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Vitamin D Deficiency In Inflammatory BoweL Disease Assessment Answer

VITAMIN D DEFICIENCY IN INFLAMMATORY BOWEL DISEASE


Assignment Format

You should submit a MS Word document, a PDF document will not be acceptable.

Your assignment should be spaced 1.5 lines.

Times New Roman size 12 font.

You are required to identify your own topic area

for this assignment. You will do this by searching recent 

peer-reviewed literature and identifying a disease or condition that has recently been suggested to be linked to vitamin D. 

Please note that bone related conditions are excluded from this assignment, as the involvement of vitamin D is well established.

We are interested in new research developments. 

Once you have identified a topic i.e. ‘the involvement of vitamin D in x’, then you need to find 3 recent primary research papers. These will be the focus of your assignment. These papers need to be recent (from within last 5 years), peer-reviewed research papers

(not review articles). Please check with me if you are unsure about the suitability of your topic or the papers you have chosen.

Read the papers carefully.You will describe

the research undertaken in those papers. In the body of the assignment, firstly provide a brief description of the

disease/condition. Then, focus on the research that was undertaken in each paper.


 For each paper think about the following questions:


  • Who were the participants (were they humans or animals)? 
  • How many participants were there and how were they chosen? 
  • How were the control and test groups defined?
  • What exactly was being tested? 
  • Were any statistically significant results obtained?
  • Can you think of any problems (limitations) with this study?

Then compare the three articles by thinking about the following questions:


  • What were the similarities or differences between the studies? 
  • Did the studies reach the same conclusions?
  • Did they have differing conclusions and if so, 
  • can you think of why this might have occurred?


At the end of your assignment you must write a 

conclusion. This should answer the 

question:


 Do you think that the association between Vitamin D and this disease state has been properly proven? 

In the conclusion you should state how strong the evidence is for 

the involvement of vitamin D deficiency in the disease that you have chosen. Are you convinced that there is a link? 


Please use other articles or references to help provide additional information as required. Please do not focus on the production of Vitamin D – a description of this process is not required


Some questions you might like to consider include:

  • Is there enough evidence from the studies undertaken to show a relationship between vitamin D and the condition?
  • What were the limitations of the studies?
  • How could these limitations be addressed in the future? What else needs to happen before a (causal) link could be established?
  • If a relationship has been identified, what does this mean for the patients?
  • Is there more research needed, or do you think that the association is not convincing and that further research is not warranted?

Read the rubric carefully to see how marks will be allocated for this assignment.Think about how you should set out the assignment –what will be the clearest way to provide the information?

Answer

VITAMIN D DEFICIENCY IN INFLAMMATORY BOWEL DISEASE

Introduction

Vitamin D is considered to be very essential for healthy development and also mineralisation of human bones. The invention of] Vitamin D Receptor or VDR in cells and the tissues in the human body has come with some additional information about the function of Vitamin D which was unknown to us. The number of researches has increased in this field where the role of Vitamin D in various serious illnesses like cancer and other autoimmune diseases like sclerosis and cardiovascular diseases is being examined.

 Though it is still not defined completely, the causes of IBD or Inflammatory Bowel Disease, is related to interaction between genetic, environmental, and other factors related to immunology. The patients, who suffers from IBD along with UC(ulcerative colitis) and CD (Crohn’s disease) have a remarkable deficit of Vitamin D. It is still unknown if the deficit of Vitamin D is a cause or result of (Inflammatory Bowel Disease). Vitamin D which signals through VDR, were found in the test subjects like mouse, rat etc which would dictate the result of the experimental IBD. It is observered that the Vitamin D controls the development and also the function of T-cell which can affect the output of the immune response by either preventing the autoimmunity or by promoting it. 

To test the impact of Vitamin D deficiency in IBD(inflammatory bowel disease), three articles will be compared. All these three articles are based on primary reaserch. It means, only those studies are included which involved living participants.

