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Weidner J, Glauche I, Manuwald U, Kern I, Reinecke I, Bathelt F, Amin M, Dong F, Rothe U, Kugler J. Correlation of Socioeconomic and Environmental Factors With Incidence of Crohn Disease in Children and Adolescents: Systematic Review and Meta-Regression. JMIR Public Health Surveill 2024; 10:e48682. [PMID: 38526534 PMCID: PMC11002755 DOI: 10.2196/48682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The worldwide incidence of Crohn disease (CD) in childhood and adolescence has an increasing trend, with significant differences between different geographic regions and individual countries. This includes an increase in the incidence of CD in countries and geographic regions where CD was not previously prevalent. In response to the increasing incidence, the pediatric care landscape is facing growing challenges. OBJECTIVE This systematic review and meta-analysis were undertaken to comprehensively delineate the incidence rates of CD in pediatric populations across different countries and to explore potential influencing factors. METHODS We performed a systematic review of PubMed and Embase (via Ovid) for studies from January 1, 1970, to December 31, 2019. In addition, a manual search was performed in relevant and previously published reviews. The results were evaluated quantitatively. For this purpose, random effects meta-analyses and meta-regressions were performed to investigate the overall incidence rate and possible factors influencing the incidence. RESULTS A qualitative synthesis of 74 studies was performed, with 72 studies included in the meta-analyses and 52 in the meta-regressions. The results of our meta-analysis showed significant heterogeneity between the individual studies, which cannot be explained by a sample effect alone. Our findings showed geographical differences in incidence rates, which increased with increasing distance from the equator, although no global temporal trend was apparent. The meta-regression analysis also identified geographic location, UV index, and Human Development Index as significant moderators associated with CD incidence. CONCLUSIONS Our results suggest that pediatric CD incidence has increased in many countries since 1970 but varies widely with geographic location, which may pose challenges to the respective health care systems. We identified geographic, environmental, and socioeconomic factors that contribute to the observed heterogeneity in incidence rates. These results can serve as a basis for future research. To this end, implementations of internationally standardized and interoperable registries combined with the dissemination of health data through federated networks based on a common data model, such as the Observational Medical Outcomes Partnership, would be beneficial. This would deepen the understanding of CD and promote evidence-based approaches to preventive and interventional strategies as well as inform public health policies aimed at addressing the increasing burden of CD in children and adolescents. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42020168644; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168644. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-037669.
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Affiliation(s)
- Jens Weidner
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ulf Manuwald
- Faculty of Applied Social Sciences, University of Applied Sciences (FHD), Dresden, Germany
| | - Ivana Kern
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ines Reinecke
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Bathelt
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Thiem-Research GmbH, Cottbus, Germany
| | - Makan Amin
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department for Trauma Surgery and Orthopaedics, Park-Klinik Weissensee, Berlin, Germany
| | - Fan Dong
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Joachim Kugler
- Institute and Policlinic for Occupational and Social Medicine, Department of Health Sciences/Public Health, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Yeaman F, Nguyen A, Abasszade J, Gupta S, Bell S, Moore G. Assessing vitamin D as a biomarker in inflammatory bowel disease. JGH Open 2023; 7:953-958. [PMID: 38162852 PMCID: PMC10757496 DOI: 10.1002/jgh3.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim A reliable serum biomarker for inflammatory bowel disease (IBD) activity is needed. Vitamin D is involved in inflammation and has been demonstrated to be low in IBD patients with active disease. It is routinely measured in IBD patients. Therefore, vitamin D may have a role as a serum biomarker in IBD. This study aims to investigate whether serum vitamin D may be useful as a biomarker in IBD in a real-world IBD population. Methods Patients were identified by review of fecal calprotectin (FCP) results, and those who had a clinical review, vitamin D test, and FCP performed within 3 months were included. Clinical scores were calculated from chart review. Nonparametric tests were used to investigate vitamin D and FCP levels, serum biomarkers, and clinical scores. Results Of 616 patients identified, 325 episodes of matched vitamin D level and biomarker data were obtained. A statistically significant correlation was found between vitamin D levels and FCP levels for all patients (r = -0.19 [s -0.29 to -0.080], P < 0.001]. This remained true when patients were divided into IBD subsets. Low vitamin D was associated with partial Mayo scores and C-reactive protein (CRP) to albumin ratio in ulcerative colitis, and CRP and CRP/albumin ratio in Crohn's disease. Conclusion Vitamin D level is negatively correlated with FCP and it may be considered as an adjunct biomarker at this stage. A prospective study would be beneficial to investigate further correlations between vitamin D and existing biomarkers of inflammation in IBD.
