Blood levels of vitamin D in children and adolescents with chronic cholestasis

Abstract

ResumoObjetivo: verificar os níveis plasmáticos de vitamina D de pacientes colestáticos crônicos e relacionar com estado nutricional, tempo de colestase e uso de suplemento vitamínico.Métodos: estudo transversal controlado, cujo fator em estudo é colestase crônica e o desfecho, o nível plasmático de vitamina D. Pacientes entre quatro meses a 18 anos, atendidos na unidade de gastroenterologia pediátrica do HCPA; como controles, crianças eutróficas da mesma faixa etária. Foi coletado sangue para as dosagens por radioimunoensaio, e realizadas avaliação antropomé-trica, pesquisa de tempo de colestase e uso de suplemento vitamínico.Resultados: foram avaliadas 22 crianças e adolescentes com colestase crônica e 17 controles. O valor médio de vitamina D entre os pacientes foi de 13,7 ± 8,39 ng/ml, enquanto que nos controles foi de 25,58 ± 16,73 ng/ml (p= 0,007). A prevalência de hipovitaminose D, entre os pacientes, foi de 36%. A mediana do tempo de colestase foi de um ano. A avaliação antropométrica (NCHS) demonstrou 36% de desnutrição pelo peso, e 41% para estatura. Na avaliação antropométrica pelo escore z, obtivemos prevalência de desnutrição para os critérios altura/idade e peso/idade de 33,3% e 23,8%, respectivamente. Avaliado peso em relação altura, não observamos valores abaixo de dois desvios padrão. Não foi observada relação entre o estado nutricional, o uso de suplemento oral e os níveis plasmáticos de vitamina D Conclusões: os níveis plasmáticos de vitamina D em colestáti-cos foram menores do que os dos controles, sem relação com estado nutricional, tempo de colestase e/ou uso suplementação vitamínica. AbstractObjective: to verify blood levels of vitamin D in patients with chronic cholestasis, and relate them to nutritional status, length of time since the onset of cholestasis and use of vitamin supplement.Methods: controlled cross-sectional study with chronic cholestasis as study factor and blood levels of vitamin D as outcome. The study included patients aged between 4 months and 18 years, who were cared for at the Pediatric Gastroenterology Unit of Hospital de Clínicas de Porto Alegre. Controls were eutrophic children in the same age range. Blood was collected for radioimmunoassay. Anthropometric analyses were performed, as was determination of the length of time since the onset of cholestasis and use of vitamin supplement.Results: twenty-two patients and 17 controls were evaluated. Average vitamin D level in patients was 13.7 ± 8.39 ng/ml, compared to 25.58 ± 16.73 ng/ml in controls (p = 0.007). Prevalence of hypovitaminosis D in patients was 36%. Median of period of time since the onset of cholestasis was 1 year with variation of 6 months to the 25th percentile and 3.9 years to the 75th percentile. Anthropometric evaluation (NCHS) showed 36% of malnutrition by weight and 41% by height. Anthropometric evaluation according to Z score showed 33.3% and 23.8% prevalence of malnutrition for the criteria height/age and weight/age, respectively. The evaluation of weight regarding height did not show values bel...

Relationship of Serum Vitamin D with Liver Disease Severity and Bone Abnormalities in Cholestatic Children

“…The high prevalence of vitamin D deficiency (92%) that we observed in the current study is considerably higher than that observed by Bastos from Brazil (36% or 5/22), 2 Argao from the United States (29% or 10/34) 15 and Mohammadi from Iran (10% or 5/48). 1 In the latter, however, 60% (29 of 48) also had vitamin D insufficiency.…”

“…Cholestasis is defined as reduced flow of bile in the duodenum caused by the absence of intrahepatic bile ducts, an obstruction of the extrahepatic ducts or the failure of hepatocytes to secrete bile. 2 Metabolic bone disease that may occur in individuals with chronic liver disease is referred to as hepatic osteodystrophy. 10 Our study showed that vitamin D deficiency is present in majority of children with cholestatic liver disease.…”

“…Vitamin D deficiency occurs in patients with cholestasis, from 10% to 36% in children, to 92% in adults, regardless of the underlying cause of liver disease. [1][2][3][4] This may be secondary to dietary insufficiency, decreased availability of bile salts essential for the absorption of fat-soluble vitamins, defective hepatic conversion of vitamin D2 or D3 to the hydroxylated molecule or a reduced production of vitamin D-binding protein. 5 Normally, exposure to sunlight is the main source of vitamin D, which is converted to 25-hydroxyvitamin D (25-[OH]D) in the liver, and then converted into the metabolically active form, 1,25-dihydroxyvitamin D (1,25-[OH]D) in the kidney.…”

Nutritional evaluation of children with chronic cholestatic disease

“…23 Nutritional inadequacy was higher when AC, TST, and AMC indices were used. Regarding AC, 43.9% of patients had some degree of depletion; TST, 46.2%; and AMC, 71.1%.…”

Association between vitamin D level and patients with cholestasis

“…17,18 In this study, 56% of patients were found to have hypovitaminosis D a finding that is higher than similar studies with reported prevalence of 25%-36% in patients with chronic hepatopathy and cholestasis. 16,19 Vitamin D deficiency was reported in 30% < 20ng/ml) and 26% had insufficient levels (20-30 ng/ml). Findings are less than the reported 92.4% among 109/118 patients with vitamin D deficiency secondary to liver diseases not only cholestasis which disrupt activation of vitamin D in liver.…”