Vitamin D deficiency in Crohn's disease and healthy controls: A prospective case–control study in the Netherlands

Background and aimsVitamin D deficiency has been observed in a wide range of medical conditions including Crohn's disease (CD). We aimed to assess whether CD patients have lower vitamin D levels than healthy controls, and to determine risk factors for vitamin D deficiency.Methods25(OH)D was measured by chemiluminescent immunoassay in serum obtained from 101 CD patients and 41 controls. Demographics, sunlight exposure, dietary vitamin D intake, comorbidities and medication were recorded using validated questionnaires. In CD patients the Harvey–Bradshaw index, Montreal classification and surgical resections were also evaluated. 25(OH)D levels of > 75 nmol/L, between 50 and 75 nmol/L and < 50 nmol/L were considered as normal, suboptimal and deficient, respectively.ResultsVitamin D levels were rather low but comparable among CD patients and controls (mean 25(OH)D 51.6 nmol/L(± 26.6) in CD, and 60.8 nmol/L(± 27.6) in controls. Multivariate regression analysis revealed BMI, sun protection behaviour, non-Caucasian ethnicity, no use of tanning beds, and no holidays in the last year as significantly associated with serum 25(OH)D levels in CD patients (R = 0.62). In the control group no statistically significant factors were identified that had an impact on 25(OH)D serum levels.ConclusionsVitamin D deficiency is common in CD patients, but also in healthy controls. Appropriate vitamin D screening should be advised in patients with CD. Moreover, the positive effect of sunlight on the vitamin D status should be discussed with CD patients, but this should be balanced against the potential risk of developing melanomas, especially in patients using thiopurines.     

Vitamin D deficiency in Crohn's disease: Prevalence,risk factors and supplement use in an outpatient setting

Background and aimsVitamin D deficiency impacts on bone health and has potential new roles in inflammation. We aimed to determine the prevalence of and risk factors for vitamin D deficiency and to explore vitamin D supplement usage in patients with Crohn's disease (CD) in an outpatient setting, compared with controls.MethodsSerum 25-hydroxyvitamin D [25(OH)D] concentrations were measured by radioimmunoassay in 151 participants, comprising 81 CD patients and 70 age-, sex- and socio-economic status-matched healthy controls. Levels of 25(OH)D < 50 nmol/L were classed as deficient. Data on vitamin supplement usage were recorded for all participants at interview.ResultsVitamin D deficiency was common in patients with CD (63%) and significantly higher in winter than summer (68% v 50%; p < 0.001, χ²). Notably, the deficiency rate remained high even in summer (50%). On regression analysis, 25(OH)D levels were inversely associated with winter season. Disease-specific factors for lower serum 25(OH)D levels were longer disease duration and smoking. Overall, 43% of patients reported using a vitamin D-containing supplement, primarily at low dosages (200–400 IU/d); however, this level of supplement did not prevent deficiency. For the majority of CD patients, 25(OH)D remained below optimal levels proposed to confer bone and immune health benefits.ConclusionsVitamin D deficiency was common in patients with CD and associated with longstanding disease, smoking and winter. While over 40% of patients used a vitamin D-containing supplement, the dosages were inadequate to prevent deficiency. Appropriate vitamin D screening and supplementation should be considered in the context of health promotion of outpatients with CD.     

