Journal of Crohn's and Colitis, 2017, 761 doi:10.1093/ecco-jcc/jjw190 Advance Access publication October 20, 2016 Letter to the Editor
Letter to the Editor Lower Vitamin D Status May Explain why African Americans Have Poorer Outcomes than Non-African Americans After Surgery for Crohn’s Disease William B. Grant, PhD Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA. Email:
[email protected]
The recent paper by Arsoniadis and colleagues reported that African Americans with Crohn’s disease [CD] had significantly poorer short-term outcomes for surgical site infection, post operative sepsis, and any complication compared with non-African Americans.1 A number of factors to explain the findings were considered, with only race and comorbid diseases remaining statistically significant. A possible explanation for their finding is that African Americans have lower 25-hydroxyvitamin D (25[OH]D) concentrations than White and Hispanic Americans [16 ng/ml, 26 ng/ ml, and 21 ng/ml, respectively.2 This is due to the fact that solar UVB exposure is the primary source of vitamin D for most people, and that African Americans have darker skin pigmentation, thereby lowering the rate of vitamin D production. The hypothesis that differences in 25[OH]D concentrations may explain a number of Black-White health disparities in general was discussed in a review paper.2 A study in Boston involving approximately 1770 patients with CD found significantly higher risk of surgery for those patients with 25[OH]D concentration < 20 ng/ml and significantly less risk for those with 25[OH]D concentration > 30 ng/ml.3 In a double-blind placebo-controlled vitamin D clinical trial with 108 patients with Crohn’s disease, those who received 1200 IU/ day vitamin D3 achieved increased 25[OH]D concentrations from a mean value of 69 nmol/l to 96 nmol/l, and experienced a nonsignificantly reduced relapse rate [13% for vitamin D3 vs 29% for the placebo, p = 0.06].4 Since most 25[OH]D concentration-health outcome relations have rapidly increasing risk at lower 25[OH]D concentrations, the findings would very likely have been significant if patients with lower baseline 25[OH]D concentrations were studied. A study based on solar UV doses throughout the USA found that lower UV doses were associated with significantly increased rates of prolonged hospitalisations, bowel surgeries, and deaths for those with CD.5
Thus, there is mounting evidence that higher 25[OH]D concentrations are associated with reduced risk of Crohn’s disease symptoms, so it would be worthwhile to consider counselling patients with Crohn’s disease to increase 25[OH]D concentrations to above 30 ng/ml, especially before planned surgery.
Funding I receive funding from Bio-Tech Pharmacal Inc. [Fayetteville, AR] and the Vitamin D Society [Woodstock, ON, Canada] and have received funding from the Vitamin D Council [San Luis Obispo, CA].
Conflict of Interest None declared.
References 1. Arsoniadis EG, Ho YY, Melton GB, Madoff RD, Le C, Kwaan MR. African Americans and short term outcomes after surgery for Crohn’s disease: An ACS-NSQIP Analysis. J Crohns Colitis 2016 Sep 28. pii: jjw175. [Epub ahead of print.] 2. Grant WB, Peiris AN. Possible role of serum 25-hydroxyvitamin D in Black–White health disparities in the United States. J Am Med Directors Assoc 2010;11:617–28. 3. Ananthakrishnan AN, Cagan A, Gainer VS, et al. Normalization of plasma 25-hydroxy vitamin D is associated with reduced risk of surgery in Crohn’s disease. Inflamm Bowel Dis 2013;19:1921–7. 4. Jørgensen SP, Agnholt J, Glerup H, et al. Clinical trial: vitamin D3 treatment in Crohn’s disease a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther 2010;32:377–83. 5. Limketkai BN, Bayless TM, Brant SR, Hutfless SM. Lower regional and temporal ultraviolet exposure is associated with increased rates and severity of inflammatory bowel disease hospitalisation. Aliment Pharmacol Ther 2014;40:508–17.
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