Clin Nutr. 2013 Feb 21. pii: S0261-5614(13)00051-4. doi: 10.1016/j.clnu.2013.02.005
Ellegård L, Kurlberg G, Bosaeus I.
Department of Clinical Nutrition, Sahlgrenska University Hospital, Göteborg, Sweden. Electronic address: lasse.ellegard at nutrition.gu.se.
BACKGROUND: In intestinal failure, specific nutrient deficiencies especially for fat-soluble vitamins can be expected in addition to energy-protein malnutrition. We report serum levels of fat soluble vitamins, and bone density in out-patients with intestinal failure (IF).
METHODS: 106 outpatients with IF were assessed during routine visits. 78 patients underwent DXA-scan for bone density. Vitamin D levels < 50 nmol/l were defined as deficiency, and 75-150 as optimal. Vitamin A and E deficiencies were defined as <1.0 and <14 μmol/l respectively. INR ≥ 1.2 without liver disease or anti-vitamin K therapy was classified as vitamin K deficiency.
RESULTS: Mean serum vitamin D level was 45 nmol/l at first visit, and 64 nmol/l at follow up (n = 76, p = 0.0001 by paired t-test). Overall prevalence of vitamin D deficiency was 67%.
Only 12% of all patients had optimal D-vitamin status. 88% of assessed patients had low bone density.
12% had subnormal vitamin A levels and 25% had subnormal vitamin E levels. 32% had abnormal INR values. At follow up 34% remained vitamin D deficient whereas 29% had optimal levels. By oral substitution, vitamin A and E status were normalised, and K status improved.
CONCLUSION: Vitamin D deficiency and osteoporosis are common in outpatients with intestinal failure, and should be adequately substituted.
Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Strange that they supplemented with Vitamin A and Vitamin E, but not Vitamin D. which was the most deficient.
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