Vitamin D levels in patients with small and medium vessel vasculitis

ObjectivesTo determine the prevalence of vitamin D deficiency in patients with small and medium vessel systemic vasculitis.MethodsIn this cross-sectional study, 25-hydroxy (OH) vitamin D3 levels were measured in adult patients with systemic small and medium vessel vasculitis including antineutrophil cytoplasmic antibody-associated vasculitis (AAV), cryoglobulinaemic vasculitis (CryV), IgA vasculitis (IgAV) and polyarteritis nodosa (PAN), and age- and sex-matched healthy subjects (HS) and patients with rheumatoid arthritis (RA) as control groups. 25OH vitamin D3 levels < 30 ng/ml and <20 ng/ml were regarded as insufficiency and deficiency, respectively.ResultsFifty-seven patients (42 AAV, 2 CryV, 8 IgA vasculitis, 5 PAN) with systemic vasculitis, 101 HS, and 111 RA patients were included. The mean 25OH vitamin D3 level was 21.8 ± 14.2 ng/mL in patients with vasculitis, 42.7 ± 27.6 ng/mL in HS (p < .001) and 20.1 ± 18.47 ng/mL in patients with RA (p = .54). Vitamin D insufficiency and deficiency were significantly higher in patients with systemic vasculitis compared to HS (75.4% vs 33.7%, p < .001; %50 vs 21.8%, p < .001, respectively). Vitamin D status was not different in patients with systemic vasculitis compared to RA. There was a negative correlation between vitamin D status and CRP levels (=?.364, p = .007). The multivariate logistic regression analysis showed that renal involvement was significantly associated with vitamin D deficiency/insufficiency in patients with vasculitis (OR 22.5 [95% CI 1.6–128.9].ConclusionVitamin D deficiency and insufficiency are more frequent in patients with systemic small and medium vessel vasculitis and RA than HS. Renal involvement is one of the factors associated with vitamin D deficiency/insufficiency in patients with vasculitis.     

Defining a cutoff point for vitamin D deficiency based on insulin resistance in children

BackgroundVitamin D deficiency is a common worldwide problem. Low levels of serum 25-hydroxy vitamin D [25(OH)D], as a marker of vitamin D deficiency, have been linked to a wide field of health problems, including metabolic diseases such as insulin resistance, type 1 and type 2 DM. There is no universal definition for cutoff value of vitamin D deficiency and it seems that it varies in different populations.ObjectiveMost previous studies have used a start rise of PTH as a criteria to detect threshold of serum 25(OH)D, However, the aim of this study was to determine a cutoff point of serum 25(OH)D for vitamin D deficiency based on HOMA-IR.Materials and methodsTwo hundred and ninety seven healthy children (aged 7–11 years) were enrolled. Serum 25(OH)D and PTH were measured and HOMA-IR was calculated. The ROC curve was utilized to obtain a cutoff of vitamin D deficiency based on HOMA-IR.Results25(OH)D concentrations were inversely correlated with HOMA-IR levels (Spearman's r = ?0.14, p = 0.016). Serum 25(OH)D cutoff point was 11.6 ng/mL (29 nmol/L) in relation with HOMA-IR >2.1. By using this cutoff value, the prevalence of vitamin D deficiency was 43.4% in this study population of healthy children.ConclusionWe found that serum 25(OH)D levels are inversely associated with insulin resistance. These results suggest that in MetS patients it may benefit to determine cutoff value of 25(OH)D levels based on HOMA-IR.     

Is vitamin D status a predictor glycaemic regulation and cardiac complication in type 2 diabetes mellitus patients?

ObjectiveTo evaluate vitamin D as a predictor of glycaemic regulation in type 2 diabetes mellitus patients.Research design and methodsIn observational study 171 type 2 diabetic patients who are followed for median (range) of 10.15 (3–18) years. Mean ± SD age was 56 ± 10. Plasma 25-hydroxyvitamin D3 levels were determined by high-performance liquid chromatography/tandem mass spectrometry on baseline samples. Vitamin D deficiency was defined as a 25-OHD level of less than 20 ng/ml. Vitamin D levels between 20 and 30 ng/ml are termed ‘insufficient’. Vitamin D levels greater than 30 ng/ml are termed ‘optimal’.Results125 patients have vitamin D deficiency, 14 patients have insufficient and the others have optimal. Vitamin D levels were not associated with sex, age, BMI, HDL, LDL, kreatinin, hypertension and smoking. But vitamin D deficiency patients had more longer duration (p = 0.011), more higher uric acid (p = 0.021), fasting glucose (p = 0.037), postprandial glucose (p = 0.001) and HbA1c (p = 0.026).ConclusionsIn our study type 2 diabetic patients have 73% of vitamin D deficiency. Vitamin D deficiency predicts higher fasting and postprandial blood glucose and diabetes disregulation. Type 2 DM patients and low 25-OH vitamin D levels could increased cardiovascular disease directly or indirectly (low HDL and high uric acid in 25-OH vitamin D <20 ng/ml). Whether vitamin D substitution improves prognosis remains to be investigated.     

