Inflammatory Bowel Diseases

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Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0b013e3182902ad9
Original Clinical Articles

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

Ananthakrishnan, Ashwin N. MD, MPH*,†; Cagan, Andrew; Gainer, Vivian S. MS; Cai, Tianxi PhD§; Cheng, Su-Chun ScD§; Savova, Guergana PhD||; Chen, Pei||; Szolovits, Peter PhD; Xia, Zongqi MD, PhD†,**; De Jager, Philip L. MD, PhD†,**; Shaw, Stanley Y. MD, PhD†,††; Churchill, Susanne PhD‡‡; Karlson, Elizabeth W. MD†,§§; Kohane, Isaac MD, PhD†,||,‡‡; Plenge, Robert M. MD, PhD†,§§; Murphy, Shawn N. MD, PhD†,‡,||||; Liao, Katherine P. MD, MPH†,§§

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Background: Vitamin D may have an immunologic role in Crohn’s disease (CD) and ulcerative colitis (UC). Retrospective studies suggested a weak association between vitamin D status and disease activity but have significant limitations.

Methods: Using a multi-institution inflammatory bowel disease cohort, we identified all patients with CD and UC who had at least one measured plasma 25-hydroxy vitamin D (25(OH)D). Plasma 25(OH)D was considered sufficient at levels ≥30 ng/mL. Logistic regression models adjusting for potential confounders were used to identify impact of measured plasma 25(OH)D on subsequent risk of inflammatory bowel disease–related surgery or hospitalization. In a subset of patients where multiple measures of 25(OH)D were available, we examined impact of normalization of vitamin D status on study outcomes.

Results: Our study included 3217 patients (55% CD; mean age, 49 yr). The median lowest plasma 25(OH)D was 26 ng/mL (interquartile range, 17–35 ng/mL). In CD, on multivariable analysis, plasma 25(OH)D <20 ng/mL was associated with an increased risk of surgery (odds ratio, 1.76; 95% confidence interval, 1.24–2.51) and inflammatory bowel disease–related hospitalization (odds ratio, 2.07; 95% confidence interval, 1.59–2.68) compared with those with 25(OH)D ≥30 ng/mL. Similar estimates were also seen for UC. Furthermore, patients with CD who had initial levels <30 ng/mL but subsequently normalized their 25(OH)D had a reduced likelihood of surgery (odds ratio, 0.56; 95% confidence interval, 0.32–0.98) compared with those who remained deficient.

Conclusion: Low plasma 25(OH)D is associated with increased risk of surgery and hospitalizations in both CD and UC, and normalization of 25(OH)D status is associated with a reduction in the risk of CD-related surgery.

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

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