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Vitamin D levels of children with chronic liver disease

Year 2018, Volume: 43 Issue: 2, 450 - 456, 30.06.2018
https://doi.org/10.17826/cumj.365057

Abstract

Purpose: Vitamin D is a hormone that plays an important role in the regulation of calcium homeostasis and bone health. Vitamin D also has many functions other than skeletal health. The liver is one of the main organs involved in vitamin D metabolism. Recent studies have demonstrated a very high prevalence of vitamin D deficiency and/or insufficiency in patients with chronic liver disease. However, studies in this subject are scarce in children.

Materials and Methods: Vitamin D levels and treatment response of children with chronic liver disease diagnosed were evaluated retrospectively. A total of 50 patients, including 17 (34%) female and 33 (66%) male patients, who were being followed for 4 years, were recruited.

Results: Vitamin D deficiency or insufficiency was detected in 29 (48%) of 50 patients with a mean age of 7.83 (± 3.70) years at the time of diagnosis. Mean 25-OH vitamin D level was 12.79 (± 4.63) ng/ml ). In 24 (82.8%) patients with vitamin D deficiency or insufficiency vitamin D level was recovered after treatment, whereas in 5 patients (17.2%) there was insufficient response. In the presence of cholestasis, the response to treatment was observed to decrease.

Conclusion: Since vitamin D levels in patients with chronic liver disease may be low, patients should be examined and treated in this respect. This would also provides support for the current disease.


