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Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

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By HM Pappa, et al • www.ProHealth.com • December 6, 2006


Journal: Pediatrics. 2006 Nov;118(5):1950-61. Authors and affiliation: Pappa HM, Gordon CM, Saslowsky TM, Zholudev A, Horr B, Shih MC, Grand RJ. Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Children's Hospital Boston, Massachusetts, USA. [E-mail: helen.pappa@childrens.harvard.edu ] Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. helen.pappa@childrens.harvard.edu PMID: 17079566

Objectives: Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report:
1. The prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration < or = 15 ng/mL) in a large population with inflammatory bowel disease.
2. Factors predisposing to this problem, and
3. Its relationship to bone health and serum parathyroid hormone concentration.

Patients and Methods: A total of 130 patients (8-22 years of age) with inflammatory bowel disease, 94 with Crohn disease, and 36 with ulcerative colitis, had serum 25-hydroxy-vitamin D, intact parathyroid hormone, and lumbar spine bone mineral density (using dual-energy x-ray absorptiometry) measured at Children's Hospital Boston.

Results:
n The prevalence of vitamin D deficiency was 34.6%.
n Mean serum 25-hydroxy-vitamin D concentration was similar in patients with Crohn disease and ulcerative colitis, 52.6% lower among patients with dark skin complexion, 33.4% lower during the winter months (December 22 to March 21), and 31.5% higher among patients who were taking vitamin D supplements.
n Serum 25-hydroxy-vitamin D concentration was positively correlated with weight and BMI z score, disease duration, and serum albumin concentration and negatively correlated with erythrocyte sedimentation rate.
n Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it.
n Serum 25-hydroxy-vitamin concentration was not associated with lumbar spine bone mineral density z score or serum parathyroid hormone concentration.

Conclusions: Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn disease. The long-term significance of hypovitaminosis D for this population is unknown at present and merits additional study.




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