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Affiliation(s)
- Fiona Yeaman
- Department of Gastroenterology and HepatologyMonash HealthClaytonVictoriaAustralia
| | - Anke Nguyen
- Department of Gastroenterology and HepatologyMonash HealthClaytonVictoriaAustralia
| | - Joshua Abasszade
- Department of Gastroenterology and HepatologyMonash HealthClaytonVictoriaAustralia
| | - Sanjana Gupta
- Department of Medicine, School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
| | - Sally Bell
- Department of Gastroenterology and HepatologyMonash HealthClaytonVictoriaAustralia
- Department of Medicine, School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
| | - Gregory Moore
- Department of Gastroenterology and HepatologyMonash HealthClaytonVictoriaAustralia
- Department of Medicine, School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
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Wei H, Yuan Z, Ren K, Jin Y, Ren L, Cao B, Zhou Y, Chen L. Body Composition in Inflammatory Bowel Disease. Arch Iran Med 2023; 26:172-175. [PMID: 37543940 PMCID: PMC10685726 DOI: 10.34172/aim.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 08/08/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with body composition changes, which are associated with clinical prognosis, response to therapy, and quality of life in IBD patients. Therefore, it is critical to review the body composition distribution in IBD, summarize the potential factors affecting body composition distribution, and take steps to improve the body composition distribution of IBD patients as early as possible. In the current review, we searched PubMed via keywords 'inflammatory bowel disease', or 'IBD', or 'Crohn's disease', or 'CD', or 'ulcerative colitis', or 'UC', and 'body composition'. Malnutrition and sarcopenia are common in IBD patients and are associated with the clinical course, prognosis, and need for surgery. Disease activity, reduced nutrition intake, vitamin D deficiency, and intestinal dysbiosis are factors contributing to changed body composition. Early use of biological agents to induce remission is critical to improving body composition distribution in IBD patients, supplementation of vitamin D is also important, and moderate physical activity is recommended in IBD patients with clinical remission.
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Affiliation(s)
- Hongyun Wei
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Ziying Yuan
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Keyu Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yanchun Jin
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Linlin Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Bin Cao
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yuanyuan Zhou
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Linlin Chen
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
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Tulewicz-Marti EM, Lewandowski K, Rydzewska G. Bone Metabolism Alteration in Patients with Inflammatory Bowel Disease. J Clin Med 2022; 11:jcm11144138. [PMID: 35887903 PMCID: PMC9316624 DOI: 10.3390/jcm11144138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Metabolic bone disease is a common disorder, but there is a lack of data on it in patients with inflammatory bowel disease (IBD). Methods: In this prospective, one-centre study, we assessed bone mineral and vitamin D alterations in 187 IBD patients (119 with Crohn’s disease (CD) and 68 with ulcerative colitis (UC)). Results: While 81.3% of the patients had vitamin D deficiency, 14.2% of them had a severe deficiency. Elevated serum PTH concentrations were found in 14.9% of the patients. Only in 4.1% of cases was there an elevated level of a serum marker for bone formation (osteocalcin), whereas in 14.4% of cases, the bone resorption marker (CTX) was raised. The concentration of phosphate in urine was higher in the CD than in the UC group (51.20 vs. 31.25; p = 0.003). PTH was negatively associated with vitamin D level. Among the patients receiving corticosteroids, the CTX and CRP median levels were higher (0.49 vs. 0.38; p = 0.013 and 6.45 vs. 2.2; p = 0.029, respectively) compared with the group who did not receive them. Urine phosphate levels were lower (48.60 vs. 26.00; p = 0.005), as were osteocalcin (15.50 vs. 23.80; p < 0.001), and PTH (29.05 vs. 36.05; p = 0.018). Conclusions: Bone mineral alterations were common in patients with IBD, mostly in the CD patients. This may be associated with poor absorption, making CD patients vulnerable to changes in bone mineralization. Vitamin D supplementation remains crucial, especially when taking corticosteroids.
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Affiliation(s)
- Edyta Maria Tulewicz-Marti
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
- Correspondence:
| | - Konrad Lewandowski
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
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Abstract
INTRODUCTION Vitamin D deficiency is common in patients with ulcerative colitis (UC). Moreover, vitamin D supplementation seems to contribute to disease relief. Nevertheless, the exact etiological link between vitamin D deficiency and UC is far from clear, and an agreement has not been reached on the frequency and dosage of vitamin D supplementation required. AREAS COVERED This review will outline the possible role of vitamin D in the pathogenesis of UC and summarize the current state of clinical research on vitamin D. Literature was searched on PUBMED, with 'Vitamin D,' 'Ulcerative colitis,' 'Vitamin D receptor,' and 'disease activity' as MeSH Terms. Relevant information is presented in figures or tables. EXPERT OPINION The etiological relationship between vitamin D and the onset of UC is still being researched. More high-quality double-blind randomized clinical studies are needed to determine the efficacy of vitamin D supplementation in the treatment of UC, whether as the main treatment or as an adjuvant treatment. Importantly, determining the dosage and frequency of vitamin D supplementation should be the main research direction in the future, and regional factors should also be fully considered in this respect.