References

  • 1. Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008;8(9):685–698.
  • 2. Cantorna MT, Mahon BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Exp Biol Med (Maywood). 2004;229(11):1136–1142.
  • 3. Hollick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancer and cardiovascular disease. Am J Clin Nutr 2004;80(Suppl 6):1678-1688.
  • 4. Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J 2005;98:1024-1027.
  • 5. Lim LY, Chalasani N. Vitamin d deficiency in patients with chronic liver disease and cirrhosis. Curr Gastroenterol Rep. 2012 Feb;14(1):67-73.
  • 6. Holick MF. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets 2011;12:4-18.
  • 7. Health Quality Ontario. Clinical utility of vitamin d testing: an evidence-based analysis. Ont Health Technol Assess Ser 2010;10:1-93.
  • 8. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr. 2016;85(2):83-106.
  • 9. Hernandez-Gea V, Friedman SL. Pathogenesis of liver fibrosis. Annu Rev Pathol 2011; 6: 425–456.
  • 10. Chen EQ, Shi Y, Tang H. New insight of vitamin D in chronic liver diseases. Hepatobiliary Pancreat Dis Int. 2014;13(6):580-585.
  • 11. Stokes CS, Volmer DA, Grunhage F, Lammert F. Vitamin D in chronic liver disease. Liver Int 2013;33:338-352.
  • 12. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–281.
  • 13. Arteh J, Narra S, Nair S. Prevalence of vitamin D defi ciency in chronic liver disease. Dig Dis Sci 2010;55:2624-2628.
  • 14. Targher G, Bertolini L, Scala L, et al. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2007;17:517-524.
  • 15. Konstantakis C, Tselekouni P, Kalafateli M, Triantos C. Vitamin D deficiency in patients with liver cirrhosis. Ann Gastroenterol. 2016;29(3):297-306.
  • 16. Putz-Bankuti C, Pilz S, Stojakovic T, et al. Association of 25-hydroxyvitamin D levels with liver dysfunction and mortality in chronic liver disease. Liver Int 2012;32:845-851.
  • 17. Venu M, Martin E, Saeian K, Gawrieh S. High prevalence of vitamin A defi ciency and vitamin D defi ciency in patients evaluated for liver transplantation. Liver Transpl 2013;19:627-633.
  • 18. Stokes CS, Krawczyk M, Reichel C, Lammert F, Grunhage F. Vitamin D defi ciency is associated with mortality in patients with advanced liver cirrhosis. Eur J Clin Invest 2014;44:176-183.
  • 19. Savic Z, Damjanov D, Curic N, et al. Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis. Bratisl Lek Listy 2014;115:573-578.
  • 20. Garcia-Alvarez M, Pineda-Tenor D, Jimenez-Sousa MA, Fernandez-Rodriguez A, Guzman-Fulgencio M, Resino S. Relationship of vitamin D status with advanced liver fi brosis and response to hepatitis C virus therapy: a meta-analysis. Hepatology 2014;60:1541-1550.
  • 21. Kitson MT, Dore GJ, George J, et al. Vitamin D status does not predict sustained virologic response or fi brosis stage in chronic hepatitis C genotype 1 infection. J Hepatol 2013;58:467-472.
  • 22. Han YP, Kong M, Zheng S, et al. Vitamin D in liver diseases: from mechanisms to clinical trials. J Gastroenterol Hepatol 2013;28(Suppl 1):49-55.
  • 23. Kitson MT, Roberts SK. D-livering the message: the importance of vitamin D status in chronic liver disease. J Hepatol 2012;57:897-909.
  • 24. Petta S, Camma C, Scazzone C, et al. Low vitamin D serum level is related to severe fi brosis and low responsiveness to interferonbased therapy in genotype 1 chronic hepatitis C. Hepatology 2010;51:1158-1167.
  • 25. Anty R, Tonohouan M, Ferrari-Panaia P, et al. Low levels of 25-Hydroxy vitamin D are independently associated with the risk of bacterial infection in cirrhotic patients. Clin Transl Gastroenterol 2014;5:e56.
  • 26. Finkelmeier F, Kronenberger B, Koberle V, et al. Severe 25-hydroxyvitamin D defi ciency identifi es a poor prognosis in patients with hepatocellular carcinoma - a prospective cohort study. Aliment Pharmacol Th er 2014;39:1204-1212.
  • 27. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015;63:971-1004.
  • 28. Efe C, Kav T, Aydin C, et al. Low serum vitamin D levels are associated with severe histological features and poor response to therapy in patients with autoimmune hepatitis. Dig Dis Sci 2014;59:3035-3042.
  • 29. Luong KV, Nguyen LT. Th e role of vitamin D in autoimmune hepatitis. J Clin Med Res 2013;5:407-415.
  • 30. Hepner GW, Roginsky M, Moo HF. Abnormal vitamin D metabolism in patients with cirrhosis. Am J Dig Dis 1976;21:527-532.
  • 31. Long RG, Skinner RK, Wills MR, Sherlock S. Serum-25-hydroxyvitamin-D in untreated parenchymal and cholestatic liver disease. Lancet 1976;2:650-652.
  • 32. Malham M, Jorgensen SP, Ott P, Agnholt J, Vilstrup H, Borre M, Dahlerup JF. Vitamin D deficiency in cirrhosis relates to liver dysfunction rather than aetiology. World J Gastroenterol 2011;17:922-925.
  • 33. Chen CC, Wang SS, Jeng FS, Lee SD. Metabolic bone disease of liver cirrhosis: Is it parallel to the clinical severity of cirrhosis? J Gastroenterol Hepatol 1996; 11: 417–421.
  • 34. Crawford BAL, Kam C, Donaghy AJ, Mccaughan GW. The heterogeneity of bone disease in cirrhosis: A multivariate analysis. Osteoporos Int 2003; 14: 987–994.
  • 35. Menon KV, Angulo P, Weston S, Dickson ER, Lindor KD. Bone disease in primary biliary cirrhosis: independent indicators and rate of progression. J Hepatol 2001; 35:316–23. 36. Collier JD, Ninkovic M, Compston JE. Guidelines on the management of osteoporosis associated with chronic liver disease. Gut. 2002;50 Suppl 1:1–9.
  • 37. Shiomi S, Masaki K, Habu D, et al. Calcitriol for bone loss in patients with primary biliary cirrhosis. J Gastroenterol 1999; 34: 241–245.
  • 38. Bitetto D, Fattovich G, Fabris C, et al. Complementary role of vitamin D deficiency and the interleukin-28B rs12979860 C/T polymorphism in predicting antiviral response in chronic hepatitis C. Hepatology 2011; 53:1118–1126.
  • 39. Vidot H, Potter A, Cheng R, Allman-Farinelli M, Shackel N. Serum 25-hydroxyvitamin D deficiency and hepatic encephalopathy in chronic liver disease. World J Hepatol. 2017 Apr 8;9(10):510-518.

Kronik karaciğer hastalığı olan çocukların D vitamini düzeyleri

Year 2018, Volume: 43 Issue: 2, 450 - 456, 30.06.2018
https://doi.org/10.17826/cumj.365057

Abstract

Amaç: D vitamini kalsiyum metabolizması ve iskelet sağlığında önemli rol oynayan bir hormondur. Ayrıca D vitamininin iskelet sağlığı dışı birçok fonksiyona sahip olduğu bilinmektedir. Karaciğer, vitamin D metabolizmasına katılan başlıca organlardan biridir. Son yıllarda yapılan çalışmalar kronik karaciğer hastalığına sahip hastalarda vitamin D eksikliğinin ve yetersizlik prevalansının yüksek olduğunu ortaya koymuştur. Ancak çocukluk çağında bu konuda az sayıda çalışma mevcuttur. 

