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Dwivedi S, Sikarwar MS. Diabetic Nephropathy: Pathogenesis, Mechanisms, and Therapeutic Strategies. Horm Metab Res 2025; 57:7-17. [PMID: 39572154 DOI: 10.1055/a-2435-8264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
Diabetic nephropathy represents a predominant etiology of end-stage renal disease (ESRD) on a global scale, significantly impacting the morbidity and mortality rates of individuals with diabetes. The primary objective of this analysis is to furnish a comprehensive examination of the etiology, fundamental mechanisms, and treatment modalities for DN. The development of DN stems from a multitude of factors, encompassing a intricate interplay involving metabolic irregularities induced by hyperglycemia, alterations in hemodynamics, inflammatory responses, oxidative stress, and genetic susceptibility. Principal mechanisms encompass the generation of advanced glycation end products (AGEs), activation of protein kinase C (PKC), and overexpression of the renin-angiotensin-aldosterone system (RAAS). These processes precipitate glomerular hyperfiltration, hypertrophy, and eventually, fibrosis and scarring of the renal parenchyma. Initially, hyperglycemia triggers mesangial proliferation and thickening of the glomerular basement membrane in the incipient stages of DN, subsequently leading to progressive glomerular sclerosis and tubulointerstitial fibrosis. Inflammatory cascades, notably involving cytokines like TGF-β and NF-κB, play pivotal roles in the advancement of DN by fostering the accumulation of extracellular matrix and renal fibrosis. Inflammation pathways, particularly those involving cytokines like TGF-β and NF-κB, play essential roles in diabetic nephropathy progression by stimulating extracellular matrix accumulation and renal fibrosis. The presence of oxidative stress, worsened by dysfunctional mitochondria, contributes further to renal injury via lipid peroxidation and DNA damage. Current therapeutic approaches for diabetic nephropathy concentrate on optimizing glycemic control, controlling hypertension, and suppressing the renin-angiotensin-aldosterone system. Among antihypertensive medications, ACE inhibitors and angiotensin II receptor blockers are crucial for decelerating disease advancement.
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Affiliation(s)
- Shivangi Dwivedi
- College of Pharmacy, Teerthanker Mahaveer University, Moradabad, India
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Neamți L, Drugan TC, Drugan C, Silaghi C, Ciobanu L, Ilyés T, Crăciun A. Assessing seasonal variations of biomarkers in inflammatory bowel disease. Eur J Gastroenterol Hepatol 2024; 36:993-999. [PMID: 38973542 DOI: 10.1097/meg.0000000000002795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Inflammatory bowel diseases are chronic pathologies characterized by a complex interplay of genetic and environmental factors, as well as aberrant immune responses. This study aimed to investigate inflammation markers' seasonality and association with disease exacerbation episodes in patients with Crohn's disease and ulcerative colitis. METHODS 284 patients were classified based on clinical, endoscopic, and histopathological criteria. Systemic inflammation was evaluated using C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and chitotriosidase, while fecal calprotectin was measured to assess intestinal inflammation. Serum vitamin D levels and the seasonality of an activity score that combines several clinical and biological parameters were also evaluated. RESULTS The peak number of patients reporting endoscopic activity occurred in autumn for Crohn's disease (82%) and spring for ulcerative colitis (95%). Regarding histological activity, spring saw the highest number of patients for both diseases (72% for Crohn's disease; 87% for ulcerative colitis). Most of the inflammatory markers exhibited lower values during winter. Systemic inflammatory markers follow a slightly different trend than fecal calprotectin and differ in the two pathologies. The maximum values of intestinal inflammation were observed in autumn for Crohn's disease (784 µg/g) and in spring for ulcerative colitis (1269 µg/g). Serum vitamin D concentrations were consistently low throughout the year. Statistical analysis revealed differences between the seasons for CRP and ESR (P < 0.05). CONCLUSION The evolution of flares and inflammatory markers in Crohn's disease and ulcerative colitis displayed distinct seasonal patterns. Systemic inflammation did not consistently parallel intestinal inflammation.
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Affiliation(s)
| | | | | | | | - Lidia Ciobanu
- Department of Internal Medicine
- Department of Gastroenterology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Johansen I, Småstuen MC, Løkkeberg ST, Kristensen VA, Høivik ML, Lund C, Olsen B, Strande V, Huppertz-Hauss G, Aabrekk TB, Bengtson MB, Ricanek P, Detlie TE, Frigstad SO, Jelsness-Jørgensen LP, Opheim R. Symptoms and symptom clusters in patients newly diagnosed with inflammatory bowel disease: results from the IBSEN III Study. BMC Gastroenterol 2023; 23:255. [PMID: 37501083 PMCID: PMC10373240 DOI: 10.1186/s12876-023-02889-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease report multiple symptoms, but the relationships among co-occurring symptoms are poorly understood. This study aimed to examine the prevalence of symptoms and explore symptom clusters and possible associations between symptom clusters and socio-demographic and clinical variables in patients newly diagnosed with inflammatory bowel disease. METHODS The IBSEN III study is a prospective population-based inception cohort of patients with inflammatory bowel disease. This study used patient data from the three largest hospitals in the study catchment area. The Memorial Symptom Assessment Scale was used to assess the prevalence of symptoms. Symptom clusters were identified using principal component analysis. Possible associations between socio-demographic and clinical variables and symptom cluster membership were estimated using regression analysis. RESULTS Of the 573 patients (age, ≥18 years) diagnosed with inflammatory bowel disease, 350 (61.1%) completed the questionnaire (responders). Eleven symptoms were reported by >50% of the responders. The three most prevalent symptoms were bloating (84%), drowsiness (81%), and lack of energy (81%). Three symptom clusters were identified: psychological (56% of the patients), impaired energy (28%), and physical (16%) clusters. Multinomial regression analysis revealed that vitamin D deficiency was significantly associated with the impaired energy cluster (odds ratio=2.49, 95% confidence interval [1.00-6.2], p=0.05). CONCLUSIONS We found high symptom prevalence in patients newly diagnosed with inflammatory bowel disease. Three distinct symptom clusters were identified, and the psychological cluster includes >50% of the patients. Vitamin D deficiency is the only factor associated with cluster membership, namely the impaired energy cluster.
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Affiliation(s)
- Ingunn Johansen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Stine Torp Løkkeberg
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
| | | | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Lund
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Olsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Vibeke Strande
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Tone Bergene Aabrekk
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - May-Bente Bengtson
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Svein Oskar Frigstad
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Baerum, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Fredrikstad, Norway
| | - Randi Opheim
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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Guo Y, Zhang T, Xu Y, Karrar E, Cao M, Sun X, Liu R, Chang M, Wang X. Effects of Medium- and Long-Chain Structured Triacylglycerol on the Therapeutic Efficacy of Vitamin D on Ulcerative Colitis: A Consideration for Efficient Lipid Delivery Systems. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:4101-4112. [PMID: 36847830 DOI: 10.1021/acs.jafc.2c07437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Due to intestinal malabsorption and poor water solubility, vitamin D (VitD) deficiency in ulcerative colitis (UC) continues to increase. Medium- and long-chain triacylglycerols (MLCT), as novel lipids, have been widely applied in the field of functional food and medicine nutrition. Our previous studies showed that the difference in MLCT structure could affect VitD bioaccessibility in vitro. In this study, our results further indicate that, although identical in fatty acid composition, structured triacylglycerol (STG) had a higher VitD bioavailability (AUC = 15470.81 μg/L × h) and metabolism efficacy [s-25(OH)D, p < 0.05] than physical mixtures of triacylglycerol (PM), which further affect the amelioration efficiency in UC mice. Compared with PM, the damage of colonic tissues, intestinal barrier proteins, and inflammatory cytokines in STG showed better amelioration at the same dose of VitD. This study provides a comprehensive understanding of the mechanism of nutrients in different carriers and a solution for developing nutrients with high absorption efficiency.
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Affiliation(s)
- Yiwen Guo
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Tao Zhang
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
- European Research Institute for the Biology of Aging, University Medical Centre Groningen, University of Groningen, Groningen 9713 AV, The Netherlands
| | - Ying Xu
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Emad Karrar
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Minjie Cao
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Xiaotian Sun
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Ruijie Liu
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Ming Chang
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Xingguo Wang
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
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Mărginean CO, Meliț LE, Borka Balas R, Văsieșiu AM, Fleșeriu T. The Crosstalk between Vitamin D and Pediatric Digestive Disorders. Diagnostics (Basel) 2022; 12:diagnostics12102328. [PMID: 36292016 PMCID: PMC9600444 DOI: 10.3390/diagnostics12102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. Vitamin D3, the most effective vitamin D isoform is produced in the human epidermis as a result of sunlight exposure. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to reach its active form, 1,25-dihydroxyvitamin D. Recent studies highlighted a complex spectrum of roles regarding the wellbeing of the gastrointestinal tract. Based on its antimicrobial effect, it was recently indicated that vitamin D supplementation in addition to standard eradication therapy might enhance H. pylori eradication rates. Moreover, it was suggested that low levels of vitamin D might also be involved in the acquisition of H. pylori infection. In terms of celiac disease, the negative effects of vitamin D deficiency might begin even during intrauterine life in the setting of maternal deficiency. Moreover, vitamin D is strongly related to the integrity of the gut barrier, which represents the core of the pathophysiology of celiac disease onset, in addition to being correlated with the histological findings of disease severity. The relationship between vitamin D and cystic fibrosis is supported by the involvement of this micronutrient in preserving lung function by clearing airway inflammation and preventing pathogen airway colonization. Moreover, this micronutrient might exert anticatabolic effects in CF patients. Inflammatory bowel disease patients also experience major benefits if they have a sufficient level of circulating vitamin D, proving its involvement in both induction and remission in these patients. The findings regarding the relationship between vitamin D, food allergies, diarrhea and constipation remain controversial, but vitamin D levels should be monitored in these patients in order to avoid hypo- and hypervitaminosis. Further studies are required to fill the remaining gaps in term of the complex impact of vitamin D on gastrointestinal homeostasis.
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Affiliation(s)
- Cristina Oana Mărginean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
| | - Lorena Elena Meliț
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
- Correspondence:
| | - Reka Borka Balas
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
| | - Anca Meda Văsieșiu
- Department of Infectious Disease, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania
| | - Tudor Fleșeriu
- Department of Infectious Disease, County Clinical Hospital Târgu Mureș, Gheorghe Doja Street No 89, 540394 Târgu Mureș, Romania
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Triantos C, Aggeletopoulou I, Mantzaris GJ, Mouzaki Α. Molecular basis of vitamin D action in inflammatory bowel disease. Autoimmun Rev 2022; 21:103136. [DOI: 10.1016/j.autrev.2022.103136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022]
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Guo Y, Xu Y, Zhang T, Wang Y, Liu R, Chang M, Wang X. Medium and long-chain structured triacylglycerol enhances vitamin D bioavailability in an emulsion-based delivery system: combination of in vitro and in vivo studies. Food Funct 2022; 13:1762-1773. [PMID: 35112696 DOI: 10.1039/d1fo03407c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vitamin D (VitD) is an essential fat-soluble micronutrient required for maintaining and regulating calcium homeostasis. Although sunlight can provide VitD, epidemiological studies indicate that the occurrence of VitD deficiency and insufficiency is widespread. Lipids are required at all stages of VitD digestion and absorption. In this research two different medium and long-chain triacylglycerol structures, possessing identical fatty acid composition lipids, namely structured triacylglycerol (STG), and physical mixtures of medium/long-chain triacylglycerol (MCT/LCT), were selected. Our results demonstrated that STG had a significant VitD bioavailability compared to MCT/LCT. In terms of the lipid digestion and absorption, the extent of the higher free fatty acid released (69.42%, p < 0.05), extent of lipolysis (89.28%, p < 0.05), lipolysis rate (0.06 s-1, p < 0.05), and the ratio of the long-chain fatty acid to medium-chain fatty acid of STG (4.8, p < 0.05), result in a higher capacity for accommodating VitD when forming mixed micelles (61.31%, p < 0.05). An in vivo animal study also demonstrated that STG significantly increases the delivery ability of VitD (18.75 ng mL-1, p < 0.05). The findings of this work may have unique applications for designing novel interesterified lipids with an effective delivery capacity for fat-soluble nutrients.
