Is Vitamin D Deficiency a Risk of Celiac Disease?

Abstract

Recent studies have shown that vitamin D can perform many non-skeletal functions through modulation of innate and acquired immunity. Based on this, it has been suggested that vitamin D may play a fundamental role in the development, clinical course and treatment of autoimmune disorders such as celiac disease. Celiac disease (CD) is an inflammatory disease of the small intestine characterized by intolerance to dietary gluten with autoimmune features. Its prevalence has reached almost 1% of the world’s population and is one of the most common autoimmune disorders. The main environmental factor in the pathogenesis of CD is gluten and a gluten-free diet continues to be the mainstay of celiac treatment. However, it has been reported that a gluten-free diet is not sufficient to prevent nutritional deficiencies in children and adults with CD. Studies have shown that 25(OH)D vitamin levels are lower in celiac patients compared to the control group, and although they increase after gluten-free diet treatment, they do not reach sufficient levels. Decreased bone mineral density and mass, and increased bone fragility are seen as important causes of some clinical symptoms of celiac disease. Vitamin D has a potential effect on the onset and course of CD through various mechanisms on the gastrointestinal system and immune system. Although there is evidence that vitamin D supplementation during gluten-free diet treatment prevents further bone loss, improves symptoms associated with osteomalacia, and normalizes calcium levels, data on the efficacy of vitamin D in the literature are conflicting. However, most experts recommend systematic monitoring of serum D vitamin levels in all individuals with celiac disease, regardless of initial levels or age during the gluten-free diet, and correction of documented D vitamin deficiency.

Keywords

• Vitamin D
• celiac disease
• autoimmune diseases

D Vitamini Eksikliği Çölyak Hastalığı İçin Bir Risk mi?

Abstract

Son yıllarda yapılan çalışmalar, D vitamininin esas olarak doğuştan gelen ve kazanılmış bağışıklıkla ilgili modülasyonu yoluyla birçok iskelet dışı işlevi yerine getirebileceğini göstermiştir. Bundan yola çıkarak D vitamininin Çölyak gibi otoimmün bozuklukların gelişimi, klinik seyri ve tedavisinde temel bir rol oynayabileceğini öne sürülmüştür. Çölyak hastalığı (ÇH), diyet glutenine intolerans ile karakterize otoimmün özellikleri olan ince bağırsağın enflamatuar bir hastalığıdır. Günümüzde prevelansı dünya nüfusunun neredeyse %1’ine ulaşmış olup en yaygın otoimmün bozukluklardan biridir. ÇH’nın patogenezinde başlıca çevresel faktör glutendir ve glutensiz diyet çölyak tedavisinin temel dayanağı olmaya devam etmektedir. Ancak glutensiz diyetin ÇH’lı çocuklarda ve yetişkinlerde beslenme yetersizliğini önlemede yeterli olmadığı bildirilmiştir. Yapılan çalışmalarda çölyak hastalarında kontrol grubuna göre 25(OH)D vitamin seviyelerinin daha düşük olduğu, glutensiz diyet tedavisi sonrası yükselmesine rağmen yeterli seviyeye ulaşamadığı gösterilmiştir. ÇH’da kemik mineral yoğunluğu ve kütlesinin azalması, kemik kırılganlığının ise artması Çölyak hastalığının bazı klinik belirtilerinin önemli nedeni olarak görülmektedir. D vitamininin ÇH’nın ortaya çıkmasında ve seyrinde gastrointestinal sistem ve bağışıklık sistemi üzerine çeşitli mekanizmalar yoluyla potansiyel etkisi görülmektedir. Glutensiz diyet tedavisi sırasında D vitamini takviyesinin daha fazla kemik kaybını önlediği, osteomalazi ile ilişkili semptomları iyileştirdiği ve kalsiyum seviyelerini normalleştirdiğine yönelik kanıtlar olsa da literatürde D vitamininin etkinliğine dair veriler çelişkilidir. Bununla birlikte, uzmanların çoğu başlangıçtaki veya glutensiz diyet sırasındaki D vitamini seviyelerine ve yaşa bakılmaksızın ÇH'lı tüm bireylerde sistematik olarak D vitamini serum seviyesi takibinin yapılmasını ve belgelendiğinde D vitamini eksikliğinin düzeltilmesini tavsiye etmektedir.

Keywords

• D vitamini
• Çölyak hastalığı
• Otoimmün hastalıklar

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