Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of Vitamin D Deficiency in Chronic Liver Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Vitamin D deficiency has been associated with cholestatic liver disease such as primary biliary cirrhosis. Some studies have suggested that cirrhosis can predispose patients to development of osteoporosis because of altered calcium and vitamin D homeostasis. The aim of this study was to determine the prevalence of vitamin D deficiency in patients with chronic liver disease.

Methods

One hundred and eighteen consecutive patients (43 with hepatitis C cirrhosis, 57 with hepatitis C but no cirrhosis, 18 with nonhepatitis C-related cirrhosis) attending the University of Tennessee Hepatology Clinic had their 25-hydroxyvitamin D level measured. Severity of vitamin D deficiency was graded as mild (20–32 ng/ml), moderate (7–19 ng/ml) or severe (<7 ng/ml), normal being >32 ng/ml.

Results

Of patients, 109/118 (92.4%) had some degree of vitamin D deficiency. In the hepatitis C cirrhosis group, 16.3% (7/43) had mild, 48.8% (21/43) had moderate, and 30.2% (13/43) had severe vitamin D deficiency. In the hepatitis C noncirrhotic group, 22.8% (19/57) had mild, 52.6% (30/57) had moderate, and 14% (8/57) had severe vitamin D deficiency. In the nonhepatitis C-related cirrhosis group, 38.9% (7/18) had mild, 27.8% (5/18) had moderate, and 27.8% (5/18) had severe vitamin D deficiency. Severe vitamin D deficiency (<7 ng/ml) was more common among patients with cirrhosis compared with noncirrhotics (29.5% versus 14.1%, P value = 0.05). Female gender, African American race, and cirrhosis were independent predictors of severe vitamin D deficiency in chronic liver disease.

Conclusion

Vitamin D deficiency is universal (92%) among patients with chronic liver disease, and at least one-third of them suffer from severe vitamin D deficiency. African American females are at highest risk of vitamin D deficiency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CLD:

Chronic liver disease

HCV:

Hepatitis C virus

MMP:

Matrix metalloproteinase

25(OH)D:

25-hydroxyvitamin D

References

  1. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004;80(Suppl):1689S–1696S.

    CAS  PubMed  Google Scholar 

  2. Imawari M, Akanuma Y, Itakura H, Muto Y, Kosaka K, Goodman DS. The effects of diseases of the liver on serum 25 hydroxyvitamin D and on serum binding protein for vitamin D and its metabolites. J Lab Clin Med. 1979;93:171–180.

    CAS  PubMed  Google Scholar 

  3. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281.

    Article  CAS  PubMed  Google Scholar 

  4. Looker AC, Mussolino ME. Serum 25-hydroxyvitamin D and hip fracture risk in older US white adults. J Bone Miner Res. 2008;23:143–150.

    Article  CAS  PubMed  Google Scholar 

  5. Peterlik M, Cross HS. Vitamin D and calcium deficits predispose for multiple chronic diseases. Eur J Clin Invest. 2005;35:290–304.

    Article  CAS  PubMed  Google Scholar 

  6. Tsuneoka K, Tameda Y, Takase K, et al. Osteodystrophy in patients with chronic hepatitis and liver cirrhosis. J Gastroenterol. 1996;31:669–678.

    Article  CAS  PubMed  Google Scholar 

  7. Masuda S, Okano T, Osawa K, et al. Concentrations of vitamin D-binding protein and vitamin D metabolites in plasma of patients with liver cirrhosis. J Nutr Sci Vitaminol (Tokyo). 1989;35:225–234.

    CAS  Google Scholar 

  8. Bouillon R, Auwerx J, Dekeyser L, et al. Serum vitamin D metabolites and their binding protein in patients with liver cirrhosis. J Clin Endocrinol Metab. 1984;59:86–89.

    Article  CAS  PubMed  Google Scholar 

  9. Chen CC, Wang SS, Jeng FS, et al. Metabolic bone disease of liver cirrhosis: is it parallel to the clinical severity of cirrhosis? J Gastroenterol Hepatol. 1996;11:417–421.

