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Vitamin D status in pediatric irritable bowel syndrome
Benjamin Udoka Nwosu1, Louise Maranda2, Ninfa Candela3
1Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
Insights
Children and adolescents with Irritable Bowel Syndrome (IBS) have significantly lower vitamin D levels compared to healthy peers. Over half of pediatric IBS patients exhibit vitamin D deficiency, necessitating routine monitoring and further research into supplementation.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Nutritional Science
Background:
- Irritable Bowel Syndrome (IBS) significantly impacts children and adolescents, with limited treatment efficacy.
- The vitamin D status in pediatric IBS patients and its relation to psychosomatic symptoms remain largely uncharacterized.
Purpose of the Study:
- To determine the vitamin D status of pediatric patients diagnosed with IBS.
- To compare vitamin D levels between pediatric IBS patients and a control group.
Main Methods:
- A retrospective case-controlled study was conducted involving 55 IBS patients and 116 controls.
- Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured, with deficiency defined as <50 nmol/L.
- Psychosomatic symptoms including depression, anxiety, and migraine were analyzed in relation to vitamin D levels.
Main Results:
- Over 50% of pediatric IBS subjects exhibited vitamin D deficiency (<50 nmol/L), compared to 27% in controls (p=0.001).
- Mean 25(OH)D levels were significantly lower in IBS subjects (53.2 ± 15.8 nmol/L) versus controls (65.2 ± 28.0 nmol/L) (p=0.003).
- IBS patients with migraine showed significantly lower mean 25(OH)D concentrations.
Conclusions:
- Pediatric IBS patients demonstrate significantly lower vitamin D levels than controls, irrespective of BMI.
- A high prevalence of vitamin D deficiency (>50%) exists in pediatric IBS, exceeding that in IBD.
- Routine monitoring for vitamin D deficiency is recommended for pediatric IBS patients, with a need for RCTs on vitamin D supplementation.
Importance:
Irritable bowel syndrome (IBS) is associated with significant morbidity in children and adolescents, and the therapeutic efficacy of available treatment options is limited. The role of vitamin D supplementation in pediatric IBS is unclear as the vitamin D status of pediatric patients with IBS is unknown. Equally, the relationship of vitamin D status with psychosomatic symptoms in children and adolescents is unclear.
Aim:
To characterize the vitamin D status of pediatric patients with IBS using a case-control study design.
Hypothesis:
Serum 25-hydroxyvitamin D [25(OH)D] concentration will be similar between patients with IBS and controls.
Subjects And Methods:
A retrospective case-controlled study of 116 controls (age 14.6 ± 4.3 y), female (n = 67; 58%) and 55 subjects with IBS (age 16.5 ± 3.1y), female (n = 44; 80%). Overweight was defined as BMI of ≥85th but <95th percentile, and obesity as BMI ≥95th percentile. Vitamin D deficiency was defined as 25(OH)D of <50 nmol/L, while seasons of vitamin D draw were categorized as summer, winter, spring, and fall. Major psychosomatic manifestations included in the analysis were depression, anxiety, and migraine.
Results:
More than 50% of IBS subjects had vitamin D deficiency at a cut-off point of <50 nmol/L (53% vs. 27%, p = 0.001); and >90% of IBS subjects had vitamin D deficiency at a cut-off point of <75 nmol/L (93% vs. 75%, p = 0.006). IBS subjects had significantly lower mean 25(OH)D: 53.2 ± 15.8 nmol/L vs. 65.2 ± 28.0 nmol/L, p = 0.003; and albumin: 6.2 ± 0.6 vs. 6.5 ± 0.6 μmol/L, p = 0.0.01. IBS subjects with migraine had significantly lower mean 25(OH)D concentration compared to controls (p = 0.01). BMI z-score was similar between the controls and IBS subjects (0.5 ± 1.4 vs. 1.2 ± 2.9, p = 0.11).
Conclusions:
Pediatric patients with IBS had significantly lower 25(OH)D concentration compared to controls despite having similar mean BMI values as controls. Only 7% of the children and adolescents with IBS were vitamin D sufficient, and >50% of the subjects with IBS had vitamin D deficiency. This is a much higher prevalence of vitamin D deficiency compared to IBD and other malabsorption syndromes. Monitoring for vitamin D deficiency should be part of the routine care for patients with IBS. Randomized control trials are warranted to determine the role of adjunctive vitamin D therapy in pediatric IBS.
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