Pancreatitis and Vitamin D - many studies

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Effect of serum vitamin D levels on the severity of acute pancreatitis: A prospective study (detiails behind paywall) - March 2024

Pancreatology Volume 24, Issue 2, March 2024, Pages 206-210 https://doi.org/10.1016/j.pan.2024.01.004 brhind paywall
Serkan Ocal a, Kubra Cerci b, Osman Cagin Buldukoglu a, Galip Egemen Atar a, Ferda Akbay Harmandar a, Ayhan Hilmi Cekin a

Abstract
Acute pancreatitis (AP) is a serious and complex disorder with varying disease course and severity. Early and prompt interventions are crucial in management of AP. Vitamin D, being a prominent actor in calcium metabolism, also takes part in immunity and thus in immune-system related disorders, ranging from infections to cancer. In this study, the role of vitamin D status of a patient on the severity of AP was investigated.

This study was conducted between June 2021 to August 2022 with a total of 315 patients. Blood samples were obtained upon admission. A 25-(OH)D3 level less than 10 ng/ml was defined as vitamin D deficiency. 10–19 ng/ml was defined as vitamin D insufficiency whereas 20 ng/ml or above was considered to be sufficient. Scoring systems (Ranson score, CTSI, BISAP, Revised Atlanta Classification (RAC) were applied.

Serum 25-(OH)D3 levels of patients with AP were found to be negatively correlated with severity of the disease according to RAC (p < 0.001). In concordance to this finding, both Ranson score and BISAP were found to be statistically significantly related to 25-(OH)D3 levels. Both scoring systems revealed higher scores in patients with insufficient or deficient levels of 25-(OH)D3. Serum 25-(OH)D3 levels were not found to be related to intensive care unit admission or mortality.

This study revealed that serum 25-(OH)D3 level is related to the severity of AP. In the future, interventional studies with vitamin D therapy in otherwise serum 25-(OH)D3 deficient AP patients might reveal a new potential therapeutic agent in this mechanically complex, burdensome disorder.

Introduction
Acute pancreatitis (AP) is a serious and complex disorder with varying disease course and severity. It is a major cause of hospital admissions and the incidence of the disease, which is 34 per 100,000 people in the general population, is rising [1,2]. AP is both a local and systemic disease and organ failure is seen in 20 % of patients. Organ failure is the hallmark of severe acute pancreatitis (SAP) and the major determining factor of prognosis [3].

Leading causes of acute pancreatitis are gallstones and alcohol. Gallstones obstructing the pancreatic and/or biliary ducts lead to an increase in ductal pressure which ends up in uncontrolled activation of digestive enzymes. On the other hand, ethanol has direct effects on aciner cells [4]. Regardless of the various etiological factors underlying AP, end picture is both local and systemic inflammation with a wide spectrum of severity [5].

Since AP is a disease with organ failure potential and mortality risk, scoring systems were developed in order to recognize patients who are at risk for severe disease. Early and prompt interventions are crucial in management of AP and commonly used scoring systems such as BISAP, Ranson's, CTSI, APACHE-II and Revised Atlanta Classification (RAC) help the clinician define the under-the-risk population with a probable severe disease course [6].

Vitamin D is an essential molecule in human physiology. The hormonal and active form of vitamin D, 1alpha,25-dihydroxyvitamin D3, is synthesized after a series of reactions in different organs and acts on nuclear receptors to exert its functions. Vitamin D is a prominent actor in calcium homeostasis and is responsible for maintaining a constant level of plasma calcium concentration through mobilization and increased absorbtion of calcium [7]. Vitamin D also takes part in immunity and thus in immune-system related disorders, ranging from infections to cancer. Vitamin D deficiency and in turn supplementation of a deficient state of it is being thought and studied as an independent determinant of mortality in various clinical pictures [8], [9], [[10]].

In this study, the role of vitamin D status of a patient on the severity and disease course of AP was investigated. Given the strong link of vitamin D and inflammation, vitamin D was hypothesized to be a causative and/or a prognostic factor in AP, a disease in which inflammation is the main factor in disease course and patient outcome.

