title: Vitamin D deficiency in children with intestinal failure receiving home parenteral nutrition.
abstract: BACKGROUND
  Vitamin D plays important roles in both skeletal and nonskeletal health. Limited data suggest that patients with intestinal failure (IF) receiving home parenteral nutrition (PN) are at risk for vitamin D deficiency due to inadequate oral intake, poor absorption, and chronic illness. The purpose of this study was to document vitamin D status in pediatric patients with IF receiving home PN.
  
  
  METHODS
  We performed a 2-year retrospective review of children with IF followed at our center who had been on home PN for ≥6 months and had ≥1 serum 25-hydroxyvitamin D (25-OHD) level checked as part of routine clinical care. Patients were then categorized as deficient (<20 ng/mL), insufficient (20-29 ng/mL), or normal (≥30 ng/mL) based on their lowest vitamin D level. Demographic data and clinical characteristics were also assessed.
  
  
  RESULTS
  Eleven of 27 children (41%) had ≥1 insufficient 25-OHD level, including one child with vitamin D deficiency. Diagnosis of short bowel syndrome (compared with dysmotility or malabsorption syndromes) was associated with decreased likelihood of suboptimal vitamin D status, with an odds ratio of 0.12 (95% confidence interval, 0.02-0.8, P = .028). Osteopenia was noted in 59% of the cohort. There was a trend toward higher risk for osteopenia in patients with low 25-OHD levels compared with those with normal 25-OHD levels (82% vs 44%, P = .109).
  
  
  CONCLUSIONS
  Suboptimal 25-OHD levels are common in children with IF on home PN. This emphasizes the critical importance of routine surveillance of serum vitamin D levels and consideration of enteral supplementation when indicated.
authors.affiliation: Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, California lwozniak@mednet.ucla.edu.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Wozniak
authors.affiliation: Medical Student Pathway in Clinical and Translational Research, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Bechtold
authors.affiliation: Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Reyen
authors.affiliation: Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Hall
authors.affiliation: Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Jorge H
authors.initials: JH
authors.lastname: Vargas
mesh_terms: D001851:Bone Diseases, Metabolic / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000628:therapy; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000628:therapy*; D008297:Male; D016017:Odds Ratio; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000628:therapy; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology / Q000209:etiology*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: home parenteral nutrition; intestinal failure; pediatrics; vitamin D