title: Prevalence and predictors of vitamin D deficiency and response to oral supplementation in patients receiving long-term home parenteral nutrition.
abstract: Previous studies have suggested a high prevalence of vitamin D deficiency in patients receiving long-term home parenteral nutrition (HPN). The aim of this study was to determine the prevalence and predictors of vitamin D deficiency in long-term HPN patients.
  
  
  METHODS
  A retrospective, institutional review board-approved study was performed on all adult patients followed by the Cleveland Clinic HPN program receiving HPN therapy >6 months between 1989 and 2013 with a 25-(OH) D3 level reported. Patients were categorized by serum vitamin D status as follows: sufficient, insufficient, and deficient with respective 25-(OH) D3 levels of ≥30 ng/mL, 20-30 ng/mL, and <20 ng/mL.
  
  
  RESULTS
  Seventy-nine patients were categorized based on serum vitamin D status as follows: 35 (44.3%) deficient, 24 (30.4%) insufficient, and 20 (25.3%) sufficient. The mean age of the cohort at the initiation of HPN was 52.0 ± 12.7 years, and 26 (32.9%) were male. The median HPN duration was 39 months, and the most common indication was inflammatory bowel disease (36.7%). Most (82.3%) patients had at least 1 prescription of oral vitamin D supplement (50,000 International Units) during this time. History of jejunal resection (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.9-15.1; P = .002) and lack of oral vitamin D supplementation (OR, 0.7; 95% CI, 0.52-0.93; P = .038) were the strongest predictors of vitamin D deficiency.
  
  
  CONCLUSIONS
  Vitamin D deficiency is common among patients receiving long-term HPN despite oral supplementation.
authors.affiliation: Cleveland Clinic, Cleveland, Ohio reachshishira@gmail.com.
authors.forename: Shishira
authors.initials: S
authors.lastname: Bharadwaj
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Tushar D
authors.initials: TD
authors.lastname: Gohel
authors.affiliation: Torrance Memorial Medical Center, Torrance, California.
authors.forename: Omer J
authors.initials: OJ
authors.lastname: Deen
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Coughlin
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mandy L
authors.initials: ML
authors.lastname: Corrigan
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jill
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Shatnawei
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Donald F
authors.initials: DF
authors.lastname: Kirby
mesh_terms: D000328:Adult; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D015995:Prevalence; D012189:Retrospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood* / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D014815:Vitamins / Q000097:blood* / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: avitaminosis; home parenteral nutrition; total parenteral nutrition; vitamin D; vitamin D deficiency