Changes in Vitamin D and Parathyroid Hormone Metabolism in Incident Pediatric Crohn's Disease

Department of Pediatrics, Yale-New Haven Children's Hospital, New Haven, Connecticut.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 01/2013; 19(1). DOI: 10.1002/ibd.22969
Source: PubMed


BACKGROUND: Prior studies of vitamin D metabolism in Crohn's disease (CD) did not include controls or examine changes following diagnosis. This study examined associations among 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2) D], and parathyroid hormone (PTH) levels in incident pediatric CD, compared with controls, and following diagnosis. METHODS: Serum vitamin D and PTH were measured at diagnosis (n = 78), 6, 12, and a median of 43 months (n = 52) later in CD participants, and once in 221 controls. Multivariate regression was used to examine baseline associations and quasi-least squares regression to assess subsequent changes. RESULTS: At diagnosis, 42% of CD participants were 25(OH)D-deficient (<20 ng/mL). The odds ratio for deficiency was 2.1 (95% confidence interval [CI]: 1.1, 3.9; P < 0.05) vs. controls, adjusted for age, race, and season. 1,25(OH)(2) D was lower in CD vs. controls (P < 0.05), adjusted for 25(OH)D, tumor necrosis factor alpha (TNF-α), and PTH. TNF-α was associated with lower 1,25(OH)(2) D (P < 0.05), and the positive association between PTH and 1,25(OH)(2) D in controls was absent in CD (interaction P = 0.02). Among participants with 25(OH)D <30 ng/mL, CD was associated with lower PTH (P < 0.05) vs. controls. Following diagnosis, 25(OH)D and 1,25(OH)(2) D improved (P < 0.001). At the final visit, 3% were 25(OH)D-deficient, PTH was no longer low relative to 25(OH)D, and 1,25(OH)(2) D was significantly elevated (P < 0.001) compared with controls. CONCLUSIONS: Incident CD was associated with 25(OH)D and 1,25(OH)(2) D deficiency and a relative hypoparathyroidism that resolved following diagnosis. Inflammatory cytokine suppression of PTH and renal 1-α-hyroxylase may contribute to these alterations. (Inflamm Bowel Dis 2012;).

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    • "The increase in PTH was followed by an increase in serum 1,25(OH) 2 D in 47% of the present T1DM patients, more often in those with moderate to severe periodontitis (64%) than in those with no or mild periodontitis (36%) (Fig. 2), implying that in these individuals increased PTH may have accounted for the increased hydroxylation of 25(OH)D into 1,25(OH) 2 D by 1 a-hydroxylase. Analogously, in the Crohn's disease studies an overall increase in 1,25(OH) 2 D was most likely related to PTH and restitution of 1a-hydroxylase activity after treatment of the disease (Prosnitz et al. 2013, Augustine et al. 2014). One reason for the lack of correlation between the changes in serum PTH and 1,25(OH) 2 D (Fig. 2) may be the relatively high proportion of subjects with no or mild periodontitis, who showed no significant PTH response. "
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    Full-text · Article · Jul 2015 · Journal Of Clinical Periodontology
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