Fat-Soluble Vitamin Deficiency in Children With Intestinal Failure Receiving Home Parenteral Nutrition
To the Editor: Ubesie et al (1) reported a high prevalence of vitamin D deficiency (39.8%) in children with intestinal failure (IF). We routinely monitored vitamin A, E, and D levels every 6 months for children who were receiving home parenteral nutrition for IF, following European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines (2). In 2013, we completed a cross-sectional assessment of 32 home parenteral nutrition patients who had fat-soluble vitamin levels measured for 1 year. Twenty children with nonsurgical IF (dysmotility and malabsorption) (group A) and 12 with surgical IF (short bowel syndrome) (group B) were included in the study. All of the patients received daily parenteral nutrition with a standard pediatric multivitamin formulation containing vitamin A, 3500 IU; vitamin D, 250 IU; and vitamin E, 11.20 IU. Vitamin levels were low in groups A and B, respectively, as follows: vitamin A in 5 (25%) and 4 (30%), vitamin D in 9 (45%) and 4 (30%), and vitamin E in 2 (10%) and 0. Overall, 15 patients in group A (75%) and 6 patients in group B (50%) showed low levels of fat-soluble vitamins. The likelihood of low fat-soluble vitamin levels was significantly greater in nonsurgical IF than in patients with short bowel syndrome (odds ratio 6, 95% confidence interval 1.5–24.5). Thus, we agree that routine surveillance of fat-soluble vitamins and consideration of enteral or parenteral supplementation, including periodic intramuscular injection, may be useful in children with IF.
1. Ubesie AC, Heubi JE, Kocoshis SA, et al. Vitamin D deficiency and low bone mineral density in pediatric and young adult intestinal failure. J Pediatr Gastroenterol Nutr
© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
2. Koletzko B, Goulet O, Hunt J, et al. Guidelines on pediatric parenteral nutrition of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr