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Increasing Vitamin D Serum Levels Is Associated With Reduced Pulmonary Exacerbations in Patients With Cystic Fibrosis

Abu-Fraiha, Yasmeen; Elyashar-Earon, Hila; Shoseyov, David; Cohen-Cymberknoh, Malena; Armoni, Shoshana; Kerem, Eitan; Wilschanski, Michael

Journal of Pediatric Gastroenterology and Nutrition: January 2019 - Volume 68 - Issue 1 - p 110–115
doi: 10.1097/MPG.0000000000002126
Original Article: Nutrition

Context: In 2012, The North American Cystic Fibrosis Foundation (NACFF) published new guidelines for the treatment of vitamin D deficiency in individuals with cystic fibrosis (CF).

Objective: The objectives of our study were to assess the efficacy of these guidelines, and to test the effect of increasing vitamin D dosage on pulmonary function and exacerbations.

Design: Pulmonary function tests and serum concentrations of 25-hydroxyvitamin D [25(OH)D] were measured 1 year before increasing vitamin D dosage according to the guidelines and at least 1 year later. In addition, days of hospitalization and pulmonary exacerbations were counted and an average per year (average number of days of hospitalization and average number of pulmonary exacerbations [PEA], respectively) was calculated.

Setting and Participants: A total of 90 patients from The Cystic Fibrosis Clinic at Hadassah Mount-Scopus Hospital, Jerusalem, Israel.

Results: The mean serum concentration of vitamin D increased significantly from 20.97 ng/mL (52.34 nmol/L) at baseline to 25.41 ng/mL (63.42 nmol/L) at the end of follow-up (P < 0.001). The number of PEA decreased significantly from 2.79 ± 3.96 to 2.15 ± 2.91 (P = 0.007). The change in vitamin D levels was correlated with a decrease in PEA (correlation coefficient = −0.318, P = 0.002).

Conclusions: The NACFF guidelines for management of vitamin D deficiency improve vitamin D levels in patients with CF but did not reach the normal values in most patients. The increase in vitamin D serum levels was, however, associated with a decrease in number of pulmonary exacerbations.

CF Center, Hadassah-University Medical Center, Jerusalem, Israel.

Address correspondence and reprint requests to Dr Yasmeen Abu-Fraiha, 18th Hakerem st, Omer, POB 1230, Jerusalem Israel, 8496500 (e-mail:

Received 15 April, 2018

Accepted 27 June, 2018

Precis: Supplementing high doses of vitamin D in 90 cystic fibrosis patients for 1-2 years showed an association between improved vitamin D levels and a decrease in pulmonary exacerbations. registration number: NCT02043717.

Other Study ID Numbers: vitaminD-HMO-CTIL.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,