P685 Vitamin D levels in newly diagnosed UC are lower in South Asians than white Europeans: Could this be contributing to the increasing incidence of UC in South Asians?
R. Misra*1, U. Selvarajah2, O. Faiz3, J. Burisch4, P. Munkholm4, N. Arebi5
1St Marks Academic Institute, Gastroenterology, London, United Kingdom, 2Imperial College NHS Healthcare Trust, Gastroenterology, London, United Kingdom, 3St Mark’s Academic Institute, Colorectal Surgery & IBD Unit, London, United Kingdom, 4North Zealand University Hospital, Gastroenterology, Frederikssun, Denmark, 5St Marks Academic Institute, Gastroenterology, London, United Kingdom
In healthy populations, Vitamin D deficiency is commoner in hyperpigmented people than light-skinned ones. Low vitamin D levels are thought to predispose to pro-inflammatory states and are reported in IBD. The effect is related to the recognised immunoregulatory effects of Vitamin D. There is no literature on vitamin D levels in ethnic groups with IBD. There is evidence of an increasing incidence and more severe disease phenotype of IBD in migrant South Asian (SA) groups. We hypothesise SA patients with IBD will have lower vitamin D levels compared with White Europeans (WE) which may account for the changing incidence and disease phenotype in this group. We aimed to examine the vitamin D level at diagnosis in a prospective inception cohort.
All patients with newly diagnosed IBD between February 2015 and October 2015 with a vitamin D level at diagnosis were included. Patient demographics including ethnicity were documented. Levels of vitamin D deficiency were defined as: Deficient (< 25ng/mL), Insufficient (25–49ng/mL), Sufficient (50–75ng/mL) and Optimal (>75). The mean Vitamin D level in the SA and WE groups were compared. Three patients on vitamin D replacement were excluded.
In total, 37 patients were identified: 21/37 (57%) were males and 20/37 (54%) were SA. 29 (78.3%) patients had ulcerative colitis (UC) and 8 (21.6%) Crohn’s disease (CD). The mean vitamin D level of the cohort was 43.5 (± 24.1, 2 SD). 23/37 (62.1%) patients were vitamin D deficient or insufficient with the majority diagnosed with UC (17/23, 73.9%). The mean vitamin D level in the SA group was 30.9 (± 18.7, 2 SD) compared with 61.3 (± 38.5, 2 SD) in the WE group. (P < 0.17). 14/20 (70%) SAs were either vitamin D deficient or insufficient in comparison to 2/6 (33.3%) WE. UC was the predominant disease in the SA group, 15/20 (75%). Vitamin D levels in newly diagnosed patients by ethnic group
Vitamin D level (ng/mL) South Asian White European Other Mixed Black Deficient (<25) 3 1 2 1 Insufficient (254– 9) 11 1 1 1 2 Sufficient (507– 4) 4 3 2 Optimal (>75) 2 1 1 1
Vitamin D levels in newly diagnosed patients by ethnic group
The mean Vitamin D level of the cohort was within the insufficient range. The majority of patients with insufficient Vitamin D levels had UC which suggests that mechanisms other than malabsorption contributing to vitamin D status. The average vitamin D level in SAs with IBD was insufficient or deficient in a majority of SA and although there were inadequate number of WE to make a valid comparison the result highlights the need to screen this at-risk population. Ongoing recruitment within this cohort with extension to other sites in England will assess the significance of the observations in addition to the impact on the clinical course of IBD and response to therapy.