Original Article

Vitamin D Deficiency and Chronic Liver Disease: Investigating Predictive Factors and Their Implications for Patient Care in Pakistan

Abstract

Background: Chronic liver disease (CLD) and its end-stage manifestation, cirrhosis, present significant global health challenges, contributing to substantial morbidity and mortality. Despite its impact on various organ systems, the musculoskeletal effects of CLD, particularly vitamin D deficiency remain underexplored. This study aimed to identify significant predictors of vitamin D deficiency among CLD patients.
Methods: Overall, 177 CLD patients of either gender, aged 18 yr and above were included using the non-probability consecutive sampling technique. This cross-sectional study was conducted at the medical units of Isra University Hospital, Hyderabad, from Jan to Jun 2023. Various markers of hepatic function including bilirubin, albumin, and International normalised ratio (INR), were analyzed, along with a complete blood count and each patient was assigned a Child-Turcotte-Pugh (CTP) score. The relationship of vitamin D with different variables was assessed through Chi-Square tests. Pearson correlation and regression analyses were carried out to identify predictors of vitamin D deficiency.
Results: Mean age of patients was 51.76±5.77 yr and the majority were male (68.4%). Vitamin D deficiency was present in 28.24%, particularly among those with cirrhosis. Vitamin D levels correlated negatively with disease severity, as indicated by CTP (P<0.05) and Model for End-Stage Liver Disease (MELD) (P<0.05) scores, and positively with albumin levels (P<0.05). Increasing age, male gender, and higher CTP and MELD scores were significant predictors (P<0.05) of vitamin D deficiency.
Conclusion: Vitamin D levels correlate with hepatic dysfunction and are negatively associated with disease progression. Significant predictors of vitamin D deficiency identified include increasing age, male gender, and higher MELD and CTP Score.

