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Vitamin D Deficiency and Low Bone Mineral Density in Pediatric and Young Adult Intestinal Failure

Ubesie, Agozie C.*; Heubi, James E.*; Kocoshis, Samuel A.*; Henderson, Carol J.*; Mezoff, Adam G.*; Rao, Marepalli B.; Cole, Conrad R.*

Journal of Pediatric Gastroenterology & Nutrition: September 2013 - Volume 57 - Issue 3 - p 372–376
doi: 10.1097/MPG.0b013e31829c10eb
Original Articles: Hepatology and Nutrition

Objectives: The aim of the present study was to determine the prevalence and predisposing factors for vitamin D deficiency and low bone mineral density (BMD) in patients with intestinal failure (IF).

Methods: A retrospective review of patients with IF managed at the Cincinnati Children's Hospital Medical Center. IF was defined as history of parenteral nutrition (PN) >30 days. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25 (OH) D) <20 ng/dL. Reduced BMD was defined using dual x-ray absorptiometry z score ≤–2. A binary logistic regression model was used to test for association of significant risk factors and the outcome variables after univariate analyses.

Results: One hundred and twenty-three patients with median age of 4 years (range 3–22 years) were evaluated. Forty-nine (39.8%) patients had at least a documented serum 25 (OH) D deficiency during the study interval, whereas 10 of 80 patients (12.5%) with dual x-ray absorptiometry scans completed had a low BMD z score. Age at study entry was associated with both 25 (OH) D deficiency (P = 0.01) and low BMD z score (P = 0.03). Exclusive PN at study entry was associated with reduced bone mass (P = 0.03). There was no significant association between vitamin D deficiency and low BMD z score (P = 0.31).

Conclusions: The risk of 25 (OH) D deficiency and low BMD z score increases with age among patients with IF. Strategies for monitoring and preventing abnormal bone health in older children receiving exclusive PN need to be developed and evaluated.

*Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children Hospital Medical Center, Cincinnati, OH

Department of Biostatistics, University of Cincinnati, Cincinnati, OH.

Address correspondence and reprint requests to Agozie C. Ubesie, Department of Paediatrics, University of Nigeria Teaching Ituku/Ozalla, Enugu, Nigeria (e-mail:

Received 29 January, 2013

Accepted 14 May, 2013

Funding for this study was provided by the Global Health Center, Cincinnati Children's Hospital Medical Center OH (ACU). The project described was also supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8 UL1 TR000077–04. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,