title: Association between reduced plasma 25-hydroxy vitamin D and increased risk of cancer in patients with inflammatory bowel diseases.
abstract: OBJECTIVE
  Vitamin D deficiency is common among patients with inflammatory bowel diseases (IBD) (Crohn's disease or ulcerative colitis). The effects of low plasma 25-hydroxy vitamin D (25[OH]D) on outcomes other than bone health are understudied in patients with IBD. We examined the association between plasma level of 25(OH)D and risk of cancers in patients with IBD.
  
  
  METHODS
  From a multi-institutional cohort of patients with IBD, we identified those with at least 1 measurement of plasma 25(OH)D. The primary outcome was development of any cancer. We examined the association between plasma 25(OH)D and risk of specific subtypes of cancer, adjusting for potential confounders in a multivariate regression model.
  
  
  RESULTS
  We analyzed data from 2809 patients with IBD and a median plasma level of 25(OH)D of 26 ng/mL. Nearly one-third had deficient levels of vitamin D (<20 ng/mL). During a median follow-up period of 11 years, 196 patients (7%) developed cancer, excluding nonmelanoma skin cancer (41 cases of colorectal cancer). Patients with vitamin D deficiency had an increased risk of cancer (adjusted odds ratio, 1.82; 95% confidence interval, 1.25-2.65) compared with those with sufficient levels. Each 1-ng/mL increase in plasma 25(OH)D was associated with an 8% reduction in risk of colorectal cancer (odds ratio, 0.92; 95% confidence interval, 0.88-0.96). A weaker inverse association was also identified for lung cancer.
  
  
  CONCLUSIONS
  In a large multi-institutional IBD cohort, a low plasma level of 25(OH)D was associated with an increased risk of cancer, especially colorectal cancer.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: aananthakrishnan@partners.org.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Su-Chun
authors.initials: SC
authors.lastname: Cheng
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Tianxi
authors.initials: T
authors.lastname: Cai
authors.affiliation: Research Computing, Partners HealthCare, Charlestown, Massachusetts.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cagan
authors.affiliation: Research Computing, Partners HealthCare, Charlestown, Massachusetts.
authors.forename: Vivian S
authors.initials: VS
authors.lastname: Gainer
authors.affiliation: Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Peter
authors.initials: P
authors.lastname: Szolovits
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Stanley Y
authors.initials: SY
authors.lastname: Shaw
authors.affiliation: i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Susanne
authors.initials: S
authors.lastname: Churchill
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Karlson
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Research Computing, Partners HealthCare, Charlestown, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Shawn N
authors.initials: SN
authors.lastname: Murphy
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Children's Hospital Boston, Boston, Massachusetts; i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Isaac
authors.initials: I
authors.lastname: Kohane
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Liao
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Colorectal Cancer; Crohn’s Disease; Malignancy; Ulcerative Colitis; Vitamin D