Post on 19-Aug-2020
Ten Minute PhD: Vitamin D
Khursheed Jeejeebhoy
NEJM 2007; 357:266-281
<50 50-200 >300 nmol/L
Paedriatr Perinat Epidemiol 2014; 28:166-176
INSUFFICIENT INSUFFICIENT
DEFICIENT DEFICIENT
NEJM 2007; 357:266-281
Vitamin D and IBD
• Canadian Cohort 52/242 25-OH Vitamin D <40 nmol/L • (Canadian J Gastroenterol 2003; 17:473-478)
• Case Controlled Cohort : Control IBD ESR <21 IBD ESR >21
• 25-OH Vitamin D nmol/L 65.3 65.6 49.3
• P NS 0.045 • (PLOS ONE 2014 ; 9:e101583
Reich et al: World J Gastroenterol 2014; 20:4934-4947
• 1, 25 Dihydroxy Vitamin D acts on CD4 cells to promote Th2 cell development and on dendritic cells to reduce Th1 cells.
• 1, 25 Dihydroxy Vitamin D indices cytokines which suppress inflammation • Il-4, IL-5 and IL-10
• Normalization of Vitamin D levels:
• Reduced risk of relapse after surgery
• Improves quality of life.
PLOS ONE 2014;9: e101583
Distribution Of 25-OH Vitamin D
0
10
20
30
40
50
60
70
80
90
25-OH Vitamin D <50 nmol/L 25-OH Vitamin D <75 nmol/L 25-OH Vitamin D > 75 nmol/L
CD % UC % CONTROL %
%
Endocrine Society Guidelines J Clin Endocrinol Metab 2011; 96:1911-1930
• Screen for 25-OH Vitamin Levels in high risk (IBD) and those with pigmented skin.
• Deficiency 50,000 IU D2 weekly or 6000 IU D3 daily for 8 weeks
• Monitor to show levels >75 nmol/L
• Maintenance 1500-2000 D3 IU daily or 50000 D2 IU alt weeks.
Treatment of Vitamin D Insufficiency in Children and Adolescents with Inflammatory Bowel Disease: A Randomized Clinical Trial Comparing Three Regimens J Clin Endocrinol Metab 2012; 97:2134-2142
Inclusion: 25-OH Vitamin D levels <50 nmol/L Number: 61
Age: 5-21 years
Duration: 6 Weeks
PROTOCOL:
ARM A 2000 IU D2/daily
ARM B 2000 IU D3/daily
ARM C 50000 IU D2/weekly
Conclusion
• Measure 25-OH vitamin D levels in IBD patients
• Treat deficiency, monitor and give supplementary maintenance
• Benefits Include:
• Bone health
• Reduced inflammation
• Improved quality of life.