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Vitamin D supplementation in people with IBS has no effect on symptom severity and quality of life: results of a randomised controlled trial. Eur J Nutr 2021; 61:299-308. [PMID: 34328539 PMCID: PMC8783891 DOI: 10.1007/s00394-021-02633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
Purpose Several small trials suggest a benefit of vitamin D supplementation in irritable bowel syndrome (IBS). The generalisability of these reports is limited by their design and scale. This study aimed to assess whether vitamin D supplementation improved IBS symptoms in a UK community setting. Methods This was a randomised, double-blind, placebo-controlled study. Participants were recruited from the community in winter months between December 2017 and March 2019. 135 participants received either vitamin D (3,000 IU p.d.) or placebo for 12 weeks. The primary outcome measure was change in IBS symptom severity; secondary outcomes included change in IBS-related quality of life. Results The participants were analysed on an intent-to-treat basis. 60% of participants were vitamin D deficient or insufficient at baseline. Although vitamin D levels increased in the intervention arm relative to placebo (45.1 ± 32.88 nmol/L vs 3.1 ± 26.15 nmol/L; p < 0.001). There was no difference in the change of IBS symptom severity between the active and placebo trial arms (− 62.5 ± 91.57 vs – 75.2 ± 84.35, p = 0.426) over time. Similarly there was no difference between trial arms in τhe change in quality of life (− 7.7 ± 25.36 vs – 11.31 ± 25.02, p = 0.427). Conclusions There is no case for advocating use of vitamin D in the management of IBS symptoms. The prevalence of vitamin D insufficiency suggests routine screening and supplementation should be implemented in this population for general health reasons. This trial was retrospectively registered with ISRCTN (ISRCTN13277340) on 24th April 2018 after recruiting had been initiated. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02633-w.
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Kim GL, Yi YH, Hwang HR, Kim J, Park Y, Kim YJ, Lee JG, Tak YJ, Lee SH, Lee SY, Cho YH, Park EJ, Lee Y. The Risk of Osteoporosis and Osteoporotic Fracture Following the Use of Irritable Bowel Syndrome Medical Treatment: An Analysis Using the OMOP CDM Database. J Clin Med 2021; 10:jcm10092044. [PMID: 34068814 PMCID: PMC8126251 DOI: 10.3390/jcm10092044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with irritable bowel syndrome (IBS) are at increased risk of osteoporosis and osteoporotic fracture. This study investigated whether IBS medication attenuated the rate of osteoporosis and osteoporotic fracture risk. We conducted a retrospective large-scale multicenter study across eight hospital databases encoded in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The primary outcome was the incidence of osteoporosis, whereas secondary outcomes were osteoporotic fractures. After 1:4 matching, 24,723 IBS patients, 78,318 non-IBS patients, 427,640 non-IBS patients with IBS medication, and 827,954 non-IBS patients without IBS medication were selected. The risk of osteoporosis was significantly increased in the IBS group compared to the non-IBS group (hazard ratio (HR) 1.33; confidence interval (CI) 1.17~1.51). Even in patients who were not diagnosed with IBS, the risk of osteoporosis was significantly increased in those with IBS medication compared to those without (HR 1.77, CI 1.62~1.93). The risk of osteoporotic fracture was significantly increased in the IBS medication group (HR 1.69, CI 1.55~1.84). Patients exposed to IBS treatment even without IBS diagnosis were at increased risk of osteoporosis and osteoporotic fracture. Early diagnosis and treatment of osteoporosis should be considered in patients who have received medication for IBS symptoms.
