Vitamin D supplementation for chronic liver diseases in adults

Bjelaković, Goran; Nikolova, Dimitrinka; Bjelaković, Marija; Gluud, Christian

doi:10.1002/14651858.cd011564

Cited by 19 publications

(21 citation statements)

References 75 publications

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“…Furthermore, the efficacy of VitD supplementation towards osteopenia/osteoporosis remains unclear, as parathyroid hormone levels were not affected by VitD supplementation in the study by Pilz et al [28] and since several studies displayed no benefits of VitD supplementation on bone density/osteoporosis in patients with liver disease [30][31][32]. Similarly, a systematic review on VitD supplementation in chronic liver disease suggested limited efficacy of VitD supplementation on mortality, but importantly no effects on morbidity and health-related quality of life [33]. Nevertheless, in the absence of significant toxicity related to VitD supplementation in patients with ACLD, VitD supplementation seems safe, and thus, it may be argued that ACLD patients with VitD deficiency should still receive VitD supplements in case of low VitD levels.…”

Section: Discussionmentioning

confidence: 99%

Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

et al. 2020

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Background and Aims The liver plays a key role in the storage, metabolism and homeostasis of fat-soluble vitamins. We investigated the relation of Vitamin(Vit)A/D/E serum levels with severity of liver disease and portal hypertension (PHT). Methods VitA/D/E serum levels were assessed in 234 patients with advanced chronic liver disease (ACLD, i.e. hepatic venous pressure gradient [HVPG] ≥ 6 mmHg). Patients with hepatocellular carcinoma, pre-/post-hepatic PHT, TIPS or liver transplantation were excluded. Results Most patients were male (n = 153; 65%) with a median age of 57.6 (49.7–64.5) years. Thirty-two (14%) patients had HVPG 6–9 mmHg, 66 (28%) 10-15 mmHg, and 136 (58%) ≥ 16 mmHg, respectively. VitD deficiency (25-OH-vitamin-D <50 nmol/L) was found in 133 (57%) with higher prevalence in Child-Turcotte-Pugh (CTP)-C: 85% vs. B: 66% vs. A: 47% (p < 0.001). VitD levels displayed significant but weak correlations with hepatic dysfunction and PHT. VitE levels were normal in 227 (97%) patients and displayed no relevant association with hepatic dysfunction or PHT. Only 63 (27%) patients had normal (>1.05 µmol/L) VitA levels, while 58 (25%) had mild (0.70–1.04 µmol/L), 71 (30%) moderate (0.35–0.69 µmol/L), and 42(18%) severe(<0.35 µmol/L) VitA deficiency. VitA correlated with HVPG (Rho = −0.409), CTP score (Rho = −0.646), and serum bile acid levels (Rho = −0.531; all p < 0.001). The prevalence of decompensated ACLD (dACLD) continuously increased with severity of VitA deficiency (no: 40% vs. mild: 51% vs. moderate: 67% vs. severe: 91% had dACLD; p < 0.001). CTP score (per point; OR 2.46; 95%CI 1.80–3.37; p <0.001), age (per year; OR 0.95; 95%CI 0.92–0.98; p = 0.001) and elevated bile acid levels(>10 µmol/L; OR 3.62; 95%CI 1.61–8.14; p = 0.002) were independently associated with VitA deficiency. Conclusion VitA and VitD but not VitE deficiencies are highly prevalent in ACLD. VitA deficiency strongly correlates with hepatic dysfunction, PHT and bile acid levels and is associated with decompensated ACLD. Trial registration number NCT03267615.