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Affiliation(s)
- HongQian Wang
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
| | - Xue He
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
| | - ShiMin Liang
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
| | - Xi Chen
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
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Bhutia SK. Vitamin D in autophagy signaling for health and diseases: Insights on potential mechanisms and future perspectives. J Nutr Biochem 2021; 99:108841. [PMID: 34403722 DOI: 10.1016/j.jnutbio.2021.108841] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023]
Abstract
Vitamin D regulates the pleiotropic effect to maintain cellular homeostasis and epidemiological evidence establishes an association between vitamin D deficiency and various human diseases. Here, the role of autophagy, the cellular self-degradation process, in vitamin D-dependent function is documented in different cellular settings and discussed the molecular aspects for treating chronic inflammatory, infectious diseases, and cancer. Vitamin D activates autophagy through a genomic and non-genomic signaling pathway to influence a wide variety of physiological functions of different body organs along with bone health and calcium metabolism. Moreover, it induces autophagy as a protective mechanism to inhibit oxidative stress and apoptosis to regulate cell proliferation, differentiation, and immune modulation. Furthermore, vitamin D and its receptor regulate autophagy signaling to control inflammation and host immunity by activating antimicrobial defense mechanisms. Vitamin D has been revealed as a potent anticancer agent and induces autophagy to increase the response to radiation and chemotherapeutic drugs for potential cancer therapy. Increasing vitamin D levels in the human body through timely exposure to sunlight or vitamin D supplements could activate autophagy as part of the homeostasis mechanism to prevent multiple human diseases and aging-associated dysfunctions.
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Affiliation(s)
- Sujit Kumar Bhutia
- Cancer and Cell Death Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, 769008, India.
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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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Bauset C, Gisbert-Ferrándiz L, Cosín-Roger J. Metabolomics as a Promising Resource Identifying Potential Biomarkers for Inflammatory Bowel Disease. J Clin Med 2021; 10:jcm10040622. [PMID: 33562024 PMCID: PMC7915257 DOI: 10.3390/jcm10040622] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a relapsing chronic disorder of the gastrointestinal tract characterized by disruption of epithelial barrier function and excessive immune response to gut microbiota. The lack of biomarkers providing early diagnosis or defining the status of the pathology difficulties an accurate assessment of the disease. Given the different metabolomic profiles observed in IBD patients, metabolomics may reveal prime candidates to be studied, which may help in understanding the pathology and identifying novel therapeutic targets. In this review, we summarize the most current advances describing the promising metabolites such as lipids or amino acids found through untargeted metabolomics from serum, faecal, urine and biopsy samples.
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Affiliation(s)
- Cristina Bauset
- Department of Pharmacology and CIBER, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.B.); (L.G.-F.)
| | - Laura Gisbert-Ferrándiz
- Department of Pharmacology and CIBER, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.B.); (L.G.-F.)
| | - Jesús Cosín-Roger
- Hospital Dr. Peset, Fundación para la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO, 46017 Valencia, Spain
- Correspondence: ; Tel.: +34-963851234
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Lu Y, Chen J, He X, Xu S, Chen YE, Gao J, Hou S. Combined Administration of Vitamin D 3 and Geniposide Is Less Effective than Single Use of Vitamin D 3 or Geniposide in the Treatment of Ulcerative Colitis. Front Pharmacol 2021; 12:714065. [PMID: 34650431 PMCID: PMC8505666 DOI: 10.3389/fphar.2021.714065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/04/2021] [Indexed: 02/05/2023] Open
Abstract
With the increasing incidence of ulcerative colitis (UC) in China, Chinese medicinal herbs or relatively active compounds are widely applied in treating UC. These medicines may be combined with other therapeutic agents such as vitamin D3. Nevertheless, the efficacy of these combinations for UC is unclear. Geniposide is an active component in many Chinese herbal medicines. It could ameliorate dextran sulfate sodium (DSS)-induced colitis in mice. This study was designed to determine the efficacy and mechanism of the single use and combination of geniposide and vitamin D3 on a mouse model of acute colitis. Data showed that a single administration of geniposide (2 mg/kg) or vitamin D3 (4 IU/day) could significantly improve the symptoms of UC and relieve colon damage. Geniposide and vitamin D could significantly decrease the levels of TNF-α and IL-6 in serum and colon, and increase the level of IL-10 in the colon. However, the combined treatment of geniposide (2 mg/kg) and vitamin D3 (4 IU/day) exerted less beneficial effects on UC in mice, indicating by less improvement of UC symptoms, colon damage, and inflammatory infiltration. The combination only downregulated the level of TNF-α in serum and IL-6 in the colon. Our data further demonstrated that geniposide could inhibit the activation of p38 MAPK and then restrict the vitamin D receptor signaling stimulated by vitamin D3. These results implied that the combination of geniposide and vitamin D3 might not be an ideal combined treatment for acute colitis, and the combination of vitamin D supplementary and geniposide (or herbal medicines rich in geniposide) need more evaluation before being applied to treat UC in clinic.
