Vitamin D and malabsorptive gastrointestinal conditions: A bidirectional relationship?

Abstract

This paper is one of the outcomes of the 5th International Conference "Controversies in Vitamin D" held in Stresa, Italy from 15 to 18 September 2021 as part of a series of annual meetings which was started in 2017. The scope of these meetings is to discuss controversial issues about vitamin D. Publication of the outcomes of the meeting in international journals allows a wide sharing of the most recent data with the medical and academic community. Vitamin D and malabsorptive gastrointestinal conditions was one of the topics discussed at the meeting and focus of this paper. Participants to the meeting were invited to review available literature on selected issues related to vitamin D and gastrointestinal system and to present their topic to all participants with the aim to initiate a discussion on the main outcomes of which are reported in this document. The presentations were focused on the possible bidirectional relationship between vitamin D and gastrointestinal malabsorptive conditions such as celiac disease, inflammatory bowel diseases (IBDs) and bariatric surgery. In fact, on one hand the impact of these conditions on vitamin D status was examined and on the other hand the possible role of hypovitaminosis D on pathophysiology and clinical course of these conditions was also evaluated. All examined malabsorptive conditions severely impair vitamin D status. Since vitamin D has known positive effects on bone this in turn may contribute to negative skeletal outcomes including reduced bone mineral density, and increased risk of fracture which may be mitigated by vitamin D supplementation. Due to the immune and metabolic extra-skeletal effects there is the possibility that low levels of vitamin D may negatively impact on the underlying gastrointestinal conditions worsening its clinical course or counteracting the effect of treatment. Therefore, vitamin D status assessment and supplementation should be routinely considered in all patients affected by these conditions. This concept is strengthened by the existence of a possible bidirectional relationship through which poor vitamin D status may negatively impact on clinical course of underlying disease. Sufficient elements are available to estimate the desired threshold vitamin D level above which a favourable impact on the skeleton in these conditions may be obtained. On the other hand, ad hoc controlled clinical trials are needed to better define this threshold for obtaining a positive effect of vitamin D supplementation on occurrence and clinical course of malabsorptive gastrointestinal diseases.

Understanding and Managing Metabolic Deficiencies Post Bariatric and Esophagectomy Surgeries: A Narrative Review of the Literature

“…After bariatric surgery, a minimum of 60 g of protein per day is recommended to maintain favorable albumin levels [ 51 , 53 , 54 ]. It is recommended to monitor protein intake and albumin presence before and after surgical procedures, together with a balanced diet [ 55 ].…”

“…The incidence of deficiency is around 50% to 70% at two to four years. Vitamin A deficiency is most frequent in third-world countries and people with liver storage diseases [ 55 ]. The clinical manifestation of vitamin A deficiency is more notable and frequent than that of vitamin K [ 40 ].…”

“…In the vast majority of patients, esophageal cancer and gastric cancers are linked to malnutrition. This correlation is partly due to the nature of the disease, the tumor's location, and additional factors such as dysphagia, the presence of cancer cachexia, altered metabolism, and tissue wasting [ 55 ]. Patients with these cancers commonly endure symptoms related to the tumor, including cancer-related pain, loss of appetite, and difficulties with nutrient absorption.…”

Acromegaly and Bone: An Update

“…Vitamin D is a crucial hormone with skeletal and extraskeletal effects [ 91 ]. The most relevant skeletal action of vitamin D is an increase in intestinal calcium absorption and bone mineralization [ 92 ]. Its deficiency, when severe, may cause rickets in children and osteomalacia in adults.…”

Nutrition, Nutritional Status, Micronutrients Deficiency, and Disease Course of Inflammatory Bowel Disease

“…During the last few years, there has been an increase in interest concerning the immunomodulating role of vitamin D [25,222]. Firstly, several observational and cross-sectional studies included in three meta-analyses showed that IBD patients presented low serum vitamin D levels compared to healthy people [183,223,224].…”