Normalization of Plasma 25-Hydroxy Vitamin D Is Associated with Reduced Risk of Surgery in Crohn's Disease

被引:128
作者
Ananthakrishnan, Ashwin N. [1 ,2 ]
Cagan, Andrew [3 ]
Gainer, Vivian S. [3 ]
Cai, Tianxi [4 ]
Cheng, Su-Chun [4 ]
Savova, Guergana [5 ]
Chen, Pei [5 ]
Szolovits, Peter [6 ]
Xia, Zongqi [2 ,7 ]
De Jager, Philip L. [2 ,7 ]
Shaw, Stanley Y. [2 ,8 ]
Churchill, Susanne [9 ]
Karlson, Elizabeth W. [2 ,10 ]
Kohane, Isaac [2 ,5 ,9 ]
Plenge, Robert M. [2 ,10 ]
Murphy, Shawn N. [2 ,3 ,11 ]
Liao, Katherine P. [2 ,10 ]
机构
[1] Massachusetts Gen Hosp, Div Gastroenterol, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Partners HealthCare, Res Comp, Charlestown, MA USA
[4] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[5] Childrens Hosp, Boston, MA 02115 USA
[6] MIT, Cambridge, MA 02139 USA
[7] Brigham & Womens Hosp, Dept Neurol, Boston, MA 02115 USA
[8] Massachusetts Gen Hosp, Ctr Syst Biol, Boston, MA 02114 USA
[9] Brigham & Womens Hosp, Natl Ctr Biomed Comp I2b2, Boston, MA 02115 USA
[10] Brigham & Womens Hosp, Div Rheumatol, Boston, MA 02115 USA
[11] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA
基金
美国国家卫生研究院;
关键词
Crohn's disease; ulcerative colitis; vitamin D; surgery; hospitalization; INFLAMMATORY-BOWEL-DISEASE; ULCERATIVE-COLITIS; D DEFICIENCY; EPIDEMIOLOGY; PATHWAY; HEALTH; COHORT;
D O I
10.1097/MIB.0b013e3182902ad9
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background:Vitamin D may have an immunologic role in Crohn's disease (CD) and ulcerative colitis (UC). Retrospective studies suggested a weak association between vitamin D status and disease activity but have significant limitations.Methods:Using a multi-institution inflammatory bowel disease cohort, we identified all patients with CD and UC who had at least one measured plasma 25-hydroxy vitamin D (25(OH)D). Plasma 25(OH)D was considered sufficient at levels 30 ng/mL. Logistic regression models adjusting for potential confounders were used to identify impact of measured plasma 25(OH)D on subsequent risk of inflammatory bowel disease-related surgery or hospitalization. In a subset of patients where multiple measures of 25(OH)D were available, we examined impact of normalization of vitamin D status on study outcomes.Results:Our study included 3217 patients (55% CD; mean age, 49 yr). The median lowest plasma 25(OH)D was 26 ng/mL (interquartile range, 17-35 ng/mL). In CD, on multivariable analysis, plasma 25(OH)D <20 ng/mL was associated with an increased risk of surgery (odds ratio, 1.76; 95% confidence interval, 1.24-2.51) and inflammatory bowel disease-related hospitalization (odds ratio, 2.07; 95% confidence interval, 1.59-2.68) compared with those with 25(OH)D 30 ng/mL. Similar estimates were also seen for UC. Furthermore, patients with CD who had initial levels <30 ng/mL but subsequently normalized their 25(OH)D had a reduced likelihood of surgery (odds ratio, 0.56; 95% confidence interval, 0.32-0.98) compared with those who remained deficient.Conclusion:Low plasma 25(OH)D is associated with increased risk of surgery and hospitalizations in both CD and UC, and normalization of 25(OH)D status is associated with a reduction in the risk of CD-related surgery.
引用
收藏
页码:1921 / 1927
页数:7
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