Fat-soluble vitamin assessment, deficiency and supplementation in infants with cholestasis

Sara Mancell; Maeisha Islam; Anil Dhawan; Kevin Whelan

doi:10.1111/jhn.12957

Fat-soluble vitamin assessment, deficiency and supplementation in infants with cholestasis

Sara Mancell^*, Maeisha Islam, Anil Dhawan, Kevin Whelan

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Background: Infants with cholestasis are at risk of fat-soluble vitamin deficiency. The present study amied to review practice relating to the assessment, deficiency and supplementation of fat-soluble vitamins in infants with cholestasis. Methods: The medical records of all newly diagnosed infants with cholestasis (conjugated bilirubin >17 mmol L^–1/>20% total bilirubin) at King's College Hospital between 2017 and 2019 were reviewed. Data extracted included bilirubin, serum vitamin concentrations (A, D, E), international normalised ratio and evidence of supplementation at initial assessment, as well as at 3 and 6 months. Rates of vitamin assessment, deficiency and supplementation were compared using chi-squared or Fisher's exact test. Results: In total, 136 infants (87 male) with idiopathic neonatal cholestasis (n = 62), biliary atresia (n = 40) and other aetiology (n = 34) were included. Assessment of serum vitamins (A, D, E) was low (33.3%–52.2%) and deficiency was initially high for vitamin D (60.6%) and vitamin E (70.9%). Supplementation prevalence at initial assessment was high (A, E, K), but dropped significantly at 3 and 6 months for vitamin E (p = 0.003) and vitamin K (p = 0.001), whereas vitamin D supplementation was consistently low throughout (25%–33.3%). Infants with biliary atresia were more likely to have vitamins assessed (3 months), be deficient initially (D, E) and supplemented (E, K) throughout. Supplementation continued in up to 80% of infants despite cholestasis resolving. Conclusions: Supplementation was generally high and continued in many despite cholestasis resolving. Deficiency of vitamin D and vitamin E was high at initial assessment, although lower at follow-up. Actual prevalence of deficiency of all vitamins is unknown because monitoring was not consistently performed.

Original language	English
Journal	Journal of Human Nutrition and Dietetics
Volume	35
Issue number	2
Early online date	22 Oct 2021
DOIs	https://doi.org/10.1111/jhn.12957
Publication status	E-pub ahead of print - 22 Oct 2021

Keywords

cholestasis
cholestatic jaundice
fat-soluble vitamins
micronutrients

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10.1111/jhn.12957

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@article{44037ae60bec43d0a6c973572a891889,

title = "Fat-soluble vitamin assessment, deficiency and supplementation in infants with cholestasis",

abstract = "Background: Infants with cholestasis are at risk of fat-soluble vitamin deficiency. The present study amied to review practice relating to the assessment, deficiency and supplementation of fat-soluble vitamins in infants with cholestasis. Methods: The medical records of all newly diagnosed infants with cholestasis (conjugated bilirubin >17 mmol L–1/>20% total bilirubin) at King's College Hospital between 2017 and 2019 were reviewed. Data extracted included bilirubin, serum vitamin concentrations (A, D, E), international normalised ratio and evidence of supplementation at initial assessment, as well as at 3 and 6 months. Rates of vitamin assessment, deficiency and supplementation were compared using chi-squared or Fisher's exact test. Results: In total, 136 infants (87 male) with idiopathic neonatal cholestasis (n = 62), biliary atresia (n = 40) and other aetiology (n = 34) were included. Assessment of serum vitamins (A, D, E) was low (33.3%–52.2%) and deficiency was initially high for vitamin D (60.6%) and vitamin E (70.9%). Supplementation prevalence at initial assessment was high (A, E, K), but dropped significantly at 3 and 6 months for vitamin E (p = 0.003) and vitamin K (p = 0.001), whereas vitamin D supplementation was consistently low throughout (25%–33.3%). Infants with biliary atresia were more likely to have vitamins assessed (3 months), be deficient initially (D, E) and supplemented (E, K) throughout. Supplementation continued in up to 80% of infants despite cholestasis resolving. Conclusions: Supplementation was generally high and continued in many despite cholestasis resolving. Deficiency of vitamin D and vitamin E was high at initial assessment, although lower at follow-up. Actual prevalence of deficiency of all vitamins is unknown because monitoring was not consistently performed.",

keywords = "cholestasis, cholestatic jaundice, fat-soluble vitamins, micronutrients",

author = "Sara Mancell and Maeisha Islam and Anil Dhawan and Kevin Whelan",

note = "Publisher Copyright: {\textcopyright} 2021 The British Dietetic Association.",

year = "2021",

month = oct,

day = "22",

doi = "10.1111/jhn.12957",

language = "English",

volume = "35",

journal = "Journal of Human Nutrition and Dietetics",

issn = "0952-3871",

publisher = "Wiley-Blackwell",

number = "2",

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TY - JOUR

T1 - Fat-soluble vitamin assessment, deficiency and supplementation in infants with cholestasis

