The Prevalence of Vitamin D Insufficiency and Deficiency and Their Relationship with Bone Mineral Density and Fracture Risk in Adults Receiving Long-Term Home Parenteral Nutrition
Nutrients 2017, 9(5), 481; doi:10.3390/nu9050481
2,000 IU of vitamin D with Home Parenteral Nutrition (This includes initial 7,000 IU daily) Average of only 26 nanograms of Vitamin D
It is amazing that HPN does not use gut-friendly forms of Vitamin D
They know that the person cannot get nutrtion via the gut, yet they continue to give vitamin D orally!
With just 200 IU vitamin D in intravenous feeds, deficiency results
Vitamin D injection is far better than oral for diabetics (poor gut) – RCT March 2017
Getting Vitamin D into your body has the following chart
Overview Gut and vitamin D contains the following summary
- Gut problems result in reduced absorption of Vitamin D, Magnesium, etc.
- Celiac disease has a strong genetic component.
- Most, but not all, people with celiac disease have a gene variant.
- An adequate level vitamin D seems to decrease the probability of getting celiac disease.
- Celiac disease causes poor absorption of nutrients such as vitamin D.
- Bringing the blood level of vitamin D back to normal in patients with celiac disease decreases symptoms.
- The prevalence of celiac disease, not just its diagnosis, has increased 4X in the past 30 years, similar to the increase in Vitamin D deficiency.
- Review in Nov 2013 found that Vitamin D helped
- Many intervention clinical trials for vitamin D to prevent or treat Gut problems (93 trials listed as of Jan 2017)
- All items in category gut and vitamin D
Gut category listing contains the following
139 items in GUT category - see also Overview Gut and vitamin D,
- "Ulcerative Colitis" OR UC 689 items March 2019
- "celiac disease" OR CD 1280 items Feb 2018
- "inflammatory bowel disease" OR "inflammatory bowel symptom" 1010 items as of March 2019
- Crohn's 1230 items as of Feb 2019
- Gut-Friendly forms of vitamin D
such as: bio-emulsion, topical, spray, sublingual, inhaled, injection . .
Short bowel syndrome 61 % - Crohn’s disease 53 % - Bowel ischemia 29 % - Bowel atresia 1 3% - Other short bowel 16% Mucosal defect 6 % Motility disorder 11 %
Navaporn Napartivaumnuay 1,* and Leah Gramlich 1,2
1 Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
2 Nutrition Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
(This article belongs to the Special Issue Parenteral Nutrition 2016)
It has been demonstrated that low bone mass and vitamin D deficiency occur in adult patients receiving home parenteral nutrition (HPN). The aim of this study is to determine the prevalence of vitamin D insufficiency and deficiency and its relationship with bone mineral density (BMD) and fracture risk in long-term HPN patients.
Methods: A retrospective chart review of all 186 patients in the HPN registry followed by the Northern Alberta Home Parenteral Nutrition Program receiving HPN therapy >6 months with a 25 (OH) D level and BMD reported were studied.
Results: The mean age at the initiation of HPN was 53.8 (20–79) years and 23 (37%) were male. The mean HPN duration was 56 (6–323) months and the most common diagnosis was short bowel syndrome. Based on a total of 186 patients, 62 patients were categorized based on serum vitamin D status as follows: 1 (24.2%) sufficient, 31 (50%) insufficient and 16 (25.8%) deficient. Despite an average of 1891 IU/day orally and 181 IU/day intravenously vitamin D, the mean vitamin D level was 25.6 ng/mL (insufficiency) and 26.2 ± 11.9 ng/mL in patients with the highest 10-year fracture risk.
Conclusion: Suboptimal vitamin D levels are common among patients on long-term HPN despite nutrient intake that should meet requirements.
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