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Affiliation(s)
- Yingyu Lu
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianqiang Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xueling He
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuoxi Xu
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yong-er Chen
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Gao
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Jie Gao, ; Shaozhen Hou,
| | - Shaozhen Hou
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Jie Gao, ; Shaozhen Hou,
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Shi Y, Cui X, Sun Y, Zhao Q, Liu T. Intestinal vitamin D receptor signaling ameliorates dextran sulfate sodium-induced colitis by suppressing necroptosis of intestinal epithelial cells. FASEB J 2020; 34:13494-13506. [PMID: 32779265 DOI: 10.1096/fj.202000143rrr] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
Vitamin D status is closely related to inflammatory bowel disease (IBD), but the mechanism has not been fully elucidated. This study explored the effect of intestinal vitamin D signaling on necroptosis and the underlying mechanism in colitis. Serum 25(OH)D levels and the expression of necroptotic proteins were examined in patients with IBD. Colitis was induced in an intestinal-specific hVDR transgenic model, and the gross manifestation, histological integrity, and intestinal barrier function were tested. The findings were further confirmed in vitro. Immunoprecipitation and colocalization were performed to investigate the association between the vitamin D receptor and necroptotic proteins. We found that serum 25(OH)D decreased in patients with IBD, while the expression of necroptotic proteins increased. The intestinal hVDR transgenic model could largely ameliorate the structural destruction, restore barrier dysfunction, and suppress necroptosis caused by DSS. This was probably achieved by binding to RIPK1/3 necrosomes, as we observed decreased RIPK1/3 necrosome formation and increased VDR expression in the cytosol. This study demonstrated an inhibitory effect of the intestinal vitamin D signaling pathway on necroptosis in DSS-induced colitis. The vitamin D receptor shifts from the nucleus to the cytosol to impede the formation of RIPK1/3. Our findings may offer some theoretical basis for a novel treatment of IBD in clinical practice.
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Affiliation(s)
- Yongyan Shi
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Xuewei Cui
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yanli Sun
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, P.R. China
| | - Qun Zhao
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Tianjing Liu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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Sun L, Arbesman J, Piliang M. Vitamin D, autoimmunity and immune-related adverse events of immune checkpoint inhibitors. Arch Dermatol Res 2021; 313:1-10. [PMID: 32519001 DOI: 10.1007/s00403-020-02094-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022]
Abstract
In addition to its quintessential role in bone homeostasis, vitamin D also plays an important role in regulating the immune system. As such, many studies have demonstrated the therapeutic benefit of vitamin D in treating autoimmune diseases. This immunomodulatory activity of vitamin D has recently attracted more attention due to the rapid development of immunotherapies for cancers, including melanoma. Patients on cancer immunotherapies can suffer from immune-related adverse events (irAEs), which can involve any organ system and range from common dermatological reactions to extremely severe cases of fatal myocarditis in metastatic melanoma patients. Since there are currently no effective approaches to predict or prevent irAEs, it is attractive to potentially leverage the intriguing immunomodulatory effects of vitamin D within this context. This review will discuss recent research investigating the possibility of using vitamin D to alleviate autoimmunity and irAEs with the hope of improving outcomes for patients on cancer immunotherapies, especially within the context of dermatology.
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Carlberg C, Muñoz A. An update on vitamin D signaling and cancer. Semin Cancer Biol 2020; 79:217-230. [DOI: 10.1016/j.semcancer.2020.05.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022]
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Abstract
Osteopenia and osteoporosis are common features in inflammatory bowel disease (IBD), comprising both Crohn's disease and ulcerative colitis. Moreover, Crohn's disease is associated with increased fracture risk. The etiology of bone loss in IBD is multifactorial. It includes insufficient intake or absorption of calcium, vitamin D, and potassium; smoking; a low peak bone mass; a low body mass index; and decreased physical activity. In several studies, it has been shown that elevated concentrations of systemic and local pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interferon-γ (IFNγ), interleukin (IL)-1β, IL-4, IL-5, IL-6, IL-13, and IL-17, present in IBD patients are potentially detrimental for bone metabolism and may be responsible for bone loss and increased fracture risk. This perspective aims to review the current literature on the role of inflammatory factors in the pathophysiology of skeletal problems in IBD and to suggest potential treatment to improve bone health, based on a combination of evidence and clinical and pathophysiological reasoning.
