AUTHOR=Vaughan-Shaw P. G. , Buijs L. F. , Blackmur J. P. , Ewing A. , Becher H. , Theodoratou E. , Ooi L. Y. , Din F. V. N. , Farrington S. M. , Dunlop M. G. 

TITLE=A feasibility study of perioperative vitamin D supplementation in patients undergoing colorectal cancer resection

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1106431

DOI=10.3389/fnut.2023.1106431

ISSN=2296-861X

ABSTRACT=BACKGROUND
Vitamin D supplementation improves colorectal cancer (CRC) survival outcomes in randomised trials. The aim of this study was to test the feasibility, safety and efficacy of vitamin D in the pre- and perioperative period in patients undergoing CRC surgery.    
 
METHODS
Patients were given 3200IU oral cholecalciferol (D3) per day perioperatively. Serial serum 25-hydroxyvitamin (25OHD) was measured by liquid chromatography tandem mass spectrometry and compared to untreated CRC controls. 25OHD and C-reactive protein (CRP) levels were compared using adjusted generalized linear mixed-effects models. 
 
RESULTS
122 patients underwent serial perioperative sampling, including 41 patients given high-dose perioperative supplementation.  Supplementation was well tolerated with no adverse or serious adverse events related to supplementation reported. Pre-operative supplementation increased 25OHD levels on the day of surgery (103.9nmol/l vs. 42.5nmol/l, P=8.2E-12). Supplementation increased 25OHD levels at all post-operative timepoints (P<0.001) and attenuated the post-operative drop in 25OHD (46% vs 24% drop, P=3.0E-4). Rate of vitamin D peri-operative insufficiency was significantly less in those on supplementation (e.g. day 3-5, 14% vs. 84%, P=1.41E-08), with multivariate modelling across all timepoints indicating a ~59nmol/l higher 25OHD compared to control patients (P=3.7E-21). Post-operative CRP was lower in patients taking supplementation (e.g. day 3-5 timepoint; 129mg/l vs. 81mg/l, P=0.04).
 
CONCLUSIONS
High dose pre-operative vitamin D supplementation is associated with higher perioperative 25OHD levels, lower rates of vitamin D insufficiency and reduced early postoperative CRP. Alongside published evidence for a beneficial effect of vitamin D on CRC survival outcomes, these novel findings provide strong rationale for early initiation of vitamin D supplementation after a diagnosis of CRC.