Fat-soluble Vitamin Deficiency Research Articles

Determination of nutrient adequacy of the food catered in the child care homes (CCHs) of Sunsari district

Summary Malnutrition continues to be a primary cause of ill health and mortality among school age orphan and vulnerable children in developing countries. Objective: Determination of nutrient adequacy of the food catered in the child care homes of Sunsari district. Methods: Weighing method was used for determining the amount of food eaten. T-test and bivariate spearman correlation coefficients were used to compare the nutrient intake with respective RDA and to determine the association between nutrient intake and malnutrition respectively. Results: The study revealed, 33.82% and 17.39% of study population were stunted and underweight respectively. Equal percentages (7.81%) of study population were overweight and thin. Probability of calorie and protein adequacy was found in 52.94% and 89.71% of study population in CCHs. Calcium intake of all children and adolescent were found to be below their RDA. Cereals contributed the highest amount by weight (355.3 g) and proportion (39%) to the total diet for the study population in CCHs. Fruits 1% (12.9 g) and additional oil 2% (20.9 g) made a small contribution to the study population dietary intake. Fish and eggs were completely lacking in their diet. Probability of iron inadequacy was found in 80.9% of study population in CCHs.

Fat Soluble Vitamin, B12 and Iron Deficiency in Patients with Coliform Small Intestinal Bacterial Overgrowth (SIBO)

Background and Hypothesis: Vitamin deficiency has been described as a clinical complication of SIBO. However, it is unclear if the type of bacterial colonization is an important determinant in vitamin and nutritional complications. Our aim was to characterize the prevalence of specific vitamin and mineral deficiencies (vitamins A, D, E, K, B12, and iron) in patients with and without coliform SIBO. We hypothesized that results would show a significant increase in the incidence of vitamin and/or mineral deficiency in patients with coliform SIBO. 
 Methods: A prospective registry was formulated, consisting of patients presenting to our outpatient motility clinic with suspected SIBO. Serum levels of vitamins A, D, E, INR for K, B12 and iron studies were obtained. Upper enteroscopy-aspiration and quantitative aerobic-anaerobic cultures were performed. Primary study endpoints were prevalences of clinical vitamin/mineral deficiencies (A, D, E, K, B12, and iron) based on the final diagnosis: A) SIBO by coliform bacteria (>104 CFU/mL), B) SIBO by upper respiratory tract (URT) bacteria (>105 CFU/mL) and no SIBO. 2x3 chi square, univariate and multivariate analyses were utilized. 
 Expected Results: 128 subjects were enrolled, and 96 subjects underwent aspiration. Final diagnoses were the following: coliform SIBO in 32 (33%) and no SIBO or URT SIBO in 64 (67%). The presence of any vitamin deficiency appears to be more prevalent in patients with coliform SIBO (46.7%) than those without (28.1%), but it is currently unclear if these differences reach statistical significance. 
 Conclusions: 1) Fat-soluble vitamin deficiency may be more common in coliform SIBO, but its absence does not exclude the possibility of coliform SIBO being present. 2) Although a high folate and low B12 can be suggestive of SIBO, these derangements were not common in our heterogeneous group of patients. 
 *Will send update following data analysis*

Fatty acid oxidation disorders.

Fatty acid oxidation disorders (FAODs) are inborn errors of metabolism due to disruption of either mitochondrial β-oxidation or the fatty acid transport using the carnitine transport pathway. The presentation of a FAOD will depend upon the specific disorder, but common elements may be seen, and ultimately require a similar treatment. Initial presentations of the FAODs in the neonatal period with severe symptoms include cardiomyopathy, while during infancy and childhood liver dysfunction and hypoketotic hypoglycemia are common. Episodic rhabdomyolysis is frequently the initial presentation during or after adolescence; although, these symptoms may develop at any age for most of the FAODs The treatment of all FAOD's include avoidance of fasting, aggressive treatment during illness, and supplementation of carnitine, if necessary. The long-chain FAODs differ by requiring a fat-restricted diet and supplementation of medium chain triglyceride oil and often docosahexaenoic acid (DHA)-an essential fatty acid, crucial for brain, visual, and immune functions and prevention of fat soluble vitamin deficiencies. The FAOD are a group of autosomal recessive disorders associated with significant morbidity and mortality, but early diagnosis on newborn screening (NBS) and early initiation of treatment are improving outcomes. There is a need for clinical studies including randomized, controlled, therapeutic trials to continue to evaluate current understanding and to implement future therapies.

