Determinants of vitamin D deficiency in chronic pancreatitis
P Selby1,2, N Prasad1, A Makin1 & J Berry1,2
Chronic pancreatitis (CP) may lead to deficiency of fat soluble vitamins such as vitamin D; little is known of the extent of this in chronic pancreatitics.
In order to assess the extent and severity of vitamin D deficiency in CP we examined the notes of 111 patients with CP. In addition to clinical information and calcium, vitamin D and PTH levels, exocrine function was evaluated using the PABA test to obtain a pancreatic excretion index (PEI: normal >0.7) and faecal elastase-1 (FE1: normal >200 μg/g).
Eighty five patients were male (76.6%) and the median age was 49 years (range 1479). Alcohol was the most common aetiology being the cause in 54 patients (49%). Idiopathic pancreatitis had been diagnosed in 13 patients (12%) but a further 27% were also likely to be idiopathic. 89 (80%) patients had chronic calcific, 6 (6%) had non-calcific and 7 (6%) had recurrent acute pancreatitis. All patients had normal serum calcium but PTH was elevated in 20.0%.
Of 25-hydroxy-vitamin-D3 (25OHD) levels were graded as deficient (<10 ng/ml), insufficient (1020), suboptimal (2030) and normal (>30) with 49.5, 32.4, 11.7 and 5.4% in these groups respectively. Male patients had significantly lower mean 25OHD levels than females (11.5 vs 15.9, P=0.05). Alcoholic aetiology was associated with a lower mean 25OHD compared to other causes (10.6 vs 16.8, P=0.01). There was poor correlation of 25OHD with age (r=0.01), PEI (r=0.19) and FE1 (r=0.01) but there was a weak correlation with PTH levels (r=−0.40, P=0.02).
Disturbance of vitamin D status in CP is common especially with alcoholic aetiology and male sex. Further studies are required to evaluate the effects of vitamin D deficiency on bone mineral density and long term fracture risk amongst CP patients.