Deficiency of vitamin D and its relation with clinical and laboratory activity of inflammatory bowel diseases

The relationship between 25-hydroxyvitamin D and markers of intestinal and systemic inflammation in undernourished and non-undernourished children, 6-59 months

BACKGROUND

Elevated inflammation contributes to growth faltering in children. Vitamin D (vitD) suppresses pro-inflammatory and enhances anti-inflammatory molecule production, thus vitamin D deficiency (VDD) has been associated with heightened inflammation. In undernourished children, VDD and inflammation co-exist, however, little is known about their interaction.

OBJECTIVE

This cross-sectional study aimed to investigate the association of serum 25-hydroxyvitamin D (25(OH)D) concentration with markers of inflammation in undernourished and non-undernourished children, as well as the effect of vitD supplementation on inflammatory markers in the children with low 25(OH)D in a nested before-and-after trial.

METHODS

Serum 25(OH)D, IL-1β, IL-8, IL-10, TNF-α, CRP, AGP, IFABP, sCD14, IGF-1 and FGF-21 of 121 undernourished and 51 non-undernourished children aged 6-59 months were measured cross-sectionally. Children with serum 25(OH)D < 30 ng/mL received 50,000 IU/week of vitD for three weeks.

RESULTS

TNF-α and FGF-21 in the overall and undernourished group were higher in those with serum 25(OH)D < 30 ng/mL compared to those with serum ≥ 30 ng/mL (p < 0.05), while IFABP concentration was higher in the non-undernourished children with serum 25(OH)D < 30 ng/mL (p = 0.047). Serum 25(OH)D was negatively associated with TNF-α in the overall group (β = -0.012, p = 0.034); and FGF-21 (β = -0.013, p = 0.023) in the undernourished group. After the supplementation trial, TNF-α was reduced by 55.9 % (p = 0.008) and 64.7 % (p = 0.017) in the overall and undernourished groups respectively, and AGP showed a trend of 41.6 % reduction (p = 0.099) in the overall group. IL-1β concentration increased post-supplementation in the overall (p = 0.011) and undernourished groups (p = 0.039).

CONCLUSION

Optimising vitD status may potentially be a strategy for reducing systemic and gut inflammation, and subsequently improving growth, particularly in undernourished children.

The Crosstalk between Vitamin D and Pediatric Digestive Disorders

Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. Vitamin D3, the most effective vitamin D isoform is produced in the human epidermis as a result of sunlight exposure. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to reach its active form, 1,25-dihydroxyvitamin D. Recent studies highlighted a complex spectrum of roles regarding the wellbeing of the gastrointestinal tract. Based on its antimicrobial effect, it was recently indicated that vitamin D supplementation in addition to standard eradication therapy might enhance H. pylori eradication rates. Moreover, it was suggested that low levels of vitamin D might also be involved in the acquisition of H. pylori infection. In terms of celiac disease, the negative effects of vitamin D deficiency might begin even during intrauterine life in the setting of maternal deficiency. Moreover, vitamin D is strongly related to the integrity of the gut barrier, which represents the core of the pathophysiology of celiac disease onset, in addition to being correlated with the histological findings of disease severity. The relationship between vitamin D and cystic fibrosis is supported by the involvement of this micronutrient in preserving lung function by clearing airway inflammation and preventing pathogen airway colonization. Moreover, this micronutrient might exert anticatabolic effects in CF patients. Inflammatory bowel disease patients also experience major benefits if they have a sufficient level of circulating vitamin D, proving its involvement in both induction and remission in these patients. The findings regarding the relationship between vitamin D, food allergies, diarrhea and constipation remain controversial, but vitamin D levels should be monitored in these patients in order to avoid hypo- and hypervitaminosis. Further studies are required to fill the remaining gaps in term of the complex impact of vitamin D on gastrointestinal homeostasis.

Pleiotropic Effects of Vitamin D in Patients with Inflammatory Bowel Diseases

The multifaceted activity of vitamin D in patients with inflammatory bowel disease (IBD) presents a challenge for further research in this area. Vitamin D is involved in the regulation of bone mineral metabolism, it participates in the regulation of the immune system, and it is an underlying factor in the pathogenesis of IBD. Additionally, vitamin D affects Th1 and Th2 lymphocytes, influencing the release of cytokines and inhibiting tumor necrosis factor (TNF) expression and the wnt/β-catenin pathway. As far as IBDs are concerned, they are associated with microbiota dysbiosis, abnormal inflammatory response, and micronutrient deficiency, including vitamin D hypovitaminosis. In turn, the biological activity of active vitamin D is regulated by the vitamin D receptor (VDR) which is associated with several processes related to IBD. Therefore, in terms of research on vitamin D supplementation in IBD patients, it is essential to understand the metabolic pathways and genetic determinants of vitamin D, as well as to identify the environmental factors they are subject to, not only in view of osteoporosis prevention and therapy, but primarily concerning modulating the course and supplementation of IBD pharmacotherapy.

Crohn's Disease and Female Infertility: Can Nutrition Play a Supporting Role?