Deficiencies in fat soluble vitamins and TE is not uncommon in NET patients on SSA. Creon use, prescribed for NET patients with diarrhoea and steatorrhoea was more frequent in patients on SSA for more than a year. Supplementation of fat soluble vitamins and TE should be considered

Deficiencies in fat soluble vitamins and TE is not uncommon in NET patients on SSA. Creon use, prescribed for NET patients with diarrhoea and steatorrhoea was more frequent in patients on SSA for more than a year. Supplementation of fat soluble vitamins and TE should be considered

Beneficial Effect of Oligofructose-Enriched Inulin on Vitamin D and E Status in Children with Celiac Disease on a Long-Term Gluten-Free Diet: A Preliminary Randomized, Placebo-Controlled Nutritional Intervention Study

Prebiotics have been shown to improve absorption of some nutrients, including vitamins. This pilot study evaluated the effect of the prebiotic oligofructose-enriched inulin (Synergy 1) on fat-soluble vitamins status, parathormone, and calcium-related elements in pediatric celiac disease (CD) patients (n = 34) on a strict gluten-free diet (GFD). Participants were randomized into a group receiving 10 g of Synergy 1 or placebo (maltodextrin) together with a GFD. At baseline and after 3 months of intervention, 25-hydroxyvitamin D [25(OH)D], parathormone, vitamin E and A, calcium, phosphate, magnesium, total protein, and albumin were determined. Concentration of 25(OH)D increased significantly (p < 0.05) by 42% in CD patients receiving Synergy 1 in GFD, whereas no change was observed in placebo. Vitamin D status reached an optimal level in 46% of patients receiving Synergy 1. No significant difference in parathormone, calcium, and phosphate levels was observed. Concentration of vitamin E increased significantly (p < 0.05) by 19% in patients receiving Synergy 1, but not in the placebo. Vitamin A levels were not changed. Supplementation of GFD with Synergy 1 improved vitamin D and vitamin E status in children and adolescents with CD and could be considered a novel complementary method of management of fat-soluble vitamins deficiency in pediatric CD patients.

Nutrition in Pediatric Chronic Liver Disease.

More than one-half of children with chronic liver disease suffer from malnutrition, which leads not only to a poor quality of life and even possibly catastrophic complications, but also to poor outcomes after a liver transplantation. These children have increased metabolic demands but often decreased intake with malabsorption and altered nutrient utilization, all of which make it difficult to keep up with nutritional demands. Assessment of a patient's nutritional status should be timely, and it should be performed routinely and proactively. When specific nutritional needs are identified, these should be addressed with a multidisciplinary team approach and with the close guidance of an experienced pediatric dietician. The assessment includes anthropometric and laboratory assessments, in addition to a careful physical examination and a detailed patient history. The specific nutritional needs vary, but generally dietary intervention focuses on increasing caloric intake, supplementation with medium-chain triglycerides, and prevention of essential fatty acid and fat-soluble vitamin deficiencies. [Pediatr Ann. 2018;47(11):e445-e451.].

Prevalence and factors associated with fat-soluble vitamin deficiency in adolescents.

fat-soluble vitamin deficiency may be a health problem not recognized in children and adolescents. to estimate the prevalence and factors associated with the deficiency of vitamins A, D and E among adolescent students fromNortheastern Brazil. transversal study with adolescents aged 12 to 19 of both genders. A questionnaire to collect socioeconomic and lifestyle data and foodintake was applied to adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrationsof retinol, β-carotene, α-tocopherol and 25-hydroxy vitamin D (25[OH]D). the intake of vitamins A (50.3%), E (94.0%) and D (99.8%), as well as α-tocopherol (88.1%), β-carotene (74.1%), 25(OH)D (50.9%)and retinol (46.6%) serum levels were mostly deficient/insufficient. An increased risk of α-tocopherol deficiency was observed in girls (PR = 1.11)and an increased risk of 25(OH)D deficiency was observed in boys (PR = 1.41). An increased likelihood of β-carotene (PR = 1.14) and 25(OH)D (PR = 1.38) insufficiency was observed in overweight individuals. the adolescents had a deficit in the intake and in serum levels of fat-soluble vitamins. The greatest risk of inadequacy was associatedwith gender and weight excess. However, the behavior of fat-soluble vitamins in adolescents needs further research.

Assessment and Management of Nutrition Status in the Hospitalized Patient With Cirrhosis.

Assessment and Management of Nutrition Status in the Hospitalized Patient With Cirrhosis.

Exocrine Pancreatic Insufficiency and Malnutrition in Chronic Pancreatitis: Identification, Treatment, and Consequences.

The purpose of this study was to examine the impact of exocrine pancreatic insufficiency (EPI) on chronic pancreatitis (CP) patients and to identify challenges with its diagnosis and treatment. Ninety-one patients with CP diagnosed with endoscopic ultrasound were identified and assessed for symptoms of EPI, fat-soluble vitamin levels, dual-energy x-ray absorptiometry scan T-scores, and treatment with pancreatic enzyme replacement therapy. All patients were also screened with the Malnutrition Universal Screening Test. Exocrine pancreatic insufficiency was diagnosed in 84.6% (77/91) of patients based on symptoms of bloating, steatorrhea, or weight loss. Of these patients, 35.2% (19/54) had vitamin A deficiency, 62.5% (55/88) had vitamin D deficiency, and 17.7% (9/51) had vitamin E deficiency. Either osteopenia or osteoporosis was found in 68.9% (31/45). A medium or higher risk for malnutrition based on Malnutrition Universal Screening Test score of 1 or higher was found in 31.5% (28/89). Malnutrition Universal Screening Test score of 1 or higher was associated with an increased risk for osteopenia and osteoporosis on Fisher's exact test (P = 0.0037). There is a high prevalence of fat-soluble vitamin deficiencies, osteopathy, and malnutrition in CP patients, which is underestimated due to a lack of effective diagnosis and suboptimal therapies for EPI.

Pleiotropic effect of vitamin D in cystic fibrosis.

Cystic fibrosis - CF - is the most common recessively autosomally and inherited disorder in the Caucasian population. It is incurable, multi-systemic disease with progressive course. CF is caused by CFTR gene mutation, the product of which is Cystic Fibrosis Transmembrane Conductance Regulator (CFTR). CF patients are exposed to fat-soluble vitamins deficiency, including vitamin D. It is due to the fat malabsorption (caused by exacerbation exocrine pancreatic insufficiency), decreased sun exposure (caused by receiving antibiotics photophobia), reduction of adipose tissue and insufficient supply with food. The discovery of vitamin D receptor (VDR) presence outside the skeletal system allowed to conclude, that vitamin D is responsible not only for mineral economy, but also for immunological processes, respiratory status, intestial microflora and cystic fibrosis - related diabetes (CFRD) course. Based on literature data, it is suggested that vitamin D plays an important role in the prevention of diseases coexisting with CF. The right dosage of vitamin D allows to maintain a better lung function and prevent chronic pulmonary infections. It has also been shown that normal levels of vitamin D may be important in increasing the chances of successful lung transplant surgery. Taking the wide spectrum of vitamin D effect into account, it is recommended to maintain serum concentrations above the minimum in patients with CF. In summary, maintaining the proper vitamin D levels in patients with CF is important because of its pleiotropic effect. It can be achieved through regular monitoring of vitamin D levels and individual supplementary dose for each patients.

Deficiency of fat-soluble vitamins, minerals and trace elements in patients with chronic pancreatitis of different etiology

