Relationship between vitamin D levels and pediatric celiac disease: a systematic review and meta-analysis

Abstract

Background: The relationship between Vitamin D levels and pediatric celiac disease (CD) remains controversial. In this study, we conducted a systematic review and meta-analysis to examine the relationship between Vitamin D and pediatric CD.

Methods: We screened relevant studies from PubMed, EMBASE, and Web of Science published in English from January 1, 2000, to August 1, 2023. The included studies were assessed according to the STROBE checklist. Heterogeneity was quantified by Cochran's Q test and the I² statistic. Publication bias was estimated by Begg's test and Egger's test. Meta-regression was used to detect potential sources of heterogeneity.

Results: A total of 26 studies were included in the meta-analysis. Nineteen articles compared 25(OH)D3 levels between CD patients and control groups, average 25-hydroxyvitamin D₃ [25(OH)D₃ or calcidiol], and 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃ or calcitriol] levels, as the main forms of Vitamin D, there was a significant difference in CD patients and healthy controls (weighted mean difference (WMD) = - 5.77, 95% confidence interval (CI) = [- 10.86, - 0.69] nmol/L). Meanwhile, eleven articles reported the numbers of patients and controls with Vitamin D deficiency, there was a significant difference in the incidence of 25(OH)D₃ deficiency between CD patients and healthy controls (odds ratio 2.20, 95% CI= [1.19, 4.08]). Nine articles reported changes in 25(OH)D₃ levels before and after administering a GFD in patients with CD, the result of this study revealed the increase of 25(OH)D₃ levels in CD patients after a gluten-free diet (GFD) (WMD = - 6.74, 95% CI = [- 9.78, - 3.70] nmol/L).

Conclusions: Vitamin D levels in pediatric CD patients were lower than in healthy controls, and 25(OH)D₃ deficiency was more prevalent in CD patients. We found that 25(OH)D₃ levels were elevated in CD patients after GFD, which is consistent with previous research. Further well-designed, longitudinal, prospective cohort studies focusing on the role of Vitamin D in the pathogenesis of CD are therefore needed.

Keywords: 25-hydroxyvitamin D3; Meta-analysis; Pediatric celiac disease; Vitamin D.

Fig. 1

Flowchart of study-selection process

Fig. 2

Forest plot showing significant difference in average 25(OH)D₃ levels between pediatric CD patients and controls (WMD = − 5.77, 95% CI = [− 10.86, − 0.69] nmol/L)

Fig. 3

Funnel plot of the meta-analysis

Fig. 4

Forest plot showing significant difference in the incidence of 25(OH)D₃ deficiency between patients with CD and healthy controls (OR = 2.20, 95% CI = [1.19, 4.08])

Fig. 5

Forest plot showing no significant difference in 25(OH)D₃ levels between CD patients pre-treatment and post-treatment with GFD (WMD = − 6.74, 95% CI = [− 9.78, − 3.70] nmol/L)