title: Prevalence of vitamin K deficiency in children with mild to moderate chronic liver disease.
abstract: OBJECTIVE
  Children with chronic liver disease are at risk for vitamin K deficiency because of fat malabsorption and inadequate dietary intake. The objective of this study was to determine the prevalence of vitamin K deficiency in children with mild to moderate chronic cholestatic and noncholestatic liver disease.
  
  
  METHODS
  Vitamin K status was examined in 43 children (0.25-15.9 years) with mild to moderate chronic cholestatic liver disease, 29 children (0.9-16.9 years) with chronic mild to moderate noncholestatic liver disease, and in 44 healthy children (1-18 years). Vitamin K status was assessed by the plasma PIVKA-II (protein induced in vitamin K absence) assay (enzyme-linked immunosorbent assay). Plasma PIVKA-II values greater than 3 ng/mL are indicative of vitamin K deficiency.
  
  
  RESULTS
  The mean plasma PIVKA-II (+/-SD) in cholestatic, noncholestatic, and healthy children was 61.9 +/-144, 1.2 +/- 3, and 2.1 +/- ng/mL, respectively (P < 0.002). Fifty-four percent of the children supplemented with vitamin K had plasma PIVKA-II greater than 3 ng/mL. Plasma conjugated bilirubin, total bile acids, and severity of liver disease were positively correlated with plasma PIVKA-II levels (P < 0.05).
  
  
  CONCLUSIONS
  Vitamin K deficiency is prevalent in children with mild to moderate chronic cholestatic liver disease, even with vitamin K supplementation. Elevated PIVKA-II levels occurred in children with a normal prothrombin, indicating that more sensitive markers of vitamin K status should be used in children with chronic liver disease. Vitamin K deficiency was related to degree of cholestasis and severity of liver disease in children. Children without cholestasis did not exhibit vitamin K deficiency.
authors.affiliation: Department of Clinical Dietetics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. diana.mager@sickkids.ca
authors.forename: Diana R
authors.initials: DR
authors.lastname: Mager
authors.forename: Phyllis L
authors.initials: PL
authors.lastname: McGee
authors.forename: Katryn N
authors.initials: KN
authors.lastname: Furuya
authors.forename: Eve A
authors.initials: EA
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000150:complications*; D002908:Chronic Disease; D004041:Dietary Fats / Q000008:administration & dosage / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000097:blood / Q000150:complications*; D008286:Malabsorption Syndromes; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D014812:Vitamin K / Q000008:administration & dosage* / Q000627:therapeutic use; D014813:Vitamin K Deficiency / Q000097:blood / Q000453:epidemiology*
chemical_list: D004041:Dietary Fats; D014812:Vitamin K