Association of myocardial dysfunction with vitamin D deficiency in patients with type 2 diabetes mellitus

AimsThe underlying mechanism of myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM) is unclear. Nonetheless recent studies have revealed that vitamin D (vit-D) deficiency, which is prevalent in such patients, is associated with adverse cardiovascular events. We hypothesized that vit-D deficiency in patients with T2DM may contribute to left ventricular (LV) dysfunction.MethodsWe studied 95 patients (62 ± 9 years, 58% female) with T2DM. None had any history of coronary artery disease and all underwent detailed transthoracic echocardiography, including speckle tracking derived strains. Plasma level of 25-hydoxyvitamin D (25-OHD) was also measured.ResultsVitamin D deficiency was evident in 60 (63%) patients. The LV dimension, LVEF and diastolic grade were similar between those with and without deficiency although an impaired global longitudinal strain was present in the former. Importantly, 25-OHD was negatively associated with global longitudinal strain(R = − 0.21, P = 0.046) and positively with body-mass index (BMI; R = 0.26, P = 0.01). Both vit-D deficiency and BMI were associated with impaired global LV longitudinal strain, independent of T2DM disease characteristics.ConclusionsIn patients with T2DM and no history of coronary artery disease, vit-D deficiency is independently associated with impaired global longitudinal strain. This suggests that vit-D deficiency may contribute to the development of myocardial dysfunction in these patients.     

The vitamin D status and its effects on life quality among the elderly in Jinan,China

A challenge for researchers is that vitamin D has many functions in the body, and vitamin D status across the world is not optimistic. There was little data regarding insufficient vitamin D status and its adverse effect on health of elderly Chinese people. So we selected 686 subjects (310 men and 376 women) aged 60–89 years to explore the correlation between vitamin D status and their life quality in a community-based osteoporosis prevention study at Qianfoshan Hospital of Shandong University from 2009 to 2010. All subjects were divided into three groups: vitamin D adequacy [serum 25(OH)D ≧ 75 nmol/L], hypovitaminosis D (50–74.9 nmol/L), and vitamin D insufficiency (<50 nmol/L). Participants were requested to complete SF-36 health survey. The regression models were used to evaluate respectively the association between 25(OH)D levels and parameters of SF-36. As a result, serum 25(OH)D levels were 58.60 nmol/L in male [95% confidence interval (95% CI): 56.7–60.5 nmol/L] and 54.17 nmol/L in female (95% CI: 52.8–55.8 nmol/L). Vitamin D adequacy was in 19.4% of male and 14.4% of female. With aging, proportions of insufficient vitamin D increased significantly in male (P = 0.004), and in female (P < 0.001). The elderly with hypovitaminosis D got lower scores than that with vitamin D adequacy (almost P < 0.01). Regression analysis showed that vitamin D appeared a positive association with parameters of SF-36 (almost P < 0.001). In conclusion, vitamin D status in the elderly was severely inadequate, which decreased their life quality and cause adverse effect on their health.     

Serum 25-hydroxy vitamin D levels in Egyptian patients with rheumatoid arthritis: Association with disease activity,functional disability and radiological damage

Aim of the workThe aim of this study was to examine vitamin D (VD) levels and its associations with disease activity, functional disability and radiological damage in Egyptian patients with RA.Patients and methodsThis study included 150 RA patients and 150 matched controls. All participants were not receiving VD supplements. Serum 25(OH)-D levels were measured in all participants. Serum 25(OH)-D levels at 30 and 20 ng/ml were the cut-off values for VD insufficiency and deficiency, respectively. Associations of 25(OH)-D levels with disease activity score associated with C-reactive protein (DAS-28-CRP), functional disability assessed by the Health Assessment Questionnaire (HAQ) and radiological damage as assessed by the modified Larsen method were considered.ResultsLow VD levels were frequent in RA patients (22 ± 9.2 ng/ml) compared to the control (28.7 ± 9.6 ng/ml) (p < 0.001); 42.7% had VD levels <20 ng/ml and was <30 ng/ml in 80.7%. RA patients with VD deficiency were older, more frequently females and had higher swollen joint count (SJC), tender joint count, visual analogue scale for pain and DAS28-CRP. Only SJC and DAS28-CRP remained significant following the multivariate analysis (p = 0.029, p = 0.007 respectively), while rheumatoid factor, anti-cyclic citrullinated peptide antibodies, medications used, HAQ and radiologic score had no association with VD levels.ConclusionsVitamin D insufficiency and deficiency are common among Egyptian RA patients and are associated with decreased sun exposure. VD deficiency was related to older age, female gender, swollen joint count and disease activity. Vitamin D levels had no relation with RA functional disability and radiological damage.     