Prolonged inflammation could be considered as the leading cause of chronic diseases such as cardiovascular disorders, type two diabetes, and obesity. N-acetylcysteine (NAC) is considered an antioxidant. The present meta-analysis aims to determine the efficacy of NAC in alleviating inflammation and oxidative stress. PubMed-Medline, SCOPUS, Web of Science and Embase databases and Google Scholar were searched up to Nov 2019. Random effect analysis was used to perform meta-analysis. Subgroup analyses were carried out to find heterogeneity sources. Meta-regression analysis was used to explore linear relationship between effect size and variables. Trim and fill analysis were performed in case of the presence of publication bias. Quality assessment was performed using Cochrane Collaboration's tool. A total of 28 studies were included in meta-analysis. NAC significantly decreased malondialdehyde (MDA) (SMD = −1.44 μmol/L; 95% CI: −2.05, −0.84; P < 0.001), IL-8 (WMD = −2.56 pg/ml; 95% CI: −3.89, −1.23; P < 0.001) and homocysteine (WMD = −1.45 pg/ml; 95% CI: −2.74, −0.17; P = 0.027) levels. There were no significant effects of NAC supplementation on CRP (SMD = −0.1 g/L; 95% CI: −0.52, 0.32; P = 0.647), TNF- α (WMD = −0.2 pg/ml; 95% CI: −0.65, 0.25; P = 0.378) and IL-6 (WMD = −0.41 pg/ml; 95% CI: −1.15, 0.32; P = 0.270) levels. However, NAC effects were significant in ameliorating TNF-α and IL-6 using sensitivity analysis. NAC significantly decreased MDA, IL-8, and homocysteine levels. The effects of NAC on amending TNF-α and IL-6 levels were significant after sensitivity analysis. No significant change was observed on CRP levels.

Retinol, α-Tocopherol and Vitamin D3 in White MuscleDisease

Vitamins are essential for the health of all living organisms. Vitamins E, A, D and K are known as fat-soluble vitamins, and deprivation of vitamin E causes various disorders, especially in the reproduction and cardiovascular systems and in muscle functions. Vitamin A, on the other hand, has roles in various biological functions – like eyesight – and the growth, reproduction and differentiation of epithelial cells. Vitamin A deficiency leads to the keratinization of the epithelium, and disorders related to the metaplasies of the genital and genitourinary systems. Conversely, vitamin D is defined as a pro-hormone and is responsible for Cahomeostasis, and thus indirectly affects the bone metabolism, bone structure, and cellular and neural functions of Ca. White muscle disease (WMD) can occur in newborn lambs, but is more commonly seen in lambs of up to 3 months of age. In this study, 30 lambs of 3 to 50-days-old from different flocks diagnosed with White Muscle Disease (WMD) were selected as research material, while the control group consisted of 8 healthy lambs. With the aim of clarifying the cause of WMD, serum fat-soluble vitamins, retinol, α-tocopherol and vitamin D3 levels were determined in 16 lambs. Gluteal and heart musclet issue samples also were taken from 30 lambs with WMD. The vitamin levels of the samples were analysed by HPLC. The levels of serum α-tocopherol, retinols, and vitamin D3 were foundto be low in the diseased animals, but only retinol (p&lt;0.001) and α-tocopherol (p&lt;0.0011) level differences were statistically relevant. Macroscopically, Zenker’s necrosis was determined in the heart muscles of 17 lambs, and in the gluteal and chest muscles of 6 lambs. 7 lambs displayed necrosis in both their heart and in gluteal muscles. The samples were analyzed microscopically to reach similar findings: swollen homogeneous pink muscles, pycnotic nuclei, and hyperaemic and haemorrhagic blood vessels in gluteal, chest and heart muscles. Hyaline degeneration and Zenker's necrosis, dystrophic regions in necrotic areas, cc was detected as a severe disease in lambs at an early stage of life with advanced degeneration in different muscle tissues. Deficiency of fat-soluble vitamins was also detected in the sick animals. Control group lambs had higher levels of α tocopherol and retinol (p&lt;0.001) compared to the sick lambs. .

