Prevalence of vitamin K and vitamin D deficiency in patients with hepatobiliary and pancreatic disorders.
Little is known about the role of fat-soluble vitamins K and D in liver function and bone metabolism in biliary and pancreatic diseases associated with cholestasis and/or fat malabsorption. The aim of this study was to determine vitamin K of bone, vitamin D and parathyroid hormone status in patients with biliary and pancreatic disorders. In 90 consecutive patients (mean +/- SD age, 65.5 +/- 17.7 years; 45 females) undergoing endoscopic retrograde cholangiopancreatography (68 with choledocholithiasis, 14 with other benign condition, and 8 with cholangiopancreatic cancers) fasting concentrations of carboxylated (cOC) and undercarboxylated osteocalcin (ucOC), 25-hydroxyvitamin D, calcium, phosphorus, magnesium, prothrombin time, liver function tests, lipase, and creatinine were measured. Vitamin D deficiency (25-hydroxyvitamin D <50 nmol/L) was found in 45.6% of patients and elevated parathyroid hormone levels in 27.8%. The ratio ucOC/cOC (index of vitamin K deficiency) was above 20% in 50.6% of patients, above 30% in 31%, and above 50% in 18.4%. Hyperbilirubinemia was a significant independent predictor of low cOC (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.9-59.4; P = .07). The ratio ucOC/cOC positively correlated with alanine aminotransferase levels (r = 0.410; P < .001). Elevated gamma-glutamyltransferase (>180 U/L) and international normalized ratio (>1.1) levels were significant independent predictors of ucOC/cOC greater than 30% after adjustment for other covariants (OR, 5.5; 95% CI, 1.2-25.2; P = .027, and OR, 3.1; 95% CI, 1.1-8.8; P = .036, respectively). This study demonstrates that vitamin K and vitamin D deficiencies are common in patients undergoing endoscopic retrograde cholangiopancreatography. Liver dysfunction is associated with and predictive of vitamin K deficiency of bone and decreased production of osteocalcin, indicating the need for appropriate supplementation.
Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. leonfisher@optusnet.com.au
Leon
L
Fisher
Elizabeth
E
Byrnes
Alexander A
AA
Fisher
D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001649:Bile Duct Diseases / Q000097:blood* / Q000150:complications; D001842:Bone and Bones / Q000378:metabolism*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000097:blood / Q000150:complications; D004724:Endoscopy; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000150:complications; D008107:Liver Diseases / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015675:Osteocalcin / Q000378:metabolism; D010182:Pancreatic Diseases / Q000097:blood* / Q000150:complications; D010190:Pancreatic Neoplasms / Q000097:blood / Q000150:complications; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications / Q000453:epidemiology*; D014813:Vitamin K Deficiency / Q000150:complications / Q000453:epidemiology*; D005723:gamma-Glutamyltransferase / Q000097:blood
D010281:Parathyroid Hormone; D015675:Osteocalcin; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase