Ahmad Imad I, Trikudanathan Guru, Feinn Richard, Anderson Joseph C, Nicholson Marie, Lowe Samantha, Levine Joel B
*Department of Gastroenterology and Hepatology ¶Colon Cancer Prevention Program, University of Connecticut Health Center, Farmington ‡Netter School of Medicine, Quinnipiac University, Hamden ∥Department of Mathematics, University of Connecticut, Storrs, CT †Department of Gastroenterology, University of Minnesota, Minneapolis, MN §White River Junction VAMC and Geisel School of Medicine, Dartmouth College, Hanover, NH.
J Clin Gastroenterol. 2016 Sep;50(8):644-8. doi: 10.1097/MCG.0000000000000497.
To examine the association between low 25-OH Vitamin D levels and prevalence of advanced adenomas (AAs) in screening/surveillance colonoscopy patients.
Low serum 25-OH Vitamin D has been associated with an increased risk for colon cancer. In the Adenoma-Carcinoma pathway, a subset of colon polyps (AA) have been regarded as high-risk precursor lesions. We used a retrospective case-control design to examine the association between Vitamin D deficiency and the prevalence of AA in a high-risk population.
We examined a total of 354 patients who presented for initial screening or surveillance colonoscopy at our Colon Cancer Prevention Program. Our main exposure variable was serum Vitamin D levels and the outcome was AAs defined as those adenomas that were large (≥1 cm) or had advanced pathology (>25% villous components or high-grade dysplasia). Known risk factors were also collected from the patients' charts including gender, age, smoking, and family history. Bivariate and multivariate analyses were performed to examine the relationship between serum 25-OH Vitamin D levels and AAs. A total of 354 patients [(males, 188; females, 166); average age, 61 y] charts were reviewed. Vitamin D levels ranged between 4 and 70 ng/mL, with a mean of 25 ng/mL (clinical laboratory normal>30 ng/mL). There was no significant association between serum levels and time of the year of blood draw. Risk for tubular adenoma and AA increased as Vitamin D levels decreased to <30 ng/mL (P=0.002). In total, 80% of AAs were detected in patients whose levels were below this value (odds ratio, 3.36; 95% confidence interval, 1.40-8.03; P=0.007). Bivariate analysis also showed a positive association between smokers with AA as well as those with a family history of colon cancer (P=0.011) and low Vitamin D levels (P=0.001). A multivariate analysis using quintiles of Vitamin D levels demonstrated an increased risk of AAs for patients with levels in the second quintile (33 ng/mL) (odds ratio, 4.3; P=0.01) MAIN CONCLUSIONS:: Most patients presenting in our Colon Cancer Prevention Program have low levels of serum 25-OH Vitamin D. Analysis of the results of both screening and surveillance colonoscopies demonstrated an inverse relation between serum 25-OH Vitamin D level and AAs.
研究筛查/监测结肠镜检查患者中低25-羟基维生素D水平与进展性腺瘤（AA）患病率之间的关联。
血清25-羟基维生素D水平低与结肠癌风险增加有关。在腺瘤-癌途径中，一部分结肠息肉（AA）被视为高危前驱病变。我们采用回顾性病例对照设计，研究高危人群中维生素D缺乏与AA患病率之间的关联。
我们检查了在我们的结肠癌预防项目中进行初次筛查或监测结肠镜检查的354例患者。我们的主要暴露变量是血清维生素D水平，结局是定义为大（≥1厘米）或有进展期病理（>25%绒毛成分或高级别发育异常）的腺瘤的AA。还从患者病历中收集了已知的危险因素，包括性别、年龄、吸烟和家族史。进行双变量和多变量分析以研究血清25-羟基维生素D水平与AA之间的关系。共审查了354例患者的病历[男性188例；女性166例；平均年龄61岁]。维生素D水平在4至70纳克/毫升之间，平均为25纳克/毫升（临床实验室正常>30纳克/毫升）。血清水平与采血时间之间无显著关联。当维生素D水平降至<30纳克/毫升时，管状腺瘤和AA的风险增加（P=0.002）。总共80%的AA在维生素D水平低于该值的患者中被检测到（比值比，3.36；95%置信区间，1.40-8.03；P=0.007）。双变量分析还显示，患有AA的吸烟者以及有结肠癌家族史的吸烟者（P=0.011）与低维生素D水平（P=0.001）之间存在正相关。使用维生素D水平五分位数的多变量分析表明，维生素D水平处于第二五分位数（33纳克/毫升）的患者发生AA的风险增加（比值比，4.3；P=0.01）主要结论：在我们的结肠癌预防项目中就诊的大多数患者血清25-羟基维生素D水平较低。对筛查和监测结肠镜检查结果的分析表明，血清25-羟基维生素D水平与AA之间存在负相关。