Assessment of vitamin D status in common variable immunodeficiency or ataxia–telangiectasia patients

Introduction and objectivesVitamin D plays a role in the immune system, however studies regarding this are scarce. This study aimed to evaluate the nutritional status of vitamin D in patients with Common Variable Immunodeficiency (CVID) or Ataxia–Telangiectasia (A–T) and to relate it to body composition, inflammatory and bone metabolism markers.Patients and methodsThis is a cross-sectional and controlled study involving 24 patients of both sexes (59.3% male), aged 8–56 years, with CVID (n = 15) or A–T (n = 9). The following variables were evaluated: body mass index (BMI), 25-hydroxyvitamin D (25 (OH) D), hepatic profile, parathormone, calcium, phosphorus, alkaline phosphatase, interleukin 6 and high-sensitivity C-reactive protein.ResultsThe median age was 26.0 years. A deficiency of 25 (OH) D was found in four A–T patients (44%) and two CVID patients (13%). Nine patients with CVI (60%) and six with A–T (66.7%) were overweight and underweight, respectively. There was a negative correlation between vitamin D and fat mass in the CVID group, and vitamin D and BMI in the A–T group. Vitamin D was negatively associated with the percentage of total fat among the patients (β – 0.842, 95% CI: −1.5–0.17, p = 0.015), R² = 0.21, after adjusting for sex and age.ConclusionVitamin D deficiency occurred in a quarter of the patients although there was no difference between the patient and the control group; without association with bone and inflammation biomarkers. The percentage of fat and BMI were negatively associated with the concentrations of 25 (OH) D.     

Association of vitamin D deficiency and insulin resistance with breast cancer in premenopausal Algerian women: A cross-sectional study

BackgroundLow 25(OH)D levels are mainly related to breast cancer (BC) risk in postmenopausal women, while the impact of insulin resistance (IR) on BC prognosis is controversial.ObjectiveConsidering the high prevalence of BC in younger Algerian women, this cross-sectional study analyzed whether vitamin D status and IR are biomarkers for breast tumor status in premenopausal women.MethodsIn 96 women (mean age, 40.96 ± 0.65years) newly diagnosed with BC, tumor status was determined immunohistochemically, classified by molecular subtype, then correlated with body-mass index, total plasma 25(OH)D, insulin and glucose levels and HOMA-IR, using Chi², Student t, Spearman and ANOVA tests and multivariate logistic regression.ResultsA total of 66 of the 96 patients (68.75%) showed vitamin D deficiency (9.74 ng/mL). Overweight and obese patients with HOMA-IR > 2.5, positive for HER2 and with high Ki-67 index had the most severe vitamin D deficiency. There was a significant association between vitamin D deficiency, high Ki-67 index (OR, 14.55; 95% CI: 3.43–82.59; P = 0.00078) and IR (OR, 4.99; 95% CI: 1.27–24.47; P = 0.03), and between IR and HER2-positivity (OR, 3.23; 95% CI: 1.05–10.56; P = 0.04).ConclusionsVitamin D deficiency and IR are potential biomarkers for poorer prognosis in BC patients, independently of and/or synergically with high Ki-67 index and HER2-positivity in premenopausal overweight or obese women. The potential relationship of vitamin D receptor gene expression with breast cancer survival in Algerian patients will be investigated in a large cohort.     

