title: Oral absorbable fat-soluble vitamin formulation in pediatric patients with cholestasis.
abstract: OBJECTIVE
  Fat-soluble vitamin (FSV) deficiencies are common complications in pediatric patients with chronic cholestasis. The aim of the present study was to evaluate the status of FSV deficiencies in patients under present practice and to test the effect of an oral, absorbable, fat-soluble vitamin formulation (OAFSV) in these patients.
  
  
  METHODS
  We recruited a total of 23 pediatric patients receiving conventional FSV supplementation in a single medical center, with diagnosis of biliary atresia (10), progressive familial intrahepatic cholestasis (9), Alagille syndrome (2), and other conditions (2). Ten patients switched to OAFSV and continued for 3 months. Plasma levels of vitamins A, D, and E and an international normalized ratio (INR) for prothrombin time (PT), a surrogate marker for vitamin K deficiency, were measured.
  
  
  RESULTS
  The proportion of patients with FSV A, D, E, and K deficiencies under conventional supplementation was 73.9%, 81.8%, 91.3%, and 20.0%, respectively. In patients with total bilirubin levels ≥3.0  mg/dL, the proportion of at least 1 FSV deficiency was 100%; and the deficiency rates of vitamin A, D, E, and K were 78.6%, 100.0%, 100.0% and 21.4%, respectively. Of the 10 patients receiving standard daily dose of OAFSV for 3 months, no adverse events or overdose effects were found. The rates of vitamin A, D, and E deficiency in the patients receiving OAFSV decreased from 80.0%, 100%, and 100%, respectively, to 70.0%, 60.0%, and 60.0% after 3 months of oral supplementation.
  
  
  CONCLUSIONS
  High rates of FSV deficiency were found in pediatric patients with chronic cholestasis under present follow-up. OAFSV supplementation is safe and potentially effective in pediatric patients with cholestasis.
authors.affiliation: Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Shen
authors.forename: Jia-Feng
authors.initials: JF
authors.lastname: Wu
authors.forename: Hong-Yuan
authors.initials: HY
authors.lastname: Hsu
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.forename: Mei-Hwei
authors.initials: MH
authors.lastname: Chang
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Liu
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Hsu
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Weng
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chen
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D016738:Alagille Syndrome / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D001361:Avitaminosis / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D001656:Biliary Atresia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012995:Solubility; D014801:Vitamin A / Q000097:blood / Q000627:therapeutic use; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use; D014810:Vitamin E / Q000097:blood / Q000627:therapeutic use; D014812:Vitamin K / Q000097:blood / Q000627:therapeutic use; D014815:Vitamins / Q000097:blood / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D014801:Vitamin A; D014812:Vitamin K; D014807:Vitamin D; D014810:Vitamin E; D001663:Bilirubin