Ulrich Christian Bang

Parathyroid hormone and vitamin D--markers for cardiovascular and all cause mortality in heart failure.

To investigate levels of vitamin D and parathyroid hormone (PTH) in a population of heart failure (HF) patients, and to evaluate whether vitamin D and PTH are related to prognosis.

Meta‐analysis: nitroglycerin for prevention of post‐ERCP pancreatitis

Background  Acute pancreatitis after ERCP is a severe side effect.

Variations in Serum 25-Hydroxyvitamin D during Acute Pancreatitis: An Exploratory Longitudinal Study

Objectives. We tested the hypothesis that 25-hydroxyvitamin D3 (25OHD) changes during acute inflammation in humans. Methods. Patients with first episode of acute pancreatitis were included. Blood samples were acquired on admission and on days 1, 2, and 14. Results. In total, 73 patients (35 males, median age 59) entered the study. On admission, the distribution of 25-OHD levels was as follows: severely deficient (<13 nmol/L) 23%; deficient (13–25 nmol/L) 20%; insufficient (26–50 nmol/L) 40%; and normal (<50 nmol/L) 17%. There was a significant fall and linear trend in 25OHD, albumin, and hemoglobin from day 0 to day 2. From day 0 to day 2 the drop in 25OHD was 3.1 nmol/L (95% CI 0.59–5.63). The changes from day 0 to day 2 in 25OHD were associated with changes in C-reactive protein (p = 0.02) but not with leukocyte or monocyte count. Conclusions. The 25OHD levels dropped during the first 2 days of acute pancreatitis beyond what was expected based on 25OHD half-life. This study supports our hypothesis that an acute inflammatory condition utilizes 25OHD, but other mechanisms could interfere.

Effect of propranolol on survival in patients with decompensated cirrhosis: a nationwide study based Danish patient registers.

We assessed the impact of propranolol on death, risk of hepatorenal syndrome and peritonitis in patients with cirrhosis.

Correlation of increases in 1,25-dihydroxyvitamin D during vitamin D therapy with activation of CD4+ T lymphocytes in HIV-1-infected males.

Abstract Background: In HIV-1–infected individuals, levels of CD4+ T lymphocytes are depleted and regulatory T-lymphocytes (Tregs) are elevated. In vitro studies have demonstrated effects of vitamin D on the growth and differentiation of these cells. We speculated whether supplementation with vitamin D could have an effect on CD4+ T lymphocytes or Tregs in HIV-1–infected males. Methods: We conducted a placebo-controlled randomized study that ran for 16 weeks and included 61 HIV-1–infected males, of whom 51 completed the protocol. The participants were randomized to 1 of 3 daily treatments: (1) 0.5-1.0 µg calcitriol and 1200 IU (30 µg) cholecalciferol, (2) 1200 IU cholecalciferol, (3) placebo. Percentages of the following T-lymphocyte subsets were determined: naïve CD4+ and CD8+ cells, activated CD4+ and CD8+ cells, and CD3+CD4+CD25+CD127low Tregs. Furthermore 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, and parathyroid hormone were measured. Results: No significant changes of the studied T-lymphocyte subsets occurred in the treatment groups compared to the placebo group. Increases in 1,25-dihydroxyvitamin D were associated with increases in activated CD4+ T lymphocytes (P = .001) and Tregs (P = .01) in adjusted models. Changes in parathyroid hormone correlated inversely with Tregs (P = .02). Smokers had higher levels of naïve CD4+ T lymphocytes (37% vs 25%;P = .01), naïve CD8+ T lymphocytes (28% vs 19%; P = .03), and Tregs (9% vs 7%; P = .03). Conclusion: Cholecalciferol and calcitriol administered during 16 weeks did not change the levels of T-lymphocyte fractions compared to placebo. However, increases in 1,25-dihydroxyvitamin D were associated with an expansion of activated CD4+ cells and Tregs.

The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

BACKGROUND & AIMS Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP. METHODS We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. RESULTS During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P < .0001) and CP (HR, 2.0 vs 1.5; P < .0001). Patients with CP receiving PES for fat malabsorption had a lower risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. CONCLUSIONS Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types.

Reduced risk of decompensation and death associated with use of statins in patients with alcoholic cirrhosis. A nationwide case‐cohort study

Reports have indicated that the use of statins may ameliorate the course of cirrhosis.

Oral cholecalciferol versus ultraviolet radiation B: effect on vitamin D metabolites in patients with chronic pancreatitis and fat malabsorption - a randomized clinical trial.