Retinol, α-tocopherol and vitamin D3 in White MuscleDisease

Vitamins are essential for the health of all living organisms. Vitamins E, A, D and K are known as fat-soluble vitamins, and deprivation of vitamin E causes various disorders, especially in the reproduction and cardiovascular systems and in muscle functions. Vitamin A, on the other hand, has roles in various biological functions – like eyesight – and the growth, reproduction and differentiation of epithelial cells. Vitamin A deficiency leads to the keratinization of the epithelium, and disorders related to the metaplasies of the genital and genitourinary systems. Conversely, vitamin D is defined as a pro-hormone and is responsible for Cahomeostasis, and thus indirectly affects the bone metabolism, bone structure, and cellular and neural functions of Ca. White muscle disease (WMD) can occur in newborn lambs, but is more commonly seen in lambs of up to 3 months of age. In this study, 30 lambs of 3 to 50-days-old from different flocks diagnosed with White Muscle Disease (WMD) were selected as research material, while the control group consisted of 8 healthy lambs. With the aim of clarifying the cause of WMD, serum fat-soluble vitamins, retinol, α-tocopherol and vitamin D3 levels were determined in 16 lambs. Gluteal and heart musclet issue samples also were taken from 30 lambs with WMD. The vitamin levels of the samples were analysed by HPLC. The levels of serum α-tocopherol, retinols, and vitamin D3 were foundto be low in the diseased animals, but only retinol (p&lt;0.001) and α-tocopherol (p&lt;0.0011) level differences were statistically relevant. Macroscopically, Zenker’s necrosis was determined in the heart muscles of 17 lambs, and in the gluteal and chest muscles of 6 lambs. 7 lambs displayed necrosis in both their heart and in gluteal muscles. The samples were analyzed microscopically to reach similar findings: swollen homogeneous pink muscles, pycnotic nuclei, and hyperaemic and haemorrhagic blood vessels in gluteal, chest and heart muscles. Hyaline degeneration and Zenker's necrosis, dystrophic regions in necrotic areas, cc was detected as a severe disease in lambs at an early stage of life with advanced degeneration in different muscle tissues. Deficiency of fat-soluble vitamins was also detected in the sick animals. Control group lambs had higher levels of α tocopherol and retinol (p&lt;0.001) compared to the sick lambs. .

Primary sclerosing cholangitis: a pre-malignant condition

Primary sclerosing cholangitis (PSC) is a chronic, progressive, cholestatic liver disease with no known cure. It is a serious condition, and diagnosis comes with an increased risk of developing cancer of the gallbladder, bile ducts or liver. Symptoms can include fatigue and jaundice, although the disease can be initially asymptomatic. Patients are at risk of deficiencies in fat-soluble vitamins. PSC is also associated with ulcerative colitis, and patients with a dual diagnosis will have an increased risk of developing bowel cancer. In addition, patients can develop fatal complications from colitis or liver failure. As such, primary sclerosing cholangitis can be characterised as a pre-malignant condition. In view of this, it is essential that patients undergo regular surveillance to observe and rapidly treat any developing complications.

Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis.

Chronic pancreatitis is a chronic inflammatory disease of the pancreas characterised by irreversible morphological change and typically causing pain and/or permanent loss of function. This progressive, irreversible disease results in destruction of healthy pancreatic tissue and the development of fibrous scar tissue. Gradual loss of exocrine and endocrine function follows, along with clinical manifestations such as steatorrhoea, abdominal pain and diabetes. Nutrition in chronic pancreatitis has been described as a problem area and, until recently, there was little research on the topic. It is often asserted that >90 % of the pancreas must be damaged before exocrine insufficiency occurs; however, an exploration of the original studies from the 1970s found that the data do not support this assertion. The management of steatorrhoea with pancreatic enzyme replacement therapy is the mainstay of nutritional management, and early identification and treatment is a key. The presence of steatorrhoea, coupled with poor dietary intake (due to intractable abdominal pain, gastrointestinal side effects and often alcoholism) renders the chronic pancreatitis patients at considerable risk for undernutrition, muscle depletion and fat-soluble vitamin deficiency. Premature osteoporosis/osteopenia afflicts two-thirds of patients as a consequence of poor dietary intake of calcium and vitamin D, low physical activity, low sunlight exposure, heavy smoking, as well as chronic low-grade inflammation. Bone metabolism studies show increased bone formation as well as bone resorption in chronic pancreatitis, indicating that bone turnover is abnormally high. Loss of the pancreatic islet cells occurs later in the disease process as the endocrine cells are diffusely distributed throughout the pancreatic parenchyma. Patients may develop type 3c (pancreatogenic) diabetes, which is complicated by concurrent decreased glucagon secretion, and hence an increased risk of hypoglycaemia. Diabetes control is further complicated by poor diet, malabsorption and (for some) alcoholism, and therefore those with type 3c diabetes have clinical characteristics and therapeutic goals that are different from that of type 1 and type 2 diabetes patients. This review describes emerging research and clinical guidelines for nutrition in chronic pancreatitis.