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Affiliation(s)
- Yiwen Guo
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu, 214122, China.,School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Ying Xu
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu, 214122, China.,School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Tao Zhang
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu, 214122, China.,School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Yandan Wang
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu, 214122, China.,School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Ruijie Liu
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu, 214122, China.,School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Ming Chang
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu, 214122, China.,School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Xingguo Wang
- International Joint Research Laboratory for Oil Nutrition and Safety, Jiangnan University, Wuxi, Jiangsu, 214122, China.,School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
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Abdulrahman MA, Alkass SY, Mohammed NI. Total and free vitamin D status among apparently healthy adults living in Duhok Governorate. Sci Rep 2022; 12:1778. [PMID: 35110608 PMCID: PMC8810798 DOI: 10.1038/s41598-022-05775-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Serum total 25‐OHD is a main marker of vitamin D which represents the intake and sunlight exposure. Free form of 25‐OHD, the small fraction not bound to a transporter protein has been incorporated as a new marker. This cross-sectional study aimed to evaluate the impact of several factors on total and free vitamin D levels in healthy subjects and to find out if the free form of vitamin D could be a better representative of the body’s vitamin D status. Total and free 25‐OHD were analyzed by ELISA method in a blood sample collected from 391 apparently healthy volunteers (219 female and 172 Male) from Duhok Governorate/Iraq population. Total and free 25‐OHD levels were increased proportionally to BMI with lower values seen in the underweight group, also a significant gender differences in total D3 level with higher values in males (23.90 ± 16.41) ng/ml than females (21.24 ± 15.65) ng/ml was observed. Total and Free 25‐OHD levels were significantly associated with ages, their deficiency most frequent occurs in the younger ages between (16–25) years old. Smokers had higher level of Total 25‐OHD (26.95 ± 19.01) ng/ml and Free 25‐OHD (9.47 ± 4.94) pg/ml than nonsmokers (22.14 ± 14.59) ng/ml and (7.87 ± 4.32) pg/ml respectively. A significant increase in Free 25‐OHD level in the veiled women (9.12 ± 4.64) ng/ml than unveiled (6.16 ± 3.73) ng/ml with a significant positive correlation between Free 25‐OHD level and dress style was also seen. 30% and 33% of the participants whom their daily exposure to sunlight for 30 min and > 1 h respectively were severe deficient in total 25‐OHD. 95% of the participants who had Abnormally low level of free D were exposed for ≥ 30 min to sunlight. Daily exposure to sunlight was negatively associated with Free 25‐OHD level.
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Affiliation(s)
- Masood Abdulkareem Abdulrahman
- Department of Public Health, College of Health and Medical Techniques, Duhok Polytechnic University, 61 Zakho Road, 1006 Mazi Qr., P.O.Box 101, Duhok, Kurdistan Region, Iraq.
| | - Suad Yousif Alkass
- Department of Medicinal Chemistry, College of Pharmacy, University of Duhok, Duhok, 1006 AJ, Iraq
| | - Noor Isam Mohammed
- Department of Medical Laboratory Technology, College of Health and Medical Techniques, Duhok Polytechnic University, Duhok, Iraq
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Differences in Dietary Patterns of Adolescent Patients with IBD. Nutrients 2021; 13:nu13093119. [PMID: 34578996 PMCID: PMC8471497 DOI: 10.3390/nu13093119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 12/14/2022] Open
Abstract
Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC). The prevalence of both in pediatric populations has been constantly increasing. This study aimed to analyze the diet of adolescent patients with IBD in comparison to healthy controls and the current dietary standards for the Polish population to further their optimal supplementation regimen. The study group consisted of 53 patients (21 girls and 32 boys) with IBD (CD: n = 27; UC: n = 26) at a mean age of 15.4 ± 2.4 and 14.7 ± 2.2, years for girls and boys, respectively. The control group (CG) consisted of 20 patients, and 72 h of recall diaries on nutrition were collected. The nutritional data were analyzed in the Dieta 6D dietary program. When compared to Polish dietary standards, the largest differences girls with IBD and boys with IBD were found for the intake of energy (61.9 and 71.9%), iodine (61.9 and 62.6%), folates (76.2 and 87.5%), vitamin D (100 and 96.9%), potassium (61.9 and 59.4%), and calcium (85.7 and 93.8%). The overconsumption of saturated fatty acids (SFA) (61.9 and 56.3%) and sodium (76.2 and 90.6%) in girls and boys, respectively, was noted. In relation to girls with CG, girls with IBD showed a significantly higher intake of energy (1751. 3 vs. 1558.6 p = 0.0224), total protein (71.3 vs. 56.2 p = 0.0217), animal protein (47.8 vs. 34.5 p = 0.0183), total carbohydrates (237.3 vs. 196.1 p = 0.0442), and assimilable carbohydrates (219.8 vs. 180.5 p = 0.7921). Boys in the CG consumed significantly more calcium (851.8 vs. 432 p = 0.0006), phosphorus (1024.3 vs. 1357.5 p = 0.0431), lactose (11.6 vs. 6.1 p = 0.0016), and riboflavin (1.7 vs. 1.3 p = 0.0123) compared to boys with IBD. Dietician care should therefore be mandatorily provided alongside outpatient care. Based on our results, we suggest that supplementation with the selected components be considered.
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Russell LA, Balart MT, Serrano P, Armstrong D, Pinto-Sanchez MI. The complexities of approaching nutrition in inflammatory bowel disease: current recommendations and future directions. Nutr Rev 2021; 80:215-229. [PMID: 34131736 DOI: 10.1093/nutrit/nuab015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/03/2021] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis predispose patients to malnutrition due to a combination of increased basal metabolic rate, decreased oral intake, and increased nutritional losses and malabsorption. Malnutrition is common, affecting up to 75% of patients with Crohn's disease and 62% of patients with ulcerative colitis, and is associated with worse disease prognosis, higher complication rates, decreased quality of life, and increased mortality risk. It is imperative to screen patients with IBD for malnutrition to assess those at increased risk and treat accordingly to prevent progression and complications. This literature review provides an overall approach to optimizing nutrition in IBD, focusing on the assessment for the diagnosis of malnutrition, management of macro- and micronutrient deficiencies, and identification of areas for future study.
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Affiliation(s)
- Lindsey A Russell
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - Maria Teresa Balart
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - Pablo Serrano
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - David Armstrong
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
| | - Maria Ines Pinto-Sanchez
- L.A. Russell, M.T. Balart, D. Armstrong, and M.I. Pinto-Sanchez are with Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; L.A. Russell, M.T. Balart, P. Serrano, D. Armstrong, and M.I. Pinto-Sanchez are with McMaster University, Hamilton, Ontario, Canada
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Chen R, Li L, Chao K, Hong M, Cao Q, Ye L, Zhou G, Fang X, Guo H, Cao X, Ye X, Zeng Z, Chen M, Zhang S. Platelet-to-lymphocyte percentage ratio index: a simple non-invasive index to monitor the endoscopic activity in Crohn's disease. Therap Adv Gastroenterol 2020; 13:1756284820979442. [PMID: 33425010 PMCID: PMC7758565 DOI: 10.1177/1756284820979442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/16/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Recent evidence has shown that the complete blood count (CBC) is abnormal in patients with Crohn's disease (CD). We aimed to investigate an effective CBC parameter and explore its impact on disease activity in a large CD cohort. METHODS We performed a retrospective analysis of patients with established CD who underwent clinically indicated endoscopy at four tertiary centres in China between 2016 and 2020. Individual variables of the Simple Endoscopic Score for CD, CBC parameters, C-reactive protein (CRP) levels, erythrocyte sedimentation rate, and faecal calprotectin (FC) were independently reviewed by different investigators. The hold-out method was used to verify the predictive power of the established model. RESULTS Data from a total of 1388 endoscopic procedures performed for 882 eligible CD patients were available with routine blood parameters and related indicators. The model using platelet-to-lymphocyte percentage ratio (PLpR) had high accuracy for identifying patients in endoscopic remission (ER), with an area under the curve (AUC) of 0.785 [95% confidence interval (CI): 0.784-0.787], which was comparable with that for CRP (AUC: 0.775, 95% CI: 0.774-0.777). Notably, the AUC of PLpR was significantly higher than that of CRP in patients with colonic disease and with a history of surgery. Moreover, after combining the FC with PLpR, the AUC value of FC + PLpR increased up to 0.892 (95% CI: 0.890-0.894) for identifying ER. CONCLUSIONS We explored an index (PLpR) to identify CD patients in ER based on platelet and lymphocyte percentage from the CBC. PLpR helped evaluate the degree of disease activity and monitor the therapeutic response.
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Affiliation(s)
| | | | | | - Mengzhi Hong
- Medical laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Qian Cao
- Division of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingna Ye
- Division of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gaoshi Zhou
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Xiaoli Fang
- Division of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huili Guo
- Division of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Xiaocang Cao
- Division of Gastroenterology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Xiaoqi Ye
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Zhirong Zeng
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Minhu Chen
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou 510080, P.R. China
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12
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Kellermann L, Jensen KB, Bergenheim F, Gubatan J, Chou ND, Moss A, Nielsen OH. Mucosal vitamin D signaling in inflammatory bowel disease. Autoimmun Rev 2020; 19:102672. [PMID: 32942038 DOI: 10.1016/j.autrev.2020.102672] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
Epidemiological studies have identified vitamin D (25(OH)D) deficiency to be highly prevalent among patients with inflammatory bowel disease (IBD), and low serum levels correlate with a higher disease activity and a more complicated disease course. The link to IBD pathogenesis has been subject of investigations, primarily due to the distinct immunological functions of vitamin D signaling, including anti-inflammatory and anti-fibrotic actions. Vitamin D is a pleiotropic hormone that executes its actions on cells through the vitamin D receptor (VDR). A leaky gut, i.e. an insufficient intestinal epithelial barrier, is thought to be central for the pathogenesis of IBD, and emerging data support the concept that vitamin D/VDR signaling in intestinal epithelial cells (IECs) has an important role in controlling barrier integrity. Here we review the latest evidence on how vitamin D promotes the interplay between IECs, the gut microbiome, and immune cells and thereby regulate the intestinal immune response. On the cellular level, vitamin D signaling regulates tight junctional complexes, apoptosis, and autophagy, leading to increased epithelial barrier integrity, and promotes expression of antimicrobial peptides as part of its immunomodulating functions. Further, intestinal VDR expression is inversely correlated with the severity of inflammation in patients with IBD, which might compromise the positive effects of vitamin D signaling in patients with flaring disease. Efforts to reveal the role of vitamin D in the pathophysiology of IBD will pave the road for the invention of more rational treatment strategies of this debilitating disease in the future.