Background: Patients with chronic pancreatitis (CP) often develop fat malabsorption and are susceptible to hypovitaminosis D. Aim: We wanted to evaluate the intestinal uptake of cholecalciferol in patients with CP and fat malabsorption. Methods: We did a prospective placebo-controlled study including patients with verified CP and fat malabsorption. They were randomized to 10 weeks of (A) ultraviolet radiation B (UVB) 6 min weekly in a commercial tanning bed, (B) vitamin D supplement 1,520 IU/daily, or (C) placebo. The vitamin D metabolites 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (calcitriol) were quantified at the start and end of the study. Results: In total 30 patients were randomized and 27 completed the study. Compliance to tablets and tanning sessions was >80%. The changes in 25OHD levels in group B (32.3 nmol/l; 95% CI 15–50) were significantly greater than changes in group A (p < 0.001) and group C (p < 0.001). Changes in group A (1.1 nmol/l) did not differ from the placebo group (p = 0.9). Changes in calcitriol levels were identical between groups. Conclusions: Daily vitamin D supplements increased 25OHD in patients with CP compared to placebo whereas weekly tanning bed sessions did not.

A descriptive cross-sectional study of the prevalence of 25-hydroxyvitamin D deficiency and association with bone markers in a hospitalized population

Patients with gastrointestinal disease may be in particular risk of hypovitaminosis D because of reduced intestinal uptake or metabolism in the liver. The aim of the present study was to evaluate the prevalence of vitamin D deficiency in several groups of patients with various gastroenterologic diseases compared with patients without any chronic disease. We tested the hypothesis that persons with a gastrointestinal disease are at higher risk of hypovitaminosis D than persons with no chronic disease and whether this group needs special attention regarding their nutrition. We included patients admitted to our department of gastroenterology. The concentration of 25-hydroxyvitamin D (25(OH)D2+D3) was defined as insufficient when less than 50 nmol/L, deficient when less than 25 nmol/L, and severely deficient when less than 12.5 nmol/L. We included 146 patients with a mean age of 55 years (range, 16-93 years). 25(OH)D was sufficient in 47%, insufficient in 29%, deficient in 12%, and severely deficient in 11% of the population. Participants without chronic disease had a significantly higher mean level of 25(OH)D (57 nmol/L) compared to participants with cirrhosis (15 nmol/L, P = .002) and alcoholism (31 nmol/L, P = .003). A linear relationship between 25(OH)D and alkaline phosphatase could be demonstrated (Spearman rho, -0.299; P < .001). Participants with severe 25(OH)D deficiency had higher levels of total alkaline phosphatase (149.5 vs 76 U/L, P = .001) and parathyroid hormone (5.1 vs 2.8 pmol/L; P = .001). We recommend measuring the level of 25(OH)D and parathyroid hormone in patients with chronic diseases, especially alcoholism and cirrhosis.

Changes in 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D are associated with maturation of regulatory T lymphocytes in patients with chronic pancreatitis: a randomized controlled trial.

Objectives We studied the impact of changes in 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25(OH)2D) on regulatory T lymphocytes (Tregs) in patients with chronic pancreatitis (CP) and fat malabsorption in a prospective clinical trial. Methods The patients were randomized to 1 of 3 treatments during 10 weeks: weekly UV-B in a tanning bed (group A), 1520-IU/d vitamin D supplement (group B), or placebo (group C). A placebo tanning bed was used in groups B and C. We determined the levels of CD4+ Tregs (CD3+CD4+CD25+CD127lowFoxP3+) and CD8+ Tregs (CD3+CD8+CD25+CD127lowFoxP3+), together with 25OHD and 1,25(OH)2D. For baseline comparisons, we included 8 healthy individuals. Of the 30 included patients, 27 (group A, 7 patients; group B, 9 patients; and group C, 11 patients) completed the protocol. Results The baseline levels of CD4+ Tregs relative to total CD4+ count were higher in 22 patients with CP compared with healthy controls (2.8% vs 1.9%, P < 0.05) and were comparable for CD8+ Tregs (0.13% vs 0.05%, P = 0.3). Increases in levels of CD4+ Tregs correlated to changes in 1,25(OH)2D (2% per 100 pmol/L, P = 0.002) and 25OHD (3% per 100 nmol/L, P = 0.01). Conclusions Patients with CP have elevated relative levels of CD4+ Tregs. Increases in 25OHD and 1,25(OH)2D were both related with increases in levels of Tregs.