Vitamin D status in patients with cirrhosis of the liver and their relatives-A case control study from North India.
OBJECTIVE
Liver diseases interfere with the production of the metabolites of vitamin D required for activation, thus resulting in abnormal calcium and bone metabolism. Previous studies show inconsistent results of vitamin D level in non-cholestatic liver diseases. Our aim was to determine the prevalence of vitamin D insufficiency in cirrhosis as compared to apparently normal relatives and its relationship with etiology and severity.


METHODS
One hundred and sixty cirrhotic patients attending the Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, were enrolled, and 25-hydroxy vitamin D [25(OH)D] and calcium levels assessed. Vitamin D status was graded as insufficiency (20-30 ng/mL), deficiency (<20 ng/mL), and severe deficiency (<7 ng/mL). 25(OH)D levels of patients were compared with those of their healthy family members.


RESULTS
Forty-six percent of the normal population had 25(OH)D inadequacy, whereas 51.85% of patients with cirrhosis had 25(OH)D deficiency, and 28.12% had insufficiency. Thus, 80% of patients with cirrhosis of the liver had some form of vitamin D inadequacy. 12.5% of cirrhotics had severe vitamin D deficiency. Serum calcium (Ca++) was not significantly different between the patients and control group. The etiology of cirrhosis had no relation with vitamin D levels. Prevalence of deficiency and insufficiency increased with increasing age and mean Child-Turcotte-Pugh and model for end-stage liver disease scores.


CONCLUSIONS
Vitamin D insufficiency is highly prevalent in patients with cirrhosis irrespective of etiology and significantly more common than their healthy relatives. Measurement of 25(OH) vitamin D and replacement may be considered as part of the overall management of patients with cirrhosis of the liver as well as apparently healthy individuals.
Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, 211 001, India. drravi0609@gmail.com.
Ravikant
R
Kumar
Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, 211 001, India.
Pavan
P
Kumar
Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, 211 001, India.
Kandarp Nath
KN
Saxena
Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, 211 001, India.
Manjul
M
Mishra
Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, 211 001, India.
Vivek Kumar
VK
Mishra
Department of Physiology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, 800 014, India.
Anju
A
Kumari
Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, 211 001, India.
Manisha
M
Dwivedi
Department of Gastroenterology and Hepatology, M L N Medical College, Allahabad, 211 001, India.
Sri Prakash
SP
Misra
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000150:complications / Q000453:epidemiology / Q000378:metabolism
D014807:Vitamin D; C104450:25-hydroxyvitamin D
Child-Turcotte-Pugh score; Cirrhosis; Model for end-stage liver disease score; Vitamin D