or inflamm-aging in the form of acute, chronic active, or chronic smoldering inflammation, bone loss is typically discussed to be an "accident of inflammation." METHODS Extensive literature search in PubMed central. RESULTS Using elements of evolutionary medicine, energy regulation, and neuroendocrine regulation of homeostasis and immune function, we work out that bone waste is an adaptive, evolutionarily positively selected program that is absolutely necessary during acute inflammation. However, when acute inflammation enters a chronic state due to the inability to terminate inflammation (e.g., in autoimmunity or in continuous immunity against microbes), the acute program of bone loss is a misguided adaptive program. CONCLUSIONS The article highlights the complexity of interwoven pathways of osteopenia.
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Affiliation(s)
- Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine I, University Hospital Regensburg, 93042 Regensburg, Germany.
| | - Maurizio Cutolo
- Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy
| | - Roberto Pacifici
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA
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Hlavaty T, Krajcovicova A, Payer J. Vitamin D therapy in inflammatory bowel diseases: who, in what form, and how much? J Crohns Colitis 2015; 9:198-209. [PMID: 26046136 DOI: 10.1093/ecco-jcc/jju004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The north–south geographical gradient of inflammatory bowel disease (IBD) prevalence, its epidemiology, the genetic association of vitamin D receptor polymorphisms, and results in animal models suggest that vitamin D plays an important role in the pathogenesis of IBD. AIMS The purpose of this review was to critically appraise the effectiveness and safety of vitamin D therapy in patients with IBD. METHODS MEDLINE, Scopus and Google Scholar were searched from inception to May 20, 2014 using the terms ‘Crohn’s disease’, ‘ulcerative colitis’ and ‘vitamin D’. Results: Vitamin D deficiency is common in patients with IBD. Limited clinical data suggest an association between low vitamin D concentration and increased disease activity in both ulcerative colitis (UC) and Crohn’s disease (CD). To date, only two small open label trials and one randomized controlled trial have shown a positive effect of vitamin D supplementation on disease activity in patients with CD; no effect has been shown for UC. An optimal vitamin D supplementation protocol for patients with IBD remains undetermined, but targeting serum 25-hydroxy vitamin D [25(OH)D] levels between 30 and 50 ng/mL appears safe and may have benefits for IBD disease activity. Depending on baseline vitamin D serum concentration, ileal involvement in CD, body mass index, and perhaps smoking status, daily vitamin D doses between 1800–10,000 international units/day are probably necessary. CONCLUSION Increasing preclinical and clinical evidence suggests a role for vitamin D deficiency in the development and severity of IBD. The possible therapeutic role of vitamin D in patients with IBD merits continued investigation.
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Augustine MV, Leonard MB, Thayu M, Baldassano RN, de Boer IH, Shults J, Denson LA, DeBoer MD, Herskovitz R, Denburg MR. Changes in vitamin D-related mineral metabolism after induction with anti-tumor necrosis factor-α therapy in Crohn's disease. J Clin Endocrinol Metab 2014; 99:E991-8. [PMID: 24617709 PMCID: PMC4037735 DOI: 10.1210/jc.2013-3846] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Preclinical studies suggest that TNF-α suppresses PTH synthesis, inhibits renal 1α-hydroxylase activity, and impairs fibroblast growth factor 23 (FGF23) degradation. The impact of inflammation on vitamin D and mineral metabolism has not been well-characterized in Crohn's disease (CD). OBJECTIVE The objective of the study was to assess short-term changes in vitamin D-related mineral metabolism in CD after anti-TNF-α induction therapy. DESIGN/PARTICIPANTS Eighty-seven CD participants, aged 5-39 years, were assessed at the initiation of anti-TNF-α therapy and 10 weeks later. OUTCOMES Indices of clinical disease activity and serum concentrations of vitamin D metabolites, vitamin D-binding protein (DBP), calcium, PTH, FGF23, IL-6, and TNF-α were measured at each visit. A multivariable generalized estimating equation (GEE) regression analysis was used to examine the correlates of PTH and 1,25-dihydroxyvitamin D [1,25(OH)2D] concentrations at each visit. RESULTS After anti-TNF-α therapy, cytokines and inflammatory markers [IL-6, TNF-α, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)] concentrations decreased (all P < .0001), and PTH and 1,25(OH)2D concentrations increased (median 21 vs 30 pg/mL, P < .0001, and median 41.7 vs 48.1 pg/mL, P = .014, respectively). Levels of 25-hydroxyvitamin D [25(OH)D], 24,25-dihydroxyvitamin D, DBP, and FGF23 did not change. In GEE analyses, higher IL-6, TNF-α, ESR, and CRP were associated with lower PTH concentrations (all P < .001), adjusted for corrected calcium and 25(OH)D levels. Higher PTH was associated with higher 1,25(OH)2D concentrations (P < .001) at each visit, independent of 25(OH)D concentrations. Higher levels of all inflammatory markers were associated with lower 1,25(OH)2D concentrations (all P < .05). However, when PTH was added to these models, the inflammatory markers (with the exception of CRP) were no longer significantly associated with 1,25(OH)2D. CONCLUSIONS Greater inflammation was associated with lower PTH and 1,25(OH)2D concentrations. After anti-TNF-α induction, PTH and 1,25(OH)2D concentrations increased without concomitant changes in 25(OH)D and FGF23, consistent with effects of inflammation on PTH and thereby renal conversion of 25(OH)D to 1,25(OH)2D.