Active Crohn's disease is associated with low vitamin D levels

Background and aimsCrohn's disease prevalence increases with increasing latitude. Because most vitamin D comes from sunlight exposure and murine models of intestinal inflammation have demonstrated beneficial effects of 1,25-(OH)₂ vitamin D treatment, we hypothesised that Crohn's disease activity is associated with low vitamin D levels.MethodsIn a cross-sectional study of 182 CD patients and 62 healthy controls, we measured serum 25-OH vitamin D. Stratified analysis was used to compare 25-OH vitamin D levels with Crohn's disease activity index, C-reactive protein, smoking status, intake of oral vitamin D supplements and seasonal variation in CD patients and healthy controls.ResultsSerum 25-OH vitamin D was inversely associated with disease activity: Median 25-OH vitamin D levels of Crohn's disease in remission, mildly, and moderately active diseases evaluated by Crohn's disease activity index were 64, 49, and 21 nmol/l (p < 0.01) and by CRP 68, 76, and 35 nmol/l (p < 0.05), respectively. Patients who took oral vitamin D supplementation had lower Crohn's disease activity index (p < 0.05) and C-reactive protein (p = 0.07) than non-users. Crohn's disease patients who smoked had lower vitamin D levels (51 nmol/l) than patients who did not smoke (76 nmol/l), p < 0.01. Overall, Crohn's disease patients did not differ from healthy controls regarding 25-OH vitamin D levels.ConclusionsActive Crohn's disease was associated with low serum 25-OH vitamin D. Patients who smoked had lower 25-OH vitamin D levels than patients who did not smoke, independently of disease activity.     

Metabolic effects of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency

AimEpidemiological studies suggest that vitamin D status influences type 2 diabetes mellitus. We investigate the metabolic effects of vitamin D.Material and methodsWe studied consecutive type 2 diabetic patients without insulin therapy with vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) lower than 20 ng/ml). They were treated with 16,000 IU of calcifediol orally once a week for a minimum of 8 weeks.ResultsTwenty eight patients were treated for a mean time of 84.1 days (range 56 to 120 days). All patients achieved serum levels of 25(OH)D higher than 20 ng/ml. There was a significant reduction in fasting glucose (145.6 ± 35.5 vs. 131.7 ± 30.4 mg/dl, p < 0.001). There were small non-significant reductions in HbA1c, fasting insulin and Homeostasis Model Assesment (HOMA)-insulin resistance (IR). There were small non-significant increases in HOMA-insulin sensitivity (S) and HOMA-beta cell function (B) and a small significant increase in Quantitative Insulin Sensitivity Check Index (QUICKI).ConclusionsCorrection of vitamin D deficiency in type 2 diabetic patients decreases fasting glucose. Our results do not rule out improvements in metabolic control, insulin-resistance and function of the beta cell.     

Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals

BackgroundDue to immunomodulatory properties, vitamin D status has been implicated in several diseases beyond the skeletal disorders. There is evidence that its deficiency deteriorates the gut barrier favoring translocation of endotoxins into the circulation and systemic inflammation. Few studies investigated whether the relationship between vitamin D status and metabolic disorders would be mediated by the gut microbiota composition.ObjectiveWe examined the association between vitamin D intake and circulating levels of 25(OH)D with gut microbiota composition, inflammatory markers and biochemical profile in healthy individuals.MethodsIn this cross-sectional analysis, 150 young healthy adults were stratified into tertiles of intake and concentrations of vitamin D and their clinical and inflammatory profiles were compared. The DESeq2 was used for comparisons of microbiota composition and the log2 fold changes (log2FC) represented the comparison against the reference level. The association between 25(OH)D and fecal microbiota (16S rRNA sequencing, V4 region) was tested by multiple linear regression.ResultsVitamin D intake was associated with its concentration (r = 0.220, p = 0.008). There were no significant differences in clinical and inflammatory variables across tertiles of intake. However, lipopolysaccharides increased with the reduction of 25(OH)D (p-trend < 0.05). Prevotella was more abundant (log2FC 1.67, p < 0.01), while Haemophilus and Veillonella were less abundant (log2FC − 2.92 and − 1.46, p < 0.01, respectively) in the subset with the highest vitamin D intake (reference) than that observed in the other subset (first plus second tertiles). PCR (r = − 0.170, p = 0.039), E-selectin (r = − 0.220, p = 0.007) and abundances of Coprococcus (r = − 0.215, p = 0.008) and Bifdobacterium (r = − 0.269, p = 0.001) were inversely correlated with 25(OH)D. After adjusting for age, sex, season and BMI, 25(OH)D maintained inversely associated with Coprococcus (β = − 9.414, p = 0.045) and Bifdobacterium (β = − 1.881, p = 0.051), but significance disappeared following the addition of inflammatory markers in the regression models.ConclusionThe role of vitamin D in the maintenance of immune homeostasis seems to occur in part by interacting with the gut microbiota. The attenuation of association of bacterial genera by inflammatory markers suggests that inflammation participate in part in the relationship between the gut microbiota and vitamin D concentration. Studies with appropriate design are necessary to address hypothesis raised in the current study.     

