Hypocalcemia and Vitamin D Deficiency in Children with Inflammatory Bowel Diseases and Lactose Intolerance

Abstract

Background: A diet restricted in dairy products can cause calcium and vitamin D deficiency and, secondarily, lead to malnutrition and low bone mass. The aim of the study was to determine the incidence hypocalcemia and vitamin D deficiency in children with inflammatory bowel diseases and lactose intolerance (LI). Material and Methods: A total of 107 patients were enrolled to the study (mean age 14.07 ± 3.58 years; 46.7% boys): 43 with Crohn’s disease (CD), 31 with ulcerative colitis (UC), and 33 with functional abdominal pain (AP-FGID). Hydrogen breath test with lactose and laboratory tests to assess the calcium-phosphate metabolism were performed in all patients. The results of densitometry were interpreted in 37 IBD patients. Results: LI was diagnosed in 23.2% patients with CD, 22.6% with UC, and 21.2% children with AP-FGID, (p = 0.9). Moreover, 9.5% patients with CD, in 21.4% with UC, and in 51.5% with AP-FGID had optimal concentration of 25(OH)D (p = 0.0002). Hypocalcemia was diagnosed in 21% of patients with CD, 16.1% with UC patients, AP-FGID patients had normal calcium levels (p = 0.02). There was no difference in concentrations of total calcium, phosphorus, and 25(OH)D between patients on low-lactose diet and normal diet (p > 0.05). BMD Z-score ≤ −1 SD was obtained by 12 CD patients (48%), and 6 with UC (50%). Conclusion: The use of a low-lactose diet in the course of lactose intolerance in children with inflammatory bowel diseases has no effect on the incidence of calcium-phosphate disorders and reduced bone mineral density.

Diet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease

“…Data from studies analyzing this association in IBD children require further studies due to the small sample size [ 31 ], although some researchers suggest a higher prevalence of vitamin D deficiency in patients with Crohn’s disease with upper gastrointestinal tract involvement [ 32 , 38 ]. In the literature it is suggested that resection of the small intestine may be a risk factor for vitamin D deficiency [ 39 , 40 ]. In our study, we did not confirm that hypothesis, and other researchers—mainly in pediatric studies—did not show such a correlation as well [ 41 ].…”

“…IBD patients often avoid dairy products because they are afraid of symptoms of lactose intolerance [ 39 ]. Consequently, in addition to the low dose of vitamin D, they do not provide the body with the right amount of calcium.…”

“…So far, there is not enough evidence to confirm the benefits of vitamin D supplementation in the treatment of IBD. There are some studies, the majority in adults, evaluating the influences of a vitamin D deficiency at the course and severity of the disease, but the results are conflicting [ 8 , 29 , 35 , 36 , 39 ]. It could be postulated that doses of 600 IU–1000 IU of vitamin D (used in this study) are not sufficient for IBD pediatric patients, which would explain the high prevalence of vitamin D deficiencies in IBD children despite supplementation.…”

Seasonal fluctuations in vitamin D levels in children with various diseases

“…Традиционно наше представление об обеспеченности витамином D детей было по сравнению со взрослыми было более оптимистичным в связи с большей приверженностью детей к приему профилактических доз холекальциферола [1,2]. Однако недавние исследования с включением различных по величине когорт пациентов свидетельствуют о низкой обеспеченности 25(ОН)D как среди практически здоровых детей вне зависимости от региона их проживания, так и среди детей с различными отклонениями в состоянии здоровья [3][4][5][6][7][8][9][10][11][12][13]. Основная проблема исследований по обеспеченности витамином D заключается в отсутствии комплексного подхода, то есть динамической оценки 25(ОН)D в течение всего периода детства и в различные сезоны года.…”

Metabolic Bone Disorders in Children with Inflammatory Bowel Diseases

“…The same study showed that children with CD or UC were statistically more likely to develop hypocalcemia. Due to the occurrence of malabsorption disorders and increased loss in the gastrointestinal tract, this group of patients has a greater need for supplementation, which, despite its safety and general tolerance, is not always sufficient [ 46 ]. However, maintaining the 25-OHD concentration above 30 ng/mL may improve calcium absorption and ensure an adequate range of parathyroid hormone (PTH) [ 47 ].…”