Vitamin D status in pediatric irritable bowel syndrome

Abstract

Importance Irritable bowel syndrome (IBS) is associated with significant morbidity in children and adolescents, and the therapeutic efficacy of available treatment options is limited. The role of Vitamin D supplementation in pediatric IBS is unclear as the Vitamin D status of pediatric patients with IBS is unknown. Equally, the relationship of Vitamin D status with psychosomatic symptoms in children and adolescents is unclear. Aim To characterize the Vitamin D status of pediatric patients with IBS using a case-control study design. Hypothesis Serum 25-hydroxyVitamin D [25(OH)D] concentration will be similar between patients with IBS and controls. Subjects and methods A retrospective case-controlled study of 116 controls (age 14.6 ± 4.3 y), female (n = 67; 58%) and 55 subjects with IBS (age 16.5 ± 3.1y), female (n = 44; 80%). Overweight was defined as BMI of ≥85th but <95th percentile, and obesity as BMI ≥95th percentile. Vitamin D deficiency was defined as 25(OH)D of <50 nmol/L, while seasons of Vitamin D draw were categorized as summer, winter, spring, and fall. Major psychosomatic manifestations included in the analysis were depression, anxiety, and migraine. Results More than 50% of IBS subjects had Vitamin D deficiency at a cut-off point of <50 nmol/L (53% vs. 27%, p = 0.001); and >90% of IBS subjects had Vitamin D deficiency at a cut-off point of <75 nmol/L (93% vs. 75%, p = 0.006). IBS subjects had significantly lower mean 25(OH)D: 53.2 ± 15.8 nmol/L vs. 65.2 ± 28.0 nmol/L, p = 0.003; and albumin: 6.2 ± 0.6 vs. 6.5 ± 0.6 μmol/L, p = 0.0.01. IBS subjects with migraine had significantly lower mean 25 (OH)D concentration compared to controls (p = 0.01). BMI z-score was similar between the controls and IBS subjects (0.5 ± 1.4 vs. 1.2 ± 2.9, p = 0.11). Conclusions Pediatric patients with IBS had significantly lower 25(OH)D concentration compared to controls despite having similar mean BMI values as controls. Only 7% of the children and adolescents with IBS were Vitamin D sufficient, and >50% of the subjects with IBS had Vitamin D deficiency. This is a much higher prevalence of Vitamin D deficiency compared to IBD and other malabsorption syndromes. Monitoring for Vitamin D deficiency should be part of the routine care for patients with IBS. Randomized control trials are warranted to determine the role of adjunctive Vitamin D therapy in pediatric IBS.