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PRELIMINARY INTERIM REPORT OF SERUM VITAMIN D LEVELS IN PATIENTS WITH IBD IN REMISSION AND THEIR FIRST DEGREE RELATIVES
R Kazmi, D Heilpern, J Al-Abbad, S Gladman, M Menard, J Cassoff, H Paquin, E MacNamara, P Gordon, A Szilagyi
SMBD Jewish General Hospital, McGill University, School of Medicine, Montreal, Quebec
Aims: Recent work on the non-skeletal effects of vitamin D suggest a possible modifying role in IBD, with insufficiency promoting disease. Also familial clustering of IBD is recognized. We undertook a prospective observational study to evaluate and compare vitamin D levels in patients with both IBD and first degree family members.
Methods: This ethics board approved ongoing study of IBD and family members was started in Jan 2008. Patients were predominantly in remission or mildly active. Family members were largely healthy. History and physical findings,detailed diet questionnaire was filled and blood tests targeting CBC, CRP, Albumin, Iron/ferritin, Ca, and Vitamin D 25(OH) were measured by the hospital laboratory (Vit D;RIA kit). Vitamin D levels were considered sufficient if >75nmol/l, insufficient if 50-75nmol/l or deficient if <50nmol./l. Patients were compared to family.Months of high and low sunshine were compared (Sept-May, May-Sept). Patients with CD were compared with UC. Statistical analysis was carried out using Students t test (2 tailed) and Pearsons chi-squared test. Alpha was set at 0.05.
Results: To date 40 pts [17Male, Age; 44.6, range 22-68] and 37 family [11Male, Age; 49.3, range 14-89] [all caucasians,65% Jewish] were recruited (some family were patients also). The BMI in IBD was 24.7 [range 17.8-30.7] and family 25.6 [range 21.4-33.8]. There were 23 CD and 17 UC >90% remission. Duration was 14.9, range 1-50 yrs. Distribution in CD; 47.8% TI/ colon, 17.4% Ileum only and 34.8% colon only. Of all pts 7.7% on steroids, 10.3% Aza, 15.4% on biologics and 20.5% post surgery. In IBD 25.7% vs 18.8% took D supplements. High vs low sunshine mos for the entire group for 25(OH)D was significant [84.8±38.2 vs 65.2±32.6nmol/l, p=0.035]. Overall IBD vs family was NS [75.2±35.9 vs 82.5±39.2nmol/l,p=0.4]. High sunshine levels for IBD vs family were 81.5±37.4 vs 88.3±39.5nmol/l NS. Low sunshine levels for IBD vs family were 63.6±31.1 vs 67.1±35.6, respectively NS. Comparison of CD vs UC 25(OH) Vitamin D was NS [73.7±38 vs 77.1±34.1]. Levels > 75nmol/l , IBD vs family 40.5% vs 51.5%, 50-75nmol/l, 29.7% vs 30.3% and <50nmol/l, 29.7% vs 18.2%. All NS.
Conclusions: Preliminary findings suggest that although as a group, stable IBD patients and their families have sufficient Vitamin D levels more than half of IBD and almost half of their family members have insufficient or deficient levels. As expected low sunshine reduces levels on the average into the insufficient range. Further studies are being conducted to evaluate the role of diet and it is hoped that a normal control and family group will also be evaluated in the future.