High Prevalence of Untreated and Undertreated Vitamin D Deficiency and Insufficiency in Patients with Inflammatory Bowel Disease

Abstract

-Inflammatory bowel disease (IBD) patients with vitamin D deficiency show an increased risk of hospital admission, surgery, and loss of response to biologic therapy while high vitamin D levels are identified as a protective factor. Our goal was to investigate the prevalence of untreated and undertreated vitamin D deficiency and factors associated with vitamin D deficiency. In this cross-sectional study, we measured serum vitamin D in a random sample of Caucasian IBD patients. Vitamin D deficiency was defined as <50 nmol/L and insufficiency as 50-75 nmol/L. Supplementation was defined as taking 800-2000 IU vitamin D daily. Untreated patients were defined as not taking supplementation and undertreated group as receiving supplementation but showing vitamin D deficiency or insufficiency despite treatment. Our study included 185 IBD patients, i.e. 126 (68.1%) with Crohn's disease (CD) and 59 (31.9%) with ulcerative colitis (UC). Overall, 108 (58.4%) patients had vitamin D deficiency and 60 (32.4%) patients vitamin D insufficiency. There were 16 (14.8%) and 11 (18.3%) treated patients in vitamin D deficiency and vitamin D insufficiency group, respectively. The rate of untreated patients was 81.7% (n=49) in vitamin D deficiency group and 85.2% (n=92) in vitamin D insufficiency group. Tumor necrosis factor alpha inhibitors were associated with higher serum vitamin D levels in CD and UC, and ileal involvement, ileal and ileocolonic resection with lower levels. In conclusion, not only is vitamin D deficiency common in IBD patients but the proportion of untreated and undertreated patients is considerably high. We suggest regular monitoring of vitamin D levels in IBD patients regardless of receiving vitamin D supplementation therapy.

Bone Metabolism Alteration in Patients with Inflammatory Bowel Disease

“…On one hand, vitamin D deficiency was more profound in our population than in other IBD populations, such as in a Norwegian cohort [ 20 ]. On the other hand, our data show similarities to a Croatian study in which nearly 60% of the subjects had vitamin D insufficiency [ 21 ], or to a Romanian study where only 24% of patients with CD and 21% of those with UC had normal vitamin D levels [ 22 ]. Moreover, one-third of the deficient patients had flare-ups, indicating that inflammation as well as sun exposure influence vitamin D levels [ 23 , 24 ].…”

High prevalence of vitamin D deficiency in Taiwanese patients with inflammatory bowel disease

“…Meta-analysis showed vitamin D supplementation effectively improves the vitamin D concentration and decreases CRP level in adult 43 and pediatric IBD patients 62 . However, the prevalence of untreated vitamin D deficiency is 82% in IBD patients 63 which disclosed clinical overlook of the issue of vitamin D deficiency. Society guidelines recommend supplementation of vitamin D is recommended for those with documented deficiency [49][50][51] to prevent osteoporosis during disease treatment.…”

Inflammatory Bowel Diseases: Is There a Role for Nutritional Suggestions?

“…The health benefits of vitamin D are pleiotropic and include bone health, modulation of the immune system, antimicrobial protection, and mucosal integrity [46]. Deficiency of vitamin D is common in patients affected by IBD, in particular CD, due to malabsorption, and is worsened by reduced sunlight exposure and steroid treatment [47].…”