Normalization of Plasma 25-Hydroxy Vitamin D Is Associated with Reduced Risk of Surgery in Crohn's Disease.
Inflamm Bowel Dis. 2013 Aug;19(9):1921-1927.
Ananthakrishnan AN, Cagan A, Gainer VS, Cai T, Cheng SC, Savova G, Chen P, Szolovits P, Xia Z, De Jager PL, Shaw SY, Churchill S, Karlson EW, Kohane I, Plenge RM, Murphy SN, Liao KP.
*Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; †Harvard Medical School, Boston, Massachusetts; ‡Research Computing, Partners HealthCare, Charlestown, Massachusetts; §Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts; | | Children's Hospital Boston, Boston, Massachusetts; ¶Massachusetts Institute of Technology, Cambridge, Massachusetts; **Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts; ††Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts; ‡‡i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts; §§Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts; and | | | |Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
BACKGROUND: Vitamin D may have an immunologic role in Crohn's disease (CD) and ulcerative colitis (UC). Retrospective studies suggested a weak association between vitamin D status and disease activity but have significant limitations.
METHODS: Using a multi-institution inflammatory bowel disease cohort, we identified all patients with CD and UC who had at least one measured plasma 25-hydroxy vitamin D (25(OH)D). Plasma 25(OH)D was considered sufficient at levels ≥30 ng/mL. Logistic regression models adjusting for potential confounders were used to identify impact of measured plasma 25(OH)D on subsequent risk of inflammatory bowel disease-related surgery or hospitalization. In a subset of patients where multiple measures of 25(OH)D were available, we examined impact of normalization of vitamin D status on study outcomes.
RESULTS: Our study included 3217 patients (55% CD; mean age, 49 yr). The median lowest plasma 25(OH)D was 26 ng/mL (interquartile range, 17-35 ng/mL). In CD, on multivariable analysis, plasma 25(OH)D <20 ng/mL was associated with an increased risk of surgery (odds ratio, 1.76; 95% confidence interval, 1.24-2.51) and inflammatory bowel disease-related hospitalization (odds ratio, 2.07; 95% confidence interval, 1.59-2.68) compared with those with 25(OH)D ≥30 ng/mL. Similar estimates were also seen for UC.
Furthermore, patients with CD who had initial levels <30 ng/mL but subsequently normalized their 25(OH)D had a reduced likelihood of surgery (odds ratio, 0.56; 95% confidence interval, 0.32-0.98) compared with those who remained deficient.
CONCLUSION: Low plasma 25(OH)D is associated with increased risk of surgery and hospitalizations in both CD and UC, and normalization of 25(OH)D status is associated with a reduction in the risk of CD-related surgery.
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