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P235 The association between serum vitamin D status and disease activity in paediatric inflammatory bowel disease

E. O’Neill*1, T. Raftery2, A. M. Broderick2, B. Bourke2, S. Hussey2

1University College Dublin, Dublin 4, Ireland, 2Our Lady’s Children’s Hospital Crumlin, Gastroenterology, Dublin, Ireland

Background

The role of vitamin D has been investigated in numerous inflammatory conditions including inflammatory bowel disease (IBD). In paediatric and adult studies, vitamin D status associates with disease initiation, progression and severity.1,2 This had yet to be investigated in an Irish paediatric cohort.

Aims were:

1) To determine the vitamin D status at diagnosis of paediatric IBD patients referred to the National Centre for Paediatric Gastroenterology.

2) To describe differences in vitamin D status observed between children diagnosed with Crohn’s disease (CD) and ulcerative colitis (UC).

3) To investigate associations between vitamin D status and markers of systemic (C creative protein, [CRP]), and intestinal inflammation (faecal calprotectin [FC]) and disease activity (Paediatric Ulcerative Colitis Activity Index, PUCAI score/ Paediatric Crohn’s Disease Activity Index [PCDAI] score).

Methods

Data were obtained from the Determinants and Outcomes in Children and Adolescents with IBD Study (DOCHAS). Patient classification was based on diagnosis at recruitment. Vitamin D status was compared with PUCAI/ PCDAI, CRP, and FC status. Serum 25(OH)D concentration was used to assess vitamin D status. Vitamin D deficiency was defined as serum 25(OH)D < 50 nmol/l.

Results

Included were 338 children (Table1); 25(OH)D was suboptimal in 80.7% of cases. Serum 25(OH)D inversely correlated with PCDAI (r = -0.490, p = <0.001), age (r = -0.367, p = <0.001), and CRP (r = -0.534, p = <0.001) (Figure 1). Correlation analysis was non-significant between serum 25(OH)D and FC (r = -0.084, p = 0.724), and PUCAI (r = -0.239, p = 0.123). ANOVA test showed no significance between 25(OH)D status and season, diagnosis, or living arrangement.

Table 1 Demographic data; 35.2% of total study cohort with 25(OH)D results available

n = 338Ulcerative colitisCrohn’s diseaseIBD-undefinedAtypical ulcerative colitisControl
No. of diagnoses n, (%)118 (34.9)135 (39.9)18 (5.3)4 (1.2)63 (18.6)
Male gender n, (%)57 (16.9)99 (29.3)13 (3.8)3 (0.9)37 (10.9)
Mean age, years (SD)11.9 (3.4)11.8 (3.5)12 (2.6)10.2 (4.2)9 </i> (4.5) </i>
Mean 25(OH)D (nmol/l) (SD), n = 11935.6 (18.5)33.4 (20.5)33.9 (12.9)54.5 (23.3)54 (32.3)
Urban dwelling n, (%)67 (19.8)71 (21.0)10 (3.0)2 (0.6)40 (11.8)
Rural- isolated dwelling n, (%)38 (11.2)45 (13.3)8 (2.4)1 (0.3)14 (4.1)
Rural- farm dwelling n, (%)7 (2.1)5 (1.5)8 (2.4)

Conclusion

Vitamin D deficiency is common in paediatric IBD irrespective of diagnosis, season, or living arrangement. Serum 25(OH)D inversely associates with systemic inflammation (CRP) and severity of disease in CD (PCDAI). Further study is warranted, as reverse causality cannot be excluded. Year-round supplementation of vitamin D should be considered. Investigation of the effect of vitamin D supplementation on disease activity in paediatric CD is advisable.1,2

Figure 1. Scatterplot graph demonstrates the inverse linear relationship between 25(OH)D (nmol) and CRP (mg/l)(p = <0.001), PCDAI score (p = <0.001), and age (years) (p = <0.001)”

References

[1] Pappa HM, Mitchell PD, Jiang H, et al. Maintenance of optimal vitamin D status in children and adolescents with inflammatory bowel disease: a randomised clinical trial comparing 2 regimens, J Clin Endocrinol Metab 2014;99(9):3408–17.

[2] Raftery T, Merrick M, Healy M, et al. Vitamin D status is associated with intestinal inflammation as measured by faecal calprotectin in Crohn’s disease in clinical remission. Dig Dis Sci 2015;60(8):2427–35.