Gereç ve Yöntem: Kronik karaciğer hastalığı tanısı ile izlenen çocukların vitamin D düzeyleri ve tedavi yanıtları geriye dönük olarak dosyalarından değerlendirilmiştir. Dört yıllık dönemde izlenen 17 (%34) kız, 33 (%66) erkek olmak üzere toplam 50 hastanın dosya kaydı verilerine ulaşıldı. 

Bulgular: Çalışmaya alınan 50 hastanın tanı anındaki yaş ortalamaları 7,83 (±3,70) yıl olup 29’unda (%48) D vitamin düzeylerinde eksiklik veya yetersizlik saptandı (ortalama 25-OH vitamin D: 12,79 (± 4,63) ng/ml).  Tedavi sonrası vitamin D düzeyi eksik veya yetersiz olan hastaların %82,8’inde düzelme sağlanırken, 5 hastada (%17,2) yeterli cevap yoktu. Kolestaz durumunda tedaviye verilen cevabın azaldığı görüldü. 

Sonuç: Kronik karaciğer hastalığı nedeniyle izlenen hastalardaki vitamin D düzeyleri düşük olabileceğinden, bu açıdan hastaların incelenmesi ve tedavi edilmesi gerekmektedir. Bu durum mevcut hastalığı için de bir destek sağlamaktadır. 


