Association of Vitamin D Level With Clinical Status in Inflammatory Bowel Disease: A 5-Year Longitudinal Study : Official journal of the American College of Gastroenterology | ACG

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ORIGINAL CONTRIBUTIONS: INFLAMMATORY BOWEL DISEASE

Association of Vitamin D Level With Clinical Status in Inflammatory Bowel Disease: A 5-Year Longitudinal Study

Kabbani, Toufic A MD, MPH1; Koutroubakis, Ioannis E MD, PhD1; Schoen, Robert E MD, MPH1; Ramos-Rivers, Claudia MD1; Shah, Nilesh PhD1; Swoger, Jason MD, MPH1; Regueiro, Miguel MD1; Barrie, Arthur MD, PhD1; Schwartz, Marc MD1; Hashash, Jana G MD1; Baidoo, Leonard MD1; Dunn, Michael A MD1; Binion, David G MD1

Author Information

1Department of Medicine and Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Correspondence: David G. Binion, MD, Department of Medicine and Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Presbyterian Hospital Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA. E-mail: [email protected]

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/A621

Received 02 September 2015; accepted 02 January 2016

Writing assistance: None.

Specific author contributions: Toufic A. Kabbani: enrollment of subjects, acquisition of data, analysis and interpretation of data, and drafting of manuscript. Ioannis E. Koutroubakis: acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical review of manuscript. Robert E. Schoen: critical review of manuscript. Claudia Ramos Rivers: enrollment of subjects and acquisition of data. Nilesh Shah: statistical analysis. Jason Swoger: acquisition of data. Miguel Regueiro: acquisition of data. Arthur Barrie: acquisition of data. Marc Schwartz: acquisition of data. Jana Hashash: acquisition of data. Leonard Baidoo: acquisition of data. Michael Dunn: acquisition of data. David G. Binion: acquisition of data, analysis and interpretation of data, drafting of manuscript, critical review, and final approval of the manuscript.

Financial support: Ioannis Koutroubakis was supported by a sabbatical salary of Medical Faculty University of Crete Greece; Michael Dunn and David G. Binion were supported by a grant W81XWH-11-2-0133 from the US Army Medical Research and Material Command.

Potential competing interests: Ioannis Koutroubakis: consulting/advisory board for Abbvie and MSD; Miguel Regueiro: has served as a consultant for Abbvie, Janssen, Shire, Takeda, and UCB. David Binion: consulting/advisory board for Abbvie, Janssen, FDA Safety Board of UCB Pharma, and grant support from Janssen, Merck, and UCB Pharma. The other authors declare no conflict of interest.

American Journal of Gastroenterology 111(5):p 712-719, May 2016. | DOI: 10.1038/ajg.2016.53

Abstract

OBJECTIVES: 

Emerging data suggest that vitamin D has a significant role in inflammatory bowel disease (IBD). Prospective data evaluating the association of vitamin D serum status and disease course are lacking. We sought to determine the relationship between vitamin D status and clinical course of IBD over a multiyear time period.

METHODS: 

IBD patients with up to 5-year follow-up from a longitudinal IBD natural history registry were included. Patients were categorized according to their mean serum 25-OH vitamin D level. IBD clinical status was approximated with patterns of medication use, health-care utilization, biochemical markers of inflammation (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), pain and clinical disease activity scores, and health-related quality of life.

RESULTS: 

A total of 965 IBD patients (61.9% Crohn’s disease, 38.1% ulcerative colitis) formed the study population (mean age 44 years, 52.3% female). Among them, 29.9% had low mean vitamin D levels. Over the 5-year study period, subjects with low mean vitamin D required significantly more steroids, biologics, narcotics, computed tomography scans, emergency department visits, hospital admissions, and surgery compared with subjects with normal mean vitamin D levels (P<0.05). Moreover, subjects with low vitamin D levels had worse pain, disease activity scores, and quality of life (P<0.05). Finally, subjects who received vitamin D supplements had a significant reduction in their health-care utilization.

CONCLUSIONS: 

Low vitamin D levels are common in IBD patients and are associated with higher morbidity and disease severity, signifying the potential importance of vitamin D monitoring and treatment.

© The American College of Gastroenterology 2016. All Rights Reserved.

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