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Affiliation(s)
- Lauge Kellermann
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark.
| | - Kim Bak Jensen
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, DK-2200 Copenhagen N, Denmark; Novo Nordisk Foundation Center for Stem Cell Biology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Fredrik Bergenheim
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
| | - John Gubatan
- Division of Gastroenterology and Hepatology, Dept. of Medicine, Stanford University School of Medicine, Redwood City, CA, USA
| | - Naomi D Chou
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan Moss
- Boston Medical Center & Boston University, Boston, MA, USA
| | - Ole Haagen Nielsen
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
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13
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Bafutto M, Oliveira EC, Rezende Filho J. Use of Vitamin D With Anti-Tumor Necrosis Factor Therapy for Crohn's Disease. Gastroenterology Res 2020; 13:101-106. [PMID: 32655726 PMCID: PMC7331853 DOI: 10.14740/gr1264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 12/23/2022] Open
Abstract
Background Vitamin D (VD) has an important role in regulating gut mucosal immunity, and seems to be inversely linked to disease activity and more frequent relapses in inflammatory bowel disease. In this study, we evaluated patients with Crohn’s disease (CD) treated with anti-tumor necrosis factor (TNF) in association with VD. Methods A double-blind, randomized, prospective study was conducted. Thirty patients with a history of moderate to severe CD, in use of anti-TNF, of both sexes, 18 to 70 years, with the dosage of VD < 75 nmol/L (30 ng/mL) were randomized and divided into three groups: group 1 (G1): 10 patients received 2,000 IU VD, per os (PO)/week for 8 weeks; group 2 (G2): 10 patients received 10,000 IU VD, PO/week for 8 weeks; group 3 (G3): 10 patients received 50,000 IU VD, PO/week for 8 weeks. Before and at the end of 8 weeks patients were submitted to VD, fecal calprotectin (FC) and C-reactive protein (CRP) dosage. Follow-up period was 52 weeks, and they are checked for disease activity recurrence (Crohn’s disease activity index (CDAI) > 150, FC > 300 and computerized tomography (CT) scan), FC, CRP, and VD levels. Results Increased VD levels were observed in all groups (P < 0.0001). CRP did not change. There was a significant decrease of FC in G3 (1,014 ± 850 vs. 483 ± 564; P = 0.04), no significant decrease in G2 (76,767 ± 751 vs. 535 ± 823; P = 0.2) and increase in G1 (1,101 ± 744 vs. 1,357 ± 819; P = 0.4). During the 52-week follow-up period, it was showed that recurrent disease activity (CDAI > 150, FC > 200 and CT scan) was predominant in patients with VD < 30 group, and the remission rate was predominant in patients with VD > 30 group (P = 0.0001). A statistically significant difference in VD levels was noted in CD patients after 52 weeks that presented flare or disease remission (P = 0.001). Conclusions Use of VD associated with anti-TNF treatment may improve clinical response in CD. VD levels greater than 30 ng/mL have better rates of remission.
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Affiliation(s)
- Mauro Bafutto
- Instituto Goiano de Gastroenterolgoia, Goiania, Brazil.,Department of Internal Medicine, School of Medicine, Universidade Federal de Goias, Goiania, Brazil
| | - Enio Chaves Oliveira
- Instituto Goiano de Gastroenterolgoia, Goiania, Brazil.,Department of Surgery, School of Medicine, Universidade Federal de Goias, Goiania, Brazil
| | - Joffre Rezende Filho
- Instituto Goiano de Gastroenterolgoia, Goiania, Brazil.,Department of Internal Medicine, School of Medicine, Universidade Federal de Goias, Goiania, Brazil
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14
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Fang W, Kenny R, Rizvi QUA, McMahon LP, Garg M. Hypophosphataemia after ferric carboxymaltose is unrelated to symptoms, intestinal inflammation or vitamin D status. BMC Gastroenterol 2020; 20:183. [PMID: 32522150 PMCID: PMC7288415 DOI: 10.1186/s12876-020-01298-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background Intravenous iron replacement is recommended for iron-deficient patients with inflammatory bowel disease (IBD), but may be associated with hypophosphataemia, predisposing to osteomalacia and fractures. This study aimed to evaluate the incidence and risk factors for hypophosphataemia following intravenous ferric carboxymaltose (FCM) in patients with IBD. Methods This prospective observational study of patients with and without IBD evaluated serum phosphate for 28 days following intravenous FCM, and assessed associations with symptoms, markers of inflammation and vitamin D status. Results Twenty-four patients with IBD (11 with Crohn’s disease [CD], 13 with ulcerative colitis [UC], mean age 45 years [range 19–90], 7 female), and 20 patients without IBD (mean age 56 [22–88] y, 11 female), were included. Overall, serum phosphate declined by a mean of 36% at Day 7, with a mean fall of 42% (SD 19%) at some time point over 28 days (p < 0.001). Twenty-four of 44 (55%) patients developed moderate to severe hypophosphataemia (serum phosphate < 0.6 mmol/L). No differences between patients with and without IBD were seen, but patients with CD had greater decline in phosphate than those with UC. There was no association between hypophosphataemia and symptomatic adverse events, faecal calprotectin, C-reactive protein, albumin, platelet count, 25(OH) vitamin D, or 1,25(di-OH) vitamin D. Serum phosphate < 1.05 mmol/L on Day 2 predicted susceptibility to moderate-severe hypophosphataemia (OR 7.0). Conclusions Hypophosphataemia following FCM is common, unrelated to symptomatic adverse events, baseline intestinal or systemic inflammation, or vitamin D status.
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Affiliation(s)
- Wendy Fang
- Department of Gastroenterology, Northern Health, 185 Cooper St, Epping, Victoria, 3076, Australia
| | - Rachel Kenny
- Eastern Health Clinical School, Monash University, 5 Arnold St, Box Hill, Victoria, 3128, Australia
| | - Qurat-Ul-Ain Rizvi
- Department of Gastroenterology, Northern Health, 185 Cooper St, Epping, Victoria, 3076, Australia
| | - Lawrence P McMahon
- Eastern Health Clinical School, Monash University, 5 Arnold St, Box Hill, Victoria, 3128, Australia.,Department of Nephrology, Eastern Health, 8 Arnold St, Box Hill, Victoria, 3128, Australia.,Department of Renal Medicine, Box Hill Hospital, Level 3W, Building B, 8 Arnold St, Box Hill, Victoria, 3128, Australia
| | - Mayur Garg
- Department of Gastroenterology, Northern Health, 185 Cooper St, Epping, Victoria, 3076, Australia. .,Eastern Health Clinical School, Monash University, 5 Arnold St, Box Hill, Victoria, 3128, Australia. .,Department of Gastroenterology, Northern Health, Epping, Victoria, Australia. .,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Victoria, Australia. .,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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15
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Garg M, Al‐Ani A, Mitchell H, Hendy P, Christensen B. Editorial: low population mortality from COVID-19 in countries south of latitude 35 degrees North-supports vitamin D as a factor determining severity. Authors' reply. Aliment Pharmacol Ther 2020; 51:1438-1439. [PMID: 32352178 PMCID: PMC7267669 DOI: 10.1111/apt.15796] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LINKED CONTENT This article is linked to Al‐Ani et al and Rhodes et al papers. To view these articles, visit https://doi.org/10.1111/apt.15779 and https://doi.org/10.1111/apt.15777.
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Affiliation(s)
- Mayur Garg
- Department of GastroenterologyNorthern HospitalMelbourneVic.Australia,Department of GastroenterologyRoyal Melbourne HospitalMelbourneVic.Australia,Department of MedicineUniversity of MelbourneMelbourneVic.Australia,Eastern Health Clinical SchoolMonash UniversityMelbourneVic.Australia
| | - Aysha Al‐Ani
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneVic.Australia
| | - Hannah Mitchell
- Eastern Health Clinical SchoolMonash UniversityMelbourneVic.Australia
| | - Philip Hendy
- Department of GastroenterologyChelsea and Westminster Hospital NHS TrustLondonUK
| | - Britt Christensen
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneVic.Australia
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16
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Meeker SM, Seamons A, Treuting PM, Paik J, Brabb T, Hsu CC, Grady WM, Maggio-Price L. Effect of Chronic Vitamin D Deficiency on the Development and Severity of DSS-Induced Colon Cancer in Smad3-/- Mice. Comp Med 2020; 70:120-130. [PMID: 32014085 PMCID: PMC7137544 DOI: 10.30802/aalas-cm-19-000021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/04/2019] [Accepted: 05/19/2019] [Indexed: 12/15/2022]
Abstract
Both human epidemiologic data and animal studies suggest that low serum vitamin D increases the risk of inflammatory bowel disease (IBD) and consequently IBD-associated colorectal cancer. We tested the hypothesis that vitamin D deficiency increases the risk for colitis-associated colon cancer (CAC) by using an established CAC mouse model, 129-Smad3tm1Par/J (Smad3-/-) mice, which have defective transforming growth factor β-signaling and develop colitis and CAC after the administration of dextran sodium sulfate (DSS). After determining a dietary regimen that induced chronic vitamin D deficiency in Smad3-/- mice, we assessed the effects of vitamin D deficiency on CAC. Decreasing dietary vitamin D from 1 IU/g diet (control diet) to 0.2 IU /g diet did not decrease serum 25-hydroxyvitamin D (25(OH)D) levels in Smad3-/- mice. A diet devoid of vitamin D (< 0.02 IU/g diet [no added vitamin D]; vitamin D-null) significantly decreased serum 25(OH)D levels in mice after 2 wk (null compared with control diet: 8.4 mg/mL compared with 12.2 ng/mL) and further decreased serum levels to below the detection limit after 9 wk but did not affect weight gain, serum calcium levels, bone histology, or bone mineral density. In light of these results, Smad3-/- mice were fed a vitamin D-null diet and given DSS to induce colitis. Unexpectedly, DSS-treated Smad3-/- mice fed a vitamin D-null diet had improved survival, decreased colon tumor incidence (8% compared with 36%), and reduced the incidence and severity of colonic dysplasia compared with mice fed the control diet. These effects correlated with increased epithelial cell proliferation and repair early in the disease, perhaps reducing the likelihood of developing chronic colitis and progression to cancer. Our results indicate that vitamin D deficiency is beneficial in some cases of CAC, possibly by promoting intestinal healing.
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Affiliation(s)
- Stacey M Meeker
- Department of Comparative Medicine, University of Washington, Seattle, Washington; Ohio State University, Columbus, Ohio;,
| | - Audrey Seamons
- Department of Comparative Medicine, University of Washington, Seattle, Washington
| | - Piper M Treuting
- Department of Comparative Medicine, University of Washington, Seattle, Washington
| | - Jisun Paik
- Department of Comparative Medicine, University of Washington, Seattle, Washington
| | - Thea Brabb
- Department of Comparative Medicine, University of Washington, Seattle, Washington
| | - Charlie C Hsu
- Department of Comparative Medicine, University of Washington, Seattle, Washington
| | | | - Lillian Maggio-Price
- Department of Comparative Medicine, University of Washington, Seattle, Washington
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17
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Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106. [PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484] [Citation(s) in RCA: 1452] [Impact Index Per Article: 242.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Affiliation(s)
- Christopher Andrew Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Tim Raine
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Philip Anthony Hendy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Philip J Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Bu'Hussain Hayee
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Miranda C E Lomer
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth C Parkes
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Christian Selinger
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - R Justin Davies
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Cathy Bennett
- Systematic Research Ltd, Quorn, UK
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | - Malcolm G Dunlop
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Omar Faiz
- Imperial College London, London, UK
- St Mark's Hospital, Harrow, UK
| | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Miles Parkes
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Jeremy Sanderson
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Tariq H Iqbal
- Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Stuart A Taylor
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Brookes
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Richard Hansen
- Royal Hospital for Children Glasgow, Glasgow, UK
- University of Glasgow, Glasgow, UK
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18
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Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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19
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Mentella MC, Scaldaferri F, Pizzoferrato M, Gasbarrini A, Miggiano GAD. The Association of Disease Activity, BMI and Phase Angle with Vitamin D Deficiency in Patients with IBD. Nutrients 2019; 11:E2583. [PMID: 31717788 PMCID: PMC6893633 DOI: 10.3390/nu11112583] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Hypovitaminosis D is frequently present in inflammatory bowel disease (IBD) with a higher incidence in Crohn's disease (CD) than in Ulcerative Colitis (UC). Given the involvement of the alimentary tract, many factors can contribute to hypovitaminosis D. The aim of the study was to investigate the association of disease activity, body mass index (BMI) and phase angle with vitamin D deficiency in patients with IBD. A cross-sectional study was conducted on a cohort of 206 IBD patients (October 2016-September 2018). Of these patients, 32.6% were affected by hypovitaminosis D (CD: 38.6%; UC: 25.6%; p < 0.01). Negative and significant associations (p < 0.01) were found between BMI and vitamin D serum levels both in CD and UC patients. BMI represented a determinant of hypovitaminosis D (Odds Ratio (OR) = 1.12, p < 0.01) only in UC patients; phase angle was associated to hypovitaminosis D in both groups (CD: OR = 0.64, p < 0.05; UC: OR = 0.49, p < 0.01). Results of the present study confirm a higher incidence of hypovitaminosis D in patients with CD than in those with UC, and show that nutritional status plays a crucial role in the incidence of vitamin D deficiency in patients with IBD.
