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.