References

  • 1. Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008;8(9):685–698.
  • 2. Cantorna MT, Mahon BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Exp Biol Med (Maywood). 2004;229(11):1136–1142.
  • 3. Hollick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancer and cardiovascular disease. Am J Clin Nutr 2004;80(Suppl 6):1678-1688.
  • 4. Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J 2005;98:1024-1027.
  • 5. Lim LY, Chalasani N. Vitamin d deficiency in patients with chronic liver disease and cirrhosis. Curr Gastroenterol Rep. 2012 Feb;14(1):67-73.
  • 6. Holick MF. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets 2011;12:4-18.
  • 7. Health Quality Ontario. Clinical utility of vitamin d testing: an evidence-based analysis. Ont Health Technol Assess Ser 2010;10:1-93.
  • 8. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. Horm Res Paediatr. 2016;85(2):83-106.
  • 9. Hernandez-Gea V, Friedman SL. Pathogenesis of liver fibrosis. Annu Rev Pathol 2011; 6: 425–456.
  • 10. Chen EQ, Shi Y, Tang H. New insight of vitamin D in chronic liver diseases. Hepatobiliary Pancreat Dis Int. 2014;13(6):580-585.
  • 11. Stokes CS, Volmer DA, Grunhage F, Lammert F. Vitamin D in chronic liver disease. Liver Int 2013;33:338-352.
  • 12. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–281.
  • 13. Arteh J, Narra S, Nair S. Prevalence of vitamin D defi ciency in chronic liver disease. Dig Dis Sci 2010;55:2624-2628.
  • 14. Targher G, Bertolini L, Scala L, et al. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2007;17:517-524.
  • 15. Konstantakis C, Tselekouni P, Kalafateli M, Triantos C. Vitamin D deficiency in patients with liver cirrhosis. Ann Gastroenterol. 2016;29(3):297-306.
  • 16. Putz-Bankuti C, Pilz S, Stojakovic T, et al. Association of 25-hydroxyvitamin D levels with liver dysfunction and mortality in chronic liver disease. Liver Int 2012;32:845-851.
  • 17. Venu M, Martin E, Saeian K, Gawrieh S. High prevalence of vitamin A defi ciency and vitamin D defi ciency in patients evaluated for liver transplantation. Liver Transpl 2013;19:627-633.
  • 18. Stokes CS, Krawczyk M, Reichel C, Lammert F, Grunhage F. Vitamin D defi ciency is associated with mortality in patients with advanced liver cirrhosis. Eur J Clin Invest 2014;44:176-183.
  • 19. Savic Z, Damjanov D, Curic N, et al. Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis. Bratisl Lek Listy 2014;115:573-578.
  • 20. Garcia-Alvarez M, Pineda-Tenor D, Jimenez-Sousa MA, Fernandez-Rodriguez A, Guzman-Fulgencio M, Resino S. Relationship of vitamin D status with advanced liver fi brosis and response to hepatitis C virus therapy: a meta-analysis. Hepatology 2014;60:1541-1550.
  • 21. Kitson MT, Dore GJ, George J, et al. Vitamin D status does not predict sustained virologic response or fi brosis stage in chronic hepatitis C genotype 1 infection. J Hepatol 2013;58:467-472.
  • 22. Han YP, Kong M, Zheng S, et al. Vitamin D in liver diseases: from mechanisms to clinical trials. J Gastroenterol Hepatol 2013;28(Suppl 1):49-55.
  • 23. Kitson MT, Roberts SK. D-livering the message: the importance of vitamin D status in chronic liver disease. J Hepatol 2012;57:897-909.
  • 24. Petta S, Camma C, Scazzone C, et al. Low vitamin D serum level is related to severe fi brosis and low responsiveness to interferonbased therapy in genotype 1 chronic hepatitis C. Hepatology 2010;51:1158-1167.
  • 25. Anty R, Tonohouan M, Ferrari-Panaia P, et al. Low levels of 25-Hydroxy vitamin D are independently associated with the risk of bacterial infection in cirrhotic patients. Clin Transl Gastroenterol 2014;5:e56.
  • 26. Finkelmeier F, Kronenberger B, Koberle V, et al. Severe 25-hydroxyvitamin D defi ciency identifi es a poor prognosis in patients with hepatocellular carcinoma - a prospective cohort study. Aliment Pharmacol Th er 2014;39:1204-1212.
  • 27. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015;63:971-1004.
  • 28. Efe C, Kav T, Aydin C, et al. Low serum vitamin D levels are associated with severe histological features and poor response to therapy in patients with autoimmune hepatitis. Dig Dis Sci 2014;59:3035-3042.
  • 29. Luong KV, Nguyen LT. Th e role of vitamin D in autoimmune hepatitis. J Clin Med Res 2013;5:407-415.
  • 30. Hepner GW, Roginsky M, Moo HF. Abnormal vitamin D metabolism in patients with cirrhosis. Am J Dig Dis 1976;21:527-532.
  • 31. Long RG, Skinner RK, Wills MR, Sherlock S. Serum-25-hydroxyvitamin-D in untreated parenchymal and cholestatic liver disease. Lancet 1976;2:650-652.
  • 32. Malham M, Jorgensen SP, Ott P, Agnholt J, Vilstrup H, Borre M, Dahlerup JF. Vitamin D deficiency in cirrhosis relates to liver dysfunction rather than aetiology. World J Gastroenterol 2011;17:922-925.
  • 33. Chen CC, Wang SS, Jeng FS, Lee SD. Metabolic bone disease of liver cirrhosis: Is it parallel to the clinical severity of cirrhosis? J Gastroenterol Hepatol 1996; 11: 417–421.
  • 34. Crawford BAL, Kam C, Donaghy AJ, Mccaughan GW. The heterogeneity of bone disease in cirrhosis: A multivariate analysis. Osteoporos Int 2003; 14: 987–994.
  • 35. Menon KV, Angulo P, Weston S, Dickson ER, Lindor KD. Bone disease in primary biliary cirrhosis: independent indicators and rate of progression. J Hepatol 2001; 35:316–23. 36. Collier JD, Ninkovic M, Compston JE. Guidelines on the management of osteoporosis associated with chronic liver disease. Gut. 2002;50 Suppl 1:1–9.
  • 37. Shiomi S, Masaki K, Habu D, et al. Calcitriol for bone loss in patients with primary biliary cirrhosis. J Gastroenterol 1999; 34: 241–245.
  • 38. Bitetto D, Fattovich G, Fabris C, et al. Complementary role of vitamin D deficiency and the interleukin-28B rs12979860 C/T polymorphism in predicting antiviral response in chronic hepatitis C. Hepatology 2011; 53:1118–1126.
  • 39. Vidot H, Potter A, Cheng R, Allman-Farinelli M, Shackel N. Serum 25-hydroxyvitamin D deficiency and hepatic encephalopathy in chronic liver disease. World J Hepatol. 2017 Apr 8;9(10):510-518.
There are 38 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research
Authors

Fatih Gürbüz 0000-0003-2160-9838

Mehmet Ağın This is me 0000-0001-6177-2635

Eda Mengen 0000-0003-1597-8418

Hüseyin Elçi 0000-0001-6609-5821

İlker Ünal 0000-0002-9485-3295

Gökhan Tümgör 0000-0002-3919-002X

Bilgin Yüksel 0000-0003-4378-3255

Publication Date June 30, 2018
Acceptance Date January 17, 2018
Published in Issue Year 2018 Volume: 43 Issue: 2

Cite

MLA Gürbüz, Fatih et al. “Kronik karaciğer hastalığı Olan çocukların D Vitamini düzeyleri”. Cukurova Medical Journal, vol. 43, no. 2, 2018, pp. 450-6, doi:10.17826/cumj.365057.