1. Nakahata Y, Hanai T, Miwa T, et al (2023). Effect of selenium deficiency on the development of overt hepatic encepha-lopathy in patients with chronic liver disease. J Clin Med, 12(8):2869.
2. Cheemerla S, Balakrishnan M (2021). Glob-al epidemiology of chronic liver dis-ease. Clin Liver Dis (Hoboken), 17(5): 365–370.
3. Ginès P, Krag A, Abraldes JG, Solà E, Fa-brellas N, Kamath PS (2021). Liver cir-rhosis. Lancet, 398(10308): 1359–1376.
4. Moon AM, Singal AG, Tapper EB (2020). Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroen-terol Hepatol, 18(12): 2650–2666.
5. Khullar V, Firpi RJ (2015). Hepatitis C cir-rhosis: New perspectives for diagnosis and treatment. World J Hepatol, 7(14): 1843–1855.
6. Smith A, Baumgartner K, Bositis C (2019). Cirrhosis: Diagnosis and management. Am Fam Physician, 100(12): 759–770.
7. Gu W, Hortlik H, Erasmus HP, et al (2021). Trends and the course of liver cirrhosis and its complications in Germany: Na-tionwide population-based study (2005 to 2018). Lancet Reg Health Eur, 12: 100240.
8. Premkumar M, Anand AC (2022). Overview of complications in cirrhosis. J Clin Exp Hepatol, 12(4): 1150–1174.
9. Yang YJ, Kim DJ (2021). An overview of the molecular mechanisms contributing to musculoskeletal disorders in chronic liver disease: Osteoporosis, sarcopenia, and osteoporotic sarcopenia. Int J Mol Sci, 22(5): 2604.
10. Lu K, Shi TS, Shen SY, et al (2022). Defects in a liver-bone axis contribute to hepatic osteodystrophy disease progression. Cell Metab, 34(3): 441–457.e7.
11. Shergill R, Syed W, Rizvi SA, Singh I (2018). Nutritional support in chronic liver dis-ease and cirrhotics. World J Hepatol, 10(10): 685–694.
12. Ehnert S, Aspera-Werz RH, Ruoß M, et al (2019). Hepatic osteodystrophy—molecular mechanisms proposed to fa-vor its development. Int J Mol Sci, 20(10): 2555.
13. Pike JW, Lee SM, Benkusky NA, Meyer MB (2020). Genomic mechanisms governing mineral homeostasis and the regulation and maintenance of vitamin D metabo-lism. JBMR Plus, 5(1): e10433.
14. Charoenngam N, Holick MF (2020). Immu-nologic effects of vitamin D on human health and disease. Nutrients, 12(7): 2097.
15. Cantorna MT, Snyder L, Lin YD, Yang L (2015). Vitamin D and 1,25(OH)2D regu-lation of T cells. Nutrients, 7(4): 3011–3021.
16. Ao T, Kikuta J, Ishii M (2021). The effects of vitamin D on immune system and in-flammatory diseases. Biomolecules, 11(11): 1624.
17. Khan MA, Dar HA, Baba MA, Shah AH, Singh B, Shiekh NA (2019). Impact of vitamin D status in chronic liver disease. J Clin Exp Hepatol, 9(5): 574–580.
18. Iruzubieta P, Terán Á, Crespo J, Fábrega E (2014). Vitamin D deficiency in chronic liver disease. World J Hepatol, 6(12): 901–915.
19. Ravaioli F, Pivetti A, Di Marco L, et al (2022). Role of vitamin D in liver dis-ease and complications of advanced chronic liver disease. Int J Mol Sci, 23(16): 9016.
20. Cantín M (2018). World Medical Associa-tion Declaration of Helsinki: Ethical principles for medical research involv-ing human subjects. Reviewing the latest version. Int J Med Surg Sci, 1(4): 339–346.
21. Badar K, Badar I, Badar A, Badar N, Mu-jtaba G, Rasool A (2022). Vitamin D de-ficiency in patients having chronic liver disease: A cross-sectional study. Annals of RSCB, 26(01): 2598–2607.
22. Guruprasad PA, Naaventhan P, Louise C, et al (2021). Guidelines on the manage-ment of ascites in cirrhosis. Gut, 70(1): 9–29.
23. Weissenborn K (2019). Hepatic encephalo-pathy: Definition, clinical grading and diagnostic principles. Drugs, 79(Suppl 1):5-9.
24. Philips A, Sahney C (2016). Oesophageal and gastric varices: Historical aspects, classification and grading: Everything in one place. Gastroenterol Rep (Oxf), 4(3): 186–195.
25. Acharya G, Kaushik RM, Gupta R, Kaushik R (2020). Child-Turcotte-Pugh score, MELD score and MELD-Na score as predictors of short-term mortality among patients with end-stage liver dis-ease in northern India. Inflamm Intest Dis, 5(1):1-10.
26. Jamil Z, Arif S, Khan A, Durrani AA, Ya-qoob N (2018). Vitamin D deficiency and its relationship with Child-Pugh class in patients with chronic liver dis-ease. J Clin Transl Hepatol, 6(2):135-140.
27. Zhao XY, Li J, Wang JH, et al (2016). Vita-min D serum level is associated with Child-Pugh score and metabolic enzyme imbalances, but not viral load in chron-ic hepatitis B patients. Medicine (Baltimore), 95(27): e3926.
28. Kumar R, Kumar P, Saxena KN, et al (2017). Vitamin D status in patients with cirrhosis of the liver and their rela-tives—a case-control study from North India. Indian J Gastroenterol, 36(1):50-55.
29. Fernández NF, Torres PL, Matias DJ, et al (2016). Vitamin D deficiency in chronic liver disease: Clinical-epidemiological analysis and report after vitamin D sup-plementation. Gastroenterol Hepatol, 39(5): 305–310.
30. Pop TL, Sîrbe C, Benţa G, Mititelu A, Gra-ma A (2022). The role of vitamin D and vitamin D binding protein in chronic liver diseases. Int J Mol Sci, 23(18): 10705.
31. Muhsen IN, AlFreihi O, Abaalkhail F, et al (2018). Bone mineral density loss in pa-tients with cirrhosis. Saudi J Gastroenterol, 24(6): 342–347.
32. Lin S, Wang W, Shi L, et al (2022). Severe vitamin D deficiency is strongly associ-ated with liver dysfunction and disease severity in hepatitis B virus-related cir-rhosis and liver failure patients. J Nutr Sci Vitaminol (Tokyo), 68(1): 16–22.
Files
IssueVol 54 No 5 (2025) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v54i5.18640
Keywords
Chronic liver disease Liver cirrhosis Vitamin D Vitamin D deficiency

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Meghji KA, Memon TF, Raqeeb A, Pathan MF, Raqeeb U, Shaikh TZ. Vitamin D Deficiency and Chronic Liver Disease: Investigating Predictive Factors and Their Implications for Patient Care in Pakistan. Iran J Public Health. 2025;54(5):1054-1063.