Crohn's disease (CD) is a chronic inflammatory disease (IBD) that can affect the entire gastrointestinal tract in a non-continuous mode. CD is generally diagnosed most commonly between 15 and 35 years of age and may affect female fertility. The role of diet in supporting wellbeing outcome and reproductive potential in women is well-known; however, no effective efforts have been made to improve women's awareness in CD. Our review aims to describe the burden of CD on women's fertility, reporting the most relevant nutrients that support reproductive function to ensure women diagnosed with IBD an adequate health-related quality of life.

Vitamin D and inflammatory bowel disease: what do we know so far?

In the last years,several studies have focused on the involement of vitamin D in different physiological and pathological processes. One of the most interesting actions occurs in the Inflammatory bowel disease, where a higher prevalence of vitamin D deficiency has been observed. This study aimed to review the literature in order to explain its relationship with the disease, the risk factors, measuring the importance of sun exposure, describing how treatments are affected or observing the effect of vitamin supplementation in this type of patients.

Systematic review with meta-analysis: association of vitamin D status with clinical outcomes in adult patients with inflammatory bowel disease

BACKGROUND

Vitamin D deficiency is highly prevalent among patients with IBD, however, data on its association with clinical outcomes are conflicting.

AIM

To perform a systematic review and meta-analysis to explore the association of low vitamin D status with clinical outcomes in patients with IBD.

METHODS

We searched PubMed, Embase, Scopus and Web of Science from inception to February 2018 for observational studies evaluating the association of low 25(OH)D status on IBD disease activity, mucosal inflammation, clinical relapse and quality of life. Odds ratios (ORs) were pooled and analysed using a random effects model.

RESULTS

Twenty-seven studies were eligible for inclusion comprising 8316 IBD patients (3115 ulcerative colitis, 5201 Crohn's disease). Among IBD patients, low 25(OH)D status was associated with increased odds of disease activity (OR 1.53, 95% CI 1.32-1.77, I²  = 0%), mucosal inflammation (OR 1.25, 95% CI 1.06-1.47, I²  = 0%), low quality of life (QOL) scores (OR 1.30, 95% CI 1.06-1.60, I²  = 0%) and future clinical relapse (OR 1.23, 95% CI 1.03-1.47, I²  = 0%). In subgroup analysis, low vitamin D status was associated with Crohn's disease activity (OR 1.66, 95% CI 1.36-2.03, I²  = 0%), mucosal inflammation (OR 1.39, 95% CI 1.03-1.85, I²  = 0%), clinical relapse (OR 1.35, 95% CI 1.14-1.59, I²  = 0%), and low QOL scores (OR 1.25, 95% CI 1.04-1.50, I²  = 0%) and ulcerative colitis disease activity (OR 1.47, 95% CI 1.03-2.09, I²  = 0%) and clinical relapse (OR 1.20, 95% 1.01-1.43, I²  = 0%).

CONCLUSIONS

Low 25(OH)D status is a biomarker for disease activity and predictor of poor clinical outcomes in IBD patients.

Vitamin D in inflammatory bowel disease: From biology to clinical implications

Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory disorder of the gastrointestinal tract consisting two principal categories, ulcerative colitis (UC) and Crohn's disease (CD). The precise etiology of IBD remains unknown. Vitamin D is an important micronutrient that plays a critical biological role in various processes in human tissues. However, the relationship between disruption of the gut microbiota and the development of IBD is unclear. Some studies suggest that IBD is the cause of disrupted gut microbiota while others propose that gut microbiota itself can lead to development of IBD. Regardless of this complexity, it has emerged that vitamin D is an immunoregulatory factor that plays a significant role in the pathogenesis of IBD by affecting the gut microbiome and the inflammatory response. It has been reported that 38.1% of CD patients and 31.6% of UC patients suffer from vitamin D deficiency (VDD). In this review, we aimed to evaluate the association between VDD and IBD, summarizing recent clinical studies examining the effect of low vitamin D and the role of vitamin D supplementation on IBD clinical outcomes.

Influence of Vitamin D Deficiency on Inflammatory Markers and Clinical Disease Activity in IBD Patients

Vitamin D has recently been discovered to be a potential immune modulator. Low serum vitamin D levels have been associated with risk of relapse and exacerbation of clinical outcomes in Crohn’s disease (CD) and ulcerative colitis (UC). A retrospective, longitudinal study was conducted to determine the association between vitamin D levels and inflammatory markers and clinical disease activity in inflammatory bowel disease (IBD). In addition, circulating 25(OH)D₃ progression was evaluated according to vitamin D supplementation. Participants were separated into three groups according to their vitamin D level: severe deficiency (SD), moderate deficiency (MD) and sufficiency (S). Serum 25(OH)D₃ was inversely correlated with faecal calprotectin (FC) for CD and UC but was only correlated with C-reactive protein (CRP) for UC patients. In the multivariate analysis of FC, CRP and fibrinogen (FBG), we predicted the presence of a patient in the SD group with 80% accuracy. A deficiency of 25(OH)D₃ was associated with increased hospitalisations, flare-ups, the use of steroids and escalating treatment. Supplemental doses of vitamin D were likely to be insufficient to reach adequate serum levels of 25(OH)D₃. Vitamin D intervention studies are warranted to determine whether giving higher doses of vitamin D in IBD might reduce intestinal inflammation or disease activity.