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Surgery for Crohn's disease 2X less likely if managed to raise vitamin D above 30 ng – May 2013

Normalization of Vitamin D Status is Associated with Reduced Risk of Surgery and Hospitalization in Inflammatory Bowel Disease: A Prospective Study

Gastroenterology, Volume 144, Issue 5, Supplement 1, Page S-1, May 2013
Ashwin N. Ananthakrishnan, Andrew Cagan, Vivian S. Gainer, Tianxi Cai, Susanne Churchill, Elizabeth W Karlson, Isaac Kohane, Robert M. Plenge, Katherine P. Liao, Shawn N. Murphy

Introduction: Vitamin D may have an immunological 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 been limited by inability to prospectively examine this hypothesis after excluding vitamin D values measured after outcomes of interest. Furthermore, no studies have examined whether normalization of vitamin D status is associated with improvement in patient outcomes.

Methods: Using a multi-institution validated inflammatory bowel disease (IBD) cohort, we identified all CD and UC patients who had at least one measured plasma 25-hydroxy vitamin D 25(OH)D. Our main outcomes were occurrence of first IBD-related surgery and IBD-related hospitalization. Secondary outcome included median C-reactive protein. We restricted our analysis to 25(OH)D measurements prior to the first surgery or IBD-related hospitalization. Logistic regression models adjusting for potential confounders were used.

Results: Our study included 3,217 patients (55% CD, mean age 49 yrs). A majority were white (87%) and women (61%). One-third (39%) had ever used immunomodulators and 21% had used biologics. During a median follow-up of 8 years, 16% and 40% underwent an IBD-related surgery or hospitalization respectively.
The median lowest plasma 25(OH)D was 26 ng/ml (IQR 17-35ng/ml).
One-third (32%) were deficient (plasma 25(OH)D < 20 ng/ML),
an additional 27% were insufficient.
In CD patients on multivariate analysis, plasma 25(OH)D < 20ng/ml was associated with an increased risk of surgery (OR 1.76, 95% CI 1.24 - 2.51) and IBD-related hospitalization (OR 2.07, 95% CI 1.59 - 2.68) compared to those with 25(OH)D > 30ng/ml. Similar estimates were also seen for UC.
Just under half of those with plasma 25(OH)D < 30ng/ ml subsequently normalized their 25(OH)D (> 30ng/ml, 43%). Predictors of normalization were older age, use of anti-TNF biologics, and vitamin D supplementation while non-white race was inversely associated.
Interestingly, CD patients who had initial levels < 30ng/ml but subsequently normalized their 25(OH)D had a reduced likelihood of surgery (OR 0.48, 95%CI0.32-0.70) and hospitalization (OR 0.51,95%CI0.38-0.69) compared to those who remained deficient (Figure 1). Both CD and UC patients who were deficient but subsequently normalized their vitamin D status has lower median C-reactive protein levels (CD: -5 mg/L, p=0.002; UC: -7mg/L, p=0.03) than patients who remained deficient.

Conclusion: To our knowledge, ours is the first study demonstrating prospectively that

  • (1) low 25(OH)D is associated with greater C-reactive protein levels and increased risk of surgery and hospitalizations in both CD and UC; and
  • (2) normalization of 25(OH)D status is associated with a reduction in the risk of surgery and IBD-related hospitalizations in CD.


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See also VitaminDWiki

  • Overview Gut and vitamin D contains the following summary
  • Gut problems result in reduced absorption of Vitamin D, Magnesium, etc.
  • Celiac disease has a strong genetic component.
    • Most, but not all, people with celiac disease have a gene variant.
    • An adequate level vitamin D seems to decrease the probability of getting celiac disease.
    • Celiac disease causes poor absorption of nutrients such as vitamin D.
    • Bringing the blood level of vitamin D back to normal in patients with celiac disease decreases symptoms.
    • The prevalence of celiac disease, not just its diagnosis, has increased 4X in the past 30 years, similar to the increase in Vitamin D deficiency.
  • Review in Nov 2013 found that Vitamin D helped
    Many intervention clinical trials with vitamin D for Gut problems (101 trials listed as of Sept 2019)
  • All items in category gut and vitamin D 204 items

Attached files

ID Name Comment Uploaded Size Downloads
3877 Reduced Risk of IBD surgery.pdf admin 06 May, 2014 96.94 Kb 780
3876 IBD change D.jpg admin 06 May, 2014 24.47 Kb 1035