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Affiliation(s)
- Marianne V Augustine
- The Children's Hospital of Philadelphia (M.V.A., M.B.L., M.T., R.N.B., J.S., R.H., M.R.D.), Perelman School of Medicine at the University of Pennsylvania (M.B.L., R.N.B., J.S., M.R.D.), Philadelphia, Pennsylvania 19104; Kidney Research Institute, University of Washington (I.H.d.B.), Seattle, Washington 98104; Department of Pediatrics, Cincinnati Children's Hospital Medical Center (L.A.D.), Cincinnati, Ohio 45229; and Department of Pediatrics, University of Virginia Health System (M.D.D.), Charlottesville, Virginia 22908
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Tsampalieros A, Lam CKL, Spencer JC, Thayu M, Shults J, Zemel BS, Herskovitz RM, Baldassano RN, Leonard MB. Long-term inflammation and glucocorticoid therapy impair skeletal modeling during growth in childhood Crohn disease. J Clin Endocrinol Metab 2013; 98:3438-45. [PMID: 23690309 PMCID: PMC3733850 DOI: 10.1210/jc.2013-1631] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Glucocorticoids and inflammation inhibit bone formation; however, the impact on skeletal modeling is unknown. OBJECTIVES The objectives of the study were to examine changes in bone mineral density (BMD) and cortical structure after Crohn disease (CD) diagnosis and identify associations with growth, glucocorticoids, and disease activity. DESIGN/PARTICIPANTS This was a prospective cohort study among 76 CD participants, aged 5-21 years. Tibia quantitative computed tomography trabecular BMD and cortical dimensions were obtained at diagnosis and 6 and 12 and a median of 42 months later; 51 completed the final visit. OUTCOMES Sex, race, and age-specific Z-scores were generated for outcomes based on more than 650 reference participants, and cortical dimension Z-scores were further adjusted for tibia length. Generalized estimating equations were used to model changes in Z-scores. RESULTS Disease activity improved over the study interval (P < .001). Trabecular BMD Z-scores improved over the first 6 months; increases were associated with improved disease activity (P < .001), younger age (P = .005), and increases in vitamin D levels (P = .02). Greater increases in tibia length were associated with greater increases in cortical area Z-scores (P < .001). Greater glucocorticoid doses and disease activity were significantly associated with failure to accrue cortical area and were more pronounced with greater linear growth (interaction P < .05). Mean (±SD) trabecular BMD (-1.0 ± 1.21) and cortical area (-0.57 ± 1.10) Z-scores at the final visit were significantly reduced. CONCLUSIONS CD was associated with persistent deficits in trabecular BMD, although younger participants demonstrated a greater potential for recovery. In addition, greater linear growth was associated with a greater recovery of cortical dimensions, especially among participants with less glucocorticoid exposure and inflammation. These data suggest that younger age and concurrent growth provide a window of opportunity for skeletal recovery.