Serum calcium,vitamin D and parathyroid hormone relationship among diabetic and non-diabetic pregnant women and their neonates

AimsThe purpose of the study was to determine the prevalence of osteomalacia and hypovitaminosis D among diabetic and non-diabetic pregnant women and in their neonates.MethodsSerum calcium, phosphorus, heat labile alkaline phosphatase, 25(OH) vitamin D and PTH were measured in 32 non-diabetic, 16 gestational diabetic and 8 Type 1 diabetic pregnant women and in cord blood of their newborn.ResultsAmong 32 non-diabetic subjects, 4 subjects (12.5%) had biochemical osteomalacia. 4 out of 16 gestational diabetic subjects (25%) had biochemical osteomalacia whereas 5 out of 8 Type 1 diabetic subjects (62.5%) had biochemical osteomalacia. Mean concentration of 25(OH) vitamin D in the non-diabetic group was 17.18 ± 9.88 ng/ml. Mean concentration of 25(OH) vitamin D in the Gestational diabetic group was 14.75 ± 6.90 ng/ml, while in Type 1 diabetic group, it was 7.81 ± 3.79 ng/ml. 50% of neonates of normal pregnant women had vitamin D deficiency whereas, 50% had vitamin D insufficiency. 40% of neonates of Gestational diabetic pregnant women had vitamin D deficiency whereas, 40% had vitamin D insufficiency.ConclusionVitamin D deficiency and biochemical osteomalacia was present in significant percentage of normal pregnant women and their neonates. Gestational diabetes and Type 1 diabetic women were more prone to develop vitamin D deficiency and biochemical osteomalacia.     

Associations between serum 25-hydroxyvitamin D levels and allergic sensitization in early childhood

Background and objectivesVitamin D status may be related to allergen sensitizations, but the evidence is inconsistent. The objective of this study was to assess whether serum 25-hydroxyvitamin D (25(OH)D) levels were associated with allergic sensitizations in early childhood.MethodsData were collected from 2642 children who visited the Guangdong Women and Children’s Hospital from January 2016 to May 2017 for routine health check-ups. Serum 25(OH)D levels were tested by electrochemiluminescence immunoassay. Allergic sensitizations including food and inhalant allergens were tested for specific IgE antibodies at one year (12 months 0 days through 12 months 30 days) and two years (24 months 0 days through 24 months 30 days) of age.ResultsThe mean level of serum 25(OH)D was 86.47 ± 27.55 nmol/L, with a high prevalence of vitamin D insufficiency (<75 nmol/L) in children aged 0–2 years (36.8%). Lower 25(OH)D levels with serum total IgE of more than 200 IU/mL (81.54 ± 25.53 nmol/L) compared with less than 100 IU/mL (87.92 ± 28.05 nmol/L). The common sensitization to allergens in children aged one and two years were milk (44.2%), cat epithelium (26.4%), egg (13.1%), dog epithelium (12.7%) and Dermatophagoides farinae (6.7%). After multivariate adjustment, data in 25(OH)D treated as a continuous variable or categories, no consistent associations were found between 25(OH)D levels and allergen-specific IgEs.ConclusionsSerum 25(OH)D level showed an inverse relationship with total IgE level in early childhood. However, there is lack of evidence to support associations between low 25(OH)D levels and allergic sensitization to various allergens.     

