The frequency of vitamin D deficiency in adults with Crohn’s disease: DISCUSSION (Part 4)

In: Crohn's disease

7 Aug 2012

Intestinal vitamin D malabsorption did not appear to be a major factor in determining 25-OHD status in our patients, as disease location did not influence serum 25-OHD levels. This is likely explained by the fact that the site of vitamin D absorption, the proximal jejunum, is not frequently involved in Crohn’s disease. Only two out of 242 patients in our study reported jejunal disease involvement. In addition, enterohepatic interruption, an important aspect of vitamin D absorption, remained intact since vitamin B12, a measure of ileal dysfunction, did not appear to be related to, or influence, serum levels of 25-OHD.

Interestingly, our data observed that smoking in females predicted deficient serum levels of 25-OHD. Whether smoking has a 25-OHD-lowering effect in females has never been previously reported in patients with Crohn’s disease, but a few mechanisms are proposed. One study has suggested women who smoke are thinner than their nonsmoking counterparts, yet we did not find any relationship between BMI and 25-OHD in the present study. Smoking has also been suggested to decrease estrogen production in females, conceivably leading to decreased intestinal uptake of vitamin D, decreased renal production of 1,25-OHD, and reduced levels of 25-OHD. Further studies are required to elucidate the precise mechanism behind the 25-OHD-reducing effect of cigarette smoke in Crohn’s disease patients, and to determine what implications this has for their BMD. This study did not examine the effects of small intestinal surgery, fat malabsorption or dietary intake on 25-OHD levels.

In summary, 25-OHD-deficient Crohn’s disease patients exhibit biochemical evidence of metabolic bone disease, although no detectable difference in BMD was observed. Sunlight exposure, nutrition and smoking status were predictors of 25-OHD deficiency in this patient cohort. Buy quality medications online: find generic cialis professional online every time you need treatment.


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