Levels of Vitamin D Are Low After Crohn's Disease Is Established But Not Before.

BACKGROUND & AIMS: Low serum levels of vitamin D have been associated with Crohn's disease (CD). However, it is unclear whether low vitamin D levels cause CD or CD reduces serum vitamin D. METHODS: United States military personnel with CD (n = 240) and randomly selected individuals without CD (controls, n = 240) were matched by age, sex, race, military branch, and geography. We measured 25-hydroxyvitamin D in sera 8-3 years (pre-2) and 3 years to 3 months before diagnosis (pre-1) and 3 months before through 21 months after diagnosis (pre-0). We genotyped VDR and GC vitamin D related polymorphisms. We used conditional logistic regression, including adjustments for smoking, season, enlistment status, and deployment, to estimate relative odds of CD according to vitamin D levels and interactions between genetic factors and levels of vitamin D. RESULTS: Levels of vitamin D before diagnosis were not associated with CD in pre-2 (P trend = .65) or pre-1 samples (P trend = .84). However, we found an inverse correlation between CD and highest tertile of vitamin D level in post-diagnosis samples (P trend = .01; odds ratio, 0.51; 95% CI, 0.30-0.86). Interactions were not detected between vitamin D levels and VDR or GC polymorphisms. We observed an association between VDR Taq1 polymorphism and CD (independent of vitamin D) (P = .02). CONCLUSIONS: In serum samples from military personnel with CD and matched controls, we found no evidence for an association between CD and vitamin D levels up to 8 years before diagnosis. However, we observed an inverse-association between post-diagnosis vitamin D levels and CD. These findings suggest that low vitamin D does not contribute to development of CD-instead, CD leads to low vitamin D.

Drug-induced liver injury from initial dose of infliximab.

Acute hepatotoxicity secondary to infliximab can occur with or without autoimmunity. A growing body of infliximab drug-induced liver injury cases without autoantibody formation is emerging. Nearly all other reported cases occur after at least three doses. This suggests infliximab may have a direct cytotoxic effect on the liver. We report a case of drug-induced liver injury resulting after an initial dose of infliximab.

Inflammatory bowel disease prevalence by age, gender, race, and geographic location in the U.S. military health care population.

BACKGROUND: There is limited data examining the prevalence of inflammatory bowel disease (IBD) in a diverse North American population. METHODS: Using International Classification of Diseases, Ninth Revision codes, patients with Crohn's disease (CD) and ulcerative colitis (UC) seen within the military health care system (Tricare) from October 1, 2008 to September 30, 2009 were identified. This database comprised all active duty military, retirees, and dependents. The overall prevalence of IBD, UC, and CD was calculated, and the prevalence by age, gender, race, and geographic location. RESULTS: A total of 35,404 cases of IBD were identified in 10.2 million military health care beneficiaries establishing a prevalence of total IBD, UC, and CD of 348, 202, and 146 per 100,000, respectively. IBD was more prevalent in females compared with males (417 versus 284 per 100,000; relative risk, 1.53; 95% confidence interval, 1.50-1.57). There was an increased prevalence of IBD with each decade of life. IBD was more common in Caucasians (324 per 100,000) compared with blacks, Asians, Hispanics, and American Indians (239, 162, 147, and 224 per 100,000, respectively; relative risk, 1.60; 95% confidence interval, 1.53-1.67). There was no difference in prevalence when comparing Northern versus Southern states (339 versus 333 per 100,000, respectively, P = 0.114). CONCLUSIONS: This large population study establishes a prevalence of IBD, UC, and CD (348, 202, and 146 per 100,000, respectively) in the military health care population. The prevalence of IBD, UC, and CD was higher in females and with increasing age, whereas IBD was most common in whites compared with other ethnicities in our patient population.

The use of pholasin as a probe for the determination of plasma total antioxidant capacity.

BACKGROUND AND OBJECTIVES: Total antioxidant capacity (TAC) reflects the capacity of plasma, or other body fluid, to resist oxidation. The aim of the present study was to assess the prognostic value of Pholasin as a probe for the determination of plasma TAC. DESIGN AND METHODS: Plasma samples either oxidised using the free radical generator 2'-azobis-(2-amidinopropane) hydrochloride (AAPH) at 60 degrees C for 180 min or obtained from diabetic (type 1 and type 2) patients (n = 61 and 124, respectively) with or without polyneuropathy (PN) and/or cardiovascular autonomic neuropathy (CAN) and control subjects (n = 70) were analysed for TAC status. TAC was assessed using two versions of Analysis By Emitted Light (ABEL) tests including quenching of Pholasin chemiluminescence (QPC) with peroxynitrite (ONOO(-)-QPC) and with superoxide anion (O2(-)-QPC). RESULTS: The utilisation of AAPH to induce peroxyl radical mediated plasma oxidation produced a significant decrease in TAC as assessed by ONOO(-)-QPC and O2(-)-QPC assays in a time-dependent manner. Type 1 and type 2 diabetic patients without PN and/or CAN had lower TAC (ONOO(-)-QPC and O2(-)-QPC) than in control subjects. Further alterations in TAC were noted in the presence of PN and/or CAN. Correlations were found between TAC (ONOO(-)-QPC and O2(-)-QPC) values on duration of diabetes and neurological impairment score-lower limb (NIS-LL) in type 1 diabetic patients. CONCLUSIONS: This study has established that the ONOO(-)-QPC and O2(-)-QPC versions of the ABEL test fulfil the criteria in terms of simplicity, sensitivity and reliability for the measurement of plasma TAC. These biomarkers may prove useful in studies evaluating the impact of therapeutic drugs or antioxidant interventions aimed at delaying the onset of complications in clinical conditions associated with oxidative stress.