Disclosure: B.W.H. is an academic consultant to Diasorin Corp.
Changes in vitamin D and parathyroid hormone metabolism in incident pediatric Crohn's disease†
Article first published online: 5 APR 2012
Copyright © 2012 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
How to Cite
Prosnitz, A. R., Leonard, M. B., Shults, J., Zemel, B. S., Hollis, B. W., Denson, L. A., Baldassano, R. N., Cohen, A. B. and Thayu, M. (2012), Changes in vitamin D and parathyroid hormone metabolism in incident pediatric Crohn's disease. Inflamm Bowel Dis. doi: 10.1002/ibd.22969
- Article first published online: 5 APR 2012
- Manuscript Accepted: 8 MAR 2012
- Manuscript Received: 24 FEB 2012
- National Institutes of Health (NIH). Grant Numbers: R01DK60030, K23 DK082012, K24 DK076808, R01 DK068164
- North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
- Children's Hospital of Philadelphia Clinical Translational Research Center. Grant Number: UL1 RR024134
- Crohn's disease;
- parathyroid hormone
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)2D], and parathyroid hormone (PTH) levels in incident pediatric CD, compared with controls, and following diagnosis.
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.
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)2D 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)2D (P < 0.05), and the positive association between PTH and 1,25(OH)2D 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)2D 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)2D was significantly elevated (P < 0.001) compared with controls.
Incident CD was associated with 25(OH)D and 1,25(OH)2D 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;)