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Affiliation(s)
- A. A. van Bodegraven
- Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine(Co-MIK), Zuyderland MC, Sittard-Geleen-Heerlen, Dr H van der Hoffplein 1, 6162 BG Geleen, Netherlands
- Department of Gastroenterology, Amsterdam UMC, Location Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, Netherlands
| | - N. Bravenboer
- Department of Clinical Chemistry, Research Institute Amsterdam Movement Sciences Amsterdam UMC, Location Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, Netherlands
- Department of Internal Medicine, Endocrinology Section, Centre for Bone Quality LUMC, Albinusdreef 2, Leiden, 2333 ZA Netherlands
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14
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Domislović V, Vranešić Bender D, Barišić A, Brinar M, Ljubas Kelečić D, Rotim C, Novosel M, Matašin M, Krznarić Ž. HIGH PREVALENCE OF UNTREATED AND UNDERTREATED VITAMIN D DEFICIENCY AND INSUFFICIENCY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. Acta Clin Croat 2020; 59:109-118. [PMID: 32724281 PMCID: PMC7382878 DOI: 10.20471/acc.2020.59.01.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Inflammatory bowel disease (IBD) patients with vitamin D deficiency show an increased risk of hospital admission, surgery, and loss of response to biologic therapy while high vitamin D levels are identified as a protective factor. Our goal was to investigate the prevalence of untreated and undertreated vitamin D deficiency and factors associated with vitamin D deficiency. In this cross-sectional study, we measured serum vitamin D in a random sample of Caucasian IBD patients. Vitamin D deficiency was defined as <50 nmol/L and insufficiency as 50-75 nmol/L. Supplementation was defined as taking 800-2000 IU vitamin D daily. Untreated patients were defined as not taking supplementation and undertreated group as receiving supplementation but showing vitamin D deficiency or insufficiency despite treatment. Our study included 185 IBD patients, i.e. 126 (68.1%) with Crohn’s disease (CD) and 59 (31.9%) with ulcerative colitis (UC). Overall, 108 (58.4%) patients had vitamin D deficiency and 60 (32.4%) patients vitamin D insufficiency. There were 16 (14.8%) and 11 (18.3%) treated patients in vitamin D deficiency and vitamin D insufficiency group, respectively. The rate of untreated patients was 81.7% (n=49) in vitamin D deficiency group and 85.2% (n=92) in vitamin D insufficiency group. Tumor necrosis factor alpha inhibitors were associated with higher serum vitamin D levels in CD and UC, and ileal involvement, ileal and ileocolonic resection with lower levels. In conclusion, not only is vitamin D deficiency common in IBD patients but the proportion of untreated and undertreated patients is considerably high. We suggest regular monitoring of vitamin D levels in IBD patients regardless of receiving vitamin D supplementation therapy.
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Affiliation(s)
- Viktor Domislović
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Darija Vranešić Bender
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Ana Barišić
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Marko Brinar
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Dina Ljubas Kelečić
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Cecilija Rotim
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Martin Novosel
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Marija Matašin
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Željko Krznarić
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Unit of Clinical Nutrition, Zagreb University Hospital Centre, Zagreb, Croatia; 3Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
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15
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Aksan A, Tugal D, Hein N, Boettger K, Caicedo-Zea Y, Diehl I, Schumann C, Armbruster FP, Stein J. Measuring Vitamin D Status in Chronic Inflammatory Disorders: How does Chronic Inflammation Affect the Reliability of Vitamin D Metabolites in Patients with IBD? J Clin Med 2020; 9:E547. [PMID: 32079317 DOI: 10.3390/jcm9020547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/02/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
Evidence gained from recent studies has generated increasing interest in the role of vitamin D in extraskeletal functions such as inflammation and immunoregulation. Although vitamin D deficiency has been implicated in the pathophysiology of inflammatory diseases including inflammatory bowel disease (IBD), evidence as to whether vitamin D supplementation may cure or prevent chronic disease is inconsistent. Since 25OH-vitamin D (25OHD) has been suggested to be an acute-phase protein, its utility as a vitamin D status marker is therefore questionable. In this study, possible interactions of vitamin D and inflammation were studied in 188 patients with IBD, with high-sensitivity C-reactive protein (hsCRP) levels ≥ 5 mg/dL and/or fecal calprotectin ≥ 250 µg/g defined as biochemical evidence of inflammatory activity. Levels of 25OHD and vitamin D-binding protein (VDBP) were determined by ELISA, and 1,25-dihydroxyvitamin D (1,25OHD) and dihydroxycholecalciferol (24,25OHD) by LC-MS/MS. Free and bioavailable vitamin D levels were calculated with the validated formula of Bikle. Serum 1,25OH2D and vitamin D binding protein (VDBP) levels were shown to differ between the inflammatory and noninflammatory groups: patients with inflammatory disease activity had significantly higher serum concentrations of 1,25OH2D (35.0 (16.4-67.3) vs. 18.5 (1.2-51.0) pg/mL, p < 0.001) and VDBP (351.2 (252.2-530.6) vs. 330.8 (183.5-560.3) mg/dL, p < 0.05) than patients without active inflammation. Serum 24,25OH2D levels were negatively correlated with erythrocyte sedimentation rate (ESR) (-0.155, p = 0.049) while concentrations of serum 1,25OH2D correlated positively with hsCRP (0.157, p = 0.036). Correlations with serum VDBP levels were found for ESR (0.150, p = 0.049), transferrin (0.160, p = 0.037) and hsCRP (0.261, p < 0.001). Levels of serum free and bioavailable 25OHD showed a negative correlation with ESR (-0.165, p = 0.031, -0.205, p < 0.001, respectively) and hsCRP (-0.164, p = 0.032, -0.208, p < 0.001 respectively), and a moderate negative correlation with fecal calprotectin (-0.377, p = 0.028, -0.409, p < 0.016, respectively). Serum total 25OHD concentration was the only vitamin D parameter found to have no specific correlation with any of the inflammatory markers. According to these results, the traditional parameter, total 25OHD, still appears to be the best marker of vitamin D status in patients with inflammatory bowel disease regardless of the presence of inflammation.
