Is Vitamin D Deficiency a Risk of Celiac Disease?

Yıl 2024, Cilt: 14 Sayı: 2, 299 - 304, 22.05.2024

Büşra Yurt Türer , Emine Merve Ekici

https://doi.org/10.33631/sabd.1326111

Öz

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.

Anahtar Kelimeler

Vitamin D, celiac disease, autoimmune diseases

D Vitamini Eksikliği Çölyak Hastalığı İçin Bir Risk mi?

Öz

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.

Anahtar Kelimeler

D vitamini, Çölyak hastalığı, Otoimmün hastalıklar

Kaynakça

• Mailhot G, White JH. Vitamin D and immunity in infants and children. Nutrients. 2020; 12(5): 1233.
• Bouillon R, Marcocci C, Carmeliet G, Bikle D, White JH, Dawson-Hughes B, Bilezikian J. Skeletal and extraskeletal actions of vitamin D: current evidence and outstanding questions. Endocr Rev. 2019; 40(4): 1109-51.
• Vici G, Camilletti D, Polzonetti V. Possible role of vitamin D in celiac disease onset. Nutrients. 2020; 12(4): 1051.
• Dipasquale V, Presti GL, Milani GP, Corsello A, Agostoni C, Romano C. Vitamin D in prevention of autoimmune diseases. Front Biosci (Landmark Ed). 2022; 27(10): 288.
• Lionetti E, Galeazzi T, Dominijanni V, Acquaviva I, Catassi GN, Iasevoli M, et al. Lower level of plasma 25-hydroxyvitamin d in children at diagnosis of celiac disease compared with healthy subjects: a case-control study. J Pediatr. 2021; 228: 132-7.
• Saponaro F, Saba, A, Zucchi R. An update on vitamin D metabolism. Int J Mol Sci. 2020; 21(18): 6573.
• Duque EJ, Elias RM, Moyses RM. Parathyroid hormone: a uremic toxin. Toxins. 2020; 12(3): 189.
• Di Stefano M, Miceli E, Mengoli C, Corazza GR, Di Sabatino A. The effect of a gluten-free diet on vitamin d metabolism in celiac disease: the state of the art. Metabolites. 2023; 13(1): 74.
• Rusińska A, Płudowski P, Walczak M, Borszewska-Kornacka MK, Bossowski A, Chlebna-Sokol D, et al. Vitamin D supplementation guidelines for general population and groups at risk of vitamin D deficiency in Poland—recommendations of the polish Society of Pediatric Endocrinology and Diabetes and the expert panel with participation of national specialist consultants and representatives of scientific societies—2018 update. Front Endocrinol. 2018; 9: 246.
• Ahlawat R, Weinstein T, Markowitz J, Kohn N, Pettei MJ. Should we assess vitamin D status in pediatric patients with celiac disease?. J Pediatr Gastroenterol Nutr. 2019; 69(4): 449-54.
• Jolliffe DA, Camargo CA, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, et al. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. The lancet. Diabetes & endocrinology. 2021; 9(5): 276-92.
• Kim D. The role of vitamin D in thyroid diseasesInt J Mol Sci. 2017; 18(9): 1949.
• Starchl C, Scherkl M, Amrein K. Celiac disease and the thyroid: highlighting the roles of vitamin D and iron. Nutrients. 2021; 13(6): 1755.
• Charoenngam N, Holick MF. Immunologic effects of vitamin D on human health and disease. Nutrients. 2020; 12(7): 2097.
• Infantino C, Francavilla R, Vella A, Cenni S, Principi N, Strisciuglio C, et al. Role of vitamin D in celiac disease and inflammatory bowel diseases. Nutrients. 2022; 14(23): 5154.
• Zhu W, Yan J, Zhi C, Zhou Q, Yuan X. 1, 25 (OH)2 D3 deficiency-induced gut microbial dysbiosis degrades the colonic mucus barrier in Cyp27b1 knockout mouse model. Gut Pathog. 2019; 11(1): 1-11.
• Schäffler H, Herlemann DP, Klinitzke P, Berlin P, Kreikemeyer B, Jaster R, et al. Vitamin D administration leads to a shift of the intestinal bacterial composition in Crohn's disease patients, but not in healthy controls. J Dig Dis. 2018; 19(4): 225-34.
• Chibbar R, Dieleman LA. The gut microbiota in celiac disease and probiotics. Nutrients. 2019; 11(10): 2375.
• Kahaly GJ, Frommer L, Schuppan D. Celiac disease and glandular autoimmunity. Nutrients. 2018; 10(7): 814.