    Article  CAS  PubMed  Google Scholar 

  10. Hepner GW, Roginsky M, Moo HF. Abnormal vitamin D metabolism in patients with cirrhosis. Am J Dig Dis. 1976;21:527–532.

    Article  CAS  PubMed  Google Scholar 

  11. Duarte MP, Farias ML, Coelho HS, et al. Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease. J Gastroenterol Hepatol. 2001;16:1022–1027.

    Article  CAS  PubMed  Google Scholar 

  12. Monegal A, Navasa M, Guanabens N, et al. Osteoporosis and bone mineral metabolism disorders in cirrhotic patients referred for orthotopic liver transplantation. Calcif Tissue Int. 1997;60:148–154.

    Article  CAS  PubMed  Google Scholar 

  13. Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands. Endocr Rev. 2005;26:662–687.

    Article  CAS  PubMed  Google Scholar 

  14. Koli K, Keski-Oja J. 1alpha, 25-dihydroxyvitamin D3 and its analogues down-regulate cell invasion-associated proteases in cultured malignant cells. Cell Growth Differ. 2000;11:221–229.

    CAS  PubMed  Google Scholar 

  15. Timms PM, Mannan N, Hitman GA, et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM. 2002;95:787–796.

    Article  CAS  PubMed  Google Scholar 

  16. Dobak J, Grzybowski J, Liu FT, et al. 1, 25-dihydroxyvitamin D3 increases collagen production in dermal fibroblasts. J Dermatol Sci. 1994;8:18–24.

    Article  CAS  PubMed  Google Scholar 

  17. Garcíade León Mdel C, Montfort I, Tello Montes E, et al. Hepatocyte production of modulators of extracellular liver matrix in normal and cirrhotic rat liver. Exp Mol Pathol. 2006;80(1):97–108. Epub 2005 Dec 5.

    PubMed  Google Scholar 

  18. Hamada T, Fondevila C, Busuttil RW, Coito AJ. Metalloproteinase-9 deficiency protects against hepatic ischemia/reperfusion injury. Hepatology. 2008;47(1):186–198.

    Article  CAS  PubMed  Google Scholar 

  19. Khandoga A, Kessler JS, Hanschen M, et al. Matrix metalloproteinase-9 promotes neutrophil and T cell recruitment and migration in the postischemic liver. J Leukoc Biol. 2006;79:1295–1305.

    Article  CAS  PubMed  Google Scholar 

  20. Fisher L, Fisher A. Vitamin D and parathyroid hormone in outpatients with noncholestatic chronic liver disease. Clin Gastroenterol Hepatol. 2007;5(4):513–520. Epub 2007 Jan 10.

    Article  CAS  PubMed  Google Scholar 

  21. Mawer EB, Klass HJ, Warnes TW, et al. Metabolism of vitamin D in patients with primary biliary cirrhosis and alcoholic liver disease. Clin Sci (Lond). 1985;69:561–570.

    CAS  Google Scholar 

  22. Caniggia A, Lore F, di Cairano G, et al. Main endocrine modulators of vitamin D hydroxylases in human pathophysiology. J Steroid Biochem. 1987;27:815–824.

    Article  CAS  PubMed  Google Scholar 

  23. Skinner RK, Sherlock S, Long RG, et al. 25-hydroxylation of vitamin D in primary biliary cirrhosis. Lancet. 1977;1:720–721.

    Article  CAS  PubMed  Google Scholar 

  24. Compston JE. Hepatic osteodystrophy: vitamin D metabolism in patients with liver disease. Gut. 1986;27:1073–1090.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    J. Arteh

  2. Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    S. Narra & S. Nair

Authors
  1. J. Arteh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Narra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Nair.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arteh, J., Narra, S. & Nair, S. Prevalence of Vitamin D Deficiency in Chronic Liver Disease. Dig Dis Sci 55, 2624–2628 (2010). https://doi.org/10.1007/s10620-009-1069-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-009-1069-9

Keywords

Search

Navigation