Wozniak Laura J, Bechtold Hannah M, Reyen Laurie E, Hall Theodore R, Vargas Jorge H
Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, California
Medical Student Pathway in Clinical and Translational Research, David Geffen School of Medicine at UCLA, Los Angeles, California.
JPEN J Parenter Enteral Nutr. 2015 May;39(4):471-5. doi: 10.1177/0148607114527135. Epub 2014 Mar 14.
Vitamin D plays important roles in both skeletal and nonskeletal health. Limited data suggest that patients with intestinal failure (IF) receiving home parenteral nutrition (PN) are at risk for vitamin D deficiency due to inadequate oral intake, poor absorption, and chronic illness. The purpose of this study was to document vitamin D status in pediatric patients with IF receiving home PN.
We performed a 2-year retrospective review of children with IF followed at our center who had been on home PN for ≥6 months and had ≥1 serum 25-hydroxyvitamin D (25-OHD) level checked as part of routine clinical care. Patients were then categorized as deficient (<20 ng/mL), insufficient (20-29 ng/mL), or normal (≥30 ng/mL) based on their lowest vitamin D level. Demographic data and clinical characteristics were also assessed.
Eleven of 27 children (41%) had ≥1 insufficient 25-OHD level, including one child with vitamin D deficiency. Diagnosis of short bowel syndrome (compared with dysmotility or malabsorption syndromes) was associated with decreased likelihood of suboptimal vitamin D status, with an odds ratio of 0.12 (95% confidence interval, 0.02-0.8, P = .028). Osteopenia was noted in 59% of the cohort. There was a trend toward higher risk for osteopenia in patients with low 25-OHD levels compared with those with normal 25-OHD levels (82% vs 44%, P = .109).
Suboptimal 25-OHD levels are common in children with IF on home PN. This emphasizes the critical importance of routine surveillance of serum vitamin D levels and consideration of enteral supplementation when indicated.
维生素D在骨骼和非骨骼健康方面均发挥着重要作用。有限的数据表明，接受家庭肠外营养（PN）的肠衰竭（IF）患者因口服摄入不足、吸收不良和慢性病而有维生素D缺乏的风险。本研究的目的是记录接受家庭PN的儿科IF患者的维生素D状态。
我们对在本中心接受随访的IF患儿进行了为期2年的回顾性研究，这些患儿接受家庭PN≥6个月，并且作为常规临床护理的一部分至少检查过1次血清25-羟维生素D（25-OHD）水平。然后根据患者的最低维生素D水平将其分类为缺乏（<20 ng/mL）、不足（20 - 29 ng/mL）或正常（≥30 ng/mL）。还评估了人口统计学数据和临床特征。
27名儿童中有11名（41%）的25-OHD水平至少有1次不足，其中包括1名维生素D缺乏的儿童。短肠综合征的诊断（与动力障碍或吸收不良综合征相比）与维生素D状态欠佳的可能性降低相关，比值比为0.12（95%置信区间，0.02 - 0.8，P = 0.028）。队列中有59%的患者存在骨质减少。与25-OHD水平正常的患者相比，25-OHD水平低的患者发生骨质减少的风险有升高趋势（82%对44%，P = 0.109）。
接受家庭PN的IF儿童中25-OHD水平欠佳很常见。这强调了常规监测血清维生素D水平以及在有指征时考虑肠内补充的至关重要性。
