A Quality Improvement Initiative to Improve Patient Adherence to Vitamin Supplementation in Cystic Fibrosis

Garavaglia, Lisa; Duncan, Christina L.; Toucheque, Malorie; Farley, A; Moffett, Kathryn

doi:10.1097/mpg.0000000000001273

Cited by 6 publications

(4 citation statements)

References 10 publications

(13 reference statements)

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“…In older patients, ensuring adequate knowledge and self‐management skills is an essential component in optimizing nutrition. One center evaluated the effect on vitamin levels before and after use of a knowledge and barrier assessment survey, followed by targeted education in patients with vitamin deficiencies . A significant change was seen in vitamin E levels, knowledge, and adherence.…”

Section: Extrapulmonary Complicationsmentioning

confidence: 86%

Cystic fibrosis year in review 2017

Savant

McColley

2018

Pediatric Pulmonology

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Section: Extrapulmonary Complicationsmentioning

confidence: 86%

Cystic fibrosis year in review 2017

Savant

McColley

2018

Pediatric Pulmonology

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“…Other recommendations that may improve nutritional vitamin D status in these patients include optimizing pancreatic enzyme replacement therapy, improving adherence to treatment (in CF, compliance is usually low, especially for fat soluble vitamin supplements. Recent findings show that enhanced therapeutic adherence implies an improvement in vitamin status of CF patients) [22], taking vitamins together with pancreatic enzymes, prescribing cholecalciferol (D3) [23], or changing supplement delivery systems to a water-or powder-based vehicle.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Status in Pediatric and Young Adult Cystic Fibrosis Patients. Are the New Recommendations Effective?

et al. 2021

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Introduction: In recent years, guidelines for vitamin D supplementation have been updated and prophylactic recommended doses have been increased in patients with cystic fibrosis (CF). Objective: To evaluate safety and efficacy of these new recommendations. Results: Two cohorts of pancreatic insufficient CF patients were compared before (cohort 1: 179 patients) and after (cohort 2: 71 patients) American CF Foundation and European CF Society recommendations were published. Cohort 2 patients received higher Vitamin D doses: 1509 (1306–1711 95% CI) vs 1084 (983–1184 95% CI) IU/Day (p < 0.001), had higher 25 OH vitamin D levels: 30.6 (27.9–33.26 95% CI) vs. 27.4 (25.9–28.8 95% CI) ng/mL (p = 0.028), and had a lower prevalence of insufficient vitamin D levels (<30 ng/mL): 48% vs 65% (p = 0.011). Adjusted by confounding factors, patients in cohort 1 had a higher risk of vitamin D insufficiency: OR 2.23 (1.09–4.57 95% CI) (p = 0.028). Conclusion: After the implementation of new guidelines, CF patients received higher doses of vitamin D and a risk of vitamin D insufficiency decreased. Despite this, almost a third of CF patients still do not reach sufficient serum calcidiol levels.

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“…In a fraction of patients, bowel resection contributes to fat-soluble vitamin deficiencies as well. Finally, in practice, it is not uncommon that poor adherence hinders long-term efforts to normalize fat-soluble vitamin levels [19].…”

Section: The Role Of Fat-soluble Vitamins In Cystic Fibrosismentioning

confidence: 99%

Fat-Soluble Vitamins in Standard vs. Liposomal Form Enriched with Vitamin K2 in Cystic Fibrosis: A Randomized Multi-Center Trial

Nowak

Krzyżanowska-Jankowska

Drzymała-Czyż

et al. 2022

JCM

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Background: We aimed to assess a liposomal fat-soluble vitamin formulation containing vitamin K2 with standard treatment in cystic fibrosis (CF). Methods: A multi-center randomized controlled trial was carried out in 100 pancreatic-insufficient patients with CF. The liposomal formulation contained vitamin A as retinyl palmitate (2667 IU daily) and beta-carotene (1333 IU), D3 (4000 IU), E (150 IU), K1 (2 mg), and K2 as menaquinone-7 (400 µg). It was compared with the standard vitamin preparations in the closest possible doses (2500 IU, 1428 IU, 4000 IU, 150 IU, 2.14 mg, respectively; no vitamin K2) over 3 months. Results: Forty-two patients finished the trial in the liposomal and 49 in the control group (overall 91 pts: 22.6 ± 7.6 years, 62.6% female, BMI 19.9 ± 2.8 kg/m2, FEV1% 70% ± 30%). The main outcome was the change of vitamin status in the serum during the study (liposomal vs. standard): all-trans-retinol (+1.48 ± 95.9 vs. −43.1 ± 121.4 ng/mL, p = 0.054), 25-hydroxyvitamin D3 (+9.7 ± 13.4 vs. +2.0 ± 9.8 ng/mL, p = 0.004), α-tocopherol (+1.5 ± 2.5 vs. −0.2 ± 1.6 µg/mL, p < 0.001), %undercarboxylated osteocalcin (−17.2 ± 24.8% vs. −8.3 ± 18.5%, p = 0.061). The secondary outcome was the vitamin status at the trial end: all-trans-retinol (370.0 ± 116.5 vs. 323.1 ± 100.6 ng/mL, p = 0.045), 25-hydroxyvitamin D3 (43.2 ± 16.6 vs. 32.7 ± 11.5 ng/mL, p < 0.001), α-tocopherol (9.0 ± 3.1 vs. 7.7 ± 3.0 µg/mL, p = 0.037), %undercarboxylated osteocalcin (13.0 ± 11.2% vs. 22.7 ± 22.0%, p = 0.008). Conclusion: The liposomal fat-soluble vitamin supplement containing vitamin K2 was superior to the standard form in delivering vitamin D3 and E in pancreatic-insufficient patients with CF. The supplement was also more effective in strengthening vitamin K-dependent carboxylation, and could improve vitamin A status.

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A Quality Improvement Initiative to Improve Patient Adherence to Vitamin Supplementation in Cystic Fibrosis

Abstract: Our brief, targeted educational interventions regarding vitamin supplementation showed utility in a routine clinic setting.

Cited by 6 publications

References 10 publications

Cystic fibrosis year in review 2017

Cystic fibrosis year in review 2017

Vitamin D Status in Pediatric and Young Adult Cystic Fibrosis Patients. Are the New Recommendations Effective?

Fat-Soluble Vitamins in Standard vs. Liposomal Form Enriched with Vitamin K2 in Cystic Fibrosis: A Randomized Multi-Center Trial

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