In the Journals

Low vitamin D linked to higher morbidity, disease severity in IBD

Low serum vitamin D levels were found to be associated with worse outcomes in patients with inflammatory bowel disease, and supplementation appears to be associated with reduced health care use, according to the results of a 5-year longitudinal study.

“There is growing interest in long-term, multi-year, prospective observational registry datasets, as we can gain important information regarding the natural history of complex, chronic illnesses and clinical factors including nutritional status,” David G. Binion, MD, of the department of medicine and division of gastroenterology, hepatology and nutrition at University of Pittsburgh Medical Center, told Healio Gastroenterology. “By capturing ‘Big Data’ on a large number of prospectively tracked IBD patients followed over a multi-year time period, we gained insight into the importance of vitamin D assessment and treatment. This type of prospective, observational registry data is essential, as a clinical trial which fails to correct vitamin deficiency detected in participants would be impossible, as with-holding vitamin treatment would be unethical.”

David G. Binion

Binion and colleagues identified 965 IBD patients (61.9% Crohn’s disease; 38.1% ulcerative colitis; 52.3% women; mean age, 44 years) with up to 5 years of follow-up data in University of Pittsburgh Medical Center’s longitudinal IBD natural history registry. They categorized patients based on mean serum 25-OH vitamin D levels, and examined associations between vitamin D levels, IBD clinical status and health care use.

At enrollment, 8.9% of patients were vitamin D deficient and 33.1% had vitamin D insufficiency vs. 4.9% and 23.6%, respectively, at the conclusion of the study period. Among patients who received vitamin D supplements, 67.9% achieved normal levels by the end of the study.

“Our examination of vitamin D status over a 5-year time period in close to 1,000 IBD patients demonstrated that deficiency was associated with poor clinical status as assessed by health care utilization, such as emergency room visits, hospitalizations and abdominal imaging studies,” Binion said.

Overall, patients with low vitamin D levels required significantly more steroids, biologics, narcotics, computed tomography scans, emergency department visits, hospital admissions and surgeries compared with those who had normal mean vitamin D levels (P < .05). They also had worse pain, disease activity scores and quality of life (P < .05).

“More importantly, correction of vitamin D deficiency was associated with overall improvement in clinical status,” Binion said. “Our data suggests that correcting vitamin D deficiency will help IBD patients achieve clinical remission. There is precedent for the idea that correction of vitamin D deficiency helps to improve disease course and treatment efficacy in other forms of chronic inflammation, specifically asthma. Our work extends this observation into the IBD patient population.” – by Adam Leitenberger

Disclosure: Binion reports consulting or advisory board relationships with AbbVie, Janssen and the FDA Safety Board of UCB Pharma, and grant support from Janssen, Merck and UCB Pharma. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Low serum vitamin D levels were found to be associated with worse outcomes in patients with inflammatory bowel disease, and supplementation appears to be associated with reduced health care use, according to the results of a 5-year longitudinal study.

“There is growing interest in long-term, multi-year, prospective observational registry datasets, as we can gain important information regarding the natural history of complex, chronic illnesses and clinical factors including nutritional status,” David G. Binion, MD, of the department of medicine and division of gastroenterology, hepatology and nutrition at University of Pittsburgh Medical Center, told Healio Gastroenterology. “By capturing ‘Big Data’ on a large number of prospectively tracked IBD patients followed over a multi-year time period, we gained insight into the importance of vitamin D assessment and treatment. This type of prospective, observational registry data is essential, as a clinical trial which fails to correct vitamin deficiency detected in participants would be impossible, as with-holding vitamin treatment would be unethical.”

David G. Binion

Binion and colleagues identified 965 IBD patients (61.9% Crohn’s disease; 38.1% ulcerative colitis; 52.3% women; mean age, 44 years) with up to 5 years of follow-up data in University of Pittsburgh Medical Center’s longitudinal IBD natural history registry. They categorized patients based on mean serum 25-OH vitamin D levels, and examined associations between vitamin D levels, IBD clinical status and health care use.

At enrollment, 8.9% of patients were vitamin D deficient and 33.1% had vitamin D insufficiency vs. 4.9% and 23.6%, respectively, at the conclusion of the study period. Among patients who received vitamin D supplements, 67.9% achieved normal levels by the end of the study.

“Our examination of vitamin D status over a 5-year time period in close to 1,000 IBD patients demonstrated that deficiency was associated with poor clinical status as assessed by health care utilization, such as emergency room visits, hospitalizations and abdominal imaging studies,” Binion said.

Overall, patients with low vitamin D levels required significantly more steroids, biologics, narcotics, computed tomography scans, emergency department visits, hospital admissions and surgeries compared with those who had normal mean vitamin D levels (P < .05). They also had worse pain, disease activity scores and quality of life (P < .05).

“More importantly, correction of vitamin D deficiency was associated with overall improvement in clinical status,” Binion said. “Our data suggests that correcting vitamin D deficiency will help IBD patients achieve clinical remission. There is precedent for the idea that correction of vitamin D deficiency helps to improve disease course and treatment efficacy in other forms of chronic inflammation, specifically asthma. Our work extends this observation into the IBD patient population.” – by Adam Leitenberger

Disclosure: Binion reports consulting or advisory board relationships with AbbVie, Janssen and the FDA Safety Board of UCB Pharma, and grant support from Janssen, Merck and UCB Pharma. Please see the full study for a list of all other researchers’ relevant financial disclosures.

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