Vitamin C in Home Parenteral Nutrition: A Need for Monitoring.

Julienne Grillot,Cécile Chambrier,Emilie Blond,Madeleine Lauverjat,Thomas Couronne,Charlotte Bergoin,Catherine Peraldi,Didier Barnoud,Sabrina Ait

doi:10.3390/nu12061667

Abstract

To date, there are no recommendations about screening plasma vitamin C concentration and adjust its supplementation in patients on long-term home parenteral nutrition (HPN). The aim of this study was to evaluate vitamin C status and determine if a commercial multivitamin preparation (CMVP) containing 125 mg of vitamin C is sufficient in stable patients on HPN. All clinically stable patients receiving HPN or an intravenous fluid infusion at least two times per week for at least 6 months, hospitalized for nutritional assessment, were retrospectively included, for a total of 186 patients. We found that 29% of the patients had vitamin C insufficiency (i.e., <25 µmol/L). In univariate analysis, C-reactive protein (CRP) (p = 0.002) and intake of only 125 mg of vitamin C (p = 0.001) were negatively associated with vitamin C levels, and duration of follow-up in our referral center (p = 0.009) was positively associated with vitamin C levels. In multivariate analysis, only CRP (p = 0.001) and intake of 125 mg of vitamin C (p < 0.0001) were independently associated with low plasma vitamin C concentration. Patients receiving only CMVP with a low plasma vitamin C level significantly received personal compounded HPN (p = 0.008) and presented an inflammatory syndrome (p = 0.002). Vitamin C insufficiency is frequent in individuals undergoing home parenteral nutrition; therefore, there is a need to monitor plasma vitamin C levels, especially in patients on HPN with an inflammatory syndrome and only on CMVP.

Highlights

Home parenteral nutrition (HPN) is a lifesaving therapy for patients who cannot meet nutritional requirement intakes using the oral and/or enteral route
We found that almost 30% of adult patients with home parenteral nutrition (HPN) or intravenous fluid infusion had vitamin
In our referral center, patients on long-term HPN had plasma vitamin C concentration monitoring annually or every two years, and their nutrient intakes were adjusted when needed, which probably explains the significant difference in patients with low levels of vitamin C depending on the duration of follow-up in our center

Summary

Introduction

Home parenteral nutrition (HPN) is a lifesaving therapy for patients who cannot meet nutritional requirement intakes using the oral and/or enteral route. Owing to the absence of micronutrients in parenteral formulations, provision for vitamins and trace elements is required [1]. Vitamin C (ascorbic acid) is an essential water-soluble vitamin because, unlike many animals, humans are unable to synthetize it [2]. A regular and adequate intake of vitamin C is required owing to the low storage capacity of the human body. Vitamin C has several physiologic roles in humans such as being a cofactor for various enzymes including those involved in the metabolism of cholesterol to bile. Scurvy is a clinical diagnosis of vitamin C deficiency, confirmed by low plasma vitamin C concentrations but yet not clearly define

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