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Affiliation(s)
- Maria Chiara Mentella
- UOC di Nutrizione Clinica, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Franco Scaldaferri
- UOC di Medicina Interna e Gastroenterologia, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.P.); (A.G.)
| | - Marco Pizzoferrato
- UOC di Medicina Interna e Gastroenterologia, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.P.); (A.G.)
| | - Antonio Gasbarrini
- UOC di Medicina Interna e Gastroenterologia, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.P.); (A.G.)
| | - Giacinto Abele Donato Miggiano
- UOC di Nutrizione Clinica, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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20
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Li XX, Liu Y, Luo J, Huang ZD, Zhang C, Fu Y. Vitamin D deficiency associated with Crohn's disease and ulcerative colitis: a meta-analysis of 55 observational studies. J Transl Med 2019; 17:323. [PMID: 31547829 PMCID: PMC6757415 DOI: 10.1186/s12967-019-2070-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the association of serum levels of 25(OH)D and 1,25(OH)2D3 in healthy and non-healthy controls with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Three electronic databases: PubMed, EMbase and EBSCOhost CINAHL, were searched for observational studies to measure the relationship between serum levels of vitamin D (VitD) and CD (or UC). RESULTS Fifty-five studies were included in the meta-analysis. We found that mean serum 25(OH)D levels in patients with CD were significantly lower than those in healthy controls (MD: - 3.17 ng/mL; 95% CI - 4.42 to - 1.93). Results from the meta-analysis examining 1,25(OH)2D3 levels in Crohn's patients revealed higher levels in the CD group than in healthy (MD: 3.47 pg/mL; 95% CI - 7.72 to 14.66) and UC group (MD: 5.05 pg/mL; 95% CI - 2.42 to 12.52). Serum 25(OH)D levels were lower in the UC group than in the healthy control group (MD: - 2.52 ng/mL; 95% CI - 4.02 to - 1.02). In studies investigating the level of 1,25(OH)2D3 in UC and healthy control groups, the level of 1,25(OH)2D3 in the UC groups were found to be higher than that in the control groups (MD: 3.76 pg/mL; 95% CI - 8.36 to 15.57). However, the 1,25(OH)2D3 level in patients with UC was lower than that in CD groups (MD: - 6.71 pg/mL; 95% CI - 15.30 to 1.88). No significant difference was noted between CD patients and UC patients in terms of average serum 25(OH)D levels. CONCLUSIONS This study found that VitD levels were inversely related to CD and UC. Serum levels of 25(OH)D were lower in patients with CD and UC than in healthy people, and more than half of the patients had insufficient vitamin D levels. The serum level of 1,25(OH)2D3 in both the CD and UC groups was higher than that in healthy people.
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Affiliation(s)
- Xi-Xi Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.,Zhejiang Chinese Medical University, No. 548, Binwen Road, Zhengjiang, 310053, China
| | - Yang Liu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Jie Luo
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Zhen-Dong Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.
| | - Yan Fu
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan, 442000, China.
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21
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Wennogle SA, Priestnall SL, Suárez-Bonnet A, Webb CB. Comparison of clinical, clinicopathologic, and histologic variables in dogs with chronic inflammatory enteropathy and low or normal serum 25-hydroxycholecalciferol concentrations. J Vet Intern Med 2019; 33:1995-2004. [PMID: 31496004 PMCID: PMC6766529 DOI: 10.1111/jvim.15614] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background The cause of low serum vitamin D concentrations in dogs with chronic inflammatory enteropathy (CIE) is not well understood. Objective Improve understanding of pathogenesis of low serum vitamin D concentrations in dogs with CIE by comparing several clinical, clinicopathologic, and histologic variables between CIE dogs with low and normal serum 25‐hydroxyvitamin D concentrations (25[OH]D). Animals Fifteen dogs with CIE and low serum 25[OH]D concentrations; 15 dogs with CIE and normal serum 25(OH)D concentrations. Methods Prospective cohort study. Clinical and clinicopathologic variables were compared between groups. Correlations between serum 25(OH)D concentration and histopathologic variables were assessed. Results Dogs with CIE and low serum 25(OH)D concentrations had higher canine chronic enteropathy clinical activity index scores (P = .003), lower serum α‐tocopherol (P < .001), cholesterol (P < .001), and albumin (P < .001) concentrations and higher serum C‐reactive protein (P = .004) concentrations compared to CIE dogs with normal serum 25(OH)D concentrations. Serum concentrations of vitamin D‐binding protein (VDBP) were not different between groups (P = .91). Duodenal morphologic and inflammatory histopathological scores (P = .002 and P = .004, respectively) and total histopathological scores in duodenum and combined duodenum and ileum negatively correlated with serum 25(OH)D concentration. Conclusions and Clinical Importance The pathogenesis of low serum vitamin D concentrations in dogs with CIE is likely multifactorial. Fat malabsorption deserves further study in dogs with low serum vitamin D concentration and CIE. Loss of VDBP does not appear to be an important cause of low serum vitamin D concentration in dogs with CIE.
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Affiliation(s)
- Sara A Wennogle
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - Simon L Priestnall
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
| | - Alejandro Suárez-Bonnet
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
| | - Craig B Webb
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
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22
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Abstract
Patients with inflammatory bowel disease have an increased risk of vitamin D deficiency and this may impact upon the disease activity. This study explored the association between serum vitamin D levels and inflammatory bowel disease in a Chinese population.Sixty-five patients with ulcerative colitis (UC) and 50 with Crohn's disease (CD) were investigated between January 2015 and December 2016 at the Kunshan Second People's Hospital, China. A control group of 120 healthy volunteers was also selected. Serum vitamin D levels were detected and compared between groups and among patients with different disease activity.The serum vitamin D levels in the UC (10.27 ± 4.05 ng/mL) and CD (11.13 ± 3.96 ng/mL) groups were lower than in the control group (12.96 ± 5.18 ng/mL) (P < .05). In the UC group, during the moderate (9.21 ± 3.26 ng/mL) and severe (7.58 ± 3.81 ng/mL) periods, serum vitamin D levels were significantly lower compared with during remission (12.18 ± 3.69 ng/mL) and the mild period (11.35 ± 4.08 ng/mL) (P < .05). In the CD group, serum vitamin D levels were significantly lower during the moderate (10.28 ± 3.57 ng/mL) and severe (8.52 ± 3.72 ng/mL) periods compared with remission (13.97 ± 5.61 ng/mL) (P < .05).Patients with UC and CD are both prone to vitamin D deficiency. Serum vitamin D was significantly lower with aggravating disease status. Therefore, vitamin D may be involved in the development of inflammatory bowel disease in a Chinese population.
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Affiliation(s)
- Jianmin Zhao
- Department of Gastroenterology, Kunshan Second People's Hospital, Suzhou
| | - Yunfeng Wang
- Department of Gastroenterology, Kunshan Second People's Hospital, Suzhou
| | - Qing Gu
- Department of Gastroenterology, Kunshan Second People's Hospital, Suzhou
| | - Zhiquan Du
- Department of Gastroenterology, Kunshan Second People's Hospital, Suzhou
| | - Weichang Chen
- Department of Gastroenterology, Suzhou University affiliated First Hospital, Suzhou, China
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Annese V. A Review of Extraintestinal Manifestations and Complications of Inflammatory Bowel Disease. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:66-73. [PMID: 31080385 PMCID: PMC6503692 DOI: 10.4103/sjmms.sjmms_81_18] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Extraintestinal manifestations (EIMs) are common in inflammatory bowel disease (IBD), in both Crohn's disease and ulcerative colitis. Almost any organ system can be affected, including the musculoskeletal, dermatologic, renal, hepatopancreatobiliary, pulmonary and ocular systems. However, the musculoskeletal and dermatologic systems are the most commonly involved sites of manifestations. While some manifestations such as peripheral arthritis and erythema nodosum have an association with IBD activity, others such as axial arthropathy, pyoderma gangrenosum and primary sclerosing cholangitis have an independent disease course. This review provides a summary of the most common EIMs in IBD and their prevalence and management.
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Affiliation(s)
- Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
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24
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Garg M, Royce SG, Tikellis C, Shallue C, Sluka P, Wardan H, Hosking P, Monagle S, Thomas M, Lubel JS, Gibson PR. The intestinal vitamin D receptor in inflammatory bowel disease: inverse correlation with inflammation but no relationship with circulating vitamin D status. Therap Adv Gastroenterol 2019; 12:1756284818822566. [PMID: 30719077 PMCID: PMC6348511 DOI: 10.1177/1756284818822566] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/28/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The intestinal vitamin D receptor (VDR) remains poorly characterized in patients with inflammatory bowel disease (IBD). METHODS Colonoscopic biopsies and intestinal resection specimens from the terminal ileum, ascending and sigmoid colon, from patients with and without IBD, were analyzed for VDR mRNA quantification by polymerase chain reaction, and protein localization and semi-quantification by immunohistochemistry. The relationship between VDR and intestinal inflammation, serum 25(OH)D and oral vitamin D intake was elicited. RESULTS A total of 725 biopsies from 20 patients with Crohn's disease (CD), 15 with ulcerative colitis (UC) and 14 non-IBD controls who underwent colonoscopy were studied. VDR gene expression and protein staining intensity was similar across all three groups, and across the intestinal segments. Sigmoid colon VDR mRNA expression inversely correlated with faecal calprotectin (r = -0.64, p = 0.026) and histological score (r = -0.67, p = 0.006) in UC, and histological score (r = -0.58, p = 0.019) in patients with CD. VDR staining intensity was higher in quiescent than diseased segments. No relationship with serum 25(OH)D or oral vitamin D intake was noted. Immunohistochemical staining of 28 intestinal resection specimens from 15 patients (5 each with CD, UC and non-IBD controls) showed diffuse VDR staining in the mucosa, submucosa and circular muscle. CONCLUSIONS VDR transcript expression and protein staining intensity are inversely related to inflammation in IBD, but unrelated to serum 25(OH)D, and similar to non-IBD controls. Strategies to upregulate intestinal VDR, potentially translating to modulation of disease activity, require investigation.
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Affiliation(s)
| | - Simon G. Royce
- Department of Medicine, Central Clinical School, Monash University, Victoria, Australia
| | - Chris Tikellis
- Department of Diabetes, Central Clinical School, Monash University, Victoria, Australia
| | - Claire Shallue
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Pavel Sluka
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Hady Wardan
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Patrick Hosking
- Department of Pathology, Eastern Health, Victoria, Australia
| | - Shaun Monagle
- Department of Pathology, Eastern Health, Victoria, Australia
| | - Merlin Thomas
- Department of Diabetes, Central Clinical School, Monash University, Victoria, Australia
| | - John S. Lubel
- Department of Gastroenterology, Eastern Health, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Peter R. Gibson
- Department of Gastroenterology, Alfred Hospital and Monash University, Victoria, Australia
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25
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Zhou YQ, Xu RY, Wan YP. The role of dietary factors in inflammatory bowel diseases: New perspectives. J Dig Dis 2019; 20:11-17. [PMID: 30444028 DOI: 10.1111/1751-2980.12686] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/01/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022]
Abstract
The current review aimed to elucidate the role of diet in every stage of inflammatory bowel diseases, from aspects of prevention, treatment and rehabilitation. Western diet, characterized by overconsumption of refined sugar and saturated fat and low consumption of dietary fiber, may partly be blamed for its pathogenesis. Some immune-modulated nutrients (fibers, monounsaturated fatty acids, n-3 polyunsaturated fatty acids and vitamin D) exert their potential beneficial effects on gut microbiota and immune function, resulting in clinical remission and/or preventing relapse. However, data is limited to conclude optimal micronutrient levels and therapeutic implications. Further, diet itself is complex; therefore, it is reasonable to evaluate diet as a whole rather than a single type of food. Some specific dietary patterns are generated for the management of inflammatory bowel diseases with controversial results. Only exclusive enteral nutrition has been widely recommended for pediatric patients with non-stricturing active Crohn's disease. Self-monitoring, avoidance of certain types of foods, limited intake of alcohol and smoking, supplementation of minerals and vitamins if deficiency is confirmed, and adherence to the diet enriched in vegetables and fruits and low in animal food and un-digested fiber during flares are the most common dietary recommendation. Further clinical trials with a high evidence rank are warranted.
