title: Relationships between blood levels of fat soluble vitamins and disease etiology and severity in adults awaiting liver transplantation.
abstract: OBJECTIVE
  Although malnutrition is common in liver disease, there are limited data on fat soluble vitamins in various diseases. The aims of this study were to: (i) determine fat soluble vitamin levels in patients assessed for liver transplantation; (ii) compare levels between different disease etiologies (hepatocellular and cholestatic) and between subgroups of hepatocellular disease; and (iii) assess the multivariate contribution to vitamin levels of etiology and various indicators of disease severity.
  
  
  METHODS
  This was a cross-sectional study of 107 inpatients awaiting liver transplantation, mean age 47 years. Biochemical parameters included plasma retinol, 25-hydroxycholecalciferol, and vitamin E. Biochemical (albumin, bilirubin and zinc) and clinical indicators (Child-Pugh and Model of End Stage Liver Disease [MELD] scores) of disease severity were determined.
  
  
  RESULTS
  Deficiencies of retinol (< 1.0 µmol/L), 25-hydroxycholecalciferol (< 50 nmol/L) and vitamin E (< 11 µmol/L) were present in 75%, 66% and 3%, respectively, of patients. Concentrations of retinol and vitamin E were lower in hepatocellular than cholestatic disease but 25-hydroxycholecalciferol concentrations were similar. Child-Pugh score was higher in hepatocellular than cholestatic disease. Concentrations of retinol were lower in alcoholic liver disease (ALD) than hepatitis and Child-Pugh score was higher in ALD. For the whole group, levels of retinol, 25-hydroxycholecalciferol and vitamin E were negatively related to Child-Pugh score, MELD score and bilirubin, and positively related to albumin. When Child-Pugh scores were controlled for, retinol was lower in the hepatocellular group.
  
  
  CONCLUSIONS
  There was a high prevalence of fat soluble vitamin deficiencies with vitamin levels being related to disease severity. Retinol was lower in the hepatocellular group.
authors.affiliation: School of Medicine (Southside Clinical) University of Queensland, Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia. winsome@universal.net.au
authors.forename: Winsome
authors.initials: W
authors.lastname: Abbott-Johnson
authors.forename: Paul
authors.initials: P
authors.lastname: Kerlin
authors.forename: Alan
authors.initials: A
authors.lastname: Clague
authors.forename: Helen
authors.initials: H
authors.lastname: Johnson
authors.forename: Ross
authors.initials: R
authors.lastname: Cuneo
mesh_terms: D000293:Adolescent; D000328:Adult; D001361:Avitaminosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002112:Calcifediol / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002779:Cholestasis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003430:Cross-Sectional Studies; D058625:End Stage Liver Disease / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011793:Queensland; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012995:Solubility; D014801:Vitamin A / Q000097:blood; D014810:Vitamin E / Q000097:blood; D014815:Vitamins / Q000097:blood*; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014815:Vitamins; D014801:Vitamin A; D014810:Vitamin E; D002112:Calcifediol