Enteral nutrition and antibiotic use increase the risk for vitamin K deficiency in patients with severe motor and intellectual disabilities

Abstract

Summary Background & aims We have investigated the possible risk factors for vitamin K deficiency in subjects with severe motor and intellectual disabilities (SMID). Methods Eighty-two SMID patients were evaluated for their vitamin K intake, serum PIVKA (protein induced by vitamin K absence) -II and ucOC (undercarboxylated osteocalcin) levels; which are vitamin K-dependent hepatic and bone markers, respectively. Results Thirty-six and 19 patients were receiving enteral nutrition (EN) and antibiotics, respectively. Although their serum levels were above the upper reference range in 52% of the subjects for PIVKA-II and 30% of those for ucOC, overt abnormalities in blood coagulation were not observed. Multivariate analyses revealed that EN and antibiotic treatment were significant predictors of the serum PIVKA-II and ucOC levels. Antibiotic treatment affected their serum levels differently in those with EN and those with oral intake (OI). In subjects without antibiotic treatment, vitamin K intake was significantly correlated with circulating levels of PIVKA-II and ucOC, and the breakpoints of vitamin K intake for PIVKA-II and ucOC were 2.5 μg/BW/day and 5.5 μg/BW/day, respectively. Conclusions Vitamin K deficiency was highly prevalent in SMID patients, especially in those receiving both EN and antibiotics. Considering the facts that much more vitamin K is required in the bone than in the liver, and the SMID patients are at high risk of fracture, vitamin K supplementation would be of help in these subjects.