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16
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Godny L, Reshef L, Pfeffer-Gik T, Goren I, Yanai H, Tulchinsky H, Gophna U, Dotan I. Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery. Eur J Nutr 2020; 59:3183-90. [PMID: 31813010 DOI: 10.1007/s00394-019-02158-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mediterranean diet (MED) is associated with health benefits, yet scarce data exist regarding the role of MED in inflammatory bowel diseases (IBD). Herein, we aimed to evaluate the association between MED and inflammatory markers in patients with IBD after pouch surgery. METHODS Consecutive patients after pouch surgery due to ulcerative colitis (UC) were recruited at a comprehensive pouch clinic. Adherence to MED was calculated according to MED score, ranging from 0 (low adherence) to 9 (high adherence), based on food-frequency questionnaires. Pouch behavior was defined as normal pouch (NP) or pouchitis based on Pouchitis Disease Activity Index (PDAI) and disease activity was defined as active or inactive. C-reactive protein (CRP) and fecal calprotectin were assessed. RESULTS Overall 153 patients were enrolled (male gender 47%; mean age 46 ± 14 years; mean pouch age 9.5 ± 7 years). MED scores were higher in patients with normal vs. elevated CRP and calprotectin levels (4.6 ± 1.8 vs. 4.4 ± 1.6, p = 0.28; 4.8 ± 1.8 vs. 4.07 ± 1.7, p < 0.05, respectively). In a multivariate regression, MED score was associated with decreased calprotectin levels (OR = 0.74 [0.56-0.99]). Adherence to MED was associated with dietary fiber and antioxidants intake. Finally, in a subgroup of patients with NP followed up for 8 years, higher adherence to MED trended to be inversely associated with the onset of pouchitis (log rank = 0.17). CONCLUSIONS In patients with UC after pouch surgery, adherence to MED is associated with decreased calprotectin levels. Thus, MED may have a role in modifying intestinal inflammation in IBD.
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17
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18
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Nielsen OH, Hansen TI, Gubatan JM, Jensen KB, Rejnmark L. Managing vitamin D deficiency in inflammatory bowel disease. Frontline Gastroenterol 2019; 10:394-400. [PMID: 31656565 PMCID: PMC6788352 DOI: 10.1136/flgastro-2018-101055] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 02/04/2023] Open
Abstract
Management of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, is generally cumbersome for patients and is a massive health-economic burden. In recent years, the immunomodulating effects of vitamin D have gained a huge interest in its possible pathogenic influence on the pathophysiology of IBD. Vitamin D deficiency is frequent among patients with IBD. Several clinical studies have pointed to a critical role for vitamin D in ameliorating disease outcomes. Although causation versus correlation unfortunately remains an overwhelming issue in the illusive chicken versus egg debate regarding vitamin D and IBD, here we summarise the latest knowledge of the immunological effects of vitamin D in IBD and recommend from available evidence that physicians regularly monitor serum 25(OH)D levels in patients with IBD. Moreover, we propose an algorithm for optimising vitamin D status in patients with IBD in clinical practice. Awaiting well-powered controlled clinical trials, we consider vitamin D supplementation to be an affordable and widely accessible therapeutic strategy to ameliorate IBD clinical outcomes.
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Affiliation(s)
- Ole Haagen Nielsen
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Thomas Irgens Hansen
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - John Mark Gubatan
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Kim Bak Jensen
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark,Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Stem Cell Research, University of Copenhagen, Copenhagen, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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19
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Hausmann J, Kubesch A, Amiri M, Filmann N, Blumenstein I. Vitamin D Deficiency is Associated with Increased Disease Activity in Patients with Inflammatory Bowel Disease. J Clin Med 2019; 8:jcm8091319. [PMID: 31461996 PMCID: PMC6780251 DOI: 10.3390/jcm8091319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background and Aims: Vitamin D has an inhibitory role in the inflammatory signaling pathways and supports the integrity of the intestinal barrier. Due to its immunomodulatory effect, vitamin D plays a role in chronic inflammatory bowel disease (IBD) and a deficiency is associated with an increased risk for a flare. We aimed to investigate to what extent the 25-hydroxyvitamin D (25(OH)D3) level correlates with disease activity and whether a cut-off value can be defined that discriminates between active disease and remission. Methods: Patients with IBD, treated at the University Hospital Frankfurt were analyzed retrospectively. The 25(OH)D3 levels were correlated with clinical activity indices and laboratory chemical activity parameters. A deficiency was defined as 25(OH)D3 levels <30 ng/mL. Results: A total of 470 (257 female) patients with IBD were included, 272 (57.9%) with Crohn’s disease (CD), 198 (42.1%) with ulcerative colitis (UC). The median age of the patients was 41 (18–84). In 283 patients (60.2%), a vitamin D deficiency was detected. 245 (53.6%) patients received oral vitamin D supplementation, and supplemented patients had significantly higher vitamin D levels (p < 0.0001). Remission, vitamin D substitution, and male gender were independently associated with the 25(OH)D3 serum concentration in our cohort in regression analysis. A 25(OH)D3 serum concentration of 27.5 ng/mL was the optimal cut-off value. Conclusion: Vitamin D deficiency is common in IBD patients and appears to be associated with increased disease activity. In our study, vitamin D levels were inversely associated with disease activity. Thus, close monitoring should be established, and optimized supplementation should take place.
