Autoimmune Hepatitis 8X more likely if low vitamin D – Dec 2014

Low Serum Vitamin D Levels Are Associated with Severe Histological Features and Poor Response to Therapy in Patients with Autoimmune Hepatitis - Dec 2014

Digestive Diseases and Sciences, December 2014, Volume 59, Issue 12, pp 3035-3042
Cumali Efe, Taylan Kav, Cisel Aydin, Mustafa Cengiz, Narin Nasıroglu Imga, Tugrul Purnak, Daniel S. Smyk, Murat Torgutalp, Turan Turhan, Seren Ozenirler

PDF is available free at Sci-Hub   10.1007/s10620-014-3267-3

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Background and Aim
25-Hydroxyvitamin D [25(OH)D] has an important role in fibrosis progression and inflammatory response in patients with various etiologies of chronic liver disease. However, its influence on autoimmune hepatitis (AIH) has not been investigated. We evaluated the association of serum 25(OH)D levels with clinical, biochemical and histological features and response to therapy in AIH.

Materials and methods: Serum 25(OH)D levels were quantified in 68 therapy naïve AIH patients and 34 healthy controls.

Results
Mean serum 25(OH)D levels were significantly lower in AIH compared to healthy controls (16.8 ± 9.2 vs. 35.7 ± 13.6, p < 0.0001). Low levels of 25(OH)D (<30 µg/L) were independently associated with advance fibrosis and severe interface hepatitis in AIH patients [p = 0.014; odds ratio (OR) 0.12, 95 % confidence interval (CI) 0.02–0.65 and p = 0.020; OR 0.17, 95 % CI 0.04–0.76, respectively].
Severe 25(OH)D deficiency (<10 µg/L) was associated with

  • advance fibrosis,
  • severe interface hepatitis,
  • low platelet counts and
  • sampling time in a univariate analysis.

Only interface hepatitis and fibrosis scores were independently associated with 25(OH)D deficiency in a multiple regression analysis (p = 0.005; OR 0.12, 95 % CI 0.03–0.53 and p = 0.022; OR 0.15, 95 % CI 0.03–0.75, respectively).
Mean serum 25(OH)D levels were lower in non-responders compared to responders (9.2 ± 4.8 vs. 17.1 ± 9.4, p = 0.015), and 25(OH)D deficiency was more commonly observed in non-responders than the responders (80 vs. 43 %, p = 0.036).

Conclusions
Low 25(OH)D levels are associated with advance fibrosis and severe inflammation in AIH. Our study suggests that vitamin D may be a potential biomarker that predicts response to therapy and histological features in AIH.

References
  1. Krawitt EL. Autoimmune hepatitis. N Engl J Med. 2006;354:54–66. CrossRef
  2. Vergani D, Longhi MS, Bogdanos DP, et al. Autoimmune hepatitis. Semin Immunopathol. 2009;31:421–435. CrossRef
  3. Efe C, Ozaslan E, Wahlin S, et al. Antibodies to soluble liver antigen in patients with various liver diseases: a multicentre study. Liver Int. 2013;33:190–196. CrossRef
  4. Alvarez F, Berg PA, Bianchi FB, et al. International autoimmune hepatitis group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–938. CrossRef
  5. Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48:169–176. CrossRef
  6. Manns MP, Czaja AJ, Gorham JD, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51:2193–2213. CrossRef
  7. Liberal R, Longhi MS, Mieli-Vergani G, et al. Pathogenesis of autoimmune hepatitis. Best Pract Res Clin Gastroenterol. 2011;25:653–664. CrossRef
  8. Smyk DS, Orfanidou T, Invernizzi P, et al. Vitamin D in autoimmune liver disease. Clin Res Hepatol Gastroenterol. 2013;37:535–545. CrossRef
  9. Arnson Y, Amital H, Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis. 2007;66:1137–1142. CrossRef
  10. Stokes CS, Volmer DA, Grunhage F, et al. Vitamin D in chronic liver disease. Liver Int. 2013;33:338–352. CrossRef
  11. Stokes CS, Krawczyk M, Reichel C, et al. Vitamin D deficiency is associated with mortality in patients with advanced liver cirrhosis. Eur J Clin Invest. 2013. doi:10.1111/eci.12205.
  12. Dasarathy J, Periyalwar P, Allampati S, et al. Hypovitaminosis D is associated with increased whole body fat mass and greater severity of non-alcoholic fatty liver disease. Liver Int. 2013. doi:10.1111/liv.12312.
  13. Petta S, Camma C, Scazzone C, et al. Low vitamin D serum level is related to severe fibrosis and low responsiveness to interferon-based therapy in genotype 1 chronic hepatitis C. Hepatology. 2010;51:1158–1167. CrossRef
  14. Farnik H, Bojunga J, Berger A, et al. Low vitamin D serum concentration is associated with high levels of hepatitis B virus replication in chronically infected patients. Hepatology. 2013;58:1270–1276. CrossRef
  15. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–1930. CrossRef
  16. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996;24:289–293. CrossRef
  17. Vogel A, Strassburg CP, Manns MP. Genetic association of vitamin D receptor polymorphisms with primary biliary cirrhosis and autoimmune hepatitis. Hepatology. 2002;35:126–131. CrossRef
  18. Trépo E, Ouziel R, Pradat P, et al. Marked 25-hydroxyvitamin D deficiency is associated with poor prognosis in patients with alcoholic liver disease. J Hepatol. 2013;59:344–350. CrossRef
  19. Ma Y, Longhi MS, Bogdanos DP, et al. 17 Functional impairment of CD25+CD4+ regulatory T cells characterizes autoimmune hepatitis type 2. Hepatology. 2003;38:163. CrossRef
  20. Efe C, Purnak T, Ozaslan E. Anti TNF-alpha therapy can be a novel treatment option in patients with autoimmune hepatitis. Aliment Pharmacol Ther. 2010;32:115. CrossRef
  21. Weiler-Normann C, Schramm C, Quaas A, et al. Infliximab as a rescue treatment in difficult-to-treat autoimmune hepatitis. J Hepatol. 2013;58:529–534. CrossRef
108 citations of Dec 2014 study as of Dec 2024

