title: Vitamins A and E and pulmonary exacerbations in patients with cystic fibrosis.
abstract: BACKGROUND
  Increased levels of oxidative stress result in pulmonary damage contributing to the development of chronic lung disease in cystic fibrosis (CF). The aim of this study was to investigate the longitudinal effect of serum vitamin A and E levels on the incidence of pulmonary exacerbations in pancreatic insufficient (PI) and pancreatic sufficient (PS) patients with CF.
  
  
  METHODS
  Patient records were retrospectively examined over a 3-year period and serum vitamin A and E levels were retrieved. Subsequently, levels of vitamin A and E were prospectively measured over a 2-year period at the onset of intravenous antibiotic therapy for acute exacerbation and at the first recovery visit.
  
  
  RESULTS
  Retrospectively, 597 pulmonary exacerbations were identified in 102 patients, 74 PI and 28 PS, with a mean age of 11.1 +/- 6.4 years (range, 1.5-27 y). An increased number of exacerbations was directly correlated with lower vitamin A and E levels, even within the normal range. Prospectively, 62 exacerbations were analyzed (43 PI patients and 19 PS patients). At onset of exacerbation, vitamin A and E levels were reduced in the PI patients (P < 0.001; P < 0.001) and the PS patients (P < 0.005; P < 0.07).
  
  
  CONCLUSIONS
  Reduced serum levels of vitamin A and E even in the normal range are associated with an increased rate of pulmonary exacerbations in CF. Further studies are required to confirm the necessity of supplementation of vitamins A and E to PS patients.
authors.affiliation: Department of Pediatrics, Rambam Medical Center, Haifa, Israel.
authors.forename: Fahed
authors.initials: F
authors.lastname: Hakim
authors.forename: Eitan
authors.initials: E
authors.lastname: Kerem
authors.forename: Joseph
authors.initials: J
authors.lastname: Rivlin
authors.forename: Lea
authors.initials: L
authors.lastname: Bentur
authors.forename: Halina
authors.initials: H
authors.lastname: Stankiewicz
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolach-Abram
authors.forename: Michael
authors.initials: M
authors.lastname: Wilschanski
mesh_terms: D000293:Adolescent; D000328:Adult; D000975:Antioxidants / Q000378:metabolism; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000097:blood* / Q000150:complications; D019587:Dietary Supplements; D010188:Exocrine Pancreatic Insufficiency; D005260:Female; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000097:blood* / Q000209:etiology; D008297:Male; D009752:Nutritional Status; D010084:Oxidation-Reduction; D018384:Oxidative Stress; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D014801:Vitamin A / Q000097:blood*; D014810:Vitamin E / Q000097:blood*
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D014801:Vitamin A; D014810:Vitamin E