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.
- 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 for vitamin D to prevent or treat Gut problems (93 trials listed as of Jan 2017)
- All items in category gut and vitamin D
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