Vitamin D Supplementation Is Associated with Inflammation Amelioration and Cognitive Improvement in Decompensated Patients with Cirrhosis
Por:
Diaz-Ruiz, R, Poca, M, Roman, E, Panadero-Gomez, R, Cuyàs, B, Bañares, I, Morales, A, Puerto, M, Lopez-Esteban, R, Blazquez, E, Fernández-Castillo, M, Correa-Rocha, R, Rapado-Castro, M, Breton, I, Bañares, R, Soriano, G, Garcia-Martinez, R
Publicada:
1 ene 2025
Resumen:
Background/Objectives: Decompensated cirrhosis is characterized by systemic inflammation and innate and adaptive immune dysfunction. Hepatic encephalopathy (HE) is a prevalent and debilitating condition characterized by cognitive disturbances in which ammonia and inflammation play a synergistic pathogenic role. Extraskeletal functions of vitamin D include immunomodulation, and its deficiency has been implicated in immune dysfunction and different forms of cognitive impairment. The aim was to assess changes in cognitive function and inflammation in decompensated patients with cirrhosis receiving vitamin D supplementation. Methods: Patients with cirrhosis discharged from decompensation in two tertiary hospitals in Spain (from September 2017 to January 2020) were assessed before, at 6 and 12 months after vitamin D supplementation. A comprehensive neuropsychological battery and neuroinflammatory markers were examined. In a subgroup of patients, peripheral immune blood cells were analyzed. Results: Thirty-nine patients were recruited. Of those, 27 completed the 6 months evaluation and were analyzed [age 62.4 +/- 11.3 years; 22 men; Model for End-Stage Liver Disease (MELD) 11.7 +/- 4.0; prior overt HE 33%; median 25-hydroxyvitamin D (25OHD) plasma level 12.7 mu gr/L] and 22 achieved 12 months assessment. At baseline, learning and memory (R = 0.382; p = 0.049) and working memory (R = 0.503; p = 0.047) subtests correlated with plasma 25OHD levels. In addition, processing speed (R = -0.42; p = 0.04), attention (R = -0.48; p = 0.04), Tinnetti balance (R = -0.656; p < 0.001) and Tinnetti score (R = -0.659; p < 0.001) were linked to neuroinflammation marker IL-1 beta. Patients with lower 25OHD had a greater proportion of TH1cells at baseline and a larger amelioration of IL-1 beta and IL-6 following supplementation. An improvement in working memory was found after 25OHD replacement (46.7 +/- 13 to 50 +/- 11; p = 0.047). Conclusions: This study supports that vitamin D supplementation modulates low-grade inflammation in decompensated cirrhosis providing cognitive benefits, particularly in working memory.
Filiaciones:
Diaz-Ruiz, R:
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Dept Digest Dis, Inst Invest Sanitaria, Madrid 28007, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid 28029, Spain
Poca, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid 28029, Spain
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Inst Recerca St Pau IR St Pau, Dept Gastroenterol, Bellaterra 08041, Spain
Roman, E:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid 28029, Spain
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Inst Recerca St Pau IR St Pau, Dept Gastroenterol, Bellaterra 08041, Spain
Panadero-Gomez, R:
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Inst Psychiat & Mental Hlth, CIBERSam, Madrid 28009, Spain
Cuyàs, B:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid 28029, Spain
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Inst Recerca St Pau IR St Pau, Dept Gastroenterol, Bellaterra 08041, Spain
Bañares, I:
Inst Invest Sanitaria Gregorio Maranon, Madrid 28009, Spain
Morales, A:
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Nutr Unit, Madrid 28007, Spain
Puerto, M:
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Dept Digest Dis, Inst Invest Sanitaria, Madrid 28007, Spain
Lopez-Esteban, R:
Inst Invest Sanitaria Gregorio Maranon, Lab Immune regulat, Madrid 28009, Spain
Blazquez, E:
Inst Invest Sanitaria Gregorio Maranon, Lab Immune regulat, Madrid 28009, Spain
Fernández-Castillo, M:
Inst Invest Sanitaria Gregorio Maranon, Lab Immune regulat, Madrid 28009, Spain
Correa-Rocha, R:
Inst Invest Sanitaria Gregorio Maranon, Lab Immune regulat, Madrid 28009, Spain
Rapado-Castro, M:
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Inst Psychiat & Mental Hlth, CIBERSam, Madrid 28009, Spain
Univ Melbourne, Dept Psychiat, Melbourne, Vic 3053, Australia
Breton, I:
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Nutr Unit, Madrid 28007, Spain
Bañares, R:
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Dept Digest Dis, Inst Invest Sanitaria, Madrid 28007, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid 28029, Spain
Soriano, G:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid 28029, Spain
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Inst Recerca St Pau IR St Pau, Dept Gastroenterol, Bellaterra 08041, Spain
Garcia-Martinez, R:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid 28029, Spain
Univ Complutense Madrid, Hosp Gen Univ Gregorio Maranon, Dept Internal Med, Inst Invest Sanitaria, Madrid 28007, Spain
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