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Affiliation(s)
- Yi Quan Zhou
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ren Ying Xu
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Ping Wan
- Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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26
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Ko KH, Kim YS, Lee BK, Choi JH, Woo YM, Kim JY, Moon JS. Vitamin D deficiency is associated with disease activity in patients with Crohn's disease. Intest Res 2018; 17:70-77. [PMID: 30301338 PMCID: PMC6361011 DOI: 10.5217/ir.2018.00022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Previous data suggest that vitamin D has a significant role in inflammatory bowel disease (IBD). We investigated the incidence of vitamin D deficiency in Korean patients with IBD and the correlation between serum vitamin D level and disease activity. Methods We retrospectively analyzed the medical records of patients with IBD whose serum vitamin D levels were checked. Deficiency of 25-hydroxyvitamin D was defined as <20 ng/mL. Disease activity was evaluated using the partial Mayo score for ulcerative colitis (≥2 defined as active disease) and Harvey-Bradshaw index for Crohn’s disease (≥4 defined as active disease). Results We enrolled 87 patients with IBD (ulcerative colitis [UC], 45; Crohn’s disease [CD], 42). Among them, 65.5% (57/87) were men, with a mean age of 44.9±15.1 years (range, 18–75 years). The mean duration of disease was 4.7±4.8 years (range, 0.1–17.1 years). Vitamin D deficiency was found in 73.6% (64/87) of patients with IBD. Patients with IBD (mean vitamin D level, 16.3±9.0 ng/mL) showed lower vitamin D level than the healthy control group (mean vitamin D level, 20.4±7.0 ng/mL), with no statistically significant difference (P=0.136). Disease activity was inversely correlated with vitamin D deficiency in patients with CD (P=0.007). However, no correlation was observed in patients with UC (P=0.134). Conclusions Approximately 75% of Korean patients with IBD showed vitamin D deficiency state. Vitamin D deficiency is associated with disease activity, particularly in patients with CD.
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Affiliation(s)
- Kyoung Ho Ko
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Bo Kyung Lee
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong Hyun Choi
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yong Moon Woo
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin Young Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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27
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Garg M, Rosella O, Rosella G, Wu Y, Lubel JS, Gibson PR. Evaluation of a 12-week targeted vitamin D supplementation regimen in patients with active inflammatory bowel disease. Clin Nutr 2018; 37:1375-1382. [DOI: 10.1016/j.clnu.2017.06.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 02/07/2023]
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28
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Garg M, Hendy P, Ding JN, Shaw S, Hold G, Hart A. The Effect of Vitamin D on Intestinal Inflammation and Faecal Microbiota in Patients with Ulcerative Colitis. J Crohns Colitis 2018; 12:963-972. [PMID: 29726893 DOI: 10.1093/ecco-jcc/jjy052] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Vitamin D may be immunomodulatory and alter faecal microbiota, but results from clinical studies in humans to date have been inconclusive. This study aimed to assess the effect of vitamin D replacement in vitamin D-deficient patients with and without ulcerative colitis [UC] on inflammation and faecal microbiota. METHODS Vitamin D was replaced over 8 weeks in patients with active UC [defined by faecal calprotectin ≥ 100 µg/g], inactive UC [faecal calprotectin < 100 µg/g] and non-inflammatory bowel disease [IBD] controls with baseline serum 25[OH] vitamin D <50 nmol/l, and markers of inflammation and faecal microbiota were analysed. RESULTS Eight patients with active UC, nine with inactive UC and eight non-IBD controls received 40000 units cholecalciferol weekly for 8 weeks. Mean baseline 25[OH] vitamin D increased from 34 [range 12-49] to 111 [71-158] nmol/l [p < 0.001], with no difference across the groups [p = 0.32]. In patients with active UC, faecal calprotectin levels decreased from a median 275 to 111 µg/g [p = 0.02], platelet count decreased [mean 375 to 313 × 109/l, p = 0.03] and albumin increased [mean 43 to 45 g/l, p = 0.04]. These parameters did not change in patients with inactive UC or non-IBD controls. No changes in overall faecal bacterial diversity were noted although a significant increase in Enterobacteriaceae abundance was observed in patients with UC [p = 0.03]. CONCLUSIONS Vitamin D supplementation was associated with reduced intestinal inflammation in patients with active UC, with a concomitant increase in Enterobacteriaceae but no change in overall faecal microbial diversity.
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Affiliation(s)
- Mayur Garg
- Department of Gastroenterology, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia.,St Mark's Hospital, Harrow, UK
| | | | - John Nik Ding
- St Mark's Hospital, Harrow, UK.,St Vincent's Hospital, Melbourne, Australia
| | | | - Georgina Hold
- University of Aberdeen, Aberdeen, UK.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ailsa Hart
- St Mark's Hospital, Harrow, UK.,Imperial College, London, UK
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29
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Abstract
Inflammatory bowel disease [IBD], including ulcerative colitis and Crohn's disease, is a chronic and unpredictable condition characterised by alternating periods of remission interspersed with relapses. In recent years, accumulating support for an immunomodulating effect of vitamin D on both the innate and the adaptive immune systems has been presented. Through the vitamin D receptor, the active form of vitamin D, 1,25[OH]2D, induces antimicrobial peptide secretion, decreases dendritic cell activity, and promotes Th2 and regulatory T cell development and activity. In addition, vitamin D promotes an increased ratio of anti-inflammatory cytokines to pro-inflammatory cytokines. Studies in IBD point to a role for vitamin D in ameliorating disease outcome. Suboptimal circulating levels of 25-hydroxyvitamin D are common in IBD and appear to be associated with an increased risk of flares, IBD-related hospitalisations and surgeries, an inadequate response to tumour necrosis factor [TNF] inhibitors, a deterioration in quality of life, and low bone mineral density. With only few available randomised double-blind, placebo-controlled studies investigating therapeutic effects of vitamin D related to IBD, further research is necessary to determine the true therapeutic potential of vitamin D, as well as to define its optimal range in serum to achieve and maintain quiescence of disease. This review aims to summarise the latest knowledge on the extraskeletal effects of vitamin D in IBD, and outlines the potential deleterious consequences of vitamin D deficiency in this patient cohort.
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Affiliation(s)
- Ole Haagen Nielsen
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Alan C Moss
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
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30
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Tan B, Li P, Lv H, Yang H, Li Y, Li J, Wang O, Qian JM. Treatment of vitamin D deficiency in Chinese inflammatory bowel disease patients: A prospective, randomized, open-label, pilot study. J Dig Dis 2018. [PMID: 29542862 DOI: 10.1111/1751-2980.12590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the necessity and efficacy of vitamin D (VitD) supplementation in Chinese ulcerative colitis (UC) and Crohn's disease (CD) patients with vitamin D insufficiency/deficiency. METHODS UC and CD patients were randomly assigned into one of the three arms for 12 months: arm A (VitD3 150 000 IU once per 3 months plus elemental calcium 200 mg thrice daily), arm B (elemental calcium 200 mg thrice daily) and arm C (vehicle control group), in addition to conventional treatment. Improvement in 25-hydroxyvitamin D [25(OH)D] level was the primary outcome of the study. Secondary outcomes were changes in bone mineral density (BMD) and disease activity. RESULTS Sixty-five UC and 59 CD patients completed the study. The difference in the pre-and post-treatment 25(OH)D [Δ25(OH)D] of arm A was significantly higher than in arm B or C (UC: 17.47 ± 13.01 ng/mL vs 5.30 ± 6.28 ng/mL or 2.02 ± 6.19 ng/mL, P < 0.001; CD: 12.47 ± 9.15 ng/mL vs 4.73 ± 6.97 ng/mL or 1.36 ± 4.75 ng/mL, P < 0.01). There was no significant difference between pre- and post-treatment BMD and disease activity in arm A compared to those in arms B and C (P > 0.05). Although the Mayo score and Crohn's disease activity index decreased by conventional treatment, serum 25(OH)D did not improve in arm C without vitamin D supplementation (P > 0.05). CONCLUSION VitD supplementation is necessary to treat hypovitaminosis D in UC and CD patients, even with background amelioration of disease activity.
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Affiliation(s)
- Bei Tan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Pan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hong Lv
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yue Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ji Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ou Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jia Ming Qian
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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31
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Sharifi A, Nedjat S, Vahedi H, Veghari G, Hosseinzadeh-Attar MJ. Vitamin D Status and Its Relation to Inflammatory Markers in Patients with Mild to Moderate Ulcerative Colitis. Middle East J Dig Dis 2018; 10:84-89. [PMID: 30013756 PMCID: PMC6040922 DOI: 10.15171/mejdd.2018.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/14/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND
Inflammatory bowel disease (IBD), Crohn’s disease (CD), and Ulcerative colitis (UC) are
autoimmune inflammatory diseases of the alimentary tract, which seems to be caused by the interaction
of environmental and genetic factors as well as diet and nutritional factors such as vitamin
D. The aim of this study was to assess the vitamin D status and its associations with erythrocyte
sedimentation rate (ESR), and high-sensitivity C-reactive protein (hs-CRP) as inflammatory markers
in patients with UC.
METHODS
In this analytical cross-sectional study 90 patients with mild to moderate UC who were resident
of Tehran were assessed. 25(OH)D, parathyroid hormone (PTH), ESR and hs-CRP were measured.
Dietary intake was assessed by 3-day 24h diet recall. Statistical analyses were performed using
STATA (Version 12).
RESULTS
The average serum 25-OH-vitamin D3 was 33.1 ± 8.3 ng/mL and 38.9% of the patients were
vitamin D deficient or insufficient (37.3% of men and 41% of women). No significant correlation
between serum 25(OH)D and hs-CRP, ESR, body mass index (BMI), and disease duration was
found. There were no significant differences in serum 25(OH)D between men and women. Mean
daily dietary vitamin D and calcium intakes were 189.5 Iu (95% CI: 176.0 - 203.1) and 569.5 mg
(95% CI: 538.8 - 600.2) respectively.
CONCLUSION
In this cross-sectional study 38.9% of the patients with mild to moderate UC were vitamin D
deficient or insufficient and vitamin D level was not correlated to ESR and/or hs-CRP. More studies
are needed to investigate the effect of vitamin D in the pathogenesis of UC or as a part of its treatment.
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Affiliation(s)
- Amrollah Sharifi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences (GOUMS), Gorgan, Iran
| | - Saharnaz Nedjat
- Epidemiology and Biostatistics Department, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoon Vahedi
- Digestive Disease Research Center, Digestive Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Veghari
- Biochemistry and Metabolic Disorders Research Center, Golestan University of Medical Sciences. Gorgan, Iran
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Abstract
There is emerging interest in linking vitamin D status to physiological health and disease states in the dog, as evidenced by the recent increase in publications in this area. This research has most likely been spurred by the studies exploring vitamin D and disease in humans. However, there are important differences in vitamin D intake and metabolism between humans and dogs that should be accounted for. The understanding of basic vitamin D metabolism and the relationship between vitamin D intake and vitamin D status in dogs remains even more limited than current knowledge in humans. This review will summarize current knowledge of vitamin D in the dog, including metabolism and dietary recommendations. Emphasis is placed on the limitations to current knowledge. Studies investigating links between vitamin D and disease will be discussed in light of this knowledge. Suggestions for future research, including the development of reference ranges to define blood vitamin D sufficiency, are provided.
