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Low vitamin D levels appear to follow, not cause, Crohn’s disease
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WASHINGTON — Individuals with low levels of vitamin D were not more likely to develop Crohn’s disease, but Crohn’s patients were more likely to have low vitamin D levels in a recent study, a presenter said.
Investigators concluded that these findings clarify the challenge of “reverse causation” regarding vitamin D deficiency in Crohn’s disease, suggesting that low vitamin D levels are the result of Crohn’s disease rather than a significant contributing cause.
“What we found is that before diagnosis, vitamin D levels were not associated with Crohn’s disease. However, after diagnosis, Crohn’s disease was associated with low vitamin D levels,” Berkeley Limketkai, MD, of Stanford University School of Medicine, said during his presentation. “So, these data suggest that perhaps previous associations of low vitamin D levels leading to worse Crohn’s disease may actually have been instead influenced by reverse causation.”
In a prospective nested case-control study using U.S. military personnel data spanning 1998-2011 Limketkai and colleagues measured vitamin D levels before and after diagnosis in 240 patients with Crohn’s disease and the same number of matched controls without Crohn’s. They obtained serum samples from the Department of Defense Serum Repository taken at three different points in time: 3-8 years before diagnosis (or time of index for controls); 3 months to 3 years before diagnosis; and after diagnosis.
The investigators found no association between Crohn’s disease incidence and pre-diagnosis 25-hydroxyvitamin D levels. In contrast, they found an inverse association between Crohn’s disease and vitamin D levels after diagnosis (OR = 0.74; 95% CI, 0.59–0.94; P = 0.01). The investigators noted they observed no interactions between polymorphisms in vitamin D-related genes and vitamin D levels.
Limketkai noted that the study was limited by its primarily male U.S. military cohort, lack of more granular data, discrete measurements of time points and small sample size. – by Adam Leitenberger
Reference:
Limketkai B, et al. Abstract 54. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosures: Limketkai reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.
Perspective
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Amy Foxx-Orenstein, DO, FACG
There’s plenty of evidence that vitamin D deficiency is associated with inflammatory bowel disease; in fact, it’s associated with any sort of diarrheal condition, including viruses and infections. What we know about vitamin D is that it acts as an anti-inflammatory to a certain degree. In patients with active Crohn’s, higher levels of vitamin D have been associated in some studies with less severe symptoms of IBD.
Limketkai and colleagues present a unique query as to whether vitamin D levels affect the risk for developing IBD. It is known that vitamin D levels are lower during Crohn’s and, the more severe the activity of the disease, the lower the levels may be. Certain treatments like Remicade (infliximab, Janssen) are also a concern, as they are associated with further decrease of vitamin D.
An important take away from this abstract is that monitoring vitamin D levels in Crohn’s and subsequent therapy is an important aspect of good patient care.
Mayo Clinic College of Medicine in Minnesota
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