Analysis of each article

Article 1- 

In the article proposed by Caviezel,et.al.,2017, Vitamin D carries tha immuno-modulatory properties. IBD patients ususally suffers with deficiency of Vitamin D. In this research, 25-OH-D3 (25-hydroxyvitamin D3) level is compared in IBD and irritable bowl syndrome patients. In this study, 181 patients are participants. Out of 181 patients, 156 patients are IBD and 25 were suffering from IBS. The other deteriminats were season, physical activitiy and inflammatory markers. The findings showed that 58.6% CD and 44.6% UC patients had  a low level of 25-OH-D3.Hence, It is concluded in this study that Vitamin D dificiency is common in IBD patients.

However the deficit of Vitamin D is more pronounced in CD patients. This showed significant inverse association inflammatory markers like FC and CRP.

There are few limitations like Due to several reasons related to the organisation, the patients were included within the span of April-16 and January-17, that limits the effects of the season especially in the winter season which is in the month of February and March. During this time the deficiency of Vitamin D is more prominent in this region because of sunrays which is not so bright during winter which lasts for 90-120 hours per month

Article 2- 

In 2nd article proposed by Frigstad,et.al.,2017, The deficiency of vitamin D is quite common i n the patients suffering from IBD. The main motto of this research is identification the predictors of Vitamin D deficiency in the IBD cohort and also how Vitamin D is prevalent. It was found after investigation that the deficit of Vitamin D is linked with the increase in the activities of the disease. The study also includes  IBD patients from nine hospitals.The study was conducted from Mar 2013 to April 2014. Their medical data was crossed checked. They were interviewed. 25-OH-D lab test were conducted. It was found that The deficiency of Vitamin D is quite common in IBD and is higher disease activity in Crohn’s disease. The study has several limits. The design is cross-sectional and hence subjected to recall bias.The facts also include the capability of temporarily correlating the scores of the disease activities and the level of Vitamin D. The majors outcomes in the study were concluded through the medical records. This makes the data  prone to bias. There was no severity in the endoscopic markers or to correlate the activity scores of the disease along with the inflammatory markers which are objective. The other limitation is inadequate information about bone health which is incomplete; but this question is addressed other previous studies.

Article 3- 

The main purpose of research is to explore the novel associated between Vitamin D and the IBD  disease in the patients.

As a conclusion it can be said that the deficiency of Vitamin D was a common observation in the patients with IBD. Deficiency of Vitamin D is a major factor which contributes to IBD. The design of the study allows identifying the relationship between the deficiency of Vitamin D and the disease activity. The high deficiency, screening which are regular and supplementation which are appropriate of vitamin D are also recommended in the patients with IBD.  The study is based on cohort study of 384 patients. Moe than 86,000 samples, test results was obtained. The season of year is also considered.

It was cross sectional design study which is based on intentional participation of patients. The result or the evaluation represents the total IBD patients who are treated at referral centres which are tertiary. Most of the patients suffering from Inflammatory Bowel Disease, were in remission and hence the analysis related to statistics in terms of inflammatory parameters which is mainly among the patients who are suffering from UC and may limit the conclusions regarding the associated inflammation with the deficiency of Vitamin D in the UC patients.

In the end, the analysis of Inflammatory Bowel Disease, which is cross sectional exposed that 25-OH-D3 deficiency and is usually common among the CD patients than UC patients. An inverse connection related to the parameters which are inflammatory that is calprotectin and CRP which includes Vitamin D were seen in those patients who were suffering from CD. The variations related to the change of seasons in 25-OH-D3 levels were noted in CD patients. That suggested considering of the general substitution of the patients suffering from the IBD  with Vitamin D mostly in the winter season without much exposing them in sunlight. 

