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. 2024 Jul 1;110(7):4275-4285.
doi: 10.1097/JS9.0000000000001369.

Circulating 25-hydroxyvitamin D concentration can predict bowel resection risk among individuals with inflammatory bowel disease in a longitudinal cohort with 13 years of follow-up

Lintao Dan  1   2 , Sidan Wang  1 , Xuejie Chen  1 , Yuhao Sun  3 , Tian Fu  1 , Minzi Deng  1 , Jie Chen  1   2 , Zhongyan Du  4   5 , Xiaoyan Wang  1
Affiliations

Circulating 25-hydroxyvitamin D concentration can predict bowel resection risk among individuals with inflammatory bowel disease in a longitudinal cohort with 13 years of follow-up

Lintao Dan et al. Int J Surg. .

Abstract

Background: Although the beneficial properties of vitamin D in anti-inflammation and immunity-modulation are promising in the management of inflammatory bowel disease (IBD), data were limited for the critical IBD prognosis. The association between serum vitamin D levels and the risk of bowel resection in individuals with IBD remains largely unknown.

Materials and methods: The authors performed a longitudinal cohort study among 5474 individuals with IBD in the UK Biobank. Serum 25-hydroxyvitamin D [25(OH)D] was measured using direct competitive chemiluminescent immunoassay. Bowel resection events were ascertained via national inpatient data. Multivariable-adjusted Cox proportional hazard regression was used to examine the association between serum 25(OH)D and bowel resection risk, presented with hazard ratios (HRs) and 95% CIs. Restricted cubic spline (RCS) was used to evaluate dose-response associations.

Results: During a mean follow-up of 13.1 years, the authors documented 513 incident bowel resection cases. Compared to participants with vitamin D deficiency, nondeficient participants showed a significantly reduced bowel resection risk in IBD (HR 0.72, 95% CI: 0.59-0.87, P =0.001), Crohn's disease (CD, HR 0.74, 95% CI: 0.56-0.98, P =0.038), and ulcerative colitis (UC, HR 0.73, 95% CI: 0.57-0.95, P =0.020). When comparing extreme quintiles of 25(OH)D level, participants with IBD showed a 34% reduced risk of bowel resection (95% CI: 11-51%, P =0.007) and participants with UC showed a 46% reduced risk (95% CI: 19-64%, P =0.003), while this association was not significant in CD (HR 0.93, 95% CI: 0.59-1.45, P =0.740). Linear dose-response associations were observed using the RCS curve (all P -nonlinearity>0.05).

Conclusion: Increased serum level of 25(OH)D is independently associated with reduced bowel resection risk in IBD. This association was significant in UC but may not be stable in CD. Vitamin D deficiency is a risk factor for bowel resection in individuals with IBD, and may be an effective metric in predicting and risk-screening surgical events.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flowchart of inclusion and exclusion.
Figure 2
Figure 2
Kaplan–Meier curve of IBD, CD, and UC, stratified by two methods. The first is vitamin D deficiency or nondeficiency in (A) IBD, (B) CD, and (C) UC participants. The second method is stratified by quintiles in (D) IBD, (E) CD, and (F) UC participants.
Figure 3
Figure 3
Associations between the serum 25(OH)D concentration and risk of bowel resection in individuals with (A) IBD participants; (B) CD participants; (C) UC participants using restricted cubic curves. The vertical axis represents the risk of bowel resection risk based on the fully-adjusted model. The horizontal axis represents serum 25(OH)D concentration. The solid line in blue represents HRs, and the light-blue shading represents 95% CIs.
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