Section snippets
Patients
This prospective study was conducted in Antalya Training and Research Hospital between June 2021 to August 2022 in patients with AP. Patients above the age of 18 who presented to the emergency department or outpatient clinic and were hospitalized with AP diagnosis were involved in the study. Patients with prior episodes of AP were excluded and only patients with their first episodes of AP were included in the study. AP diagnosis was based on the general accepted criteria of having two of the

Results
A total of 315 patients were enrolled in the study.
Mean age of the study population was 57.5 years and male to female ratio was close to 1:1.
Median body mass index of the study population was 24.1.
Gallstones were the leading cause of AP (74.3 %)
followed by alcohol (7.9 %) and
drug intake (4.8 %).
None of the patients had underlying hypercalcemia as a risk factor and hypercalcemia was not shown to be the underlying etiology for AP in any patient enrolled in the study. Baseline

Discussion
The relationship of serum 25-(OH)D3 levels with the severity of acute pancreatitis was investigated in this study.

AP is the end result of systemic inflammation mediated by cytokines, chemokine pathways and damage-associated molecular patterns in relation to organelle dysfunction and inappropriate intracellular trypsinogen activation in pancreatic aciner cells [12]. Recent evidence also suggest the role of monocytes as key contributors of systemic inflammatory response and organ failure in AP ...

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Vitamin D: A Potential Star for Treating Chronic Pancreatitis - June 2022

Front. Pharmacol., 06 June 2022 | https://doi.org/10.3389/fphar.2022.902639
Meifang Zheng and Runping Gao*
Department of Hepatic Biliary Pancreatic Medicine, The First Hospital of Jilin University, Changchun, China

Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas. The incidence of CP is increasing worldwide but the effective therapies are lacking. Hence, it is necessary to identify economical and effective agents for the treatment of CP patients. Vitamin D (VD) and its analogues have been confirmed as pleiotropic regulators of cell proliferation, apoptosis, differentiation and autophagy. Clinical studies show that VD deficiency is prevalent in CP patients. However, the correlation between VD level and the risk of CP remains controversial. VD and its analogues have been demonstrated to inhibit pancreatic fibrosis by suppressing the activation of pancreatic stellate cells and the production of extracellular matrix. Limited clinical trials have shown that the supplement of VD can improve VD deficiency in patients with CP, suggesting a potential therapeutic value of VD in CP. However, the mechanisms by which VD and its analogues inhibit pancreatic fibrosis have not been fully elucidated. We are reviewing the current literature concerning the risk factors for developing CP, prevalence of VD deficiency in CP, mechanisms of VD action in PSC-mediated fibrogenesis during the development of CP and potential therapeutic applications of VD and its analogues in the treatment of CP.
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Vitamin D and Pancreatitis: A Narrative Review of Current Evidence - May 2022

Nutrients 2022, 14(10), 2113; https://doi.org/10.3390/nu14102113
by Fei Cai 1,†ORCID,Cheng Hu 1,†ORCID,Chan-Juan Chen 1,Yuan-Ping Han 2,Zi-Qi Lin 1,Li-Hui Deng 1,* andQing Xia 1
1 Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
2 The Center for Growth, Metabolism and Aging, College of Life Sciences, Sichuan University, Chengdu 610017, China

Emerging research indicates that vitamin D metabolic disorder plays a major role in both acute pancreatitis (AP) and chronic pancreatitis (CP). This has been demonstrated by studies showing that vitamin D deficiency is associated with pancreatitis and its anti-inflammatory and anti-fibrotic effects by binding with the vitamin D receptor (VDR). However, the role of vitamin D assessment and its management in pancreatitis remains poorly understood. In this narrative review, we discuss the recent advances in our understanding of the molecular mechanisms involved in vitamin D/VDR signaling in pancreatic cells; the evidence from observational studies and clinical trials that demonstrate the connection among vitamin D, pancreatitis and pancreatitis-related complications; and the route of administration of vitamin D supplementation in clinical practice. Although further research is still required to establish the protective role of vitamin D and its application in disease, evaluation of vitamin D levels and its supplementation should be important strategies for pancreatitis management according to currently available evidence.
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Osteoporosis is 1.9X more likely if have Acute Pancreatitis - 2020

The Risk of Vitamin D Deficiency, Osteoporosis, and Fractures in Acute Pancreatitis
Pancreas: 5/6 2020 - p 629-633 doi: 10.1097/MPA.0000000000001538 PDF behind paywall
Abou Saleh, Mohannad MD∗; Alkhayyat, Motasem MD†; Mansoor, Emad MD‡; Khoudari, George MD†; Simons-Linares, C. Roberto MD∗; Vargo, John MD∗; Chahal, Prabhleen MD∗; Stevens, Tyler MD∗

Objectives
A few past studies have found increased utilization of 25-hydroxyvitamin D and prevalence of osteoporosis in acute pancreatitis (AP). Our aim was to obtain a survey of bone diseases after a sentinel episode of AP.