Critical comparison of articles

Similarities and Differences

The fundamental similarity of all three articles lies in their subject matter- Deficiency of vitamin D on human body. All of them make their individual attempts to show the adverse impact. All three tries to draw relationship between vitamin D deficiency and Inflammatory Bowel Disease (IBD). The similarity further extends with the discussions made on Crohn’s disease (CD) and ulcerative colitis (UC). All the three articles shed some light on the possible causes of the deficiency such as people reluctant to go under sun, incapacity to absorbing Vitamin D, resection of ileum, and decrease in the consumption of Vitamin D enriched food in everyday diet.

The dissimilarity principally appears in their individual efforts in extending deeper into the various aspects of the deficiency. Two of the three articles, “High prevalence of vitamin D deficiency among patients with Inflammatory Bowel Disease (IBD)” and “Vitamin D deficiency in Inflammatory Bowel Disease: prevalence and predictors in a Norwegian outpatient population” go on including irritable bowel syndrome (IBS) in their research.

Difference or similarities of conclusion

Each of the studies, mentioned in the articles has the same subject matter. They all shed some light of information of the hypovitaminosis D. They also tell about the most possible reasons of the deficiency. The backgrounds of the studies show more commonness than differences. The article published on “Inflammatory Intestinal Diseases” starts analysing cross-sectional data obtained from patients suffering from IBD. It goes on checking the level of 25-hydroxyvitamin D3 (25-OH-D3) from patients suffering from IBD and makes a comparison with that of the received from the sufferers of IBS. The article published in the “Scandinavian Journal of Gastroenterology” endeavours conclude on the reasons of the occurrences of hypovitaminosis D in the contest of and to classify both medical and epidemiological factors responsible for the deficiency of vitamin D among patients with IBD. Research Gate presents its result in the context of the relationship of Vitamin D Receptor cells and their role and responsibility in causing the deficiency. They all presents virtually the same conclusions that the deficiency is common among all IBD patients and they all render that the expected level of vitamin D is 25[OH]D <20 ng/dL.  

If there is difference

The conclusions, although renders seemingly different results, made on each of the articles remain the same. The conclusions found on the “High prevalence of vitamin D deficiency among patients with Inflammatory Bowel Disease (IBD)” are most common and almost universally supported by the two other articles. All IBD patients show hypovitaminosis D. The deficiency is more common among patients of Crohn’s disease (CD). “Vitamin D deficiency in Inflammatory Bowel Disease: prevalence and predictors in a Norwegian outpatient population” agrees the same and goes a little ahead and draws the conclusion that the deficiency shows potency in creating other problems too. So, in this case the second article affirms the conclusion of the first article while approaching further in with a deeper research. But the most remarkable research and the results find a place in the third article. It shows a complex relationship of hypovitaminosis D with seasons, CD and UC. It shows that the suffering from the shortage, intervenes HRQOL in people with CD only. It also gives three levels of vitamin D each one referring to a particular state like deficiency, insufficiency and sufficiency.

Reason of difference

The conclusions are not so different that the entire set of conclusions or the researches made may lose their value. The variation in results may come from many reasons. It depends on the observer and how efficiently data is recorded, the trustworthiness of tests and retests, internal factors and external factors involved during the tests. The three articles present three different scenarios with a common purpose of determining the impact of hypovitaminosis D. Each studies are made on different set of people, with some commonness in their medical background such as IBD and at different time and place. The minute differences in the results may also be due to the methodologies adopted for conducting the tests. The results are not greatly different as 58.6% with CD and 44.6% of UC as found in the first article are not far from 53% CD and 44% UC from the second article. The results show minute deviations which are not entirely unexpected and contradictory to the ethical values of research.

Conclusion

It has been found in the previous studies that there are quite a number of predictors which are the root causes of the deficiency of Vitamin D in IBD, especially in CD. Longer duration of the diseases along with their higher activity, small bowel resection, smoking and status of nutrition, small bowel involvement is included. But these studies are not quite much in terms of the definition of deficiency of Vitamin D. Hence, the present analysis confirm relationship between Vitamin D deficiency and IBD.

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