Effect of the Baseline Vitamin D Level on Growth Outcome in Pediatric Crohn Disease

ABCG2 plays a central role in the dysregulation of 25-hydrovitamin D in Crohn's disease

Vitamin D (VD) deficiency, as indicated by the main circulating form of VD metabolite 25-hydrovitamin D₃ (25(OH)D₃), in patients with Crohn's disease (CD) has been well documented, but the reasons for this remain unclear. In this study, 367 patients with CD and 57 healthy individuals who were enrolled, and the association between 25(OH)D₃ level and clinical biochemical characteristics including hepatic and renal functions, inflammatory response was analyzed with binary logistic regression models. VD metabolic enzymes and transporters were screened with bioinformatical analysis and identified with qRT-PCR and western blot. Compared to the healthy controls, serum 25(OH)D₃ was significantly reduced in patients with CD, but the protein level of adenosine triphosphate (ATP)-binding cassette efflux transporter G2 (ABCG2) was evidently increased in the ileum and colon. Meanwhile, in lipopolysaccharide (LPS)-treated CaCO2 cells, the mRNA and protein levels of ABCG2 were significantly increased, and the overexpression of ABCG2 obviously promoted 25(OH)D₃ efflux, but, Ko143, an ABCG2 inhibitors, substantially prevented the efflux of 25(OH)D₃. In addition, in 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced CD model mice, the ABCG2 protein levels were significantly increased in the ileum, colon, kidney and liver, and administration of Ko143 significantly inhibited the efflux of 25 (OH) D₃in vivo. All of these findings suggest that VD deficiency in patients with CD may be associated with an abnormal increase in ABCG2 expression, but not directly implicated in hepatic and renal function, and inflammatory response in patients with CD.

Growth, puberty, and bone health in children and adolescents with inflammatory bowel disease

BACKGROUND

Endocrine complications such as impaired growth, delayed puberty, and low bone mineral density (BMD) can be associated with inflammatory bowel disease (IBD) in children and adolescents. This study was performed to investigate the frequency, characteristics, and outcomes of endocrine complications of IBD in children and adolescents.

METHODS

This study included 127 patients with IBD diagnosed before 18 years of age [117 with Crohn disease (CD) and 10 with ulcerative colitis (UC)]. Growth profiles, pubertal status, 25-hydroxyvitamin D₃ [25(OH)D₃] levels, and BMD were reviewed retrospectively.

RESULTS

Short stature was observed in 14 of 127 (11.0 %) with a mean height-SDS of -2.31 ± 0.72. During a 2-year follow-up period, height-SDS did not significantly improve, while weight-SDS significantly improved. Among 109 patients who were older than 13 (girls) or 14 (boys) years of age during the study period, 11 patients (10.1 %) showed delayed puberty, which was associated with low weight-SDS. Vitamin D deficiency was documented in 81.7 % (94/115) with the average 25(OH)D₃ level of 14.5 ± 7.0 ng/mL. Lumbar BMD Z-score was below - 2 SDS in 25 of 119 patients (21.0 %). Height-SDS, weight-SDS, and body mass index (BMI)-SDS were lower in patients with osteoporosis than those without osteoporosis. When pediatric CD activity index scores were high (≥ 30), weight-SDS, BMI-SDS, insulin-like growth factor 1 (IGF-1)-SDS, and testosterone levels were significantly decreased.

CONCLUSIONS

Vitamin D deficiency and osteoporosis are common in pediatric IBD patients. As disease severity deteriorates, weight-SDS, IGF-1-SDS, and testosterone levels were decreased. Optimal pubertal development is necessary for bone health.

Effect of circulating 25-hydroxyvitamin D and antioxidant capacity level on cognitive function parameters of children with idiopathic short stature

Background

An optimal level of vitamin D is necessary for normal bone growth. Recently, vitamin D has been linked to many neurological disorders, changes in antioxidant capacity levels, and cognitive function decline in old age; thus, the aim was to evaluate the effect of vitamin D and antioxidant levels on the cognitive function parameters of children with idiopathic short stature (ISS).

Results

A prospective case-control study was conducted with 60 primary school-aged children with ISS who were compared to 60 unrelated healthy age- and sex-matched children as a control group. A complete clinical evaluation; anthropometric measurements; neurocognitive function parameters using the Stanford-Binet test, fifth edition; vitamin D level; total antioxidant capacity (TAC); total oxidative stress (TOS); and oxidative stress index (OSI) were measured. A total of 83.3% of children with ISS had a vitamin D level < 30 ng/ml with significantly lower vitamin D levels than the control group. The TAC level was significantly lower in children with ISS than in healthy children. Children with ISS had an average level for all of the cognitive function parameters but a lower non-verbal IQ, full-scale IQ, fluid reasoning, knowledge, quantitative reasoning, and working memory than healthy controls. A positive correlation was found between vitamin D level and all anthropometric measurements, all IQ parameters, and TAC levels in the studied children. A positive correlation was found between TAC and all IQ parameters.

Conclusion

Vitamin D level and antioxidant capacity level have a major impact on cognitive function parameters in children with ISS.

Therapeutic Efficacy of Exclusive Enteral Nutrition with Specific Polymeric Diet in Pediatric Crohn's Disease

PURPOSE

The efficacy of exclusive enteral nutrition (EEN) with a polymeric diet has not been confirmed in Korean pediatric patients with Crohn's disease (CD). This study aimed to compare the effectiveness of EEN with a specific polymeric diet (Encover®) and corticosteroids (CSs) for the induction of remission in Korean pediatric CD patients.

METHODS

We retrospectively compared data from 51 pediatric CD patients who underwent induction therapy with EEN (n=19) or CSs (n=32) at Severance Children's Hospital or Incheon St. Mary's Hospital in Korea. The primary endpoint of this study was the rate of clinical remission, defined as a Pediatric Crohn's Disease Activity Index (PCDAI) score <10, after 8 weeks of induction treatment. Clinical, laboratory, and growth data at post-induction as well as their changes from baseline were also compared between groups.

RESULTS

After 8 weeks of induction therapy, clinical remission rates were 78.9% (15/19) and 65.6% (21/32) in the EEN and CS groups, respectively (p=0.313). No significant differences in PCDAI scores, laboratory variables, and growth parameters were noted between the two groups at post-induction. However, significant changes in albumin levels at post-induction were observed in the EEN group compared to the CS group (p=0.038).

CONCLUSION

Our results suggest that the effectiveness of EEN with a polymeric diet and CSs for induction therapy did not differ in Korean pediatric CD patients. EEN with a polymeric diet is a good first-line treatment option for the induction of remission in these patients.