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Section: Discussionmentioning

confidence: 99%

Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

et al. 2020

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“…Zinc supplementation (150‐200 mg/d taken with a meal to decrease the potential side effect of nausea) has shown to at least improve taste sensation in cirrhosis . Likewise, the data on vitamin D supplementation in improving outcomes are not robust but the data regarding poor outcomes in cirrhosis with vitamin D deficiency are compelling . Research experience in the elderly suggests that vitamin D supplementation may have benefits on musculoskeletal system (eg increased bone density, muscle strength and physical activity); however, whether these findings can be extrapolated for those with cirrhosis is unknown.…”

Section: Management Of Malnutrition and Sarcopenia In Cirrhosismentioning

confidence: 99%

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Bunchorntavakul

Reddy

2019

Aliment Pharmacol Ther

143

131

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Summary Background Malnutrition/sarcopenia and frailty are common in patients with cirrhosis and are associated with poor outcomes. Aim To provide an overview of data on the importance, assessment and management of malnutrition/sarcopenia and frailty in cirrhosis. Methods A literature search was conducted in PubMed and other sources, using the search terms “sarcopenia,” “muscle,” “malnutrition,” “cirrhosis,” “liver” and “frailty” from inception to April 2019, to identify the relevant studies and international guidelines. Results The prevalence of malnutrition/sarcopenia in cirrhosis is 23%‐60%. Frailty generally overlaps with malnutrition/sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition/sarcopenia in cirrhosis is complex/multifactorial and not just reduction in protein/calorie intake. Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched‐chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality‐ and liver‐related events, they, and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long‐term ammonia‐lowering agents and myostatin antagonists, are currently under investigation. Conclusions Malnutrition/sarcopenia and frailty are unique, inter‐related and multi‐dimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.

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“…Among HIV-infected patients, lower serum vitamin D levels were also associated with a higher risk of clinical progression to AIDS and all-cause mortality in a cohort study,17 while vitamin D supplementation did not affect mortality, CD4 cell count or viral load 18. For HCV-infected patients, serum vitamin D levels were inversely associated with the grade of liver inflammation and the stage of fibrosis,19 while no protective effect of vitamin D supplementation was seen in a meta-analysis of clinical trials 20. However, the effect of vitamin D on herpesvirus infection or reactivation in the general population is unclear.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D deficiency or supplementation and the risk of human herpesvirus infections or reactivation: a systematic review protocol

et al. 2019

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IntroductionHuman herpesviruses induce lifelong latent infections and may reactivate as the immune system deteriorates. Recent studies have suggested that vitamin D, an essential element of bone health, may have some effect of protecting against infections, but investigations of its potential to prevent herpesvirus infection or reactivation are limited. We will review the current literature examining vitamin D and the risk of herpesvirus infections or reactivation.Methods and analysisOur systematic review will address two research questions: (1) Do deficient/insufficient serum vitamin D levels increase the risk of herpesvirus infections and (2) Does vitamin D supplementation protect against herpesvirus infections? We will include only intervention studies with control groups, cohort studies and case-control studies. We will use subject headings and keywords to search for synonyms of ‘vitamin D’ and ‘herpesviruses’ (including herpes simplex virus type 1 and 2, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus and human herpesviruses type 6, 7 and 8) in Medline, Embase, Global Health, Web of Science, Scopus and Cochrane Central Register of Controlled Trials, and the grey literature databases Open Grey, EThOS and BASE from inception to 31 August 2019. References to the included articles and relevant systematic reviews will also be examined. Two reviewers will independently screen the study titles and abstracts, and examine the full texts to decide the final eligibility. They will independently extract data from the studies and assess bias using the Cochrane Collaboration approach. A third researcher will solve any discrepancies. The results will be narratively synthesised; if an adequate number of studies is included and the homogeneity between studies is acceptable, a meta-analysis will be performed. We will assess the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework, and display the results in a summary of findings table.Ethics and disseminationEthical review is not required for a systematic review. We will publish the results in a peer-review journal. Any amendments to the protocol will be recorded in the supplementary section.PROSPERO registration numberCRD42019130153.

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Vitamin D supplementation for chronic liver diseases in adults

Cited by 19 publications

References 75 publications

Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Vitamin D deficiency or supplementation and the risk of human herpesvirus infections or reactivation: a systematic review protocol

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