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Affiliation(s)
- Gyu Lee Kim
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Yu Hyeon Yi
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Correspondence: ; Tel.: +82-51-240-7834; Fax: +82-51-240-7843
| | - Hye Rim Hwang
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Jinmi Kim
- Clinical Trial Center, Department of Biostatistics, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea;
| | - Youngmin Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea;
| | - Yun Jin Kim
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Jeong Gyu Lee
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Young Jin Tak
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Seung Hun Lee
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Sang Yeoup Lee
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Youn Hye Cho
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Eun Ju Park
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Youngin Lee
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
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Lee YL, Lee HS, Tsai CF, Hsu YH, Yang HY. Secular trends of patients hospitalized for major osteoporotic fractures based on a national claims database. Arch Osteoporos 2021; 16:62. [PMID: 33825998 DOI: 10.1007/s11657-021-00935-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/30/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED There was a reduction in the hospitalization rate for major osteoporotic fractures. As per our analysis, hospitalization for site-specific fractures showed a declining trend for hip and vertebral fractures for both the sexes. However, an increasing trend was noted in women regarding hospitalization for forearm fracture. PURPOSE Major osteoporotic fractures (MOFs) constitute a large proportion of the total expenditures for public healthcare. Knowing the secular trends of MOF will allow for more efficient use of healthcare resources, but such data are insufficient for the current population of Taiwan. Therefore, we investigated the epidemiological data of MOF hospitalization from adults 50 years of age or older in Taiwan during the period 2000-2015. METHODS The data analyzed were acquired from the Taiwan National Health Insurance Research Database (NHIRD) entries between 2000 and 2015. All study subjects were 50 years of age or older at the time of admission and diagnosed as having MOF. RESULTS A general decline was observed in the incidence rate (IR) of MOF hospitalization for the whole population, from 74.52 per 10,000 person-years (PYs) in 2000 to 55.19 in 2015. Females aged ≥65 years had the highest rates of hospitalization for MOF among the subgroups analyzed. Apart from the wrist fracture hospitalization rates in both sexes, which remained steady, all other site-specific fracture hospitalization rates exponentially increased with age. Among men, the IRs of all MOF hospitalization were steady, except for a slight decrease in hip and vertebral fracture hospitalizations. In women, hip and vertebral fracture hospitalization rates gradually decreased, humerus and wrist fracture hospitalization remained steady, and forearm fracture hospitalization increased. CONCLUSIONS Hospitalization rates of MOF decreased. The trend of site-specific fracture hospitalization analysis showed that hip and vertebral fractures decreased for both sexes. However, an increasing trend in forearm fracture hospitalization was noticed among females.
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Affiliation(s)
- Yi-Lin Lee
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 813, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chia-Yi, 600, Taiwan
| | - Yueh-Han Hsu
- Department of Medical Research, China Medical University Hospital and China Medical University, Taichung, 404, Taiwan
- Department of Internal Medicine, Division of Nephrology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, 736, Taiwan
| | - Hsin-Yi Yang
- Department of Medical Research, Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chia-Yi, 600, Taiwan.
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Wongtrakul W, Charoenngam N, Ungprasert P. The association between irritable bowel syndrome and osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2020; 31:1049-1057. [PMID: 32008157 DOI: 10.1007/s00198-020-05318-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent studies have suggested that irritable bowel syndrome (IBS) could be a risk factor for osteoporosis although the evidence is still limited. The current study aimed to comprehensively examine the risk of osteoporosis among patients with IBS using systematic review and meta-analysis technique. METHODOLOGY Literature search was independently conducted by two investigators using MEDLINE, EMBASE, and Google Scholar database up to October 2019. Eligible study must evaluate whether patients with IBS have a higher risk of osteoporosis and/or osteoporotic fracture. It could be either cross-sectional study, case-control study, or cohort study. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS Of the 320 articles identified from the three databases, four cohort and one cross-sectional study with 526,633 participants met the eligibility criteria and were included into the meta-analysis. All five studies investigated the risk of osteoporosis among patients with IBS, and the pooled analysis found that patients with IBS had a significantly higher risk of osteoporosis than individuals without IBS with the pooled risk ratio of 1.95 (95% CI, 1.04-3.64; I2 100%). Sensitivity analysis including only cohort studies found a lower RR (pooled RR 1.55; 95% CI, 1.39-1.72) with a lower I2 (59%). Three studies investigated the risk of osteoporotic fracture, and the pooled analysis found that patients with IBS also had a higher risk of osteoporotic fracture than individuals without IBS with the pooled risk ratio of 1.58 although statistical significance was not reached (95% CI, 0.95-2.62; I2 99%). Sensitivity analysis including only cohort studies found a lower RR (pooled RR 1.27; 95% CI, 1.20-1.39) with a dramatically lower I2 (0%). Limitations included high heterogeneity and reliance on diagnostic codes. CONCLUSION A significantly increased risk of osteoporosis among IBS patients was observed in this study. Early intervention to prevent the development of osteoporosis, such as weight-bearing exercise, adequate intake of vitamin D and calcium, and early screening for osteoporosis, may be beneficial to these patients although further studies are still required to confirm the efficacy and cost-effectiveness of this approach.
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Affiliation(s)
- W Wongtrakul
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Charoenngam
- Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.
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