Protein-calorie malnutrition does not predict subtle vitamin K depletion in hospitalized patients.
OBJECTIVE
Recent studies suggest that subtle vitamin K depletion has far-reaching consequences. As this entity is not associated with prothrombin time elevation, it is important to determine whether alternate methods can help identify it. We investigated subtle vitamin K depletion in a hospital setting and determined whether protein calorie malnutrition predicts its presence.


METHODS
Using a high-pressure liquid chromatography (HPLC) assay of plasma phylloquinone and a food frequency questionnaire for phylloquinone intake, we examined the phylloquinone status of 27 hospitalized patients with normal coagulation parameters, no liver disease, and no recent warfarin use. We assessed protein-calorie nutritional status with Reilly's criteria and anthropometrics.


RESULTS
51% of patients (95% CI = 31% to 70%) had evidence of subtle vitamin K depletion as defined by a subnormal plasma phylloquinone concentration. Patients whose phylloquinone intake was less than the Recommended Daily Allowance (RDA) over the preceding year had lower plasma phylloquinone concentrations when compared to other patients: median (range) 0.106 nmol/l (0.022-0.461) versus 0.301 nmol/l (0.067-3.928), respectively (P = 0.023). Plasma phylloquinone concentrations were no different, however, between well-nourished and malnourished patients: median (range) 0.245 nmol/l (0.022-0.522) versus 0.188 nmol/l (0.067-3.928), respectively (P=0.782).


CONCLUSIONS
Subtle vitamin K depletion is common among hospitalized patients and protein-calorie malnutrition does not predict its presence.
Jatoi
A
A
New England Medical Center, Jean Mayer USDA Human Nutritional Research Center on Aging at Tufts University, Boston, Massachusetts, USA.
Lennon
C
C
O'Brien
M
M
Booth
S L
SL
Sadowski
J
J
Mason
J B
JB
D000328:Adult; D000886:Anthropometry; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000175:diagnosis*; D011517:Prothrombin Time; D012709:Serum Albumin / Q000032:analysis; D011795:Surveys and Questionnaires; D010837:Vitamin K 1 / Q000008:administration & dosage / Q000097:blood; D014813:Vitamin K Deficiency / Q000175:diagnosis*
D012709:Serum Albumin; D010837:Vitamin K 1