Poster 363 Vitamin D Status Is an Independent Risk Factor for Colonic Dysplasia in IBD: A Case-Control Study
Author Insight from Toufic Kabbani, MD, MPH
What’s new here and important for clinicians?
Several pre-cancerous conditions and cancer types have been associated with a low vitamin D status. While there is data on vitamin D status and colon cancer in the general population, data on the risk of dysplasia in IBD subjects is lacking to date. Our study addressed the association of vitamin D status with an important IBD complication: dysplasia. Using a case-control study model, we analyzed data of IBD subjects who were diagnosed with dysplasia on surveillance colonoscopy biopsies between 2009 and 2013. For comparison, 4:1 age, gender and disease duration-matched IBD subjects who underwent colonoscopy for surveillance for CRC during the same period and had no dysplasia were randomly selected as controls.
Males constituted 63% of the patients (cases and their matched controls) and the mean age of the cohort was 48.6 years. The mean time from IBD diagnosis to dysplasia diagnosis was 12.8 years. Smoking status was comparable between cases and controls (25.9% vs. 25.5%, respectively; p=1.0). The mean vitamin D levels (prior to supplementation) for cases were significantly lower compared to controls (28.6 ng/ml vs. 37.1 ng/ml; p<0.0001). Thirty of the 54 patients (55.6%) with dysplasia received vitamin D supplementation compared to 41.3% of controls (0.09%). Multinomial logistic regression controlling for the use of steroids, immunomodulators and anti-TNF medications showed that mean vitamin D status over the study period correlated negatively with risk of dysplasia [coefficient -0.1, 95% CI (-0.2, -0.06); p=0.001].
In summary, lower Vitamin D levels are associated with higher risk of dysplasia in patients with IBD. We recommend monitoring and supplementation of vitamin D in subjects with low vitamin D levels as routine care in IBD patients. While our results are novel and promising, large, long-term, prospective studies that evaluate the effects of vitamin D supplementation on the risk of colorectal dysplasia and CRC in IBD are warranted.
What do patients need to know?
If you have IBD please be aware that taking vitamin D supplements to achieve normal vitamin D levels is not only beneficial for your bone health but may be also protective against dysplasia. Dysplasia is pre-cancerous change of the inner lining of the colon. If left untreated, dysplasia will develop into colon cancer.
Author Contact Toufic Kabbani, MD MPH
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