Methods
A database (Explorys), an aggregate of electronic health record from 26 integrated United States healthcare systems, was queried. A cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms diagnosis of AP between 2014 and 2019, after excluding patients with selected medical conditions and medications that are associated with poor bone health, was identified. The prevalence of new diagnoses of vitamin D deficiency (VDD), osteoporosis, and fractures in the study cohort was evaluated. Age-, race-, and sex-based distributions and risk factors were determined through univariate and multivariate analyses.

Results
Of the 36,087,380 individuals in the database, we identified 256,580 (0.71%) with AP. In multivariate analysis, patients with AP were more likely to develop

• VDD (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.24–1.26; P < 0.0001),
• osteoporosis (OR, 1.89; CI, 1.81–1.85; P < 0.0001), and
• fractures (OR, 1.58; 95% CI, 1.57–1.59; P < 0.0001).

Conclusions: Acute pancreatitis was associated with increased risk of VDD, osteoporosis, and fractures.

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Systematic review and meta-analysis on the prevalence of vitamin D deficiency in patients with chronic pancreatitis - 2016

Pancreatology, Available online 18 July 2016, doi:10.1016/j.pan.2016.07.010
S.A. Hoogenbooma, 1, S.J. Lekkerkerkera, 1, P. Fockensa, M.A. Boermeesterb, J.E. van Hoofta, ,

Background/Objectives
Patients with chronic pancreatitis (CP) are at risk of malnutrition due to malabsorption, pain and/or alcohol consumption. This can cause vitamin D insufficiency or deficiency, which is associated with osteoporosis and increased risks of fractures. We aimed to perform a meta-analysis to determine the prevalence of vitamin D insufficiency and deficiency in CP patients. Furthermore, we compared these results with healthy controls.

Methods
We performed a systematic review and meta-analysis on the literature by searching PubMed and EMBASE (January 2000–December 2015) on CP and vitamin D. Primary outcome was prevalence of vitamin D insufficiency (<75 nmoL/L) and deficiency (<50 nmoL/L) in CP patients. When available, data of CP patients were compared with healthy controls.

Results
Nine studies were included in our meta-analysis, reporting on the prevalence of vitamin D insufficiency/deficiency in 465 patients (mean age 41 years (range 18–60), 81% male) and in 378 controls (mean age 40 years (range 18–67), 76% male). Pooled prevalence of vitamin D insufficiency and deficiency in CP patients was 83% and 65%, respectively. Calculated odds ratio (OR) of vitamin D insufficiency and deficiency between CP patients and controls was 1.34 (0.54–3.29) and 1.14 (0.70–1.85), respectively (p > 0.05).

Conclusion
There is a high prevalence of vitamin D insufficiency and deficiency in CP patients. Nevertheless, there is no significant difference in prevalence of vitamin D insufficiency and deficiency compared to healthy controls. Further research should indicate the clinical relevance and consequences of these findings for clinical practice.
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Fat-soluble vitamin deficiency and exocrine pancreatic insufficiency among adults with chronic pancreatitis: Is routine monitoring necessary for all patients? - Oct 2023

Nutr Clin Pract . 2023 Oct 15. doi: 10.1002/ncp.11082 PDF is behind a paywall
Holly Estes-Doetsch 1 2, Kristen Roberts 1 2, Melanie Newkirk 3, Anna Parker 3

Chronic pancreatitis (CP) is often associated with exocrine pancreatic insufficiency (EPI), which may increase risk for fat-soluble vitamin depletion. Although vitamin D deficiency is widespread among the general population, vitamins A, E, and K deficiencies may more uniquely present in patients with CP. Yet, it is unclear whether fat-soluble vitamin status should be routinely monitored in all patients with CP or limited to those with EPI. The purpose of this review is to describe the laboratory status of vitamins A, E, and K in adult patients with CP and their association with exocrine pancreatic function. Five primary, observational studies met the inclusion criteria for qualitative synthesis. Biochemical deficiencies in fat-soluble vitamins were observed across trials but results varied with respect to whether EPI increased risk. Challenges related to the diagnosis and treatment of EPI along with potential confounders may contribute to the heterogeneity among study results. Although more studies are needed to determine the influence of pancreatic enzyme replacement therapy on fat-soluble vitamin status as well as effective vitamin repletion strategies, clinicians should consider periodically screening for deficiencies in all patients with CP regardless of EPI to avoid associated health effects of vitamin depletion.