Low levels of vitamin D are common in patients with ileal pouches irrespective of pouch inflammation

BackgroundVitamin D (25(OH) D3) levels in pouch patients are not well defined.AimTo evaluate the frequency and factors associated with low 25(OH) D3 levels in pouch patients with underlying inflammatory bowel disease (IBD).MethodsA consecutive of 157 pouch patients was identified from our Pouchitis Registry. A sample of 155 ulcerative colitis (UC) patients without IPAA served as controls.ResultsThe mean age of the cohort was 37.5 ± 14.2 years, with 86 (54.8%) being female. Low 25(OH)D3 levels (< 31 ng/mL) were detected in 69.4% of patients (N = 109). 34 (21.7%) of the 157 patients examined were 25(OH)D3 deficient (< 20 ng/mL). This was higher than the frequency of vitamin D insufficiency or deficiency in a sample of UC patients without IPAA. Between patients with and without normal 25(OH) D3 levels (> 31 ng/mL), no differences were identified in terms of demographic, pouch, and medication variables. A low hemoglobin level was found to be associated with low 25(OH) D3 levels in both univariate (p = 0.02) and multivariate analyses (odds ratio [OR] = 3.37; 95% confidence interval [CI]: 1.41–8.06; p = 0.01). Low levels of 25(OH)D3 was not related to markers of pouch inflammation, in particular there was no relation to pouchitis (OR = 1.20; 95% CI: 0.41–3.52; p = 0.74).ConclusionLow 25(OH)D3 level was common in this cohort, irrespective of inflammation of the pouch, possibly suggesting a strategy of routine testing in this population. Anemia was found to be associated with a low 25(OH)D3 level.     

The role of vitamin D,obesity and physical exercise in regulation of glycemia in Type 2 Diabetes Mellitus patients

AimThe aims of this study were to determine the role of vitamin D, obesity and physical exercise in the regulation of glycemia in Type 2 Diabetes Mellitus patients in a highly consanguineous population.DesignCase and control study.SettingThe survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar.SubjectsThe study was conducted from November 2012 to June 2014 among subjects above 30 years of age. Of the 2224 registered with diagnosed diabetes and free diseases attending Hamad General Hospital and PHC centers agreed and gave their consent to study.MethodsQuestionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed.ResultsThere were statistically significant difference between patients with diabetic and control in terms of ethnicity (p = 0.012), level of education (p = 0.002), occupation (p < 0.001), monthly income (p < 0.001), BMI(p = 0.024), sport activity (p = 0.018), cigarette smoking (p < 0.001), consanguinity (p = 0.029) and family history of Diabetes Mellitus (p < 0.001) and co-morbidity hypertension (p = 0.041). Further, the biochemistry values in the studied subjects with T2DM compared to healthy controls and the study revealed that serum Vitamin D, BMI, fasting glucose level, calcium, HbA1c, total cholesterol HDL, LDL, bilirubin, triglycerides, uric acid and blood pressure systolic and diastolic were higher in T2DM compared to their counterparts. Multivariate logistic regression showed that vitamin D deficiency ng/mL, Family History of T2DM, BMI (kg/m²) hypertension, consanguinity, income, mother occupation, ethnicity, educational level and Lack of physical exercise variables were significant predictors of diabetes. In the group of Diabetes Mellitus Type 2 patients, 39.3% as opposed to 51.2% in the control group had vitamin D deficiency, 25(OH) D3 levels ≤ 10 ng/ml (p < 0.001). In the group of Diabetes Mellitus Type 2 patients, 34.6% as opposed to 37.9% in the control group had vitamin D insufficiency, 25(OH)D3 levels <20 ng/ml (p < 0.001). In the group of Diabetes Mellitus Type 2 patients, 22.8% as opposed to 14.2% in the control group had vitamin D sufficiency, 25(OH)D3 levels >30 10 ng/ml (p < 0.001).ConclusionVitamin D, family history of diabetes, consanguinity marriages’ and hereditary gene-environment interactions and physical exercise may also contribute to the current diabetes epidemic in Qatari’s Arab populations.     

