Inflammatory Bowel Diseases

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Inflammatory Bowel Diseases:
doi: 10.1002/ibd.22969
Original Clinical Articles

Changes in Vitamin D and Parathyroid Hormone Metabolism in Incident Pediatric Crohn's Disease

Prosnitz, Aaron R. MD*; Leonard, Mary B. MD, MSCE†,‡; Shults, Justine PhD; Zemel, Babette S. PhD; Hollis, Bruce W. PhD§; Denson, Lee A. MD; Baldassano, Robert N. MD; Cohen, Aaron B. BS; Thayu, Meena MD, MSCE†,‡

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Background: Prior studies of vitamin D metabolism in Crohn's disease (CD) did not include controls or examine changes following diagnosis. This study examined associations among 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D], and parathyroid hormone (PTH) levels in incident pediatric CD, compared with controls, and following diagnosis.

Methods: Serum vitamin D and PTH were measured at diagnosis (n = 78), 6, 12, and a median of 43 months (n = 52) later in CD participants, and once in 221 controls. Multivariate regression was used to examine baseline associations and quasi-least squares regression to assess subsequent changes.

Results: At diagnosis, 42% of CD participants were 25(OH)D-deficient (<20 ng/mL). The odds ratio for deficiency was 2.1 (95% confidence interval [CI]: 1.1, 3.9; P < 0.05) vs. controls, adjusted for age, race, and season. 1,25(OH)2D was lower in CD vs. controls (P < 0.05), adjusted for 25(OH)D, tumor necrosis factor alpha (TNF-α), and PTH. TNF-α was associated with lower 1,25(OH)2D (P < 0.05), and the positive association between PTH and 1,25(OH)2D in controls was absent in CD (interaction P = 0.02). Among participants with 25(OH)D <30 ng/mL, CD was associated with lower PTH (P < 0.05) vs. controls. Following diagnosis, 25(OH)D and 1,25(OH)2D improved (P < 0.001). At the final visit, 3% were 25(OH)D-deficient, PTH was no longer low relative to 25(OH)D, and 1,25(OH)2D was significantly elevated (P < 0.001) compared with controls.

Conclusions: Incident CD was associated with 25(OH)D and 1,25(OH)2D deficiency and a relative hypoparathyroidism that resolved following diagnosis. Inflammatory cytokine suppression of PTH and renal 1-α-hyroxylase may contribute to these alterations.

© Crohn's & Colitis Foundation of America, Inc.

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