Single high-dose oral vitamin D3 (stoss) therapy — A solution to vitamin D deficiency in children with cystic fibrosis?

Shepherd, Darren; Belessis, Yvonne; Katz, Tamarah; Morton, John; Field, Penelope; Jaffé, Adam

doi:10.1016/j.jcf.2012.08.007

Cited by 49 publications

(60 citation statements)

References 28 publications

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“…In the present sample, 50% had low (<30 ng/mL) 25D, which was an improvement from the 90% of children and young adults found insufficient in CF Bones Study. It was similar to the 46 to 56% insufficiency found in more recent studies in the US, UK and Australia (14, 38, 41–43). The serum 25D improvement over time was likely due to enhanced clinical monitoring and increased vitamin D supplementation in patients with CF and PI.…”

Section: Discussionsupporting

confidence: 91%

Fat‐Soluble Vitamins in Cystic Fibrosis and Pancreatic Insufficiency

Bertolaso

Groleau²,

Schall³

et al. 2014

J. pediatr. gastroenterol. nutr.

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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.

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Section: Discussionsupporting

confidence: 91%

Fat‐Soluble Vitamins in Cystic Fibrosis and Pancreatic Insufficiency

Bertolaso

Groleau²,

Schall³

et al. 2014

J. pediatr. gastroenterol. nutr.

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“…Our findings may explain why there have been differences reported in the literature regarding the bioavailability of vitamin D 2 (ergocalciferol) and D 3 in CF 18 – 21 . Several studies have compared differences in the serum 25(OH)D response to oral vitamin D 2 and D 3 supplementation; however, the vehicles used in these studies were either primarily oil based or did not control for the type of vehicle when comparing vitamin D 2 and D 3 18 , 19 , 17 , 22 .…”

Section: Discussionmentioning

confidence: 66%

Prospective, Randomized, Double‐Blind, Parallel‐Group, Comparative Effectiveness Clinical Trial Comparing a Powder Vehicle Compound of Vitamin D With an Oil Vehicle Compound in Adults With Cystic Fibrosis

Hermes

Alvarez

Lee

et al. 2016

J Parenter Enteral Nutr

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Background There is little consensus on the most efficacious vehicle substance for vitamin D supplements. Fat malabsorption may impede the ability of patients with cystic fibrosis (CF) to absorb vitamin D in an oil vehicle. We hypothesized that vitamin D contained in a powder vehicle would be absorbed more efficiently than vitamin D contained in an oil vehicle in patients with CF. Methods In this double-blind, randomized controlled trial, hospitalized adults with CF were given a one-time bolus dose of 100,000 IU of cholecalciferol (D3) in a powder-based or oil-based vehicle. Serum D3, 25-hydroxyvitamin D, and parathyroid hormone concentrations were analyzed at 0, 12, 24, and 48 hours posttreatment. The area under the curve for serum D3 and the 12-hour time point were also assessed as indicators of D3 absorption. Results This trial was completed by 15 patients with CF. The median (interquartile range) age, body mass index, and forced expiratory volume in 1 second were 23.7 (19.9–33.2) years, 19.9 (18.6–22.6) kg/m2, and 63% (37%–80%), respectively. The increase in serum D3 and the area under the curve was greater in the powder group (P = .002 and P = .036, respectively). Serum D3 was higher at 12 hours in the powder group compared with the oil group (P = .002), although levels were similar between groups by 48 hours. Conclusions In adults with CF, cholecalciferol is more efficiently absorbed in a powder compared with an oil vehicle. Physicians should consider prescribing vitamin D in a powder vehicle in patients with CF to improve the absorption of vitamin D from supplements.

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“…Ideally, to provide optimal VD status, body stores should be optimized before proceeding to the transplantation process, challenging us to search for alternative ways to provide this essential vitamin. A single mega-dose VD therapy (also known as Stoss therapy) has been evaluated in other chronic illnesses, including cystic fibrosis, and could provide an alternative option for patients scheduled to undergo HSCT [21]. Prospective studies are currently underway in our institution with the goal of determining the safety and efficacy of Stoss therapy in HSCT recipients.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Deficiency in Pediatric Hematopoietic Stem Cell Transplantation Patients Despite Both Standard and Aggressive Supplementation

Wallace

Jodele

Myers

et al. 2016

Biology of Blood and Marrow Transplantation

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We recently reported that more than 70% of pediatric and young adult patients had a vitamin D (VD) deficiency at the time of their hematopoietic stem cell transplantation (HSCT). Moreover, VD deficiency was associated with inferior survival at 100 days after transplantation. The goal of the present study was to evaluate the VD requirements needed to maintain an optimal VD level (30 to 60 ng/mL) during the first 3 months after transplantation using real-time VD monitoring and personalized VD supplementation. We examined 2 cohorts in this study: cohort 1, the “preintervention” cohort (n = 35), who were treated according to National Kidney Foundation guidelines for VD therapy, and cohort 2, the “intervention” cohort (n = 25) who were treated with high-dose VD with an aggressive dosage increase in those who remained VD-insufficient. Results from cohort 1 showed that despite aggressive monitoring and VD supplementation, therapeutic vitamin D levels were difficult to achieve and maintain in HSCT recipients during the early post-transplantation period. Only 43% of cohort 1 achieved a therapeutic VD level, leading to our intervention in cohort 2. Outcomes improved in cohort 2, but still only 64% of cohort 2 patients achieved a therapeutic VD level despite receiving >200 IU/kg/day of VD enterally. The median VD level in patients who did achieve sufficient levels was 40 ng/mL, with only 1 patient in each cohort achieving a supratherapeutic but nontoxic level. These data indicate that standard guidelines for VD replacement are inadequate in HSCT recipients, and further work is needed to define more appropriate dosing in this clinical setting.

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Single high-dose oral vitamin D3 (stoss) therapy — A solution to vitamin D deficiency in children with cystic fibrosis?

Abstract: Stoss therapy effectively achieves and maintains levels of 25-hydroxyvitamin D greater than 75 nmol/L over 12 months.

Cited by 49 publications

References 28 publications

Fat‐Soluble Vitamins in Cystic Fibrosis and Pancreatic Insufficiency

Fat‐Soluble Vitamins in Cystic Fibrosis and Pancreatic Insufficiency

Prospective, Randomized, Double‐Blind, Parallel‐Group, Comparative Effectiveness Clinical Trial Comparing a Powder Vehicle Compound of Vitamin D With an Oil Vehicle Compound in Adults With Cystic Fibrosis

Vitamin D Deficiency in Pediatric Hematopoietic Stem Cell Transplantation Patients Despite Both Standard and Aggressive Supplementation

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