title: Is it necessary to assess for fat-soluble vitamin deficiencies in pediatric patients with newly diagnosed celiac disease?
abstract: BACKGROUND
  The purpose of this study was to identify the frequency of fat-soluble vitamin deficiencies in children with celiac disease (CD) and to determine the value of routine testing for these deficiencies.
  
  
  METHODS
  We conducted a retrospective medical record review of patients with a confirmed diagnosis of CD and fat-soluble vitamin levels measured at diagnosis between 1995 and 2012 at Mayo Clinic. Patients' demographics, fat-soluble vitamin levels, and pertinent clinical factors at the time of diagnosis were collected.
  
  
  RESULTS
  Eighty-three patients were included in the final analysis: 51 girls and 32 boys, with an average age at diagnosis of 12.8 years in girls and 13.0 years in boys. The most commonly reported symptoms were abdominal pain in 49 patients and diarrhea in 30 patients. Family history of CD was reported in 32 patients. Average vitamin levels for vitamin E, 25-hydroxyvitamin D (25 (OH) D), and vitamin A were 7.5 mg/L, 32.8 ng/mL, and 334.5 μg/dL, respectively. No patients had vitamin A deficiency, 2 patients had vitamin E deficiency, and 9 patients had mild-to-moderate vitamin D deficiency (none had severe deficiency). Both patients with vitamin E deficiency were symptomatic and had complete villous atrophy. Thirty-one patients had insufficiency of 25 (OH) D, which was less than the reported frequency of vitamin D insufficiency in the general pediatric population in the United States in 2004. None of the patients were receiving vitamin supplements at the time of diagnosis.
  
  
  CONCLUSIONS
  Fat-soluble vitamin deficiencies are uncommon in children with new diagnosis of CD. Routine measuring of fat-soluble vitamins levels may not be necessary.
authors.affiliation: *Division of Gastroenterology and Hepatology †Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Mohamad H
authors.initials: MH
authors.lastname: Imam
authors.forename: Yousef
authors.initials: Y
authors.lastname: Ghazzawi
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.forename: Imad
authors.initials: I
authors.lastname: Absah
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D002446:Celiac Disease / Q000150:complications*; D002648:Child; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007422:Intestines / Q000473:pathology; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D014801:Vitamin A / Q000097:blood*; D014802:Vitamin A Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D014810:Vitamin E / Q000097:blood*; D014811:Vitamin E Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D014801:Vitamin A; D014807:Vitamin D; D014810:Vitamin E; C104450:25-hydroxyvitamin D