Elevated vitamin A intake and serum retinol in preadolescent children with cystic fibrosis.
BACKGROUND
Persons with cystic fibrosis (CF) and pancreatic insufficiency (PI) are at risk of vitamin A deficiency because of steatorrhea, despite pancreatic enzyme replacement. Long-standing vitamin A supplementation may increase the risk of vitamin A toxicity.


OBJECTIVE
The aim was to describe the vitamin A intake and serum retinol concentrations of preadolescent children with CF, PI, and mild-to-moderate pulmonary disease, who were cared for under current practice recommendations.


METHODS
This cross-sectional study evaluated children aged 8.0-11.9 y with CF and PI from 13 US CF centers. Dietary and supplemental vitamin A intakes were compared with the Dietary Reference Intakes (DRIs) for healthy children, CF recommendations, and data from the National Health and Nutrition Examination Survey (NHANES), 1999-2000. Serum retinol concentrations were compared with NHANES data.


RESULTS
The 73 subjects with CF had a dietary vitamin A intake of 816 +/- 336 microg retinol activity equivalents (165 +/- 69% of the recommended dietary allowance), which was similar to the NHANES value. The supplement intake provided 2234 +/- 1574 microg retinol activity equivalents/d and exceeded recommendations in 21% of the subjects with CF. Total preformed retinol intake exceeded the DRI tolerable upper intake level in 78% of the subjects with CF. The serum retinol concentration was 52 +/- 13 microg/dL (range: 26-98 microg/dL), which was significantly higher than the NHANES value (37 +/- 10 microg/dL; range: 17-63 microg/dL; P < 0.001).


CONCLUSIONS
Although supplementation helps to prevent vitamin A deficiency in children with CF and PI, their high vitamin A intakes and serum retinol concentrations suggest that usual care may result in excessive vitamin A intake and possible toxicity that would increase the risk of CF-associated liver and bone complications.
Graham-Maar
Rose C
RC
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. grahamr@email.chop.edu
Schall
Joan I
JI
Stettler
Nicolas
N
Zemel
Babette S
BS
Stallings
Virginia A
VA
D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000097:blood* / Q000188:drug therapy; D019587:Dietary Supplements / Q000009:adverse effects; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D009749:Nutrition Surveys; D014481:United States; D014801:Vitamin A / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D014802:Vitamin A Deficiency / Q000517:prevention & control*; D014815:Vitamins / Q000008:administration & dosage / Q000097:blood
D014815:Vitamins; D014801:Vitamin A