PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1950-1961 (doi:10.1542/10.1542/peds.2006-0841)
ARTICLE |
Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease
a Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition
b Division of Endocrinology and Adolescent Medicine
c Clinical Research Program, Children’s Hospital Boston, Boston, Massachusetts
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 
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. The prevalence of vitamin D deficiency was 34.6%. 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. 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. Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it. 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.
Key Words: vitamin D deficiency • 25-hydroxy-vitamin D • inflammatory bowel disease • pediatric • bone mineral density • parathyroid hormone
Abbreviations: 25OHD—25-hydroxy-vitamin D • BMD—bone mineral density • IBD—inflammatory bowel disease • CD—Crohn disease • UC—ulcerative colitis • UGI—upper gastrointestinal tract • LSBMD—lumbar spine bone mineral density • PTH—parathyroid hormone • ESR—erythrocyte sedimentation rate • DXA—dual-energy x-ray absorptiometry • GCRC—General Clinical Research Center • zLSBMD—z score of lumbar spine bone mineral density • zWt—z score of weight • zHt—z score of height • zBMI—z score of BMI • OR—odds ratio • CI—confidence interval • DBP—vitamin D–binding protein
Accepted Jun 22, 2006.
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