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Affiliation(s)
- Nicole Weidner
- a Department of Biomedical Sciences, Ontario Veterinary College , University of Guelph , Ontario , Canada
| | - Adronie Verbrugghe
- b Department of Clinical Studies, Ontario Veterinary College , University of Guelph , Ontario , Canada
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Vitamin D Axis in Inflammatory Bowel Diseases: Role, Current Uses and Future Perspectives. Int J Mol Sci 2017; 18:ijms18112360. [PMID: 29112157 PMCID: PMC5713329 DOI: 10.3390/ijms18112360] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 12/11/2022] Open
Abstract
Increasing evidence supports the concept that the vitamin D axis possesses immunoregulatory functions, with vitamin D receptor (VDR) status representing the major determinant of vitamin D’s pleiotropic effects. Vitamin D promotes the production of anti-microbial peptides, including β-defensins and cathelicidins, the shift towards Th2 immune responses, and regulates autophagy and epithelial barrier integrity. Impairment of vitamin D-mediated pathways are associated with chronic inflammatory conditions, including inflammatory bowel diseases (IBD). Interestingly, inhibition of vitamin D pathways results in dysbiosis of the gut microbiome, which has mechanistically been implicated in the development of IBD. Herein, we explore the role of the vitamin D axis in immune-mediated diseases, with particular emphasis on its interplay with the gut microbiome in the pathogenesis of IBD. The potential clinical implications and therapeutic relevance of this interaction will also be discussed, including optimizing VDR function, both with vitamin D analogues and probiotics, which may represent a complementary approach to current IBD treatments.
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Jaime F, Riutort MC, Alvarez-Lobos M, Hoyos-Bachiloglu R, Camargo CA, Borzutzky A. Solar radiation is inversely associated with inflammatory bowel disease admissions. Scand J Gastroenterol 2017; 52:730-737. [PMID: 28362210 DOI: 10.1080/00365521.2017.1307444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To explore the associations between latitude and solar radiation with inflammatory bowel disease admission rates in Chile, the country with the largest variation in solar radiation in the world. PATIENTS AND METHODS This is an ecological study, which included data on all hospital-admitted population for inflammatory bowel disease between 2001 and 2012, according to different latitudes and solar radiation exposures in Chile. The data were acquired from the national hospital discharge database from the Department of Health Statistics and Information of the Chilean Ministry of Health. RESULTS Between 2001 and 2012 there were 12,869 admissions due to inflammatory bowel disease (69% ulcerative colitis, 31% Crohn's disease). Median age was 36 years (IQR: 25-51); 57% were female. The national inflammatory bowel disease admission rate was 6.52 (95% CI: 6.40-6.63) per 100,000 inhabitants with increasing rates over the 12-year period. In terms of latitude, the highest admission rates for pediatric ulcerative colitis and Crohn's disease, as well as adult ulcerative colitis, were observed in the southernmost region with lowest annual solar radiation. Linear regression analysis showed that regional solar radiation was inversely associated with inflammatory bowel disease admissions in Chile (β: -.44, p = .03). CONCLUSIONS Regional solar radiation was inversely associated with inflammatory bowel disease admission rates in Chile; inflammatory bowel disease admissions were highest in the southernmost region with lowest solar radiation. Our results support the potential role of vitamin D deficiency on inflammatory bowel disease flares.
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Affiliation(s)
- Francisca Jaime
- a Department of Pediatric Gastroenterology and Nutrition , School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Maria C Riutort
- a Department of Pediatric Gastroenterology and Nutrition , School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Manuel Alvarez-Lobos
- b Department of Gastroenterology , School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Rodrigo Hoyos-Bachiloglu
- c Department of Pediatric Infectious Diseases and Immunology , School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Carlos A Camargo
- d Department of Emergency Medicine and Division of Rheumatology, Allergy, and Immunology, Department of Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Arturo Borzutzky
- c Department of Pediatric Infectious Diseases and Immunology , School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile.,e Millennium Institute on Immunology and Immunotherapy , School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
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Spath P, Tisato V, Gianesini S, Tessari M, Menegatti E, Manfredini R, Occhionorelli S, Secchiero P, Zamboni P. The calendar of cytokines: Seasonal variation of circulating cytokines in chronic venous insufficiency. JRSM Cardiovasc Dis 2017; 6:2048004017729279. [PMID: 28959442 PMCID: PMC5593209 DOI: 10.1177/2048004017729279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 06/12/2017] [Accepted: 07/20/2017] [Indexed: 01/30/2023] Open
Abstract
Objectives To assess if in chronic venous insufficiency, there is a seasonal variation of cytokines levels which could explain the typical worsening of symptoms during Spring and Summer. Participants From 193 chronic venous insufficiency patients, we selected 32 patients in clinical stage C2–C3 of the Clinical–Etiology–Anatomy–Pathophysiology classification. Design A prospective, comparative and blinded cytokines assessment in two different seasons. Setting We sorted patients by two homogenous groups, 17 Autumn Group and 15 Spring Group. A complete clinical and haemodynamic assessment and laboratory analysis of 22 circulating cytokines were performed on each patient. Main outcome measures Circulating cytokines levels assessment. Results The two groups resulted homogenous for age, gender, clinical class, and haemodynamic parameters. Comparing cytokines expressions in Autumn Group vs. Spring Group, we found a significant difference of 11 out of 22 circulating cytokines (p < 0.05). Particularly Eotaxin, Interleukin-8, Monocyte Chemoattractant Protein-1, Tumour Necrosis Factor-α and Vascular Endothelial Growth Factor were increased in Autumn compared to the Control Group (p < 0.001); while significantly reduced in Spring, within the normal range (p, not significant). Conclusions Symptoms of chronic venous insufficiency are self-reported by patients more intense during warm seasons. Surprisingly, in our study, cytokines levels were significantly higher during Autumn and downregulated in Spring. These variations show for the first time the presence of a ‘Calendar of Cytokines’ in chronic venous insufficiency, which needs to be further investigated.
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Allenspach K, Rizzo J, Jergens AE, Chang YM. Hypovitaminosis D is associated with negative outcome in dogs with protein losing enteropathy: a retrospective study of 43 cases. BMC Vet Res 2017; 13:96. [PMID: 28390394 PMCID: PMC5385077 DOI: 10.1186/s12917-017-1022-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/03/2017] [Indexed: 11/24/2022] Open
Abstract
Background Hypovitaminosis D has previously been shown to be prevalent amongst dogs with protein losing enteropathy (PLE). The hypothesis of this study was that Low 25-hydroxyvitamin D (25(OH) D) serum concentrations could be a risk factor for negative outcome in dogs with PLE. Forty-three dogs diagnosed with PLE (2005–2014) and which serum Vitamin D serum concentrations were collected and archived at −80 Degrees C were analyzed. Post-diagnostic communication with referring veterinarians was made to determine outcome of PLE dogss: Dogs which died due to PLE within 4 months after diagnosis (negative outcome group, n = 22) and dogs alive or which died due to another disease at the end point of the study (1 year after diagnosis, good outcome group, n = 21). Serum samples taken at the time of diagnosis were analysed for ionized calcium (iCa) concentrations and serum 25(OH) D concentration. Results Clinical (CCECAI) scores, age at PLE diagnosis, and iCa concentrations were not significantly different between dog groups. A significantly greater (p < 0.001) number of PLE dogs treated with hydrolyzed or elimination diet alone showed good outcome as compared to the PLE negative outcome group. Median serum 25(OH) D concentration was significantly (p = 0.017) lower in dogs with negative outcome versus PLE dogs with good outcome. Using logistic regression analysis, 25(OH) D serum concentration was shown to be a statistically significant factor for outcome determination. Cox regression analysis yielded a hazard ratio of 0.974 (95% CI 0.949, 0.999) per each one nmol/l increase in serum 25(OH) D concentration. Conclusions Low serum 25(OH) D concentration in PLE dogs was significantly associated with poor outcome. Further studies are required to investigate the clinical efficacy of Vitamin D (cholecalciferol) as a potential therapeutic agent for dogs with PLE.
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Affiliation(s)
- K Allenspach
- Department of Clinical Sciences and Services, University of London, North Mymms, Hertfordshire, UK. .,Department of Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, IA, 50011, USA.
| | - J Rizzo
- Department of Clinical Sciences and Services, University of London, North Mymms, Hertfordshire, UK
| | - A E Jergens
- Research Support Office, Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Y M Chang
- Department of Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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Ali AM, Selim S, Abbassi MM, Sabry NA. Effect of alfacalcidol on the pulmonary function of adult asthmatic patients: A randomized trial. Ann Allergy Asthma Immunol 2017; 118:557-563. [PMID: 28377173 DOI: 10.1016/j.anai.2017.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the use of alfacalcidol in the management of corticosteroid-induced osteoporosis, it has never been considered an adjunct treatment for asthma management. It can target vitamin D deficiency, a possible risk factor for asthma, and, hence, improve pulmonary function of patients with asthma. OBJECTIVE To explore the effect of alfacalcidol administration on pulmonary function and study the pattern of vitamin D deficiency in adults with asthma in Egypt. METHODS Serum 25-hydroxyvitamin D was measured in 115 adults: 33 healthy subjects and 82 patients with asthma. Then, patients with asthma were randomized to receive standard asthma treatment only (n = 39) or receive it in addition to 1 μg of alfacalcidol daily for 4 months (n = 43). Randomization was stratified by the stage of asthma severity. Spirometry and measurement of 25-hydroxyvitamin were performed at baseline and end of follow-up. RESULTS Vitamin D deficiency was more common in patients with asthma (57.3%) than in healthy subjects (21.2%; P < .001). In patients with asthma, alfacalcidol significantly improved forced expiratory volume in the first second and forced vital capacity (P < .001 for the 2 tests). Moreover, more patients in the intervention arm showed improvement in asthma severity stage (P = .04). A nonsignificant difference was observed in improvement of forced expiratory volume in the first second between patients with vitamin D deficiency and those without deficiency in the intervention group (P > .05). CONCLUSION Alfacalcidol supplementation improved the pulmonary function and severity stage of adult patients with asthma regardless of deficiency. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02747381.
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Affiliation(s)
- Amani M Ali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
| | - Samah Selim
- Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maggie M Abbassi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nirmeen A Sabry
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Zheng SZ, Zhang DG, Wu H, Jiang LJ, Jin J, Lin XQ, Ding R, Jiang Y. The association between vitamin D receptor polymorphisms and serum 25-hydroxyvitamin D levels with ulcerative colitis in Chinese Han population. Clin Res Hepatol Gastroenterol 2017; 41:110-117. [PMID: 27771345 DOI: 10.1016/j.clinre.2016.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/18/2016] [Accepted: 09/02/2016] [Indexed: 02/04/2023]
Abstract
There is now growing evidence suggesting that Vitamin D is playing a critical role in modulating the innate and adaptive immune responses. Several polymorphisms have been identified in the vitamin D receptor (VDR) gene but their association with ulcerative colitis (UC) susceptibility remained controversy. In the current study, we examined the association between VDR polymorphisms and serum level of 25-hydroxyvitamin D [25(OH)D] with UC in Chinese Han population. Polymorphisms of FokI (rs2228570)/BsmI (rs1544410)/ApaI (rs7975232)/TaqI (rs731236) in the VDR gene were assessed in a case-control study comprising 404 UC patients and 612 controls. Moreover, 25(OH)D levels were measured by electro-chemiluminescence immunoassay in 75 UC patients and 120 controls. Our results suggested that BsmI polymorphism frequency was significantly lower in UC patients (P=0.028), and the frequency of AAC haplotype formed by BsmI, ApaI and TaqI was also significantly lower in UC patients (P=0.012). Moreover, FokI polymorphism was more frequently observed in patients with mild and moderate UC as compared to those with severe UC (P=0.001, P<0.001, respectively). Average 25(OH)D level was lower in UC patients than in controls (19.3±6.8 vs. 21.8±7.3ng/mL, P=0.017), and was significantly correlated with hemoglobin (β=0.49, P<0.001), C-reactive protein (β=-0.36, P<0.001), severity of UC (β=-0.21, P=0.025) and FokI polymorphism (β=-0.20, P=0.031) in UC patients. Interestingly, there was a significant correlation between FokI polymorphism and vitamin D deficiency (<20ng/mL) in UC patients (P=0.006). Together, these results supported that VDR polymorphisms and 25(OH)D level were significantly correlated with UC risk and severity in Chinese Han population.