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People with Autoimmune Hepatitis are 3.2X more likely to die if low Vitamin D – Dec 2024

Autoimmune Hepatitis and Vitamin D Deficiency: A Nationwide Perspective
Aliment Pharmacol Ther. 2024 Dec 11. doi: 10.1111/apt.18438 PDF behind paywall
Yassine Kilani 1, Saqr Alsakarneh 2, Mahmoud Y Madi 3, Daniel Alejandro Gonzalez Mosquera 1, Mariana Nunes Ferreira 1, Fouad Jaber 2, John Helzberg 4, Nikki Duong 5, Wing-Kin Syn 3 6

Background: Vitamin D deficiency is linked to worse outcomes in patients with chronic liver diseases (CLD). However, data in patients with autoimmune hepatitis (AIH) remain limited.

Aims: We aimed to assess the impact of vitamin D deficiency on the outcomes of individuals with AIH.

Methods: This retrospective cohort study used the TriNetX research network to identify patients with AIH. Patients were matched using propensity score matching and stratified to sufficient vitamin D levels (e.g., 25 (OH) D3 ≥ 30 ng/mL), vitamin D insufficiency (25 (OH) D3: 20-29.9 ng/mL) and vitamin D deficiency (e.g., 25 (OH) D3 < 20 ng/mL). The primary outcome was the all-cause mortality among adult patients with AIH. Secondary outcomes included decompensated liver cirrhosis, acute hepatic failure, liver transplantation (LT), all-cause hospitalizations and all-cause critical care admissions.

Results: A total of 1288 AIH patients with vitamin D deficiency were identified and propensity matched with 1288 patients with normal vitamin D levels.
Patients with vitamin D deficiency had significantly increased odds for

  • all-cause mortality compared to those with normal levels (adjusted odds ratio (aOR) = 3.2, 95%CI: 2.3-4.48).

Patients with vitamin D deficiency were at increased odds of

  • all-cause hospitalizations (aOR = 2.37, 95%CI: 1.97-2.84),
  • critical care unit admissions (aOR = 2.8, 95%CI: 2.21-3.71),
  • decompensated liver cirrhosis (aOR = 2.74, 95%CI: 2.13-3.54),
  • acute hepatic failure (aOR = 3.11, 95%CI: 2.09-4.62) and
  • LT (aOR = 3.47, 95%CI: 1.71-7.04), as compared to those with normal vitamin D levels.


Conclusion: This cohort study showed significantly increased odds for all-cause mortality in AIH patients with vitamin D deficiency. Vitamin D deficiency in patients with AIH was associated with increased likelihood of hospitalisation, decompensated liver cirrhosis, acute liver failure and LT.

72 references online

VitaminDWiki – Autoimmune category contains

See also web: consensus that ~50 diseases are autoimmune, ~50 more are suspected:

VitaminDWiki – Vitamin D Receptor is associated in over 58 autoimmune studies

VitaminDWiki – Overview Liver and vitamin D category contains:

  • Fact: A properly functioning liver is needed for the efficient activation of vitamin D in the body
  • Fact: Liver diseases often result in lower levels of vitamin D
  • Fact: Various pain relievers damage the liver function
  • Fact: Lower levels of vitamin D result in osteoporosis and many other diseases
  • Options with a poorly functioning liver appear to be:
  1. Increased vitamin D (example: 2X more vitamin D if Liver is 1/2 as efficient)
  2. Increase the response you get from vitamin D
  3. Increase sunshine / UVB,
  4. Get the response you get from the sun/UVB
  5. Consider supplementing with Iron - a patented Iron supplement appears to work very well
  6. Get prescription for active form of vitamin D (Calcitriol) which does not need the liver or kidney to get the benefits of vitamin D in the body
  7. Get Calcidiol which does not need the liver
  8. Use Topical Vitamin D - activation by the skin etc does not require the liver

http://vitamindwiki.com/tiki-index.php?page_id=5644
Click on image for ways of getting vitamin D even if Liver is not functioning well

Autoimmune hepatitis is not caused by a virus the way type A, B, or C are - Perplexity AI Dec 2024

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