AU - Mancell, Sara

AU - Islam, Maeisha

AU - Dhawan, Anil

AU - Whelan, Kevin

PY - 2021/10/22

Y1 - 2021/10/22

N2 - Background: Infants with cholestasis are at risk of fat-soluble vitamin deficiency. The present study amied to review practice relating to the assessment, deficiency and supplementation of fat-soluble vitamins in infants with cholestasis. Methods: The medical records of all newly diagnosed infants with cholestasis (conjugated bilirubin >17 mmol L–1/>20% total bilirubin) at King's College Hospital between 2017 and 2019 were reviewed. Data extracted included bilirubin, serum vitamin concentrations (A, D, E), international normalised ratio and evidence of supplementation at initial assessment, as well as at 3 and 6 months. Rates of vitamin assessment, deficiency and supplementation were compared using chi-squared or Fisher's exact test. Results: In total, 136 infants (87 male) with idiopathic neonatal cholestasis (n = 62), biliary atresia (n = 40) and other aetiology (n = 34) were included. Assessment of serum vitamins (A, D, E) was low (33.3%–52.2%) and deficiency was initially high for vitamin D (60.6%) and vitamin E (70.9%). Supplementation prevalence at initial assessment was high (A, E, K), but dropped significantly at 3 and 6 months for vitamin E (p = 0.003) and vitamin K (p = 0.001), whereas vitamin D supplementation was consistently low throughout (25%–33.3%). Infants with biliary atresia were more likely to have vitamins assessed (3 months), be deficient initially (D, E) and supplemented (E, K) throughout. Supplementation continued in up to 80% of infants despite cholestasis resolving. Conclusions: Supplementation was generally high and continued in many despite cholestasis resolving. Deficiency of vitamin D and vitamin E was high at initial assessment, although lower at follow-up. Actual prevalence of deficiency of all vitamins is unknown because monitoring was not consistently performed.

AB - Background: Infants with cholestasis are at risk of fat-soluble vitamin deficiency. The present study amied to review practice relating to the assessment, deficiency and supplementation of fat-soluble vitamins in infants with cholestasis. Methods: The medical records of all newly diagnosed infants with cholestasis (conjugated bilirubin >17 mmol L–1/>20% total bilirubin) at King's College Hospital between 2017 and 2019 were reviewed. Data extracted included bilirubin, serum vitamin concentrations (A, D, E), international normalised ratio and evidence of supplementation at initial assessment, as well as at 3 and 6 months. Rates of vitamin assessment, deficiency and supplementation were compared using chi-squared or Fisher's exact test. Results: In total, 136 infants (87 male) with idiopathic neonatal cholestasis (n = 62), biliary atresia (n = 40) and other aetiology (n = 34) were included. Assessment of serum vitamins (A, D, E) was low (33.3%–52.2%) and deficiency was initially high for vitamin D (60.6%) and vitamin E (70.9%). Supplementation prevalence at initial assessment was high (A, E, K), but dropped significantly at 3 and 6 months for vitamin E (p = 0.003) and vitamin K (p = 0.001), whereas vitamin D supplementation was consistently low throughout (25%–33.3%). Infants with biliary atresia were more likely to have vitamins assessed (3 months), be deficient initially (D, E) and supplemented (E, K) throughout. Supplementation continued in up to 80% of infants despite cholestasis resolving. Conclusions: Supplementation was generally high and continued in many despite cholestasis resolving. Deficiency of vitamin D and vitamin E was high at initial assessment, although lower at follow-up. Actual prevalence of deficiency of all vitamins is unknown because monitoring was not consistently performed.

KW - cholestasis

KW - cholestatic jaundice

KW - fat-soluble vitamins

KW - micronutrients

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U2 - 10.1111/jhn.12957

DO - 10.1111/jhn.12957

M3 - Article

AN - SCOPUS:85117508528

SN - 0952-3871

VL - 35

JO - Journal of Human Nutrition and Dietetics

JF - Journal of Human Nutrition and Dietetics

IS - 2

ER -

Fat-soluble vitamin assessment, deficiency and supplementation in infants with cholestasis

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