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Affiliation(s)
- Anne Tsampalieros
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ontario, Canada K1H 8L6
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21
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DeBoer MD, Denson LA. Delays in puberty, growth, and accrual of bone mineral density in pediatric Crohn's disease: despite temporal changes in disease severity, the need for monitoring remains. J Pediatr 2013; 163:17-22. [PMID: 23522861 PMCID: PMC3692567 DOI: 10.1016/j.jpeds.2013.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/18/2013] [Accepted: 02/07/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Mark D DeBoer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
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Miheller P, Gesztes W, Lakatos PL. Manipulating bone disease in inflammatory bowel disease patients. Ann Gastroenterol 2013; 26:296-303. [PMID: 24714303 PMCID: PMC3959481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/29/2013] [Indexed: 12/02/2022] Open
Abstract
Diagnostic and therapeutic recommendations of the actual guidelines regarding inflammatory bowel disease (IBD)-associated bone loss are based on the experiences from the general osteoporotic population. Moreover, the fracture, as an end point of the bone loss has a different relationship to the bone mineral density in these patients compared to the general population. In this review we aimed to review the literature of the novel therapeutic possibilities regarding IBD-related bone loss. Dual-energy X-ray absorptiometry measurement should be performed in the presence of a risk factor such as age above 50, postmenopausal state, low trauma bone fracture in the history, corticosteroid therapy for more than 3 months or signs of hypogonadism. Serum Vitamin D and calcium levels should be measured in all patients. Supplementation is definitely needed in case of low serum calcium or Vitamin D concentrations and in patients under corticosteroid induction therapy. Short-term use of bisphosphonates in case of steroid induction was proved to be efficacious in preventing bone loss, but recent approvals do not include these indications. As fluorides and hormone replacement therapy have considerable side effects, their use in the young generation is also not acceptable.
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Affiliation(s)
- Pal Miheller
- 2nd Department of Medicine (Pal Miheller, William Gesztes), Semmelweis University, Budapest, Hungary,
Correspondence to: Pal Miheller MD, PhD, 2nd Department of Medicine, Semmelweis University, Budapest H-1088-Budapest, Szentkirályi u. 46, Hungary, Tel.: +36 1 4591500/55536, Fax: +36 1-4591500/55570, e-mail:
| | - William Gesztes
- 2nd Department of Medicine (Pal Miheller, William Gesztes), Semmelweis University, Budapest, Hungary
| | - Peter L. Lakatos
- 1st Department of Medicine (Peter L. Lakatos), Semmelweis University, Budapest, Hungary
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Beilfuss J, Berg V, Sneve M, Jorde R, Kamycheva E. Effects of a 1-year supplementation with cholecalciferol on interleukin-6, tumor necrosis factor-alpha and insulin resistance in overweight and obese subjects. Cytokine 2012; 60:870-4. [PMID: 22925537 DOI: 10.1016/j.cyto.2012.07.032] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 12/27/2022]
Abstract
Insufficient vitamin D status has been linked to autoimmune diseases, cancer and metabolic disorders, like obesity and insulin resistance. In vitro and animal studies suggest that vitamin D may play a crucial role in immune activation and inflammation. The relation between vitamin D and pro-inflammatory cytokines is not completely established. Furthermore, it is not known if the effect of vitamin D on entities of metabolic syndrome is mediated through its effect on cytokines or other biomarkers. The objectives of this study were to investigate if there is a relationship between vitamin D status and such pro-inflammatory cytokines as tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6) and high sensitive C-reactive protein (hs-CRP) in patients with overweigh and obesity. We also proposed that the intervention with high dose of cholecalciferol may have effect on the cytokine levels and result in corresponding changes in the measures of insulin resistance (HOMA-IR and QUICKI). Serum levels of IL-6, TNF-α and hs-CRP were measured in 332 overweight and obese subjects who completed a 1-year randomised intervention with either 40,000 IU vitamin D (cholecalciferol) per week or 20,000 IU vitamin D per week, or placebo. We found significant associations between IL-6, TNF-α, vitamin D and insulin resistance indices at baseline. One year intervention with vitamin D decreased serum IL-6 levels; however hs-CRP levels were significantly increased. Neither measures of insulin resistance, nor TNF-α were influenced by a 1-year vitamin D supplementation.
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Affiliation(s)
- Julia Beilfuss
- Department of Gastroenterology, Medical Clinic, University Hospital of North Norway, 9038 Tromsø, Norway.
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