Diagnostic considerations for cholestatic liver disease.

Cholestatic liver disease results from insufficient bile synthesis, secretion and/or flow through the biliary tract. Common presenting features include fatigue, pruritus, and cholestatic liver enzyme abnormalities wherein elevations of serum alkaline phosphatase and gamma-glutamyltransferases levels exceed those of alanine and aspartate aminotransferases. With prolonged cholestasis, fat soluble vitamin deficiencies, fibrosis, cirrhosis, and, on occasion, carcinoma of the biliary tract or liver can occur. Once mechanical obstruction to bile flow has been ruled out, the majority of causes can be classified as immune-mediated, infectious, or miscellaneous. Because specific therapeutic options are increasing for many causes of cholestasis, an accurate diagnosis is an important first step towards treatment. Thus, this review focuses on the diagnostic features of non-mechanical causes of cholestasis.

Vitamin E supplementation in people with cystic fibrosis.

People with cystic fibrosis are at an increased risk of fat-soluble vitamin deficiency including vitamin E. Vitamin E deficiency can cause a host of conditions such as haemolytic anaemia, cerebellar ataxia and cognitive difficulties. Vitamin E supplementation is widely recommended in cystic fibrosis and aims to ameliorate this deficiency. This is an updated version of the review. To determine the effects of any level of vitamin E supplementation on the frequency of vitamin E deficiency disorders in people with cystic fibrosis. We searched the Cochrane Group's Cystic Fibrosis Trials Register and also searched international trial registers for any ongoing clinical trials that were not identified during our register search.Date of last search of the Register: 10 October 2016. Date of last search of international trial registers: 15 February 2017. Randomised controlled trials and quasi-randomised controlled trials comparing any preparation of vitamin E supplementation to placebo or no supplement, regardless of dosage or duration. Two authors extracted outcome data from each study (published information) and assessed the risk of bias of each included study. Four studies with a total of 141 participants were included in the review, two of these were in children (aged six months to 14.5 years), and the other two did not specify participants' age. All studies used different formulations and doses of vitamin E for various durations of treatment (10 days to six months). Two studies compared the supplementation of fat-soluble as well as water-soluble formulations to no supplementation in different arms of the same study. A third study compared a water-soluble formulation to a placebo; and in the fourth study a fat-soluble formulation of vitamin E was assessed against placebo.At one month, three months and six months, water-soluble vitamin E significantly improved serum vitamin E levels compared with control: at one month, two studies, mean difference 17.66 (95% confidence interval 10.59 to 24.74); at three months, one study, mean difference 11.61 (95% confidence interval 4.77 to 18.45); and at six months, one study, mean difference 19.74 (95% confidence interval 13.48 to 26.00). At one month fat-soluble vitamin E significantly improved serum vitamin E levels compared with control: one month, two studies, mean difference 13.59 (95% CI 9.52 to 17.66). The findings at three months were imprecise; one study; mean difference 6.40 (95% confidence interval -1.45 to 14.25).None of the studies report the review's primary outcomes of vitamin E total lipid ratio or the incidence of vitamin E-specific deficiency disorders, or the secondary outcomes lung function or quality of life. Only one study, comparing water-soluble vitamin E with placebo, reported the secondary outcome of growth and nutritional status (weight), but the results are uncertain due to imprecision around the effect estimate.There was limited detail about randomisation and blinding in the included studies which compromises the quality of the evidence base for the review. The heterogeneous mix of the formulations with differing biovailabilities among these studies also limits the generalisability of the data to the wider cystic fibrosis population. Vitamin E supplementation led to an improvement in vitamin E levels in people with cystic fibrosis, although the studies may have been at risk of bias. No data on other outcomes of interest were available to allow conclusions about any other benefits of this therapy.In future, larger studies are needed, especially in people already being treated with enteric-coated pancreatic enzymes and supplemented with vitamin E, to look at more specific outcome measures such as vitamin E status, lung function and nutritional status. Future studies could also look at the optimal dose of vitamin E required to achieve maximal clinical effectiveness.

Fat-Soluble Vitamin Deficiency in Pediatric Patients with Biliary Atresia.