Does insulin resistance in type 2 diabetes alter vitamin D status?

AimsData on changes of vitamin D due to insulin resistance are conflicting. We assessed vitamin D concentrations and parameters of glycemia and mineral homeostasis in patients with insulin resistant type 2 diabetes and in matched normal controls.MethodsSixty-nine patients with type 2 diabetes and 60 matched normal control subjects were studied. After an overnight fast, blood was collected for measuring the parameters of glycemia (glucose, insulin and HbA1c), mineral profile (corrected calcium, phosphate and alkaline phosphatase), total 25(OH) vitamin D and parathyroid hormone (PTH) levels.ResultsPatients had significantly elevated fasting glucose (P = 0.0001), insulin (P = 0.0003) and HbA1c (P = 0.0005) than the controls had. They had significantly raised calculated insulin resistance compared with control subjects (P = 0.0001). Patients and controls had similar levels of serum corrected calcium and ALP, whereas serum phosphate was significantly lower in the patients compared with controls (P = 0.001).Patients and controls had similar levels of 25(OH)D, but the levels of 25(OH)D in both were in the deficiency range. Intact PTH was similar in the patients and controls. Levels of 25(OH)D did not demonstrate any relation with fasting insulin, insulin resistance, or HbA1c, but correlated negatively with intact PTH (r = ?0.4, P = 0.02).ConclusionThis study demonstrated prevalent vitamin D deficiency in insulin resistant type 2 diabetic and normal subjects. Insulin resistance did not influence the status of vitamin D.     

Prevalence and Morbidity Associated with Muscle Cramps in Patients with Cirrhosis

PurposePatients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps.MethodsA total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent.ResultsA total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1 ± 0.6 g/dL vs 3.3 ± 0.7 g/dL, P = .04) and CLDQ scores (107 ± 37 vs 137 ± 34, P <.0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score > 12). Muscle cramps (P <.001) and hepatic encephalopathy (P = .009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0 ± 8.9 ng/mL vs 19.6 ± 9.5 ng/mL, P = .49).ConclusionsMuscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment.     

Low 25-hydroxyvitamin D level is independently associated with non-alcoholic fatty liver disease

Background and aimsWe sought to explore associations between serum 25-hydroxyvitamin D [25(OH)D] levels and non-alcoholic fatty liver disease [NAFLD] in an integrated healthcare delivery system in the U.S.Methods and resultsSix hundred and seven NAFLD cases were randomly matched 1:1 with controls for age, sex, race and season of measurement. Conditional logistic regression was used to evaluate if serum 25(OH)D levels were associated with increased odds of NAFLD (diagnosed by ultrasound) after adjusting for body mass index and history of diabetes, renal, peripheral vascular and liver diseases (model 1) and also for hypertension (model 2). Mean (SD) serum 25(OH)D level was significantly lower in the group with NAFLD as compared with that in the matched control group (75 ± 17 vs. 85 ± 20 nmol/L [30 ± 7 vs. 34 ± 8 ng/mL], P < 0.001). Inadequate 25(OH)D status progressively increased the odds of NAFLD when classified categorically as sufficient (25(OH)D 75 nmol/L [>30 ng/mL], reference group), insufficient (37–75 nmol/L [15–30 ng/mL]; adjusted odds ratio [OR]: 2.40, 95% confidence interval [CI]: 0.90–6.34) or deficient (<37 nmol/L [<15 ng/mL]; adjusted OR: 2.56, 95% CI: 1.27–5.19). When modeled as a continuous variable, increased log₁₀ 25(OH)D was inversely associated with the risk of prevalent NAFLD (adjusted OR: 0.25, 95% CI: 0.064–0.96, P = 0.02).ConclusionCompared with matched controls, patients with NAFLD have significantly decreased serum 25(OH)D levels, suggesting that low 25(OH)D status might play a role in the development and progression of NAFLD.