Fat‐Soluble Vitamins in Cystic Fibrosis and Pancreatic Insufficiency

Abstract

Objectives To assess the impact of LYM-X-SORB™ (LXS), an organized lipid matrix that has previously been shown to be absorbable without pancreatic enzyme therapy on fat soluble vitamin status in children with CF and PI. Methods Children with CF and PI were randomized to daily LXS or an iso-caloric placebo comparison supplement for 12 months. Serum vitamins A (retinol), D (25-hydroxyvitamin D[25D]), E (α-tocopherol, α-tocopherol:cholesterol ratio) and K (%undercarboxylated osteocalcin [%ucOC] and plasma proteins induced by vitamin K absence factor II [PIVKA II]) were assessed at baseline and 12 months. Dietary intake was determined using 3-day weighed food records, and supplemental vitamin intake by a comprehensive questionnaire. Results 58 subjects (32 males, age 10.3±2.9 yrs [mean±SD]) with complete serum vitamin, dietary and supplemental vitamin data were analyzed. After adjusting for dietary and supplemental vitamin intake, serum retinol increased 3.0±1.4 μg/dL (coefficient±SE) (Adj R2=0.02, p=0.03) and vitamin K status improved as demonstrated by a decreased %ucOC of −6.0±1.6% by 12 months (Adj R2=0.15, p<0.001). These changes occurred in both the LXS and placebo comparison groups. No changes in serum 25D or α-tocopherol were detected. Both nutrition interventions increased caloric intake a mean of 83±666 kcal/d by 12 months. Conclusions Vitamin A and K status improved, while vitamin D and E status was unchanged over 12 month of LXS and iso-caloric placebo comparison supplement in children with CF and PI.

Improved residual fat malabsorption and growth in children with cystic fibrosis treated with a novel oral structured lipid supplement: A randomized controlled trial

“…The complete inclusion/exclusion criteria, study design and method details, Encala™ composition and the results for Encala™ impact on choline and fatty acid status on the full study cohort have been previously reported [10][11][12]. Liver disease and any other significant diagnosis that might impact dietary intake, growth or body composition were exclusion criteria for subjects to participate in this study.…”

Oral Supplementation with a Special Additive of Retinyl Palmitate and Alpha Tocopherol Reduces Growth Retardation in Young Pancreatic Duct Ligated Pigs Used as a Model for Children Suffering from Exocrine Pancreatic Insufficiency

“…This finding is of special interest as there are highly concentrated preparations of fat-soluble vitamins available on the market nowadays. It must be borne in mind that these modern products, providing the fat-soluble vitamins in a water-soluble form, guarantee not only efficient supplementation but also present the risk of oversupply and toxicosis [43,44,45,46,47]. …”

Nutritional status disorders in cystic fibrosis – dietary recommendations and supplementation. A review

“…W przypadku witaminy K dokonuje się pomiaru stężenia białka indukowanego niedoborem witaminy K (Protein Induced by Vitamine K Absence, PIVKA II), które powinno wynosić < 2 ng/ml. Stężenie w osoczu krwi witaminy E powinno kształtować się na poziomie > 5,4 mg/g [41][42][43][44][45]. Badania stężenia witamin rozpuszczalnych w tłuszczach we krwi u osób z CF muszą być wykonywane nie rzadziej niż raz do roku, a po modyfikacji dawki po 3-6 miesiącach [3].…”