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P323 Prevalence of vitamin D deficiency in patients with inflammatory bowel disease

N. Toke*, P. Kakkadasam Ramaswamy, B. Sebastian, S. Mathai, C. Panackel

Medical Trust Hospital, Department of Gastroenterology, Ernakulam, India

Background

There is growing epidemiological evidence to suggest a role for vitamin D deficiency in the development of inflammatory bowel disease (IBD) and its influence on disease severity. The prevalence of vitamin D deficiency (25[OH]D3) amongst Indian IBD patients is not known and the aim of this study was to assess the prevalence in our IBD patients and to assess the association of vitamin D deficiency with disease severity and extent.

Methods

We conducted a prospective cross-sectional study which included 110 patients, 54 with ulcerative colitis (UC) and 56 with Crohn’s disease (CD). Clinical data (gender, age, BMI, disease location, and phenotype) and laboratory variables (haemoglobin, platelet count, S. albumin, S. calcium, and vitamin D levels) were collected.

Results

Of 110 patients, 80 (72.7%) had vitamin D deficiency (50 with CD and 30 with UC, p < 0.01), 27 had insufficient vitamin D levels, and only 3 patients had sufficient levels of (all 3 were patients with UC). Moreover, 55% (30/54) of patients with UC and 89% of with CD (50/56) had low vitamin D levels (Table 1).

Table 1. Vitamin D (25 OH D3) levels in UC and CD patients

Vit D Levels (ng/ml)UC (n = 54)CD (n = 56)
Deficiency (< 20)30 (55%)50 (89%)
Insufficiency (20–29)21 (39%)6 (11%)
Sufficiency (> 30)3 (6%)

In the UC group, 68% of patients with pancolitis and 50% of patients with left-sided colitis had vitamin D deficiency. Further, 47% (9/19) of patients with Mayo score < 6 and 60% (21/35) of patients with a Mayo score > 6 were deficient in vitamin D. In the CD group, vitamin D Deficiency was seen in 89% of patients with L1, L2, and L3 phenotype; 87% of patients with B1 phenotype; and 92% of patients with B2 phenotype were deficient in vitamin D. In addition, 87.5% of patients with Crohn’s Disease Activity Index [CDAI] of < 150 (43/49) and 100% of patients with CDAI > 150 (7/7) were deficient in vitamin D. CD patients with vitamin D deficiency were younger, had a lower BMI, and had higher CRP (Table 2).

Table 2. Clinical and laboratory features

UC (n = 54)CD (n = 56)P
Age51.1 ± 16.234.8 ± 13.6< 0.01
M/F33/2135/210.88
BMI (kg/m2)23.9 ± 3.220.7 ± 1.9< 0.01
Hb (g/dL)11.3 ± 1.310.9 ± 1.40.12
Platelets (x1000) cells/mm3328 ± 85343 ± 1090.42
CRP (IU/ml)41 ± 4584 ± 1130.01
S.Albumin (mg/dL)3.2 ± 0.63 ± 10.21
S.Calcium (mg/dL)8.3 ± 0.58.1 ± 0.40.06
S. Vit D (25 OH) levels (ng/ml)19 ± 915 ± 4< 0.01

No significant association was found between mean serum levels of 25(OH)D3 and gender, disease location, phenotype, disease activity, physical activity, smoking habits, BMI, or sun exposure.

Conclusion

Vitamin D deficiency occurs commonly in patients with IBD, and it is more common in CD than UC. All IBD patients should be tested for vitamin D and treated when appropriate.