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Affiliation(s)
- Shu-Zi Zheng
- Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Da-Guan Zhang
- Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Wu
- Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li-Jia Jiang
- Department of Gastroenterology, the Wenzhou Central Hospital, Wenzhou, China
| | - Jie Jin
- Department of Gastroenterology, the Wenzhou Central Hospital, Wenzhou, China
| | - Xiu-Qing Lin
- Department of Gastroenterology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ran Ding
- Department of Gastroenterology, Wenzhou Renmin Hospital, Wenzhou, China
| | - Yi Jiang
- Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Pallav K, Riche D, May WL, Sanchez P, Gupta NK. Predictors of vitamin D deficiency in inflammatory bowel disease and health: A Mississippi perspective. World J Gastroenterol 2017; 23:638-645. [PMID: 28216970 PMCID: PMC5292337 DOI: 10.3748/wjg.v23.i4.638] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/05/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To identify the predictors of vitamin D deficiency in patients with and without inflammatory bowel disease (IBD).
METHODS Patients with ulcerative colitis (UC) or Crohn’s disease (CD) related diagnostic codes who received medical care at University of Mississippi Medical Center between July 2012 and 2015 were identified. After thorough chart review, we identified patients with biopsy proven IBD who had also been tested for serum 25-hydroxyvitamin D [25(OH)D] concentration. We compared these patients to a previously studied cohort of healthy controls who also had vitamin D concentration checked. Logistic regression analysis was performed to determine the association between vitamin d deficiency and UC, CD, race, age, gender and body mass index (BMI).
RESULTS We identified 237 patients with confirmed IBD. Of these, only 211 had a serum 25(OH)D concentrations available in the medical record. The group of healthy controls consisted of 98 individuals with available serum 25(OH)D concentration. 43% of IBD patients were African American (AA). Patients with CD were more likely to have vitamin D concentration checked. Bivariate analysis showed that AA (51% vs 21%, P = 0.00001), subjects with BMI >30 kg/m2 (39% vs 23% P = 0.01) and CD (40% vs 26%, P = 0.04) were more likely to be vitamin D deficient than vitamin D sufficient. Those with Age > 65 were more likely to be vitamin D sufficient (46% vs 15%, P = 0.04). Multiple regression showed that only BMI > 30 kg/m2 and AA race are associated with vitamin D deficiency.
CONCLUSION BMI > 30 kg/m2 and AA race are predictive of vitamin D deficiency. Gender, age and diagnosis of IBD are not predictive of vitamin D deficiency.
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Frigstad SO, Høivik M, Jahnsen J, Dahl SR, Cvancarova M, Grimstad T, Berset IP, Huppertz-Hauss G, Hovde Ø, Torp R, Bernklev T, Moum B, Jelsness-Jørgensen LP. Vitamin D deficiency in inflammatory bowel disease: prevalence and predictors in a Norwegian outpatient population. Scand J Gastroenterol 2017; 52:100-106. [PMID: 27603182 DOI: 10.1080/00365521.2016.1233577] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Vitamin D deficiency is common in inflammatory bowel disease (IBD). The aims of the present study were to determine the prevalence of vitamin D deficiency and to identify clinical and epidemiological variables associated with vitamin D deficiency in an outpatient population with IBD. METHODS Participants were recruited from nine hospitals in the southeastern and western regions of Norway as part of an observational, multicentre study from March 2013 to April 2014. Clinical and epidemiological data were collected by interview and from medical records. All analyses of serum 25-hydroxyvitamin D (25-OH-D) were performed in the same laboratory. RESULTS In total, 49% (200/408) of the patients had a 25-OH-D concentration <50 nmol/L, including 53% (122/230) of the Crohn's disease (CD) patients and 44% (78/178) of the ulcerative colitis (UC) patients. In CD patients, disease activity, measured as the HBI, was inversely associated with vitamin D deficiency. No such association was observed with the Simple Clinical Colitis Activity Index (SCCAI) scores in UC, but in UC patients, vitamin D deficiency was associated with elevated faecal calprotectin >100 mg/kg. In patients with CD, there were significantly more relapses during the previous year in patients with vitamin D deficiency. CONCLUSIONS Vitamin D deficiency was common, especially in CD, and was associated with increased disease activity, a relapsing disease course and higher inflammatory activity.
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Affiliation(s)
- Svein Oskar Frigstad
- a Department of Research , Østfold Hospital Trust , Grålum , Norway.,b Department of Medicine , Bærum Hospital, Vestre Viken Hospital Trust , Drammen , Norway.,c Institute of Clinical Medicine , University of Oslo , Norway
| | - Marte Høivik
- c Institute of Clinical Medicine , University of Oslo , Norway.,d Department of Gastroenterology , Oslo University Hospital , Oslo , Norway
| | - Jørgen Jahnsen
- c Institute of Clinical Medicine , University of Oslo , Norway.,e Department of Gastroenterology , Akershus University Hospital , Lørenskog , Norway
| | - Sandra Rinne Dahl
- f The Hormone Laboratory, Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway
| | - Milada Cvancarova
- c Institute of Clinical Medicine , University of Oslo , Norway.,g Department of Biostatistics , Oslo and Akershus University College , Oslo , Norway
| | - Tore Grimstad
- h Department of Gastroenterology , Stavanger University Hospital , Stavanger , Norway
| | | | - Gert Huppertz-Hauss
- j Department of Research and Development , Telemark Hospital Trust , Skien , Norway
| | - Øistein Hovde
- c Institute of Clinical Medicine , University of Oslo , Norway.,k Department of Medicine , Innlandet Hospital Trust , Gjøvik , Norway
| | - Roald Torp
- l Department of Medicine , Innlandet Hospital Trust , Hamar , Norway
| | - Tomm Bernklev
- c Institute of Clinical Medicine , University of Oslo , Norway.,m Department of Gastroenterology , Østfold Hospital Trust , Grålum , Norway
| | - Bjørn Moum
- c Institute of Clinical Medicine , University of Oslo , Norway.,d Department of Gastroenterology , Oslo University Hospital , Oslo , Norway
| | - Lars-Petter Jelsness-Jørgensen
- m Department of Gastroenterology , Østfold Hospital Trust , Grålum , Norway.,n Department of Health Sciences , Østfold University College , Fredrikstad , Norway
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Limketkai BN, Mullin GE, Limsui D, Parian AM. Role of Vitamin D in Inflammatory Bowel Disease. Nutr Clin Pract 2016; 32:337-345. [PMID: 28537516 DOI: 10.1177/0884533616674492] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Vitamin D is a secosteroid hormone that possesses immunomodulatory properties and has been demonstrated to potentially influence inflammatory bowel disease (IBD) pathogenesis and activity. Epidemiologic data have associated vitamin D deficiency with an increased risk of IBD, hospitalizations, surgery, and loss of response to biologic therapy. Conversely, IBD itself can lead to vitamin D deficiency. This bidirectional relationship between vitamin D and IBD suggests the need for monitoring and repletion of vitamin D, as needed, in the IBD patient. This review discusses the role of vitamin D in IBD and provides practical guidance on vitamin D repletion.
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Affiliation(s)
- Berkeley N Limketkai
- 1 Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.,2 Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gerard E Mullin
- 2 Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Limsui
- 1 Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Alyssa M Parian
- 2 Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Stio M, Retico L, Annese V, Bonanomi AG. Vitamin D regulates the tight-junction protein expression in active ulcerative colitis. Scand J Gastroenterol 2016; 51:1193-9. [PMID: 27207502 DOI: 10.1080/00365521.2016.1185463] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Epithelial barrier function is primarily regulated by the tight-junction proteins. Ulcerative colitis (UC) is characterized by Th2 immune response with inflammation and epithelial barrier dysfunction, including an elevation of claudin-2 protein function. Recent studies support an important role of vitamin D in the pathogenesis as well as potential therapy of IBD. Vitamin D deficiency is in fact common in patients with IBD. The aim of the study was to determine whether vitamin D could affect IL-13 and IL-6 levels, and regulate the activity of tight-junction proteins. Claudin-1, -2, -4, and -7 in the inflamed and non-inflamed colonic mucosa of UC patients. MATERIAL AND METHODS Biopsies from inflamed and non-inflamed tract of colon and rectum from the same active UC patients were cultured with1,25(OH)2D3. IL-13, IL-6 and the tight-junction proteins level were determined. RESULTS Claudin-1 and claudin-2 proteins were up-regulated in active UC. The treatment with 1,25(OH)2D3 decreases the claudin-1 and claudin-2 protein levels in both inflamed and non-inflamed tract. Claudin-4 and claudin-7 proteins were down-regulated and their levels increase after incubation with the 1,25(OH)2D3. When the biopsies were incubated with 1,25(OH)2D3, a decrease in IL-13 and IL-6 levels was registered. CONCLUSIONS Our results, indicating the inhibition of cytokine levels and the regulation of claudin-2, claudin-4, and claudin-7 by 1,25(OH)2D3, suggest that vitamin D may represent a potential therapeutic agent for the treatment of active UC.
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Affiliation(s)
- Maria Stio
- a Department of Biomedical, Experimental and Clinical Sciences , "Mario Serio" University of Florence , Florence , Italy
| | - Luigina Retico
- b Gastroenterology Unit , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Vito Annese
- b Gastroenterology Unit , Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
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Basson A, Trotter A, Rodriguez-Palacios A, Cominelli F. Mucosal Interactions between Genetics, Diet, and Microbiome in Inflammatory Bowel Disease. Front Immunol 2016; 7:290. [PMID: 27531998 PMCID: PMC4970383 DOI: 10.3389/fimmu.2016.00290] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/19/2016] [Indexed: 12/12/2022] Open
Abstract
Numerous reviews have discussed gut microbiota composition changes during inflammatory bowel diseases (IBD), particularly Crohn’s disease (CD). However, most studies address the observed effects by focusing on studying the univariate connection between disease and dietary-induced alterations to gut microbiota composition. The possibility that these effects may reflect a number of other interconnected (i.e., pantropic) mechanisms, activated in parallel, particularly concerning various bacterial metabolites, is in the process of being elucidated. Progress seems, however, hampered by various difficult-to-study factors interacting at the mucosal level. Here, we highlight some of such factors that merit consideration, namely: (1) the contribution of host genetics and diet in altering gut microbiome, and in turn, the crosstalk among secondary metabolic pathways; (2) the interdependence between the amount of dietary fat, the fatty acid composition, the effects of timing and route of administration on gut microbiota community, and the impact of microbiota-derived fatty acids; (3) the effect of diet on bile acid composition, and the modulator role of bile acids on the gut microbiota; (4) the impact of endogenous and exogenous intestinal micronutrients and metabolites; and (5) the need to consider food associated toxins and chemicals, which can introduce confounding immune modulating elements (e.g., antioxidant and phytochemicals in oils and proteins). These concepts, which are not mutually exclusive, are herein illustrated paying special emphasis on physiologically inter-related processes.
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Affiliation(s)
- Abigail Basson
- Digestive Health Research Institute, Case Western Reserve University , Cleveland, OH , USA
| | - Ashley Trotter
- Digestive Health Research Institute, Case Western Reserve University, Cleveland, OH, USA; University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Fabio Cominelli
- Digestive Health Research Institute, Case Western Reserve University, Cleveland, OH, USA; University Hospitals Case Medical Center, Cleveland, OH, USA
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Wang JJ, Wang QM. Clinical significance of serum 25OHD level in patients with Crohn's disease. Shijie Huaren Xiaohua Zazhi 2016; 24:2737-2742. [DOI: 10.11569/wcjd.v24.i17.2737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To detect serum 25OHD levels in patients with Crohn's disease, and to analyze the relationship between serum 25OHD level and clinical parameters of Crohn's disease.
METHODS: Forty-five outpatients or inpatients with Crohn's disease (CD group) and 40 normal controls (NC group) were included in the study. Serum 25OHD levels were measured in all subjects by electrochemiluminescence. Correlation analysis was performed to identify the association between serum 25OHD levels and clinical indices of Crohn's disease. Afterwards, we analyzed the influence of related clinical indices on the level of serum 25OHD.