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Fat-Soluble Vitamin Deficiencies and Disruption of the Immune System in Pancreatic Cancer- A Vicious Cycle - Sept 2022

Pancreas 51(8):p 923-929, September 2022. | DOI: 10.1097/MPA.0000000000002128
Aziz, Mohammad Hosein MD∗; van der Meulen, Jan MD, PhD†; Mustafa, Dana A.M. PhD†,‡; van Eijck, Casper H. J. MD, PhD†,‡

Pancreatic ductal adenocarcinoma (PDAC) is currently an increasing contributor to cancer-related mortality. Despite advances in cancer treatment, PDAC survival rates have remained roughly unchanged over the years. Specifically, late diagnosis and insensitivity to currently available therapeutic regimens have been identified as the main causes for its poor survival. Pancreatic exocrine insufficiency (PEI) is a typical complication associated with PDAC diagnosis and pancreatic surgery. Pancreatic exocrine insufficiency, a major contributor to maldigestion in PDAC, is often not treated because it remains undetected because of lack of overt signs and symptoms. In this review, we will focus on the major consequences of PEI, including the inadequacy of lipase excretion, which results in deficiency of fat-soluble vitamins. Because PDAC is known for its immune-high jacking mechanisms, we describe key features in which deficiencies of fat-soluble vitamins may contribute to the aggressive biological behavior and immune evasion in PDAC. Because PEI has been shown to worsen survival rates in patients with PDAC, detecting PEI and the related fat-soluble vitamin deficits at the time of PDAC diagnosis is critical. Moreover, timely supplementation of pancreatic enzymes and fat-soluble vitamins may improve outcomes for PDAC patients.
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Pancreatitis associated with poor Vitamin D Binding Protein and Receptor (in dogs) July 2023

DOI: 10.1111/jvim.16809 FREE PDF

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9+ VitaminDWiki pages have PANCREATITIS in the title

This list is automatically updated

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VitaminDWiki - Inflammation category contains

171 items total

Example studies

• Vitamin D energizes the innate and adaptive immune systems to fight lung inflammation – Sept 2022
• COVID-19 inflammation extinguished by 60,000 IU of vitamin D nanoemulsion daily for a week – RCT May 2021
• Inflammation (C-reactive protein) associated with low vitamin D in 22 diseases – April 2020
• Vitamin D reduces inflammation in critically ill patients – Sept 2020
• Inflammation is reduced by each of the following: Vitamin D, Omega-3, Diet
• How Vitamin D reduces inflammation, improves immunity and fights autoimmunity – review Dec 2018
• CYTOKINE in VitaminDWiki 12 titles as of July 2023
• 17 pages in VitaminDWiki had REACTIVE or CRP in title as of July 2023
• Little risk of infection after surgery if have more than 50 ng of vitamin D - 2014

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Vitamin D and Pancreatitis: A Narrative Review of Current Evidence - May 2022

Nutrients 2022, 14(10), 2113; https://doi.org/10.3390/nu14102113
by Fei Cai 1,†ORCID,Cheng Hu 1,†ORCID,Chan-Juan Chen 1,Yuan-Ping Han 2,Zi-Qi Lin 1,Li-Hui Deng 1,* and Qing Xia 1

Emerging research indicates that vitamin D metabolic disorder plays a major role in both acute pancreatitis (AP) and chronic pancreatitis (CP). This has been demonstrated by studies showing that vitamin D deficiency is associated with pancreatitis and its anti-inflammatory and anti-fibrotic effects by binding with the vitamin D receptor (VDR). However, the role of vitamin D assessment and its management in pancreatitis remains poorly understood. In this narrative review, we discuss the recent advances in our understanding of the molecular mechanisms involved in vitamin D/VDR signaling in pancreatic cells; the evidence from observational studies and clinical trials that demonstrate the connection among vitamin D, pancreatitis and pancreatitis-related complications; and the route of administration of vitamin D supplementation in clinical practice. Although further research is still required to establish the protective role of vitamin D and its application in disease, evaluation of vitamin D levels and its supplementation should be important strategies for pancreatitis management according to currently available evidence.
 Download the PDF from VitaminDWiki

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See also: The global, regional, and national burden of pancreatitis in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

https://doi.org/10.1186/s12916-020-01859-5 many charts, FREE PDF

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