Objective To analyze the levels of fat-soluble vitamins (FSVs) in pediatric patients with biliary atresia (BA) before and after the Kasai procedure. Methods Pediatric patients with obstructive jaundice were enrolled in this study. The FSV levels and liver function before, 2 weeks after, and 1, 3, and 6 months after the Kasai procedure were measured. Results FSV deficiency was more obvious in patients with BA than in patients with other cholestatic liver diseases, especially vitamin D deficiency. 25-Hydroxy vitamin D (25-(OH)D) deficiency was more pronounced in younger patients before surgery. The 25-(OH)D level was significantly higher in patients with than without resolution of jaundice 3 months after surgery. At 6 months after surgery, the 25-(OH)D level was abnormally high at 8.76 ng/ml in patients with unresolved jaundice. Conclusions Preoperative FSV deficiency, particularly vitamin D deficiency, is common in patients with BA. 25-(OH)D deficiency is more pronounced in younger children before surgery. Postoperative FSV deficiency was still prevalent as shown by the lower 25-(OH)D levels in patients with BA and unresolved jaundice. This required long-term vitamin AD supplementation for pediatric patients with BA and unresolved jaundice after surgery.

Psoriasis and Fat-soluble Vitamins: A Review

Fat-soluble vitamins exhibit numerous routes of immune modulation and specifically alter a variety of pathways in psoriasis pathology. Psoriasis, a chronic immune-mediated disease, often requires a combination of topical, oral, and occasionally, subcutaneous or intravenous therapies making disease management complex. With the complexity of treatment, patient adherence is reduced. Vitamin supplementation as an adjunctive treatment would minimize potential adverse effects from systemic medication, increase patient adherence and decrease overall cost. While vitamin A and D are effective topically, oral supplementation is not currently a mainstay of therapy although data exists to support such supplementation. Data on vitamin E and K implicate the significant role each has in the alteration of the inflammatory cascade responsible for psoriasis. Research showing fat-soluble vitamin deficiency in psoriasis exists and presents greater evidence for oral vitamin treatment in addition to first-line therapies. This review presents the mechanism of action in psoriasis of each fat-soluble vitamin and the data on the efficacy of oral fat-soluble vitamin supplementation in psoriasis and systemic inflammation. We also present fat-soluble vitamin deficiency data shown in psoriasis patients. With the evidence of their targeted mechanism of action, efficacy data with oral supplementation, and evidence of deficiency in patients, oral fat-soluble vitamins should be considered as an adjunct to therapy in psoriasis patients.

Does Nutritional Status Correlate with Vitamin Deficiencies in Chronic Pancreatitis?

Introduction: While chronic pancreatitis has been known to cause fat malabsorption, it remains unclear to what degree this malabsorption leads to fat-soluble deficiencies. Few studies have reported the rate of vitamin deficiency in this population and this study examines whether nutritional status is associated with fat-soluble vitamin and mineral deficiencies. Methods: Patients with known chronic pancreatitis (diagnosed previously with endoscopic ultrasound and CT imaging) were given the Malnutrition Universal Screening Test (MUST) to assess for nutritional status. Vitamin and mineral levels (namely Vitamin A, D, and E and magnesium and calcium) were then measured and analyzed in relation to MUST scores. Results: 31.8% (22/66) of our patients had Vitamin A deficiency, 51.5% (34/66) had a Vitamin D deficiency, and 15.2% (10/66) had a Vitamin E deficiency. 10.6% (7/66) had a magnesium deficiency and 21.2% (14/66) had a calcium deficiency. 19.7% (13/66) were found to be malnourished based on MUST scores. There was no significant correlation between nutritional status based on MUST scores with any of the vitamin or mineral levels (See Figure 1).Figure 1Conclusion: There was a relatively high prevalence of vitamin and mineral deficiency in this population, which lends credence to the effects of fat malabsorption brought on by chronic pancreatitis. There was, however, no correlation between nutritional status and vitamin levels, which suggests that vitamin malabsorption may be difficult to predict and may be influenced by a variety of factors. The high prevalence of nutritional deficiencies, however, does support the routine screening of vitamin and mineral levels in this patient population.Figure 2Figure 3