RESULTS: Serum 25OHD level was significantly lower in the CD group than in the NC group (12.17 ng/mL ± 6.12 ng/mL vs 19.56 ng/mL ± 5.69 ng/mL, P < 0.05, t = 5.738). The detection rate of 25OHD deficiency was significantly higher in the CD group than that of the NC group (86.7% vs 62.5%, P < 0.05, χ2 = 6.649). Serum 25OHD level was correlated with BMI (P < 0.05, r = 0.508), CRP (P < 0.05, r = -0.713), ESR (P < 0.05, r = -0.389), duration of exposure to sunshine < 30 min/d (P < 0.05, r = 0.362), active disease (P < 0.05, r = 0.384) and use of remicade (P < 0.05, r = 0.475). Serum 25OHD level was significantly lower in patients with Crohn's disease whose duration of exposure to sunshine was < 30 min/d than in those with a duration of exposure to sunshine > 30 min/d (10.33 ng/mL ± 5.75 ng/mL vs 14.47 ng/mL ± 5.91 ng/mL, P < 0.05, t = 2.371), in patients who did not use remicade than in those who used remicade (8.51 ng/mL ± 3.95 ng/mL vs 14.19 ng/mL ± 6.21 ng/mL, P < 0.05, t = 3.302), and in patients with active disease than in those with an inactive stage (9.36 ng/mL ± 4.43 ng/mL vs 14.05 ng/mL ± 6.44 ng/mL, P < 0.05, t = 2.693).
CONCLUSION: Patients with Crohn's disease have significantly lower serum 25OHD level than healthy people. Disease activity, duration of exposure to sunshine and use of remicade can affect serum 25OHD levels in patients with Crohn's disease.
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Uranga JA, López-Miranda V, Lombó F, Abalo R. Food, nutrients and nutraceuticals affecting the course of inflammatory bowel disease. Pharmacol Rep 2016; 68:816-26. [PMID: 27267792 DOI: 10.1016/j.pharep.2016.05.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/07/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022]
Abstract
Inflammatory bowel diseases (ulcerative colitis; Crohn's disease) are debilitating relapsing inflammatory disorders affecting the gastrointestinal tract, with deleterious effect on quality of life, and increasing incidence and prevalence. Mucosal inflammation, due to altered microbiota, increased intestinal permeability and immune system dysfunction underlies the symptoms and may be caused in susceptible individuals by different factors (or a combination of them), including dietary habits and components. In this review we describe the influence of the Western diet, obesity, and different nutraceuticals/functional foods (bioactive peptides, phytochemicals, omega 3-polyunsaturated fatty acids, vitamin D, probiotics and prebiotics) on the course of IBD, and provide some hints that could be useful for nutritional guidance. Hopefully, research will soon offer enough reliable data to slow down the spread of the disease and to make diet a cornerstone in IBD therapy.
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Affiliation(s)
- José Antonio Uranga
- Área de Histología y Anatomía Patológica, Depto. de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Madrid, Spain; Unidad Asociada I+D+i al Instituto de Investigación en Ciencias de la Alimentación (CIAL) del Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain; Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL). Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Visitación López-Miranda
- Unidad Asociada I+D+i al Instituto de Investigación en Ciencias de la Alimentación (CIAL) del Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain; Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL). Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Madrid, Spain; Área de Farmacología y Nutrición, Depto. de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, URJC, Madrid, Spain; Unidad Asociada I+D+i al Instituto de Química Médica (IQM) del CSIC, Madrid, Spain
| | - Felipe Lombó
- Grupo de Investigación "Biotecnología de Nutracéuticos y Compuestos Bioactivos-BIONUC", Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Raquel Abalo
- Unidad Asociada I+D+i al Instituto de Investigación en Ciencias de la Alimentación (CIAL) del Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain; Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL). Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Madrid, Spain; Área de Farmacología y Nutrición, Depto. de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, URJC, Madrid, Spain; Unidad Asociada I+D+i al Instituto de Química Médica (IQM) del CSIC, Madrid, Spain.
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Abstract
Vitamin D deficiency is common in patients with inflammatory bowel diseases and may even precede the disease onset contributing to an increased risk. Using comprehensive data from a large, referral IBD cohort, Kabbani et al. establish that low vitamin D levels are associated with greater disease activity, increased risk of surgery and hospitalizations, and lower health-related quality of life in patients with IBD. This expands the evidence base supporting such an association. However, there is a need for this field to evolve to interventional studies with vitamin D supplementation to confirm that vitamin D has a true therapeutic role for treating disease activity in IBD.
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Xia SL, Lin XX, Guo MD, Zhang DG, Zheng SZ, Jiang LJ, Jin J, Lin XQ, Ding R, Jiang Y. Association of vitamin D receptor gene polymorphisms and serum 25-hydroxyvitamin D levels with Crohn's disease in Chinese patients. J Gastroenterol Hepatol 2016; 31:795-801. [PMID: 26513524 DOI: 10.1111/jgh.13221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM The vitamin D receptor (VDR) regulates immune responses and inflammation through binding with 1,25-dihydroxyvitamin D, the active form of vitamin D. The serum 25-hydroxyvitamin D (25(OH)D) level clinically reflects vitamin D status in the human body. We investigated the association of VDR polymorphisms and 25(OH)D levels in Chinese patients with Crohn's disease (CD). METHODS Vitamin D receptor polymorphisms (FokI, BsmI, ApaI, and TaqI) were genotyped by SNaPshot. Serum 25(OH)D levels were measured by electro-chemiluminescence immunoassay. RESULTS A total of 297 patients with CD and 446 controls were recruited. Compared with controls, mutant alleles and genotypes of BsmI and TaqI were less prevalent in patients with CD (all P < 0.05/4 = 0.0125). The AAC haplotype formed by BsmI, ApaI, and TaqI was also less prevalent in patients with CD (P = 0.004). Furthermore, 124 patients and 188 controls were randomly selected for measurements of 25(OH)D levels. Average 25(OH)D level was lower in patients with CD than in controls (15.46 ± 8.11 vs 21.64 ± 9.45 ng/mL, P < 0.001) and negatively linked to CD activity index (β = -0.829, P < 0.001), platelet count (β = -0.253, P < 0.001) and neutrophil percentage (β = -0.136, P = 0.005) in patients with CD. The ApaI mutant genotype and vitamin D deficiency (<20 ng/mL) were independently associated with CD (P = 0.009, P < 0.001, respectively). In patients with CD, vitamin D deficiency interacted with FokI, ApaI, and TaqI mutant genotypes (P = 0.027, P = 0.024, and P = 0.040, respectively). CONCLUSIONS Vitamin D receptor (BsmI, ApaI, and TaqI) mutations and lower 25(OH)D levels are associated with CD in Chinese patients. Moreover, VDR (FokI, ApaI, and TaqI) mutations and vitamin D deficiency may have a combined impact on CD.
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Affiliation(s)
- Sheng-long Xia
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin-xin Lin
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mao-dong Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Da-guan Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shu-zi Zheng
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li-jia Jiang
- Department of Gastroenterology, The Wenzhou Central Hospital, Wenzhou, China
| | - Jie Jin
- Department of Gastroenterology, The Wenzhou Central Hospital, Wenzhou, China
| | - Xiu-qing Lin
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ran Ding
- Department of Gastroenterology, The Wenzhou Renmin Hospital, Wenzhou, China
| | - Yi Jiang
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Nationality, Gender, Age, and Body Mass Index Influences on Vitamin D Concentration among Elderly Patients and Young Iraqi and Jordanian in Jordan. Biochem Res Int 2016; 2016:8920503. [PMID: 27110402 PMCID: PMC4823503 DOI: 10.1155/2016/8920503] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/10/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022] Open
Abstract
Vitamin D is necessary for maintaining and regulating calcium levels; thus, insufficiency of vitamin D increases the risk of many chronic diseases. This study aimed to examine vitamin D levels among Jordanian and Iraqi volunteers and find the relation between vitamin D level and lipid profile patients. Vitamin D levels were evaluated using enzyme-linked immunosorbent assay. For young healthy group subjects, vitamin D levels were 20.60 ± 5.94 ng/mL for Jordanian and 27.59 ± 7.74 ng/mL for Iraqi. Vitamin D concentrations for young males and females were 25.82 ± 8.33 ng/mL and 21.95 ± 6.39 ng/mL, respectively. Females wearing hijab were 20.87 ± 6.45 ng/mL, while uncovered females were 23.55 ± 6.04 ng/mL. For >40 years Iraqi subjects, vitamin D level for healthy was 29.78 ± 9.49 ng/mL and 23.88 ± 7.93 ng/mL for hyperlipidemic subjects. Vitamin D levels for overweight and obese healthy groups were significantly higher (P < 0.050) than those for the hyperlipidemic patients groups. Vitamin D levels for males were significantly higher than females and were significantly higher for healthy than those hyperlipidemic Iraqi patients. These findings showed that vitamin D levels are affected by age, nationality, gender, and health statues and highlight the importance of vitamin D supplementation for groups with low levels particularly old, hijab wearing females, and hyperlipidemic groups.
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Legaki E, Gazouli M. Influence of environmental factors in the development of inflammatory bowel diseases. World J Gastrointest Pharmacol Ther 2016; 7:112-125. [PMID: 26855817 PMCID: PMC4734944 DOI: 10.4292/wjgpt.v7.i1.112] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/20/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
Idiopathic inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), are multifactorial diseases that are manifested after disruption of a genetic predisposed individual and its intestinal microflora through an environmental stimulus. Urbanization and industrialization are associated with IBD. Epidemiological data, clinical observations and family/immigrants studies indicate the significance of environmental influence in the development of IBD. Some environmental factors have a different effect on the subtypes of IBD. Smoking and appendectomy is negatively associated with UC, but they are aggravating factors for CD. A westernized high fat diet, full of refined carbohydrates is strongly associated with the development of IBD, contrary to a high in fruit, vegetables and polyunsaturated fatty acid-3 diet that is protective against these diseases. High intake of nonsteroidal antiinflammatory drug and oral contraceptive pills as well as the inadequacy of vitamin D leads to an increased risk for IBD and a more malignant course of disease. Moreover, other factors such as air pollution, psychological factors, sleep disturbances and exercise influence the development and the course of IBD. Epigenetic mechanism like DNA methylation, histone modification and altered expression of miRNAS could explain the connection between genes and environmental factors in triggering the development of IBD.
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Meeker S, Seamons A, Maggio-Price L, Paik J. Protective links between vitamin D, inflammatory bowel disease and colon cancer. World J Gastroenterol 2016; 22:933-48. [PMID: 26811638 PMCID: PMC4716046 DOI: 10.3748/wjg.v22.i3.933] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/28/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Vitamin D deficiency has been associated with a wide range of diseases and multiple forms of cancer including breast, colon, and prostate cancers. Relatively recent work has demonstrated vitamin D to be critical in immune function and therefore important in inflammatory diseases such as inflammatory bowel disease (IBD). Because vitamin D deficiency or insufficiency is increasingly prevalent around the world, with an estimated 30%-50% of children and adults at risk for vitamin D deficiency worldwide, it could have a significant impact on IBD. Epidemiologic studies suggest that low serum vitamin D levels are a risk factor for IBD and colon cancer, and vitamin D supplementation is associated with decreased colitis disease activity and/or alleviated symptoms. Patients diagnosed with IBD have a higher incidence of colorectal cancer than the general population, which supports the notion that inflammation plays a key role in cancer development and underscores the importance of understanding how vitamin D influences inflammation and its cancer-promoting effects. In addition to human epidemiological data, studies utilizing mouse models of colitis have shown that vitamin D is beneficial in preventing or ameliorating inflammation and clinical disease. The precise role of vitamin D on colitis is unknown; however, vitamin D regulates immune cell trafficking and differentiation, gut barrier function and antimicrobial peptide synthesis, all of which may be protective from IBD and colon cancer. Here we focus on effects of vitamin D on inflammation and inflammation-associated colon cancer and discuss the potential use of vitamin D for protection and treatment of IBD and colon cancer.
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