Association between 25(OH)D Level, Ultraviolet Exposure, Geographical Location, and Inflammatory Bowel Disease Activity: A Systematic Review and Meta-Analysis

Abstract

Background: There is no consensus on the vitamin D levels and inflammatory bowel disease (IBD).

Aim: To conduct a systematic review and meta-analysis to analyze the relationship between IBD and 25(OH)D, sun exposure, and latitude, and to determine whether vitamin D deficiency affects the severity of IBD.

Methods: We searched the PubMed, EBSCO, and ClinicalTrials.gov databases to identify all studies that assessed the association between 25(OH)D, sun exposure, latitude, and IBD through November 1, 2014, without language restrictions. Studies that compared 25(OH)D levels between IBD patients and controls were selected for inclusion in the meta-analysis. We calculated pooled standardized mean differences (SMDs) and odds ratios (ORs).

Results: Thirteen case-control studies investigating CD and 25(OH)D levels were included, and eight studies part of above studies also investigated the relationship between UC and 25(OH)D. Both CD patients (SMD: 0.26 nmol/L, 95% confidence interval [CI]: 0.09-0.42 nmol/L) and UC patients (SMD: 0.5 nmol/L, 95% CI: 0.15-0.85 nmol/L) had lower levels of 25(OH)D than controls. In addition, CD patients and UC patients were 1.95 times (OR, 1.95; 95% CI, 1.48-2.57) and 2.02 times (OR, 2.02; 95% CI, 1.13-3.60) more likely to be 25(OH)D deficient than controls. We also included 10 studies investigating the relationship between CD activity and vitamin D. Results showed that patients with active CD (CD Activity Index ≥ 150) were more likely to have low vitamin D levels. In addition, whether low sun exposure and high latitude were related to a high morbidity of CD need to be provided more evidence.

Conclusion: Our study shows that IBD patients have lower vitamin D levels. For active CD patients, vitamin D levels were low. These findings suggest that vitamin D may play an important role in the development of IBD, although a direct association could not be determined in our study.

Fig 1. Flow diagram of searching.

Fig 2. Meta-analysis of studies reporting 25(OH)D levels in CD patients vs. controls, a standardized mean difference with a 95% confidence interval and weight percentage.

Subtotals of adults and children, and overall population.

Fig 3. Meta-analysis of studies reporting 25(OH)D levels in UC patients vs. controls, a standardized mean difference with a 95% confidence interval and weight percentage.

Subtotals of adults and children, and overall population.

Fig 4. Meta-analysis of studies reporting dichotomous outcomes of 25(OH)D levels in CD patients vs. controls and estimated OR with a 95% confidence interval and weight percentage.

Fig 5. Egger’s test results for publication bias about dichotomous outcomes of 25(OH)D levels in CD.

Fig 6. Meta-analysis of studies reporting dichotomous outcomes of 25(OH)D levels in UC patients vs. controls and estimated OR with a 95% confidence interval and weight percentage.