title: High prevalence of vitamin D deficiency and osteoporosis in out-patients with intestinal failure.
abstract: BACKGROUND
  In intestinal failure, specific nutrient deficiencies especially for fat-soluble vitamins can be expected in addition to energy-protein malnutrition. We report serum levels of fat soluble vitamins, and bone density in out-patients with intestinal failure (IF).
  
  
  METHODS
  106 outpatients with IF were assessed during routine visits. 78 patients underwent DXA-scan for bone density. Vitamin D levels < 50 nmol/l were defined as deficiency, and 75-150 as optimal. Vitamin A and E deficiencies were defined as <1.0 and <14 μmol/l respectively. INR ≥ 1.2 without liver disease or anti-vitamin K therapy was classified as vitamin K deficiency.
  
  
  RESULTS
  Mean serum vitamin D level was 45 nmol/l at first visit, and 64 nmol/l at follow up (n = 76, p = 0.0001 by paired t-test). Overall prevalence of vitamin D deficiency was 67%. Only 12% of all patients had optimal D-vitamin status. 88% of assessed patients had low bone density. 12% had subnormal vitamin A levels and 25% had subnormal vitamin E levels. 32% had abnormal INR values. At follow up 34% remained vitamin D deficient whereas 29% had optimal levels. By oral substitution, vitamin A and E status were normalised, and K status improved.
  
  
  CONCLUSIONS
  Vitamin D deficiency and osteoporosis are common in outpatients with intestinal failure, and should be adequately substituted.
authors.affiliation: Department of Clinical Nutrition, Sahlgrenska University Hospital, Göteborg, Sweden. Electronic address: lasse.ellegard@nutrition.gu.se.
authors.forename: L
authors.initials: L
authors.lastname: Ellegård
authors.forename: G
authors.initials: G
authors.lastname: Kurlberg
authors.forename: I
authors.initials: I
authors.lastname: Bosaeus
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood* / Q000150:complications; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology; D010045:Outpatients; D015995:Prevalence; D014801:Vitamin A / Q000097:blood; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D014810:Vitamin E / Q000097:blood; D014813:Vitamin K Deficiency / Q000097:blood / Q000209:etiology; D014815:Vitamins / Q000097:blood; D055815:Young Adult
chemical_list: D014815:Vitamins; D014801:Vitamin A; D014807:Vitamin D; D014810:Vitamin E
keywords: BMD; Bone density; DXA; HEN; HPN; IF; INR; Intestinal failure; PN; Parenteral nutrition; Vitamin D, fat malabsorption; Vitamin substitution therapy; bone mineral density; dual energy X-ray absorptiometry; home enteral nutrition; home parenteral nutrition; international normalized ratio; intestinal failure; parenteral nutrition