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Affiliation(s)
- Johannes Hausmann
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | - Alica Kubesch
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Mana Amiri
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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20
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Larussa T, Suraci E, Marasco R, Imeneo M, Abenavoli L, Luzza F. Self-Prescribed Dietary Restrictions are Common in Inflammatory Bowel Disease Patients and Are Associated with Low Bone Mineralization. ACTA ACUST UNITED AC 2019; 55:medicina55080507. [PMID: 31434334 PMCID: PMC6722983 DOI: 10.3390/medicina55080507] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/26/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022]
Abstract
Background and objectives: Despite the serious concerns of patients about the role of food in triggering or ameliorating their intestinal disease, there are few studies dealing with patients’ beliefs and practices regarding diet in inflammatory bowel disease (IBD). The aim of this study was to investigate how the disease affected the dietary habits of patients with IBD, and to assess if patients’ food restrictions were responsible for low bone mineralization. Materials and Methods: For this study, 90 consecutive patients referred for IBD were interviewed regarding their dietary habits. Demographic features and clinical characteristics potentially associated with the dietary habits were collected. A validated and self-administered survey questionnaire dealing with dietary habits and patients’ beliefs and perceptions regarding food was analyzed. Multivariate logistic regression analysis was performed in order to identify risk factors for dietary restrictions among participants and to evaluate the relationship between dietary restrictions and low bone mineral density (BMD). Results: Among the 63 (70%) patients who claimed a self-prescribed dietary restriction, 84% avoided dairy products. Significant risk factors (adjusted odds ratio (OR), 95% confidence interval (CI)) for the dietary restrictions were a younger age (p = 0.02), a higher level of education (p = 0.007), and a higher visceral sensitivity index (p = 0.009). Most (80%) of the patients displayed an inadequate calcium intake, and an abnormal result at dual-energy X-ray absorptiometry (DXA) scan accounting for low BMD was reported in 46 (51%) of them. Dietary restrictions (p = 0.03), and in particular avoiding dairy products (p = 0.001), were significant risk factors for a low BMD, along with female gender (p = 0.001), smoking (p = 0.04), and steroid abuse (p = 0.03). Almost all (86%) patients changed their diet after IBD diagnosis, as 8% believed that foods could have been a trigger for IBD and 37% that a proper diet was more important than drugs in controlling disease. Although 61% of the patients claimed to have received nutritional advice, 78% of the participants showed interest in receiving more. Conclusions: Dietary habits of IBD patients should be investigated by healthcare professionals as part of the routine visit. Clinicians are invited to provide nutritional recommendations to these patients in order to avoid unnecessary self-prescribed dietary restrictions.
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Affiliation(s)
- Tiziana Larussa
- Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Evelina Suraci
- Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Raffaella Marasco
- Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Maria Imeneo
- Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy.
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21
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Hammer T, Lophaven SN, Nielsen KR, Petersen MS, Munkholm P, Weihe P, Burisch J, Lynge E. Dietary risk factors for inflammatory bowel diseases in a high-risk population: Results from the Faroese IBD study. United European Gastroenterol J 2019; 7:924-932. [PMID: 31428417 PMCID: PMC6683641 DOI: 10.1177/2050640619852244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/28/2019] [Indexed: 12/30/2022] Open
Abstract
Background The Faroe Islands currently have the highest recorded inflammatory bowel disease (IBD) incidence in the world. Objective This study investigated environmental risk factors for IBD in the Faroese population. Methods Environmental exposure data including lifestyle risk factors and neurotoxicants collected for over 30 years were retrieved from the Children's Health and the Environment in the Faroes (CHEF) cohorts including mainly mother–child pairs, with exposure data collected from pregnant mothers. For lifestyle risk factors, the incidence of IBD and ulcerative colitis (UC) was calculated as the rate ratio (RR) with 95% confidence intervals (CI) in exposed versus non-exposed persons. For neurotoxicants RR was calculated for persons with high versus low exposure. Results Six cohorts included 5698 persons with complete follow-up data and at least one exposure, and 37 were diagnosed with IBD. For pilot whale/blubber, the RR was 1.02 (95% CI, 0.48–2.18); RR of 1.01 for fish (95% CI, 0.35–2.91); and of the pollutants studied, a statistical significantly increased risk was found for 1,1,1,-trichloro-2,2-bis-(p-chlorophenyl) ethane (p,p'-DDT); RR 3.04 (95% CI, 1.12–8.30). RRs were 1.96 (95% CI, 1.03–3.73) for smoking and 1.10 (95% CI, 0.55–2.19) for alcohol intake. Conclusion The high IBD incidence is unlikely to be caused by special dietary habits or by environmental pollutants.