• Lungaro L, Manza F, Costanzini A, Barbalinardo M, Gentili D, Caputo F, et al. Osteoporosis and celiac disease: Updates and hidden pitfalls. Nutrients. 2023; 15(5): 1089.
• Lebwohl B, Sanders DS, Green PH. Coeliac disease. The Lancet. 2018; 391(10115): 70-81.
• Andren Aronsson C, Liu X, Norris JM, Uusitalo U, Butterworth MD, Koletzko S, et al. 25 (OH) D levels in ınfancy ıs associated with celiac disease autoimmunity in at-risk children: a case–control study. Front Nutr. 2021; 8: 720041.
• Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC Med. 2019; 17: 1-20.
• Di Nardo G, Villa MP, Conti L, Ranucci G, Pacchiarotti C, Principessa L, et al. Nutritional deficiencies in children with celiac disease resulting from a gluten-free diet: a systematic review. Nutrients. 2019; 11(7): 1588.
• Duerksen DR, Lix LM, Johansson H, McCloskey EV, Harvey NC, Kanis JA, et al. Fracture risk assessment in celiac disease: a registry-based cohort study. Osteoporos Int. 2021; 32: 93-9.
• Mosca C, Thorsteinsdottir F, Abrahamsen B, Rumessen JJ, Handel MN. Newly diagnosed celiac disease and bone health in young adults: a systematic literature review. Calcif Tissue Int. 2022; 110(6): 641-8.
• Jivraj A, Hutchinson JM, Ching E, Marwaha A, Verdu EF, Armstrong D, et al. Micronutrient deficiencies are frequent in adult patients with and without celiac disease on a gluten-free diet, regardless of duration and adherence to the diet. Nutrition. 2022; 103: 111809.
• Aguiar M, Andronis L, Pallan M, Högler W, Frew E. Micronutrient deficiencies and health-related quality of life: The case of children with vitamin D deficiency. Public Health Nutr. 2020; 23(7): 1165-72.
• Lu C, Zhou W, He X, Zhou X, Yu C. Vitamin D status and vitamin D receptor genotypes in celiac disease: A meta-analysis. Crit Rev Food Sci Nutr. 2021: 61(12): 2098-106.
• Akhshayaa G, Seth A, Kumar P, Jain A. Prevalence and management of vitamin D deficiency in children with newly diagnosed coeliac disease: cohort study. Paediatr Int Child Health. 2021; 41(4): 247-52.
• Bittker SS. Elevated levels of 1, 25-dihydroxyvitamin D in plasma as a missing risk factor for celiac disease. Clin Exp Gastroenterol. 2020; 1-15.
• Akelma A, Keskin M, Erdeve Ş, Bursa N, Çelik O, İmrat E, et al. Decreased vitamin D levels in children and adolescents with Celiac disease: A nationwide cross-sectional study. Gulhane Med J. 2022; 64(3).
• Barera G, Maruca K, Sgaramella P, Di Stefano M, Mora S. Short-term, low dose vitamin D supplementation in young patients with celiac disease: a pilot study. Eur J Gastroenterol Hepatol. 2020; 32(5): 663-4.
• Verma A, Lata K, Khanna A, Singh R, Sachdeva A, Jindal P, et al. Study of effect of gluten-free diet on vitamin D levels and bone mineral density in celiac disease patients. J Family Med Prim Care. 2022; 11(2): 603.
• Aydemir Y, Erdogan B, Türkeli A. Vitamin D deficiency negatively affects both the intestinal epithelial integrity and bone metabolism in children with Celiac disease. Clin Res Hepatol Gastroenterol. 2021; 45(4): 101523.
• Sulimani RA. Celiac disease and severe vitamin D deficiency: The case for anti-tissue transglutaminase antibody screening. Arch Osteoporos. 2019; 14: 1-6.
• Trasciatti S, Piras F, Bonaretti S, Marini S, Nencioni S, Biasci E, et al. Effect of oral cholecalciferol in a murine model of celiac disease: A dose ranging study. J Steroid Biochem Mol Biol. 2022; 2020: 106083.
• Karras SN, Dursun E, Alaylıoğlu M, Gezen-Ak D, Annweiler C, Skoutas D, et al. Diverse effects of combinations of maternal-neonatal vdr polymorphisms and 25-hydroxyvitamin D concentrations on neonatal birth anthropometry: functional phenocopy variability dependence, highlights the need for targeted maternal 25-hydroxyvitamin D cut-offs during pregnancy. Nutrients. 2021; 13(2): 443.