The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty

• Published in: The American journal of clinical nutrition Vol. 93; no. 5; pp. 1006 - 1011
• Main Authors: Reid, David, Toole, Barry J, Knox, Susan, Talwar, Dinesh, Harten, Johann, O’Reilly, Denis St J, Blackwell, Scott, Kinsella, John, McMillan, Donald C, Wallace, A Michael
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Elsevier Inc 01-05-2011; American Society for Nutrition; American Society for Clinical Nutrition, Inc
• Subjects: 25-Hydroxyvitamin D 2 - blood; Aged; Aged, 80 and over; Algorithms; Arthroplasty, Replacement, Knee - adverse effects; Binding sites; Biological and medical sciences; C-Reactive Protein - analysis; Calcifediol - blood; Elective Surgical Procedures; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Hyperparathyroidism, Secondary - complications; Inflammatory diseases; Joint surgery; Knee; Male; Middle Aged; Nutritional Status; Osteoarthritis - blood; Osteoarthritis - complications; Osteoarthritis - immunology; Osteoarthritis - therapy; Proteins; Statistics, Nonparametric; Studies; Systemic Inflammatory Response Syndrome; Time Factors; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin D; Vitamin D Deficiency - complications; Vitamin D-Binding Protein - blood; Knee; Human; Acute; Inflammation; Change; Concentration; Blood plasma
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.110.008490

Background: Studies indicate that low plasma 25-hydroxyvitamin D [25(OH)D] is associated with a range of disease processes, many of which are inflammatory. However, other lipid-soluble vitamins decrease during the systemic inflammatory response, and this response may confound the interpretation of plasma 25(OH)D.
Objective: The objective was to examine whether plasma 25(OH)D concentrations change during evolution of the systemic inflammatory response.
Design: Patients (n = 33) who underwent primary knee arthroplasty had venous blood samples collected preoperatively and postoperatively (beginning 6–12 h after surgery and on each morning for 5 d) for the measurement of 25(OH) D, vitamin D–binding protein, parathyroid hormone (PTH), calcium, C-reactive protein, and albumin. A final sample was collected at 3 mo.
Results: Preoperatively, most patients were 25(OH)D deficient (<50 nmol/L) and had secondary hyperparathyroidism (PTH > 5 pmol/L). Age, sex, body mass index, season, medical history, and medication use were not associated with significant differences in preoperative plasma 25(OH)D concentrations. By day 2 there was a large increase in C-reactive protein concentrations (P < 0.001) and a significant decrease in 25(OH)D of ≈40% (P < 0.001). C-reactive protein, 25(OH)D, and calculated free 25(OH)D had not returned to preoperative concentrations by 5 d postoperatively (all P < 0.001). At 3 mo, 25(OH)D and free 25(OH)D remained significantly lower (20% and 30%, respectively; P < 0.01).
Conclusion: Plasma concentrations of 25(OH)D decrease after an inflammatory insult and therefore are unlikely to be a reliable measure of 25(OH)D status in subjects with evidence of a significant systemic inflammatory response.