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Affiliation(s)
- T Hammer
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands.,Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - M Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands.,Centre of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - P Munkholm
- Department of Gastroenterology, North Zealand Hospital, Frederikssund, Denmark
| | - P Weihe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands.,Centre of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - J Burisch
- Department of Gastroenterology, North Zealand Hospital, Frederikssund, Denmark
| | - E Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
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22
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Singh P, Kumar M, Al Khodor S. Vitamin D Deficiency in the Gulf Cooperation Council: Exploring the Triad of Genetic Predisposition, the Gut Microbiome and the Immune System. Front Immunol 2019; 10:1042. [PMID: 31134092 PMCID: PMC6524467 DOI: 10.3389/fimmu.2019.01042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/24/2019] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is a fat soluble secosteroid that is primarily synthesized in the skin upon exposure to Ultraviolet B (UVB) sun rays. Vitamin D is essential for the growth and development of bones and helps in reducing inflammation by strengthening muscles and the immune system. Despite the endless supply of sunlight in the Gulf Cooperation Council (GCC) countries which includes United Arab Emirates, Qatar, Kuwait, Bahrain, Saudi Arabia, and Oman, Vitamin D deficiency in the (GCC) general population at various age groups remains alarmingly high. In parallel runs the increasing prevalence of acute and chronic illnesses including, autoimmune diseases, cancer, type 1 diabetes mellitus, cardiovascular disease and Inflammatory bowel disease in the adult as well as the pediatric population of these countries. The exact association between Vitamin D deficiency and chronic disease conditions remains unclear; however, studies have focused on the mechanism of Vitamin D regulation by assessing the role of the Vitamin D associated genes/proteins such as VDR (Vitamin D receptor), VDBP (Vitamin D Binding protein), CYP27B1 as these are integral parts of the Vitamin D signaling pathway. VDR is known to regulate the expression of more than 200 genes across a wide array of tissues in the human body and may play a role in controlling the Vitamin D levels. Moreover, reduced Vitamin D level and downregulation of VDR have been linked to gut dysbiosis, highlighting an intriguing role for the gut microbiome in the Vitamin D metabolism. However, this role is not fully described yet. In this review, we aim to expand our understanding of the causes of Vitamin D deficiency in the GCC countries and explore the potential relationship between the genetic predisposition, Vitamin D levels, immune system and the gut microbiome composition. Trying to unravel this complex interaction may aid in understanding the mechanism by which Vitamin D contributes to various disease conditions and will pave the way toward new therapeutics treatments for Vitamin D deficiency and its associated outcomes.
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Affiliation(s)
- Parul Singh
- Research Department, Sidra Medicine, Doha, Qatar
| | - Manoj Kumar
- Research Department, Sidra Medicine, Doha, Qatar
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23
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Leskovar D, Meštrović T, Barešić A, Kraljević I, Panek M, Čipčić Paljetak H, Perić M, Matijašić M, Rogić D, Barišić A, Ljubas Kelečić D, Vranešić Bender D, Krznarić Ž, Verbanac D. The Role of Vitamin D in Inflammatory Bowel Disease - Assessing Therapeutic and Preventive Potential of Supplementation and Food Fortification. Food Technol Biotechnol 2019; 56:455-463. [PMID: 30923443 PMCID: PMC6399717 DOI: 10.17113/ftb.56.04.18.5805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Inflammatory bowel diseases are a group of chronic inflammatory conditions that affect gastrointestinal tract due to inapt and continuous immune activation in response to a myriad of predisposing factors (most notably genetics, environmental impact and gut microbiota composition). It has been shown that vitamin D status can also play a role in the disease pathogenesis, as its deficiency is commonly observed in two major forms of inflammatory bowel diseases - Crohn's disease and ulcerative colitis. Mounting evidence supports the concept of intricate relationship between gut dysbiosis and vitamin D metabolism, while suboptimal levels of this vitamin have been linked to increased clinical disease relapse rates, inadequate response to drugs, as well as decreased quality of life in patients with Crohn's disease and ulcerative colitis. Consequently, the pertinent question is whether increased vitamin D supplementation and (on a population level) food fortification may bring significant benefit to the affected individuals. In this short review we discuss the synthesis, functions, status and food sources of vitamin D, appraise biotechnological facets of vitamin D status analysis and food fortification, and concentrate on novel developments in the field that describe its influence on intestinal microbiota and inflammatory bowel disease.
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Affiliation(s)
- Dunja Leskovar
- University of Zagreb School of Medicine, Šalata 3, 10 000 Zagreb, Croatia
| | | | - Anja Barešić
- MRC London Institute of Medical Sciences, Du Cane Rd, London W12 0NN, United Kingdom
| | - Ivana Kraljević
- University Hospital Centre, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | - Marina Panek
- University of Zagreb School of Medicine, Šalata 3, 10 000 Zagreb, Croatia
| | | | - Mihaela Perić
- University of Zagreb School of Medicine, Šalata 3, 10 000 Zagreb, Croatia
| | - Mario Matijašić
- University of Zagreb School of Medicine, Šalata 3, 10 000 Zagreb, Croatia
| | - Dunja Rogić
- University Hospital Centre, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | - Ana Barišić
- University Hospital Centre, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | | | | | - Željko Krznarić
- University Hospital Centre, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | - Donatella Verbanac
- University of Zagreb School of Medicine, Šalata 3, 10 000 Zagreb, Croatia.,University of Zagreb, Faculty of Pharmacy and Biochemistry, A. Kovačića 1, 10 000 Zagreb, Croatia
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